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1.
BMC Cancer ; 24(1): 171, 2024 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-38310262

RESUMO

BACKGROUND: Radiotherapy delivery regimens can vary between a single fraction (SF) and multiple fractions (MF) given daily for up to several weeks depending on the location of the cancer or metastases. With limited evidence comparing fractionation regimens for oligometastases, there is support to explore toxicity levels to nearby organs at risk as a primary outcome while using SF and MF stereotactic ablative radiotherapy (SABR) as well as explore differences in patient-reported quality of life and experience. METHODS: This study will randomize 598 patients in a 1:1 ratio between the standard arm (MF SABR) and the experimental arm (SF SABR). This trial is designed as two randomized controlled trials within one patient population for resource efficiency. The primary objective of the first randomization is to determine if SF SABR is non-inferior to MF SABR, with respect to healthcare provider (HCP)-reported grade 3-5 adverse events (AEs) that are related to SABR. Primary endpoint is toxicity while secondary endpoints include lesional control rate (LCR), and progression-free survival (PFS). The second randomization (BC Cancer sites only) will allocate participants to either complete quality of life (QoL) questionnaires only; or QoL questionnaires and a symptom-specific survey with symptom-guided HCP intervention. The primary objective of the second randomization is to determine if radiation-related symptom questionnaire-guided HCP intervention results in improved reported QoL as measured by the EuroQoL-5-dimensions-5levels (EQ-5D-5L) instrument. The primary endpoint is patient-reported QoL and secondary endpoints include: persistence/resolution of symptom reporting, QoL, intervention cost effectiveness, resource utilization, and overall survival. DISCUSSION: This study will compare SF and MF SABR in the treatment of oligometastases and oligoprogression to determine if there is non-inferior toxicity for SF SABR in selected participants with 1-5 oligometastatic lesions. This study will also compare patient-reported QoL between participants who receive radiation-related symptom-guided HCP intervention and those who complete questionnaires alone. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT05784428. Date of Registration: 23 March 2023.


Assuntos
Neoplasias , Radiocirurgia , Humanos , Neoplasias/mortalidade , Neoplasias/patologia , Neoplasias/radioterapia , Intervalo Livre de Progressão , Qualidade de Vida , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Estudos de Equivalência como Asunto
2.
BMC Psychiatry ; 22(1): 543, 2022 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-35953787

RESUMO

BACKGROUND: Individuals with psychiatric disorders (PD) have a high prevalence of tobacco use. Patients with PD also potentially receive substandard care in comparison to the general population. Previous research has shown that individuals with PD have a decreased risk of receiving a tobacco related (TR) cancer diagnosis. To further assess this trend, this study assesses the survival of patients with a TR cancer with or without a PD. MATERIALS AND METHODS: Our study utilized multiple databases, with methods described elsewhere,6 to identify people in British Columbia that have been diagnosed with psychiatric disorders and appendicitis (our control group). From these groups, we selected individuals who also had a TR cancer. We subsequently extracted information pertaining to these patients from these databases. RESULTS: Thirty-nine thousand eight hundred forty-one patients with cancer were included in our study. Analyses of these patients were controlled for by age, gender, cancer type and diagnosis year. This analysis displayed shorter survival time among patients who were diagnosed with depression (HR = 1.16; p = 0.01; 95% CI: 1.04-1.29), schizophrenia (HR = 1.62; p < 0.01; 95% CI: 1.43-1.84), or bipolar disorder (HR = 1.35; p < 0.01; 95% CI: 1.12-1.64) compared to the cancer patients without a PD, all of which were statistically significant. People that were diagnosed with anxiety disorders did not have a survival time that was significantly different from our control population (HR = 1.07; p = 0.22; 95% CI: 0.96-1.19). CONCLUSIONS: Individuals with PD, except for those with anxiety, were found to have a shorter survival time following diagnosis with a TR cancer as compared to our control group. We hypothesize several factors, which may account for this statistically significant difference: (1) delayed diagnosis, (2) poor access to care, (3) poor assessment or follow-up, or (4) physician beliefs of poor treatment adherence.


Assuntos
Transtorno Bipolar , Transtornos Mentais , Neoplasias , Tabagismo , Ansiedade , Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia
4.
Paediatr Child Health ; 26(8): 451-455, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34992698

RESUMO

Rural consultant paediatricians in Canada are in short supply. Rural communities across the country could benefit from the implementation of strategies to ensure access to consistent, local consultant paediatric care. Compared to their urban counterparts, rural paediatricians face unique challenges, including significant call requirements, potential risk of burnout and difficulty in recruitment. In response to these challenges, a number of strategies to bolster the provision of paediatric care to rural, remote, and underserved communities have evolved in British Columbia, including virtual support, the development of a rural paediatric network, and new training opportunities. It is time for discussions about the vulnerability of consulting paediatric care in rural or underserved communities to occur at the national level. National engagement will foster collaboration, drive research, and facilitate workforce planning, with the goal of ensuring that all Canadian communities have access to consulting paediatric care.

5.
Int J Radiat Oncol Biol Phys ; 114(4): 617-626, 2022 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-35667528

RESUMO

PURPOSE: Despite increasing utilization of SABR for oligometastatic cancer, prospective outcomes are lacking. The purpose of this study was to determine progression-free survival (PFS), local control (LC), and prognostic factors from the population-based phase 2 SABR-5 trial. METHODS AND MATERIALS: The SABR-5 trial was a single-arm phase 2 study with the primary endpoint of toxicity, conducted at the 6 regional cancer centers across British Columbia (BC), Canada, during which time SABR for oligometastases was only offered on trial. Patients with up to 5 oligometastases (total or not controlled by prior treatment and including induced oligometastatic disease) underwent SABR to all lesions. Patients were 18 years of age or older, had an Eastern Cooperative Oncology Group score of 0 to 2, and had life expectancy ≥ 6 months. The secondary outcomes of PFS and LC are presented here. RESULTS: Between November 2016 and July 2020, 381 patients underwent SABR on trial. Median follow-up was 27 months (interquartile range, 18-36). Median PFS was 15 months (95% confidence interval [CI], 12-18). LC at 1 and 3 years were 93% (95% CI, 91-95) and 87% (95% CI, 84-90), respectively. On multivariable analysis, increasing tumor diameter (hazard ratio [HR], 1.09; P < .001), declining performance status (HR, 2.13; P < .001), disease-free interval <18 months (HR, 1.52; P = .003), 4 or more metastases at SABR (HR, 1.48; P = .048), initiation or change in systemic treatment (HR, 0.50; P < .001), and oligoprogression (HR, 1.56; P = .008) were significant independent predictors of PFS. Tumor diameter (sub-hazard ratio [SHR], 1.28; P < .001), colorectal histology (SHR, 4.33; P = .002), and "other" histology (SHR, 3.90; P < .001) were associated with worse LC. CONCLUSIONS: In this population-based cohort including patients with genuine oligometastatic, oligoprogressive, and induced oligometastatic disease, the median PFS was 15 months and LC at 3 years was 87%. This supports ongoing efforts to randomize patients in phase 3 trials, even outside the original 1 to 5 metachronous oligometastatic paradigm.


Assuntos
Neoplasias , Radiocirurgia , Adolescente , Adulto , Colúmbia Britânica , Humanos , Intervalo Livre de Progressão , Estudos Prospectivos , Radiocirurgia/métodos
6.
Cajamarca; s.n; 2021. 95 p.
Tese em Espanhol | MMyP | ID: biblio-1370979

RESUMO

El objetivo de esta investigación fue determinar el nivel de conocimiento sobre salud sexual y reproductiva en adolescentes de 14 a 17 años del distrito de Cajamarca, 2021. El estudio es de tipo aplicado, el diseño es no experimental; los métodos usados fueron el descriptivo, inductivo- deductivo y estadístico; la muestra fueron 194 adolescentes con edades comprendidas entre los 14 a 17 años del distrito de Cajamarca, 2021; se usó un cuestionario de la autoría de Acosta (2020) para medir el nivel de conocimiento y actitud hacia la sexualidad en adolescentes, la validez fue por juicio de expertos y la confiabilidad buena con un valor de 0.865; para el procesamiento de los resultados se usó Excel. Entre los resultados, se halló que la edad mayoritaria es de 17 años, son en un 55% mujeres, el 71% tiene enamorado, el 60% ha tenido o tiene relaciones sexuales, el 70% son católicos y el 50% señala informarse sobre sexualidad a través de medios de comunicación. Se identificó un nivel medio de conocimientos en anatomía, fisiología sexual y reproductiva de acuerdo en el 57.7% de adolescentes; se identificó un nivel medio de conocimientos en prevención de infecciones de transmisión sexual de acuerdo en el 52.6% de adolescentes; se identificó un nivel medio de conocimientos sobre métodos anticonceptivos de acuerdo en el 55.1% de adolescentes. Se concluye identificando un nivel medio de conocimiento sobre salud sexual y reproductiva de acuerdo con el 5.2% de adolescentes de 14 a 17 años del distrito de Cajamarca, 2021. (AU)


The objective of this research was to identify the level of knowledge on sexual and reproductive health in adolescents aged 14 to 17 in the district of Cajamarca, 2021. The study is of applied type, the design is simple non-experimental correlational; the methods used were descriptive, inductive-deductive and statistical; the sample were 194 adolescents with ages ranging from 14 to 17 years in the district of Cajamarca, 2021; a questionnaire authored by Acosta (2020) was used to measure the level of knowledge and attitude towards sexuality in adolescents, the validity was by expert judgment and the good reliability with a value of 0.865; for the processing of the results Excel was used. Among the results, it was found that the majority age is 17 years, they are 55% women, 71% have fallen in love 60% have had or have sex, 70% are Catholics and 50% report to be informed through the media. A medium level of knowledge in anatomy, sexual and reproductive physiology was identified in agreement in 57.7% of adolescents; a medium level of knowledge in prevention of sexually transmitted infections was identified in agreement in 52.6% of adolescents; An average level of knowledge on contraceptive methods was identified in agreement in 55.1% of adolescents. We conclude by identifying a medium level of knowledge on sexual and reproductive health according to the 5.2% of adolescents aged 14 to 17 in the district of Cajamarca, 2021.


Assuntos
Adolescente , Adolescente , Saúde Sexual/educação , Peru
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