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1.
JAMA Oncol ; 2024 May 23.
Artículo en Inglés | MEDLINE | ID: mdl-38780960

RESUMEN

Importance: Advance care planning (ACP) remains low among patients with advanced cancer. Multilevel interventions compared with clinician-level interventions may be more effective in improving ACP. Objective: To evaluate whether a multilevel intervention could improve clinician-documented ACP compared with a clinician-level intervention alone. Design, Setting, and Participants: This randomized clinical trial, performed from September 12, 2019, through May 12, 2021, included adults with advanced genitourinary cancers at an academic, tertiary hospital. Data analysis was performed by intention to treat from May 1 to August 10, 2023. Intervention: Participants were randomized 1:1 to a 6-month patient-level lay health worker structured ACP education along with a clinician-level intervention composed of 3-hour ACP training and integration of a structured electronic health record documentation template (intervention group) or to the clinician-level intervention alone (control group). Main Outcome and Measures: The primary outcome was ACP documentation in the electronic health record by the oncology clinician within 12 months after randomization. Secondary, exploratory outcomes included shared decision-making, palliative care use, hospice use, emergency department visits, and hospitalizations within 12 months after randomization. Results: Among 402 participants enrolled in the study, median age was 71 years (range, 21-102 years); 361 (89.8%) identified as male. More intervention group participants had oncology clinician-documented ACP than control group participants (82 [37.8%] vs 40 [21.6%]; odds ratio [OR], 2.29; 95% CI, 1.44-3.64). At 12-month follow-up, more intervention than control group participants had palliative care (72 [33.2%] vs 25 [13.5%]; OR, 3.18; 95% CI, 1.91-5.28) and hospice use (49 [22.6%] vs 19 [10.3%]; OR, 2.54; 95% CI, 1.44-4.51). There were no differences in the proportion of participants between groups with an emergency department visit (65 [30.0%] vs 61 [33.0%]; OR, 0.87; 95% CI, 0.57-1.33) or hospitalization (89 [41.0%] vs 85 [46.0%]; OR, 0.82; 95% CI, 0.55-1.22). Intervention group participants had fewer hospitalizations than control group participants (mean [SD] number of hospitalizations per year, 0.87 [1.60] vs 1.04 [1.77]) and a lower risk of hospitalization (incidence rate ratio, 0.80; 95% CI, 0.65-0.98). Conclusions and Relevance: In this randomized clinical trial, a multilevel intervention improved oncology clinician-documented ACP compared with a clinician-level intervention alone for patients with genitourinary cancer. The intervention is one approach to effectively increase ACP among patients with cancer. Trial Registration: ClinicalTrials.gov Identifier: NCT03856463.

2.
J Clin Oncol ; 42(14): 1646-1654, 2024 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-38478794

RESUMEN

PURPOSE: Lung cancer is the leading cause of cancer death in the United States. Disparities in lung cancer mortality among racial and ethnic minorities are well documented. Less is known as to whether racial and ethnic minority patients with lung cancer experience higher rates of intensity of care at the end of life (EOL) compared with non-Hispanic White (NHW) patients. METHODS: We conducted a population-based analysis of patients 18 years and older with a lung cancer diagnosis who died between 2005 and 2018 using the California Cancer Registry linked to patient discharge data abstracts. Our primary outcome was intensity of care in the last 14 days before death (defined as any hospital admission or emergency department [ED] visit, intensive care unit [ICU] admission, intubation, cardiopulmonary resuscitation [CPR], hemodialysis, and death in an acute care setting). We used multivariable logistic regression models to evaluate associations between race and ethnicity and intensity of EOL care. RESULTS: Among 207,429 patients with lung cancer who died from 2005 to 2018, the median age was 74 years (range, 18-107) and 106,821 (51%) were male, 146,872 (70.8%) were NHW, 1,045 (0.5%) were American Indian, 21,697 (10.5%) were Asian Pacific Islander (API), 15,490 (7.5%) were Black, and 22,325 (10.8%) were Hispanic. Compared with NHW patients, in the last 14 days before death, API, Black, and Hispanic patients had greater odds of a hospital admission, an ICU admission, intubation, CPR, and hemodialysis and greater odds of a hospital or ED death. CONCLUSION: Compared with NHW patients, API, Black, and Hispanic patients who died with lung cancer experienced higher intensity of EOL care. Future studies should develop approaches to eliminate such racial and ethnic disparities in care delivery at the EOL.


Asunto(s)
Disparidades en Atención de Salud , Neoplasias Pulmonares , Cuidado Terminal , Humanos , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/etnología , Masculino , Anciano , Femenino , Cuidado Terminal/estadística & datos numéricos , Persona de Mediana Edad , Anciano de 80 o más Años , Disparidades en Atención de Salud/etnología , Adulto , Adolescente , Adulto Joven , California/epidemiología , Hispánicos o Latinos/estadística & datos numéricos , Minorías Étnicas y Raciales/estadística & datos numéricos , Población Blanca/estadística & datos numéricos
3.
Support Care Cancer ; 32(3): 161, 2024 Feb 16.
Artículo en Inglés | MEDLINE | ID: mdl-38366165

RESUMEN

PURPOSE: Financial toxicity is a source of significant distress for patients with urologic cancers, yet few studies have addressed financial burden in this patient population. METHODS: We developed a financial toxicity screening program using a lay health worker (LHW) and social worker (SW) to assess and mitigate financial toxicity in a single academic medical clinic. As part of a quality improvement project, the LHW screened all newly diagnosed patients with advanced stages of prostate, kidney, or urothelial cancer for financial burden using three COST tool questions and referred patients who had significant financial burden to an SW who provided personalized recommendations. The primary outcome was feasibility defined as 80% of patients with financial burden completing the SW consult. Secondary outcomes were patient satisfaction, change in COST Tool responses, and qualitative assessment of financial resources utilized. RESULTS: The LHW screened a total of 185 patients for financial toxicity; 82% (n = 152) were male, 65% (n = 120) White, and 75% (n = 139) reported annual household income >$100,000 US Dollars; 60% (n = 114) had prostate cancer. A total of 18 (9.7%) participants screened positive for significant financial burden and were referred to the SW for consultation. All participants (100%) completed and reported satisfaction with the SW consultation and had 0.83 mean lower scores on the COST Tool post-intervention assessment compared to pre-intervention (95% confidence interval [0.26, 1.41]). CONCLUSION: This multidisciplinary financial toxicity intervention using an LHW and SW was feasible, acceptable, and associated with reduced financial burden among patients with advanced stages of urologic cancers. Future work should evaluate the effect of this intervention among cancer patients in diverse settings.


Asunto(s)
Neoplasias de la Próstata , Neoplasias Urológicas , Humanos , Masculino , Estrés Financiero , Personal de Salud , Derivación y Consulta
4.
JAMA Netw Open ; 6(8): e2329497, 2023 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-37606926

RESUMEN

Importance: Esophageal cancer (EC) is the 7th most common cancer worldwide and 14th in the US. More data are needed to study the changing incidence patterns of its 2 primary histologic subtypes, squamous cell carcinoma of the esophagus (SCE) and adenocarcinoma of the esophagus (ACE). Objective: To examine temporal trends in incidence rates of EC, ACE, and SCE from 1975 through 2018. Design, Setting, and Participants: In this population-based cross-sectional study, data were derived from 9 Surveillance, Epidemiology, and End Results (SEER) registries from January 1975 through December 2018 and from all 21 registries for January 2000 through December 2018 for patients with a diagnosis of EC from 1975 through 2018 (International Classification of Disease-Oncology, Third Edition codes). Age-adjusted incidence rates (AAIRs) of EC, ACE, and SCE were calculated. The timing and magnitude of the annual percentage change (APC) in incidence were examined using Joinpoint regression analyses. Data analysis was started in 2021 and updated and completed in 2023. Main Outcome and Measures: The APC for age-adjusted EC incidence rates as stratified by histology, anatomical location, stage, sex, age, race and ethnicity, and geographic region. Results: A total of 47 648 patients with a diagnosis of EC were retained for analysis. These included 22 419 (47.1%) with a diagnosis of SCE, 22 217 (46.6%) with ACE, and 3012 (6.3%) with other subtypes. The AAIR for EC changed from 4.14 per 100 000 population in 1975 to 4.18 in 2018, AAIRs of SCE declined from 3.06 in 1975 to 1.15 in 2018 as well as for ACE, and AAIRs increased from 0.42 in 1975 to 2.78 in 2018. From 1975 through 2004, EC incidence significantly increased (APC, 0.53; 95% CI, 0.4 to 0.7) but significantly decreased (APC, -1.03; 95% CI, -1.3 to -0.7) from then until 2018. The APC of SCE significantly continued to decline (-2.80, 95% CI, -3.0 to -2.6), and ACE increased from 2000 to 2006 (APC, 2.51; 95% CI, 1.0 to 4.0) but has since stabilized from 2006 to 2018. Conclusions and Relevance: The results of this cross-sectional study suggest that the incidence of EC modestly declined since 2004 and that the incidence of SCE continued to decline while the incidence rate of ACE plateaued for more than a decade. Understanding factors associated with plateaued rates of ACE may help inform public health interventions.


Asunto(s)
Adenocarcinoma , Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Humanos , Estudios Transversales , Neoplasias Esofágicas/epidemiología , Adenocarcinoma/epidemiología
5.
JCO Oncol Pract ; 19(7): 427-434, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-37155941

RESUMEN

PURPOSE: The COVID-19 pandemic has greatly affected cancer care delivery for patients, including cancellation or delays in surveillance imaging, clinic visits, and treatments. Yet, gaps remain in understanding the extent of the impact of the COVID-19 pandemic on patients with cancer and potential ways to overcome these impacts. METHODS: We conducted semistructured, in-depth, one-on-one qualitative interviews among adults with a past or current history of cancer in the United States. Participants from a parent quantitative survey were purposively sampled to participate in a qualitative interview. Interview questions addressed (1) experiences with cancer care delivery during the COVID-19 pandemic; (2) unmet concerns regarding care and other impacts; and (3) approaches to improve patient experiences. We conducted inductive thematic analysis. RESULTS: Fifty-seven interviews were conducted. Four themes emerged: (1) concern regarding the risk of COVID-19 infection among patients with cancer and their families; (2) disruptions in care increased patients' anxiety about poor cancer outcomes and death from cancer; (3) significant social and economic impacts; and (4) increased social isolation and anxiety about the future. Suggestions for current clinical practice include (1) clear communication on patients' health risks; (2) increased attention to mental health needs and access to mental health services; and (3) routine use of telemedicine as frequently as possible when clinically appropriate. CONCLUSION: These rich findings reveal the significant impact of the COVID-19 pandemic on patients with cancer and potential approaches to mitigate the impact from the patient perspective. The findings not only inform current cancer care delivery but also health system responses to future public health or environmental crises that may pose a unique health risk for patients with cancer or disrupt their care.


Asunto(s)
COVID-19 , Neoplasias , Telemedicina , Adulto , Humanos , Estados Unidos/epidemiología , COVID-19/epidemiología , Pandemias , Atención a la Salud , Neoplasias/complicaciones , Neoplasias/epidemiología , Neoplasias/terapia , Miedo
6.
JCO Oncol Pract ; 19(7): 411-419, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-37027797

RESUMEN

As the voice of cancer care clinicians and the patients they serve, ASCO has taken steps to elevate awareness about biosimilar products and their use in oncology. In 2018, ASCO released its Statement on Biosimilars in Oncology which was subsequently published in the Journal of Clinical Oncology to serve as an educational tool which highlighted and provided guidance on several topical areas surrounding biosimilars. At the time of its publication, the US Food and Drug Administration (FDA) had approved eight biosimilar products for use in the United States, including one product for use as a supportive care agent in the cancer setting and two products for use in the treatment for cancer. This number has risen dramatically (40 approvals), with a total of 22 cancer or cancer-related biosimilar products approved since 2015. Recently, the FDA also approved the four interchangeable biosimilar products for diabetes, certain inflammatory diseases, and certain ophthalmic diseases. Given the current market dynamics and the regulatory landscape, this ASCO manuscript now seeks to propose several policy recommendations across the scope of value, interchangeability, clinician barriers, and patient education and access. This policy statement is intended to guide ASCO's future activities and strategies and serves to affirm our commitment to providing education to the oncology community on the use of biosimilars in the cancer setting.


Asunto(s)
Biosimilares Farmacéuticos , Neoplasias , Humanos , Estados Unidos , Biosimilares Farmacéuticos/farmacología , Biosimilares Farmacéuticos/uso terapéutico , Aprobación de Drogas , Oncología Médica , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Políticas
7.
J Cancer Educ ; 38(3): 845-853, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-35829986

RESUMEN

As the number of cancer survivors continues to increase and given the shortage of oncology clinicians in safety net health care settings, primary care providers (PCPs) in these settings will increasingly provide cancer survivorship care. In order to ensure equitable care for low-income and underserved breast and colon cancer survivors, it is essential to understand the safety-net PCPs' perspective. We conducted semi-structured, in-depth qualitative interviews with 11 PCPs working in a safety-net health care system to identify their needs in caring for cancer survivors. Interviews were audio-recorded and professionally transcribed. Two coders independently coded the interviews and conducted regular meetings until we reached consensus on the results. Analysis was based in grounded theory and performed using the constant comparative method. Thematic analysis identified six themes as follows: (1) Cancer survivorship care can be integrated with the whole person and chronic disease care management that occurs in primary care; (2) PCPs' perceptions regarding patients' survivorship care needs and their confidence in meeting those needs; (3) preference for a shared care model; (4) coordination of care; (5) PCPs' need for survivorship care education and training; and (6) unique issues involved in the care of older cancer survivors. PCPs in the safety-net believe that providing comprehensive survivorship care requires coordination of care through the cancer continuum. Tools like checklists, electronic health records-based communication, and convenient electronic consultations with cancer specialists would enhance the quality of survivorship care. Respondents advocate the inclusion of survivorship care education in medical education. The continuity of care with PCPs means that they play a particularly important role in the care of older cancer survivors.


Asunto(s)
Supervivientes de Cáncer , Neoplasias del Colon , Médicos de Atención Primaria , Humanos , Neoplasias del Colon/terapia , Atención Primaria de Salud
8.
Support Care Cancer ; 31(1): 76, 2022 Dec 22.
Artículo en Inglés | MEDLINE | ID: mdl-36544063

RESUMEN

PURPOSE: Latinx adults with cancer, as compared with non-Latinx White adults, are diagnosed with more advanced stages and experience worse quality of life. Identifying barriers in cancer care among low-income Latinx adults is crucial to designing and implementing culturally appropriate interventions. The objective of this study was to explore the specific barriers encountered by Latinx adults after a cancer diagnosis and perspectives on the use of community health workers (CHWs) to address these barriers. METHODS: We conducted semi-structured qualitative interviews with low-income Latinx adults with a past or current history of cancer and/or their caregivers in a community oncology clinic located in an agricultural community in California. Analysis was based in grounded theory and performed using the constant comparative method. RESULTS: Sixteen interviews were conducted with patients alone (n = 11), a caregiver alone (n = 1), and patient-caregiver pairs (n = 4 patients; n = 4 caregivers). Four major themes emerged: (1) low cancer health literacy including cancer diagnosis and treatment, cancer fatalism, navigating next steps after diagnosis, advance directives, and precision medicine; (2) challenges in communicating and receiving supportive services due to language barriers; (3) stress and anxiety regarding financial hardships related to job loss, insurance barriers, and the COVID-19 pandemic; (4) the need for supportive, bilingual, and bicultural personnel to assist in overcoming these challenges. CONCLUSIONS: Low-income Latinx adults with cancer and their caregivers experience health literacy, communication, and financial barriers that impede quality cancer care delivery. Embedding CHWs in the care team could be one way to address these barriers to culturally concordant, accessible care.


Asunto(s)
COVID-19 , Neoplasias , Humanos , Adulto , Calidad de Vida , Pandemias , Investigación Cualitativa , Atención a la Salud , Neoplasias/terapia
9.
Contemp Clin Trials ; 121: 106906, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-36084898

RESUMEN

BACKGROUND: Precision cancer care has reduced cancer-related mortality. However, minorities remain less likely to receive precision medicine than White populations with cancer due to language and system-level barriers. Precision medicine knowledge increases involvement in treatment decisions and receipt of such treatment. Few interventions exist that seek to improve precision medicine knowledge among low-income and racial and ethnic minorities with cancer. METHODS: We designed a randomized controlled trial to evaluate the effectiveness of a community health worker (CHW)-delivered intervention on patients' knowledge of precision medicine in partnership with a community oncology clinic in Monterey County, California. Eligibility includes adults with newly diagnosed, progression or recurrence of cancer, low-income, or racial and ethnic minorities, or uninsured, insured by Medicaid or by a local agricultural employer. We will randomize 110 patients with cancer to the intervention or usual cancer care. The intervention group will be assigned to a CHW who will deliver culturally tailored and personalized education on precision medicine and advance care planning, screen for social determinants of health barriers and connect patients to community resources. The primary outcome is precision medicine knowledge measured by a 6-item survey adapted from Davies at baseline, 3-, 6- and 12-months post-enrollment. Exploratory outcomes include patient satisfaction with decision, activation, health care utilization, and receipt of evidence-based precision medicine care. CONCLUSION: This trial will assess whether the CHW-led intervention can increase knowledge of precision medicine as well as several exploratory outcomes including receipt of evidence-based cancer care among low-income and racial and ethnic minority adults with cancer. CLINICALTRIALS: gov Registration # NCT04843332.


Asunto(s)
Agentes Comunitarios de Salud , Grupos Minoritarios , Adulto , Etnicidad , Humanos , Medicina de Precisión , Grupos Raciales , Estados Unidos
10.
Nutr. clín. diet. hosp ; 42(2): 43-57, Jul 2022. graf, tab
Artículo en Español | IBECS | ID: ibc-207154

RESUMEN

Introducción: A los fines de identificar los factores que generan las bajas tasas de Lactancia Materna (LM) en los dos primeros años de vida, se han realizado numerosas investigaciones a nivel mundial y desarrollando cuestionarios. Objetivos: Determinar la disponibilidad de cuestionarios para investigación en LM, en bases de datos especializadas, que midan las actitudes, conocimientos y apoyo social a la LM, validados en español. Métodos: Se realizó una revisión sistemática de artículos en LM usando Pubmed, Embase y Web of Science. Resultados: Se obtuvieron nueve artículos de investigación que cumplieron con los criterios de: estar disponibles en inglés o español, contener un instrumento para investigar la LM en español y describir el proceso para determinar la validez. Cinco provinieron del idioma inglés, traducidos al español y cuatro fueron construidos originalmente en español. Conclusiones: Son pocos los estudios que contienen cuestionarios sustentados sobre pilares sólidos de validación para investigación en LM, que permitan generar confianza para su uso, y más aún en español.(AU)


Background: In order to identify the factors that generatethe low rates of Breastfeeding (BF) in the first two years oflife, numerous investigations have been carried out world-wide. As part of these, questionnaires are developed to ob-tain relevant information on the identified problem, whichcould be valuable resources to be used by other researchersinterested in the subject. Objectives: To determine the availability of questionnairesfor BF research, in specialized databases, that measure atti-tudes, knowledge and social support for BF, validated inSpanish. Material and methods: A systematized review of primaryarticles on BF research was carried out, with questionnairesavailable in Spanish, published in the last 10 years in thedatabases: Pubmed, Embase and Web of Science using thedescriptors “questionnaire, validation, breastfeeding, Spanish” and that they met the inclusion criteria of beingtranslated, adapted and validated from English to Spanish orcreated and validated in Spanish. Results: Nine scientific research articles have been ob-tained that met the criteria of: being available in English or Spanish, containing an instrument to investigate BF in Spanish, and describing the process followed to determine validity. Five came from the English language, translated intoSpanish and four originally has been built in Spanish. Conclusions: Few studies contain questionnaires, sup-ported by solid validation pillars for BF research, which cangenerate confidence for their use, and even more so in theSpanish language.(AU)


Asunto(s)
Lactancia Materna , Encuestas y Cuestionarios , Bases de Datos Bibliográficas , Investigación
11.
Con-ciencia (La Paz) ; 10(1): [1-16], 20220600.
Artículo en Español | LILACS | ID: biblio-1399696

RESUMEN

INTRODUCCION: la mitad de los pacientes hipertensos abandona la terapia a partir del primer año del diagnóstico. El uso del teléfono para mejorar la adherencia es aceptado por los pacientes, a través del envío de mensajes a sus celulares o de llamadas telefónicas concertadas, para hacerles recordar la toma de medicación o información sobre su enfermedad. OBJETIVO: evaluar la adherencia al tratamiento mediante recordatorio por teléfono en pacientes hipertensos que retiran sus medicamentos de una Clínica de la seguridad social en Paraguay. METODOLOGÍA: estudio cuasi experimental; aplicando una encuesta y seguimiento mediante contacto telefónico para evaluar la adherencia a la terapia. RESULTADOS: el 50% (n=11) de los pacientes se clasificaron como no adherentes a la terapia farmacológica; al final de las intervenciones se redujo a 9,1%. La causa principal de la falta de adherencia fue el olvido, 90,9%. La adherencia al tratamiento mejoro significativamente luego de las intervenciones. CONCLUSIÓN: la utilización de la tecnología podría constituirse en una herramienta para la prevención primaria en la población con factores de riesgo, y el seguimiento de pacientes con hipertensión arterial.


INTRODUCTION: half of hypertensive patients drop out of therapy from the first year of diagnosis. The use of the telephone to improve adherence is accepted by patients, through sending messages to their cell phones or concerted phone calls, to remind them of taking medication or information about their disease. OBJECTIVE: This work evaluated the use of technology to optimize the adherence of hypertensive patients who withdraw their medicines from a social security clinic in Paraguay. METHODOLOGY: quasi-experimental study; applying a survey and follow-up through telephone contact to evaluate adherence to therapy. RESULTS: 50% (n=11) of patients were classified as non-adherent to drug therapy; at the end of the interventions it was reduced to 9.1%. The main cause of the lack of adherence was forgetfulness, 90.9%. Adherence to treatment improved significantly after interventions. CONCLUSION: the use of technology could be a tool for primary prevention in the population with risk factors, and the monitoring of patients with blood pressure.


Asunto(s)
Pacientes , Prevención Primaria , Seguridad Social , Teléfono Celular
12.
JCO Oncol Pract ; 18(5): 388-395, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35544646

RESUMEN

This manuscript reviews the status of Hispanic/Latinx physicians in oncology, the benefits and challenges to achieving equitable representation, and potential solutions and actions to increase diversity in the oncology workforce. Persons of Hispanic/Latinx origin comprise 18.7% of the population and 16.8% of the adult population in the United States but are only 4.7% of practicing oncologists. The reasons for the lack of representation of Hispanic/Latinx individuals in medicine are multifaceted and include discrimination and biases, exclusionary practices, financial barriers, and lack of role modeling. As a result, patients are deprived the benefits of a representative workforce, such as improved access, enhanced culturally and linguistically competent care, and minimization of health disparities. Solutions included in the manuscript include a description of efforts by ASCO to improve the representativeness of the oncology workforce through its awards programs and educational efforts, especially for Hispanic/Latinx clinicians. The manuscript also outlines individual actions that attending physicians, senior oncologists, oncology leaders, and hospital/cancer center leadership can take to improve the diversity of the oncology workforce and support our Latinx/Hispanic trainees and colleagues. Improving the representativeness of the oncology workforce will require collective action by institutions, medical societies, and individuals. Nevertheless, widespread commitment to creating an inclusive and supported workforce is necessary to ensure the quality of care for minority patients, reduce existing cancer care disparities, and advance innovation in oncology.


Asunto(s)
Oncología Médica , Médicos , Adulto , Instituciones Oncológicas , Hispánicos o Latinos , Humanos , Estados Unidos/epidemiología , Recursos Humanos
14.
Blood Cancer Discov ; 3(2): 95-102, 2022 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-35015688

RESUMEN

To obtain a deeper understanding of poor responses to COVID-19 vaccination in patients with lymphoma, we assessed blocking antibodies, total anti-spike IgG, and spike-specific memory B cells in the peripheral blood of 126 patients with lymphoma and 20 age-matched healthy controls 1 and 4 months after COVID-19 vaccination. Fifty-five percent of patients developed blocking antibodies postvaccination, compared with 100% of controls. When evaluating patients last treated from days to nearly 18 years prior to vaccination, time since last anti-CD20 was a significant independent predictor of vaccine response. None of 31 patients who had received anti-CD20 treatment within 6 months prior to vaccination developed blocking antibodies. In contrast, patients who initiated anti-CD20 treatment shortly after achieving a vaccine-induced antibody response tended to retain that response during treatment, suggesting a policy of immunizing prior to treatment whenever possible. SIGNIFICANCE: In a large cohort of patients with B-cell lymphoma, time since anti-CD20 treatment was an independent predictor of neutralizing antibody response to COVID-19 vaccination. Comparing patients who received anti-CD20 treatment before or after vaccination, we demonstrate that vaccinating first can generate an antibody response that endures through anti-CD20-containing treatment. This article is highlighted in the In This Issue feature, p. 85.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Formación de Anticuerpos , Vacunas contra la COVID-19/uso terapéutico , Humanos , Lactante , SARS-CoV-2 , Vacunación
15.
Am J Clin Oncol ; 44(11): 580-587, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-34519677

RESUMEN

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic abruptly disrupted cancer care. The impact of these disruptions on patient experiences remain relatively understudied. The objective of this study was to assess patients' perspectives regarding the impact of COVID-19 on their experiences, including their cancer care, emotional and mental health, and social determinants of health, and to evaluate whether these outcomes differed by cancer stage. MATERIALS AND METHODS: We conducted a survey among adults with cancer across the United States from April 1, 2020 to August 26, 2020 using virtual snowball sampling strategy in collaboration with professional organizations, cancer care providers, and patient advocacy groups. We analyzed data using descriptive statistics, χ2 and t tests. RESULTS: Three hundred twelve people with cancer participated and represented 38 states. The majority were non-Hispanic White (n=183; 58.7%) and female (n=177; 56.7%) with median age of 57 years. Ninety-one percent spoke English at home, 70.1% had health insurance, and 67% had access to home internet. Breast cancer was the most common diagnosis (n=67; 21.5%). Most had Stage 4 disease (n=80; 25.6%). Forty-six percent (n=145) experienced a change in their care due to COVID-19. Sixty percent (n=187) reported feeling very or extremely concerned that the pandemic would affect their cancer and disproportionately experienced among those with advanced cancer stages compared with earlier stages (P<0.001). Fifty-two percent (n=162) reported impact of COVID-19 on 1 or more aspects of social determinants of health with disproportionate impact among those with advanced cancer stages compared with earlier stages. CONCLUSIONS: COVID-19 impacted the care and well-being of patients with cancer and this impact was more pronounced among people with advanced cancer stages. Future work should consider tailored interventions to mitigate the impact of COVID-19 on patients with cancer.


Asunto(s)
COVID-19 , Neoplasias , Telemedicina , Tiempo de Tratamiento , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/psicología , Femenino , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/patología , Neoplasias/psicología , Neoplasias/terapia , Aislamiento Social , Encuestas y Cuestionarios , Estados Unidos
16.
J Clin Oncol ; 39(2): 155-169, 2021 01 10.
Artículo en Inglés | MEDLINE | ID: mdl-33290128

RESUMEN

This report presents the American Society of Clinical Oncology's (ASCO's) evaluation of the adaptations in care delivery, research operations, and regulatory oversight made in response to the coronavirus pandemic and presents recommendations for moving forward as the pandemic recedes. ASCO organized its recommendations for clinical research around five goals to ensure lessons learned from the COVID-19 experience are used to craft a more equitable, accessible, and efficient clinical research system that protects patient safety, ensures scientific integrity, and maintains data quality. The specific goals are: (1) ensure that clinical research is accessible, affordable, and equitable; (2) design more pragmatic and efficient clinical trials; (3) minimize administrative and regulatory burdens on research sites; (4) recruit, retain, and support a well-trained clinical research workforce; and (5) promote appropriate oversight and review of clinical trial conduct and results. Similarly, ASCO also organized its recommendations regarding cancer care delivery around five goals: (1) promote and protect equitable access to high-quality cancer care; (2) support safe delivery of high-quality cancer care; (3) advance policies to ensure oncology providers have sufficient resources to provide high-quality patient care; (4) recognize and address threats to clinician, provider, and patient well-being; and (5) improve patient access to high-quality cancer care via telemedicine. ASCO will work at all levels to advance the recommendations made in this report.


Asunto(s)
Investigación Biomédica , COVID-19/terapia , Oncología Médica , Neoplasias/terapia , SARS-CoV-2 , Ensayos Clínicos como Asunto , Atención a la Salud , Humanos , Proyectos de Investigación , Sociedades Médicas
17.
Ars pharm ; 61(2): 97-103, abr.-jun. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-191329

RESUMEN

INTRODUCCIÓN: La OMS recomienda que durante los seis primeros meses de vida, los lactantes debieran ser alimentados exclusivamente con leche materna. A partir de ese momento, deberían recibir alimentos complementarios adecuados e inocuos, sin abandonar la lactancia natural al menos hasta los dos años de edad. El tratamiento farmacológico es una de las razones de abandono de la lactancia materna a pesar de que la mayoría de los medicamentos actuales son compatibles con la lactancia. OBJETIVO: Determinar las causas de la interrupción de la lactancia materna en mujeres participantes dedos plataformas virtuales nacionales. MÉTODO: Estudio observacional, descriptivo utilizando una encuesta virtual en 33 mujeres que hayan suspendido la lactancia materna de abril 2015 a abril 2017, participantes de dos plataformas virtuales de apoyo a la lactancia y maternidad del Paraguay. El muestreo no probabilístico por conveniencia. RESULTADOS: La edad promedio de 28±4,2 años, la mayoría universitarias, residentes en el departamento Central. Se detectó 30,3% de destetes antes de los 6 meses, y solo 9,0% alcanzaron los 24 meses de lactancia materna recomendada por la OMS. Las causas de la interrupción de la lactancia más frecuente fue la medicación (36,4%), seguida de sensación de falta de leche (27,3%) y de que el niño se quedaba con hambre (18,2%). CONCLUSIONES: La medicación representó la mayor causa de destete involuntario, siendo medicamentos compatibles con la lactancia en más de la mitad de los casos reportados. El farmacéutico, profesional con mayor conocimiento de fuentes de información sobre medicamentos, podría haber contribuido en estos casos para la preservación de la lactancia


INTRODUCTION: Who recommends that during the first six months of life, infants should be fed exclusively with breast milk. From that moment, they should receive adequate and safe complementary foods, without abandoning breastfeeding at least until two years of age. Pharmacological treatment is one of the reasons for abandoning breastfeeding despite the fact that most current medications are compatible with breastfeeding. OBJECTIVE: To determine the causes of the interruption of breastfeeding in women participants of two national virtual platforms. METHOD: Observational, descriptive study using a virtual survey of 33 women who have suspended breastfeeding from April 2015 to April 2017, participants of two virtual breastfeeding and maternity support platforms in Paraguay. Sampling not probabilistic for convenience. RESULTS: The average age of 28 ± 4.2 years, mostly university, residents in the Central department.30.3% of weaning was detected before 6 months, and only 9.0% reached 24 months of breastfeeding recommended by WHO. The causes of the most frequent interruption of breastfeeding were medication (36.4%), followed by a feeling of lack of milk (27.3%) and that the child was left hungry (18.2%). CONCLUSIONS: The medication represented the major cause of involuntary weaning, being compatible with breastfeeding drugs in more than half of the cases reported. The pharmacist, a professional with greater knowledge of information sources on medications, could have contributed in these cases to the preservation of breastfeeding


Asunto(s)
Humanos , Femenino , Recién Nacido , Lactante , Preescolar , Adulto Joven , Adulto , Utilización de Medicamentos/estadística & datos numéricos , Lactancia Materna/estadística & datos numéricos , Factores Socioeconómicos , Estudios Transversales , Factores de Tiempo , Paraguay
19.
Support Care Cancer ; 28(10): 4923-4931, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32016600

RESUMEN

BACKGROUND: Primary care providers (PCPs) are critical to the provision of comprehensive care for cancer survivors, yet there is very little data on the practices and quality of survivorship care occurring in safety net primary care settings. This study aimed to assess the knowledge and attitudes of PCPs and preferences for care models for breast and colon cancer survivors in a safety net health network. METHODS: A modified National Cancer Institute Survey of Physician Attitudes Regarding the Care of Cancer Survivors was sent electronically to 220 PCPs in 12 primary care clinics in the San Francisco Health Network affiliated with Zuckerberg San Francisco General Hospital and Trauma Center. RESULTS: The response rate was 50% (110/220). About half of PCPs strongly/somewhat agreed (vs. strongly/somewhat disagreed) that PCPs have the knowledge needed to provide follow-up care related to breast (50%) and colon cancer (54%). Most providers (93%) correctly reported recommended frequency of mammography, however, frequency of blood tests and other imaging surveillance were not as well recognized for breast or colon cancer. Recognition of long-term side effects of chemotherapy drugs ranged from 12% for oxaliplatin to 44% for doxorubicin. Only 33% of providers reported receiving any survivorship training. The most preferred model for survivorship care was shared care model (40%). CONCLUSIONS: Safety net PCPs prefer a shared care model for care of cancer survivors but are limited by lack of training, poor communication, and poor delineation of roles. Patient-centered survivorship care can be improved through effective oncologist-PCP-patient partnerships and coordination.


Asunto(s)
Neoplasias de la Mama/rehabilitación , Supervivientes de Cáncer , Neoplasias del Colon/rehabilitación , Cuidados Posteriores , Actitud del Personal de Salud , Neoplasias de la Mama/diagnóstico , Neoplasias del Colon/diagnóstico , Continuidad de la Atención al Paciente , Femenino , Humanos , Conocimiento , Masculino , Persona de Mediana Edad , Médicos de Atención Primaria/psicología , Médicos de Atención Primaria/normas , Médicos de Atención Primaria/estadística & datos numéricos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Atención Primaria de Salud/estadística & datos numéricos , San Francisco , Autoeficacia , Encuestas y Cuestionarios
20.
J Sci Food Agric ; 98(7): 2824-2829, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29168202

RESUMEN

BACKGROUND: Ecuador exports two major types of cocoa beans, the highly regarded and lucrative National, known for its fine aroma, and the CCN-51 clone type, used in bulk for mass chocolate products. In order to discourage exportation of National cocoa adulterated with CCN-51, a fast and objective methodology for distinguishing between the two types of cocoa beans is needed. RESULTS: This study reports a methodology based on computer vision, which makes it possible to recognize these beans and determine the percentage of their mixture. The methodology was challenged with 336 samples of National cocoa and 127 of CCN-51. By excluding the samples with a low fermentation level and white beans, the model discriminated with a precision higher than 98%. The model was also able to identify and quantify adulterations in 75 export batches of National cocoa and separate out poorly fermented beans. CONCLUSION: A scientifically reliable methodology able to discriminate between Ecuadorian National and CCN-51 cocoa beans and their mixtures was successfully developed. © 2017 Society of Chemical Industry.


Asunto(s)
Cacao/química , Cacao/clasificación , Análisis Discriminante , Ecuador , Fermentación , Semillas/química , Semillas/clasificación
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