The role of residential history in cancer research: A scoping review.

The role of residential history in cancer prevention, diagnosis, treatment, and survivorship is garnering increasing attention in cancer research. To our knowledge, there is no comprehensive synthesis of the current state of knowledge in the field. We reviewed the extant literature on this topic and conducted a scoping analysis to examine two main research questions: (a) To what degree, and how, have researchers accounted for residential history/mobility in cancer research? and (b) What are the gaps in the literature based on a knowledge synthesis using scoping review and concept mapping? To answer these questions, this scoping analysis focuses on how researchers compile, analyze and discuss residential history/mobility in studies on cancer. The study is focused on peer-reviewed articles from 6 different datasets (PubMed, Cinahl, Scopus, Web of Science and JSTOR, ERIC) from 1990 to August 2020. The review captured 1951 results in total, which was scoped to 281 relevant peer-reviewed journal articles. First, we examined these articles based on cancer continuum, cancer type and the main theme. Second, we identified 21 main themes and an additional 16 sub-themes in the pool of the selected articles. We utilized concept mapping to provide a conceptual framework and to highlight the underlying socioecological assumptions and paradigms. Results show that cancer research incorporating residential histories is primarily focused on incidence and estimating cumulative exposure, with little consideration across the cancer continuum. Additionally, our review suggests that although the social environment plays an important role across the cancer continuum, a small number of articles were focused on such factors and this area remains relatively unexplored. Additionally, the expansion of interdisciplinary research on residential mobility before and after cancer diagnosis will enhance understanding of the role of environmental and socioeconomic characteristics and exposures on cancer continuum.

A pilot randomized controlled trial of a decision aid with tailored fracture risk tool delivered via a patient portal.

We tested the feasibility of a fracture prevention decision aid in an online patient portal. The decision aid was acceptable for patients and successfully decreased decisional conflict. This study suggests the possible utility of leveraging the patient portal to enhance patient education and decision making in osteoporosis care. INTRODUCTION: Although interventions have improved osteoporosis screening and/or treatment for certain populations of high-risk patients, recent national studies suggest that large-scale uptake of these interventions has been limited. We aimed to determine the feasibility and potential efficacy of a patient portal-based osteoporosis decision aid (DA). METHODS: We conducted a pilot randomized controlled trial of primary care patients aged ≥55 who were enrolled in a patient portal and had a T-score of <-1. Intervention subjects were provided a link to a patient DA. The DA contained a 10-year fracture risk calculator, summary of medication risks and benefits (prescription and nonprescription), and an elicitation of values. Subjects completed questionnaires assessing the primary outcomes of decisional conflict and preparation for decision making and secondary outcomes related to feasibility and planning for a larger trial. Charts were reviewed for physician-subject interactions and medication uptake. RESULTS: The DA was acceptable to subjects, but 17 % of the patients in the decision aid arm incorrectly entered their T-scores into FRAX-based risk calculator. Decisional conflict was lower post-intervention for those who were randomized to the decision aid arm compared to controls (17.8 vs. 47.1, p < .001), and there was a significant difference in the percentage of patients who made a treatment decision at 3 months. No significant differences were observed in medication uptake. CONCLUSIONS: A portal-based osteoporosis DA was acceptable and improved several measures of decision quality. Given its effect on improving the quality of patients' decisions, future studies should examine whether it improves physician guideline adherence or medication adherence uptake among treated patients.

Medical preparedness, incidents, and group dynamics during the analog MARS2013 mission.

Participants on spaceflights and international scientific analog Mars missions can encounter medical incidents (accidents, illnesses) and psychological issues (e.g., stress, group interaction, sleep disturbance, emotions). The aim of this study was to examine these parameters in a field crew living in a desert environment similar to Mars (Group 1) and in Mission Support Center (MSC) personnel on "Earth" (Group 2) during a 4-week mission. Of the 107 medical interventions in the field, 73 mainly minor incidents together with four near accidents and 29 medical checkup interventions were recorded. Of the 32 medical interventions, medical treatments for 23 incidents of minor severity were necessary in Group 2. Injuries (Group 1: 1.4/100 h, Group 2: 0.1/100 h) were significantly increased in the field, and illnesses (Group 1: 0.3/100 h, Group 2: 3.0/100 h) in the MSC personnel. Causes of accidents and illnesses are described. Psychological results show that emotions and stress remained stable in both groups. Sympathy, social competence, teamwork, and leadership showed high scores. These scores were lower on "Earth" but significantly increased in the last weeks. The Sahara's nighttime coldness was reflected in an increased wake-up frequency, and a longer sleeping time peaked in the third week, probably as a result of overfatigue. MARS2013 was a successful mission with highly motivated participants and minor medical incidents. For future analog missions and possibly long-distance open-space missions, some recommendations in terms of medical and psychological preparedness are made to reduce risks for field crew members and MSC personnel.

Fracture risk and adjuvant hormonal therapy among a population-based cohort of older female breast cancer patients.

UNLABELLED: The risk of hip and other fractures was examined among a population-based group of older women with breast cancer. Women using aromatase inhibitors (AIs) were found to be over three times more likely to have a hip fracture over approximately 3 years' follow-up. Other fracture risk factors were also identified. INTRODUCTION: Aromatase inhibitors have been shown in randomized trials to increase total fracture risk compared with tamoxifen, but the fracture risks in the trials were relatively low, and no difference in hip fracture has been demonstrated. METHODS: A population-based cohort of 2003 breast cancer survivors ≥65 were followed prospectively for a median of 36 months. Patient survey information regarding adjuvant breast cancer therapies, prescription osteoporosis treatments, and other factors potentially associated with fracture was supplemented with cancer registry information. Hip and total nonvertebral fractures were determined using a validated Medicare algorithm, and the association of these fractures with adjuvant hormonal therapies was examined using Cox models. RESULTS: The cohort of 2,748 women with a mean age of 72.8 (SD 5.4) included 28.2% who took an aromatase inhibitor and 27.8% tamoxifen. There were 41 hip fractures (1.5%) and 218 nonvertebral fractures (7.9%) among the cohort. Subjects using AIs (adjusted hazard ratio 3.24 (1.05, 9.98)) and subjects not using hormone therapy (3.32 (1.14, 9.65)) were more likely than users of tamoxifen to have a hip fracture. Bisphosphonate use was more common among AI users but did not explain these results. Users of AIs were more likely to have nonvertebral fractures, but this result did not reach statistical significance (adjusted hazard 1.34 (0.92, 1.94)). CONCLUSIONS: Hip and other fractures were common in an older population-based cohort of breast cancer survivors, and aromatase inhibitor use was associated with an increase in the short-term risk of hip fractures not detected in randomized controlled trials.