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1.
BMJ Open ; 11(2): e041447, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526497

RESUMO

OBJECTIVE: Cancer care providers' (CCPs) attitudes towards smoking cessation are influenced by many factors, including their smoking status and knowledge. Our objective was to assess CCPs' characteristics, tobacco use and smoking cessation practices in two Latin American cancer centres. DESIGN: Cross-sectional survey. SETTINGS: Two urban cancer centres located in Colombia and Mexico. PARTICIPANTS: A total of 238 CCPs. MEASURES: Online survey consisted of 28 close-ended questions adapted from the 2012 International Association for the Study of Lung Cancer survey and the Global Adult Tobacco Survey developed by the WHO. Means, frequencies and proportions were reported for each country. Factors associated to providing of smoking cessation treatment or referral at initial visit were evaluated using logistic regression. RESULTS: Current smoking prevalence was 10.5% and 12.3% among Colombian and Mexican CCPs, respectively. Around three quarters of the Colombian (86.4%) and Mexican CCPs (66.1%) considered to have inadequate training in smoking cessation. Approximately two-thirds of Colombian (67.5%) and Mexican CCPs (63.9%) reported always or most of the time asking patients about tobacco use during the initial visit. In Colombia and Mexico, the most relevant barriers for providing cessation services were (1) difficulties for motivating patients with cancer, (2) patient resistance in quitting smoking, (3) lack of local resources or referral centres for smoking cessation and (4) lack of training in smoking cessation. CCPs appointed at Instituto Nacional de Cancerología were less likely to provide cessation treatment or referral to their patients if they had less than 50% of their time devoted to patient care and were former or current smokers. The regression model for Instituto de Cancerología did not retain statistically significant variables. CONCLUSION: Our findings highlight an urgent need for assisting Latin American CCPs in their quitting efforts as well as expanding formal smoking cessation training specifically tailored to these professionals for improving patients' cancer prognosis and quality of life.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33409738

RESUMO

BACKGROUND: Immune checkpoint inhibitors (ICIs) can cause profound immune-related adverse events (irAEs). The host genetic background is likely to play a role in irAE susceptibility because the presentation of toxicity varies among patients and many do not develop irAEs despite continued ICI use. We sought to identify potential genetic markers conferring risk for irAEs. METHODS: We conducted a pilot exploratory study in 89 melanoma patients who received ICIs (44 with irAEs, and 45 without irAEs after at least 1 year from starting treatment). Genotyping was performed using the Infinium Multi-Ethnic Global-8 v1.0 Bead Chip. The genotype data were extracted using PLINK (v1.90b3.34) and processed for quality control. Population structure-based clustering was carried out using IBS matrix, pairwise population concordance test (p < 1 × 10-3), and phenotype distribution for all study participants, resulting in seven population structure-based clusters. In the analytical stage, 599,931 variants in autosomal chromosomes were included for the association study. The association test was performed using an additive genetic model with exact logistic regression, adjusted for age, sex, and population cluster. RESULTS: A total of 30 variants or single-nucleotide polymorphisms with p < 1 × 10-4 were identified; 12 were associated with an increased risk of irAEs, and the remaining 18 were associated with a decreased risk. Overall, nine of the identified single-nucleotide polymorphisms mapped to eight unique genes that have been associated with autoimmunity or inflammatory diseases. CONCLUSION: Several genetic variants associated with irAEs were identified. Additional larger studies are needed to validate these findings and establish their potential functional relevance.

3.
Addict Behav ; 115: 106790, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33387979

RESUMO

BACKGROUND: There is an established link between depression and tobacco use among adults; however, to date, research has not explored the association of use of dual/poly tobacco products with symptoms and use of medication for depression. METHODS: Data were derived from a 2018 Texas population health assessment survey (n = 2034). Multivariable logistic and multinomial regressions were used to examine for associations between self-reported symptoms of depression and use of prescription medications for depression with use of dual/poly tobacco products. RESULTS: About 20% of adults used one tobacco product, while 9.7% used two or more products. Compared to those without depressive symptoms, those with depressive symptoms had greater odds of single (aOR: 1.66, 95% CI; 1.21 - 2.29) or dual/poly (aOR: 3.09, 95% CI; 1.92 - 4.96) tobacco product use relative to non-users; and relative to single product use, those with depressive symptoms had greater odds of dual/poly tobacco product use (aOR: 2.07; 95% CI, 1.30 - 3.32). Compared to those not using medication for depression, use of medication for depression was associated with a 1.80 (95% CI: 1.15 - 2.84) greater odds of dual/poly tobacco product use relative to non-users; and a 1.91 (95% CI: 1.14 - 3.19) greater odds of dual/poly product use relative to single product users. CONCLUSIONS: Study findings call for primary care providers and psychiatrists to expand screening of individuals experiencing depressive symptoms and using medication for depression, to include assessment for dual/poly tobacco product use.

4.
Lung Cancer ; 152: 58-65, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33352384

RESUMO

INTRODUCTION: The relationship between Body-Mass-Index (BMI) and lung cancer prognosis is heterogeneous. We evaluated the impact of sex, smoking and race on the relationship between BMI and overall survival (OS) in non-small-cell-lung-cancer (NSCLC). METHODS: Data from 16 individual ILCCO studies were pooled to assess interactions between BMI and the following factors on OS: self-reported race, smoking status and sex, using Cox models (adjusted hazard ratios; aHR) with interaction terms and adjusted penalized smoothing spline plots in stratified analyses. RESULTS: Among 20,937 NSCLC patients with BMI values, females = 47 %; never-smokers = 14 %; White-patients = 76 %. BMI showed differential survival according to race whereby compared to normal-BMI patients, being underweight was associated with poor survival among white patients (OS, aHR = 1.66) but not among black patients (aHR = 1.06; pinteraction = 0.02). Comparing overweight/obese to normal weight patients, Black NSCLC patients who were overweight/obese also had relatively better OS (pinteraction = 0.06) when compared to White-patients. BMI was least associated with survival in Asian-patients and never-smokers. The outcomes of female ever-smokers at the extremes of BMI were associated with worse outcomes in both the underweight (pinteraction<0.001) and obese categories (pinteraction = 0.004) relative to the normal-BMI category, when compared to male ever-smokers. CONCLUSION: Underweight and obese female ever-smokers were associated with worse outcomes in White-patients. These BMI associations were not observed in Asian-patients and never-smokers. Black-patients had more favorable outcomes in the extremes of BMI when compared to White-patients. Body composition in Black-patients, and NSCLC subtypes more commonly seen in Asian-patients and never-smokers, may account for differences in these BMI-OS relationships.

6.
Cancer ; 126(23): 5124-5136, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32888342

RESUMO

BACKGROUND: Oral mucositis (OM) is a debilitating sequela for patients treated for squamous cell carcinoma of the head and neck (HNSCC). This study investigated whether oral microbial features before treatment or during treatment are associated with the time to onset of severe OM in patients with HNSCC. METHODS: This was a cohort study of newly diagnosed patients with locoregional HNSCC who received chemotherapy with or without radiotherapy from April 2016 to September 2017. OM was based on the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 4.0. The oral microbiome was characterized on the basis of the 16S ribosomal RNA V4 region with the Illumina platform. A mixture cure model was used to generate hazard ratios for the onset of severe OM. RESULTS: Eighty-six percent of the patients developed OM (n = 57 [33 nonsevere cases and 24 severe cases]) with a median time to onset of OM of 21 days. With adjustments for age, sex, and smoking status, genera abundance was associated with the hazard for the onset of severe OM as follows: 1) at the baseline (n = 66), Cardiobacterium (P = .03) and Granulicatella (P = .04); 2) immediately before the development of OM (n = 57), Prevotella (P = .03), Fusobacterium (P = .03), and Streptococcus (P = .01); and 3) immediately before the development of severe OM (n = 24), Megasphaera (P = .0001) and Cardiobacterium (P = .03). There were no differences in α-diversity between the baseline samples and Human Microbiome Project data. CONCLUSIONS: Changes in the abundance of genera over the course of treatment were associated with the onset of severe OM. The mechanism and therapeutic implications of these findings need to be investigated in future studies.

7.
Front Med ; 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32889700

RESUMO

Although genome-wide association studies have identified more than eighty genetic variants associated with non-small cell lung cancer (NSCLC) risk, biological mechanisms of these variants remain largely unknown. By integrating a large-scale genotype data of 15 581 lung adenocarcinoma (AD) cases, 8350 squamous cell carcinoma (SqCC) cases, and 27 355 controls, as well as multiple transcriptome and epigenomic databases, we conducted histology-specific meta-analyses and functional annotations of both reported and novel susceptibility variants. We identified 3064 credible risk variants for NSCLC, which were overrepresented in enhancer-like and promoter-like histone modification peaks as well as DNase I hypersensitive sites. Transcription factor enrichment analysis revealed that USF1 was AD-specific while CREB1 was SqCC-specific. Functional annotation and gene-based analysis implicated 894 target genes, including 274 specifics for AD and 123 for SqCC, which were overrepresented in somatic driver genes (ER = 1.95, P = 0.005). Pathway enrichment analysis and Gene-Set Enrichment Analysis revealed that AD genes were primarily involved in immune-related pathways, while SqCC genes were homologous recombination deficiency related. Our results illustrate the molecular basis of both well-studied and new susceptibility loci of NSCLC, providing not only novel insights into the genetic heterogeneity between AD and SqCC but also a set of plausible gene targets for post-GWAS functional experiments.

8.
Int J Health Geogr ; 19(1): 37, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928225

RESUMO

BACKGROUND: The investigation of perceived geographical disease clusters serves as a preliminary step that expedites subsequent etiological studies and analysis of epidemicity. With the identification of disease clusters of statistical significance, to determine whether or not the detected disease clusters can be explained by known or suspected risk factors is a logical next step. The models allowing for confounding variables permit the investigators to determine if some risk factors can explain the occurrence of geographical clustering of disease incidence and to investigate other hidden spatially related risk factors if there still exist geographical disease clusters, after adjusting for risk factors. METHODS: We propose to develop statistical methods for differentiating incidence intensity of geographical disease clusters of peak incidence and low incidence in a hierarchical manner, adjusted for confounding variables. The methods prioritize the areas with the highest or lowest incidence anomalies and are designed to recognize hierarchical (in intensity) disease clusters of respectively high-risk areas and low-risk areas within close geographic proximity on a map, with the adjustment for known or suspected risk factors. The data on spatial occurrence of sudden infant death syndrome with a confounding variable of race in North Carolina counties were analyzed, using the proposed methods. RESULTS: The proposed Poisson model appears better than the one based on SMR, particularly at facilitating discrimination between the 13 counties with no cases. Our study showed that the difference in racial distribution of live births explained, to a large extent, the 3 previously identified hierarchical high-intensity clusters, and a small region of 4 mutually adjacent counties with the higher race-adjusted rates, which was hidden previously, emerged in the southwest, indicating that unobserved spatially related risk factors may cause the elevated risk. We also showed that a large geographical cluster with the low race-adjusted rates, which was hidden previously, emerged in the mid-east. CONCLUSION: With the information on hierarchy in adjusted intensity levels, epidemiologists and public health officials can better prioritize the regions with the highest rates for thorough etiologic studies, seeking hidden spatially related risk factors and precisely moving resources to areas with genuine highest abnormalities.

9.
Int J Cancer ; 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32914876

RESUMO

At the time of cancer diagnosis, body mass index (BMI) is inversely correlated with lung cancer risk, which may reflect reverse causality and confounding due to smoking behavior. We used two-sample univariable and multivariable Mendelian randomization (MR) to estimate causal relationships of BMI and smoking behaviors on lung cancer and histological subtypes based on an aggregated genome-wide association studies (GWASs) analysis of lung cancer in 29 266 cases and 56 450 controls. We observed a positive causal effect for high BMI on occurrence of small-cell lung cancer (odds ratio (OR) = 1.60, 95% confidence interval (CI) = 1.24-2.06, P = 2.70 × 10-4 ). After adjustment of smoking behaviors using multivariable Mendelian randomization (MVMR), a direct causal effect on small cell lung cancer (ORMVMR = 1.28, 95% CI = 1.06-1.55, PMVMR = .011), and an inverse effect on lung adenocarcinoma (ORMVMR = 0.86, 95% CI = 0.77-0.96, PMVMR = .008) were observed. A weak increased risk of lung squamous cell carcinoma was observed for higher BMI in univariable Mendelian randomization (UVMR) analysis (ORUVMR = 1.19, 95% CI = 1.01-1.40, PUVMR = .036), but this effect disappeared after adjustment of smoking (ORMVMR = 1.02, 95% CI = 0.90-1.16, PMVMR = .746). These results highlight the histology-specific impact of BMI on lung carcinogenesis and imply mediator role of smoking behaviors in the association between BMI and lung cancer.

10.
JAMA Netw Open ; 3(8): e2012164, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32744630

RESUMO

Importance: Continued cigarette smoking after cancer diagnosis has been shown to adversely alter the cancer survivor's health outcomes and quality of life. Although considerable progress has been made in reducing cigarette smoking in the United States over the last decades, trends in cigarette smoking cessation among cancer survivors have not yet been fully investigated. Objective: To evaluate temporal trends in cigarette smoking cessation and their sociodemographic and behavioral correlates in the US population of adult cancer survivors. Design, Setting, and Participants: This investigation was a serial cross-sectional study of the National Health Interview Survey (NHIS) from 2006 to 2018, a household survey of civilian US residents who were 18 years or older. Data analysis was performed from June to October 2019. The NHIS is population based and representative of the US population. Included in this study were 381 989 respondents to the NHIS in 2006 to 2018. Main Outcomes and Measures: The primary outcome was the probability of quitting cigarette smoking after first cancer diagnosis. Secondary outcomes were factors associated with quitting cigarette smoking after cancer diagnosis. Results: Data on 381 989 adults (weighted N = 239 114 051; mean [SD] age, 48.96 [18.28] years; 211 508 [55.37%] female; 61.90% non-Hispanic White, 13.97% non-Hispanic Black, and 16.22% Hispanic individuals) 18 years or older were analyzed from the 2006 to 2018 NHIS, of whom 8.80% (n = 35 524; weighted n = 21 016 720) were diagnosed with cancer. Among cancer survivors diagnosed between 2000 and 2017, the age-adjusted prevalence of current cigarette smoking at the time of first cancer diagnosis was 24.45% (n = 4054; weighted n = 2 395 173). The probability of reporting a cigarette smoking cessation event after first cancer diagnosis statistically significantly increased with each year of cancer diagnosis (hazard ratio [HR], 1.05; 95% CI, 1.02-1.08), indicating upward trends in the prevalence of quitting cigarette smoking over time. Older individuals (HR, 1.02; 95% CI, 1.01-1.03), individuals diagnosed as having a smoking-related cancer (HR, 1.28; 95% CI, 1.06-1.54), individuals with an undergraduate degree (HR, 1.39; 95% CI, 1.08-1.79) or a postgraduate degree (HR, 1.61; 95% CI, 1.18-2.20), and individuals with obesity (HR, 1.32; 95% CI, 1.06-1.63) had a higher probability of reporting a cigarette smoking cessation event after cancer diagnosis, whereas individuals living below the poverty level (HR, 0.62; 95% CI, 0.48-0.81) had a lower probability of reporting a cigarette smoking cessation event after cancer diagnosis. Conclusions and Relevance: In this nationally representative survey of the US adult population, the likelihood of cigarette smoking cessation among cancer survivors increased with the year of cancer diagnosis from 2000 to 2017; however, the improvement is incremental, and the prevalence of smoking remained high among this population. Considering the projected increase in the population of cancer survivors in the United States, urgent action is needed to increase cigarette smoking cessation rates in this high-risk population.

12.
Hum Vaccin Immunother ; : 1-8, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32692632

RESUMO

Programs aimed at boosting human papillomavirus (HPV)-related awareness are considered one of the most effective strategies for increasing vaccination uptake and eliminating HPV-associated cancers. Several US states have made strong commitments to this effort through legislation and dedicated funds. However, it is not known if these efforts have resulted in population-level increments in HPV awareness overtime. Using the Health Information National Trends Survey data, we examined the awareness of HPV and HPV vaccine in the US, between 2008 and 2018. Prevalence estimates and confidence intervals were calculated for HPV and HPV vaccine awareness. Further, we assessed awareness after stratifying by key sociodemographic characteristics. Overall, the awareness of HPV and HPV vaccine declined over time. The lowest awareness was among racial minorities, rural residents, male respondents, those aged 65 years and older, as well as those with the lowest educational and socioeconomic standing. Between 2013 and 2018, the awareness of HPV and HPV vaccine declined by almost 10% among males, those with a high school level of education or lower, and those who earned less than USD 35,000 per annum. In 2018, the awareness of HPV and HPV vaccine was highest among non-Hispanic whites (65.8% and 66.5%) and female adults (70.5% and 71.4%); however, these figures represented declines of about 5% from rates observed in 2008. Amidst a background of sub-optimal HPV vaccination uptake and a growing incidence of HPV-associated cancers in the US, HPV-related awareness within the general US population has declined over time. This calls for stricter enforcement of legislation aimed at boosting HPV awareness, as well as frequent evaluation of government-funded HPV awareness programs.

13.
JAMA Netw Open ; 3(7): e209504, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32633765

RESUMO

Importance: In 2006, a US district court judge ordered tobacco companies to sponsor nationwide antismoking advertising campaigns. This landmark ruling and its subsequent execution represent an unprecedented tobacco control event; however, the association of this campaign with intentions and/or attempts to quit smoking is unknown. Objectives: To assess the reach of the expanded court-ordered tobacco industry antismoking advertisements (via television, newspapers, tobacco company websites, and/or cigarette packages), to examine associations between exposure to industry antismoking advertisements and intentions and/or attempts to quit smoking among cigarette smokers, and to calculate the numbers of US smokers who would have quit intentions associated with exposure to multiple advertisements. Design, Setting, and Participants: Data for this study were obtained from 5309 US adults, including 610 smokers, who responded to the Health Information National Trends Survey, a nationally representative cross-sectional survey conducted from January 22 to April 30, 2019. Respondents were representatives of households selected by equal-probability sampling of a database of US residential addresses. Exposure: Reported exposure to antismoking messages. Main Outcomes and Measures: Cigarette smoking cessation attempt in the past 12 months and intentions to quit cigarette smoking in the next 6 months. Covariates were age, sex, household annual income, race/ethnicity, educational level, and geographical residence. Data were weighted to be nationally representative after applying survey weights specified for the survey cycle. Results: The overall sample of 5309 respondents were a mean (SD) age of 55.6 (19.1) years and included 3073 women (51.2%), 3037 non-Hispanic white respondents (59.1%), 4645 respondents who lived in urban US areas (84.7%), and 610 current smokers (12.5%). Findings indicate that 2464 US adults (45.8%; 95% CI, 43.2%-48.5%) and 410 current smokers (66.8%; 95% CI, 61.1%-72.4%) were exposed to antismoking advertisements. Exposure to multiple antismoking messages was associated with 2.19 (95% CI, 1.10-4.34) greater odds of having intentions to quit cigarette smoking but was not associated with attempts to quit (adjusted odds ratio, 1.31; 95% CI, 0.69-2.52). Furthermore, an examination of the association of cumulative exposure to antismoking messages with cessation intentions revealed that, with each additional exposure to an antismoking message, the odds of smoking cessation intentions increased by 1.21 (95% CI, 1.02-1.44). If all smokers were to be exposed to multiple antitobacco messages, there could be an estimated 3.98 million (95% CI, 492 480-7 223 040) current smokers in the United States with intentions to quit. Conclusions and Relevance: Although the reach of court-ordered industry advertisements increased among smokers, the reach of these advertisements within the general population remains suboptimal. The finding that industry advertisements helped smokers consider quitting highlights their potential to aid smoking cessation. However, the lack of association with actual attempts to quit suggests that the industry antismoking advertisement campaigns were inadequate. The design and content of industry antismoking advertisement campaigns should be enhanced to help smokers quit.

14.
JAMA Netw Open ; 3(7): e209072, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32614423

RESUMO

Importance: The population of cancer survivors is rapidly growing in the US. Tobacco smoking is associated with many cancers; however, whether cigarette smoking behaviors among cancer survivors vary according to cancer type-that is, smoking-related cancers (SRCs) vs non-smoking-related cancers (NSRCs)-remains unclear. Objectives: To examine cigarette smoking prevalence and behaviors (ie, continuing or quitting smoking) among cancer survivors and to compare them between survivors of SRCs and NSRCs. Design, Setting, and Participants: This study was a cross-sectional analysis of the 2017 National Health Interview Survey, a household survey of civilian US residents who were aged 18 years or older. The National Health Interview Survey is population based and is representative of the US population. Data analysis was performed from June to October 2019. Main Outcomes and Measures: The primary outcomes were prevalence of current cigarette smoking among cancer survivors and prevalence of continuing smoking and quitting smoking after a cancer diagnosis. Secondary outcomes included factors associated with continued smoking vs quitting smoking after a cancer diagnosis. Results: A total of 26 742 respondents (mean [SD] age, 50.97 [18.61] years; 14 646 women [51.76%]) to the 2017 National Health Interview Survey were included in this study. Of the 3068 individuals (9.42%) in the study population who had cancer, 589 (19.96%) were SRC survivors, 2297 (74.50%) were NSRC survivors, 168 (4.96%) were survivors of both SRC and NSRC, and the remaining 14 (0.58%) had missing information about the type of cancer. Four hundred forty-nine SRC survivors (54.08%) were women, compared with 1412 NSRC survivors (54.30%). Ninety-six SRC survivors (15.69%) and 151 NSRC survivors (7.99%) were younger than 45 years. Overall, 372 cancer survivors (13.16%) were current smokers. Current smoking prevalence was higher among survivors of SRCs (145 survivors [19.78%]) compared with NSRC survivors (251 survivors [10.63%]). Among cancer survivors, 309 current smokers at cancer diagnosis (43.96%) reported having successfully quit smoking and 372 (56.04%) reported continuing smoking. Among the continuing smokers, 176 (56.49%) reported an unsuccessful quit attempt in the last 12 months. After cancer diagnosis, SRC survivors had higher odds of continued smoking compared with NSRC survivors (odds ratio [OR], 2.10; 95% CI, 1.12-3.93; P = .02). Men (OR, 1.93; 95% CI, 1.05-3.57; P = .04), those with angina pectoris (OR, 5.40; 95% CI, 1.33-21.91; P = .02), and those with chronic bronchitis (OR, 2.55; 95% CI, 1.05-6.19; P = .04) had higher odds of continued smoking, whereas Hispanic participants (compared with non-Hispanic white participants: OR, 0.18; 95% CI, 0.05-0.68; P = .01) and married participants (compared with never married participants: OR, 0.33; 95% CI, 0.12-0.96; P = .04) had lower odds of continued smoking. Conclusions and Relevance: These findings suggest that compared with NSRC survivors, SRC survivors may be at higher risk of being cigarette smokers at cancer diagnosis and of continuing smoking afterward. Although smoking cessation interventions are critically important for all cancer survivors, special efforts should target survivors of SRCs.

15.
Cancer Epidemiol Biomarkers Prev ; 29(10): 1983-1992, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32699080

RESUMO

BACKGROUND: Lung cancer remains the leading cause of cancer death worldwide, with 15% to 20% occurring in never smokers. To assess genetic determinants for prognosis among never smokers, we conducted a genome-wide investigation in the International Lung Cancer Consortium (ILCCO). METHODS: Genomic and clinical data from 1,569 never-smoking patients with lung cancer of European ancestry from 10 ILCCO studies were included. HRs and 95% confidence intervals of overall survival were estimated. We assessed whether the associations were mediated through mRNA expression-based 1,553 normal lung tissues from the lung expression quantitative trait loci (eQTL) dataset and Genotype-Tissue Expression (GTEx). For cross-ethnicity generalization, we assessed the associations in a Japanese study (N = 887). RESULTS: One locus at 13q22.2 was associated with lung adenocarcinoma survival at genome-wide level, with carriers of rs12875562-T allele exhibiting poor prognosis [HR = 1.71 (1.41-2.07), P = 3.60 × 10-8], and altered mRNA expression of LMO7DN in lung tissue (GTEx, P = 9.40 × 10-7; Lung eQTL dataset, P = 0.003). Furthermore, 2 of 11 independent loci that reached the suggestive significance level (P < 10-6) were significant eQTL affecting mRNA expression of nearby genes in lung tissues, including CAPZB at 1p36.13 and UBAC1 at 9q34.3. One locus encoding NWD2/KIAA1239 at 4p14 showed associations in both European [HR = 0.50 (0.38-0.66), P = 6.92 × 10-7] and Japanese populations [HR = 0.79 (0.67-0.94), P = 0.007]. CONCLUSIONS: Based on the largest genomic investigation on the lung cancer prognosis of never smokers to date, we observed that lung cancer prognosis is affected by inherited genetic variants. IMPACT: We identified one locus near LMO7DN at genome-wide level and several potential prognostic genes with cis-effect on mRNA expression. Further functional genomics work is required to understand their role in tumor progression.

16.
Cancer Med ; 9(14): 5281-5290, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32483891

RESUMO

BACKGROUND: The upward trends of vaccine exemptions in Texas are alarming. While HPV vaccine rates in this State are among the lowest nationwide, factors that contribute to the low HPV vaccination uptake among adults remain unknown. In this study, we examined the main reasons for not receiving HPV vaccination among age-eligible adults. METHODS: The Texas health screening survey (2018), a multistage area probability design-based survey of a representative sample of Texas residents, was used to identify 907 eligible adults (age ≥ 18 years) respondents, including 724 women aged ≤ 26 years in 2007 (≤38 years in 2018), and 183 men aged ≤ 21 years in 2011 (≤28 years in 2018). Participants who reported having never received an HPV shot, where asked the main reason for not receiving the vaccine. RESULTS: Overall, 58.5% (95%CI: 55.1-62.0) of vaccine eligible adults reported having never received the HPV vaccine. The most commonly reported reasons for not receiving it were: did not know about the vaccine (18.5% (14.9-22.1)), and provider did not recommend (14.1% (10.9-17.4)). In contrast, commonly perceived reasons such as: safety concerns (7.2% (4.8-9.5)), lack of insurance (3.4% (1.7-5.1), and concerns about increasing sexual activity if vaccinated (0.2% (0.0-0.5)), were less frequently reported. CONCLUSION: Among vaccine-eligible adults, safety and sexuality concerns do not appear to be the prime factors underlying low HPV vaccination rates. Rather than emphasizing them, educational interventions should aim at improving vaccine's knowledge, and enhancing provider recommendations on the necessity of HPV vaccination.

17.
Lancet ; 395(10241): 1907-1918, 2020 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-32473681

RESUMO

BACKGROUND: Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness. METHODS: In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing. FINDINGS: Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57-76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53-2·21), male sex (1·63, 1·07-2·48), smoking status (former smoker vs never smoked: 1·60, 1·03-2·47), number of comorbidities (two vs none: 4·50, 1·33-15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3·89, 2·11-7·18), active cancer (progressing vs remission: 5·20, 2·77-9·77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2·93, 1·79-4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07-0·84) or the US-Midwest (0·50, 0·28-0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality. INTERPRETATION: Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments. FUNDING: American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias/epidemiologia , Pneumonia Viral/epidemiologia , Idoso , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , Betacoronavirus , Causas de Morte , Comorbidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Neoplasias/terapia , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/mortalidade , Prognóstico , Fatores de Risco
18.
Tob Prev Cessat ; 6: 2, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32548339

RESUMO

INTRODUCTION: This study aimed to assess the association between current smoking and gender identity among transgender individuals. METHODS: Data were collected using a cross-sectional survey distributed among transgender individuals attending the Houston Pride Festival and those seeking care at a local transgender health clinic. Relevant variables were compared between female-to-male (FTM) and male-to-female (MTF) transgender individuals using χ2, Fisher's exact, and two-sample t-tests, when appropriate. Gender identity was used to predict current smoking status using logistic regression, adjusting for other sociodemographic determinants. RESULTS: The study sample (N=132) comprised 72 MTF (54.5%) and 60 FTM (45.5%) transgender individuals. Mean age of participants was 31.8 years. The sample was racially and ethnically diverse: 45.8% Caucasian, 25.2% Hispanic/Latino, 16.8% African American, and 12.2% other. Current smoking prevalence was 26.7% and 13.9% among FTM and MTF individuals, respectively. Transgender individuals were more likely to self-report current smoking if they were FTM (OR=3.76; 95% CI: 1.17-12.06; p=0.026) or were insured (OR=4.49; 95% CI: 1.53-13.18; p=0.006). CONCLUSIONS: This study reports on important findings by examining intragroup differences in smoking behavior among the transgender population. However, further research is needed for tailoring smoking prevention and cessation interventions for transgender subgroups.

19.
J Educ Health Promot ; 9: 30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32318598

RESUMO

BACKGROUND: Occupational stress is known as harmful physical and emotional responses that occur when the requirements of the job do not match the resources, needs, or capabilities of an employee, leading to poor mental and physical health. OBJECTIVE: The objective of the present study was to assess the effect of 1-week residential yoga training program on occupational stress and its subscales among principals. METHODS: Thirty-three principals with ages 40-59 years completed the assessment. They received yoga training at Kaivalyadham Yoga Institute. All the participants were recruited by Kendriya Vidyalaya Sangathan as part of their on-duty yoga training. At the baseline and after 1 week of yoga training participants were assessed for occupational stress. The yoga intervention was given in the morning and evening for 105 min. Apart from yoga training, all the participants were engaged in lectures based on stress management, yoga for total health, meditation, yoga in school education, and scientific basis of yoga, daily for 3 h. RESULTS: The principals showed a significant decrease in role overload (P < 0.001), role ambiguity (P < 0.01), role conflict (P < 0.05), under participation (P < 0.001), powerlessness (P < 0.001), intrinsic impoverishment (P < 0.01), law status (P < 0.001), and overall occupational stress (P < 0.001) after 7 days of yoga training intervention. However, there was no significant change in unreasonable group and political pressure (P > 0.05), responsibility for persons (P > 0.05), poor peer relations (P > 0.05), strenuous working conditions (P > 0.05), and unprofitability (P > 0.05) after yoga training intervention. CONCLUSION: The present study suggests that 1 week of residential yoga training program can improve occupational stress in principals.

20.
Cancer Cytopathol ; 128(8): 553-562, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32320527

RESUMO

BACKGROUND: Approximately one third of needle biopsies that are performed to rule out malignancy of indeterminate pulmonary nodules detected radiologically during lung cancer screening are negative, thus exposing cancer-free patients to risks of pneumothorax, bleeding, and infection. A noninvasive confirmatory tool (eg, liquid biopsy) is urgently needed in the lung cancer diagnosis setting to stratify patients who should receive biopsy versus those who should be monitored. METHODS: A novel antigen-independent, 4-color fluorescence in situ hybridization (FISH)-based method was developed to detect circulating tumor cells (CTCs) with abnormalities in gene copy numbers in mononuclear cell-enriched peripheral blood samples from patients with (n = 107) and without (n = 100) lung cancer. RESULTS: Identification of CTCs using FISH probes at 10q22.3/CEP10 and 3p22.1/3q29 detected lung cancer cases with 94.2% accuracy, 89% sensitivity, and 100% specificity compared with biopsy. CONCLUSION: The high accuracy of this liquid biopsy method suggests that it may be used as a noninvasive decision tool to reduce the frequency of unnecessary needle biopsy in patients with benign pulmonary lesions.


Assuntos
Pneumopatias/diagnóstico , Neoplasias Pulmonares/diagnóstico , Células Neoplásicas Circulantes , Tomografia Computadorizada por Raios X/métodos , Células A549 , Idoso , Aneuploidia , Diagnóstico Diferencial , Feminino , Humanos , Hibridização in Situ Fluorescente/métodos , Biópsia Líquida , Pneumopatias/diagnóstico por imagem , Pneumopatias/genética , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/genética , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Sensibilidade e Especificidade
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