Category: Statistics

Lancet Oncol. 2022 Jul;23 Suppl 1:S33. doi: 10.1016/S1470-2045(22)00432-6.

ABSTRACT

BACKGROUND: Colorectal cancer is the third most frequent malignant disease worldwide. In Chile, colorectal cancer has been part of the Garantías Explícitas en Salud (Explicit Guarantees in Health Programme; also known as GES), which aims to ensure prompt access to affordable and quality health care, since 2014. Survival depends on the diagnosis of the disease in the earliest possible stage and on rapid access to adequate treatment. However, extreme inequality in social factors, such as education and income, has resulted in poor outcomes in cancer survival. The aim of this study was to obtain data on the epidemiology of colorectal cancer in Chile (in 2009-18) and on the effect of measurable factors on survival.

METHODS: Publicly available data corresponding to the period of 2009-18 were obtained from registries of mortality and hospital discharges published by the Chilean Health Ministry and National Institute of Statistics, allowing for follow-up of individuals. Individual survival was studied by Kaplan-Meier curves. A Cox proportional-hazards model was used to estimate the effect of the measurable factors.

FINDINGS: 103 239 hospital discharges of 41 615 patients with colorectal cancer were recorded in Chile in 2009-18. 24 217 (65·9%) patients died of the disease. By analysing empirical Kaplan-Meier survival rates, we observed a 5-year survival rate of 43·2% (95% CI 42·7-43·8), considering all patients in the treatment database, with no significant differences observed between men and women. A significant survival difference was observed between patients treated in public (5-year survival: 39·1% (38·5-39·7) and private (5-year survival: 63·4 % (61·9-64·9) health insurance systems (p<0·0001). We also observed differences within the public health insurance subgroups, showing poorer outcomes with decreased socioeconomic conditions (5-year survival rates ranging from 46·7% [45·2-48·3] in the wealthiest group to 30·9% [29·6-32·2] in the poorest group; p<0·0001). Higher survival rates were also seen in patients treated in Santiago, the capital, than in patients treated in other regions in the country. Survival rates did not improve since the implementation of GES (hazard ratio 0·99 [95% CI 0·94-1·05]; p=0·81).

INTERPRETATION: We found an overall 5-year survival rate of 43·2% and a significant difference between health insurance status, with patients with private health insurance reaching survival curves similar to those observed in high-income countries. Barriers to health access, affected by a centralised distribution of resources, with higher availability of resources, such as specialty physicians and colonoscopy, in private hospitals, can be affecting factors. Although GES was created to ensure transversal access to diagnosis and treatment of colorectal cancer, no effect of the programme was found. It is yet to be determined whether results regarding colorectal cancer are not visible because 5 years are not enough to assess the effect of GES, or whether early diagnosis for colorectal cancer is the dominant factor, which can only be managed with screening programmes that are not included in GES.

FUNDING: Complex Engineering Systems Institute (Centro Basal ANID/AFB18003) and Agencia Nacional de Investigación y Desarrollo/Programa de Becas/Doctorado Nacional 21200869.

PMID:35837930 | DOI:10.1016/S1470-2045(22)00432-6

Lancet Oncol. 2022 Jul;23 Suppl 1:S28. doi: 10.1016/S1470-2045(22)00427-2.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had a direct effect on patients with cancer, as reflected by the large number of COVID-19-related cancer deaths reported worldwide and the substantial decrease in cancer-related consultations during the pandemic. However, the impact of the COVID-19 pandemic on cancer mortality in Latin American countries has not been properly estimated. The aim of this study was to analyse the excess mortality related to cancer during the pandemic in Peru, including deaths directly or indirectly attributed to COVID-19.

METHODS: Excess mortality, which compares the number of deaths by any cause with the average number of expected deaths in typical circumstances during a specific timeframe, can be used as a simple but reliable indicator of the impact of the COVID-19 pandemic on cancer services. We carried out a descriptive study using data from the Peruvian death registration system, from which we filtered records that had registered neoplastic diseases (according to the tenth revision of WHO’s International Statistical Classification of Diseases and Related Health Problems) as the cause of death between. Only data for the period of March 15 to June 30 in the years 2017-20 was included. We calculated excess mortality by subtracting the average number of deaths recorded for the indicated period between 2017 and 2019 from the same period of 2020 records (ie, the duration of lockdown measures in Peru) to obtain the percentage of excess mortality.

FINDINGS: The percentage of changes in the number of cancer-related deaths in Peru was +13·90% from 2017 to 2018, -1·27% from 2018 to 2019, and +16·94% from 2019 to 2020. We found an excess mortality of 928 cases (corresponding to an excess mortality of +17·27%) among patients with cancer, when comparing years 2017-19 with the year 2020. During the lockdown in 2020, 3135 (58·4%) of 5372 cancer deaths happened at home (vs 5900 [44·2%] of 13 338 for the years 2017-19). The highest excess mortality percentage was observed in patients with prostate cancer (+50·43%), breast cancer (+33·62%), and leukaemia (32·78%). Although these findings appear to be in line with reports from other countries, only 184 (3·4%) of 5372 deaths were registered with COVID-19 as an additional cause of death.

INTERPRETATION: Our results suggest that COVID-19 control measures (eg, lockdowns, physical distancing, and isolation of symptomatic patients), alongside the overwhelming strain on the health-care system, had a detrimental impact on cancer mortality in Peru. The pandemic has exposed flaws in the Peruvian health-care system, especially regarding cancer care. Although we recognise that the rate of COVID-19 testing in Peru is one of the lowest in Latin America, the excess of cancer deaths cannot be fully explained by COVID-19. These findings might be an indication that the alarming increase in cancer mortality in Peru could continue over the upcoming months if no action is taken. Our study also shows the importance of an adequate registry of deaths. We recommend that the national authorities should implement policies to limit the impact of the COVID-19 pandemic on patients with cancer, and that the continuous update and monitoring of deaths initiated during the COVID-19 pandemic is sustained. These measures can help to confirm the increasing trend in cancer deaths; serve as a rationale to develop strategies that can alleviate this burden (eg, by adopting models for delivering optimal cancer care while minimising transmission of COVID-19); and minimise the possibility of an increase in patients presenting with advanced-stage cancers.

FUNDING: International Joint Laboratories Programme of the French National Research Institute for Sustainable Development.

PMID:35837924 | DOI:10.1016/S1470-2045(22)00427-2

Lancet Oncol. 2022 Jul;23 Suppl 1:S10. doi: 10.1016/S1470-2045(22)00409-0.

ABSTRACT

BACKGROUND: Aggressive medical care can increase suffering and the health-care burden on patients with advanced haematological malignancies. Our palliative care team has been pioneering an integrated palliative care (IPC) programme for patients with advanced haematological malignancies in Hong Kong since 2018. The aim of the study was to evaluate the effect of IPC on the administration of chemotherapy or other treatments within the 14 days before death; multiple (more than one) emergency department visits within the 90 days before death; multiple (more than one) unplanned hospitalisations within the 90 days before death; and intensive care unit admission within the 90 days before death.

METHODS: We retrospectively reviewed the outcomes of patients with advanced haematological malignancies who received IPC during the period of Jan 1, 2017, to Dec 31, 2020. Patients who died on the day of referral to palliative care or younger than 18 years were excluded. Our IPC programme comprised: early palliative care referral and advance care planning discussions; baseline and regular assessment of patient’s physical and psychospiritual distress and family concerns; consensus for symptom management and supportive services; and regular meetings with haematologists to review and modify care plans for their patients and community providers. Patients matched by disease status and patient characteristics but who did not receive IPC were selected as control in a 1:2 ratio. Descriptive statistics were used to illustrate general patient characteristics, stratified by matching group. Multivariate analyses were used to assess the effect of IPC on the outcomes of interest. The effect of duration of IPC on patient outcomes was also investigated. Ethical approval for this study was issued by the Institutional Review Board of the University of Hong Kong and Hospital Authority Hong Kong West Cluster (reference UW 18-282).

FINDINGS: 317 patients with advanced haematological malignancies (of whom 105 received IPC) were included for analysis. The primary diagnosis was lymphoma (134 [42%] of 317 patients), leukaemia (106 [33%]), myelodysplastic syndrome (46 [15%]), and myeloma (31 [10%]). The use of IPC was associated with less multiple emergency department visits (odds ratio 0·19 [95% CI 0·16-0·23]; p=0·019], reduced multiple unplanned hospitalisations (0·24 [0·19-0·31]; p=0·0021), and lower risk of intensive care unit admission (0·12 [0·08-0·18]; p=0·0032) within the 90 days before death, and decreased need of chemotherapy or other treatments within the 14 days before death (0·34 [0·25-0·46]; p=0·0012). Receiving IPC for more than 90 days was associated with 2% fewer multiple emergency department visits, 12% less multiple unplanned hospitalisations, 3% less intensive care unit admissions, and 11% less need of chemotherapy or other treatments in the defined near-death intervals.

INTERPRETATION: This study was limited by its retrospective design and the scarcity of details on the frequency and intensity of the palliative care service. Despite these limitations, we found that the use of IPC service was associated with reduced need for acute and aggressive medical services in patients with advanced haematological malignancies.

FUNDING: None.

PMID:35837905 | DOI:10.1016/S1470-2045(22)00409-0

Lancet Oncol. 2022 Jul;23 Suppl 1:S26. doi: 10.1016/S1470-2045(22)00425-9.

ABSTRACT

BACKGROUND: Oral squamous cell carcinoma is a substantial health burden and one of the most common cancers worldwide. 40% of patients with oral squamous cell carcinoma have metastasis to cervical lymph nodes. Modern diagnostic aids for the assessment of lymph node metastasis have some limitations and drawbacks. miR-21 targets genes associated with the metastatic process in oral squamous cell carcinoma. The aim of the study was to evaluate the sensitivity and specificity of miR-21 for the assessment of cervical lymph node metastasis in patients with oral squamous cell carcinoma.

METHODS: This work was conducted at Sumandeep Vidyapeeth, Vadodara, India. Unstimulated whole saliva and tumour tissue was obtained from patients with a clinically suspicious oral squamous cell carcinoma. The assessment of cervical lymph node metastasis was done before surgery by imaging techniques (CT or MRI) and post-surgically confirmed by histopathological examination of excised lymph nodes. miR-21 expression was evaluated using real-time PCR. Data were analysed for correlation analysis, cutoff values, sensitivity, and specificity. Kappa statistics were applied to assess the degree of agreement between the lymph node metastasis and miR-21 expression.

FINDINGS: 130 patients diagnosed with oral squamous cell carcinoma were included. miR-21 expression showed a significant correlation with cervical lymph node metastasis, with a diagnostic accuracy of 65-72% in saliva and 69-82% in tumour tissue. The mean cutoff value, defined as the value of fold (ie, to the power of) change indicating maximum sensitivity and specificity of miR-21 expression, was 2·32 cycle threshold (ct) for miR-21-5p (sensitivity 42·6%, specificity 90·3%) and 2·16 ct for miR-21-3p (sensitivity 60·3%, specificity 83·9%) in saliva, and 1·80 ct for miR-21-5p (sensitivity 76·5%, specificity 61·3%) and 0·89 ct for miR-21-3p in tumour tissue (sensitivity 82·4%, specificity 80·6%). We observed that when miR-21 expression is above the cutoff score, the probability of lymph node metastasis was higher. The independent t test showed a significant correlation (p<0·001) between cervical lymph node metastasis and miR-21 expression in saliva and tumour tissue, but not for miR-21-3p expression in tumour tissue (p=0·11). Very good agreement (Cohen’s kappa=0·63) was observed between tumour tissue miR-21-3p and cervical lymph node metastasis, with a specificity of 80·60% and a sensitivity of 82·40%. The statistical analysis for correlation between saliva and tumour tissue miR-21 expression and age, sex, site of tumour (eg, buccal mucosa, tongue), and tobacco consumption habits did not show any significant correlation, but a significant correlation was observed with one-way ANOVA testing for the comparison between TNM stage and miR-21-5p and miR-21-3p expression in saliva and tumour tissue (p<0·0001).

INTERPRETATION: miR-21 expression in saliva and tumour tissue samples from patients with oral squamous cell carcinoma showed high diagnostic accuracy for assessment of cervical lymph node metastasis, and it could be used as an alternative for the assessment of cervical lymph node metastasis before surgery.

FUNDING: None.

PMID:35837922 | DOI:10.1016/S1470-2045(22)00425-9

Ann Surg. 2022 Jul 15. doi: 10.1097/SLA.0000000000005552. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Studies indicate that COVID-19 infection before or soon after operations increases mortality, but they do not comment on the appropriate timing for interventions after diagnosis. We sought to determine what the safest time would be for COVID-19 diagnosed patients to undergo major operative interventions.

METHODS: High-risk operations, between January 2020 and May 2021, were identified from the Veterans Affairs COVID-19 Shared Data Resource. Current Procedural Terminology (CPT) codes were used to exact match COVID-19 positive cases (n=938) to negative controls (n=7,235). Time effects were calculated as a continuous variable and then grouped into two-week intervals. The primary outcome was 90-day, all-cause postoperative mortality.

RESULTS: 90-day mortality in cases and controls was similar when the operation was performed within 9 weeks or longer after a positive test; but significantly higher in cases vs. controls when the operation was performed within 7-8 weeks (12.3% vs. 4.9%), 5-6 weeks (10.3 vs. 3.3%), 3-4 weeks (19.6 vs. 6.7%), and 1-2 weeks (24.7 vs. 7.4%) from diagnosis. Among patients who underwent surgery within 8 weeks from diagnosis, 90-day mortality was 16.6% for cases vs. 5.8% for the controls (P<0.001). In this cohort, we assessed interaction between case status and any symptom (P=0.93), and case status and either respiratory symptoms or fever (P=0.29), neither of which were significant statistically.

CONCLUSIONS: Patients undergoing major operations within 8 weeks after a positive test have substantially higher postoperative 90-day mortality than CPT-matched controls without a COVID-19 diagnosis, regardless of presenting symptoms.

PMID:35837893 | DOI:10.1097/SLA.0000000000005552

Minerva Surg. 2022 Jul 15. doi: 10.23736/S2724-5691.22.09607-1. Online ahead of print.

ABSTRACT

BACKGROUND: Nipple reconstruction, which allows a reconstructed breast to assume a more natural look, represents the completion of the breast reconstruction journey. Several techniques have already been described in literature but unfortunately, loss of the projection of the new nipple has been a common problem for all of them. We report our experience using a personal modification of the popular arrow flap, to which we have added manoeuvres to compensate for the weaknesses of the conventional procedures.

METHODS: A prospective study was performed on women who required nipple reconstruction after autologous or implant-based breast reconstruction; revisions of reconstructed nipples have been also included. Patients who underwent radiotherapy after reconstruction of the breast mound were excluded from the study. The new nipples were reconstructed using our modified arrow flap. Immediate post-operative nipple projection was recorded and compared after 6weeks and 6moths. Descriptive statistics were used to summarize the characteristics of the study patients and the results. The F-test was performed to assess the statistical significance of our findings.

RESULTS: Our modified arrow-flap procedure was used to reconstruct 27 nipples. The average projection reduction has been of 12,9% at 6weeks and 19,7% at 6 months, and no statistical significance was recorded among the postoperative assessments. (p=0.14). Complications have been recorded in 3 patients and consisted of 2 small wound dehiscence and 1 superficial infection.

CONCLUSIONS: Our modified arrow-flap method for nipple reconstruction achieves a reproducible and reliable natural look and stable projection.

PMID:35837873 | DOI:10.23736/S2724-5691.22.09607-1

Exp Dermatol. 2022 Jul 15. doi: 10.1111/exd.14645. Online ahead of print.

ABSTRACT

The analytical technology of Raman spectroscopy has an almost 100-year history. During this period many modifications and developments happened in the method like discovery of laser, improvements in optical elements and sensitivity of spectrometer and also more advanced light detection systems. Many types of the innovative techniques appeared (e.g. Transmittance Raman spectroscopy, Coherent Raman Scattering microscopy, Surface Enhanced Raman scattering and Confocal Raman spectroscopy/microscopy). This review article gives a short description about these different Raman techniques and their possible applications. Then a short statistical part is coming about the appearance of Raman spectroscopy in the scientific literature from the beginnings to these days. The third part of the paper shows the main application options of the technique (especially confocal Raman spectroscopy) in skin research, including skin composition analysis, drug penetration monitoring and analysis, diagnostic utilizations in dermatology and cosmeto-scientific applications. At the end the possible role of artificial intelligence in Raman data analysis and the regulatory aspect of this techniques in dermatology are briefly summarized. For the future of Raman Spectroscopy increasing clinical relevance and in vivo applications can be predicted with spreading of non-destructive methods and appearance with the most advanced instruments with rapid analysis time.

PMID:35837832 | DOI:10.1111/exd.14645

Allergy Asthma Immunol Res. 2022 Jul;14(4):439. doi: 10.4168/aair.2022.14.4.439.

ABSTRACT

This corrects the article on p. 289 in vol. 14, PMID: 35557494.

PMID:35837826 | DOI:10.4168/aair.2022.14.4.439

J Asthma. 2022 Jul 15:1-7. doi: 10.1080/02770903.2022.2093218. Online ahead of print.

ABSTRACT

BACKGROUND: Patient education is a key element in the management of asthma.

AIMS: This study aimed to evaluate the popularity and usefulness of YouTube videos on asthma.

METHODS: Two authors screened and evaluated the 200 most popular videos. Data on likes, dislikes, views, comment, source of uploader, days since upload, and usefulness were recorded and included for analyses. The usefulness of the videos was categorized as follows: useful, misleading, or neutral. Misleading videos provided at least one scientifically incorrect detail, whereas useful videos contained scientifically correct information.

RESULTS: A total of 130 videos were included, and the total number of views was 100,290,242 with a total duration of 29 h and 8 min. While 26.6% of videos were uploaded by TV shows and YouTube channels, only 7.7% were uploaded by lung specialists. 65.4% of the videos contained scientifically correct information, whereas 18.5% contained misleading information. Although videos from medical professionals had a higher quality than videos from YouTube channels and TV shows, the latter were more popular. Misleading videos had numerically, but not statistically significant higher views compared with useful videos.

CONCLUSIONS: YouTube videos on asthma are popular in terms of viewer interaction, and the popularity is not restricted to videos uploaded by professional sources. Although more than half of the videos were found to be useful, a non-negligible proportion of videos were assessed as misleading. The usefulness of YouTube videos on asthma is variable and initiatives should be taken to increase the potential of YouTube as an useful source in patient education.

PMID:35837808 | DOI:10.1080/02770903.2022.2093218

Eur J Neurol. 2022 Jul 15. doi: 10.1111/ene.15496. Online ahead of print.

ABSTRACT

AIMS: To explore associations between plasma neurofilament light chain concentration (pNfL; pg/mL) and disease activity in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and examine the usefulness of pNfL concentrations in determining disease remission.

METHODS: We examined pNfL concentrations in treatment-naïve CIDP patients (n=10) before and after intravenous immunoglobulin (IVIg) induction treatment, differences in pNfL concentrations in patients on maintenance IVIg treatment who had stable (n=15) or unstable disease (n=9), and in clinically stable IVIg-treated patients (n=10) in whom we suspended IVIg to determine disease activity and ongoing need for maintenance IVIg. pNfL concentrations in an age-matched healthy control group were measured for comparison.

RESULTS: Treatment-naïve patients: pNfL concentration was higher in patients before IVIg treatment than healthy controls and subsequently reduced comparable to control group values after IVIg induction. CIDP patients on IVIg treatment: pNfL concentration was significantly higher in unstable patients than stable patients. A pNFL concentration above 16.6 pg/mL identified unstable treated CIDP from stable treated CIDP (sensitivity= 86.7%, specificity= 66.7%, area under ROC= 0.73). Treatment withdrawal group: There was statistically significant correlation between pNfL concentration at time of IVIg withdrawal and the likelihood of relapse (r=0.72, p<0.05), suggesting an association of higher pNfL concentration with active disease.

CONCLUSION: pNfL concentrations may be a sensitive, clinically useful biomarker in assessing subclinical disease activity.

PMID:35837802 | DOI:10.1111/ene.15496