A model building exercise of mortality risk for Taiwanese women with breast cancer

Abstract Background The accurate estimation of outcome in patients with malignant disease is an essential component of the optimal treatment, decision-making and patient counseling processes. The prognosis and disease outcome of breast cancer patients can differ according to geographic and ethnic factors. To our knowledge, to date these factors have never been validated in a homogenous loco-regional patient population, with the aim of achieving accurate predictions of outcome for individual patients. To clarify this topic, we created a new comprehensive prognostic and predictive model for Taiwanese breast cancer patients based on a range of patient-related and various clinical and pathological-related variables. Methods Demographic, clinical, and pathological data were analyzed from 1 137 patients with breast cancer who underwent surgical intervention. A survival prediction model was used to allow analysis of the optimal combination of variables. Results The area under the receiver operating characteristic (ROC) curve, as applied to an independent validation data set, was used as the measure of accuracy. Results were compared by comparing the area under the ROC curve. Conclusions our model building exercise of mortality risk was able to predict disease outcome for individual patients with breast cancer. This model could represent a highly accurate prognostic tool for Taiwanese breast cancer patients.</p

Motivations and reasons for women attending a Breast Self-Examination training program: A qualitative study

<p>Abstract</p> <p>Background</p> <p>Breast cancer is a major threat to Taiwanese women's health. Despite the controversy surrounding the effectiveness of breast self-examination (BSE) in reducing mortality, BSE is still advocated by some health departments. The aim of the study is to provide information about how women decide to practice BSE and their experiences through the training process. Sixty-six women aged 27-50 were recruited.</p> <p>Methods</p> <p>A descriptive study was conducted using small group and individual in-depth interviews to collect data, and using thematic analysis and constant comparison techniques for data analysis.</p> <p>Results</p> <p>It was found that a sense of self-security became an important motivator for entering BSE training. The satisfaction in obtaining a sense of self-security emerged as the central theme. Furthermore, a ladder motivation model was developed to explain the participants' motivations for entering BSE training. The patterns of motivation include opportunity taking, clarifying confusion, maintaining health, and illness monitoring, which were connected with the risk perception for breast cancer.</p> <p>Conclusions</p> <p>We recognize that the way women decide to attend BSE training is influenced by personal and social factors. Understanding the different risk assessments women rely on in making their health decisions is essential. This study will assist researchers and health professionals to gain a better understanding of alternative ways to deal with breast health, and not to be limited by the recommendations of the health authorities.</p

Adult mortality of diseases and injuries attributable to selected metabolic, lifestyle, environmental, and infectious risk factors in Taiwan: A comparative risk assessment

Background: To facilitate priority-setting in health policymaking, we compiled the best available information to estimate the adult mortality (>30 years) burden attributable to 13 metabolic, lifestyle, infectious, and environmental risk factors in Taiwan. Methods: We obtained data on risk factor exposure from nationally representative health surveys, cause-specific mortality from the National Death Registry, and relative risks from epidemiological studies and meta-analyses. We applied the comparative risk assessment framework to estimate mortality burden attributable to individual risk factors or risk factor clusters. Results: In 2009, high blood glucose accounted for 14,900 deaths (95% UI: 11,850-17,960), or 10.4% of all deaths in that year. It was followed by tobacco smoking (13,340 deaths, 95% UI: 10,330-16,450), high blood pressure (11,190 deaths, 95% UI: 8,190-14,190), ambient particulate matter pollution (8,600 deaths, 95% UI: 7,370-9,840), and dietary risks (high sodium intake and low intake of fruits and vegetables, 7,890 deaths, 95% UI: 5,970-9,810). Overweight-obesity and physical inactivity accounted for 7,620 deaths (95% UI: 6,040-9,190), and 7,400 deaths (95% UI: 6,670-8,130), respectively. The cardiometabolic risk factors of high blood pressure, high blood glucose, high cholesterol, and overweight-obesity jointly accounted for 12,120 deaths (95% UI: 11,220-13,020) from cardiovascular diseases. For domestic risk factors, infections from hepatitis B virus (HBV) and hepatitis C virus (HCV) were responsible for 6,300 deaths (95% UI: 5,610-6,980) and 3,170 deaths (95% UI: 1,860-4,490), respectively, and betel nut use was associated with 1,780 deaths from oral, laryngeal, and esophageal cancer (95% UI: 1,190-2,360). The leading risk factors for years of life lost were similar, but the impact of tobacco smoking and alcohol use became larger because the attributable deaths from these risk factors occurred among young adults aged less than 60 years. Conclusions: High blood glucose, tobacco smoking, and high blood pressure are the major risk factors for deaths from diseases and injuries among Taiwanese adults. A large number of years of life would be gained if the 13 modifiable risk factors could be removed or reduced to the optimal level

Women, Health and Aging: Building a Statewide Movement

Provides an overview of current policy and program environments that affect the state's most vulnerable elder population, and considers some effective strategies to address the growing needs of older persons in California

Higher dietary diversity scores and protein-rich food consumption were associated with lower risk of all-cause mortality in the oldest old

Background & aims: Dietary diversity is widely advocated in national and international recommendations although whether the beneficial effects on survival or longevity still apply in the final phase of the lifespan remains understudied. We aimed to prospectively examine the association of dietary diversity, food items with all-cause mortality among the oldest old (80+) and determine whether dietary diversity recommendations were appropriate for this population. Methods: The study included 28,790 participants aged 80+ (9957 octogenarians, 9925 nonagenarians, and 8908 centenarians). A baseline dietary diversity score (DDS) was constructed based on nine food items of a food frequency questionnaire. Cox models with penalized splines evaluated non-linear associations of DDS as continuous variable with mortality to identify cut-offs of DDS. Results: We documented 23,503 deaths during 96,739 person-years of follow-up. Each one unit increase in DDS was associated with a 9% lower risk of mortality (adjusted hazard ratio (HR): 0.91; 95% confidential interval (CI): 0.90–0.92). Compared to participants whose DDS less than 2 scores, those with a DDS of 2, 3, 4, 5, and higher than 6 scores had a lower mortality risk, the HRs were 0.86 (0.82–0.89), 0.78 (0.75–0.81), 0.69 (0.66–0.72), 0.65 (0.62–0.68), and 0.56 (0.53–0.58) respectively, and a significant trend emerged (p \u3c 0.001). Protein-rich food items were associated with prominent beneficial effects on mortality including meat (HR and 95% CI for high vs low frequency: 0.70 (0.68–0.72)), fish and sea food (HR, 0.74 (0.72–0.77)), egg (HR, 0.75 (0.73–0.77)), and bean (HR, 0.80 (0.78–0.82)). Conclusions: Even after the age of 80, the DDS tool may offer a simple and straightforward mean of identifying and screening individuals at high risk for mortality. Recommendation of dietary diversity, especially consumption of protein-rich food, may be advocated to reduce mortality risk and promote longevity in the oldest old

Assessment of mammary adiposity in breast cancer using digital pathology

L'obesit\ue0 \ue8 un fattore di rischio significativo per molti tumori, compreso il carcinoma della mammella. I pazienti con carcinoma della mammella che sono sovrappeso o obesi hanno un aumentato rischio di recidiva e di mortalit\ue0 correlata al tumore. Sebbene siano state proposte diverse ipotesi per descrivere i meccanismi biologici alla base dell\u2019interazione tra obesit\ue0 e carcinoma della mammella, i progressi nella comprensione del microambiente tumorale e del ruolo degli adipociti presenti in esso e della loro rilevanza per lo sviluppo e la progressione tumorale o per l'emergere di resistenze alle terapie sono ancora limitati. Parallelamente alle importanti scoperte sull'obesit\ue0 come fattore di rischio per diverse malattie e tipi di tumore, i ricercatori hanno iniziato a utilizzare la patologia digitale per caratterizzare il microambiente tumorale. Studi pionieristici hanno scoperto l'esistenza di un tipo particolare di adipociti chiamati adipociti associati al tumore presenti nel microambiente di tumori che crescono a stretto contatto con il tessuto adiposo. Nel momento in cui \ue8 stata scritta questa tesi, solo pochi studi con piccole coorti di pazienti e spesso, un numero limitato di adipociti analizzati, per lo pi\uf9 distanti dal tumore, hanno mostrato la rilevanza del tessuto adiposo e degli adipociti come componente del microambiente tumorale. Tuttavia, allo stato attuale manca ancora una conoscenza approfondita del ruolo degli adipociti nel carcinoma della mammella. Lo studio presentato in questa tesi descrive le potenzialit\ue0 della patologia digitale e fornisce una rappresentazione dello stato dell'arte sui software con algoritmi dedicati per la misurazione degli adipociti, con una attenzione per gli adipociti presenti nel microambiente di carcinomi mammari. Oltre a stabilire criteri istopatologici per l'analisi degli adipociti, i risultati presentati dimostrano che \ue8 possibile effettuare l'analisi degli adipociti associati al tumore come di quelli distanti, utilizzando un software di patologia digitale. Inoltre, abbiamo mostrato che gli adipociti associati al tumore sono pi\uf9 piccoli degli adipociti distanti, riflettendo il processo di delipidazione subito dagli stessi. Infine, l'indice di massa corporea del paziente \ue8 associato alle dimensioni degli adipociti distanti e associati al tumore, fornendo nuove prospettive per la valutazione dell'adiposit\ue0 mammaria di un paziente. I dati qui presentati, sono preliminari per un cambiamento diretto nella pratica clinica, ma forniscono i criteri per eseguire l'analisi degli adipociti su coorti pi\uf9 ampie di pazienti ed evidenziano l\u2019importanza della valutazione del tessuto adiposo nella gestione del carcinoma della mammella.Increased adiposity is a significant risk factor for many cancers, including breast cancer. Patients with breast cancer who are overweight or obese have an increased risk of recurrence, and breast cancer-related mortality. While several hypotheses have been proposed to explain the biological mechanisms that drive the obesity-breast cancer interconnections, progress in our understanding of the adipose tissue tumor microenvironment and its relevance to breast cancer initiation and progression or the emergence of resistance to therapy has been limited. In parallel to major breakthroughs on the increased adiposity as risk factor for several diseases and cancers, researchers have begun to utilize digital pathology to characterize the tumor microenvironment in diverse types of adipose tissue-rich neoplasia. Pioneering studies have uncovered the existence of a peculiar type of adipocytes named cancer-associated adipocytes in the microenvironment of tumors that grow in close contact with adipose tissue. At the time this thesis was started, only a few studies with small cohorts of patients and often, a limited number of adipocytes analyzed, mostly distant from the tumor, have shown the importance of the adipose tissue tumor microenvironment. However, an in-depth knowledge was currently lacking for breast cancer. The work presented here harnesses the strength of digital pathology and state of the art of adipocyte measurement tools to analyze adipocytes in the adipose tissue microenvironment of breast cancer. Beyond providing histopathological criteria for adipocyte analysis, these results suggest that the analysis of mammary cancer-associated adipocytes is feasible using image analysis software. Moreover, our analyses reveal that cancer-associated adipocytes are smaller than distant adipocytes, reflecting the delipidation process undergone by cancer-associated adipocytes. The body mass index of the patient is associated with the size of distant and cancer-associated adipocytes giving new insights in the evaluation of mammary adiposity of a patient. The data presented here are too preliminary to derive practice-changing evidence but provide the basis for performing adipocyte analysis on larger number of patients and support the concept that the evaluation of adipose tissue should be taken into account in breast cancer management

Building Blocks for the Development of a Chronic Care Lung Cancer Model

Lung cancer, is the leading cause of cancer death in the United States for both men and women, and as such, represents a tremendous burden on the healthcare system. Survival rates have remained relatively unchanged over the past forty years, yet we seem to be on the verge of a paradigm shift as a result of advances in early screening, diagnosis and better treatment modalities. Lung cancer is different from all other cancers in that 90% of lung cancer cases can be attributed to the conscious behavioral risk factor of smoking, either currently or previously engaged in by the patient. Funding and research has been limited in terms of identifying the unique characteristics and needs of these patients, their physicians and their caregivers. If survival rates improve dramatically, these patients will be managed chronically rather than acutely in the near future. When this occurs, a lung cancer treatment model for the future must be developed in order to more successfully prepare the market place for adapting to these unique patients and their providers who will be operating in a chronic rather than acute care environment. Prior to the development of such a model, the need exists to first develop a comprehensive information map identifying knowledge and knowledge gaps with regards to these patients and providers and their healthcare interactions and individualized needs. Productive patient provider interactions are critical for successful chronic disease management, and therefore several questions must be answered as they relate to treating lung cancer in a more chronic versus acute environment

Developing an Evidence-Based Supportive Services Program for Cancer Survivors in a Private Oncology Practice

Improvements in cancer treatment have led to a rapidly increasing survivor population. In response, multiple side effects of cancer and cancer treatment as well as the various wellness needs of survivors have been recognized. Survivorship programs have been developed to care for survivors with residual effects of cancer and the side effects of treatment; however, additional support is needed. The purpose of the project was to highlight the need for a comprehensive supportive services program for the cancer survivor population and describe the steps that were required to successfully develop the program. The clinical question addressed by the project was: What is an evidence-based, efficient, cost-effective, and sustainable program that delivers supportive services to cancer survivors in a private oncology practice? The objective of the project was to develop a supportive services program toolkit and gain implementation approval from the organization’s manager and director of multispecialty services. The objective was completed using an organizational assessment of a private oncology practice, the application of the Health Promotion Model, Kotter’s Eight-Step Process for Leading Change, and the implementation of evidence-based practice into the program toolkit. The project outcome was an evidence-based, supportive services program toolkit, composed of multiple wellness initiatives, which was accepted and implemented into practice by the organization. After implementation, sustainability of the program will be ensured through well-developed, evidence-based evaluation and sustainability plans. Practice implications include increasing revenue through performance-based payments, recognizing the practice as a leader in oncology care, and improving the quality of life of cancer survivors