Do treatment patterns alter beliefs cancer patients hold regarding oral oncolytic agents?

ObjectiveCancer patients, particularly those prescribed with oral oncolytic medications, face treatment side effects and temporary and permanent stoppages of treatment. This research examines how events during treatment affect patients’ beliefs regarding oral oncolytic medications.MethodsA total of 272 cancer patients initiating 1 of 28 oral oncolytic agents were followed for 12 weeks. Assessments of Beliefs About Medications Questionnaire, symptoms, physical function, and depression measures were performed during telephone interviews at intake (medication start) and 4, 8, and 12 weeks. Electronic medical record audits identified dates of temporary and permanent medication stoppages. Linear mixed‐effects models were used for longitudinal analyses of the Beliefs About Medications Questionnaire scores in relation to patient characteristics, symptom severity, and medication stoppages.ResultsOver the initial 12 weeks, beliefs about the necessity of oral medications have increased, concerns have decreased, and interference of medications with daily lives has increased. Permanent stoppage of a medication predicted significant declines in beliefs about its necessity over time. Male patients, those less educated, those reporting higher symptom severity, and those experiencing temporary stoppages had greater concerns. Interference of medications with daily life was higher for males, increased with higher symptom severity, and differed by drug category.ConclusionsPatients’ beliefs in the necessity of their oral medication were affected only by a permanent drug stoppage. Symptom severity, education, and patient sex affected patients’ beliefs about their concerns with their medications and the interference medications posed for their daily lives. Interventions may need to target the distinct dimensions of beliefs during treatment with oral oncolytic agents.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142470/1/pon4606.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142470/2/pon4606_am.pd

Bayesian penalized model for classification and selection of functional predictors using longitudinal MRI data from ADNI

The main goal of this paper is to employ longitudinal trajectories in a significant number of sub-regional brain volumetric MRI data as statistical predictors for Alzheimer's disease (AD) classification. We use logistic regression in a Bayesian framework that includes many functional predictors. The direct sampling of regression coefficients from the Bayesian logistic model is difficult due to its complicated likelihood function. In high-dimensional scenarios, the selection of predictors is paramount with the introduction of either spike-and-slab priors, non-local priors, or Horseshoe priors. We seek to avoid the complicated Metropolis-Hastings approach and to develop an easily implementable Gibbs sampler. In addition, the Bayesian estimation provides proper estimates of the model parameters, which are also useful for building inference. Another advantage of working with logistic regression is that it calculates the log of odds of relative risk for AD compared to normal control based on the selected longitudinal predictors, rather than simply classifying patients based on cross-sectional estimates. Ultimately, however, we combine approaches and use a probability threshold to classify individual patients. We employ 49 functional predictors consisting of volumetric estimates of brain sub-regions, chosen for their established clinical significance. Moreover, the use of spike-and-slab priors ensures that many redundant predictors are dropped from the model

Medication burden of treatment using oral cancer medications

Objective: With the changes in healthcare, patients with cancer now have to assume greater responsibility for their own care. Oral cancer medications with complex regimens are now a part of cancer treatment. Patients have to manage these along with the management of medications for their other chronic illnesses. This results in medication burden as patients assume the self-management. Methods: This paper describes the treatment burdens that patients endured in a randomized, clinical trial examining adherence for patients on oral cancer medications. There were four categories of oral agents reported. Most of the diagnoses of the patients were solid tumors with breast, colorectal, renal, and gastrointestinal. Results: Patients had 1u4 pills/day for oral cancer medications as well as a number for comorbidity conditions (3), for which they also took medications (10u11). In addition, patients had 3.7u5.9 symptoms and side effects. Patients on all categories except those on sex hormones had 49%u57% drug interruptions necessitating further medication burden. Conclusions: This study points out that patients taking oral agents have multiple medications for cancer and other comorbid conditions. The number of pills, times per day, and interruptions adds to the medication burden that patients' experience. Further study is needed to determine strategies to assist the patients on oral cancer medications to reduce their medication burden.National Cancer Institute, an institute of the National Institutes of Health [1R01CA162401-01A1. 2013-2017]Open access journal.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Absence of neurocognitive disadvantage associated with paediatric HIV subtype A infection in children on antiretroviral therapy.

Infection with HIV subtype A has been associated with poorer neurocognitive outcomes compared to HIV subtype D in Ugandan children not eligible for antiretroviral therapy (ART). In this study, we sought to determine whether subtype-specific differences are also observed among children receiving ART. Children were recruited from a clinical trial in which they were randomized to receive either lopinavir (LPV)- or non-nucleoside reverse transcriptase inhibitor (NNRTI)- based ART (NCT00978068). Age at initiation of ART ranged from six months to six years. HIV subtype was determined by PCR amplification and population sequencing of the pol region derived from peripheral blood mononuclear cell DNA, followed by application of the REGA and Recombinant Identification Programme algorithms. General cognition was assessed using the Kaufman Assessment Battery for Children (Second Edition), attention using the Test of Variables of Attention, and motor skills using the Bruininks-Oseretsky Test of Motor Proficiency (Second Edition). Home environment was assessed using the Home Observation for the Measurement of the Environment (HOME). Age-adjusted test z-scores were entered into a regression model that adjusted for sex, socio-economic status score, HOME score, years of schooling, and ART treatment type. One hundred and five children were tested; median (interquartile range) age was 7.05 years (6.30 to 8.44), CD4 count was 867.7 cells/mm3 (416.0 to 1203.5), and duration on ART was 4.03 years (3.55 to 4.23). Seventy-eight children had HIV subtype A and 27 had subtype D; the groups had comparable home and socio-economic status, except that there were more males among children infected with subtype A than D (64.7% vs. 35.3%, p = 0.02). There were no differences between the subtypes in general cognition (estimated mean difference: 0.20; 95% CI: -0.11 to 0.50); p = 0.21), attention (-0.18, 95% CI: -0.60 to 0.24, p = 0.41) and motor skills (1.60, 95% CI: -0.84 to 4.04, p = 0.20). Our results imply that ART may diminish the neurocognitive disadvantage seen in treatment-naïve HIV-infected children with subtype A