Health-related quality of life in cancer immunotherapy: a systematic perspective, using causal loop diagrams.

PURPOSE: System science offers a unique set of tools, including causal loop diagrams (CLDs), for stakeholders to better grasp the complexity of factors surrounding quality of life. Because the health-related quality of life (HRQoL) of cancer immunotherapy patients exists within an intricate system affected by and affecting many factors across multiple dimensions, the development of a systems-level model can provide a powerful framework to aid the understanding of this complexity. We developed a CLD for HRQoL of cancer immunotherapy patients. METHODS: We first applied a literature-based approach to construct a CLD for patients following immunotherapy. We then iteratively reviewed and enhanced the CLD through interviews with subject matter experts. RESULTS: Based on the reviewed literature and subject matter expert input, we produced a CLD representing the system surrounding cancer immunotherapy patients' HRQoL. Several feedback loops are identified that span clinical experiences, oncology teams' perceptions about immunotherapy, social support structures, and further research and development in cancer immunotherapy, in addition to other components. The CLD enables visualization of thought experiments regarding how a change anywhere in the system can ultimately worsen or improve patients' HRQoL. CONCLUSION: The CLD illustrates the valuable contribution of a systems perspective to quality-of-life research. This systems-based qualitative representation gives insight on strategies to inhibit harmful effects, enhance beneficial effects, and inherent tradeoffs within the system. The CLD identifies gaps in the literature and offers a communication tool for diverse stakeholders. Our research method provides an example for studying the complexities of quality of life in other health domains

Prognostic Significance of MYC Rearrangement and Translocation Partner in Diffuse Large B-Cell Lymphoma : A Study by the Lunenburg Lymphoma Biomarker Consortium

PURPOSE: MYC rearrangement (MYC-R) occurs in approximately 10% of diffuse large B-cell lymphomas (DLBCLs) and has been associated with poor prognosis in many studies. The impact of MYC-R on prognosis may be influenced by the MYC partner gene (immunoglobulin [IG] or a non-IG gene). We evaluated a large cohort of patients through the Lunenburg Lymphoma Biomarker Consortium to validate the prognostic significance of MYC-R (single-, double-, and triple-hit status) in DLBCL within the context of the MYC partner gene. METHODS: The study cohort included patients with histologically confirmed DLBCL morphology derived from large prospective trials and patient registries in Europe and North America who were uniformly treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone therapy or the like. Fluorescence in situ hybridization for the MYC, BCL2, BCL6, and IG heavy and light chain loci was used, and results were correlated with clinical outcomes. RESULTS: A total of 5,117 patients were identified of whom 2,383 (47%) had biopsy material available to assess for MYC-R. MYC-R was present in 264 (11%) of 2,383 patients and was associated with a significantly shorter progression-free and overall survival, with a strong time-dependent effect within the first 24 months after diagnosis. The adverse prognostic impact of MYC-R was only evident in patients with a concurrent rearrangement of BCL2 and/or BCL6 and an IG partner (hazard ratio, 2.4; 95% CI, 1.6 to 3.6; P < .001). CONCLUSION: The negative prognostic impact of MYC-R in DLBCL is largely observed in patients with MYC double hit/triple-hit disease in which MYC is translocated to an IG partner, and this effect is restricted to the first 2 years after diagnosis. Our results suggest that diagnostic strategies should be adopted to identify this high-risk cohort, and risk-adjusted therapeutic approaches should be refined further

Construction d'un index pronostique ( application au lymphome de Hodgkin)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

President Trump’s speech on the Paris Agreement was full of confusion and bogus claims

Donald Trump has indicated that he intends to withdraw the United States from the Paris Climate Agreement. Bob Ward writes that the President’s speech put forward a confused interpretation of the agreement, included references to climate research that has previously been debunked, and gave a highly misleading account of the agreement’s impact on the United States’ coal industry

Modelling the effect of tamoxifen chemoprevention on long-term mortality in white women at high risk of breast cancer

International audienc

[Methodological tools for critical reading of scientific articles in medicine].

International audienc

Modélisation et prédiction (application en cancérologie)

When dealing with prediction, statistical models have to fit some criteria. The requirements are different for marginal predictions and for individual predictions. Based on two exemples in oncology, particularities and criteria of prognostic models are explored. The first exemple deals with the margianl effect of breast cancer chemoprevention on overall survival for women at high risk. The second exemple deals with individual prediction with a marginal model for Hodgkin's lymphoma patients. Measures of predictive quality are studied, in particular in survival context, especially in Cox proportional hazards modelLorsque l'objectif est la prédiction, les modèles statistiques doivent répondre à un certain nombre de critères. Ces critères varient selon que l'on s'intéresse à une prédiction marginale ou à une prédiction individuelle. A partir de deux applications en cancérologie, nous avons réfléchi aux particularités et aux critères des modèles pronostiques. Le premier exemple traite de la prédiction marginale de l'effet de la chimioprévention du cancer du sein sur la survie globale d'une population de femmes à haut risque. Le second exemple traite de la prédiction individuelle à partir d'un modèle marginal pour des individus atteints de lymphome de Hodgkin. Les mesures de la qualité prédictive des modèles ont été étudiées, plus particulièrement dans le contexte de la survie et du modèle de CoxLYON1-BU.Sciences (692662101) / SudocSudocFranceF