The molecular evolution of surgical oncology

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88126/1/22050_ftp.pd

Osasairauspäiväraha Suomessa : Etuutta saaneiden kokemuksia ja työhön paluu

0,00 euro

Clinical effectiveness and cost-effectiveness of foot orthoses for people with established rheumatoid arthritis: an exploratory clinical trial

Objectives: Foot orthoses are commonly prescribed as an intervention for people with rheumatoid arthritis (RA). Data relating to the cost-effectiveness of foot orthoses in people with RA are limited. The aim was to evaluate the clinical and cost-effectiveness of two types of foot orthoses in people with established RA. Method: A single-blind randomized controlled trial was undertaken to compare custom-made foot orthoses (CMFOs) and simple insoles (SIs) in 41 people with established RA. The Foot Function Index (FFI) was used to measure foot pain, disability, and functional limitation. Costs were estimated from the perspective of the UK National Health Service (NHS), societal (patient and family) perspective, and secondary care resource use in terms of the intervention and staff time. Effects were assessed in terms of health gain expressed as quality-adjusted life years (QALYs). Results: At baseline, 20 participants received a CMFO and 21 participants received an SI. After 16 weeks foot pain improved in both the CMFOs (p = 0.000) and the SIs (p < 0.01). However, disability scores improved for CMFOs (p < 0.001) but not for SIs (p = 0.40). The cost-effectiveness results demonstrated no difference in cost between the arms (CMFOs: £159.10; SIs: £79.10; p = 0.35), with the CMFOs being less effective in terms of cost per QALY gain (p < 0.001). Conclusions: In people with established RA, semi-rigid customized foot orthoses can improve pain and disability scores in comparison to simple insoles. From a cost-effectiveness perspective, the customized foot orthoses were far more expensive to manufacture, with no significant cost per QALY gain

Long-term prognosis of breast cancer detected by mammography screening or other methods

Introduction Previous studies on breast cancer have shown that patients whose tumors are detected by mammography screening have a more favorable survival. However, little is known about the long-term prognostic impact of screen-detection. The purpose of the current study was to compare breast cancer-specific long-term survival between patients whose tumors were detected in mammography screening and those detected by other methods. Methods Breast cancer patients diagnosed within five specified geographical areas in Finland in 1991-92 were identified (n=2,936). Detailed clinical, treatment and outcome data as well as tissue samples were collected. Women with in situ carcinoma, distant metastases at the primary diagnosis and women who were not operated were excluded. Main analyses were made with exclusions of patients with other malignancy or contralateral breast cancer followed by to sensitivity analyses with different exclusion criterias. Median follow-up time was 15.4 years. Univariate and multivariate analysis of breast cancer-specific survival were performed. Results Of patients included in the main analyses (n=1,884) 22% (n=408) were screen-detected and 78% (n=1,476) were detected by other methods. Breast cancer-specific 15-year survival was 86% for patients with screen-detected cancer and 66% for patients diagnosed by other methods (p<0.0001, HR=2.91). Similar differences in survival were also observed in women at screening age (50-69 years) as well as in clinically important subgroups, such as patients with small tumors ([less than or equal to]1cm in diameter) and without nodal involvement (N0). Women with breast cancer diagnosed by screening mammography had a more favorable prognosis compared to those diagnosed outside of screening program following adjustments according to patient age, tumor size, axillary lymph node status, histological grade and hormone receptor status. Significant differences in the risk of having future contralateral breast cancer according to method of detection was not observed . Conclusions Breast cancer detection in mammography screening is an independent prognostic factor in breast cancer and is associated with a more favorable survival also in long-term follow-up.BioMed Central open acces

Physical activity, physical fitness and self-rated health: cross-sectional and longitudinal associations in adolescents.

This is the final version. Available from BMJ Publishing via the DOI in this record. Data availability statement: Data are available on reasonable request. The data are available from THT on reasonable request.OBJECTIVES: To evaluate the independent associations of physical activity and physical fitness with self-rated health in adolescents. METHODS: Data from a 2-year observational study (2013-2015) were used (n=256, 58% girls, 13.7±0.3 years at baseline). Self-rated health was assessed with a questionnaire, physical activity by an accelerometer and a questionnaire, and physical fitness via the measurements included in the Finnish national Move! monitoring system for physical functional capacity and their z-score average (fitness index). RESULTS: Self-reported physical activity had cross-sectional associations with self-rated health (girls β 0.213, p=0.006, β 0.221 boys p=0.021) while accelerometer-based moderate-to-vigorous physical activity did not. Higher self-reported physical activity at baseline was associated with higher self-rated health at follow-up in boys (β 0.289, p<0.001), but not in girls (β -0.056, p=0.430). Accelerometer-based moderate-to-vigorous physical activity had positive longitudinal associations with future self-rated health in boys, but some of these similar associations were negative in girls. Fitness index had a positive cross-sectional association with self-rated health in boys (β 0.282 or β 0.283, p=0.002), but not in girls (β 0.162 or β 0.161, p=0.051). Physical fitness was not longitudinally associated with self-rated health. CONCLUSIONS: Self-reported physical activity showed potential to explain current and future self-rated health better than accelerometer-based physical activity or physical fitness. We recommended to consider self-reported physical activity as an adequate metric of adolescent health in the population-level surveillance systems.Finnish Ministry of Education and CultureJuho Vainio Foundatio

Reply: An inverse association between tumour size and overdiagnosis may explain the results by Bucchi et al

..

Benefit of pazopanib in advanced gastrointestinal stromal tumours : results from a phase II trial (SSG XXI, PAGIST)

Background: Patients with advanced gastrointestinal stromal tumours (GISTs) resistant to the tyrosine kinase inhibitors imatinib and sunitinib may be treated with regorafenib, which resulted in a median progression-free survival (PFS) of 4.8 months in the GRID trial. Also, pazopanib, another tyrosine kinase inhibitor, has been studied in a randomized, placebo-controlled trial (PAZOGIST) in the third line, which showed a PFS of 45.2% 4 months after study entry, but patients intolerant to sunitinib were also included. We designed another trial evaluating pazopanib, enrolling only patients with progression on both imatinib and sunitinib. Patients and methods: Since all eligible patients had progressive disease, we preferred a non-randomized, phase II multicentre trial so that all patients could receive a potentially active drug. Patients had a progressive metastatic or locally advanced GIST and were >= 18 years of age, with a performance status of 0-2, and sufficient organ functions. The primary endpoint was disease control rate (defined as complete remission thorn partial remission thorn stable disease) at 12 weeks on pazopanib. A Simon's two-stage analysis was used with an interim analysis 12 weeks after enrollment of the first 22 patients, and if passed, there was a full enrolment of 72 patients. GIST mutational analysis was done, and most patients had pazopanib plasma concentration measured after 12 weeks. Results: Seventy-two patients were enrolled. The disease control rate after 12 weeks was 44%, and the median PFS was 19.6 weeks (95% confidence interval 12.6-23.4 weeks). Pazopanib-related toxicity was moderate and manageable. No statistically significant differences were found related to mutations. Plasma concentrations of pazopanib had a formal but weak correlation with outcome. Conclusion: Pazopanib given in the third line to patients with GIST progressing on both imatinib and sunitinib was beneficial for about half of the patients. The PAGIST trial confirms the results from the PAZOGIST trial, and the median PFS achieved seems comparable to the PFS achieved with regorafenib in the third-line setting.Peer reviewe

Markers for the identification of late breast cancer recurrence

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited