Journal of the National Cancer Institute
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J. Natl. Cancer Inst. · Mar 2015
Palliative care and the aggressiveness of end-of-life care in patients with advanced pancreatic cancer.
We examined the impact of palliative care (PC) on aggressiveness of end-of-life care for patients with advanced pancreatic cancer. Measures of aggressive care included chemotherapy within 14 days of death; and at least one intensive care unit (ICU) admission, more than one emergency department (ED) visit, and more than one hospitalization, all within 30 days of death. ⋯ PC consultation and a higher intensity of PC were associated with less aggressive care near death in patients with advanced pancreatic cancer.
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J. Natl. Cancer Inst. · Mar 2015
Relationship between surgical oncologic outcomes and publically reported hospital quality and satisfaction measures.
Hospital-level measures of patient satisfaction and quality are now reported publically by the Centers for Medicare and Medicaid Services. There are limited metrics specific to cancer patients. We examined whether publically reported hospital satisfaction and quality data were associated with surgical oncologic outcomes. ⋯ Currently available measures of patient satisfaction and quality are poor predictors of outcomes for cancer patients undergoing surgery. Specific metrics for long-term oncologic outcomes and quality are needed.
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J. Natl. Cancer Inst. · Mar 2015
A statistical evaluation of dose expansion cohorts in phase I clinical trials.
Phase I trials often include a dose expansion cohort (DEC), in which additional patients are treated at the estimated maximum tolerated dose (MTD) after dose escalation, with the goal of ensuring that data are available from more than six patients at a single dose level. However, protocols do not always detail how, or even if, the additional toxicity data will be used to reanalyze the MTD or whether observed toxicity in the DEC will warrant changing the assigned dose. A DEC strategy has not been statistically justified. ⋯ Where feasible, a CRM design with no explicit DEC is preferred to designs that fix a dose for all patients in a DEC.
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J. Natl. Cancer Inst. · Feb 2015
Meta Analysis15q12 variants, sputum gene promoter hypermethylation, and lung cancer risk: a GWAS in smokers.
Lung cancer is the leading cause of cancer-related mortality worldwide. Detection of promoter hypermethylation of tumor suppressor genes in exfoliated cells from the lung provides an assessment of field cancerization that in turn predicts lung cancer. The identification of genetic determinants for this validated cancer biomarker should provide novel insights into mechanisms underlying epigenetic reprogramming during lung carcinogenesis. ⋯ A functional 15q12 variant was identified as a risk factor for gene methylation and lung cancer. The associations could be mediated by GABAergic signaling that drives the smoking-induced mucous cell metaplasia. Our findings also substantiate DSBR-HR as a critical pathway driving epigenetic gene silencing.
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J. Natl. Cancer Inst. · Feb 2015
Review Meta AnalysisAdult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies.
Adiposity, measured by body mass index, is implicated in carcinogenesis. While adult weight gain has diverse advantages over body mass index in measuring adiposity, systematic reviews on adult weight gain in relation to adiposity-related cancers are lacking. ⋯ Avoiding adult weight gain itself may confer protection against certain types of cancers, particularly among HRT nonusers.