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Artificial Intelligence in Head and Neck Cancer: Towards Precision Medicine
No full textOver the past 20 years, the capabilities of artificial intelligence (AI) have gained significant interest. While AI has been implemented to various degrees in several disciplines, its unique applications in head and neck cancer (HNC) remain underdeveloped. This narrative review examines the existing body of literature regarding the use of AI in HNC. Studies to date have demonstrated AI’s utility across multiple phases of the HNC treatment continuum. Despite its promise, integrating AI into clinical practice faces several challenges, including concerns about system integrity, generalizability, privacy, and bias. In this review, we address these challenges and offer insights into future directions to help overcome them and advance AI’s integration into HNC care as a step toward personalized medicine. Additionally, we highlight the importance of multidisciplinary and multispecialty collaboration in cultivating a robust body of research that will support the optimization of AI in clinical practice
Disparities in Access to Care in the Multimodal Treatment of Primary Nonmetastatic Liver Cancers and Their Impact on Patient Outcomes
No full textBackground: Liver cancer incidence and mortality have been shown to differ by race, ethnicity, and geography. This study aims to analyze disparities in the multimodal treatment of liver cancers in Louisiana. Methods: Cases of nonmetastatic liver cancer in Louisiana from 2010 to 2020 were obtained from the Louisiana Tumor Registry. Generalized linear mixed models were used to model the receipt of therapy. Results: A total of 2948 patients met inclusion criteria where 30.5% received no therapy. Multivariable models identified patients with increased odds of pursuing no treatment which include those 70 and older, no domestic partner, uninsured, high poverty, and rural residence (p \u3c 0.05). Conclusions: Available therapeutic modalities are underutilized in Louisiana with a considerable number of patients receiving no treatment for liver cancer. Older age, no domestic partner, uninsured, rural residence, and high poverty are risk factors for not receiving treatment. Allocating resources to these patients is an important step in reversing inequities
Familial Mediterranean Fever (FMF): Emerging Concepts in Diagnosis, Pain Management, and Novel Treatment Options: A Narrative Review
No full textPURPOSE OF REVIEW: Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disorder predominantly affecting individuals of Mediterranean and Middle Eastern descent, including those with certain heritages including Sephardic Jewish, Armenian, Turkish, and Arab. The disorder affects up to 1 in 200 people making it a very common etiology for pain states worldwide, including serositis mediated painful states of the chest, joint, and abdomen. RECENT FINDINGS: Defined by recurrent episodes of fever and inflammation, FMF can lead to not only severe pain, but complications such as renal amyloidosis, if untreated. This narrative review explores the genetic basis, clinical manifestations, diagnostic criteria, and current management strategies for FMF. Mutations in the MEFV gene result in the dysregulation of the pyrin inflammasome, leading to excessive production of inflammatory cytokines. Diagnosis primarily relies on clinical criteria supported by genetic testing. Colchicine remains the cornerstone of treatment, effectively preventing inflammatory attacks and complications. For colchicine-resistant patients, IL-1 antagonists like anakinra and canakinumab show promise, although their long-term benefits require further investigation. The present investigation underscores the importance of early diagnosis and integrated treatment approaches to improve patient outcomes, pain management, and quality of life
Technology Enhanced Multidisciplinary Cancer Conferences in Gynecologic Oncology: Impact on Quality and Education
No full textMultidisciplinary cancer conferences (MCCs) improve patient outcomes. Our goals were to investigate the impact of a technology platform, navify® Clinical Hub for Tumor Boards (nCH) on the quality and educational value of gynecologic oncology MCCs. We conducted a prospective, mixed methods study of the gynecologic oncology MCC at a comprehensive cancer center from 2020 to 2023. Using a validated observational tool, we assessed the quality of case presentation and discussion (as measured by a mean composite score) before and after the introduction of nCH. We also evaluated compliance of care plans with national guidelines, changes in care plans, and concordance of treatment received with MCC recommendations. Surveys and interviews were used to evaluate the educational value of the MCCs. Analyses were conducted using SAS v9.4 (Cary, NC) and Dedoose v9.0.17, (Los Angeles, CA). Pre- and post-nCH cohorts consisted of 49 and 60 patients, respectively. When comparing both cohorts, there was a difference in the mean composite score (50.57 vs 54.11; p = 0.016). Care plans were changed by the MCC in approximately 12% of cases, and MCC recommendations were 93–96% concordant with treatment received, but no statistically significant differences were observed. Additionally, MCC recommendations were 100% compliant with guidelines. Interviews of MCC participants revealed that the post-nCH presentation was more concise and structured. Despite limited use of some nCH features, GYN fellows reported a high educational value of the MCC. nCH improved the quality of the gynecologic oncology MCC and the educational experience of trainees
The Anatomy of Gossip: Dissecting Dynamics and Impacts in Surgical Residency
No full textBackground: Gossip, defined by social scientists as “evaluative talk about an absent third party,” is anecdotally pervasive yet poorly understood in surgical residency programs. Gossip is known to have both positive and negative impacts. This study sought to deconstruct the role of gossip in surgical residency and evaluate its impact through the lens of surgical residents. Study Design: In this qualitative study, semistructured interviews were conducted with 36 general surgery residents from 9 surgical training programs across the United States. Interviews were conducted from July 2, 2023, to October 5, 2023, via Zoom videoconferencing. A thematic analysis using a grounded theory approach was conducted, and a process model was developed to represent study findings. Results: Seven themes were developed: (1) the definition of gossip is elusive yet can include both positive and negative connotations, (2) gossip contributes durably to one\u27s reputation within a program, (3) gossip can be used as a form of instruction, (4) gossip flourishes in environments without transparency and among those experiencing burnout, (5) gossiping across a hierarchy may force those lower on the hierarchy into uncomfortable situations, (6) remaining mindful of gossip\u27s potential impact can improve culture, and (7) gossip can build or destroy trust. Conclusion: Gossip is a complex social phenomenon with the potential to harm or help surgical residents. Rather than trying to eliminate gossip, programs should encourage the known positive impacts of gossip by increasing transparency, enhancing resident wellness, building awareness of existing hierarchies, and improving resident emotional intelligence
Event-driven PrEP beyond cisgender men who have sex with men
No full textDespite advancements in existing antiretroviral-based prevention strategies, including daily oral, locally acting, and injectable options, there is a pressing need for more inclusive and flexible event-driven pre-exposure prophylaxis (PrEP) strategies for all. Event-driven or intermittent dosing of PrEP in populations beyond cisgender men who have sex with men would offer a promising alternative by fitting prevention into the diverse lifestyles of affected populations and thereby advancing health equity. Evidence from PrEP clinical trials, pharmacokinetic studies, modelling studies, and real-world observational research suggests that event-driven PrEP could be a flexible and inclusive option, yet optimal dosing has not been established across sex and gender spectrums. To advance PrEP equity through inclusivity, studies on event-driven PrEP should include people across the gender spectrum. Real-world demonstration studies and simulation studies of optimal dosing strategies are needed. While awaiting further evidence, clinical providers can offer shared decision making and counselling on available data to include event-driven dosing as an option, especially when daily oral, locally acting, or injectable PrEP are not acceptable or preferred methods. Wider access to diverse PrEP options for all populations fosters a more inclusive and effective global HIV prevention strategy
Financial Distress Screening and Navigation in Pediatric Oncology Within the National Cancer Institute Community Oncology Research Program
No full textPURPOSE Cancer-related financial hardship is associated with poor quality of life, risk of household material hardship, and psychological distress for families affected by pediatric cancer. Current processes on financial distress screening and financial navigation across the pediatric National Cancer Institute Community Oncology Research Program (NCORP) network remain unknown. METHODS Financial distress screening and financial navigation services among NCORP practices were assessed using two survey items from the 2022 NCORP Landscape Assessment Survey. Practices answering yes to providing oncology care for pediatric patients were included. Univariable models were used to test associations between practice characteristics and financial screening and financial navigation. RESULTS Of the 53 NCORP practices serving pediatric patients with cancer that responded to the survey, 44 (83%) reported routinely conducting financial distress screening. Most of the practices reported that financial screening is completed by social workers (n 5 40/44, 91%). One third of practices reported financial screening using a survey completed by patients/caregivers (n 5 14/44, 32%). Almost all practices (n 5 51/53, 96%) reported responding to financial needs through a social worker. One third of the practices reported having a cancer-specific financial navigator (n 5 17/53, 32%) or a nondedicated (not cancer-specific) financial navigator (n 5 19/53, 36%). Practices that served a proportion of new patients with cancer at or above the national average of Hispanic individuals in the United States were as likely to screen for financial distress as practices below the national average (odds ratio, 2.42 [95% CI, 0.45 to 13.03]; P 5 .30). CONCLUSION Most pediatric NCORP practices report screening for financial distress. Fewer groups offer dedicated cancer-specific financial navigation, and practices vary. Further research is needed to explore the development and implementation of standardized financial distress measures and financial navigation interventions within pediatric cancer care