1,720,975 research outputs found
Prognostic indicators of survival
No full textThe three main components of medical intervention are diagnosis, therapy, and prognosis, of which, the last is often the least studied aspect in the scientific literature as it is a known fact that physicians do not feel comfortable with the issue of prognosis. Recent studies show that simultaneous palliative care or early palliative care is effective at any stage of cancer disease, leading to specific choices regarding therapeutic programs and appropriate care settings. However, in order to provide early integrated care, good prognostication and an active identification of patients with poor prognosis are needed for both oncological and nononcological patients. In all patients, prognostication and identification of palliative approach needs should be seen as one and part of a thorough evaluation process. With the increased survival rate in cancer patients and the many anticancer treatment options available, good prognostication has become necessary not only to help in the decision-making process, but also to limit the frequency of chemotherapy administration close to death. For patients with advanced stage of nonneoplastic disease, due to the variability of the disease trajectory, the access to palliative care services often happens late. As a result of population aging and the increased frequency of noncancer diseases in the elderly, in the past few years, interest has increased in the area of prognosis in noncancer patients too.
In this chapter, we focus on prognosis from a palliative care point of view and we will give a description of prognostic indicators and scores available for clinical and research purposes. We chose to refer to older papers through their evaluation in recent reviews and integrate such references with more up-to-date significant original studies
Cancer as a continuum: a literature review and a biological interpretation
No full textBasic research shows that the genetic control of development cannot fully explain the phenotypic plasticity of humans and other metazoans. This challenges some tenets of the conventional paradigm of life sciences based on DNA, restoring a role of the environment in biological processes like the regulation of development, cell differentiation and disease. The environment — in a broad sense — affects biological phenotypes throughout the entire lifespan and can induce cancer, its progression and recurrence as well as its reversal. This is very important in cancer epidemiology as it implies that environmental exposures can be considered both as risk (or protective) and prognostic factors. This review integrates information from epidemiologic and biological research. We studied the impact of hazardous and protective exposures, lifestyles, and diet on the survival of patients who had been diagnosed with cancer.We selected studies from two digital databases, using a few combinations of key terms, namely overall survival, cancer-specific survival, recurrence and quality of life (QoL). Survival and/or recurrence were expressed as hazard or risk ratios, as second cancer diagnosis and as indicators of QoL such as performance status. We found 53 articles indicating that risk and protective factors can also influence prognosis after cancer diagnosis. Cigarette smoking and, among protective factors, diet and physical activity are the exposures most frequently investigated after a diagnosis of cancer
Occupational exposures and colorectal cancers: A quantitative overview of epidemiological evidence.
No full textA traditional belief widespread across the biomedical
community was that dietary habits and genetic predisposition
were the basic factors causing colorectal
cancer. In more recent times, however, a growing evidence
has shown that other determinants can be very
important in increasing (or reducing) incidence of this
malignancy. The hypothesis that environmental and
occupational risk factors are associated with colorectal
cancer is gaining ground, and high risks of colorectal
cancer have been reported among workers in some
industrial branches. The aim of this study was to investigate
the epidemiologic relationship between colorectal
cancer and occupational exposures to several industrial
activities, by means of a scientific literature review and
meta-analysis. This work pointed out increased risks
of colorectal cancer for labourers occupied in industries
with a wide use of chemical compounds, such as
leather (RR = 1.70, 95%CI: 1.24-2.34), basic metals (RR
= 1.32, 95%CI: 1.07-1.65), plastic and rubber manufacturing
(RR = 1.30, 95%CI: 0.98-1.71 and RR = 1.27,
95%CI: 0.92-1.76, respectively), besides workers in the
sector of repair and installation of machinery exposed
to asbestos (RR = 1.40, 95%CI: 1.07-1.84). Based on
our results, the estimated crude excess risk fraction attributable
to occupational exposure ranged from about
11% to about 15%. However, homogeneous pattern
of association between colorectal cancer and industrial
branches did not emerge from this review
Impact of palliative care unit admission on symptom control evaluated by the Edmonton Symptom Assessment System
No full textThe aim of the present study was to evaluate the impact of palliative care on patients' symptoms, using the Edmonton Symptom Assessment System (ESAS) to measure symptom intensity at the time of admission and variations registered during the first 7 days' hospitalization. Three hundred fourteen patients were admitted to the unit during its first year of activity. Of these, 162 patients (51.6%) completed, 62 (19.7%) partially completed, and 90 (28.7%) did not complete the ESAS. The mean (±SD) value of the Symptom Distress Score (SDS) (sum of the values of the different symptoms) for the 162 evaluable patients on Day 1 was 33.93 (±16.24). On Day 7 the mean was 28.14 (±15.11) (ANOVA for repeated measurements, P < 0.0001). ESAS values for patients with moderate-severe symptom intensity (average values Day 1-Day 7 and P value, ANOVA for repeated measurements) were as follows: pain (7.12-4.23, P < 0.0001), fatigue (7.46-5.68, P < 0.0001), nausea (7.12-1.96, P < 0.0001), depression (7.26-5.28, P < 0.0001), anxiety (7.13-5.14, P < 0.0001), drowsiness (7.42-6.40, P = 0.002), anorexia (7.33-4.33, P < 0.0001), well-being (6.83-3.85, P < 0.0001), and dyspnea (7.08-3.86, P < 0.0001). These data seem to indicate that the patients who benefit most from inpatient palliative care are those with the most complex symptomatology. © 2005 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Occupational brain cancer risks in Umbria (Italy), with a particular focus on steel foundry workers.
No full textObjectives. As a part of the Occupational Cancer
Monitoring (OCCAM) project, a routine analysis based on
Umbria region cancer registry (RTUP) database in 2002-2008
was performed. Among other results, the incidental finding of
brain cancer increased risk in steel foundry workers in Terni
province (Italy), lead us to deepen the analysis, focusing
on this specific industrial sector.
Methods. A monitoring study, based on Umbria Regional
Cancer Registry data, was recently carried out. Brain cancer
cases and controls identified within this preliminary study were
selected. Therefore, we considered all incident cases (in Umbria
region 2002-2008) of brain cancer occurred among workers
occupied for at least one year in private companies since 1974
and controls randomly sampled from the same population.
Afterwards, taking in to account results from steel foundry in
Terni province, we further deepened our analysis, focusing on
this productive sector. Odds ratios (ORs) and corresponding 90%
confidence intervals (CIs) were calculated using multiple logistic
regression models, adjusted by age at diagnosis or sampling,
sex and province of residence, when appropriate.
Results. Statistical analyses were carried out on 14913 subjects,
56 cases and 14857 controls. Significantly increased ORs were
observed for garment, mechanical manufacturing and chemical
industries. Moreover, the risk estimates were strongly correlated
with exposures in iron and steel foundries and a cluster of 14
cases in the same foundry in Terni was observed (OR 9.59,
90%CI 2.76-33.34).
Conclusions. Results of this explorative study showed increased
ORs of brain cancer in some productive branches, involving
possible exposures to chemical compounds and/or solvents.
Moreover, our results pointed out a significantly increased
risk in Terni foundry workers, determining an interesting
brain cancer cluster (14 cases). Further studies on this
industrial sector are needed with improved definitions
of tasks and exposures
[Study of lung cancer risk in the electroplating industry in Lombardy based on the OCCAM method].
No full textLa metodologia OCCAM consiste nello studio dei rischi professionali di tumore per area e comparto produttivo con
un disegno di tipo caso-controllo, utilizzando le informazioni degli archivi correnti per l’identificazione dei casi e
dei controlli e per l’attribuzione delle esposizioni. OCCAM assegna come esposizione a ciascun soggetto il codice di comparto produttivo dove abbia lavorato per la maggiore quantità di tempo. La categoria dei “non esposti” è costituita
dai lavoratori del terziario. Il comparto produttivo, a sua volta, è determinato dal codice di attività economica
ATECO attribuito da INPS a ciascuna azienda ove abbia lavorato il soggetto. In questo lavoro le aziende di lavorazione
galvanica della Lombardia sono state ricercate mediante la descrizione in chiaro della attività produttiva,
anch’essa presente negli archivi INPS, nell’intento di ottenere una maggiore sensibilità e specificità rispetto al settore
“trattamento metalli” previsto dal codice ATECO pure fornito da INPS. Sono stati considerati i casi incidenti di
tumore del polmone nel periodo 2001-2008 residenti in Lombardia identificati mediante le schede di dimissione
ospedaliera. Con questa riclassificazione il rischio di tumore del polmone negli addetti alla lavorazione galvanica è
passato nei maschi da 1.32 (90% CI 1,06-1,64, 67 casi), relativo a “trattamento metalli” a 2.03 (90% CI 1,33-
3,10, 18 casi) nelle industrie galvaniche e nelle femmine da 1.33 (90% CI 0.51-3.59, 10 casi) a 3.00 (90% CI
1,38-9,03, 4 casi). Il miglioramento della classificazione ha prodotto una stima superiore del rischio, anche se basata
su di un numero inferiore di casi. Pur trattandosi di rischi dovuti ad esposizioni del passato, la storia di alcuni
casi e l’avere osservato casi recenti di perforazione del setto nasale in lavoratori delle galvaniche indicano che, almeno
in alcune aziende, ancora oggi vi possano essere situazioni di rischio
[Female breast cancer and occupational sectors: a preliminary study in the provinces of Lombardy, Italy].
No full textBackground. The role of occupational exposures in
breast cancer development is still uncertain. A recent paper
showed increased risks in some occupational sectors in
Lombardy, Italy. We deepened this analysis at the level of singleprovinces of the same Italian region.
Methods. Based on administrative data, a case-control study was
carried out recruiting all incident cases of female breast cancer in the period 2002-2009, aged between 35 and 69 years, residing in Lombardy, Italy. Controls were randomly sampled from all women residing in Lombardy as of December 31, 2005.
Occupational histories, including blue collar status, were
available from 1974 through record linkage with a social security
pension database, and were obtained for 11188 cases and 25329 controls. Adjusted odds ratios (ORs) and corresponding 90% confidence intervals (CIs) were calculated using multiple
unconditional logistic regression models. Analyses were
performed also by single provinces of Lombardy, Italy.
Multiple comparisons were accounted for according to the
Benjamini-Hochberg method.
Results. The ORs for female breast cancer were modestly
but significantly increased for employment in electrical
manufacturing (OR 1.12, 90% CI 1.04-1.21), textile (OR 1.08,
90% CI 1.02-1.15), paper (OR 1.25, 90% CI 1.06-1.46) and rubber
(OR 1.26, 90% CI 1.03-1.54) industries. Analysis by province
showed significantly increased ORs for electrical manufacturing
in the Milano province. After adjustment for multiple
comparisons no estimates remained statistically significant,
except OR for electrical manufacturing in the Milano province.
Conclusions. Although with several limitations, our results point
to a possible role of exposures in electrical manufacturing,
textile, paper and rubber industries in the process leading to
breast cancer. An in-dept study for the electrical manufacturing industry has been already planned in Milano province
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