PURPOSE: The COVID-19 pandemic forced rapid adoption of telemedicine (TM) for breast oncology visits in the United States, but the appropriate role of postpandemic TM is uncertain. We sought to understand physician and advance practice practitioner perspectives on the use of TM for outpatient breast cancer care through an electronically administered survey. METHODS: Breast medical oncology clinicians at two academic cancer centers and five satellite locations affiliated with the Dana Farber Cancer Institute and the Massachusetts General Cancer Center were invited to respond to a 21-question survey administered in September 2021 about clinicians' perceptions and attitudes toward TM during the previous 12 months. RESULTS: Of the 71 survey invitations, 51 clinicians (36 physicians and 15 advance practice practitioners) provided survey responses (response rate = 72%). Ninety-two percent of respondents (n = 47) agreed that TM visits enhance patient care. Ninety-two percent of respondents (n = 46) also agreed that TM is valuable for early-stage breast cancer follow-up visits. Most respondents felt that there was no difference between TM and face-to-face (F2F) visits when it came to patient adherence, ease of ordering tests, ease of accessing patient records, and workflow outside of the visit (82%, 82%, 78%, and 53%, respectively). Fifty-one percent of respondents (n = 26) said that TM was better for timely access to follow-up appointments. Most respondents said that F2F visits were better for seeing physical problems, personal connection with patients, overall quality of visits, and patient-physician communication (100%, 75%, 65%, and 63%, respectively). CONCLUSION: Breast clinicians believe that TM is a valuable tool to enhance outpatient breast cancer care. TM was felt to be appropriate for routine follow-up visits and second opinion consultations and is as good as or better than F2F visits for several routine aspects of breast cancer care.
ImportanceThe BCG vaccine—used worldwide to prevent tuberculosis—confers multiple nonspecific beneficial effects, and intravesical BCG vaccine is currently the recommended treatment for non–muscle-invasive bladder cancer (NMIBC). Moreover, BCG vaccine has been hypothesized to reduce the risk of Alzheimer disease and related dementias (ADRD), but previous studies have been limited by sample size, study design, or analyses.ObjectiveTo evaluate whether intravesical BCG vaccine exposure is associated with a decreased incidence of ADRD in a cohort of patients with NMIBC while accounting for death as a competing event.Design, Setting, and ParticipantsThis cohort study was performed in patients aged 50 years or older initially diagnosed with NMIBC between May 28, 1987, and May 6, 2021, treated within the Mass General Brigham health care system. The study included a 15-year follow-up of individuals (BCG vaccine treated or controls) whose condition did not clinically progress to muscle-invasive cancer within 8 weeks and did not have an ADRD diagnosis within the first year after the NMIBC diagnosis. Data analysis was conducted from April 18, 2021, to March 28, 2023.Main Outcomes and MeasuresThe main outcome was time to ADRD onset identified using diagnosis codes and medications. Cause-specific hazard ratios (HRs) were estimated using Cox proportional hazards regression after adjusting for confounders (age, sex, and Charlson Comorbidity Index) using inverse probability scores weighting.ResultsIn this cohort study including 6467 individuals initially diagnosed with NMIBC between 1987 and 2021, 3388 patients underwent BCG vaccine treatment (mean [SD] age, 69.89 [9.28] years; 2605 [76.9%] men) and 3079 served as controls (mean [SD] age, 70.73 [10.00] years; 2176 [70.7%] men). Treatment with BCG vaccine was associated with a lower rate of ADRD (HR, 0.80; 95% CI, 0.69-0.99), with an even lower rate of ADRD in patients aged 70 years or older at the time of BCG vaccine treatment (HR, 0.74; 95% CI, 0.60-0.91). In competing risks analysis, BCG vaccine was associated with a lower risk of ADRD (5-year risk difference, −0.011; 95% CI, −0.019 to −0.003) and a decreased risk of death in patients without an earlier diagnosis of ADRD (5-year risk difference, −0.056; 95% CI, −0.075 to −0.037).Conclusions and RelevanceIn this study, BCG vaccine was associated with a significantly lower rate and risk of ADRD in a cohort of patients with bladder cancer when accounting for death as a competing event. However, the risk differences varied with time.
BackgroundRetraining the immune system offers a potential means of preventing or treating Alzheimer’s disease (AD). Vaccines can confer non‐specific beneficial effects (NSBEs), impacting diseases far afield from the original target. The Bacillus Calmette‐Guérin (BCG) vaccine, used worldwide in the prevention of tuberculosis, causes NSBE on non‐TB respiratory infections, type 1 diabetes, and multiple sclerosis. BCG is the gold‐standard therapy for non–muscle‐invasive bladder cancer. Recently, several retrospective studies have associated intravesicular BCG treatment of bladder cancer with lowered risk of AD (Gofrit et al., 2019, Klinger et al., 2021, Kim et al., 2021). We sought to replicate the retrospective study in a large cohort of patients in the Massachusetts General Brigham (MGB) System.MethodWe retrieved 30y of electronic health records from MGB, consisting of 17,920 subjects with new bladder cancer diagnoses. We limited records to patients aged >50y, without a previous dementia diagnosis, and with at least one year MGB follow‐up after diagnosis. Using natural language processing (NLP), we identified and assigned pathological stages to each patient’s first transurethral resection of bladder tumor (TURBT) surgical pathology report. The study population consisted of non‐muscle‐invasive bladder cancer (NMIBC) patients (n = 6467). The intervention group was patients who had any exposure to intravesical BCG, determined by semiautomated methods using NLP and manual validation. The control group was NMIBC patients without exposure to intravesical BCG.ResultWe found a protective effect of BCG on the risk of dementia. Cox analysis of time to AD: HR 0.84, CI (0.7‐0.99), p = 0.049, age and sex‐adjusted. In a stratified analysis by age, the effect of BCG treatment on patients 70 or older was more pronounced (HR 0.77, CI 0.63‐0.95, p = 0.017), whereas there was no effect on patients younger than 70 (HR 0.98, CI 0.72 ‐ 1.36, p = 0.98).ConclusionFindings from our large retrospective study suggest an overall protective effect of BCG treatment on the subsequent incidence of Alzheimer’s Disease, with the effect largely drawing from patients 70yo or older. Further survival and competing risk analyses will be provided to contextualize the basis for these apparently beneficial effects of BCG.
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