IMPORTANCE Surgeon sex is associated with differential postoperative outcomes, though the mechanism remains unclear. Sex concordance of surgeons and patients may represent a potential mechanism, given prior associations with physician-patient relationships.OBJECTIVE To examine the association between surgeon-patient sex discordance and postoperative outcomes. DESIGN, SETTING, AND PARTICIPANTSIn this population-based, retrospective cohort study, adult patients 18 years and older undergoing one of 21 common elective or emergent surgical procedures in Ontario, Canada, from 2007 to 2019 were analyzed. Data were analyzed from November 2020 to March 2021.EXPOSURES Surgeon-patient sex concordance (male surgeon with male patient, female surgeon with female patient) or discordance (male surgeon with female patient, female surgeon with male patient), operationalized as a binary (discordant vs concordant) and 4-level categorical variable. MAIN OUTCOMES AND MEASURESAdverse postoperative outcome, defined as death, readmission, or complication within 30-day following surgery. Secondary outcomes assessed each of these metrics individually. Generalized estimating equations with clustering at the level of the surgical procedure were used to account for differences between procedures, and subgroup analyses were performed according to procedure, patient, surgeon, and hospital characteristics.RESULTS Among 1 320 108 patients treated by 2937 surgeons, 602 560 patients were sex concordant with their surgeon (male surgeon with male patient, 509 634; female surgeon with female patient, 92 926) while 717 548 were sex discordant (male surgeon with female patient, 667 279; female surgeon with male patient, 50 269). A total of 189 390 patients (14.9%) experienced 1 or more adverse postoperative outcomes. Sex discordance between surgeon and patient was associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio [aOR], 1.07; 95% CI, 1.04-1.09), as well as death (aOR, 1.07; 95% CI, 1.02-1.13), and complications (aOR, 1.09; 95% CI, 1.07-1.11) but not readmission (aOR, 1.02; 95% CI, 0.98-1.07). While associations were consistent across most subgroups, patient sex significantly modified this association, with worse outcomes for female patients treated by male surgeons (compared with female patients treated by female surgeons: aOR, 1.15; 95% CI, 1.10-1.20) but not male patients treated by female surgeons (compared with male patients treated by male surgeons: aOR, 0.99; 95% CI, 0.95-1.03) (P for interaction = .004). CONCLUSIONS AND RELEVANCEIn this study, sex discordance between surgeons and patients negatively affected outcomes following common procedures. Subgroup analyses demonstrate that this is driven by worse outcomes among female patients treated by male surgeons. Further work should seek to understand the underlying mechanism.

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Background: Immunotherapy agents are an innovative oncological treatment modality and as a result their use has expanded widely. Understanding the treatment-related adverse events (AEs) of these drugs compared with traditional chemotherapy is crucial for clinical practice. Design: A systematic review of studies indexed in Medline (PubMed), Embase, Web of Science, and the Cochrane Databases from January 2000 to 14 February 2019 was conducted. Randomized clinical trials comparing immunotherapy [cytotoxic T-lymphocyte protein-4 (CTLA-4), programmed cell death protein 1 (PD-1), or programmed death-ligand 1 (PD-L1)] with standard-of-care chemotherapy in the treatment of advanced solidorgan neoplasms were included if AEs were reported as an outcome. Primary outcome was AEs ! grade 3 in severity. Secondary outcomes were proportion of overall AEs, treatment discontinuation due to AEs, deaths due to AEs, and specific AEs [fatigue, diarrhea, acute kidney injury (AKI), colitis, pneumonitis, and hypothyroidism]. PauleeMandel pooling and a random effects model were used to produce odds ratios (ORs) for measures of effects. Results: Among 10 598 abstracts screened, we included 22 studies involving 12 727 patients. In the immunotherapy group, 16.5% of patients developed an AE ! grade 3 in severity, compared with 41.09% in the chemotherapy arm [OR ¼ 0.26, 95% confidence interval (CI) 0.19e0.35, I 2 ¼ 92%]. Patients receiving immunotherapy also had lower odds of developing an AE overall (OR ¼ 0.35, 95% CI 0.28e0.44; I 2 ¼ 77%), terminating therapy due to an AE (OR ¼ 0.55, 95% CI 0.39e0.78, I 2 ¼ 80%), or dying from a treatment-related AE (OR ¼ 0.67, 95% CI 0.46e0.98, I 2 ¼ 0%). When treated with chemotherapy versus immunotherapy, patients more frequently experienced fatigue (25.10% versus 15.83%), diarrhea (14.97% versus 11.13%), and AKI (1.79% versus 1.31%). However, colitis (1.02% versus 0.26%), pneumonitis (3.36% versus 0.36%), and hypothyroidism (6.82% versus 0.37%) were more common in those treated with immunotherapy. Conclusions: Treatment of advanced solid-organ malignancies with immunotherapy compared with traditional chemotherapy is associated with a lower risk of AEs.

ABSTRACT"Radiation recall"-also called "radiation recall dermatitis"-has been defined as the "recalling" by skin of previous radiation exposure in response to the administration of certain response-inducing drugs. Although the phenomenon is relatively well known in the medical world, an exact cause has not been documented. Here, we report a rare occurrence of the radiation recall phenomenon in a breast cancer patient after palliative radiotherapy for bone, brain, and orbital metastases. KEY WORDSRadiation recall dermatitis, breast cancer, orbital metastases HISTORYA 55-year-old woman was diagnosed with breast adenocarcinoma in August 2006. In late September, she complained of back pain and slight numbness. A bone scan revealed a mild increase in activity in the thoracic spine and the proximal fourth and anterior sixth ribs. Magnetic resonance imaging (MRI) of the spine confirmed metastatic involvement in the tenth thoracic vertebra. The patient received radiotherapy with 20 Gy in 5 fractions in October 2006. She tolerated the treatment very well with complete pain relief.The woman returned to her medical oncologist for systemic therapy. A combination of paclitaxel (175 mg/m 2 ) and gemcitabine (1000 mg/m 2 ) was commenced in November 2006. After receiving a single dose, the patient complained of double vision. A computed tomography examination confirmed left orbital metastases (Figure 1) and multiple intraparenchymal brain metastases in the left frontal lobe and left cerebellum. The woman was treated with wholebrain radiotherapy (WBRT), including the left orbit, which received a dose of 20 Gy in 5 fractions. The initial chemotherapy treatment took place 13 days C A S E R E P O R T Ten days after completion of the WBRT, the patient received her second dose of paclitaxel and gemcitabine. Within 2 days, the patient detected discoloured and inflamed skin limited to the region that had previously been irradiated. She also experienced swelling in the left ear, muffled hearing, and discomfort in the eyes as a result of the reaction. Surprisingly, increased pigmentation also occurred in the area of the thoracic bone metastases treated with palliative radiotherapy approximately 7 weeks earlier.Silver sulphadiazine cream and hydrocortisone eardrops were prescribed to treat external symptoms. All chemotherapy was put on hold.Approximately 4 weeks after development of the skin reaction, the patient developed new cervical nodes compatible with clinical progression of her breast cancer. Once the external skin reaction had improved significantly, with only mild discolouration remaining, chemotherapy was resumed. At this time, nearly 6 weeks had passed since the appearance of the radiation recall dermatitis (RRD). A chemotherapy regimen of cyclophosphamide (600 mg/m 2 ), epirubicin (100 mg/m 2 ), and 5-fluorouracil (600 mg/m 2 ) replaced the paclitaxel and gemcitabine. Dexamethasone (Decadron: Merck, Whitehouse Station, NJ, U.S.A) was administered at 20 mg before the first chemotherapy treatment and at 10 mg before each subsequ...

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Symptom clustering has proved to be therapeutically important because treatment of one symptom may affect others within the same cluster. The significant correlations between worst pain and the functional interference items reaffirm the importance of pain reduction as a treatment goal for palliative radiotherapy. By treating a patient's symptom of worst pain, it would subsequently ease their response burden on their daily functional activities by decreasing symptom severity, increasing function, and improving overall quality of life.