Although considered a disease of the elderly, a subset of patients with mesothelioma are young (<40 years). The goal of this study was to understand their characteristics and outcomes. The Surveillance, Epidemiology, and End Results (SEER) database was used to extract mesothelioma cases (1990-2010). We modeled Kaplan-Meyer survival curves stratified by site of disease, and age of presentation. 2% (207 of 12345) of mesothelioma patients are young. Sex distribution is comparable among the young (51% males, 49% females); males predominated (78%, 22%) in the older cohort. Frequency of pleural and peritoneal mesothelioma are similar in the young (47%, 48% respectively); pleural disease predominated in the old (90%, 9%). Cancer-directed surgeries are more frequent in the young. Regardless of histologic subtype, young patients with pleural (11 vs. 8 months) and peritoneal (not reached vs. 10 months) mesothelioma had significantly improved overall survival. In multivariate analysis, younger age was an independent prognostic factor. Although rare, mesothelioma do occur in the young; their characteristics are distinct from those of older patients. Further studies are needed to understand the interplay between genetic susceptibility and mineral fiber carcinogenesis in the pathogenesis of mesothelioma in the young.
44 Background: Recent research shows tele-health and remote access technology enhances patient-provider communication. Among oncology patients, studies demonstrate that electronic access promotes improved treatment adherence and symptom management and provides better continuity of care and patient satisfaction. In a previous audit, we found only 26% of our oncology patients had activated our EHR (EPIC) online patient portal. MyChart facilitates communication by allowing patients to see results and email providers through a secure network. We undertook this study to discover patient opinions about MyChart and barriers to wider adoption. Methods: A short, self-administered questionnaire was distributed to a convenience sample of patients in waiting areas or the infusion center of the outpatient oncology clinic. Results: 76/108 patients knew of MyChart; 32 did not. 54/76 (71.1%) of patients who knew of MyChart had used it. 81.5% of 54 users were very or somewhat satisfied with it. Users rated features of MyChart on a 5 point scale: certain their confidentiality is protected 4.7,ability to track tests 4.4,receiving faster answers 3.0,and ease of contacting providers 2.8. 21 non-users gave several reasons for not using MyChart: preference to speak with a live person 38.1%, discomfort with the internet 23.8%, not having internet 19.0%, concern about personal information on the internet 14.3%, and too complicated 9.5%. Among 32patients not previously aware of MyChart, 43.7% said they would definitely or probably start using it.56.3% thought MyChart would make it easier to contact providers and 53.1%cited convenience over telephone.However, 28.1%,preferred speaking to a live person; 12.5% were uncomfortable with the internet, and 9.4% expressed concern with their information on the internet. Conclusions: In this sample, 50% of respondents used MyChart. Patients using MyChart were generally satisfied, specifically with confidentiality and ability to monitor their care. Barriers to increased use included a desire to speak directly to providers and lack of internet skill or access. While those using MyChart were confident that it was secure and confidential, those not using expressed concern about this issue.
e15716 Abstract Background: Pancreatic adenocarcinoma (PAC) is the fourth leading cause of cancer-related deaths in the United States. Although the vast majority of cases are sporadic, up to 10% of cases are related to a hereditary cancer predisposition syndrome, the most common of which is germline BRCA mutation. Although BRCA2 mutation has been well described in the literature, data on BRCA1 mutation-associated PAC is limited. This work aims at reviewing the literature on BRCA1 mutation-associated PAC and discussing the relevant findings. Methods: We have searched the Pubmed database for articles using the search terms “pancreatic”, “BRCA”, BRCA1”, “adenocarcinoma” or any combination of these keywords. Data about epidemiology, staging, prior history of other tumors, and management were collected. Systematic data extraction and assessments of quality were carried out by two reviewers, and good agreement was found. Results: A total of 13 studies were selected for review and included a total of 149 patients. The prevalence rate of PAC among patients with germline BRCA1 mutations ranged between 0.002% and 0.03%. Moreover, the prevalence of BRCA1 mutations in patients with BRCA-related PAC was found to be between 27% and 30%. Of note, PAC was diagnosed as the first tumor in 74% of patients with BRCA1-related PAC. The most common stage at diagnosis was stage 4 (56%) followed by stage 2 (22%). Conclusions: Germline BRCA1 mutation-associated PAC is an under-recognized entity when compared to BRCA2 mutations. Given the incredibly poor prognosis and the growing interest in targeted therapies, physicians need to be familiar with BRCA1 mutations as a possible etiology of PAC. A significant number of patients with BRCA1 mutation-associated PAC were diagnosed with PAC as the first tumor. Therefore, upper gastrointestinal screening should be considered in patients with germline BRCA1 mutations.
Background: Chronic pancreatitis is a complex disease associated with recurrent hospitalizations and interventions. A lack of standardized management algorithms and lack of access to the necessary highly specialized physicians has led to highly variable care for these patients. The purpose of this study was to evaluate the trends in management of patients with chronic pancreatitis in the United States. Methods: A retrospective analysis of the Nationwide Inpatient Sample (HCUP-NIS) from 2007 to 2016 was performed. Patients 18 years of age and older who were admitted under primary diagnosis of chronic pancreatitis were included for analysis. Patient demographic factors, interventions (surgical, endoscopic, percutaneous), length of stay, discharge disposition, and mortality over the study period were evaluated. Statistical analyses to evaluate significant trends in care were performed. Results: 32,563 patients (age 48.87AE13.9 years, 49.1% female) were analyzed. Alcoholic chronic pancreatitis was identified in 8793 patients (27%). Average overall length of stay was 5AE5.7 days. The majority of the patients were discharged home to self-care (72.0%), 1.6% were discharged to an inpatient rehab, 6.7% with home health care, and 3.2% were sent to skilled nursing facility. 114 (0.4%) of patients died during their hospitalization. 4904 patients (15.1%) underwent interventions, which increased during the study period from 13.3% in 2007 to 15.8% in 2016 (P < 0.001). Endoscopic interventions were performed in 2462 (7.6%) and percutaneous procedures in 440 (1.4%) patients, which were both stable during the study period. Surgery was performed on 2235 (6.9%) patients, which increased from 4.8% in 2007 to 8.2% in 2016 (P < 0.001). Pancreatic surgical procedures were the most common (2187 of 2235; 97.9%), of which resective procedures were most commonly performed (1589/2187; 72.7%). Pancreatic surgical procedures increased in frequency over the study period from 4.7% in 2007 to 7.6% in 2016 (P < 0.001), with resective procedures increasing from 3.3% to 6.1% (P < 0.001). Overall mortality was 0.9% in surgical group (P < 0.001), but 0.4% in patients with endoscopic interventions (P=0.893). Conclusion:There is an increasing rate of interventions being performed on chronic pancreatitis patients in the United States. Surgical procedures are becoming more frequently performed on chronic pancreatitis patients, with an increased frequency and predominance of resective procedures. These results suggest a surprisingly long length of stay and low rate of endoscopic interventions compared to surgical interventions. There is therefore a need for evidence-based consensus guidelines for the management of chronic pancreatitis, including centralization of care to centers with advanced endoscopic and surgical specialists.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.