Background
Bladder cancer affects life quality, overall health, and mortality negatively. The effect of bladder cancer on activities of daily living (ADLs) is not well established.
Objective
To examine the effect of bladder cancer diagnosis on ADLs, in addition to physical, mental, and overall health measures.
Design, setting, and participants
Using data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) registry, responses regarding ADLs and overall health were evaluated in bladder cancer patients over time. The Short Form 12 health survey responses were analyzed to determine the change in physical and mental health scores following bladder cancer diagnosis.
Outcome measurements and statistical analysis
Changes in self-reported ability to perform ADLs and health outcomes following bladder cancer diagnosis were evaluated. Chi-square statistics were used to determine whether the baseline and follow-up surveys were statistically independent for each ADL. Composites scores for physical health (PCS12) and mental health (MCS12) were compared with two-sample
t
test.
Results and limitations
A total of 498 patients with surveys before and after bladder cancer diagnosis were identified. An increased percentage of patients reported difficulty in all ADL tasks following bladder cancer diagnosis; this increase was statistically significant for bathing (
p
= 0.02) and using the toilet (
p
= 0.03). These patients also reported a significant decline in overall health status (
p
= 0.0002). A significant reduction in the mean PCS12 and mean MCS12 composite scores was observed (
p
< 0.0001 and
p
= 0.0003, respectively).
Conclusions
Patients with bladder cancer report a significant decline in functional status and overall health, including both physical and mental well-being after diagnosis. Further study is needed for factors that may be most predictive of the decline in functional independence for this population.
Patient summary
There is a decreased ability to perform daily activities following bladder cancer diagnosis, and patients report a decrease in their physical and mental health. This information can help patients and their caregivers anticipate patient needs following bladder cancer diagnosis, in addition to helping manage their expectations when making decisions regarding treatment options.
Objective: The purpose of this project was to study the incidence of ophthalmologic findings which are known to be risk factors for amblyopia in children who have coexisting metopic suture abnormalities and deformational plagiocephaly (DP) and brachycephaly (DB). Design: Institutional Review Board–approved retrospective study reviewing records of a consecutive cohort of children under 2 years of age with metopic suture abnormalities and cranial vault asymmetries seen in both the plastic surgery and ophthalmology clinics from 2007 to 2017. Setting: Institutional tertiary care center with all care in plastic surgery under the senior author and the standard of care accepted in pediatric ophthalmology under one of two ophthalmologists. Patients: After application of exclusion criteria, 76 children diagnosed with metopic suture abnormalities and DP/DB were included in the study. Patients with severe trigonocephaly, other suture involvement, syndromic diagnoses, and primary ocular disorders were excluded. Main Outcome Measures: Describe the incidences of refractive errors (astigmatism, hyperopia, and myopia), anisometropia, strabismus, and amblyopia within the study population. Results: In our patient population, the rates of amblyopia (17.1%) and strabismus (15.8%) are higher than the general pediatric population rates of 1.5% to 1.8% and 2.4% to 3.6%, respectively. Overall, 47.4% had significant refractive error: 28.9% with astigmatism, 15.8% with hyperopia, 5.3% with myopia, and 10.5% with anisometropia. Conclusions: In our patient population, children with coexisting metopic suture abnormalities and DP or DB had significant risk for amblyopia, strabismus, and refractive errors.
Embryo selection after PGT-A is typically limited to morphological grading. This study investigates the rate at which patients elect to obtain additional information from polygenic risk scoring for embryo selection.MATERIALS AND METHODS: Patients proceeding with PGT-A at a single IVF center were recruited for participation in an IRB approved study, beginning in 2021. Patients were informed on ''The Embryo Health Study'' limitations and capabilities by a licensed genetic counselor. PGT-A was provided at standard cost to the patient, while PGT for polygenic disease risk (PGT-P) was reported in euploid embryos at no additional cost. PGT-P studies include an Embryo Health Score, which is calculated by combining polygenic scores of different disease predictors to compare overall disease risk between embryos. Diseases available for analysis included type 1 diabetes, type 2 diabetes, coronary artery disease, heart attack, hypercholesterolemia, hypertension, breast cancer, testicular cancer, prostate cancer, basal cell carcinoma, malignant melanoma, and schizophrenia. Parental DNA was collected using saliva swabs to complete the PGT-P studies, using the same biopsy sample collected for PGT-A studies. The percentage of patients consenting to participate, whether they preferred simultaneous results (PGT-A + PGT-P) or sequential results (PGT-A first, then PGT-P by request), conditions selected for analysis, and the outcomes of genetic testing were documented.RESULTS: At the time of writing this abstract, 47 patients were counseled for potential participation. Twenty-five (53.2%) elected to obtain polygenic risk scores. Of the 25 patients, 19 (76%) preferred simultaneous reporting and 6 (24%) opted for sequential reporting. All participating patients (25/ 25) elected to report the maximum number of available conditions. The average number of embryos tested per patient was 4, with an average of 2 (56%) determined to be euploid by PGT-A (mean maternal age 37 AE 4.1). No significant difference in mean maternal age between participating and non-participating patients (37.1 vs. 38.4 years p¼0.42) was identified.CONCLUSIONS: These results indicate that a high percentage of patients have an interest in obtaining additional information on polygenic disease risk to aid in the embryo selection process. Most patients elected to obtain PGT-P results at the same time as PGT-A and all elected the maximum number of available conditions. No significant age difference between patients who elected and declined screening was identified, indicating that expected number of euploid embryos may not significantly influence patient decision-making.IMPACT STATEMENT: These data represent the first experience with informing patients of the option to incorporate PGT for polygenic disease risk into their IVF plan. When presented with the option, over half of patients utilizing PGT elect to obtain embryonic polygenic risk scores. Efforts to reduce barriers to access (costs and limited awareness) are warranted and underway.
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