Individuals with schizophrenia are a vulnerable population that has been relatively neglected in health disparities research. Despite having an equivalent risk of developing most cancers, patients with schizophrenia are more likely to die of cancer than the general population. Cancer care disparities are likely the result of patient-, provider-, and systems-level factors and influenced by the pervasive stigma of mental illness. Individuals with schizophrenia have higher rates of health behaviors linked with cancer mortality including cigarette smoking. They also have significant medical comorbidity, are less likely to have up-to-date cancer screening, and may present at more advanced stages of illness. Patients with schizophrenia may be less likely to receive chemotherapy or radiotherapy, have more postoperative complications, and have less access to palliative care. However, opportunities exist for the interdisciplinary team, including medical, surgical, and radiation oncologists; psychiatrists; and primary care physicians, to intervene throughout the continuum of cancer care to promote survival and quality of life. This review summarizes data on overall and cancer-specific mortality for individuals with schizophrenia and reviews specific disparities across the cancer care continuum of screening, diagnosis, treatment, and end-of-life care. Using a case, the authors illustrate clinical challenges for this population including communication, informed consent, and risk of suicide, and provide suggestions for care. Finally, recommendations for research to address the disparities in cancer care for individuals with schizophrenia are discussed. Despite significant challenges, with collaboration between oncology and mental health teams, individuals with schizophrenia can receive high-quality cancer care. Cancer 2014;120:323-34.
The first aim of this investigation was to assemble a group of photographs of 30 male and 30 female faces representing a standardized spectrum of facial attractiveness, against which orthognathic treatment outcomes could be compared. The second aim was to investigate the influence of the relationship between ANB differences and anterior lower face height (ALFH) percentages on facial attractiveness. The initial sample comprised standardized photographs of 41 female and 35 male Caucasian subjects. From these, the photographs of two groups of 30 male and 30 female subjects were compiled. A panel of six clinicians and six non-clinicians ranked the photographs. The results showed there to be a good level of reliability for each assessor when ranking the photographs on two occasions, particularly for the clinicians (female subjects r = 0.76-0.97, male subjects r = 0.72-0.94). Agreement among individuals within each group was also high, particularly when ranking facial attractiveness in male subjects (female subjects r = 0.57-0.84, male subjects r = 0.91-0.94). Antero-posterior (AP) discrepancies, as measured by soft tissue ANB, showed minimal correlation with facial attractiveness. However, a trend emerged that would suggest that in faces where the ANB varies widely from 5 degrees, the face is considered less attractive. The ALFH percentage also showed minimal correlation with facial attractiveness. However, there was a trend that suggested that greater ALFH percentages are considered less attractive in female faces, while in males the opposite trend was seen. Either of the two series of ranked photographs as judged by clinicians and non-clinicians could be used as a standard against which facial attractiveness could be assessed, as both were in total agreement about the most attractive faces. However, to judge the outcome of orthognathic treatment, the series of ranked photographs produced by the non-clinician group should be used as the 'standard' to reflect lay opinion.
Summary Delayed lymphocyte and T‐cell immune reconstitution following bendamustine‐rituximab (BR) for indolent non‐Hodgkin lymphoma (iNHL) has been described, but no information is available for chronic lymphocytic leukaemia (CLL). We present a population‐based retrospective analysis of immune reconstitution and risk of infection following BR. Outcomes included timing/correlates of CD4+ recovery and risk of ≥grade 3 infections. Consecutively treated patients (1 April 2014 to 31 January 2017) were included (n = 295),with a median age of 65 years (range 33–92); 57% were 1st line treatments. Median cumulative bendamustine dose was 1080 mg/m2 (range 140–1440 mg/m2). CD4/CD8/CD19/NK subsets were available for 148 patients. Median follow‐up was 24 months. Median times to lymphocyte count (ALC) recovery (≥1 × 109/l) and CD4+ recovery (≥0·2 × 109/l) were 26 and 24 months, respectively. Bendamustine total dose >1080 mg/m2 (hazard ratio [HR] 0·4; 95% confidence interval [CI]: 0·2–0·8), end‐of‐treatment ALC ≤0·4 × 109/l (HR 0·53; 95% CI: 0·3–0·9) and CD4+ <0·1 × 109/l 1‐year post‐BR (HR 0·03; 95% CI: 0·008–0·15) were covariables for delayed CD4+ recovery. ALC‐recovery ≥1 × 109/l was an unreliable predictor of CD4+ recovery (negative predictive vale 74%, positive predictive value 86%, likelihood ratio 3·3). CD4+ lymphopenia >3 years was a significant risk factor for ≥grade 3 infections (Odds ratio 3·4; 95% CI: 1·4–6·9). CD4+ recovery after BR is unexpectedly delayed and late recovery is associated with risk of serious infections. Monitoring CD4+ following BR could identify patients at high risk of delayed infections.
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.