Objective-To explore the perceptions of breast cancer patients with mobility impairments of the physical accessibility of health care equipment and facilities Research Approach-One-to two-hour individual interviews, audiotaped Setting-Interviews in homes or workplaces or by telephoneParticipants-20 women with chronic mobility impairments who developed early-stage breast cancer before age 60; 3 recruited from oncologist panels and 17 from informal networks of disabled women nationwide Methodologic Approach-Qualitative analyses of interview transcripts to identify common themesMain Research Variables-Extent and nature of mobility impairments; concerns raised by interviewees about barriers to careFindings-The 20 participants identified problems with inaccessible equipment, including mammography machines, examining tables, and weight scales. Sometimes women needed to insist on being transferred to an examining table when physicians preferred to examine them seated in their wheelchairs. When staff would transfer them, patients feared injury; patients felt badly when clinical personnel were injured during transfers. Other problems included difficulties with positioning and handling patients' uncontrollable movements. Even when clinical sites had accessible equipment, this equipment was sometimes unavailable when the woman arrived for her appointment.Conclusions-Women with major mobility problems who developed breast cancer confronted numerous physical barriers during the course of their breast cancer diagnosis and treatment.Interpretation-With the aging of "baby boomers," increasing numbers of persons seeking health care services will have mobility impairments. Health care providers should plan proactively to accommodate these patients by considering accessibility whenever they acquire new equipment, renovate older structures, or build new facilities. They should also establish policies and procedures to assure that accessible equipment is available during appointments of people who Most findings relating to mammography and breast cancer care disparities come from large population-based surveys or cancer registry data, without sufficient detail to identify specific causes (Chan et al., 1999;Chevarley et al., 2006;Iezzoni et al., 2000;Iezzoni et al., 2001;Iezzoni et al., 2008; McCarthy, Ngo, Roetzheim, Chirikos, Li, Drews, & Iezzoni, 2006a;Wei et al., 2006). To explore how physical access affects breast cancer diagnosis and treatment experiences, we conducted in-depth, individual interviews with 20 women with chronic mobility impairments who developed early stage breast cancer. Although this study focuses specifically on breast cancer, we identify issues that all clinicians and health care facilities should consider more generally to improve physical access for their patients. Methods Conceptual ModelAs our conceptual model, we used definitions from the International Classification of Functioning, Disability and Health ( Study ParticipantsWe recruited English-speaking women diagnosed with early stage breast ca...
PURPOSE In this multicenter phase II trial, we evaluated atezolizumab combined with bevacizumab in patients with advanced renal cell carcinoma (RCC) with variant histology or any RCC histology with ≥ 20% sarcomatoid differentiation. PATIENTS AND METHODS Eligible patients may have received previous systemic therapy, excluding prior bevacizumab or checkpoint inhibitors. Patients underwent a baseline biopsy and received atezolizumab 1,200 mg and bevacizumab 15 mg/kg intravenously every 3 weeks. The primary end point was overall response rate (ORR) by RECIST version 1.1. Additional end points were progression-free survival (PFS), toxicity, biomarkers of response as determined by programmed death-ligand 1 (PD-L1) status, and on-therapy quality-of-life (QOL) metrics using the Functional Assessment of Cancer Therapy Kidney Symptom Index-19 and the Brief Fatigue Inventory. RESULTS Sixty patients received at least 1 dose of either study agent; the majority (65%) were treatment naïve. The ORR for the overall population was 33% and 50% in patients with clear cell RCC with sarcomatoid differentiation and 26% in patients with variant histology RCC. Median PFS was 8.3 months (95% CI, 5.7 to 10.9 months). PD-L1 status was available for 36 patients; 15 (42%) had ≥ 1% expression on tumor cells. ORR in PD-L1–positive patients was 60% (n = 9) v 19% (n = 4) in PD-L1–negative patients. Eight patients (13%) developed treatment-related grade 3 toxicities. There were no treatment-related grade 4-5 toxicities. QOL was maintained throughout therapy. CONCLUSION In this study, atezolizumab and bevacizumab demonstrated safety and resulted in objective responses in patients with variant histology RCC or RCC with ≥ 20% sarcomatoid differentiation. This regimen warrants additional exploration in patients with rare RCC, particularly those with PD-L1–positive tumors.
On average, patients rate quality of life with melanoma recurrence much lower than even severe IFN alpha-2b toxicity. These results suggest that recurrence-free survival is highly valued by patients. The utilities measured in our study can be applied directly to quality-of-life determinations in clinical trials of adjuvant IFN alpha-2b to measure the net benefit of therapy.
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