This report describes recruitment of minority cancer survivors for a randomized trial of I Can Cope, a support program of the American Cancer Society. Survivor Education and Evaluation (SURE), was designed to recruit patients, age 19 and older, with a primary cancer diagnosis. Recruitment was primarily carried out in a public hospital in Birmingham, Alabama. Of 373 patients approached, 226 were eligible for the study, 175 consented, and 140 were randomized during the 20-month recruitment period. Only 43 declined participation. This resulted in a 61.9% recruitment yield. The mean age of participants was 54.2 years (SD=10.9), 92 (65.7%) were female, and 111 (79.3%) were African American. Twenty-three different cancers were represented including breast (37.1%), colorectal (12.1%), hematologic (12.9%), and lung (7.1%). Over half (63%) had been diagnosed within 12 months. The experience of the SURE project provides evidence for optimism in recruiting racial minorities to cancer research studies.
The American Cancer Society is a leader in the development of cancer survivorship resources. One resource of the American Cancer Society is the I Can Cope program, an educational program for cancer survivors and their families. Evaluations of this program indicate that cancer patients highly rate its objectives. Yet, there are gaps in the understanding of the full impact of the program on diverse cancer survivors. In this study, the authors used a randomized trial to evaluate the program. Participants included 140 low-income survivors (79% Black; 38% breast cancer) from community hospitals who were randomized to 4 sessions of I Can Cope (learning about cancer; understanding cancer treatments; relieving cancer pain; and keeping well in mind and body) or 4 sessions of a wellness intervention (humor, meditation, relaxation, and music therapy). The authors’ primary outcome was “met information needs.” After controlling for covariates, their analysis indicated that I Can Cope was no more effective than the wellness intervention in addressing survivor information needs relative to the learning objectives. Participants provided high overall ratings for both interventions. Self-efficacy for obtaining advice about cancer, age, education, and income were associated with information needs. Educational programs tailored to levels of self-efficacy and patient demographics may be needed.
Introduction:
Metastases to the brain (MB) occur in up to 30% of adults with cancer; of these, 15% to 35% may have seizures. We investigated clinical and pathologic associations with seizure and EEG findings in patients with MB, given the sparse literature in this area.
Methods:
We performed a retrospective chart review of adults with pathologically confirmed MB treated at a large tertiary care center between April 8, 2006, and December 14, 2018. Primary outcomes were odds of “chart-documented seizure” (CDS) in the full sample and EEG-captured seizure or any epileptiform discharges among those monitored on EEG.
Results:
We studied 187 patients with MB, of whom 55 (28.3%) were monitored on EEG. We found an overall CDS prevalence of 29.4% and an EEG-captured seizure of 18.9% among patients monitored on EEG. Of those monitored on EEG, 47.2% had epileptiform discharges. Adenocarcinoma pathology was associated with lower odds of CDS (odds ratio [OR] 0.50, 95% CI 0.26–0.96) and EEG-captured seizure (OR 0.09, 95% CI 0.01–0.87) versus other pathologies. When modeled separately, melanoma pathology was associated with CDS (OR 4.45, 95% CI 1.58–12.57) versus other pathologies. Hemorrhagic MB were associated with any epileptiform discharges (OR 5.50, 95% CI 1.65–18.37), regardless of pathology modeled. Increasing size of the largest dimension of the largest MB was associated with lower odds of CDS (OR 0.68, 95% CI 0.52–0.89 when adenocarcinoma modeled, OR 0.69, 95% CI 0.53–0.91 when melanoma modeled).
Conclusions:
Seizures and epileptiform discharges are common in patients with MB. Tumor size and pathology were significantly associated with CDS. Larger studies are needed for further analysis.
Dirofilariasis is a filarial infection of domestic and sylvatic vertebrates such as canines, felines, raccoons, and bears (the definitive hosts) and is transmitted mostly by mosquitoes (the vector) with the exception being Dirofilaria ursi that is transmitted by the black fly. At least 60 cases of subcutaneous dirofilariasis in humans have been reported; however, the overall incidence of dirofilarial infection has increased, and dirofilariasis is considered an emerging zoonosis. Here, we present a case of subcutaneous Dirofilaria in an otherwise healthy woman in her sixth decade who presented with a painless, mobile, nonerythematous pea-sized nodule of the right upper extremity of 1 month's duration. Evaluation regarding possible disseminated infection, microfilaremia, filarial serology, pulmonary, and central nervous system involvement was negative. She reported no travel outside of South Carolina. Her only risk factor was exposure to mosquitoes 5 months prior in her backyard, composed primarily of wetlands, a common habitat in coastal southeastern United States. No antihelminthics were given. She had complete resolution of the lesion after surgical excision, with no sequelae. This is the second case reported in Charleston, South Carolina.
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