IMPORTANCE Head and neck cancer (HNC) is more common among socioeconomically disenfranchised individuals, making financial burden particularly relevant. OBJECTIVE To assess the financial burdens of HNC compared with other cancers. DESIGN, SETTING, AND PARTICIPANTS In this retrospective review of nationally representative, publicly available survey, data from the Medical Expenditure Panel Survey were extracted from January 1, 1998, to December 31, 2015. A total of 444 867 adults were surveyed, which extrapolates to a population of 221 503 108 based on the weighted survey design. Data analysis was performed from April 18, 2018, to August 20, 2018. EXPOSURES Of 16 771 patients with cancer surveyed (weighted count of 10 083 586 patients), 489 reported HNC (weighted count of 261 631). MAIN OUTCOMES AND MEASURES Patients with HNC were compared with patients with other cancers on demographics, income, employment, and health. Within the HNC group, risk factors for total medical expenses and relative out-of-pocket expenses were assessed with regression modeling. Complex sampling methods were accounted for with weighting using balanced repeated replication. RESULTS A total of 16 771 patients (mean [SD] age, 62.3 [18.9] years; 9006 [53.7%] female) with cancer were studied. Compared with patients with other cancers, patients with HNC were more often members of a minority race/ethnicity, male, poor, publicly insured, and less educated, with lower general and mental health status. Median annual medical expenses
Studies in Higher Education 0307-5079 (print)/1470-174X (online) Original Article 2010 Society for Research into Higher Education 00 0 0000002010 RachelSpronken-Smith rachel.spronken-smith@otago.ac.nzInquiry-based learning has been promoted as a student-centred approach that can strengthen the links between teaching and research. This article examines the potential of inquiry-based learning to strengthen the teaching-research nexus by analysing three case studies: a 'structured inquiry' third-year endocrinology medicine module, a 'guided inquiry' second-year political communications course and an 'open inquiry' third-year ecology course. The relation between teaching and research differed significantly amongst these three cases and led to a reconceptualisation of inquiry-based learning. A model was then developed to link the focus of learning (using Levy's framing of information or discovery-oriented inquiry) with the level of independence and the potential strength of the teachingresearch nexus. The findings show that, if teachers are aiming for strong links between teaching and research, they should adopt an open, discovery-oriented inquiry-based learning approach. However, more structured and guided forms of inquiry can be useful to progressively develop particular inquiry skills.
Overall and disease-specific survival is poor for oral and oropharyngeal cancer patients, and Black men fare worst. This illustrates the need for long-term cancer survival plans incorporating disparity effects in overall cancer outcomes.
Objective
To determine if there are differences in mortality from oral cavity squamous cell carcinoma (OCSCC) based on oral cavity (OC) subsites.
Methods
Using the Surveillance, Epidemiology, and End Results Program (SEER) 9 database, patients with sequence number 0 or 1 squamous cell OCSCC were analyzed by OC subsite for 5‐year cause‐specific mortality (CSM) from OCSCC. Proportional hazards regression determined the association between 5‐year CSM and OC subsites while controlling for treatment modality, stage, and demographic characteristics using hazard ratios. Significance was set at alpha = 0.05.
Results
20,647 OC patients were included in the regression analysis. The most commonly diagnosed sites were floor of mouth (34.4%) and oral tongue (34.3%). Floor of mouth, upper gum, and retromolar trigone were associated with lower CSM compared to oral tongue. Not receiving surgery and receiving radiation were associated with increased CSM, and CSM increased with cancer staging when distant or regional disease was compared to localized disease. Also, patients diagnosed at 60 years or older and black patients had increased CSM.
Conclusion
Among OCSCC patients, those with oral tongue cancer are more likely to experience CSM than patients with floor of mouth, upper gum, and retromolar trigone cancer. It is important to understand these mortality related differences in the management of OCSCC patients. Understanding subsite‐specific mortality may benefit prognosis counseling of OCSCC patients and elicit subsite‐directed research as a means to improve outcomes.
Level of Evidence
NA
Laryngoscope, 129:1400–1406, 2019
SUMMARY
Background: Chronic Kidney Disease (CKD) is associated with the development of serious co‐morbidities. Patients with CKD are encouraged to adhere to regimens to lower this risk. This study aimed to explore the experiences of patients attempting to integrate lifestyle changes into their lives.
Method: Face‐to‐face recorded interviews were conducted with nine consenting patients with CKD Stage 4 under the care of a consultant nephrologist. Each recording was analysed by two independent investigators using thematic analysis.
Results: Five themes emerged: Self in relation to others, Control, Adherence, Beliefs about treatment and illness and Uncertainty. Participants highlighted the importance of personal support and recounted their sense of being a burden on close family. They described how they approached disclosure about their condition, their beliefs regarding treatment and their decision making processes and how these factors impacted on adherence to behaviour change.
Conclusion: Practical support from family and healthcare professionals, a willingness to disclose their condition and help to make good decisions in difficult circumstances were identified as important factors in supporting success with behaviour change.
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