Despite better understanding of Multiple Myeloma (MM) and the development of novel therapeutic strategies which improved overall survival, MM still remain largely incurable. This warrants a better understanding of socio-demographic factors that may influence disease course and outcomes across MM patient
Indo-American Journal of Agricultural and Veterinary Sciences". It appears to be an international online journal that publishes research and review articles in English on topics related to agriculture and veterinary sciences of the journals in research .
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...JohnJulie1
The purpose of this study was to examine contextual factors associated with physical and mental health-related quality of life (HRQOL) in older adult cancer survivors.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...EditorSara
The purpose of this study was to examine contextual factors associated with physical and mental health-related quality of life (HRQOL) in older adult cancer survivors.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...EditorSara
This study is a secondary data analysis of the 2014 Behavioral Risk Factor Surveillance System. Only adults age 65 and older who had a cancer history in the Cancer Survivorship module were included (n=3,846).
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...semualkaira
The purpose of this study was to examine contextual factors associated with physical and mental health-related quality of life (HRQOL) in older adult cancer survivors.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...semualkaira
This study is a secondary data analysis of the 2014 Behavioral Risk Factor Surveillance System. Only adults age 65 and older who had a cancer history in the Cancer Survivorship module were included (n=3,846).
Indo-American Journal of Agricultural and Veterinary Sciences". It appears to be an international online journal that publishes research and review articles in English on topics related to agriculture and veterinary sciences of the journals in research .
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...JohnJulie1
The purpose of this study was to examine contextual factors associated with physical and mental health-related quality of life (HRQOL) in older adult cancer survivors.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...EditorSara
The purpose of this study was to examine contextual factors associated with physical and mental health-related quality of life (HRQOL) in older adult cancer survivors.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...EditorSara
This study is a secondary data analysis of the 2014 Behavioral Risk Factor Surveillance System. Only adults age 65 and older who had a cancer history in the Cancer Survivorship module were included (n=3,846).
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...semualkaira
The purpose of this study was to examine contextual factors associated with physical and mental health-related quality of life (HRQOL) in older adult cancer survivors.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...semualkaira
This study is a secondary data analysis of the 2014 Behavioral Risk Factor Surveillance System. Only adults age 65 and older who had a cancer history in the Cancer Survivorship module were included (n=3,846).
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...semualkaira
The purpose of this study was to examine contextual
factors associated with physical and mental health-related quality
of life (HRQOL) in older adult cancer survivors.
It's great to hear that presumably the Asian Journal of Agricultural Sciences and Veterinary Medicine hopes to facilitate research and development in the fields of Agricultural Sciences and Veterinary Medicine through its journal publications of the scopus database journal.
Indo-American Journal of Agricultural and Veterinary Sciences". It appears to be an international online journal that publishes research and review articles in English on topics related to agriculture and veterinary sciences is the journal of the journal papers
Objective: The prognostic indictors of age-related poor outcomes in patients with acute myeloid leukemia (AML) are still controversial. The aim of this work was to provide comprehensive insights into the effect of different hemocytes and to investigate the association between age and clinical features in adult patients with AML.
Study Design: A retrospective study was performed to determine the role of age in the therapeutic outcomes of AML. A total of 166 newly diagnosed adult patients’ data from January 2015 to November 2019 in Zhongshan Hospital of Xiamen University were collected and analyzed.
Results: Older patients presented a poorer prognosis (p=0.001) with shorter overall survival, which is served as age-related outcomes. Binary logistic regression demonstrated that cytogenetic risk (OR=4.508, 95% CI 2.733–7.435), leukocyte (OR=7.410, 95% CI 1.139–5.910), and bone marrow blast cells (OR=3.261, 95% CI 1.075–5.615) were independent indictors for age-related prognosis. In addition, Kaplan-Meier curve also revealed that the above factors were associated with overall survival (all p values <0.001).
Conclusion: Cytogenetic risk, leukocyte, and bone marrow blast cells are dominant factors which account for the age-related poor outcomes and shorter overall survival in AML.
Keywords: acute myeloid leukemia, adult, cytogenetic risk, hemocyte, leukemia, overall survival
Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the ...Δρ. Γιώργος K. Κασάπης
There was a more than twofold increase in the rate of suspected self-poisoning suicide cases between 2011 and 2018, according to a new study that looked at more than 1.6 million such cases.
Here’s what else you need to know:
•Overall trends: Cases of suicide attempts by self-poisoning doubled in those aged 10-18 between 2011 and 2018, rising from around 39,000 to more than 78,000.
•Gender: More girls than boys attempted suicide by self-poisoning. The rate of intentional attempts among girls 10-18 also steadily increased from 2011-2018.
•Outcomes: The number of serious outcomes — including death and hospitalizations — as a result of the poisoning increased 235% between 2000 and 2018, and more than 1,400 children died.
Cancer and other noncommunicable diseases (NCDs) arenowwidely recognized as a threat to global development.The latest United Nations high-level meeting on NCDs reaffirmed thisc observation and also highlighted the slow progress in meeting the 2011 Political Declarationon the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting,and budgeting have been identified as major obstacles in achieving these goals. All of these have incommon that they require information on the local cancer epidemiology.
The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Seroprevalence among blood donors is a major public health problem, both in
developed and developing countries, in its magnitude. The aim of this study
was to determine the seroprevalence of hepatitis B in blood donors. This is a
descriptive study carried out in the city of Mbuji-Mayi at the General Hospital
of Dipumba in blood donors (family, volunteer and remunerated) recorded
from 01/to31/December 2016; the data were collected in a transverse fashion.
The following observations were made: During the study period, 1584 blood
donors were registered. After analyzing the data, the seroprevalence of hepatitis
B in blood donors was 2.2%, 77.8% were male (sex ratio M/F 3.5 and voluntary
donors were 50.4%.
Circulating Tumor Cells and Cell-Free Nucleic Acids as Predictor Factors for ...AnonIshanvi
Pancreatic cancer remains as one of the most aggressive and deadliest of cancers largely due to formidable challenges in diagnosis and therapy. Consensus standard treatment for patients with nonmetastatic Pancreatic Cancer (PC) incorporates possible neoadjuvant chemotherapy with timely surgical resection and adjuvant chemotherapy. However, despite all the sophistication of modern radiological and endoscopic techniques, the decision regarding operability is often only made intra-operatively, therefore subjecting a patient to unnecessary surgical intervention, and postponing the possibility of starting early chemotherapy.
Research Progress in Chronic Lymphocytic LeukemiaAnonIshanvi
Cancer is an uncontrolled division of cell occurs due to genetic alterations and mutation. Chronic lymphocytic leukemia is the heterogeneous lymphocytic malignancy worldwide that leads to death.
Genetics of Breast and Ovary Cancers Associated with Hereditary Cancers and t...AnonIshanvi
Carriers of the BRCA-1/2 mutation have increased and variable risks of Breast Cancer (BC) and ovarian cancer and vary or are modified by common genetic variants and their incidence genetic testing and risk-reducing surgery has increased, they should receive advice and evaluation by the physician with experience in genetics.
Increased of Protein O-Fucosyl Transferase 1 and 2 Genes Expression in Gastri...AnonIshanvi
Gastric cancer is one of the most common cancers in the world. Gastric cancer usually occurs at an advanced age (average ≥ 65 years) and has symptoms similar to gastric ulcers and other gastric infections, its early diagnosis is one of the major problems of this type of cancer. Molecular mechanisms initiate cancer and the molecular changes of normal cells compared to cancer cells are very important. dysfunction of Fucosyl transferase enzymes is associated with gastric cancer.
The impact of the SARS-CoV-2 infection in all areas at the national and international level is undeniable, the aftermath of this “tornado” will be visible for a long time, even when the infection manages to be controlled. Two aspects of great interest to those of us who work in the area of oncology must be considered: on the one hand, the need to contain and control the devastating effects of the disease forced a reorganization in the operation of services, giving priority to COVID, conversion of medical units to hospitals COVID created a high-risk scenario for patients with other types of pathologies; This reorganization includes the allocation of large amounts of budget to COVID areas to the detriment of patients with other types of equally serious diseases - such as cancer, among others - who cannot wait for care in better times.
Meta-Analysis of Lateral Lymph Node Dissection for Mid Lower Rectal Cancer: I...AnonIshanvi
Presence of lateral lymph node metastasis in rectal cancer was originally reported in the 1950s.Lateral lymph node metastasis occurs in 15 to 20% of patients with locally advanced low rectal cancer which escalates likelihood of local recurrence and reduced survival following neoadjuvant chemoradiotherapy (nCRT) and Total Mesolectal Excision (TME).
More Related Content
Similar to Marital Status and Survival in Patients with Multiple Myeloma: The Role of Marriage in the Management of Multiple Myeloma
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...semualkaira
The purpose of this study was to examine contextual
factors associated with physical and mental health-related quality
of life (HRQOL) in older adult cancer survivors.
It's great to hear that presumably the Asian Journal of Agricultural Sciences and Veterinary Medicine hopes to facilitate research and development in the fields of Agricultural Sciences and Veterinary Medicine through its journal publications of the scopus database journal.
Indo-American Journal of Agricultural and Veterinary Sciences". It appears to be an international online journal that publishes research and review articles in English on topics related to agriculture and veterinary sciences is the journal of the journal papers
Objective: The prognostic indictors of age-related poor outcomes in patients with acute myeloid leukemia (AML) are still controversial. The aim of this work was to provide comprehensive insights into the effect of different hemocytes and to investigate the association between age and clinical features in adult patients with AML.
Study Design: A retrospective study was performed to determine the role of age in the therapeutic outcomes of AML. A total of 166 newly diagnosed adult patients’ data from January 2015 to November 2019 in Zhongshan Hospital of Xiamen University were collected and analyzed.
Results: Older patients presented a poorer prognosis (p=0.001) with shorter overall survival, which is served as age-related outcomes. Binary logistic regression demonstrated that cytogenetic risk (OR=4.508, 95% CI 2.733–7.435), leukocyte (OR=7.410, 95% CI 1.139–5.910), and bone marrow blast cells (OR=3.261, 95% CI 1.075–5.615) were independent indictors for age-related prognosis. In addition, Kaplan-Meier curve also revealed that the above factors were associated with overall survival (all p values <0.001).
Conclusion: Cytogenetic risk, leukocyte, and bone marrow blast cells are dominant factors which account for the age-related poor outcomes and shorter overall survival in AML.
Keywords: acute myeloid leukemia, adult, cytogenetic risk, hemocyte, leukemia, overall survival
Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the ...Δρ. Γιώργος K. Κασάπης
There was a more than twofold increase in the rate of suspected self-poisoning suicide cases between 2011 and 2018, according to a new study that looked at more than 1.6 million such cases.
Here’s what else you need to know:
•Overall trends: Cases of suicide attempts by self-poisoning doubled in those aged 10-18 between 2011 and 2018, rising from around 39,000 to more than 78,000.
•Gender: More girls than boys attempted suicide by self-poisoning. The rate of intentional attempts among girls 10-18 also steadily increased from 2011-2018.
•Outcomes: The number of serious outcomes — including death and hospitalizations — as a result of the poisoning increased 235% between 2000 and 2018, and more than 1,400 children died.
Cancer and other noncommunicable diseases (NCDs) arenowwidely recognized as a threat to global development.The latest United Nations high-level meeting on NCDs reaffirmed thisc observation and also highlighted the slow progress in meeting the 2011 Political Declarationon the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting,and budgeting have been identified as major obstacles in achieving these goals. All of these have incommon that they require information on the local cancer epidemiology.
The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Seroprevalence among blood donors is a major public health problem, both in
developed and developing countries, in its magnitude. The aim of this study
was to determine the seroprevalence of hepatitis B in blood donors. This is a
descriptive study carried out in the city of Mbuji-Mayi at the General Hospital
of Dipumba in blood donors (family, volunteer and remunerated) recorded
from 01/to31/December 2016; the data were collected in a transverse fashion.
The following observations were made: During the study period, 1584 blood
donors were registered. After analyzing the data, the seroprevalence of hepatitis
B in blood donors was 2.2%, 77.8% were male (sex ratio M/F 3.5 and voluntary
donors were 50.4%.
Circulating Tumor Cells and Cell-Free Nucleic Acids as Predictor Factors for ...AnonIshanvi
Pancreatic cancer remains as one of the most aggressive and deadliest of cancers largely due to formidable challenges in diagnosis and therapy. Consensus standard treatment for patients with nonmetastatic Pancreatic Cancer (PC) incorporates possible neoadjuvant chemotherapy with timely surgical resection and adjuvant chemotherapy. However, despite all the sophistication of modern radiological and endoscopic techniques, the decision regarding operability is often only made intra-operatively, therefore subjecting a patient to unnecessary surgical intervention, and postponing the possibility of starting early chemotherapy.
Research Progress in Chronic Lymphocytic LeukemiaAnonIshanvi
Cancer is an uncontrolled division of cell occurs due to genetic alterations and mutation. Chronic lymphocytic leukemia is the heterogeneous lymphocytic malignancy worldwide that leads to death.
Genetics of Breast and Ovary Cancers Associated with Hereditary Cancers and t...AnonIshanvi
Carriers of the BRCA-1/2 mutation have increased and variable risks of Breast Cancer (BC) and ovarian cancer and vary or are modified by common genetic variants and their incidence genetic testing and risk-reducing surgery has increased, they should receive advice and evaluation by the physician with experience in genetics.
Increased of Protein O-Fucosyl Transferase 1 and 2 Genes Expression in Gastri...AnonIshanvi
Gastric cancer is one of the most common cancers in the world. Gastric cancer usually occurs at an advanced age (average ≥ 65 years) and has symptoms similar to gastric ulcers and other gastric infections, its early diagnosis is one of the major problems of this type of cancer. Molecular mechanisms initiate cancer and the molecular changes of normal cells compared to cancer cells are very important. dysfunction of Fucosyl transferase enzymes is associated with gastric cancer.
The impact of the SARS-CoV-2 infection in all areas at the national and international level is undeniable, the aftermath of this “tornado” will be visible for a long time, even when the infection manages to be controlled. Two aspects of great interest to those of us who work in the area of oncology must be considered: on the one hand, the need to contain and control the devastating effects of the disease forced a reorganization in the operation of services, giving priority to COVID, conversion of medical units to hospitals COVID created a high-risk scenario for patients with other types of pathologies; This reorganization includes the allocation of large amounts of budget to COVID areas to the detriment of patients with other types of equally serious diseases - such as cancer, among others - who cannot wait for care in better times.
Meta-Analysis of Lateral Lymph Node Dissection for Mid Lower Rectal Cancer: I...AnonIshanvi
Presence of lateral lymph node metastasis in rectal cancer was originally reported in the 1950s.Lateral lymph node metastasis occurs in 15 to 20% of patients with locally advanced low rectal cancer which escalates likelihood of local recurrence and reduced survival following neoadjuvant chemoradiotherapy (nCRT) and Total Mesolectal Excision (TME).
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Dysarthria is a common postoperative sequela of glossectomy and can greatly impact daily function and Quality of Life (QOL). It is important to study the anatomic and physiological factors that influence speech function, even with the challenges of conducting clinical research during the COVID pandemic. Therefore, our study aims to 1) display the feasibility of using a telecare platform to conduct clinical research; 2) analyze speech outcomes of patients who underwent hemiglossectomy with radial forearm free flap (RFFF) tongue reconstruction.
Uterine Myoma, Risk Factor and Pathophysiology: A Review ArticleAnonIshanvi
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Functional Disparity of Carcinoma Associated Fibroblasts in Different Stages ...AnonIshanvi
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Marital Status and Survival in Patients with Multiple Myeloma: The Role of Marriage in the Management of Multiple Myeloma
1. Clinics of Oncology
ISSN: 2640-1037
Research Article
Marital Status and Survival in Patients with Multiple Myeloma:
The Role of Marriage in the Management of Multiple Myeloma
Islam MS1*
, Lee C2
, Kim J3
, Enright R4
and Kotoucek P5
1
Department of Hematology, Queen Elizabeth Hospital and Guy’s Hospital, London, SE18 4QH, UK
2
Examinations, National Council of State Boards of Nursing, 111 E Upper Wacker Dr Suite 2900, Chicago, IL 60601, USA
3
Department of Psychology, Liberty University, Lynchburg, VA 24515, USA
4
University of Wisconsin-Madison and International Forgiveness Institute, Inc., Madison, WI
5
Department of Hematology, Broomfield Hospital, Court Road, Chelmsford, CM1 7LE, UK
Volume 2 Issue 3- 2019
Received Date: 30 Nov 2019
Accepted Date: 16 Dec 2019
Published Date: 26 Dec 2019
2. Keywords
Myeloma, Marriage, Survival,
Psychosocial
1. Abstract
Despite better understanding of Multiple Myeloma (MM) and the development of novel therapeutic
strategies which improved overall survival, MM still remain largely incurable. This warrants a
better understanding of socio-demographic factors that may influence disease course and outcomes
across MM patient. Positive influence of marital status is well established for many solid and liquid
cancers. However, limited literature is available showing its influence on MM patients. Surveillance,
EpidemiologyandEndResultsprogramme(SEER)datawasusedtoidentifytotal29,507MMpatients
diagnosed in 2011 through 2015 and 16,519 patients who had symptomatic MM and their clinical
and follow-up information available were analysed. The outcome variable was the survival time from
diagnosis to death due to myeloma. On mixed effects Cox regression for myeloma-specific mortality,
there was a significant interaction between marital status and sex at the nominal significance level
(α) of 0.01. Holding demographic covariates age, income, education, race, and residence at a fixed
value, the hazard ratio (HR) of myeloma-specific mortality for married male patients over the HR
for married female patients was about 18% lower. In addition, younger age, high income, African-
American patients were less likely to die of myeloma. Further analysis indicated that patients
who were unmarried, widowed or divorced, were at significantly greater risk of myeloma-specific
mortality after being adjusted for the demographic covariates (p< 0.01). Our analysis supports the
positive effect of marriage on the outcome of MM patients. The effect of strengthening psychosocial
support should be investigated as supplementary treatment for MM patients.
*Corresponding Author (s): Md Serajul Islam, Department of Hematology, Queen Eliz-
abeth Hospital and Guy’s Hospital, London SE18 4QH, UK, E-mail: serajul@doctors.
org.uk
clinicsofoncology.com
Citation: Islam MS, Marital Status and Survival in Patients with Multiple Myeloma: The Role of Marriage
in the Management of Multiple Myeloma. Clinics of Oncology. 2019; 2(3): 1-8
3. Introduction
Multiple myeloma (MM) accounts for 1% and 10% of all cancers
and of all hematologic malignancies respectively [1]. Each year
over 30,000 new MM cases are diagnosed in the United States,
and over 12,000 patient’s die of the disease [2]. The median age
of diagnosis is about 65 years [3]. MM is currently an incurable
condition. Introduction of several novel anti-myeloma drugs over
the last decade has improved the survival of MM patients; however,
MM still remains largely incurable. Survival estimates in MM
vary based on the source of the data. Data from trials using novel
therapies show that the median survival in MM is approximately
6years [4]. In the subset of patients eligible for autologous stem
cell transplant (ASCT), the median overall survival (OS) is
approximately 8 years [5]. Among elderly patients (age >75years),
median OS is lower, and is approximately 5 years [6].Evidence also
suggests greater improvements in OS among white individuals
3. income, education, and survival months, than unmarried patients.
As shown in (Table 2), all the mean differences of age, income,
education, and survival months between married and unmarried
patients were statistically significant. However, their effect sizes
were small according to the criteria suggested by Cohen [20]. For
the marital status, a plot of survival curves using Kaplan-Meier
method [21] is in (Figure 1a). The dark grey curve is for married
patients and the light grey curve is for unmarried patients. The
dotted line represents the median survival probability (0.5). The
survival curves indicated that the married patients had higher
survival probability than the unmarried patients. The survival
probability of 0.5 for the unmarried patients reached at about 53rd
month. Married patients were more likely to be male or white. Most
of patients in the data were urban situated. During five years from
2011 to 2015, the percentages of patients diagnosed with myeloma
between married and unmarried patients were quite similar
one another. Married patients were more likely to be alive than
unmarried patients. The χ2
test showed that sex, race, and mortality
had a strong relationship with marital status while residence and
year of diagnosis did not (Table 2).
On mixed effects Cox regression for MM mortality, there was
a significant interaction between marital status and sex at the
nominal significance level (α) of 0.01. Holding the other covariates,
such as age, income, education, race, and residence at a fixed value,
the hazard ratio of MM mortality for married female patients over
the hazard ratio for married male was about 18% higher. In other
words, male patients benefitted more from marriage than did
female patients. In contrast, female patients who were not married
benefitted more than male patients who were not married. In
addition to the male married patients, younger patients, or patients
who had a higher income or were African American were less
likely to die of MM. The output of the mixed effects Cox regression
is described in (Table 3a).
The associations between subgroups of unmarried patients and the
myeloma mortality were also investigated. (Table 3b) summarizes
the adjusted hazard ratio, the 95% confidence interval (CI), and the
p value, for each subgroup of unmarried patients after adjusting
for demographics. All the subgroups of unmarried patents,
except separated patients, were at significantly greater risk of MM
mortality. For example, patients who were never married showed
the highest hazard ratio, about 52% higher, than patients who were
married, followed by patients who were widowed and divorced,
with 46% and 39% higher, respectively. (Figure 1b) depicted the
density of married patients and three subgroup unmarried patients
over predicted probability of myeloma mortality. The distribution
of married patients lied in the lowest probability while the widowed
patients lied in the highest probability.
7. Discussion
Adhering to the vow, “Til death do us part,” may be health
promoting. Among individuals who are well and among patients
who are suffering a wide array of illnesses, marriage is often
Figure 1a: Survival curves (Kaplan-Meier curves) for Marital Status
clinicsofoncology.com 3
Figure 1b: Density plots of Predicted Probability of Myeloma Mortality
Volume 2 Issue 3 -2019 Research Article
4. associated with longer life and better quality of life [22]. The
aim of this study was to investigate the impact of marital status
on the survival of MM patients. Our results demonstrated that
married patients had better survival compared with unmarried
patients. These findings remained significant after controlling for
demographic variables.
Studies assessing the impact of marital status on disease specific
survival among cancer patients showed conflicting results, with
protective [23,24], mixed, [25] and non-significant, [26] effects.
Very little literature is available about the effect on marriage on
the survival of MM. None of these above studies has examined
the effect of marriage on the outcome of MM treatment and its
survival. National Institutes of Health/National Cancer Institute
spends approximately $5 billion per annum [27]on cancer research
focused mainly on biologic investigations. However, our study
suggests that targeted psychosocial support interventions could
prove to be a cost-effective method of improving survival among
patients with myeloma.
Previous studies among cancer patients showed associations
between marital status and improved outcomes [15,28] An
explanation for the relationship is that marriage is a source of
social support. Spouses may encourage their partners to take
cancer screening, support to complete recommended treatment,
and receive more intensive therapy. Numerous published studies
have observed that unmarried patients are at significantly higher
risk of late stage diagnosis, suboptimal treatment, and cancer death
[15]. We found that unmarried patients, including those who are
never married, are at significantly greater risk of death resulting
from MM than patients who are married. It may be because
married people seek medical attention earlier due the possible
clinicsofoncology.com 4
Characteristic
Unmarried Married
(n = 6,443) (n = 10,076)
No. % No. %
Age, years
Mean 67.1 65.8
SD 13.1 11.3
Income, USD*
Mean 58,519.8 60,227.7
SD 15,185.2 15,439.8
Percent that completed high school*
Mean 85.0 85.4
SD 6.0 6.1
Survival months
Mean 19.2 21.7
SD 16.6 16.7
Sex
Male 2,694 41.8 6,375 63.3
Female 3,749 58.2 3,701 36.7
Race
White 3,357 52.1 6,545 65
African American 1,921 29.8 1,451 14.4
Native American 40 0.6 48 0.5
Asian 285 4.4 738 7.3
Hispanic 840 13.1 1,294 12.8
Residence*
Rural 72 1.1 138 1.4
Urban 6,371 98.9 9,938 98.6
Year diagnosis
2011 1,147 17.8 1,732 17.2
2012 1,241 19.3 1,935 19.2
2013 1,295 20.1 2,021 20.1
2014 1,310 20.3 2,121 21.1
2015 1,450 22.5 2,267 22.5
Mortality
Alive (Censored) 4,316 67.0 7,585 75.3
Dead (Myeloma) 2,127 33.0 2,491 24.7
* County-level data
Table 1: Demographic Statistics
t-test
Mean
Difference
95% CI of the
Difference
Pr
(2-tailed)
Effect
Size*
Age, years 1.371 0.981 to 1.760 < 0.001 0.114
Income, USD -1,707.83
-2,185.751 to
-1,229.911
< 0.001 0.112
Percent that completed high
school
-0.460 -0.650 to -0.270 < 0.001 0.076
Survival months -2.451 -2.972 to -1.930 < 0.001 0.147
Chi-squared (χ2) test χ2 Statistics df Pr
Sex 729.900 1 < 0.001
Race 620.800 4 < 0.001
Residence 1.794 1 0.180
Year diagnosis 1.832 4 0.767
Mortality 133.700 1 < 0.001
Table 2: Comparison between the married and unmarried patients
Volume 2 Issue 3 -2019 Research Article
5. encouragement by their spouses and have an early diagnosis
and early appropriate treatment. Spouses also may encourage
patients to undergo definitive versus expectant management [29],
potentially accounting for the discrepancies in the survival. There
are many explanations for the vital question of why marriage is
associated with improved cancer-specific survival after adjustment
for demographics, stage, and treatment, but the most likely reason
is that married patients have better adherence with prescribed
treatments than unmarried patients [30].
Psychologically, cancer diagnosis usually results in more distress
than other diagnoses [31]. Married patients display less distress,
depression, and anxiety than their unmarried counterparts
after cancer diagnosis, this may be because a partner shares the
emotional burden and provide appropriate psychological support
[32]. Labile psychological state can lead to poor adherence to
treatment and as a consequence poor outcome. A study showed
that women with depression who are diagnosed with breast cancer
undergo definitive treatment less often, hence poorer survival [33].
Treating healthcare professionals should consider screening for
psychological health among unmarried patients with MM and refer
patients to mental health specialists if symptoms are identified.
In addition, physicians should consider closer observation of
unmarried patients with MM to maximize adherence.
One study has shown that cortisol levels to be lower in patients
with cancer who have adequate support networks. A diurnal
cortisol patterns have been linked with natural-killer cell count
and survival in cancer patients [34], providing a physiological
basis for the psychologically data. Hence the married MM patient
may have shown survival advantage in our study. If the benefits
of marriage on MM survival are mediated through spousal
psychosocial support, then the most effective way to combat the
increased risks associated with unmarried MM patients would
be to aggressively promote support mechanisms. A randomized
controlled trial revealed that a psychosocial support-based
intervention was associated with a near doubling of overall survival
among advanced metastatic breast cancer patients [35]. Similar
effect was shown among metastatic non–small-cell lung cancer
that early implementation of supportive measures/palliative care
along with standard oncologic care improved the median survival
of patients relative to standard oncologic care alone [36].This may
again explain why married MM patient has better survival in our
study in compare to their unmarried counterpart as the married
patients had better support system.
Our study shows a clear protective effect of marriage among
myeloma patients. Interestingly, the impact of marriage specific
mortality seemed to be greater in men than in women in our study.
The exact reasons for this will need to be explored further, but it
could, for example, reflect that unmarried women receive greater
psychosocial support from their relatives (e.g. their own children),
clinicsofoncology.com 5
Random effects
Group Variable Std Dev Variance
County Intercept 0.055126838 0.003038968
Estimate HR
Std.
Error
z value Pr ( >|z|)
Married -0.448 0.639 0.042 -10.690 0.00E+00 ***
Age 0.047 1.048 0.001 34.290 0.00E+00 ***
Income 0.000 1.000 0.000 -5.640 1.70E-08 ***
Education -0.002 0.998 0.003 -0.530 0.590000
Female -0.225 0.798 0.044 -5.070 4.10E-07 ***
African
American
-0.138 0.871 0.041 -3.390 0.000710 ***
Native
American
-0.106 0.899 0.202 -0.530 0.600000
Asian 0.010 1.01 0.067 0.150 0.880000
Hispanic 0.048 1.049 0.049 0.980 0.330000
Rural -0.071 0.931 0.125 -0.570 0.570000
Married x
Female
0.163 1.177 0.061 2.650 0.008000 **
Signif. Codes: 0 ‘***’ 0.001 ‘**’ 0.01
Table 3a: Estimate and Hazard Ratio from the Mixed Effects Cox Regression
Note. HR refers to Hazard Ratio.
HR 95% CI Pr (>|z|)
Married Reference Group -
Never Married 1.517 1.392 to 1.654 0.00E++ ***
Separated 1.071 0.791 to 1.450 0.66
Divorced 1.386 1.250 to 1.537 5.30E-10 ***
Widowed 1.464 1.346 to 1.592 0.00E++ ***
Table 3b: Association between subgroups of unmarried patients and the myeloma
mortality
Volume 2 Issue 3 -2019 Research Article
6. should be considered for better outcomes for unmarried MM
patients, who are at greater risk. Some roles of marriage in the
management of multiple myeloma are not included in statistics like
the story of a lawyer who was the wife and caregiver of her husband
a consultant cardiologist who was a patient with myeloma. She
convinced scientists in Harvard University and the clinician in
UAMS hospital to use Thalidomide in treatment of myeloma [39].
In her desperate effort she inspired an international research on
immunomodulatory drugs in myeloma, nowadays a back bone of
any treatment regimes.
8. Conclusion
Findings from our analysis support the positive effect of marriage
on the survival of multiple myeloma patients. Psychological distress
among cancer patients is enormous. Unmarried MM patients (i.e.
divorced, widowed and never married) often lack adequate support
network to cope with such distress. Given the potential benefits
of psychological and social support via marriage linked to the
greater survival of MM patients, the effects of adding empirically
supported interventions such as Forgiveness Therapy [40] to the
regular treatment regimen should be further investigated.
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