National guidelines for gastric cancer: redundant or needed?
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ABSTRACT:
SUBMITTER: Lordick F
PROVIDER: S-EPMC10761429 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
Publications
National guidelines for gastric cancer: redundant or needed?
Lordick Florian F Wörmann Bernhard B
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 20231017 1
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Project description:BackgroundLung cancer has become the second most common cancer and the leading cause of cancer death in the United States. We aim to determine factors associated with newly diagnosed lung cancer at the Emergency Department (ED) and identify specific patient populations eligible for lung cancer diagnostic screening.MethodsThis is a single-center retrospective observational study. We included all patients aged between 50 and 80 years old, who presented to the ED seeking healthcare between January 1, 2019, and December 31, 2023. Patients' socio-demographics, clinical information, and whether they were eligible for lung cancer screening determined by the United States Preventive Services Task Force (USPSTF) guideline were analyzed and compared between patients who had newly diagnosed lung cancer at ED and those without. Factors associated with newly diagnosed lung cancer patients were determined by multivariable logistic regressions with inverse probability weighting (IPW) to account for observed selection bias of lung cancer screening eligibility.ResultsOut of 75,516 patients in this study, 18,641 (25%) patients had documented smoking histories. Among these, only 8,051 (10.66%) were eligible for lung cancer screening, while 18,348 patients received lung computer tomography (CT). Among all patients whose CTs were performed, 123 individuals were identified as having been newly diagnosed with lung cancer. Multivariable logistic regressions showed that the adjusted odds ratio (AOR) for eligible lung cancer diagnostic screening was 3.07 [95% confidence interval (CI): 2.08-4.53, P<0.001] without IPW and 3.49 (95% CI: 2.24-5.42, P<0.001) with IPW. Other factors associated with newly diagnosed lung cancer in ED were older age, female, and patients who spoke neither English nor Spanish.ConclusionsTo optimize the identification of suitable patients for lung cancer diagnostic screening in the ED, it may be beneficial to modify the eligibility criteria beyond those currently outlined by the USPSTF guidelines. Integrating additional factors such as advanced age, female sex, and a preference for non-English languages could improve the screening's effectiveness by capturing at-risk populations that might otherwise be overlooked.
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Project description:BackgroundCurrent US Preventive Services Task Force (USPSTF) lung cancer screening guidelines are based on smoking history and age (55-80 years). These guidelines may miss those at higher risk, even at lower exposures of smoking or younger ages, because of other risk factors such as race, family history, or comorbidity. In this study, we characterized the demographic and clinical profiles of those selected by risk-based screening criteria but were missed by USPSTF guidelines in younger (50-54 years) and older (71-80 years) age groups.MethodsWe used data from the National Health Interview Survey, the CISNET Smoking History Generator, and results of logistic prediction models to simulate lifetime lung cancer risk-factor data for 100 000 individuals in the 1950-1960 birth cohorts. We calculated age-specific 6-year lung cancer risk for each individual from ages 50 to 90 years using the PLCOm2012 model and evaluated age-specific screening eligibility by USPSTF guidelines and by risk-based criteria (varying thresholds between 1.3% and 2.5%).ResultsIn the 1950 birth cohort, 5.4% would have been ineligible for screening by USPSTF criteria in their younger ages but eligible based on risk-based criteria. Similarly, 10.4% of the cohort would be ineligible for screening by USPSTF in older ages. Notably, high proportions of blacks were ineligible for screening by USPSTF criteria at younger (15.6%) and older (14.2%) ages, which were statistically significantly greater than those of whites (4.8% and 10.8%, respectively; P < .001). Similar results were observed with other risk thresholds and for the 1960 cohort.ConclusionsFurther consideration is needed to incorporate comprehensive risk factors, including race and ethnicity, into lung cancer screening to reduce potential racial disparities.
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Project description:PurposeThe Finnish National Esophago-Gastric Cancer Cohort (FINEGO) was established with the aim of identifying factors that could contribute to improved outcomes in oesophago-gastric cancer. The aim of this study is to describe the patients with gastric cancer included in FINEGO.ParticipantsA total of 10 457 patients with gastric cancer or tumour diagnosis in the Finnish Cancer Registry or the Finnish Patient Registry during 1987-2016 were included in the cohort, with follow-up from Causes of Death Registry until 31 December 2016. All of the participants were at least 18 years of age, and had undergone either resectional or endoscopic mucosal surgery with curative or palliative intent.Findings to dateOf the 10 457 patients, 90.1% were identified to have cancer in both cancer and patient registries. In all, the median age was 70 at the time of surgery, 54.5% of the patients were men and 64.4% had no comorbidities. Education data were available for 31.1% of the patients, of whom the majority had had <12 years of formal education. Of the 7798 with cancer staging data available, 41.1% had a local cancer. Adenocarcinoma was the most common (94.2%) histological type. Almost all patients underwent open gastrectomy and 214% in hospitals with annual volume of more than 30 gastrectomies per year. A total of 8561 deaths occurred during the study period, of which 6474 were due to oesophago-gastric cancers. The 5-year survival was 34.6% and 5-year cancer-specific survival was 39.7%.Future plansThe data in FINEGO can be currently used for registry-based research but is being expanded by data extraction from patient records and scanning of histological samples from the Finnish biobanks. Initially, we are planning on studies on the national trends in treatment and mortality, and studies on the demographic factors and their influence on survival.
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Project description:ObjectivesExisting bronchiolitis guidelines do not reflect the needs of infants admitted to the PICU. This study aimed to identify PICU providers' reported practice variations and explore the need for critical bronchiolitis clinical guidelines.MethodsCross-sectional electronic survey available in English, Spanish, and Portuguese between November 2020 and March 2021, distributed via research networks from North and Latin America, Asia, and Australia/New Zealand.ResultsA total of 657 PICU providers responded, including 344 English, 204 Spanish, and 109 Portuguese. PICU providers indicated frequently using (≥25% of time) diagnostic modalities for nonintubated and intubated patients on PICU admission (complete blood count [75%-97%], basic metabolic panel [64%-92%], respiratory viral panel [90%-95%], chest x-ray [83%-98%]). Respondents also reported regularly (≥25% of time) prescribing β-2 agonists (43%-50%), systemic corticosteroids (23%-33%), antibiotics (24%-41%), and diuretics (13%-41%). Although work of breathing was the most common variable affecting providers' decision to initiate enteral feeds for nonintubated infants, hemodynamic status was the most common variable for intubated infants (82% of providers). Most respondents agreed it would be beneficial to have specific guidelines for infants with critical bronchiolitis who are requiring both noninvasive (91% agreement) and invasive (89% agreement) respiratory support.ConclusionsPICU providers report performing diagnostic and therapeutic interventions for infants with bronchiolitis more frequently than recommended by current clinical guidelines, with interventions occurring more frequently for infants requiring invasive support. More clinical research is needed to inform the creation of evidence-based guidelines specifically for infants with critical bronchiolitis.
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Project description:Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.
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