Unmarried Patients Research Articles

Predictive model of prognosis index for invasive micropapillary carcinoma of the breast based on machine learning: a SEER population-based study

BackgroundInvasive micropapillary carcinoma (IMPC) is a rare subtype of breast cancer. Its epidemiological features, treatment principles, and prognostic factors remain controversial.ObjectiveThis study aimed to develop an improved machine learning-based model to predict the prognosis of patients with invasive micropapillary carcinoma.MethodsA total of 1123 patients diagnosed with IMPC after surgery between 1998 and 2019 were identified from the Surveillance, Epidemiology, and End Results (SEER) database for survival analysis. Univariate and multivariate analyses were performed to explore independent prognostic factors for the overall and disease-specific survival of patients with IMPC. Five machine learning algorithms were developed to predict the 5-year survival of these patients.ResultsCox regression analysis indicated that patients aged > 65 years had a significantly worse prognosis than those younger in age, while unmarried patients had a better prognosis than married patients. Patients diagnosed between 2001 and 2005 had a significant risk reduction of mortality compared with other periods. The XGBoost model outperformed the other models with a precision of 0.818 and an area under the curve of 0.863.ConclusionsA machine learning model for IMPC in patients with breast cancer was developed to estimate the 5-year OS. The XGBoost model had a promising performance and can help clinicians determine the early prognosis of patients with IMPC; therefore, the model can improve clinical outcomes by influencing management strategies and patient health care decisions.

Desire for pregnancy and fertility preservation in young patients with breast cancer.

Data on the desire for pregnancy and the status of fertility preservation (FP) in patients with breast cancer remain unclear. This study aimed to determine the status of patients with breast cancer who desired pregnancy and FP implementation before systemic therapy. This retrospective study surveyed the institutional clinical databases and electronic medical records of patients aged < 43years with stages 0-III primary breast cancer during surgery and treated between April 2020 and March 2021. All patients were enquired about their desire for pregnancy in a questionnaire by "present," "absent," and "unsure" at their first visit. The correlation between the desire for pregnancy, implementation of FP, and clinicopathological factors was investigated. Among 1005 patients who underwent surgery for primary breast cancer, 146 were included in the analysis. Of them, 34 (23.3%) patients had a desire for pregnancy, and 45 (30.8%) chose "unsure." Factors associated with the desire for pregnancy were younger age during surgery (p < 0.0022), unmarried status (p < 0.001), nulliparity (p < 0.001), early-stage disease (p = 0.0016), and estrogen receptor positivity (p = 0.008). Among 115 patients who underwent systemic therapy, 13 (11.3%) underwent FP before systemic therapy. Patients who were nulliparous frequently pursued FP (p = 0.0195). The proportion of FP implementation was low in patients who received neoadjuvant chemotherapy (p = 0.0863). Our study suggests that unmarried, nulliparous, and younger patients were more interested in pregnancy, and nulliparous patients frequently pursued FP.

Clinical characteristic, laboratory biomarkers, treatment regimen and psychiatry problems predictors of outcomes of alopecia areata: a prospective study

Background Alopecia areata (AA) has multiple aetiology such as genetic and environmental triggers. Aims To assess the recovery rate of AA and examine the associated psychiatric problems. Additionally, the relationship between clinical, psychiatric, and laboratory biomarkers and alopecia outcomes were investigated, along with potential risk factors that could aid in treating alopecia. Patients and methods A prospective cohort research included 42 AA patients and 45 healthy controls. Group A (active disease), group B (inactive disease), and group C (healthy control) were based on illness outcomes after 3 months of treatment. The Severity of Alopecia Tool (SALT), treatment regimens, laboratory investigation Interleukins 19 and 33 (IL-19 and IL-33), Symptom Checklist 90, and post-traumatic stress disorder Checklist for DSM-5 (PCL-5) were evaluated. Results After 3 months of therapy, the incidence of inactive AA was found to be 57.14%. Being females with family history of dermatitis were highly related with active illness, while smoking and unmarried patients were associated with inactive disease. After 3 months of treatment, active illness had the highest mean IL-33 and IL-19 levels. Conclusion The active disease group exhibited the highest mean IL-33 and IL-19 levels at baseline following three months of treatment. Our patients had 7.1% somatization, 7.1% obsessive-compulsive symptoms, 4.8% depression, 4.8% anxiety, 15.9% anger-hostility, 35.7% phobic-anxiety, 26.2% paranoid ideation, 4.8% psychoticism, and 61.9% post-traumatic stress disorder. AA outcomes were linked to females, a family history of dermatological disorders, smoking, being single, and higher mean IL-33 and IL-19 levels. Psychosis was highly linked with active AA. Only khellin and Ultraviolet A improved AA results.

Association of marital status with cardiovascular death risk in patients with lung cancer: A population-based study

BackgroundTo investigate the association of marital status on cardiovascular death risk in lung cancer patients. MethodsUsing data from the Surveillance, Epidemiology, and End Results (SEER) database in the United States from 2011 to 2015 (N = 118,293), the association between marital status and cardiovascular death (CVD) risk in patients with lung cancer was assessed by competing-risks regression models. ResultsUnmarried status was associated with increased risk of cardiovascular death in lung cancer patients [hazard ratio (HR) = 1.398, 95 % confidence interval (CI): 1.268–1.542], which remained significant even after adjusting for potential covariates (HR = 1.407, 95 % CI: 1.276–1.551). Further unmarried subgroups analysis showed that the different unmarried status were associated with increased cardiovascular death risk as follows: single (HR = 1.397, 95 % CI: 1.236–1.1.580), separated (HR = 1.630, 95 % CI: 1.153–2.305), divorced (HR = 1.318, 95 % CI: 1.158–1.500), and widowed (HR = 1.561, 95 % CI: 1.393–1.749). Further subgroup analysis by sex revealed that compared to male lung cancer patients with married, CVD risk was significant increased in their counterparts with widowed (adjusted HR = 1.509, 95 % CI: 1.291–1.764, P<0.001), single (adjusted HR = 1.361, 95 % CI: 1.168–1.585, P<0.001) and divorced (adjusted HR = 1.353, 95 % CI: 1.177–1.555, P<0.001) rather than those with separated. However, similar phenomena was only observed in female lung cancer patients with widowed (adjusted HR = 1.414, 95 % CI: 1.220–1.640, P<0.001) and single (adjusted HR = 1.438, 95 % CI: 1.195–1.730, P<0.001). ConclusionUnmarried status was associated with increased cardiovascular death risk in patients with lung cancer, which highlighted that more attention and humanistic/supportive care should be offered to unmarried lung cancer patients for improving the prognosis.

Sexual function in patients with testicular neoplasm before specialized treatment methods. Clinical trial

Introduction. Testicular neoplasms (TN) are one of the most common oncological diseases among young men. Currently the sexual function of such patients remains understudied. The aim of the study was to assess the state of sexual function in men with testicular neoplasms before treatment.Material and methods. The cross-sectional continuous single-center study included 35 men with TN. The average age of patients was 34.2–8.2 years (95% CI: 31.4-37.1). The comparison group included 28 healthy volunteers, average age 30.5–4.9 years (95% CI: 28.6-32.4). Some social characteristics of the patient (marriage and children), the state of sexual function (using the IIEF-15 and ICF questionnaires), the level of anxiety and depression (according to the HADS scale), the levels of total and free testosterone, globulin-binding sex hormone (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin were evaluated.Results. Patients in the main group showed a decrease in erection in 10 (28.6%), satisfaction with sexual intercourse in 12 (34.3%), impaired orgasmic function in 2 (5.7%), decreased libido and overall satisfaction in 9 (25.7%). Nonparametric analysis revealed a statistically significant decrease in libido (p &lt; 0.05), satisfaction with sexual intercourse (p &lt; 0.05) and overall satisfaction (p = 0.007) in patients of the main group compared with the control group. Patients with testicular neoplasms had disorders of the mental component – in 12 (34.3%), erection – in 20 (57.1%), neurohumoral – in 25 (71.4%), ejaculatory – in 10 (28.6%) patients. Subclinical depression was observed in 13 (37.1%) and clinically pronounced depression in 11 (31.4%) patients of the main group. Anxiety and depression were statistically significantly more common in the main group (p = 0.0013). The level of anxiety and depression was more pronounced in unmarried (p = 0.013) children-free patients (p = 0.025). Low levels of total testosterone were detected in 13 (39.4%), free testosterone in 12 (38.7%), LH in 11 (33.3%), FSH in 6 (18.7%) patients from the main group. Elevated levels of LH were recorded in 4 (12.1%), FSH in 4 (12.5%), prolactin in 2 (6.9%) and SHBG in 1 (5%).Conclusion. Patients with TN have a deterioration in sexual function compared to a healthy population of the same age group. The further studies are needed to access the influence of tumor histology and treatment of sexual function.

Assessment of Quality of Life in Patients With End-Stage Kidney Disease on Maintenance Hemodialysis Using the Missoula-Vitas Quality of Life Index.

This study aimed to evaluate the quality of life (QoL) in end-stage kidney disease (ESRD) patients on maintenance hemodialysis through the Missoula-Vitas Quality of Life Index-15 (MVQOLI-15) to identify factors affecting their well-being. A cross-sectional study was conducted at the Dialysis Unit of the Nephrology Department, Nishtar Hospital Multan. Over six months, 140 eligible patients were enrolled using non-probability consecutive sampling. Participants aged 18-80 yearson maintenance hemodialysis for at least six monthswere evaluated using the MVQOLI-15questionnaire assessing symptoms, function, interpersonal, well-being, and transcendence dimensions of QoL. Data were analyzed using theIBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York). Inferential statistical tests, including the t-test for comparing two groups and analysis of variance (ANOVA) for comparing multiple groups, were utilized to determine the significance of differences in QoL scores among different demographic and clinical categories. P-values less than 0.05 were considered statistically significant. The study analyzed 140 hemodialysis patients, with a mean age of 52.41 ± 16.31 years and an average hemodialysis duration of 4.55 ± 2.46 years. Most participants were aged 61-80 years (35.7%), had secondary education (44.3%), and were married (67.1%). QoLscores, measured using the MVQOLI, indicated mean values for symptoms at 4.51 ± 10.71, function at 5.77 ± 8.04, interpersonal at 7.49 ± 13.67, well-being at -13.60 ± 7.11, transcendence at 8.24 ± 13.12, and a total score of 16.24 ± 2.75. Significant findings include the following: females had higher symptomscores (p=0.001) and lower well-being scores (p=0.000); younger patients (<30 years) had higher function scores (p=0.054); patients on hemodialysis three times per week had higher function scores (p=0.006); patients taking 1 to 3 pills per day had higher transcendence scores (p=0.000); unmarried patients had higher symptoms scores (p=0.064) and lower well-being scores (p=0.004); and illiterate patients had higher symptoms (p=0.005) and transcendence scores (p=0.034). In total score, patients on hemodialysis once per week reported significantly better scores (p=0.011). This study highlights varied QoL experiences among hemodialysis patients, with transcendence scoring the highest and well-being, the lowest. Demographic factors such as age, gender, and education level significantly impact the QoL dimensions. Understanding these findings can guide personalized interventions to improve the well-being of hemodialysis patients.

Budd Chiari Syndrome: Radiological Aspects of the Disease Pertaining to Infertility and Role of Interventional Radiology in Successful Conception

PurposeTo study the association of infertility in patients with Budd Chiari syndrome, radiological aspects of the disease determining infertility and to see if there are improved chances of conception following radiological intervention. MethodsRetrospective search of the hospital records was done and patients with Budd Chiari syndrome, who underwent radiological intervention between January 2016 till October 2021 were initially included. Patients outside the reproductive age group, unmarried patients, patients who did not attempt conception or attempted for less than 1 year and patients having other causes of infertility were excluded. 90 patients were assessed for presence of primary or secondary infertility using infertility questionnaire. In patients with infertility, conception during 1 year follow-up period following radiological intervention, was assessed. Results146 patients underwent radiological intervention for budd chiari syndrome in the study period. 56 patients meeting the exclusion criteria were excluded from the study and subsequently 90 patients were assessed for infertility. 16.7% (15/90) of our patients with Budd Chiari syndrome had infertility, of which 7 were male, and 8 were female. Infertility is more common in younger age group (mean – 28.8±4.2 years) (p<0.001). In females, presence of pelvic venous congestion on preprocedural imaging showed significant association with infertility(p<0.001). 6 (40%) out of 15 of patients with infertility conceived during a 1year follow-up period after radiological intervention. ConclusionInfertility is a common in patients with Budd Chiari syndrome, with a prevalence of 16.7%. Pelvic venous congestion is associated with women having infertility. Radiological interventions play important role in management of Budd Chiari and may help to overcome infertility in these patients.

Incidence rate and risk factors for suicide in patients with breast cancer in the USA: A surveillance, epidemiology, and end results analysis (SEER)

PurposeTo investigate suicide mortality and the related factors among female breast cancer patients in the United States. MethodsThe SEER database was used to identify 716,422 patients diagnosed with breast cancer between 2010 and 2018 to calculate a standardized mortality rate (SMR). An analysis of risk factors for suicide death was conducted using the univariate and multivariate Cox proportional risk model. An estimation of suicide probability was performed through a nomogram model. ResultsCompared with the expected suicide cases (n = 155) in the general population of the United States at the corresponding period (a suicide death rate of 5.71 per 100,000 person-years), the suicide rate among 716,422 breast cancer patients was followed during 2010–2018 and showed a relatively higher rate of 9.02 per 100,000 person-years. The SMR was 1.58 (95%CI: 1.39–1.79). White and other races were nine and seven times more likely to complete suicide than Black race, respectively (aHR = 9.013, 95%CI: 3.335–24.36, P < 0.001; aHR = 7.129, 95%CI: 2.317–21.931, P = 0.001); unmarried or single patients were at higher risk than married patients (aHR = 1.693, 95%CI: 1.206–2.377, P = 0.002). Patients receiving radiotherapy (aHR = 0.731, 95%CI: 0.545–0.980, P = 0.036) were less likely to complete suicide than those who did not. ConclusionFemale breast cancer patients in the United States have a higher suicide rate than the general public, and the risk factors consist of non-black ethnicity, being single or unmarried, and not being treated with radiotherapy. As a result of this study, clinicians may be able to identify female breast cancer patients who are at high risk of suicide, thus providing appropriate psychological support at the early stage.

Adherence, burden, and morbidity of chronic diseases in an outpatient clinic: A-CaMo I

Introduction: Chronic non-communicable diseases (NCDs) are a significant global health challenge due to their prolonged duration and varied progression rates, leading to increased noncompliance, especially in developing nations. Pharmacological adherence, defined by WHO, is crucial for maintaining patients' quality of life and reducing morbidity, yet it remains inadequate, with about 50% non-adherence in developed countries, 30% of which is unintentional. Understanding disease burden is vital, but research on medication adherence, burden, and morbidity in the Dominican Republic and Latin American countries is lacking, necessitating comprehensive studies. Objectives: Ascertaining the degree of pharmaceutical adherence, disease burden, and morbidity amongst individuals with chronic illnesses were the study’s primary endpoints. Methodology: The project was a cross-sectional, prospective study that examined the sociodemographic data, past medical history, and medication regimens of a sample of 284 patients attending an outpatient clinic. Patients were selected using convenience sampling, to be later screened and interviewed after consultation for any of the diseases present on the MAR-Scale or the DBMA questionnaires. The screening sought only those individuals who met inclusion criteria (&gt; 18 years old, diagnosed with a disease present on either scale) and did not meet exclusion criteria (not being able to fill the questionnaire due to language barrier). Data collected was stored using the KoboToolBox program and later summarized with mean and standard deviation for further processing using STATA BE. Statistical tests were programmed with an alpha of 5%, 95% CI, and p &lt; 0.05 for statistical significance. Results: The sample, comprising 133 individuals, had a mean age of approximately 58.4 years, with a majority of female participants. Most participants were married, Dominican, and of Hispanic Latino ethnicity, with Christianity being the predominant religion. Regarding past medical history, while a substantial portion had no prior respiratory or cardiovascular ailments, diabetes mellitus was prevalent, indicating potential implications for current health status and treatment adherence. Adherence, measured by daily and weeklyscores, ranged from 1.0 to 3.8, with the burden score per patient averaging 50.1 and per disease averaging 2.6. The analysis revealed that 16.9% of participants were monomorbid, while 83.1% were multimorbid, showcasing the complexity of health conditions within the cohort. Conclusion: The study's key results reveal a significant portion of patients without a history of respiratory or cardiovascular diseases, suggesting a relatively healthy baseline. However, a notable proportion had diabetes, potentially impacting their current health status and treatment adherence. Furthermore, the study delves into factors influencing adherence, burden levels, and reasons for nonadherence. Findings indicate unmarried patients and those with lower education levels tend to exhibit higher burden levels and lower adherence scores. Mental health conditions like depression or anxiety, osteoporosis, and heart failure are associated with elevated burden levels. The study also assesses the reliability of adherence and burden measurement tools, emphasizing the importance of considering population variability in interpreting results. Limitations include challenges in patient selection and data collection, particularly regarding patients with multimorbidity. Overall, the study highlights the need for comprehensive exploration of adherence, burden, and morbidity to predict disease control, progression, and patient quality of life effectively in future research endeavors.

Abstract PO2-10-05: The Impact of Socioeconomic Factors on Breast Cancer Diagnosis in Latin America: The LATINA study (LACOG 0615/MO39485)

Abstract Background: Breast cancer (BC) is the most common malignancy and one of the leading causes of cancer death in women in Latin America (LATAM). Studies have highlighted the importance of understanding contextual characteristics of each patient population to inform health policy-making. However, few data are available on women from LATAM, a region with marked inequalities. Methods: LATINA (LACOG 0615/MO39485) is a multicenter prospective cohort study designed to describe sociodemographic characteristics, diagnosis, treatment, and outcomes of patients with BC in LATAM. Female and male patients aged ≥18 years newly diagnosed (i.e., &amp;lt; 12 months from research site activation) histologically confirmed clinical stage I-IV BC were enrolled. Eligible patients provided informed consent and had data collected from medical records at diagnosis and every 6 months up to 5 years. Results: Between February 2020 and August 2022, 3276 patients with BC from 31 research sites in 10 LATAM countries were included. Median age was 54 years (range 23–95), 91.8% (N=3008) were Hispanic or Latinos, the majority (68%, N=2224) were diagnosed with stage II or III BC, and 73% (N=2362) were treated in the public health system. Age, stage and detection method stratified by education level, marital status and employment status are shown in Table 1. Overall, 38.8% (N=1149) of patients had not completed high school. These patients were more frequently diagnosed by symptoms and diagnosed at later stages than those who had completed high school or college. Half of the patients were married/in a civil partnership at BC diagnosis (50.5%, N=1497). Unmarried patients were more commonly diagnosed by symptoms (71.7%, N=835 vs. 64%, N=916, p&amp;lt; 0.001) and with stage II/III BC (71.4%, N=868 vs. 67.6%, N=1038, p&amp;lt; 0.001) than married patients. Most patients (54.1%, N=1603) were not employed at BC diagnosis. Patients not employed were more frequently diagnosed by symptoms (68.8%, N=1044) than employees/self-employed (61.6%, N=675). After adjusting for age, country, health care provision (public or private), stage, and BC subtype, being diagnosed by symptoms was associated with not being married (adjusted odds ratio [aOR] 1.41, 95% CI 1.11–1.82, p=0.004), being not employed (aOR 1.41, 95% CI 1.08–1.84, p=0.011), and not having completed high school (aOR 1.46, 95% CI 1.00–2.13, p=0.031). Conclusions: Patients with a lower level of education, unmarried and not employed, are more likely not to perform BC screening and to be diagnosed by symptoms. Socioeconomic characteristics impact the method of detection of BC in LATAM and are associated with diagnosis at later stages. Further analyses of the LATINA study will provide invaluable data for informing regional health policy-making in LATAM. Citation Format: Gustavo Werutsky, Cynthia Villarreal-Garza, Henry Gómez, Juan Manuel Donaire, José Bines, Luis Henrique Fein, Maria Clara Horsburgh, Paula Cabrera-Galeana, Heloísa Resende, Rosa Vasallo Veras, Miriam Raimondo, Ricardo Elías Brugés Maya, Vidal Maria Del Rosario, Yeni Nerón, Ana Maria Donoso, Fernanda B. Damian, José D'Oliveira, Couto Filho, Maria Isabel Alonso, Victoria Costanzo, Tomás Reinert, Adriana Elizabeth Borello, Eduardo Cronenberger, Luis Fein, Marcela Urrego, Enrique Alanya, Jorge Luis Soriano García, Saúl Campos-Gomez, Eduardo A. Richardet, Hugo Castro-Salguero, Felipe Cruz, Diego Gómez, Angel Hernández, Carlos Alberto Farfan Tello, Ronald Rodríguez, Rafaela Jesus, Gustavo Gössling, Carlos Barrios. The Impact of Socioeconomic Factors on Breast Cancer Diagnosis in Latin America: The LATINA study (LACOG 0615/MO39485) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-10-05.

Unmarried Status Effect on Stage at Presentation and Treatment Patterns in Non-Metastatic Upper Tract Urothelial Carcinoma Patients

BackgroundUnmarried status has been associated with higher proportions of locally advanced stage and lower treatment dose intensification rates in several urological and non-urological malignancies. However, no previous investigators focused on the association between unmarried status and advanced stage (T3-4N0-2) at presentation and lower nephroureterectomy (RNU) and systemic therapy (ST) rates in non-metastatic upper tract urothelial carcinoma (UTUC) patients. MethodsUsing the Surveillance, Epidemiology, and End Results (SEER) database 2000-2020, all non-metastatic UTUC patients were identified. Multivariable logistic regression models (LRMs) tested for differences in stage at presentation and treatment (RNU and ST) according to marital status (married vs unmarried), in a sex-specific fashion. ResultsOf all 8544 non-metastatic UTUC patients, 4748 (56%) were male vs 3190 (44%) were female. Of all 4748 male UTUC patients, 1191 (25%) were unmarried. Of all 3190 female UTUC patients, 1608 (50%) were unmarried. In multivariable LRMs predicting RNU, unmarried status was an independent predictor of lower RNU rates in male (Odds Ratio [OR]: 0.56; P < .001), but not in female (OR: 0.81; P = .1) non-metastatic UTUC patients. In multivariable LRMs predicting ST exposure, unmarried status was an independent predictor of lower ST rates in both male (OR:0.73; P = .03) and female (OR:0.64; P < .001) UTUC patients. In multivariable LRMs predicting locally advanced stage (T3-4N0-2), unmarried status was not associated with an increased risk of locally advanced stage at presentation in either male (OR: 0.95; P = .5) or female (OR: 0.99; P = .9) UTUC patients. ConclusionsUnmarried male UTUC patients appear at risk of less being able to access RNU, relative to their married counterparts. Moreover, unmarried UTUC patients appear to less benefit from ST, regardless of sex. Conversely, unmarried status was not associated with an increased risk of locally advanced stage at presentation in either male or female UTUC patients.

ASSOCIATIONS BETWEEN QUALITY OF LIFE WITH PSYCHOLOGICAL STATE, DISORDERS OF THE CARDIOVASCULAR SYSTEM AND PECULIARITIES OF INFECTIOUS PNEUMONIA 3 MONTHS AFTER COVID-19

Highlights The severity of pneumonia and the presence of cardiovascular diseases have a negative impact on the physical aspect of quality of life. Women`s quality of life indicators tend to be worse than men`s. Regular work activity is a factor that improves the physical aspect of the quality of life. AbstractAim. To analyze the relationship between the quality of life (QoL) and the psychological and somatic state of patients 3 months after Coronavirus disease 2019 (COVID-19) pneumonia.Methods. The study is a part of the “Prospective Follow-up Study of Patients after COVID-19 Pneumonia” that involves data on 351 patients (age 53±11) 3 months after hospitalization. Women accounted for 51% of all patients. Cardiologist and clinical psychologist examined cardiovascular and psychological health of patients. We assessed QoL by using the SF-36 survey, and psychometric properties by using the GAD-7, PHQ-9 and PSS-10. We estimated the severity of the COVID-19 using the discharge summaries information.Results. The prevalence of stress symptoms (27,4% vs 5,1%, p = 0,030) and depression (18,00 [13,00–25,00] vs 20,00 [15,00–24,00], p = 0,032) were higher in patients with cardiovascular disorders. Moreover, QoL was lower in this group of patients in all subscales except for “Mental health” and “Mental health aspect”. Women were more 3 times more likely to experience psychological and emotional disorders compared to men (29,1% vs 16,2%, ОR = 2,615 95%; 95% CI 1,695–4,035; p&lt;0,001). At the same time, all QoL indicators in women were significantly lower. For example, the average score on subscales “Mental health aspect” was equal to 47,17 [41,33–51,35] in women and 50,16 [46,65–52,35] in men (p&lt;0,001), and the average score on subscale “Physical health aspect” was equal to 66,32 [60,71–72,62] in women and 63,82 [56,04–70,93] in men (p = 0,003). The QoL scores on physical health subscales were higher in patients with mild and moderate lung lesions. Scores on the “Social functioning” subscale were higher in unmarried patients (87,00 [62,50–100,00] in married patients and 100,00 [75,10–100,00] in unmarried patients; p = 0,017), and scores on the subscale “Physical health aspect” were lower in unemployed patients (48,73 [44,43–52,31] in employed patients and 44,84 [41,32–49,73] in unemployed patients; p&lt;0,001).Conclusion. Тhe presence of cardiovascular disorders and severity of the COVID-19 pneumonia affected the physical aspect of QoL. QoL in women is worse compared with men. Regular work activity improves the physical aspect of QoL. There is a decrease in social activity in married patients after COVID-19 compared to unmarried patients.

Disparities Exist in the Experience of Financial Burden Among Orthopedic Trauma Patients: A Systematic Review.

There are substantial costs associated with orthopedic injury and management. These costs are likely not experienced equally among patients. At the level of the healthcare and hospital systems, disparities in financial burden and patient demographics have already been identified among orthopedic trauma patients. Accordingly, disparities may also arise at the level of the patient and how they experience the cost of their care. We sought to determine (1) how patient demographics are associated with financial burden/toxicity and (2) if patients experience disproportionate financial burden/toxicity and social support secondary to their economic standing. It has been described that there is an inequitable experience in clinical and economic outcomes in certain socioeconomic demographics leading to disparities in financial burden. It has been further reported that orthopedic injury, management, and outcomes are not experienced equitably among all demographic and socioeconomic groups. Ten articles met inclusion criteria, among which financial burden was disproportionately experienced amid orthopedic trauma patients across age, gender, race, education, and marital status. Financial hardship was also unequally distributed among different levels of income, employment, insurance status, and social deprivation. Younger, female, non-White, and unmarried patients experience increased financial burden. Patients with less education, lower income, limited or no insurance, and greater social deprivation disproportionately experienced financial toxicity compared to patients of improved economic standing. Further investigation into policy changes, social support, and barriers to appropriate care should be addressed to prevent unnecessary financial burden and promote greater patient welfare.

Adherence to antihypertensives in the United States: A comparative meta-analysis of 23 million patients.

Adherence to antihypertensives is crucial for control of blood pressure. This study analyzed factors and interventions that could affect adherence to antihypertensives in the US. PubMed, Scopus, Web of Science, and Embase were searched on January 21, 2022 and December 25, 2023 for studies on the adherence to antihypertensives in the US. Nineteen studies and 23545747 patients were included in the analysis, which showed that adherence to antihypertensives was the highest among Whites (OR: 1.47, 95% CI 1.34-1.61 compared to African Americans). Employment status and sex were associated with insignificant differences in adherence rates. In contrast, marital status yielded a significant difference where unmarried patients demonstrated low adherence rates compared to married ones (OR: 0.8, 95% CI 0.67-0.95). On analysis of comorbidities, diabetic patients reported lower adherence to antihypertensives (OR: 0.95, 95% CI 0.92-0.97); furthermore, patients who did not have Alzheimer showed higher adherence rates. Different BMIs did not significantly affect the adherence rates. Patients without insurance reported significantly lower adherence rates than insured patients (OR: 3.93, 95% CI 3.43-4.51). Polypill users had higher adherence rates compared with the free-dose combination (OR: 1.21, 95% CI 1.2-1.21), while telepharmacy did not prove to be as effective. Lower adherence rates were seen among African Americans, uninsured, or younger patients. Accordingly, interventions such as fixed-dose combinations should be targeted at susceptible groups. Obesity and overweight did not affect the adherence to antihypertensives.

The influence of marital status at diagnosis on survival of adult patients with mantle cell lymphoma

PurposeMarital status has been reported to influence the survival outcomes of various cancers, but its impact on patients with mantle cell lymphoma (MCL) remains unclear. This study aimed to assess the influence of marital status at diagnosis on overall survival (OS) and cancer-specific survival (CSS) in patients with MCL.MethodsThe study utilized data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER)-18 databases, including 6437 eligible individuals diagnosed with MCL from 2000 to 2018. A 1:1 propensity matching method (PSM) minimized confounding factor. Univariate and multivariate analyses determined hazard ratios (HR). Stratified hazard models were developed for married and unmarried statuses across time intervals.ResultsMarried patients exhibited better 5-year OS and CSS rates compared to unmarried patients (54.2% vs. 39.7%, log-rank p < 0.001; 62.6% vs. 49.3%, log-rank p < 0.001). Multivariate analysis indicated that being unmarried was an independent risk factor for OS (adjusted HR 1.420, 95% CI 1.329–1.517) and CSS (adjusted HR 1.388, 95% CI 1.286–1.498). After PSM, being unmarried remained an independent risk factor for both OS and CSS. Among unmarried patients, widowed individuals exhibited the poorest survival outcomes compared to patients with other marital statuses, with 5-year OS and CSS rates of 28.5% and 41.0%, respectively. Furthermore, in the 10-year OS and CSS hazard model for widowed individuals had a significantly higher risk of mortality, with the probability of overall and cancer-specific mortality increased by 1.7-fold and 1.6-fold, respectively.ConclusionMarital status at diagnosis is an independent prognostic factor for MCL patients, with widowed individuals showing worse OS and CSS than those who are married, single, or divorced/separated. Adequate psychological and social support for widowed patients is crucial for improving outcomes in this patient population.

Studying the impact of marital status on diagnosis and survival prediction in pancreatic ductal carcinoma using machine learning methods

Pancreatic cancer is a commonly occurring malignant tumor, with pancreatic ductal carcinoma (PDAC) accounting for approximately 95% of cases. According of its poor prognosis, identifying prognostic factors of pancreatic ductal carcinoma can provide physicians with a reliable theoretical foundation when predicting patient survival. This study aimed to analyze the impact of marital status on survival outcomes of PDAC patients using propensity score matching and machine learning. The goal was to develop a prognosis prediction model specific to married patients with PDAC. We extracted a total of 206,968 patient records of pancreatic cancer from the SEER database. To ensure the baseline characteristics of married and unmarried individuals were balanced, we used a 1:1 propensity matching score. We then conducted Kaplan–Meier analysis and Cox proportional-hazards regression to examine the impact of marital status on PDAC survival before and after matching. Additionally, we developed machine learning models to predict 5-year CSS and OS for married patients with PDAC specifically. In total, 24,044 PDAC patients were included in this study. After 1:1 propensity matching, 8043 married patients and 8,043 unmarried patients were successfully enrolled. Multivariate analysis and the Kaplan–Meier curves demonstrated that unmarried individuals had a poorer survival rate than their married counterparts. Among the algorithms tested, the random forest performed the best, with 0.734 5-year CSS and 0.795 5-year OS AUC. This study found a significant association between marital status and survival in PDAC patients. Married patients had the best prognosis, while widowed patients had the worst. The random forest is a reliable model for predicting survival in married patients with PDAC.

Incidence, prognostic factors, and a nomogram of cervical cancer with lung metastasis: A SEER-based study

AimsThe purpose of this study was to investigate the incidence, survival and prognostic factors of cervical cancer with lung metastasis at the initial diagnosis and to develop a visual nomogram to predict the prognosis of these patients. MethodsWe used the Surveillance, Epidemiology and End Results (SEER) database to screen patients diagnosed with cervical cancer from 2010 to 2015. After strict inclusion and exclusion, the chi-square test was used to evaluate the differences in the clinical characteristics of patients with cervical cancer, and then we used Kaplan–Meier method to perform survival analysis among cervical cancer patients with lung metastasis. Next, univariate and multivariate Cox proportional hazard regression models were used to estimate prognostic factors of these patients and we developed a visualized and novel nomogram to judge the prognosis. Results476 patients with lung metastasis and 12,016 patients without lung metastasis were included in this study. The incidence of lung metastasis was higher in unmarried white cervical cancer patients between the ages of 40 and 60, and grade III cervical squamous cell carcinoma patients were more likely to have lung metastasis. In addition, grade, surgery, radiotherapy, sequence of surgery and radiotherapy and chemotherapy were significantly related to the outcomes of cervical cancer patients with lung metastasis. Furthermore, our nomogram could predict the 3-year and 5-year overall survival (OS) of these patients. Finally, the AUC of 3-year OS and 5-year OS were confirmed to be 0.969 and 0.939 respectively by ROC curves, with good consistency. ConclusionsAge at diagnosis, race, marital status, and characteristics of the tumor can influence the incidence of lung metastasis in cervical cancer patients. Besides, grade, surgery, radiotherapy, sequence of surgery and radiotherapy and chemotherapy may deeply affect the prognosis of cervical cancer patients with lung metastasis. The nomogram built in this study may help clinicians to formulate individualized treatment strategies and encourage the development of more and more comprehensive and accurate predictive models.

Association of Major Adverse Financial Events and Later-Stage Cancer Diagnosis in the United States.

This study assessed the prevalence of specific major adverse financial events (AFEs)-bankruptcies, liens, and evictions-before a cancer diagnosis and their association with later-stage cancer at diagnosis. Patients age 20-69 years diagnosed with cancer during 2014-2015 were identified from the Seattle, Louisiana, and Georgia SEER population-based cancer registries. Registry data were linked with LexisNexis consumer data to identify patients with a history of court-documented AFEs before cancer diagnosis. The association of AFEs and later-stage cancer diagnoses (stages III/IV) was assessed using separate sex-specific multivariable logistic regression. Among 101,649 patients with cancer linked to LexisNexis data, 36,791 (36.2%) had a major AFE reported before diagnosis. The mean and median timing of the AFE closest to diagnosis were 93 and 77 months, respectively. AFEs were most common among non-Hispanic Black, unmarried, and low-income patients. Individuals with previous AFEs were more likely to be diagnosed with later-stage cancer than individuals with no AFE (males-odds ratio [OR], 1.09 [95% CI, 1.03 to 1.14]; P < .001; females-OR, 1.18 [95% CI, 1.13 to 1.24]; P < .0001) after adjusting for age, race, marital status, income, registry, and cancer type. Associations between AFEs prediagnosis and later-stage disease did not vary by AFE timing. One third of newly diagnosed patients with cancer had a major AFE before their diagnosis. Patients with AFEs were more likely to have later-stage diagnosis, even accounting for traditional measures of socioeconomic status that influence the stage at diagnosis. The prevalence of prediagnosis AFEs underscores financial vulnerability of patients with cancer before their diagnosis, before any subsequent financial burden associated with cancer treatment.

Characterizing Tobacco Usage in Otolaryngology Patients to Target Smoking Cessation Efforts.

Smoking cessation is critical in reducing incidence of head and neck cancers (HNC) and improving postoperative outcomes. Accurate documentation of tobacco usage is necessary to understand prevalence in patients to target smoking cessation. This study aims to characterize tobacco usage documentation, including electronic nicotine delivery systems (ENDS) use, among otolaryngology patients. Retrospective chart review. Penn State Health Milton S. Hershey Medical Center (PSHMC). A retrospective chart review was conducted on adult otolaryngology patients seen from January 1, 2020 - December 31, 2020. Patient demographics, details of alcohol and tobacco usage, including type of tobacco, and subspecialty seen were collected. Associations were evaluated using chi-square tests and a multivariable logistic regression model. Patients (n = 2137) were an average of 58.4years old ±18.0, 59.3% female, and 78.0% white. Of participants with documented tobacco history (n = 944), 56.7% were never users, 28.9% were former users, and 14.4% were current users. Among current users (n = 308), 86.4% used cigarettes, and 5.2% used ENDS. The remainder used chew (4.9%) and cigars (3.25%). Odds of tobacco use were 1.5x greater for males (95% CI 1.19-2.00), 1.6x greater for unmarried patients (95% CI 1.24-2.09), 2.1x greater for those with no insurance vs government (95% CI 1.43-3.18), and 2.4x greater for those diagnosed with HNC (95% CI 1.64-3.49). Most patients report cigarette smoking when asked about tobacco use. Taking into consideration the rise of ENDS use, our sample showed ENDS use that was higher than the national average. There is significant opportunity for improved history taking, especially within general and head and neck oncology subspecialties for more comprehensive treatment.

Effect of marital status on the survival outcomes of cervical cancer: a retrospective cohort study based on SEER database

BackgroundCervical cancer is the fourth most common malignant tumor troubling women worldwide. Whether marital status affects the prognosis of cervical cancer is still unclear. Here, we investigate the prognostic value of marital status in patients with cervical cancer based on the seer database.Material/MethodsThe demographic and clinical data of patients with cervical cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2017. Patients were divided into two groups (married and unmarried) according to marital status, and then the clinical characteristics of each group were compared using the chi-square test. Propensity score matching (PSM) was used to reduce differences in baseline characteristics. The overall survival (OS) and cervical cancer-specific survival (CCSS) were assessed by the Kaplan-Meier method, univariate and multivariate Cox regression models, and stratified analysis. Moreover, univariate and multivariate competing risk regression models were performed to calculate hazard ratios (HR) of death risk.ResultsA total of 21,148 patients were included in this study, including 10,603 married patients and 10,545 unmarried patients. Married patients had better OS(P < 0.05) and CCSS (P < 0.05) compared to unmarried patients, and marital status was an independent prognostic factor for both OS (HR: 0.830, 95% CI: 0.798–0.862) and CCSS (HR: 0.892, 95% CI: 0.850–0.937). Moreover, after eliminating the competing risk, married patients (CCSD: HR:0.723, 95% CI: 0.683–0.765, P < 0.001) had a significantly decreased risk of death compared to unmarried patients. In stratified analysis, the married patients showed better OS and CCSS than the unmarried patients diagnosed in 1975–2000 and 2001–2017.ConclusionsBeing married was associated with a favorable prognosis of cervical cancer, and marital status was an independent prognostic factor for cervical cancer.