Bradley D. Hunter

Conditional Survival Among Cancer Patients in the United States

PURPOSE To report 5-year relative cancer survival probabilities conditional on having already survived > or = 1 years after the initial diagnosis for 11 cancer sites, diagnosed during 1990-2001 and followed through 2006. METHODS Analyses are based on 1,151,496 cancer cases in population-based cancer registries in the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. RESULTS The 5-year relative conditional survival probability tended to improve with each year already survived. Improvement was greatest for more lethal cancers (e.g., lung or pancreas) and for cases with a more advanced stage at diagnosis. The 5-year relative survival probability conditional on already having survived 5 years exceeded 90% for locally staged prostate cancer, melanoma (whites only), breast cancer (females only), corpus uteri cancer, urinary bladder cancer, Hodgkins lymphoma, rectal cancer, colon cancer, ovary cancer, and pancreatic cancer. Only lung cancer did not reach 90%. For these cancer sites combined, 5-year relative survival probability conditional on already having survived 5 years averaged about 85% for regionally staged disease, 68% for distant staged disease, and 87% for unknown staged disease. The 5-year relative conditional survival probability tended to be significantly lower among patients diagnosed at older ages, among males, among nonwhites, and among those diagnosed during 1990-1995 compared with later years. CONCLUSION Conditional survival probability estimation provides further useful prognostic information to cancer patients, tailored to the time already survived since diagnosis.

The importance of addressing social determinants of health at the local level: the case for social capital

Social determinants are gaining momentum in public health practice. Many proposed solutions for tackling social determinants are outside the scope of local public health professionals. This article reviews the literature to find possible moderating variables which may buffer the effects of the social determinants of health at the local level, and allow social determinants to be addressed within the purview of local health departments. The systematic approach employed for this article entailed searches of electronic academic databases (PubMed, EBSCO and Medline) and additional searches using Internet search engines and relevant websites for articles published between 1,975 and May 2010. The search revealed 2,554 articles, and 36 were determined appropriate for inclusion. The purpose of the search was to identify published articles relating to social determinants of health, social capital and effective approaches for addressing both at the level of the local health department. The search was then expanded to include unpublished material, to include the perspectives of local health departments. This process resulted in the inclusion of content from five sources. In this article, the case is made for focusing on social capital interventions to mitigate health problems associated with social determinants. Examples of successful interventions are provided to aid public health professionals in developing locale-specific solutions for addressing social determinants.

Religious Orientation and Health among Active Older Adults in the United States

This study utilizes a combination of intrinsic and extrinsic Religious Orientation Scales to explore the connection between religion and health in a sample of physically active, older adults. The revised Religious Orientation Scale and the RAND Short Form 36 (SF-36) were adopted to relate religious orientation (intrinsic, extrinsic, pro-religious, and non-religious) and self-rated mental and physical health status. Individuals of pro-religious orientation reported significantly worse health for physical functioning, role limitations due to physical health, and energy or fatigue when compared with those of all other religious orientations; however, no dose–response relationships were found between religious orientation and self-rated health. The results of this study indicate that deleterious health effects may accompany pro-religious orientation. Caution is provided for directors of religious programs for older adults.

Pleural effusions in patients with Hodgkin lymphoma: clinical predictors and associations with outcome.

Abstract Pleural effusions are common in Hodgkin lymphoma (HL). However, little is known about their prognostic significance. One hundred and ten patients with HL who presented to the University of Rochester from 1 January 2003 to 12 December 2010 were reviewed. Pleural effusions were evaluated on review of diagnostic-quality computed tomography (CT) scans. Pleural effusions were present in 26/110 patients: 1/7 (14%) stage I, 11/61 (18%) stage II, 3/18 (17%) stage III and 11/24 (46%) stage IV, and 25/91 (27%) patients had mediastinal involvement, 16/38 (42%) patients had extranodal involvement (any) and 5/14 (35%) patients had E lesions (direct extension to extranodal tissue). Unilateral and bilateral pleural effusions were equally prevalent. Survival analysis demonstrated decreased overall survival for patients with pleural effusions of borderline significance for stage I–IV (p = 0.055) but failed to show significance for patients with stage I–III (p = 0.115). Increasing stage, any extranodal involvement and bulky mediastinal disease were each predictive of pleural effusions. The presence of pleural effusion at presentation may be predictive of inferior survival for patients with Hodgkin lymphoma.

A comparison of religious orientation and health between Whites and Hispanics.

The study of religious orientation thus far has neglected the influence of race/ethnicity as well as all four religious orientations (intrinsic, extrinsic, pro-religious and nonreligious) in explaining differences in both physical and psychological health. A representative sample of 250 Hispanics and 236 non-Hispanic Whites in Utah was drawn and analysed for differences in health (self-rated health, life satisfaction, exercise) according to race/ethnicity, religious orientation and religious attendance. Responses to the Religious Orientation Scale differed significantly by race/ethnicity, indicating that future studies of religious orientation should take cultural context into account. For both Whites and Hispanics, pro-religious individuals reported the highest life satisfaction scores, which highlight the utility of employing the fourfold religious orientation typology.

Anticoagulation for the treatment of venous thromboembolism in patients with brain metastases: a meta-analysis and systematic review

The risk benefit decision in providing anticoagulation for patients with brain metastases is amongst the most difficult decisions faced by clinicians. The purpose of our study was to evaluate both the risk of intracerebral hemorrhage (ICH) associated with anticoagulation therapy and the effect of anticoagulation on survival in patients with brain metastases and venous thromboembolism (VTE). A systematic review of the literature was performed via the PubMed, EMBASE, and the Cochrane databases. Our initial search resulted in 1304 unique citations, and 5 studies satisfied all eligibility criteria and were included for analysis. The odds ratio for development of ICH in the setting of anticoagulation was 1.37 (CI 0.86–2.17, p = 0.18). The hazard ratio for survival was 0.96 (CI 0.51–1.81, p = 0.90). While limited, the best available evidence suggests that there is no increased risk of ICH and no survival benefit associated with providing anticoagulation to patients with brain metastases who develop VTE. These patients merit individualized discussion of the risk and benefit of anticoagulation therapy. Current guidelines should be updated to include more recent studies and highlight the uncertainty of the net clinical benefit associated with anticoagulation.

Late Relapses After High-dose Chemotherapy and Autologous Stem Cell Transplantation in Patients With Diffuse Large B-cell Lymphoma in the Rituximab Era

Background The standard of care for diffuse large B‐cell lymphoma (DLBCL) relapsing after front‐line therapy is high‐dose chemotherapy and autologous stem cell transplantation (ASCT). Evidence has suggested that early relapses (ie, within 1 year) after this approach portends exceptionally poor outcomes. However, data examining relapses > 1 year after ASCT for patients with refractory or relapsed DLBCL are limited, in particular, in the rituximab era. We sought to examine the effect of early (≤ 1 year) and late (> 1 year) relapse after ASCT in a single‐institution cohort of patients with relapsed and refractory DLBCL treated with chemoimmunotherapy. Materials and Methods A retrospective analysis was performed on the data from 85 consecutive patients who had undergone ASCT for biopsy‐confirmed relapsed or refractory DLBCL from 2001 to 2010 at the University of Rochester Medical Center. All patients had received rituximab as a part of treatment. Of the 85 patients, 35 developed relapse after ASCT. These 35 patients were divided into 2 groups according to the timing of the relapse (≤ 1 year and > 1 year after ASCT). Results The median follow‐up period was 6.4 years. For all patients, the overall survival (OS) from post‐ASCT relapse was 5.2 years. For the 27 patients developing relapse at ≤ 1 year after ASCT, the median OS was 0.6 year and progression‐free survival was 0.4 year. For the 8 patients developing relapse at > 1 year after ASCT, the median OS was 5.9 years and progression‐free survival was 2.9 years. Conclusion Patients with relapsed or refractory DLBCL experiencing relapse > 1 year after ASCT had good outcomes. Despite the relative rarity in incidence, a significant risk of relapse of DLBCL after ASCT remains, suggesting the need for continued monitoring because of the possibility of later progression. Micro‐Abstract The standard of care for diffuse large B‐cell lymphoma (DLBCL) relapsing after front‐line therapy is high‐dose chemotherapy and autologous stem cell transplantation (ASCT). Patients with relapsed or refractory DLBCL experiencing relapse > 1 year after ASCT had good outcomes. Despite the relative rarity in incidence, a significant risk of relapse of DLBCL after ASCT remains, suggesting the need for continued monitoring because of the possibility of later progression.