How are non-numerical prognostic statements interpreted and are they subject to positive bias?

Frank, clear communication with family members of terminally ill or incapacitated patients has important implications for well-being, satisfaction with care and sound decision-making | BMJ Supportive & Palliative Care

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Objectives: Numerical prognostic statements, particularly more negative ones, have been found to be interpreted in a positively biased manner. Less precise non-numerical statements, preferred by physicians, and particularly statements using threatening terms (dying vs surviving) may be even more subject to such biases.

Methods: Participants (N=200) read non-numerical prognostic statements framed in terms of dying or surviving and indicated their interpretation of likelihood of survival.

Results: Even the most extreme statements were not interpreted to indicate 100% likelihood of surviving or dying, (eg, they will definitely survive, 92.77%). The poorness of prognoses was associated with more optimistically biased interpretations but this was not, however, affected by the wording of the prognoses in terms of dying versus surviving.

Conclusions: The findings illuminate the ways in which commonly used non-numeric language may be understood in numeric terms during prognostic discussions and provide further evidence of recipients’ propensity for positive bias.

Full reference: Moyer, A. et al. (2017) How are non-numerical prognostic statements interpreted and are they subject to positive bias? 

Cancer mortality in patients with schizophrenia

Previous studies have reported conflicting results on the association between schizophrenia and cancer mortality | The British Journal of Psychiatry

Aims: To summarise available evidence and quantify the association between schizophrenia and cancer mortality using meta-analysis.

Method: We systematically searched literature in the PubMed and Embase databases. Risk estimates and 95% confidence intervals reported in individual studies were pooled using the DerSimonian–Laird random-effects model.

Results: We included 19 studies in the meta-analysis. Among them, 15 studies reported standardised mortality ratios (SMRs) comparing patients with schizophrenia with the general population, and the pooled SMR was 1.40 (95% CI 1.29–1.52, P<0.001). The other four studies reported hazard ratios (HRs) comparing individuals with schizophrenia with those without schizophrenia; the pooled HR was 1.51 (95% CI 1.13–2.03, P = 0.006).

Conclusions: Patients with schizophrenia are at a significantly increased risk of cancer mortality compared with the general population or individuals without schizophrenia.

Full reference: Zhuo, C. et al. (2017) Cancer mortality in patients with schizophrenia: systematic review and meta-analysis. The British Journal of Psychiatry. Published online: 8 June 2017.

Interactive prostate cancer guides

Prostate Cancer UK has launched interactive online guides relating to prostate cancer.  The guides are intended to support men who have symptoms or side effects from prostate cancer, prostatitis or their treatments.  Topics range from dealing with fatigue or urinary problems, to managing sex and relationships. The guides are interactive so tools and information can be tailored to the individual.

New chemotherapy approach offers breast cancer patients a better quality of life

The chemotherapy drug capecitabine gives patients a better quality of life and is as effective at preventing breast cancer from returning as the alternative regimen called CMF, when given following epirubicin. | ScienceDaily | Cancer Research UK

Around 4,400 patients on the TACT2 clinical trial were treated with the chemotherapy drug epirubicin followed by either capecitabine or CMF, after surgery.

Researchers at The Institute of Cancer Research, London, and the Cancer Research UK Edinburgh Centre found that capecitabine resulted in patients experiencing fewer side effects and having a better quality of life, and it was as effective at preventing cancer’s return as CMF.

Most patients experienced some side effects regardless of the treatment they were given. But those taking CMF were more likely to experience severe side effects including early menopause, nausea, infection, thrombosis, and anemia.

During the trial, patients were followed up after 12, 18 and 24 months, and then yearly for at least 10 years, to see if their cancer had returned and to monitor side effects. More than 85 per cent of patients did not experience their cancer returning for at least five years.

More detail at

Link to the research:

Cameron, D., et al.  Accelerated versus standard epirubicin followed by cyclophosphamide, methotrexate, and fluorouracil or capecitabine as adjuvant therapy for breast cancer in the randomised UK TACT2 trial (CRUK/05/19): a multicentre, phase 3, open-label, randomised, controlled trial. The Lancet Oncology.

New insight into how cancer spreads

Engineers have offered new insight into how cancer cells move based on their ability to sense their environment. The discovery could have a major impact on therapies to prevent the spread of cancer. | Via ScienceDaily

Researchers have found that cells have the ability to sense the stiffness of their environment and their ability to move is dependent upon that environment. These environments range from stiff (bone tissue) to soft (fatty tissue) with a medium stiffness (muscle tissue).

David Odde, a University of Minnesota biomedical engineering professor and Masonic Cancer Center researcher who led the study said “If we can trick cancer cells into believing it is not a good environment for migration, we can prevent the cancer cells from spreading.” The findings have been published in the Journal, Nature Communications

Full story at ScienceDaily

Journal reference: Benjamin L. Bangasser et al.  Shifting the optimal stiffness for cell migration. Nature Communications, 2017; 8

 

Comorbid conditions delay diagnosis of colorectal cancer

Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis | British Journal of Cancer

Method: Incident cases (aged greater than or equal to40 years, 2007–2009) with colorectal cancer were identified in the Clinical Practice Research Datalink, UK. Diagnostic interval was defined as time from first symptomatic presentation of colorectal cancer to diagnosis. Comorbid conditions were classified as ‘competing demands’ (unrelated to colorectal cancer) or ‘alternative explanations’ (sharing symptoms with colorectal cancer). The association between diagnostic interval (log-transformed) and age, gender, consultation rate and number of comorbid conditions was investigated using linear regressions, reported using geometric means.

Results: Out of the 4512 patients included, 72.9% had greater than or equal to1 competing demand and 31.3% had greater than or equal to1 alternative explanation. In the regression model, the numbers of both types of comorbid conditions were independently associated with longer diagnostic interval: a single competing demand delayed diagnosis by 10 days, and four or more by 32 days; and a single alternative explanation by 9 days. For individual conditions, the longest delay was observed for inflammatory bowel disease (26 days; 95% CI 14–39).

Conclusions: The burden and nature of comorbidity is associated with delayed diagnosis in colorectal cancer, particularly in patients aged greater than or equal to80 years. Effective clinical strategies are needed for shortening diagnostic interval in patients with comorbidity.

Full reference: Mounce, L.T.A et al. (2017) Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records. British Journal of Cancer 116, 1536-1543

Pre-diagnosis diet and survival after a diagnosis of ovarian cancer

The relationship between diet and survival after ovarian cancer diagnosis is unclear as a result of a limited number of studies and inconsistent findings.

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Methods: We examined the association between pre-diagnostic diet and overall survival in a population-based cohort (n=811) of Australian women diagnosed with invasive epithelial ovarian cancer between 2002 and 2005. Diet was measured by validated food frequency questionnaire. Deaths were ascertained up to 31 August 2014 via medical record review and Australian National Death Index linkage. We conducted Cox proportional hazards regression analysis, controlling for diagnosis age, tumour stage, grade and subtype, residual disease, smoking status, body mass index, physical activity, marital status, and energy intake.

Results: We observed improved survival with highest compared with lowest quartile of fibre intake (hazard ratio (HR)=0.69, 95% CI: 0.53–0.90, P-trend=0.002). There was a suggestion of better survival for women with highest compared with lowest intake category of green leafy vegetables (HR=0.79, 95% CI: 0.62–0.99), fish (HR=0.74, 95% CI: 0.57–0.95), poly- to mono-unsaturated fat ratio (HR=0.76, 95% CI: 0.59–0.98), and worse survival with higher glycaemic index (HR=1.28, 95% CI: 1.01–1.65, P-trend=0.03).

Conclusions: The associations we observed between healthy components of diet pre-diagnosis and ovarian cancer survival raise the possibility that dietary choices after diagnosis may improve survival.

Full reference: Playdon, M.C. et al. (2017) Pre-diagnosis diet and survival after a diagnosis of ovarian cancer. British Journal of Cancer. 116. pp. 1627–1637