Publications by authors named "Edward Christopher Dee"

47 Publications

Medical imaging and nuclear medicine: points to note.

Lancet Oncol 2021 06;22(6):e226

Department of Radiation Oncology, The Medical City, Pasig City 1605, Philippines. Electronic address:

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http://dx.doi.org/10.1016/S1470-2045(21)00292-8DOI Listing
June 2021

Generalisability through local validation: overcoming barriers due to data disparity in healthcare.

BMC Ophthalmol 2021 May 21;21(1):228. Epub 2021 May 21.

Harvard TH Chan School of Public Health, Boston, MA, USA.

Cho et al. report deep learning model accuracy for tilted myopic disc detection in a South Korean population. Here we explore the importance of generalisability of machine learning (ML) in healthcare, and we emphasise that recurrent underrepresentation of data-poor regions may inadvertently perpetuate global health inequity.Creating meaningful ML systems is contingent on understanding how, when, and why different ML models work in different settings. While we echo the need for the diversification of ML datasets, such a worthy effort would take time and does not obviate uses of presently available datasets if conclusions are validated and re-calibrated for different groups prior to implementation.The importance of external ML model validation on diverse populations should be highlighted where possible - especially for models built with single-centre data.
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http://dx.doi.org/10.1186/s12886-021-01992-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138973PMC
May 2021

Association of Medicaid expansion and insurance status, cancer stage, treatment and mortality among patients with cervical cancer.

Cancer Rep (Hoboken) 2021 May 2:e1407. Epub 2021 May 2.

Harvard Medical School, Boston, Massachusetts, USA.

Background: Currently, little is known about the effect of the Patient Protection and Affordable Care Act's Medicaid expansion on care delivery and outcomes in cervical cancer.

Aim: We evaluated whether Medicaid expansion was associated with changes in insurance status, stage at diagnosis, timely treatment, and survival outcomes in cervical cancer.

Methods And Results: Using the National Cancer Database, we performed a difference-in-differences (DID) cross-sectional analysis to compare insurance status, stage at diagnosis, timely treatment, and survival outcomes among cervical cancer patients residing in Medicaid expansion and nonexpansion states before (2011-2013) and after (2014-2015) Medicaid expansion. January 1, 2014 was used as the timepoint for Medicaid expansion. The primary outcomes of interest were insurance status, stage at diagnosis, treatment within 30 and 90 days of diagnosis, and overall survival. Fifteen thousand two hundred sixty-five patients (median age 50) were included: 42% from Medicaid expansion and 58% from nonexpansion states. Medicaid expansion was significantly associated with increased Medicaid coverage (adjusted DID = 11.0%, 95%CI = 8.2, 13.8, p < .01) and decreased rates of uninsured (adjusted DID = -3.0%, 95%CI = -5.2, -0.8, p < .01) among patients in expansion states compared with non-expansion states. However, Medicaid expansion was not associated with any significant changes in cancer stage at diagnosis or timely treatment. There was no significant change in survival from the pre- to post-expansion period in either expansion or nonexpansion states, and no significant differences between the two (DID-HR = 0.95, 95%CI = 0.83, 1.09, p = .48).

Conclusion: Although Medicaid expansion was associated with an increase in Medicaid coverage and decrease in uninsured among patients with cervical cancer, the effects of increased coverage on diagnosis and treatment outcomes may have yet to unfold. Future studies, including longer follow-up are necessary to understand the effects of Medicaid expansion.
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http://dx.doi.org/10.1002/cnr2.1407DOI Listing
May 2021

Clinical characterization of radiation-associated muscle-invasive bladder cancer.

Urology 2021 Apr 20. Epub 2021 Apr 20.

Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Objective: To characterize the presentation, patterns of care, and outcomes of radiation-associated muscle-invasive bladder cancer (RA-MIBC) compared to primary (non-radiation associated) MIBC. RA-MIBC has been suggested to represent a more aggressive disease variant and be more difficult to treat compared to primary (non-radiation associated) MIBC.

Methods: We identified 60,090 patients diagnosed with MIBC between 1988-2015 using the Surveillance, Epidemiology, and End Results database and stratified patients based on whether radiation had been administered to a prior pelvic primary cancer. We used Fine-Gray competing risks regression to compare adjusted bladder cancer-specific mortality (BCSM) for RA-MIBC compared to primary MIBC.

Results: There were 1,093 patients with RA-MIBC and 58,997 patients with primary MIBC. RA-MIBCs were more likely to be T4 at diagnosis (21.0% vs 17.3%, P < .001), and less likely to be node-positive (10.3% vs 17.1%, P < .001). The rate of 5-year BCSM was significantly higher for patients with RA-MIBC vs primary MIBC (56.1% vs 35.3%, AHR 1.24, P < .001), even after stratification by other tumor, treatment and patient-specific factors.

Conclusion: RA-MIBCs tended to present with higher grade and T stage disease and were less likely to receive curative treatment. Even when accounting for stage, grade, and receipt of treatment, patients with RA-MIBC had worse survival compared to those with primary MIBC. These findings suggest that RA-MIBC present unique clinical challenges and may also represent a biologically more aggressive disease compared to primary MIBC. Future research is needed to better understand the biology of RA-MIBC and develop improved treatment approaches.
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http://dx.doi.org/10.1016/j.urology.2021.03.033DOI Listing
April 2021

Evolution of the Role of Radiotherapy for Anal Cancer.

Cancers (Basel) 2021 Mar 10;13(6). Epub 2021 Mar 10.

Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.

Prior to the 1980s, the primary management of localized anal cancer was surgical resection. Dr. Norman Nigro and colleagues introduced neoadjuvant chemoradiotherapy prior to abdominoperineal resection. Chemoradiotherapy 5-fluorouracil and mitomycin C afforded patients complete pathologic response and obviated the need for upfront surgery. More recent studies have attempted to alter or exclude chemotherapy used in the Nigro regimen to mitigate toxicity, often with worse outcomes. Reductions in acute adverse effects have been associated with marked advancements in radiotherapy delivery using intensity-modulated radiation therapy (IMRT) and image-guidance radiation delivery, resulting in increased tolerance to greater radiation doses. Ongoing trials are attempting to improve IMRT-based treatment of locally advanced disease with efforts to increase personalized treatment. Studies are also examining the role of newer treatment modalities such as proton therapy in treating anal cancer. Here we review the evolution of radiotherapy for anal cancer and describe recent advances. We also elaborate on radiotherapy's role in locally persistent or recurrent anal cancer.
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http://dx.doi.org/10.3390/cancers13061208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001637PMC
March 2021

Trends in frequency of e-cigarette use among cancer patients and survivors in the United States, 2014-2018.

Addict Behav 2021 08 16;119:106913. Epub 2021 Mar 16.

Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, United States. Electronic address:

Introduction: Electronic cigarettes (e-cigarettes) have become increasingly popular in the United States, including among cancer survivors; however, the majority of prior studies do not report frequency of active e-cigarette usage.

Methods: Using data from the National Health Interview Survey (2014-2018), frequency of active e-cigarette usage was estimated among cancer survivors reporting history of e-cigarette usage. Multivariable logistic regression analyses defined adjusted odds of active e-cigarette usage (either every day and some days vs. not at all) by year of survey and baseline demographic characteristics.

Results: Among 1529 cancer survivors who reported ever using e-cigarettes, 1172 (76.7%) were not active users, while 145 (9.5%) and 212 (13.9%) actively used e-cigarettes every day or some days, respectively. Later year of survey was negatively associated with active e-cigarette usage (p < 0.001) as was Black race (as compared to white race, AOR 0.47, p = 0.02). Age 45-54 was positively associated with active usage (as compared to 18-34 years, AOR 1.58, p = 0.02). Notably, individuals who were former or current traditional cigarette smokers had greater odds of reporting active e-cigarette use (27.0%, AOR 4.39, p < 0.001, 23.4%, AOR 3.28, p = 0.002, respectively) as compared to never traditional cigarette smokers (7.6%).

Conclusions: The majority of cancer survivors who have ever used e-cigarettes do not appear to be actively using them. Rather, our findings suggest that the reported increasing popularity of e-cigarettes may be driven by a growing absolute proportion of individuals trying e-cigarettes over time. Those who were current or former traditional cigarette smokers were more likely to actively use e-cigarettes. Our findings can help inform current policies on e-cigarettes and contextualize studies on long-term effects of e-cigarettes among survivors of cancer.
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http://dx.doi.org/10.1016/j.addbeh.2021.106913DOI Listing
August 2021

Financial worry and psychological distress among cancer survivors in the United States, 2013-2018.

Support Care Cancer 2021 Mar 16. Epub 2021 Mar 16.

Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.

Background: A growing proportion of cancer survivors experience financial toxicity. However, the psychological burden of cancer costs and associated mental health outcomes require further investigation. We assessed prevalence and predictors of self-reported financial worry and mental health outcomes among cancer survivors.

Patients And Methods: Data from the 2013-2018 National Health Interview Survey (NHIS) for adults reporting a cancer diagnosis were used. Multivariable ordinal logistic regressions defined adjusted odds ratios (AORs) of reporting financial worry by relevant sociodemographic variables, and sample weight-adjusted prevalence of financial worry was estimated. The association between financial worry and psychological distress, as defined by the six-item Kessler Psychological Distress Scale was also assessed.

Results: Among 13,361 survey participants (median age 67; 60.0% female), 9567 (71.6%) self-reported financial worry, including worries regarding costs of paying for children's college education (62.7%), maintaining one's standard of living (59.7%), and medical costs due to illness or accident (58.3%). Female sex, younger age, and Asian American race were associated with increased odds of financial worry (P < 0.05 for all). Of 13,218 participants with complete responses to K6 questions, 701 (5.3%) met the threshold for severe psychological distress. Participants endorsing financial worry were more likely to have psychological distress (6.6 vs. 1.2%, AOR 2.89, 95% CI 2.03-4.13, P< 0.001) with each additional worry conferring 23.9% increased likelihood of psychological distress.

Conclusions: A majority of cancer survivors reported financial worry, which was associated with greater odds of reporting psychological distress. Policies and guidelines are needed to identify and mitigate financial worries and psychologic distress among patients with cancer, with the goal of improving psychological well-being and overall cancer survivorship care.
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http://dx.doi.org/10.1007/s00520-021-06084-1DOI Listing
March 2021

Disparities in Refusal of Locoregional Treatment for Prostate Adenocarcinoma.

JCO Oncol Pract 2021 Feb 25:OP2000839. Epub 2021 Feb 25.

Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Purpose: We assessed sociodemographic factors associated with and survival implications of refusal of potentially survival-prolonging locoregional treatment (LT, including radiotherapy and surgery) despite provider recommendation among men with localized prostate adenocarcinoma.

Methods: The National Cancer Database (2004-2015) identified men with TxN0M0 prostate cancer who either received or refused LT despite provider recommendation. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% CI of refusing LT, with sociodemographic and clinical covariates. Models were stratified by low-risk and intermediate- or high-risk (IR or HR) disease, with a separate interaction analysis between race and risk group. Multivariable Cox proportional hazard ratios compared overall survival (OS) among men who received versus refused LT.

Results: Of 887,839 men (median age 64 years, median follow-up 6.14 years), 2,487 (0.28%) refused LT. Among men with IR or HR disease (n = 651,345), Black and Asian patients were more likely to refuse LT than White patients (0.35% 0.29% 0.17%; Black White AOR, 1.75; 95% CI, 1.52 to 2.01; < .001; Asian White AOR, 1.47; 95% CI, 1.05 to 2.06; = .027, race * risk group interaction < .001). Later year of diagnosis, community facility type, noninsurance or Medicaid, and older age were also associated with increased odds of LT refusal, overall and when stratifying by risk group. For men with IR or HR disease, LT refusal was associated with worse OS (5-year OS 80.1% 91.5%, HR, 1.65, < .001).

Conclusion: LT refusal has increased over time; racial disparities were greater in higher-risk disease. Refusal despite provider recommendation highlights populations that may benefit from efforts to assess and reduce barriers to care.
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http://dx.doi.org/10.1200/OP.20.00839DOI Listing
February 2021

Radiation Delay Is Okay, but Where Is the Evidence?-Reply.

JAMA Oncol 2021 Mar;7(3):464-465

Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamaoncol.2020.7618DOI Listing
March 2021

Response.

Chest 2021 01;159(1):450-451

Harvard Medical School, Boston, MA; Massachusetts Institute of Technology, Cambridge, MA. Electronic address:

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http://dx.doi.org/10.1016/j.chest.2020.08.2093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787061PMC
January 2021

Vaccination in the Philippines: experiences from history and lessons for the future.

Hum Vaccin Immunother 2021 06 24;17(6):1873-1876. Epub 2020 Dec 24.

Department of Health, Health Promotion and Communication Service, Philippines.

In anticipation of a potential vaccine for COVID-19, vaccine uptake may be critical in overcoming the pandemic, especially in countries like the Philippines, which has among the highest rates of infection in the region. Looking at the progress of vaccination in the country - its promises, pitfalls, and challenges - may provide insight for public health professionals and the public. The history of vaccination in the Philippines is marked by strong achievements, such as the establishment and growth of a national programme for immunization, and importantly, the eradication of poliomyelitis and maternal and neonatal tetanus. It is also marred by critical challenges which provide a springboard for improvement across all sectors - vaccine stock-outs,strong opposition from certain advocacy groups, and the widely publicized Dengvaxia controversy. Moving forward, with recent surveys having shown that vaccine confidence has begun to improve, these experiences may inform the approaches taken to address vaccine uptake. These lessons from the past highlight the importance of a strong partnership between health leaders and the local community, bearing in mind cultural appropriateness and humility; the engagement of multidisciplinary stakeholders; and the importance of foresight in preparing public health infrastructure for the arrival of a COVID-19 vaccine.
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http://dx.doi.org/10.1080/21645515.2020.1841541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115747PMC
June 2021

Association Between Travel Distance and Use of Postoperative Radiation Therapy Among Men With Organ-Confined Prostate Cancer: Does Geography Influence Treatment Decisions?

Pract Radiat Oncol 2021 Feb 5. Epub 2021 Feb 5.

Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address:

Purpose: After radical prostatectomy, men with adverse pathologic features or a persistent postoperative detectable prostate-specific antigen (PSA) are candidates for postoperative radiation therapy (PORT). Previous data have suggested disparities in receipt of adjuvant radiation therapy for adverse pathologic features according to travel distance. Among patients without adverse pathologic features (pT2 disease and negative margins), the main indication for PORT is a persistent postoperative detectable PSA. However, it remains unknown whether the rate of receipt of PORT in this cohort of men with persistently detectable PSA is related to travel distance from the treating facility.

Methods And Materials: Using the National Cancer Database, we identified 170,379 men with prostate cancer diagnosed from 2004 to 2015 managed with upfront surgery who were found to have pT2 disease with negative surgical margins. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% confidence intervals (CIs) of receiving PORT as the primary dependent variable and distance (<5, 5-10, 10-20, ≥20 miles from the treatment facility) as the primary independent variable.

Results: Within our cohort, progressively farther distance from the treatment facility was associated with lower rates of PORT. In patients living <5 miles, 5 to 10 miles, 10 to 20 miles, and >20 miles from the treating facility, rates of PORT of were 1.37% (referent), 1.16% (AOR, 0.90; 95% CI, 0.79-1.04; P = .158), 0.98% (AOR, 0.80; 95% CI, 0.70-0.93; P = .003), and 0.64% (AOR, 0.47; 95% CI, 0.41-0.54; P < .001), respectively.

Conclusions: For men with localized prostate cancer without adverse pathologic features managed with surgery, increasing distance from treatment facility was associated with lower receipt of PORT. Given that the rate of a persistent postoperative detectable PSA is unlikely to depend on the distance to the treatment facility, these findings raise the possibility that the geographic availability of radiation treatment facilities influences the decision to undergo PORT for patients with persistent postoperative detectable PSA.
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http://dx.doi.org/10.1016/j.prro.2020.12.002DOI Listing
February 2021

Factors Influencing Noncompletion of Radiation Therapy Among Men With Localized Prostate Cancer.

Int J Radiat Oncol Biol Phys 2021 Apr 1;109(5):1279-1285. Epub 2020 Dec 1.

Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida; Office of Community Outreach and Engagement, Sylvester Comprehensive Cancer Center, Miami, Florida. Electronic address:

Purpose: Treatment noncompletion may occur with radiation therapy (RT), especially with protracted treatment courses such as RT for prostate cancer, and may affect the efficacy of RT. For men with localized prostate cancer managed with primary RT, we evaluated associations between rates of treatment noncompletion and RT fractionation schedules.

Methods And Materials: The National Cancer Database identified men diagnosed from 2004 to 2014 treated with primary RT. Patients receiving 180 cGy/fraction or 200 cGy/fraction were defined as having completed radiation therapy if they received ≥41 fractions of 180 cGy/fraction or ≥37 fractions of 200 cGy/fraction. Stereotactic body radiation therapy (SBRT) was defined as 5 to 8 fractions of 600 to 800 cGy/fraction. Odds ratios compared rates of treatment noncompletion, adjusting for sociodemographic covariates. A propensity-adjusted multivariable Cox regression assessed the association between treatment completion and overall survival.

Results: Of 157,657 patients, 95.7% (n = 150,847) received conventional fractionation and 4.3% (n = 6810) received SBRT. Rates of noncompletion were 12.5% (n = 18,803) among patients who received conventional fractionation and 1.9% (n = 131) among patients who received SBRT (odds ratio [OR] versus conventional, 0.21; 95% confidence interval [CI], 0.18-0.26; P < .001). The rate of noncompletion among 25,727 African American patients was 12.8%, compared with 11.8% among 126,199 white patients (OR, 1.14; 95% CI, 1.09-1.19; P < .001). In a subgroup analysis, the disparity in noncompletion persisted for conventional fractionation (13.2% vs 12.3%, respectively; OR, 1.09; 95% CI, 1.05-1.13; P < .001), but not for SBRT (2.2% vs 1.8%, respectively; OR, 1.26; 95% CI, 0.79-2.00; P = .34). Noncompletion was associated with worse survival in a propensity-adjusted multivariable analysis (hazard ratio, 1.25; 95% CI, 1.22-1.29; P < .001).

Conclusions: SBRT was associated with lower rates of RT noncompletion among men with localized prostate cancer. African American race was associated with greater rates of treatment noncompletion, although the disparity may be decreased among men receiving SBRT.
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http://dx.doi.org/10.1016/j.ijrobp.2020.11.064DOI Listing
April 2021

Enabling hope.

Lancet Oncol 2020 12;21(12):e549

Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.1016/S1470-2045(20)30616-1DOI Listing
December 2020

General and Health-Related Internet Use Among Cancer Survivors in the United States: A 2013-2018 Cross-Sectional Analysis.

J Natl Compr Canc Netw 2020 11 2;18(11):1468-1475. Epub 2020 Nov 2.

Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.

Background: A significant proportion of cancer survivors endorse ongoing health information needs and may use the internet to access information. We assessed patterns and predictors of general and health-specific internet use among cancer survivors.

Methods: Using data from the National Health Interview Survey (NHIS), which was administered in 2013 through 2018, for adults reporting a cancer diagnosis, sample weight-adjusted estimates defined prevalence and multivariable logistic regressions defined adjusted odds ratios (aORs) of general and health-specific internet use, adjusting for relevant sociodemographic covariates, including healthcare satisfaction as the primary independent variable. The analysis for health-specific internet use was also repeated including a sex (female vs male)*healthcare satisfaction (very satisfied/somewhat satisfied vs somewhat dissatisfied/very dissatisfied) interaction term.

Results: Among 12,970 survivors of cancer, general and health-specific internet use increased from 2013 to 2018 (from 63.2% to 70.8% and from 46.8% to 52.2%, respectively; P<.05 for both). Survivors who were very dissatisfied with healthcare were more likely to use the internet for health information compared with those who were very satisfied (59.5% vs 48.0%; aOR, 1.78; 95% CI, 1.20-2.64; P=.004). Younger age, female sex, higher educational attainment, and higher socioeconomic status were all associated with increased reported use of the internet for both general and health-specific purposes (P<.001 for all). There was a significant sex*healthcare satisfaction interaction (P=.009) such that for female survivors, healthcare dissatisfaction was associated with higher odds of health-specific internet use (61.4% vs 52.5%; P<.001; men, P=.97). No association was found between healthcare satisfaction and general internet use (P=.42).

Conclusions: The increasing proportion of survivors of cancer using the internet for health-specific information may be associated with self-reported dissatisfaction with healthcare. Efforts are needed to improve both access to the internet and the quality of cancer-relevant online health information, and to enhance patients' online health literacy.
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http://dx.doi.org/10.6004/jnccn.2020.7591DOI Listing
November 2020

Availability and Readability of Online Patient Information on Osteosarcoma: Assessment of Pediatric Hospital and National Cancer Institute-Designated Cancer Center (NCIDCC) Osteosarcoma Web Pages.

JB JS Open Access 2020 Jul-Sep;5(3). Epub 2020 Aug 19.

Boston Children's Hospital, Boston, Massachusetts.

Online patient information (OPI) plays an important role in pediatric orthopaedic patient/caregiver education and decision-making. We assessed the availability and readability of OPI about osteosarcoma found at pediatric hospital and U.S. National Cancer Institute-designated cancer center (NCIDCC) websites.

Methods: The websites of all NCIDCCs and the top 50 pediatric hospitals identified using were included. The names of NCIDCCs and pediatric hospitals along with the terms "osteosarcoma," "bone sarcoma," and "sarcoma" were entered into Google.com, and were classified according to the availability of osteosarcoma-specific web pages. Unpaid monthly visits were assessed using the Ahrefs.com Organic Traffic Score (OTS) metric. Readability was assessed using 5 validated metrics and the composite grade level (CGL), the rounded mean of the 5 metrics.

Results: Of the 71 NCIDCCs and 50 pediatric hospitals, 48 (67.6%) and 18 (36.0%), respectively, did not have at least 1 web page dedicated to osteosarcoma-specific OPI. The mean OTS for all 116 NCIDCC and pediatric hospital osteosarcoma-specific web pages assessed was 177 estimated visits per month, which was less than the mean OTS for the top 10 Google.com "osteosarcoma" search results (3,287.9; p < 0.001). The 52 NCIDCC web pages with osteosarcoma OPI (representing 23 centers) had an average CGL of 12.9, representing a readability level of at least a high school degree. The mean CGL for the 64 pediatric hospital web pages with osteosarcoma OPI (representing 32 hospitals) was 12.8, also representing readability of at least a high school degree. Only 8 (12.5%) of the 64 web pages were written at a seventh or eighth-grade level.

Conclusions: Taken together, the majority of NCIDCCs and pediatric hospitals did not have a dedicated page of OPI for osteosarcoma. Of those that did, NCIDCC and pediatric hospital sites were visited much less frequently than sites visited through the most common Google.com searches. None of the osteosarcoma web pages offering OPI from NCIDCCs and pediatric hospitals met the American Medical Association readability recommendation (sixth-grade reading level). Therefore, greater effort must be made to create and direct patients and parents toward high-quality OPI of the appropriate level.

Clinical Relevance: The clinical relevance of this study lies in its evaluation of OPI and its ability to impact the patient experience of clinical care.
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http://dx.doi.org/10.2106/JBJS.OA.20.00054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480967PMC
August 2020

Psychological Distress and Access to Mental Health Services Among Cancer Survivors: a National Health Interview Survey Analysis.

J Gen Intern Med 2020 Sep 15. Epub 2020 Sep 15.

Department of Radiation Oncology, Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.

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http://dx.doi.org/10.1007/s11606-020-06204-3DOI Listing
September 2020

Chemoradiation for Patients with Resected Biliary Tract Cancers in the Adjuvant Setting: Reply to a Letter to the Editor.

Ann Surg Oncol 2020 12 10;27(Suppl 3):937-939. Epub 2020 Sep 10.

Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.1245/s10434-020-09130-0DOI Listing
December 2020

Disparities in Mortality from Larynx Cancer: Implications for Reducing Racial Differences.

Laryngoscope 2021 04 1;131(4):E1147-E1155. Epub 2020 Sep 1.

Department of Otolaryngology-Head & Neck Surgery, New York University Langone Health, New York, New York, U.S.A.

Objective: Race predicts overall mortality (OM) of laryngeal squamous cell carcinoma (LSCC) in the United States (US). We assessed whether racial disparities affect cancer-specific mortality (CSM) using the Surveillance, Epidemiology, and End Results (SEER) database.

Methods: Adults with LSCC from 2004 to 2015 were selected. Univariable and multivariable Cox proportional hazards and Fine-Gray competing-risks regression analysis adjusted for clinicodemographic factors defined hazard ratios (aHR).

Results: We identified 14,506 patients. The median age was 63 years. Most were male (11,725, 80.8%) and white (11,653, 80.3%), followed by Black (2294, 15.8%). Most had early-stage disease (7544, 52.0%) and received radiotherapy only (4107, 28.3%), followed by chemoradiation (3748, 25.8%). With median follow-up of 60 months, overall 3- and 5-year OM were 34.0% and 43.2%; CSM were 16.0% and 18.9%, respectively. Black patients had higher OM than white patients on univariable (HR 1.35, 95% CI, 1.26-1.44, P < .001) and multivariable (aHR 1.10, 95% CI, 1.02-1.18, P = .011) analyses. Black patients had higher CSM on univariable analysis (HR 1.22, 95% CI, 1.09-1.35, P < .001) but not on multivariable CSM analysis (aHR 1.01, 95% CI, 0.90-1.13, P = .864). On multivariable analysis, year of diagnosis, age, disease site, stage, treatment, nodal metastasis, marital status, education, and geography significantly predicted CSM.

Conclusion: On multivariable analyses controlling for sociodemographic, clinical, and treatment characteristics, Black and white patients differed in OM but not in CSM. However, Black patients presented with greater proportions of higher stage cancers and sociodemographic factors such as income and marital status that were associated with worse outcomes. Efforts to target sociodemographic disparities may contribute to the mitigation of racial disparities in LSCC.

Level Of Evidence: 4 Laryngoscope, 131:E1147-E1155, 2021.
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http://dx.doi.org/10.1002/lary.29046DOI Listing
April 2021

Data science to analyse the largest natural experiment of our time.

BMJ Health Care Inform 2020 08;27(3)

Division of Pulmonary Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

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http://dx.doi.org/10.1136/bmjhci-2020-100177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445349PMC
August 2020

Mental Distress and Mental Health Services Receipt in Foreign-Born Survivors of Cancer: a National Health Interview Survey Analysis.

J Gen Intern Med 2020 Aug 17. Epub 2020 Aug 17.

Department of Radiation Oncology, Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.

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http://dx.doi.org/10.1007/s11606-020-06031-6DOI Listing
August 2020

ASO Author Reflections: Adjuvant Chemoradiation for Patients with Resected Biliary Tract Cancers.

Ann Surg Oncol 2020 Dec 3;27(13):5173-5174. Epub 2020 Aug 3.

Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.1245/s10434-020-08970-0DOI Listing
December 2020

Patterns of Failure and the Need for Biliary Intervention in Resected Biliary Tract Cancers After Chemoradiation.

Ann Surg Oncol 2020 Dec 1;27(13):5161-5172. Epub 2020 Aug 1.

Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Background: This study assessed patterns of failure and rates of subsequent biliary intervention among patients with resected biliary tract cancers (BTCs) including gallbladder carcinoma (GBC) and extra- and intrahepatic cholangiocarcinoma (eCCA and iCCA) treated with adjuvant chemoradiation therapy (CRT).

Methods: In this single-institution retrospective analysis of 80 patients who had GBC (n = 29), eCCA (n = 43), or iCCA (n = 8) treated with curative-intent resection and adjuvant CRT from 2007 to 2017, the median radiation dose was 50.4 Gy (range 36-65 Gy) with concurrent 5-fluorouracil (5-FU) chemotherapy. All but two of the patients received adjuvant chemotherapy. The 2-year locoregional failure (LRF), 2-year recurrence-free survival (RFS), and 2-year overall survival (OS), and univariate predictors of LRF, RFS, and OS were calculated for the entire cohort and for a subgroup excluding patients with iCCA (n = 72). The predictors of biliary interventions also were assessed.

Results: Of the 80 patients (median follow-up period, 30.5 months; median OS, 33.9 months), 54.4% had American Joint Committee on Cancer (AJCC) stage 1 or 2 disease, 57.1% were lymph node-positive, and 66.3% underwent margin-negative resection. For the entire cohort, 2-year LRF was 23.8%, 2-year RFS was  43.7%, and 2-year OS was 62.1%.  When patients with iCCA were excluded, the 2-year LRF was 22.6%, the 2-year RFS was 43.9%, and the 2-year OS was 59.2%. In the overall and subgroup univariate analyses, lymph node positivity was associated with greater LRF, whereas resection margin was not. Biliary intervention was required for 12 (63.2%) of the 19 patients with LRF versus 11 (18%) of the 61 patients without LRF (P < 0.001). Of the 12 patients with LRF who required biliary intervention, 4 died of biliary complications.

Conclusions: The LRF rates remained significant despite adjuvant CRT. Lymph node positivity may be associated with increased risk of LRF. Positive margins were not associated with greater LRF, suggesting that CRT may mitigate LRF risk for this group. An association between LRF and higher rates of subsequent biliary interventions was observed, which may yield significant morbidity. Novel strategies to decrease the rates of LRF should be considered.
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http://dx.doi.org/10.1245/s10434-020-08967-9DOI Listing
December 2020

Refusal of surgery for colon cancer: Sociodemographic disparities and survival implications among US patients with resectable disease.

Am J Surg 2021 01 23;221(1):39-45. Epub 2020 Jun 23.

Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Newton-Wellesley Hospital, Newton, MA, USA. Electronic address:

Background: We aimed to identify factors associated with refusal of surgery among patients with colon cancer.

Methods: This 2004-2016 NCDB retrospective study identified AJCC stage I-III colon cancer patients who were recommended surgery. Multivariable logistic regression defined adjusted odds ratios of refusing treatment, with sociodemographic and clinical covariates. Treatment propensity-adjusted Cox proportional hazard ratios defined differential survival stratified by clinical stage, controlling for potential confounders.

Results: Of 170,594 patients recommended surgery, 1116 refused. Increased rates of surgery refusal were associated with older age, African American race, CDCC>3, and female sex. Decreased rates of surgery refusal were associated with higher income and private insurance. Stratifying by stage, refusal rates among African Americans remained disparately high. Refusal of surgery was associated with worse overall survival.

Conclusions: Disparate rates of refusal of surgery for resectable colon cancer by race and other sociodemographic factors highlight potential treatment adherence reinforcement beneficiaries, necessitating further study of shared decision-making.
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http://dx.doi.org/10.1016/j.amjsurg.2020.06.020DOI Listing
January 2021

Prostate cancer-specific mortality burden by risk group among men with localized disease: Implications for research and clinical trial priorities.

Prostate 2020 09 13;80(13):1128-1133. Epub 2020 Jul 13.

Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Objective: To estimate contemporary population-based patterns of the relative burden of prostate cancer-specific mortality (PCSM) attributable to each N0M0 prostate cancer risk-group, that may guide prioritization in research, trial design, and clinical practice.

Methods: We categorized 2004-2015 Surveillance, Epidemiology, and End Results database patients by risk group (low, favorable intermediate, unfavorable intermediate, high, and very highrisk). Using the Fine-Gray method, we calculated the relative burden of 10-year PCSM attributable to each risk group.

Results: Among N = 337 162 men (6.8-year median follow-up; median age 65 years), the relative proportion of low-, favorable intermediate-, unfavorable intermediate-, high-, and very high-risk diagnoses were 29.9% (N = 100 969), 31.1% (N = 104 696), 17.9% (N = 60 360), 18.1% (N = 61 023), and 3.0% (N = 10 114). Within 10 years of diagnosis, among patients who died of prostate cancer (N = 15 064), 5.0% (N = 746) had low-risk, 13.7% (N = 2060) had favorable intermediate-risk, 16.1% (N = 2429) had unfavorable intermediate-risk, 47.8% (N = 7196) had high-risk, and 17.5% (N = 2633) had very high-risk disease at diagnosis. Patients aged 65 and older accounted for 51.9% of all diagnoses and 72.3% of 10-year PCSM. Although black patients accounted for 15.0% of low-risk diagnoses, they accounted for 20.6% of 10-year PCSM. White patients accounted for 80.3% of low-risk diagnoses and 75.7% of 10-year PCSM.

Conclusion: Although high-risk and very high-risk disease account for one-fifth of diagnoses, they account for two-thirds of 10-year PCSM. Older patients and black patients with low-risk disease accounted for a disproportionately large proportion of deaths. These findings support targeting research toward high-risk disease and ensuring adequate representation of older and black men in clinical trials.
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http://dx.doi.org/10.1002/pros.24041DOI Listing
September 2020

Silver lining of COVID-19: Heightened global interest in pneumococcal and influenza vaccines, an infodemiology study.

Vaccine 2020 07 25;38(34):5430-5435. Epub 2020 Jun 25.

Harvard Medical School, Boston, MA, USA. Electronic address:

Background: Health-seeking behaviors change during pandemics and may increase with regard to illnesses with symptoms similar to the pandemic. The global reaction to COVID-19 may drive interest in vaccines for other diseases.

Objectives: Our study investigated the correlation between global online interest in COVID-19 and interest in CDC-recommended routine vaccines.

Design, Settings, Measurements: This infodemiology study used Google Trends data to quantify worldwide interest in COVID-19 and CDC-recommended vaccines using the unit search volume index (SVI), which estimates volume of online search activity relative to highest volume of searches within a specified period. SVIs from December 30, 2019 to March 30, 2020 were collected for "coronavirus (Virus)" and compared with SVIs of search terms related to CDC-recommended adult vaccines. To account for seasonal variation, we compared SVIs from December 30, 2019 to March 30, 2020 with SVIs from the same months in 2015 to 2019. We performed country-level analyses in ten COVID-19 hotspots and ten countries with low disease burden.

Results: There were significant positive correlations between SVIs for "coronavirus (Virus)" and search terms for pneumococcal (R = 0.89, p < 0.0001) and influenza vaccines (R = 0.93, p < 0.0001) in 2020, which were greater than SVIs for the same terms in 2015-2019 (p = 0.005, p < 0.0001, respectively). Eight in ten COVID-19 hotspots demonstrated significant positive correlations between SVIs for coronavirus and search terms for pneumococcal and influenza vaccines.

Limitations: SVIs estimate relative changes in online interest and do not represent the interest of people with no Internet access.

Conclusion: A peak in worldwide interest in pneumococcal and influenza vaccines coincided with the COVID-19 pandemic in February and March 2020. Trends are likely not seasonal in origin and may be driven by COVID-19 hotspots. Global events may change public perception about the importance of vaccines. Our findings may herald higher demand for pneumonia and influenza vaccines in the upcoming season.
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http://dx.doi.org/10.1016/j.vaccine.2020.06.069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315971PMC
July 2020