BMJ oncology最新文献

{"title":"Long-term opioid therapy trajectories and overdose in patients with and without cancer.","authors":"Jessica S Merlin, Anne C Black, Amanda M Midboe, Lara Troszak, Steven M Asch, Amy Bohnert, Brenda T Fenton, Karleen F Giannitrapani, Peter Glassman, Robert D Kerns, Maria Silveira, Karl A Lorenz, Erica A Abel, William C Becker","doi":"10.1136/bmjonc-2022-000023","DOIUrl":"10.1136/bmjonc-2022-000023","url":null,"abstract":"<p><strong>Objective: </strong>Pain is experienced by most patients with cancer and opioids are a cornerstone of management. Our objectives were (1) to identify patterns or trajectories of long-term opioid therapy (LTOT) and their correlates among patients with and without cancer and (2) to assess the association between trajectories and risk for opioid overdose, considering the potential moderating role of cancer.</p><p><strong>Methods and analysis: </strong>We conducted a retrospective cohort study among individuals in the US Veterans Health Administration (VHA) database with incident LTOT with and without cancer (N=44,351; N=285,772, respectively) between 2010-2017. We investigated the relationship between LTOT trajectory and all International Classification of Diseases-9 and 10-defined accidental and intentional opioid-related overdoses.</p><p><strong>Results: </strong>Trajectories of opioid receipt observed in patients without cancer and replicated in patients with cancer were: low-dose/stable trend, low-dose/de-escalating trend, moderate-dose/stable trend, moderate-dose/escalating with quadratic downturn trend, and high-dose/escalating with quadratic downturn trend. Time to first overdose was significantly predicted by higher-dose and escalating trajectories; the two low-dose trajectories conferred similar, lower risk. Conditional hazard ratios (99% CI) for the moderate-dose, moderate-dose/escalating with quadratic downturn and high-dose/escalating with quadratic downturn trends were 1·84 (1·18, 2·85), 2·56 (1·54, 4·25), and 2·41 (1·37, 4·26), respectively. Effects of trajectories on time to overdose did not differ by presence of cancer; inferences were replicated when restricting to patients with stage 3/4 cancer.</p><p><strong>Conclusion: </strong>Patients with cancer face opioid overdose risks like patients without cancer. Future studies should seek to expand and address our knowledge about opioid risk in cancer patients.</p><p><strong>Trial registration: </strong>None.</p>","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42532458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-generated solutions to cancer inequity: recommendations from transgender, non-binary and intersex people on improving cancer screening and care.","authors":"Sachiko Ragosta,&nbsp;Jasmine Berry,&nbsp;Moria Mahanaimy,&nbsp;Laura Fix,&nbsp;Anu Manchikanti Gomez,&nbsp;Juno Obedin-Maliver,&nbsp;Heidi Moseson","doi":"10.1136/bmjonc-2022-000014","DOIUrl":"https://doi.org/10.1136/bmjonc-2022-000014","url":null,"abstract":"<p><strong>Objective: </strong>Transgender, non-binary and intersex people are less likely to receive appropriate cancer screening for their bodies and have a higher incidence of certain cancers than cisgender people. We aimed to elicit community-generated solutions to improve cancer screening for these populations.</p><p><strong>Methods and analysis: </strong>We conducted six online, asynchronous focus groups in English and Spanish with transgender, non-binary, intersex and cisgender participants who were at least 15 years of age from across the USA. Participants shared their experiences with cancer screening and related conversations with healthcare providers and recommendations for making screening practices more inclusive of their bodies and experiences. Focus group data were exported into transcripts and analysed with thematic analysis.</p><p><strong>Results: </strong>The 23 participants represented a diversity of races, genders, sexualities, ages and geographical locations. Transgender, non-binary and intersex participants, particularly Black, Indigenous and/or people of colour, reported having to self-advocate to receive necessary care by initiating conversations about screening with their providers, requesting specific screenings and educating providers about the appropriate care for their body. Notably, no white or cisgender participants described having to request relevant screenings or initiate conversations with their providers. Participants recommended that forms ask about body parts and allow for self-identification.</p><p><strong>Conclusion: </strong>The ability to properly screen patients can have a direct impact on cancer outcomes. More inclusive intake forms may alleviate the need for transgender, non-binary and intersex patients to self-advocate to receive necessary care. More work should be done to educate providers on cancer risk for transgender, non-binary and intersex individuals.</p>","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/74/a3/nihms-1919957.PMC10424502.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10006281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Welcome to <i>BMJ Oncology</i>.","authors":"Ananya Choudhury, Kathleen P Lyons, Kristoffer T Stewart","doi":"10.1136/bmjonc-2022-000011","DOIUrl":"10.1136/bmjonc-2022-000011","url":null,"abstract":"","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"1 1","pages":"e000011"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11203080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44351451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}