Survival Rate

BackgroundThe mortality rate of severely ill patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains unknown because of differences in patient background, clinical settings, and sample sizes between studies. We determined the in-hospital mortality of VA-ECMO patients and the proportion weaned from VA-ECMO using a national inpatient database in Japan.MethodsPatients aged ≥ 19 years who received VA-ECMO during hospitalization for cardiogenic shock, pulmonary embolism, hypothermia, poisoning, or trauma between 1 July 2010 and 31 March 2013 were identified, using The Japanese Diagnosis Procedure Combination national inpatient database.ResultsThe primary outcome was in-hospital mortality and the secondary outcome was the proportion weaned from VA-ECMO. A total of 5263 patients received VA-ECMO during the study period. The majority of patients had cardiogenic shock (n = 4,658). The number of patients weaned from VA-ECMO was 3389 (64.4%) and in-hospital mortality after weaning from VA-ECMO was 1994 (37.9%). In-hospital mortality without cardiac arrest in the cardiogenic shock group was significantly lower than that in patients with cardiac arrest (70.5% vs. 77.1%, p ConclusionsThe present nationwide study showed high mortality rates in patients who received VA-ECMO, and in particular in patients with cardiogenic shock and in patients with cardiac arrest. Weaning from VA-ECMO did not necessarily result in survival. Further studies are warranted to clarify risk-adjusted mortality of VA-ECMO using more detailed data on patient background.

ImportanceThe association between delayed surgical treatment and oncologic outcomes in patients with non-small cell lung cancer (NSCLC) is poorly understood given that prior studies have used imprecise definitions for the date of cancer diagnosis.ObjectiveTo use a uniform method to quantify surgical treatment delay and to examine its association with several oncologic outcomes.Design, setting, and participantsThis retrospective cohort study was conducted using a novel data set from the Veterans Health Administration (VHA) system. Included patients had clinical stage I NSCLC and were undergoing resection from 2006 to 2016 within the VHA system. Time to surgical treatment (TTS) was defined as the time between preoperative diagnostic computed tomography imaging and surgical treatment. We evaluated the association between TTS and several delay-associated outcomes using restricted cubic spline functions. Data analyses were performed in November 2021.ExposureWait time between cancer diagnosis and surgical treatment (ie, TTS).Main outcomes and measuresSeveral delay-associated oncologic outcomes, including pathologic upstaging, resection with positive margins, and recurrence, were assessed. We also assessed overall survival.ResultsAmong 9904 patients who underwent surgical treatment for clinical stage I NSCLC, 9539 (96.3%) were men, 4972 individuals (50.5%) were currently smoking, and the mean (SD) age was 67.7 (7.9) years. The mean (SD) TTS was 70.1 (38.6) days. TTS was not associated with increased risk of pathologic upstaging or positive margins. Recurrence was detected in 4158 patients (42.0%) with median (interquartile range) follow-up of 6.15 (2.51-11.51) years. Factors associated with increased risk of recurrence included younger age (hazard ratio [HR] for every 1-year increase in age, 0.992; 95% CI, 0.987-0.997; P = .003), higher Charlson Comorbidity Index score (HR for every 1-unit increase in composite score, 1.055; 95% CI, 1.037-1.073; P Conclusions and relevanceUsing a more precise definition for TTS, this study found that surgical procedures delayed more than 12 weeks were associated with increased risk of recurrence and worse survival. These findings suggest that patients with clinical stage I NSCLC should undergo expeditious treatment within that time frame.

BackgroundAs evidenced by the increasing popularity of YouTube (www.youtube.com), personal narratives shared through social media are an area of rapid development in communication among cancer survivors. Identifying the thematic and linguistic characteristics of YouTube cancer stories can provide a better understanding of this naturally occurring communication channel and inform social media communication efforts aiming to use personal stories to reach individuals with serious illnesses.ObjectiveThe objective of our study was to provide an in-depth description of authentic personal cancer stories. Through a linguistically based narrative analysis of YouTube stories, the analysis explicates the common attributes of these narratives.MethodsInformed by narrative theories, we conducted an iterative, bottom-up analysis of 35 YouTube videos identified by the search terms "cancer survivor" and "cancer stories". A list of shared thematic and linguistic characteristics was identified and analyzed.ResultsA subnarrative on the cancer diagnosis was present in 86% (30/35) of the stories under analysis. These diagnostic narratives were characterized by dramatic tension, emotional engagement, markers of the loss of agency or control, depersonalized reference to the medical personnel, and the unexpectedness of a cancer diagnosis. The analysis highlights the themes of story authenticity and emotional engagement in this online communication medium.ConclusionsInternet advances have enabled new and efficient exchange of personal stories, including the sharing of personal cancer experience among cancer survivors and their caregivers. The analytic results of this descriptive study point to the common characteristics of authentic cancer survivorship stories online. Furthermore, the results of this descriptive study may inform development of narrative-based communication, particularly in maintaining authenticity and emotional engagement.

ImportanceSocial determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations.ObjectiveTo determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity.Design, setting, and participantsThis cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023.ExposureDifferential state-level public assistance spending.Main outcome and measureThe main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage.ResultsA total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P Conclusions and relevanceThis cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.