Lived experiences of transgender and nonbinary people in the perioperative context: a qualitative study.

BACKGROUND: Transgender and nonbinary (TNB) people experience obstacles that create barriers to accessing health care, including stigmatization and health inequities. Our intention was to describe the lived experiences of TNB patients and identify potential gaps in the education of health care professionals. METHODS: We conducted a qualitative descriptive study influenced by phenomenology by interviewing with TNB adults who underwent surgery in Canada within the previous 5 years. We recruited participants using purposeful and snowball sampling via online social networking sites. Audio recordings were transcribed. Two authors coded the transcripts and derived the themes. RESULTS: We interviewed 21 participants, with a median interview duration of 49 minutes. Participants described positive and negative health care encounters that led to stress, confusion, and feelings of vulnerability. Major themes included having to justify their need for health care in the face of structural discrimination; fear and previous traumatic experiences; community as a source of support and information; and the impact of interactions with health care professionals. INTERPRETATION: Participants detailed barriers to accessing care, struggled to participate in shared decision-making, and desired trauma-informed care principles; they described strength in community and positive interactions with health care professionals, although barriers to accessing gender-affirming care often overshadowed other aspects of the perioperative experience. Additional research, increased education for health care professionals, and policy changes are necessary to improve access to competent care for TNB people.

Localization of spots in FISH images of breast cancer using 3-D shape analysis.

The fluorescence in situ (FISH) belongs to the most often used molecular cytogenetic techniques, applied in many areas of diagnosis and research. The analysis of FISH images relies on localization and counting the red and green spots in order to determine HER2 status of the breast cancer samples. The algorithm of spot localization presented in the paper is based on 3-D shape analysis of the image objects. The subsequent regions of the image are matched to the reference pattern and the results of this matching influence localization of spots. The paper compares different shapes of the reference pattern and their efficiency in spot localization. The numerical experiments have been performed on the basis of 12 cases (patients), each represented by three images. Few thousands of cells have been analysed. The quantitative analyses comparing different versions of algorithm are presented and compared to the expert results. The best version of the procedure provides the absolute relative difference to the expert results smaller than 3%. These results confirm high efficiency of the proposed approach to the spot identification. The proposed method of FISH image analysis improves the efficiency of detecting fluorescent signals in FISH images. The evaluation results are encouraging for further testing of the developed automatic system directed to application in medical practice.

Fractionated proton radiation treatment for pediatric craniopharyngioma: preliminary report.

UNLABELLED: This retrospective preliminary review evaluated the efficacy and toxicity of fractionated proton radiotherapy in the management of pediatric craniopharyngioma. METHODS: Sixteen patients, aged 7-34 years, were treated with proton-beam radiation. All had undergone at least one tumor resection. Seven patients underwent repeat resection for recurrence; one had previous x-ray radiotherapy. A daily dose of 1.8 cobalt gray equivalent was used to give a total dose in the range of 50.4-59.4 cobalt gray equivalent. RESULTS: Local control was achieved in 14 of 15 patients. Twelve of 15 patients survived. There were few acute side effects. Long-term complications included newly diagnosed panhypopituitarism, a cerebrovascular accident from which the patient fully recovered, and an out-of-proton-field meningioma in the single patient who received previous radiotherapy. DISCUSSION: Fractionated proton radiotherapy is an effective treatment for children with craniopharyngioma. Longer follow-up is needed to evaluate late complications.

Patient tolerance of rectal balloons in conformal radiation treatment of prostate cancer.

PURPOSE: To evaluate patient tolerance of intrarectal balloons used during conformal prostate irradiation. METHODS AND MATERIALS: A retrospective analysis was performed on 3,561 patients who underwent conformal radiation for prostate cancer. Therapy consisted of proton irradiation of the prostate and seminal vesicles and X-ray treatment of the pelvis when warranted. The number of treatments in which the balloon was tolerated was recorded. Results were stratified according to method of irradiation (protons alone vs. combined proton/X-ray) and method of planning (2D vs. 3D planning of X-ray fields in patients undergoing combination treatment). RESULTS: Of all the patients evaluated, 3,474 (97.6%) tolerated the balloon throughout treatment; 87 (2.4%) declined the balloon for 1 or more treatments and tolerated the balloon for 85.5% of their treatments. Chi-square analysis revealed a significant tolerance advantage in those who received protons alone compared with combination treatment (99.5% vs. 95.7%; p < 0.001). In patients undergoing combination treatment, chi-square analysis did not reveal significant tolerance differences in patients undergoing 3D vs. 2D planning for pelvic X-ray fields (95.74% vs. 95.72%; p = 0.990). CONCLUSIONS: Intrarectal balloons are well tolerated over a course of conformal prostate irradiation.

Proton radiation for treatment of cancer of the oropharynx: early experience at Loma Linda University Medical Center using a concomitant boost technique.

PURPOSE: To assess accelerated fractionation using photon and proton radiation to improve local control and reduce complications in treating locally advanced oropharyngeal cancer. METHODS AND MATERIALS: Twenty-nine patients with localized Stage II-IV oropharyngeal cancer received accelerated photon and proton radiation, 75.9 GyE in 45 fractions/5.5 weeks, to the primary disease, involved lymph nodes, and potential areas of subclinical spread. Follow-up ranged from 2 to 96 months. RESULTS: Five-year actuarial control for local disease was 88%, and for neck node disease, 96%; yielding a 84% locoregional control rate at 5 years. Four patients developed distant metastases. The 5-year actuarial locoregional control rate was 84%. The actuarial 2-year disease-free survival rate was 81%; at 5 years, it was 65%. All patients completed the prescribed treatment; though aggressive nutritional and anesthetic support was necessary. Late Grade 3 toxicity was seen in 3 patients. CONCLUSIONS: Protons used as a concomitant boost with photons effectively delivered an accelerated time-dose schedule to the cancer with a more tolerable schedule to surrounding normal tissues. Preliminary results reveal increased locoregional control without increased toxicity. Future studies must evaluate the optimum time-dose schedule.

Influence of patient age on biochemical freedom from disease in patients undergoing conformal proton radiotherapy of organ-confined prostate cancer.

OBJECTIVES: To examine a large, single-institution series of patients to test the perception among clinicians that radiotherapy is preferred for "older" patients and surgery should be indicated for "younger" men. Both radiotherapy and surgery are used to control prostate cancer, and both yield similar results in terms of long-term biochemical disease-free (bNED) survival. METHODS: The bNED survival results from more than 1000 patients treated solely with conformal radiotherapy were analyzed to determine whether a difference in outcome supervened for patients younger than 60 years of age versus older patients. RESULTS: No statistically significant difference in bNED survival was found, in terms of patient age. Statistically significant predictors of outcome included pretreatment prostate-specific antigen level, clinical stage at diagnosis, and Gleason score. CONCLUSIONS: Patient age younger than 60 years versus older than 60 years at treatment did not influence bNED survival significantly. Patient age at treatment should not be used in and of itself to recommend one type of treatment over another.

Proton therapy for prostate cancer: the initial Loma Linda University experience.

PURPOSE: We analyzed results of conformal proton radiation therapy for localized prostate cancer, with emphasis on biochemical freedom from relapse. METHODS AND MATERIALS: Analyses were performed for 1255 patients treated between October 1991 and December 1997. Outcomes were measured on primarily in terms of biochemical relapse and toxicity. RESULTS: The overall biochemical disease-free survival rate was 73%, and was 90% in patients with initial PSA