Assuntos
COVID-19 , Pandemias , Formulação de Políticas , Humanos , COVID-19/epidemiologia , Política de SaúdeRESUMO
BACKGROUND: The goal of therapy for many patients with advanced stage malignancies, including those with metastatic gastric and esophageal cancers, is to extend overall survival while also maintaining quality of life. After weighing the risks and benefits of treatment with palliative chemotherapy (PC) with non-curative intent, many patients decide to pursue treatment. It is known that a subset of patients who are treated with PC experience significant side effects without clinically significant survival benefits from PC. METHODS: We use data from 150 patients with stage-IV gastric and esophageal cancers to train machine learning models that predict whether a patient with stage-IV gastric or esophageal cancers would benefit from PC, in terms of increased survival duration, at very early stages of the treatment. RESULTS: Our findings show that machine learning can predict with high accuracy whether a patient will benefit from PC at the time of diagnosis. More accurate predictions can be obtained after only two cycles of PC (i.e., about 4 weeks after diagnosis). The results from this study are promising with regard to potential improvements in quality of life for patients near the end of life and a potential overall survival benefit by optimizing systemic therapy earlier in the treatment course of patients.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Neoplasias Esofágicas , Neoplasias Gástricas , Humanos , Neoplasias Esofágicas/tratamento farmacológico , Qualidade de Vida , Neoplasias Gástricas/tratamento farmacológicoRESUMO
In this article, we analyze the National Cancer Institute's Virus Cancer Programs (1964-1978). The NCI's organizational mandate established program goals that iteratively braided together both scientific research and public health outcomes. The distinctive environment of the NCI as a federal research institute made scientific programs accountable to evaluations of both experimental and administrative appropriateness. To this end, NCI scientist-administrators adopted management techniques drawn from the Cold War defense industry to direct open-ended exploratory research on virally induced cancers, aimed at developing a vaccine as a public health solution to cancer. Facing the limitations of the state of viral cancer research as simultaneously an administrative and experimental problem, the Programs launched a monumental effort to develop infrastructure for cancer virus studies through long-term planning initiatives utilizing defense-style networks of contracted academic laboratories throughout the US. The organizational mandate guiding the Programs contributed to conceptual and experimental changes that directly led to the subversion of its fundamental presupposition of viral causation in favor of the cellular oncogene theory. We thus propose a reinterpretation of the historiography of the oncogene hypothesis as a radical break from viral explanations of cancer etiology, a reinterpretation that re-centers the direct contributions this federal vaccine program made to current molecular biological explanations of cancer causation.
Assuntos
Vacinas Anticâncer , Neoplasias , Academias e Institutos , Humanos , Neoplasias/etiologia , Neoplasias/prevenção & controle , Oncogenes , Saúde Pública , Estados UnidosRESUMO
Approaches to the organization and conduct of cancer research changed dramatically throughout the 20th century. Despite marked differences between the epidemiological approaches of the first half of the century and molecular techniques that gained dominance in the 1980s, prominent 20th-century researchers investigating the link between sexual activity and anogenital cancers continuously invoked the same 1842 treatise by Italian surgeon Domenico Rigoni-Stern, who is said to originate the problem of establishing a causal link between sex and cancer. In this article, I investigate 20th-century references to Rigoni-Stern as a case of a broader phenomenon: scientists situating their work through narratives of venerated ancestors, or originators. By explaining shifting versions of originator narratives in light of their authors' cultural context and research practices, we can reimagine as meaningful cultural symbols the references that previous scholars have treated as specious rhetorical maneuvers. In this case, references to Rigoni-Stern provide an interpretive anchor for American scientists to construct continuity between their work and a diverse historical legacy of cancer research.