RESUMO
PURPOSE: The incidence of esophageal adenocarcinoma (EAC) has risen substantially in recent decades, while the average 5-year survival remains only ~20%. Disease stage and treatment are the strongest prognostic factors. The role of lifestyle factors in relation to survival remains uncertain, with a handful of studies to date investigating associations with obesity, smoking, physical activity, diet, or medications. METHODS: This study included patients diagnosed with primary adenocarcinoma of the esophagus, gastroesophageal junction, or cardia (N = 371) at Roswell Park Comprehensive Cancer Center between 2003 and 2019. Leveraging extensive data abstracted from electronic medical records, epidemiologic questionnaires, and a tumor registry, we analyzed clinical, behavioral, and environmental exposures and evaluated stage-specific associations with survival. Survival distributions were visualized using Kaplan-Meier curves. Cox proportional hazards regression models adjusted for age, sex, stage, treatment, and comorbidities were used to estimate the association between each exposure and all-cause or cancer-specific mortality. RESULTS: Among patients presenting with localized/regional tumors (stages I-III), current smoking was associated with increased overall mortality risk (HR = 2.5 [1.42-4.53], p = 0.002), while current physical activity was linked to reduced risk (HR = 0.58 [0.35-0.96], p = 0.035). Among patients with stage IV disease, individuals reporting pre-diagnostic use of statins (HR = 0.62 [0.42-0.92], p = 0.018) or NSAIDs (HR = 0.61 [0.42-0.91], p = 0.016) had improved overall survival. Exploratory analyses suggested that high pre-diagnostic dietary consumption of broccoli, carrots, and fiber correlated with prolonged overall survival in patients with localized/regional disease. CONCLUSION: Our data suggest that lifestyle exposures may be differentially associated with EAC survival based on disease stage. Future investigation of larger, diverse patient cohorts is essential to validate these findings. Our results may help inform the development of lifestyle-based interventions to improve EAC prognosis and quality of life.
RESUMO
Objective:Interpersonal functioning is a core area of impairment for young adults with Attention-Deficit/Hyperactivity Disorder (ADHD), yet the assessment of their interpersonal problems has not been approached using a comprehensive model of interpersonal behaviors. Method: Interpersonal problems of young adults with ADHD (n = 24) were compared to non-ADHD peers (n = 26) by self- and collateral-report using the Inventory of Interpersonal Problems-Circumplex-Item Response Theory (IIP-C-IRT). Results: Both self- and collateral-reports yielded significantly higher scores across interpersonal problem domains, except for self-reported Hostile-Dominant (HD) interpersonal problems. Discrepancy scores between self- and collateral-report supported larger differences in the ADHD versus non-ADHD groups for HD problems. Large correlations between collateral-reported family relationship impairments and HD problems were found only for the ADHD group. Conclusion: Young adults with ADHD have higher levels of interpersonal problems relative to their non-ADHD peers, but also appear to underreport HD interpersonal problems relative to non-ADHD peers, suggesting the presence of a bias. (J. of Att. Dis. XXXX; XX[X] XX-XX).
