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Biomedical subjects

Jay F Piccirillo

Publications and source records attributed to Jay F Piccirillo.

At least 19 recordsLinked to original sources
PubMed2007

Using comorbidity indexes to predict costs for head and neck cancer.

OBJECTIVE: To determine whether the general Charlson Comorbidity Index (CCI) and the head and neck cancer-specific Washington University Head and Neck Cancer Comorbidity Index (WUHNCCI) were useful for predicting cost of treatment for elderly patients with head and neck cancer. DESIGN: Retrospective, observational study. PATIENTS: A total of 1780 Medicare patients with head and neck cancer, who were treated between 1984 and 1994, were analyzed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. MAIN OUTCOME MEASURES: Total Medicare payments were accumulated for each patient up to 1 and 5 years. Linear regression was used to estimate the impact of the comorbidity indexes on costs, controlling for demographics, site, stage, and treatment modality. RESULTS: Neither the WUHNCCI nor the CCI was significantly associated with 1-year costs. However, the effect of the WUHNCCI on 5-year costs was statistically significant (P<.001). A 1-point increase in the WUHNCCI from 4 to 5 was associated with an increase in 5-year costs of $2105. A 1-point increase in the WUHNCCI from 9 to 10 was associated with an increase in 5-year costs of $2837. CONCLUSION: These results suggest that comorbidity indexes for head and neck cancer may be useful for prognostication of patient outcomes and predicting costs.

Aged↗
PubMed2006

Comorbidity in patients with cancer of the head and neck: prevalence and impact on treatment and prognosis.

At the time of diagnosis, many patients with head and neck cancer have other medical conditions, referred to as comorbidity. These other medical conditions may affect treatment and prognosis. Several valid instruments are available to capture the individual comorbid ailments and their prognostic impact. Inclusion of comorbidity information will assist in the analysis of treatment effectiveness, quality of care assessment, and outcomes studies based on observational studies.

Comorbidity↗
PubMed2006

The effects of melatonin on tinnitus and sleep.

GOAL: To determine if melatonin improves tinnitus and if this improvement is related to improvement in sleep. STUDY DESIGN AND SETTING: Prospective open-label study of 24 patients with tinnitus. The patients took 3 mg of melatonin per day for 4 weeks, followed by 4 weeks of observation. The Tinnitus Handicap Inventory (THI) and the Pittsburgh Sleep Quality Index (PSQI) were administered. RESULTS: The mean THI score decreased significantly between weeks 0 and 4, and between weeks 0 and 8. The mean PSQI significantly decreased between weeks 0 and 4 (P < 0.0001), and between weeks 0 and 8 (P = 0.0003). The change in PSQI was significantly associated with the change in THI between weeks 0 and 4. The change in PSQI was not significantly associated with the change in THI between weeks 0 and 8. The change in the PSQI in the first 4 weeks was associated with the initial PSQI. There was no association between the initial THI and the change in the THI in the first 4 weeks. CONCLUSION: Melatonin use is associated with improvement of tinnitus and sleep. There was an association between the amount of improvement in sleep and tinnitus. The impact of melatonin on sleep was greatest among patients with the worst sleep quality, but its impact on tinnitus was not associated with the severity of the tinnitus. SIGNIFICANCE: Melatonin may be a safe treatment for patients with idiopathic tinnitus, especially those with sleep disturbance due to tinnitus.

Adolescent↗
PubMed2004

Validation of the Composite Laryngeal Recurrence Staging System.

BACKGROUND: The Composite Laryngeal Recurrence Staging System (CLRSS) has been described recently as an improved alternative to the retreatment TNM system (rTNM) for staging patients with recurrent laryngeal squamous cell carcinoma. The objectives of this study were to validate the CLRSS and compare its use with the rTNM system. METHODS: A retrospective chart review was conducted of 67 patients with recurrent laryngeal squamous cell carcinoma who had their initial treatment between 1980 and 1992. The external validity of the CLRSS was assessed, and its ability to stage patients and to predict survival was compared with the rTNM system. RESULTS: The overall 2-year survival rate was 51% (34 of 67 patients). The rTNM system was unable to stage 12 patients (18%), whereas all patients could be staged using the CLRSS. The CLRSS predicted survival better than the rTNM system (c-statistic = 0.79). CONCLUSIONS: The newer CLRSS staging system for recurrent laryngeal carcinoma outperformed the rTNM system in its ability to stage more patients and to predict survival.

Adult↗
PubMed2004

Differential prognostic impact of comorbidity.

PURPOSE: Cancer patients with concurrent comorbid conditions have worse outcomes than patients with no comorbidities. We hypothesized that the prognostic impact of comorbidities would be greatest for patients with cancers associated with a long natural history and least in patients with aggressive cancers. PATIENTS AND METHODS: Using the Barnes-Jewish Hospital Oncology Data Services cancer registry, we grouped 11,558 patients with breast, lung, colon, or prostate cancer by morphologic stage at diagnosis and then determined the 1-year overall survival rate for each group. Overall, severity of comorbidity was assessed from chart review and classified into one of four groups: none, mild, moderate, or severe. The relative prognostic impact of comorbidity was measured by the hazard ratio and adjusted for the prognostic impact of age, race, and sex. RESULTS: One-year overall survival rate ranged from 20% for 1,005 patients with distant spread of lung cancer to 98% for 3,325 patients with localized prostate cancer. Adjusted hazard ratio of moderate/severe comorbidity (relative to none/mild) ranged from 1.04 to 4.48. The correlation between overall survival rate and severity of comorbidity was statistically significant (r2 = 0.56; P < .001). The proportion of variance in outcome explained by comorbidity ranged from less than 1% to almost 9%, depending on tumor site and stage. CONCLUSION: Concurrent comorbidities had the greatest prognostic impact among groups with the highest survival rate and the least impact in groups with the lowest survival rate. These findings can be used to help determine the role comorbidity information should play in studies of cancer outcomes.

Aged↗
PubMed2004

Prognostic importance of comorbidity in a hospital-based cancer registry.

CONTEXT: Patients with cancer often have other medical ailments, referred to as comorbidity. Comorbidity may impact treatment decision-making, prognosis, and quality of care assessment. OBJECTIVE: To assess whether comorbidity information can provide important prognostic information in a hospital-based cancer registry. DESIGN, SETTING, AND PARTICIPANTS: An observational prospective cohort study using comorbidity data collected by trained hospital-based cancer registrars. Comorbidity was obtained through medical record review using the Adult Comorbidity Evaluation 27, a validated chart-based comorbidity instrument. A total of 17,712 patients receiving care between January 1, 1995, and January 31, 2001, for the primary diagnosis of new cancer of the prostate, lung (nonsmall cell), breast, digestive system, gynecological, urinary system, or head and neck were included. MAIN OUTCOME MEASURE: Duration in months of overall survival. RESULTS: A total of 19,268 patients were included in the study; median duration of follow-up was 31 months. Of these patients, 1556 (8.0%) were excluded due to missing or unknown data. Severity of comorbidity strongly influenced survival in a dose-dependent fashion and the impact of comorbidity was independent of cancer stage. Compared with patients without comorbidity, the adjusted hazard ratio associated with mild comorbidity was 1.21 (95% confidence interval [CI], 1.13-1.30), moderate comorbidity was 1.86 (95% CI, 1.73-2.00), and severe comorbidity was 2.56 (95% CI, 2.35-2.81). Adjusted Kaplan-Meier survival curves revealed that at any point in time the patients with more severe levels of comorbidity had worse survival (partial chi2(3) due to comorbidity, 523.54; P<.001). Model discrimination ranged from 0.71 for head and neck to 0.86 for prostate cancers. CONCLUSIONS: Comorbidity is an important independent prognostic factor for patients with cancer. The inclusion of comorbidity in hospital-based cancer registries will increase the value and use of observational research.

Adult↗
PubMed2004

The impact of computed tomography on pretherapeutic staging in patients with laryngeal cancer: demonstration of the Will Rogers' phenomenon.

BACKGROUND: The purpose of this study was to demonstrate that pretherapeutic CT of patients with primary laryngeal cancer results in stage migration, therefore affecting laryngeal cancer outcome data. METHODS: We retrospectively reviewed the medical records of 90 patients with primary laryngeal cancer diagnosed between January 1, 1995, and December 31, 1997, at a university hospital. RESULTS: The disease in 15 (17%) of 90 patients was reclassified into a new TNM stage after pretherapeutic CT. As a result, stage-specific survival rates improved in three of four TNM stages, even though average survival for the entire cohort did not change. CONCLUSIONS: The TNM staging system is not a temporally stable classification and prediction system, because TNM assignment varies on the basis of the type of pretherapeutic evaluation. Outcome data for patients with laryngeal cancer must account for the introduction of new technologies that affect our ability to diagnose and stage this disease.

Aged↗
PubMed2004

The epidemiology of bronchioloalveolar carcinoma over the past two decades: analysis of the SEER database.

Bronchioloalveolar carcinoma of the lung (BAC) is a subtype of adenocarcinoma of the lung. Although traditionally grouped with other non-small cell lung carcinomas (NSCLC), BAC has unique morphological features and clinical behavior such as bilateral lung involvement, indolent course and lack of association with smoking. Some epidemiologic studies report a significant increase in the incidence of BAC. We used the SEER database to compare the incidence, demographics, and overall survival of BAC patients as compared to other NSCLC types over the past two decades (1979-1998). Although the incidence of BAC has increased over the past two decades, BAC represents less than 4% of all NSCLC in every time period evaluated. The 1 year survival rate is significantly better for BAC patients relative to other histological subtypes of NSCLC. There has not been a marked increase in the incidence of BAC reported to SEER over the past 20 years.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2004

Comparison of comorbidity indices for patients with head and neck cancer.

BACKGROUND: Comorbidity is an important prognostic factor for elderly patients with head and neck cancer. Investigators are faced with the dilemma of selecting the appropriate comorbidity instrument for outcomes research in cancer. The goal of this study was to compare 2 general comorbidity indices with 2 disease-specific indices. METHODS: The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database was used to identify 15,493 patients with incident squamous cell carcinomas of the oral cavity, pharynx, and larynx first diagnosed between December 1983 and December 1994. Comorbid ailments were identified through the use of the International Classification of Diseases, 9th edition codes in the Medicare inpatient and outpatient claims for 7131 patients. The overall severity of comorbidity was classified according to 2 general comorbidity indices: the Charlson Comorbidity Index and the Klabunde Index, and 2 disease-specific indices: the Washington University Head and Neck Index and the Head and Neck Cancer Index. Overall survival was the primary end point. Cox proportional hazards analysis was used to assess the performance and discrimination of the comorbidity indices. RESULTS: For each of the 4 comorbidity indices, there was a weak trend of worse survival with higher levels of comorbidity. The 2 general indices performed as well as the 2 disease-specific indices and no instrument clearly performed better than the others. CONCLUSION: Both the general and disease-specific comorbidity indices provided important prognostic information. The disease-specific indices did not perform better than the general indices. In this claims-based analysis, there was no apparent advantage to using a disease-specific index when attempting to predict overall survival.

Aged↗
PubMed2003

Methodologic assessment of studies on endoscopic sinus surgery.

BACKGROUND: Functional endoscopic sinus surgery (ESS) has become the procedure of choice for surgical treatment of chronic rhinosinusitis. Does the published literature support the claims of greater efficacy than medical treatment alone or older sinus procedures? OBJECTIVE: To analyze the methodology of the published literature regarding the efficacy of ESS. DATA SOURCES: MEDLINE search for primary studies published in 1987 through 2001, written in the English language, reporting results on more than 100 patients, using the MeSH (medical subject headings) terms sinusitis [subheadings surgery or therapy] and endoscopy. STUDY SELECTION: Of 512 studies initially identified, 29 studies met the inclusion and exclusion criteria for further assessment of methodologic criteria. An additional 6 studies were found when the reference lists of reviews or included studies were searched. DATA EXTRACTION: Articles were evaluated for 4 core (inclusion/exclusion criteria, control group, intervention, and clear outcome measure) methodologic criteria essential to the determination of efficacy of ESS. Eight additional methodologic criteria were also used to rate the articles. DATA SYNTHESIS: Three studies met all 4 core methodologic criteria. Only 4 of 35 studies used a control group to evaluate efficacy of ESS to treat chronic sinusitis. Mean number of criteria met was 7.2, with a range of 2 to 11. CONCLUSIONS: Absence of a control group is the most important reason that studies are unable to scientifically assess the comparative efficacy of ESS to medical therapy or other sinus procedures. The methodologic criteria described here can be used to evaluate studies of interventions for other disorders.

Comorbidity↗
PubMed2003

Prognostic staging system and therapeutic effectiveness for recurrent or chronic sinusitis in children.

OBJECTIVE: We sought to assess the clinical status of pediatric sinusitis patients after a minimum of 2 years follow-up and to evaluate relative treatment effectiveness. Study design We conducted a medical record review of 308 patients, with a 2-year follow-up questionnaire. RESULTS: Overall, 55% of children were "much improved." A 4-stage prognostic system was developed and used to compare results in 133 patients who had not responded to medical treatment and who had positive sinus computed tomography scans. Endoscopic sinus surgery (ESS) had no apparent advantages in stages I and IV, but in stages II and III, rates of "much improved" for ESS versus medical therapy were 79% versus 54% and 68% versus 42%, respectively. CONCLUSION: These results suggest that ESS may be particularly effective for patients from intermediate prognostic stages. SIGNIFICANCE: This type of prognostic staging and evaluation of treatment effectiveness is necessary and important in chronic sinusitis, where randomized trials are unlikely to be performed.

Child, Preschool↗
PubMed2003

Vestibular dysfunction after cochlear implantation.

OBJECTIVE: To determine the prevalence, symptom characteristics, and potential risk factors for vestibular symptoms after cochlear implantation. STUDY DESIGN: Case-control study design embedded within an ongoing cohort of patients undergoing implantation. SETTING: Academic medical center cochlear implant research program funded by the National Institutes of Health. PATIENTS: Seventy five eligible consecutive patients undergoing cochlear implantation. INTERVENTION: Medical record review. MAIN OUTCOME MEASURE: Recorded symptoms of vestibular symptoms after cochlear implantation. Subjects with vestibular symptoms were considered case subjects; those without vestibular symptoms were considered control subjects. RESULTS: Twenty-nine of 75 (39%) patients experienced dizziness postoperatively. Four patients experienced a single, transient acute vertigo attack occurring less than 24 hours after surgery. The majority, 25 patients, experienced delayed, episodic onset of vertigo. The median (interquartile range) time of delayed onset was 74 (26-377) days after implantation. Delayed dizziness manifested as spontaneous episodic or positional vertigo. Preoperative dizziness, age at implantation, and age at onset of hearing loss were significantly greater in the dizzy group. Preoperative electronystagmography did not differentiate between groups. CONCLUSIONS: Thirty-nine percent (29/75) of subjects with implants were dizzy after implantation. The majority of subjects experienced dizziness in a delayed episodic fashion. Dizziness was not related to implant activation. It seemed that delayed dizziness was not related to immediate surgical intervention but could result from chronic changes occurring in the inner ear; there was some suggestion this could take the form of endolymphatic hydrops.

Acute Disease↗
PubMed2002

Development of a new head and neck cancer-specific comorbidity index.

BACKGROUND: Most patients with head and neck squamous cell carcinoma are older and may have coexistent or comorbid diseases. OBJECTIVES: To determine the prognostic impact of individual comorbid conditions in patients with head and neck cancer, to combine the individual comorbid conditions to form a new a head and neck-specific comorbidity instrument, and to compare it with the Modified Kaplan-Feinstein Index to determine if the new disease-specific instrument offers any improvement in survival prediction over a general comorbidity index. DESIGN: Retrospective review of medical records. POPULATION: The study population comprised 1153 patients with biopsy-proven, newly diagnosed squamous cell carcinoma of the oral cavity, oropharynx, or larynx. RESULTS: Seven comorbid conditions (congestive heart disease, cardiac arrhythmia, peripheral vascular disease, pulmonary disease, renal disease, cancer controlled, and cancer uncontrolled) were significantly related to survival. These comorbid conditions were assigned integer weights to reflect their relative prognostic importance and combined to create the new Washington University Head and Neck Comorbidity Index (WUHNCI). Survival was significantly related to levels of comorbidity severity as defined by the WUHNCI. The WUHNCI predicted survival better than the Modified Kaplan-Feinstein Index despite containing far fewer ailments. CONCLUSIONS: Comorbidity is an important feature of the patient with head and neck cancer. The WUHNCI can be used for retrospective review or prospective outcomes research.

Adolescent↗
PubMed2002

Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20).

A valid measure of rhinosinusitis health status and quality of life is required for the complete assessment of treatment effectiveness. The purpose of this study was to analyze the psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20), a disease-specific, health-related quality-of-life measure for rhinosinusitis. The SNOT-20 is a modification of the 31-Item Rhinosinusitis Outcome Measure, and it contains 20 nose, sinus, and general items. To complete the instrument, patients indicate how much they are affected in each area and identify the 5 most important items. The SNOT-20 was completed by 102, 72, and 46 patients at the initial visit and at 6 months and 1 year after treatment commencement, respectively. Cronbach's alpha was 0.9; test-retest scores were highly correlated (r = 0.9). Patients who were more affected had greater SNOT-20 scores (P < 0.002), and patients who had improved had greater change scores (P < 0.04). Items identified as important had greater scores (P < 0.0001) and showed greater change scores (P < 0.0002). The SNOT-20 is a valid outcome measure for patients with rhinosinusitis; it describes the health burden and is sensitive to clinical change.

Adolescent↗