BACKGROUND & AIMS: :Background and purpose - Few studies have evaluated the long- and mid-term outcomes after minimally invasive periacetabular osteotomy (PAO). We investigated: (1) the long-term hip survival rate after PAO; (2) the risk of complications and additional surgery after PAO; and (3) the hip function at different follow-up points.Patients and methods - We reviewed 1,385 hips (1,126 patients) who underwent PAO between January 2004 and December 2017. Through inquiry to the Danish National Patient Registry we identified conversions to total hip arthroplasty (THA) and complications after PAO. We evaluated the Hip disability and Osteoarthritis Outcome Score (HOOS) obtained preoperatively, and at 6 months, 2-, 5-, and 10-years' follow-up.Results - 73 of the 1,385 hips were converted to THA. The overall Kaplan-Meier hip survival rate was 80% (95% CI 68-88) at 14 years with a mean follow-up of 5 years (0.03-14). 1.1% of the hips had a complication requiring surgical intervention. The most common additional surgery was removal of screws (13%) and 11% received a hip arthroscopy. At the 2-year follow-up, HOOS pain improved by a mean of 26 points (CI 24-28) and a HOOS pain score > 50 was observed in 86%.Interpretation - PAO preserved 4 of 5 hips at 14 years, with higher age leading to lower survivorship. The PAO technique was shown to be safe; 1.1% of patients had a complication that demanded surgical intervention. The majority of the patients with preserved hips have no or low pain. The operation is effective with a good clinical outcome.

背景与目标： 背景和目的-很少有研究评估微创髋臼周围截骨术 (PAO) 后的长期和中期结果。我们调查了 :( 1) PAO术后的长期髋关节存活率; (2) PAO术后并发症和额外手术的风险; (3) 不同随访点的髋关节功能。患者和方法-我们回顾了2004年1月和2017年12月之间接受PAO的1,385例髋关节 (1,126例患者)。通过对丹麦国家患者登记处的询问，我们确定了PAO后转为全髋关节置换术 (THA) 和并发症。我们评估了术前获得的髋关节残疾和骨关节炎结局评分 (HOOS)，并在6个月时，将1,385个髋关节的2、5和10年follow-up.Results 73转换为THA。14年时，总Kaplan-Meier髋关节存活率为80% (95% CI 68-88)，平均随访5年 (0.03-14)。髋关节1.1% 有需要手术干预的并发症。最常见的额外手术是移除螺钉 (13%)，11% 接受了髋关节镜检查。在2年的随访中，HOOS疼痛平均改善了26分 (CI 24-28)，并且在86% 中观察到HOOS疼痛评分> 50。解释-PAO在14岁时保留了5个臀部中的4个，年龄较高导致存活率较低。PAO技术被证明是安全的; 1.1% 的患者有需要手术干预的并发症。大多数保留臀部的患者没有疼痛或疼痛。该手术有效，临床效果良好。

BACKGROUND & AIMS: :The United States and the European Union (EU) vary widely in approaches to ensuring affordable health care coverage for our respective populations. Such variations stem from differences in the political systems and beliefs regarding social welfare. These variations are also reflected in past and future initiatives to provide high quality cancer survivorship care. The United States spends considerably more on health care compared to most European countries, often with no proven benefit. In the United States, individuals with chronic illnesses, such as cancer survivors, often experience difficulties affording insurance and maintaining coverage, a problem unknown to EU countries with national health insurance. This article reviews health policy development over time for the United States and EU and the impact for cancer survivors. For the United States, the impact of the Affordable Care Act on improving access to affordable care for cancer survivors is highlighted. For the EU, the importance of multiple-morbidity disease management, cancer plan development, and pan-European data collection for monitoring cancer outcomes is addressed. Given predicted workforce shortages and ever-increasing numbers of aging cancer survivors on both sides of the Atlantic, sharing lessons learned will be critical.

背景与目标： : 美国和欧盟 (EU) 在确保为我们各自人群提供负担得起的医疗保健覆盖的方法上差异很大。这种差异源于政治制度和关于社会福利的信念的差异。这些变化也反映在过去和未来的举措中，以提供高质量的癌症幸存者护理。与大多数欧洲国家相比，美国在医疗保健上的支出要高得多，通常没有得到证实的好处。在美国，患有慢性病的人 (例如癌症幸存者) 经常在提供保险和维持保险方面遇到困难，这是拥有国民健康保险的欧盟国家所不知道的问题。本文回顾了随着时间的推移，美国和欧盟的卫生政策发展以及对癌症幸存者的影响。对于美国，强调了《平价医疗法案》对改善癌症幸存者获得平价医疗的影响。对于欧盟而言，解决了多发病疾病管理，癌症计划制定和泛欧数据收集对监测癌症结果的重要性。鉴于预计的劳动力短缺和大西洋两岸老龄化癌症幸存者数量的不断增加，分享经验教训将是至关重要的。

BACKGROUND & AIMS: :The 2019 Coronavirus Pandemic challenges the delivery of care for patients with head and neck cancer. An important aspect of this care has been the evolution of enhanced survivorship services, which include surveillance for recurring cancer and prevention of second primaries. The application of evidence-based approaches to the identification and management of treatment and tumor-related toxicities has embraced the use of validated patient-reported outcomes instruments, health promotion, and care coordination. In this manuscript, we describe how our multidisciplinary team of survivorship providers has accommodated to the need to provide patients with social distancing while acknowledging the importance of continued care during treatment and through the spectrum of survivorship.

背景与目标： : 2019冠状病毒大流行挑战了头颈癌患者的护理。这种护理的一个重要方面是增强生存服务的发展，其中包括监测复发癌症和预防第二原发疾病。基于证据的方法在治疗和肿瘤相关毒性的识别和管理中的应用包括使用经过验证的患者报告的结果工具，健康促进和护理协调。在本手稿中，我们描述了我们的生存提供者的多学科团队如何满足为患者提供社交距离的需求，同时承认在治疗期间和生存范围内持续护理的重要性。

BACKGROUND & AIMS: :This article describes the implementation and evaluation of a survivorship protocol for cancer survivors to improve knowledge about their disease and decrease anxiety. The study included a convenience sample of 30 cancer survivors at an outpatient community cancer center in the southeastern United States following completion of acute oncology treatment. One month after the survivorship protocol was delivered, knowledge about diagnosis, treatments, recommended follow-up, signs of recurrence, and late side effects increased. Anxiety scores were lower one month after the intervention, and satisfaction with the protocol was high. The results demonstrated that the survivorship protocol is a feasible method of educating cancer survivors, supporting the Institute of Medicine's recommendation that strategies for delivering education to cancer survivors are important. Survivors have additional needs that must be addressed following treatment, and a survivorship protocol can provide the knowledge survivors need to participate in their own health care.

背景与目标： : 本文介绍了针对癌症幸存者的生存方案的实施和评估，以提高对其疾病的了解并减少焦虑。该研究包括在完成急性肿瘤治疗后在美国东南部的门诊社区癌症中心的30名癌症幸存者的便利样本。生存方案交付后一个月，有关诊断，治疗，建议随访，复发迹象和晚期副作用的知识增加。干预后一个月的焦虑评分较低，对方案的满意度较高。结果表明，生存方案是教育癌症幸存者的可行方法，支持医学研究所的建议，即向癌症幸存者提供教育的策略很重要。幸存者有其他需要，必须在治疗后解决，生存方案可以提供幸存者参与自己的医疗保健所需的知识。

BACKGROUND & AIMS: BACKGROUND:There has been a call for comprehensive cancer care that gives greater consideration to changing lifestyle risk factors such as smoking to improve prognosis and long-term health. Cancer diagnosis, treatment, and survivorship offer challenges and opportunities ("teachable moments") to promote smoking cessation. METHODS:This review provides a rationale for the importance of smoking cessation programs in the cancer context, highlights practice guidelines for the delivery of these interventions, summarizes the challenges to smoking cessation unique to cancer patients, and recommends approaches to capitalize on the cancer context to promote smoking cessation. RESULTS:Barriers to smoking cessation by patients with cancer include heavy nicotine dependence, urgency of cessation, fatalistic attitudes about cessation benefits, cancer-related psychological distress, treatment factors, and the presence of smokers in the social network. Opportunities to promote cessation include the transition from inpatient to outpatient care, involvement in cancer patient care by family members who smoke, and distribution of clinical feedback (eg, test results). CONCLUSIONS:Teachable moments in the cancer context are not being fully utilized to promote smoking cessation. Evidence-based guidelines can assist cancer care teams in promoting cessation.

背景与目标：

BACKGROUND & AIMS: :We piloted a patient-reported screener in a clinic for survivors of childhood cancers to facilitate detection of late effects, psychosocial needs, and distress. The mean number of patient-reported survivorship concerns endorsed per patient was 3.2; most frequent were difficulties with body weight, sleep, work/school, and fertility. Few individuals reported clinically significant distress or fear of recurrence. Electronic health record data produced an average of 2.3 late effects. Administration of a brief screener was effective in identifying additional current medical and psychosocial care needs among adult survivors of childhood cancers in a survivorship clinic.

背景与目标： : 我们在一家针对儿童癌症幸存者的诊所中试用了患者报告的筛查器，以促进发现晚期影响，社会心理需求和痛苦。每位患者报告的生存关注的平均数量为3.2; 最常见的是体重，睡眠，工作/学校和生育能力方面的困难。很少有人报告临床上有明显的困扰或担心复发。电子健康记录数据平均产生2.3个晚期影响。在生存诊所中，进行简短筛查可以有效地确定儿童癌症成年幸存者中当前的其他医疗和社会心理护理需求。

BACKGROUND & AIMS: BACKGROUND:Recent advances have improved the likelihood of long-term survival for patients with lung cancer. However, little attention has been given to the growing need for dedicated survivorship care for these patients. To address this unmet need, we developed a unique follow-up care model. METHODS:In 2006, we convened a multidisciplinary working group to design a thoracic survivorship program (TSP) that provides follow-up by a nurse practitioner (NP) trained in survivorship care. Patients with early-stage lung cancer who were disease free for at least 1 year after resection were eligible for the program, which incorporates a standardized approach to cancer surveillance. Data on symptoms and outcomes were prospectively collected. Real-time electronic medical documentation was developed to optimize communication with primary physicians. RESULTS:Data were analyzed for the initial phase of the program, which comprised 655 patients. Ninety-two percent of eligible survivors who remained disease free chose to continue their care in the TSP, rather than receive follow-up with their thoracic surgeon. Clinically significant posttreatment symptoms were common, including fatigue (46%), anxiety (32%), chronic pain (25%), dyspnea (14%), and depression (12%). The majority of recurrences (72%) and second primary cancers (91%) in this cohort were identified by scheduled chest computed tomography at TSP visits. CONCLUSIONS:Survivorship care for patients with lung cancer, delivered in our NP-led TSP, is feasible, effective, and well accepted by patients. Through the implementation of a uniform self-sustaining patient-centered system, the TSP model improves on the variation of physician-led follow-up care.

背景与目标：

BACKGROUND & AIMS: :To investigate the effects of increased weight and body mass index (BMI) on total knee arthroplasty (TKA) survivorship and on functional outcomes and quality of life following revision TKA, a prospective cohort study of 291 consecutive revision TKA patients was performed. Average patient BMI was 32.3 +/- 7.7, and 57% of patients were obese (BMI > or = 30). The obese group was not significantly different from the nonobese group regarding reasons for prosthesis failure; however, they were more likely to experience certain comorbidities. Body mass index and weight were both significant predictors of survivorship of primary TKA (regression coefficient BMI = -1.852, P = .004; regression coefficient weight = -0.405, P = .000) in multivariate regression. At 6-month follow-up, improvement of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) stiffness, WOMAC difficulty of function, and Knee Society Score (KSS) function scales at 6 months after revision TKA was significantly lower (at the 0.001 level, two tailed) in patients with higher BMI, weight, or both. In regression analysis, BMI was a significant predictor of Short Form-36, WOMAC difficulty of function, and KSS. Weight and BMI have deleterious effects on the longevity of primary TKA and functional and quality of life outcomes following revision TKA. These findings indicate a need for more effective management of these patients.

背景与目标： : 为了研究体重和体重指数 (BMI) 增加对全膝关节置换术 (TKA) 生存率以及对修订TKA后功能结局和生活质量的影响，进行了291例连续修订TKA患者的前瞻性队列研究。平均患者BMI为32.3 +/- 7.7，57% 患者为肥胖 (BMI> 或 = 30)。在假体失败的原因上，肥胖组与非肥胖组没有显着差异; 但是，他们更有可能出现某些合并症。在多元回归中，体重指数和体重都是原发性TKA存活率的重要预测指标 (回归系数BMI = -1.852，P = 0.004; 回归系数权重 = -0.405，P = .000)。在6个月的随访中，西安大略和麦克马斯特大学骨关节炎指数 (WOMAC) 僵硬度，WOMAC功能难度和修订后6个月的膝关节社会评分 (KSS) 功能量表的改善在BMI较高的患者中，TKA显着降低 (在0.001水平，两尾) 重量，或者两者兼而有之。在回归分析中，BMI是Short Form-36，WOMAC功能困难和KSS的重要预测指标。体重和BMI对原发性TKA的寿命以及修订后TKA后的功能和生活质量结果具有有害影响。这些发现表明需要对这些患者进行更有效的管理。

BACKGROUND & AIMS: BACKGROUND:The aging process is accompanied by several conditions that could affect the outcome of meniscal allograft transplantation (MAT). These conditions have made it difficult for clinicians to determine the effect of chronologic age on survivorship after MAT. HYPOTHESIS:Advanced age does not have an adverse effect on survivorship of MAT when controlling for age-related factors, such as cartilage status and time from previous meniscectomy. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:The records of 264 consecutive patients who underwent primary medial or lateral MAT were reviewed. To check whether there was a difference in MAT survivorship according to age, a cutoff value was calculated from a time-dependent receiver operating characteristic curve. Survival rates, as well as clinical improvement as determined using the Lysholm score, were compared between groups divided by the cutoff value. Patients were matched for cartilage status and elapsed time from previous meniscectomy. Differences in survivorship and clinical outcomes were assessed between the matched groups. RESULTS:A time-dependent receiver operating characteristic curve showed that the difference in MAT survivorship was maximized with a cutoff age of 43 years. Kaplan-Meier analysis showed a significant difference in MAT survivorship between the older and younger groups (log-rank test, P = .01). However, after matching for cartilage status and time from previous meniscectomy, which left 56 patients per group, there was no significant difference in MAT survivorship (log-rank test, P = .10) between the groups. Regarding clinical outcomes, the mean Lysholm scores were not significantly different between the older and younger groups (P = .19, before matching; P = .39, after matching). CONCLUSION:MAT survivorship was more affected by age-related prognostic factors, such as cartilage status and time from previous meniscectomy, than age itself. Clinical outcomes did not show differences according to age, either.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Uncemented femoral components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the third decade. QUESTIONS/PURPOSES:We evaluated (1) survivorship using femoral revision for any reason as the end point; (2) survivorship using femoral revision for aseptic loosening as the end point; and (3) patient-related and surgical risk factors for aseptic stem loosening at a minimum 20-year followup with an uncemented tapered titanium stem. METHODS:We reviewed the clinical and radiographic results of 354 THAs in 326 patients performed between January 1985 and December 1989 using an uncemented grit-blasted, tapered titanium femoral stem. Mean age at surgery was 57 years (range, 13-81 years). Kaplan-Meier survivorship analysis was used to estimate long-term survival. Minimum followup evaluation was 20 years (mean, 22 years; range, 20-25 years); at that time, 120 patients (127 hips) had died, and four patients (five hips) were lost to followup. Multivariate survival analysis using a Cox regression model was performed. RESULTS:Survivorship at 22 years with revision of the femoral component for any reason as the end point was 86% (95% confidence interval [CI], 81%-90%). Survivorship for femoral revision for aseptic loosening as the end point was 93% at 22 years (95% CI, 90%-96%). Undersized stems (canal fill index≤80%) and stems in hips with cup revision were at higher risk for aseptic loosening (hazard ratio, 4.2 and 4.3, respectively). There was a high rate of acetabular revision in this series (38%), mostly related to smooth-threaded, cementless sockets. CONCLUSIONS:Uncemented femoral fixation was reliable into the third decade. Age, male sex, and diagnosis were not associated with a higher risk of aseptic loosening. LEVEL OF EVIDENCE:Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

背景与目标：

BACKGROUND & AIMS: PURPOSE/OBJECTIVES:To evaluate the feasibility, usability, and satisfaction of a survivorship care plan (SCP) and identify the optimum time for its delivery during the first 12 months after diagnosis. DESIGN:Prospective, descriptive, single-arm study. SETTING:A National Cancer Institute-designated cancer center in the southeastern United States. SAMPLE:28 nonmetastatic colon cancer survivors within the first year of diagnosis and their primary care physicians (PCPs). METHODS:Regular screening identified potential participants who were followed until treatment ended. An oncology certified nurse developed the JourneyForward™ SCP, which then was delivered to the patient by the oncology nurse practitioner (NP) during a routine follow-up visit and mailed to the PCP. MAIN RESEARCH VARIABLES:Time to complete, time to deliver, usability, and satisfaction with the SCP. FINDINGS:During one year, 75 patients were screened for eligibility, 34 SCPs were delivered, and 28 survivors and 15 PCPs participated in the study. It took an average of 49 minutes to complete a surgery SCP and 90 minutes to complete a surgery plus chemotherapy SCP. Most survivors identified that before treatment ended or within the first three months was the preferred time to receive an SCP. CONCLUSIONS:The SCPs were well received by the survivors and their PCPs, but were too time and labor intensive to track and complete. IMPLICATIONS FOR NURSING:More work needs to be done to streamline processes that identify eligible patients and to develop and implement SCPs. Measuring outcomes will be needed to demonstrate whether SCPs are useful or not.

背景与目标：

BACKGROUND & AIMS: :The St. Jude Cloud, an online resource for cancer researchers to download, upload, process, and visualize pediatric cancer data, has announced the release of the St. Jude Survivorship Portal, which contains a wealth of clinical and genomic data about survivors of childhood cancers.

背景与目标： : 圣裘德云 (st.Jude Cloud) 是供癌症研究人员下载，上传，处理和可视化儿科癌症数据的在线资源，已宣布发布圣裘德生存门户网站，其中包含有关儿童癌症幸存者的大量临床和基因组数据。

BACKGROUND & AIMS: BACKGROUND:In a previously reported series of 51 patients with 62 cemented, fixed-bearing unicompartmental knee arthroplasties, we reported a 10-year, 98% survival rate with an average knee score of 92 points. The survivorship and modes of failure past 10 years are incompletely understood. QUESTIONS/PURPOSES:At 15-year followup we sought to determine (1) the overall durability and survivorship of this design; (2) modes of failure; and (3) the progression of arthritis in the nonresurfaced compartments. METHODS:Nineteen knees in 16 patients were available for study with 34 patients lost to death and one lost to followup. At 15 years, we analyzed the Kaplan-Meier survivorship as well as durability with regard to radiographic loosening and knee scores, determined modes of failure, and assessed radiographs for degeneration in the nonresurfaced compartments. RESULTS:Fifteen-year survivorship was 93% and 20-year survivorship was 90%. Four of 62 knees were revised to total knee arthroplasty at a mean of 144 months. One knee was revised for patellofemoral and lateral compartment degeneration, one for lateral compartment degeneration, one for polyethylene disengagement and metallosis, and one for pain of unclear etiology. No patients had aseptic loosening or osteolysis. The mean knee score was 78 at latest followup. Arthritic progression in the nonresurfaced compartments was common although symptomatic in only two patients. CONCLUSIONS:With this cemented, fixed-bearing design, the failure rates were low, there were no cases of failure secondary to wear or loosening, and the survivorship was similar to that reported for total knee arthroplasty.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Balancing the relative advantages and disadvantages of unicompartmental knee arthroplasties (UKAs) against those for TKAs can be challenging. Survivorship is one important end point; arthroplasty registers repeatedly report inferior midterm survival rates, but longer-term data are sparse. Comparing survival directly by using arthroplasty register survival reports also may be inadequate because of differences in indications, implant designs, and patient demographics in patients having UKAs and TKAs. QUESTIONS/PURPOSES:The aims of this study were to assess the survivorship of UKA in the context of one large, northern European registry, and to compare the rates of survivorship with those of cemented TKAs performed for primary knee osteoarthritis during the same 27-year period. METHODS:From the Finnish Arthroplasty Register, we obtained the data for 4713 patients undergoing UKAs for primary osteoarthritis (mean age, 63.5 years; minimum followup, 0 years; mean, 6.0 years; range, 0-24 years) who had surgical revision between 1985 and 2011. From this cohort, we calculated the Kaplan-Meier survivorship for revision performed for any reason and compared it with the survivorship of 83,511 patients (mean age, 69.5 years; minimum followup 0 years; mean, 6.4 years; range, 0-27 years) with TKAs treated for primary osteoarthritis during the same period. Data were adjusted for age and sex in a comparative analysis. RESULTS:Kaplan-Meier survivorship of UKAs was 89.4% at 5 years, 80.6% at 10 years, and 69.6% at 15 years; the corresponding rates for TKAs were 96.3%, 93.3%, and 88.7%, respectively. UKAs had inferior long-term survivorship compared with cemented TKAs, even after adjusting for the age and sex of the patients (hazard ratio 2.2, p < 0.001). CONCLUSIONS:A UKA offers tempting advantages compared with a TKA; however, the revision frequency for UKAs in widespread use, as measured in a large, national registry, was poorer than that of TKAs. When choosing between a UKA and a TKA, patients should be informed of advantages of both procedures, but they also should be advised about the generally higher revision risk after UKA. LEVEL OF EVIDENCE:Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

背景与目标：

BACKGROUND & AIMS: :As more and more people are successfully treated for and live longer with cancer, greater attention is being directed toward the survivorship needs of this population. Women treated for cancer often experience issues related to sexual health and intimacy, which are frequently cited as areas of concern, even among long-term survivors. Unfortunately, data suggest that providers infrequently discuss these issues. We reviewed a contemporary understanding of sexual health of women and the impact of treatment on both sexual function and intimacy. We also provide a review of the diagnosis using the newest classification put forth by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and potential treatments, including both endocrine and nonendocrine treatments that the general oncologist may be asked about when discussing sexual health with his or her patients.

背景与目标： : 随着越来越多的人成功接受癌症治疗并寿命更长，人们越来越关注该人群的生存需求。接受癌症治疗的妇女经常遇到与性健康和亲密有关的问题，即使在长期幸存者中，这些问题也经常被视为关注的领域。不幸的是，数据表明提供商很少讨论这些问题。我们回顾了当代对女性性健康以及治疗对性功能和亲密关系的影响的理解。我们还使用美国精神病学协会在《精神疾病诊断和统计手册》第五版中提出的最新分类对诊断进行了回顾，并提供了潜在的治疗方法，包括一般肿瘤学家可能会询问的内分泌和非内分泌治疗与他或她的患者讨论性健康时。