Prostate cancer outcomes, mortality rates among US children and adolescents, labor-related complications after elective induction

An important part of a career in health care is keeping abreast of current medical news. With an abundance of medical journals, research and studies, it can be challenging to keep up to date with the latest information. We have combed through the latest findings to share three recent studies that DOs will find relevant to the work they do. See below for summaries and links to original research.

“Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer,” The New England Journal of Medicine, April 27, 2023

Over the course of a decade, over 82,000 men in the United Kingdom between the ages of 50 and 69 years old received a prostate-specific antigen (PSA) test. In 2,664 men, localized prostate cancer was diagnosed; of those men, 1,643 were enrolled in a trial to gauge effectiveness of treatments. Among those enrolled in the trial, 545 men were randomly assigned to receive active monitoring, 553 men were chosen to undergo prostatectomy and 545 men underwent radiotherapy.

With an average follow-up of 15 years (between 11 to 21), researchers compared results in the participants in regard to death from prostate cancer—the primary outcome—and death from any cause, metastases, disease progression and initiation of long-term androgen-deprivation therapy (secondary outcomes). Researchers were successfully able to follow-up with 1,610 patients, or 98%.

A risk-stratification analysis showed that over one-third of the patients had intermediate- or high-risk disease at diagnosis. Death caused by prostate cancer occurred in 45 men (2.7%). Of those 45 patients, 17 (3.1%) were in the active monitoring group, 12 (2.2%) in the prostatectomy group and 16 (2.9%) in the radiotherapy group.

Meanwhile, death from secondary causes occurred in 356 men, or 21.7%, with similar numbers in all three groups. Of the men in the active monitoring group, 133 men (24.4%) were alive and without any prostate cancer treatment at the end of follow-up. Researchers saw no differential effects on cancer-specific mortality in relation to the baseline PSA level, tumor stage or grade or risk-stratification score. After the 10-year analysis, no treatment complications were reported by patients.

Researchers concluded that after 15 years of follow-up, prostate cancer-specific mortality was low, regardless of the treatment method assigned. Therefore, the choice of therapy must be weighed with trade-offs between benefits and harms associated with each treatment option available for localized prostate cancer.

“Current Causes of Death in Children and Adolescents in the United States,” The New England Journal of Medicine, May 19, 2022

The Centers for Disease Control and Prevention (CDC) released official, updated mortality data that showed over 45,000 firearm-related deaths in the United States in 2020, which is a new high. In previous years, the analyses have shown increases in firearm-related mortality from 2015 to 2019 as compared to the relatively stable rates of these deaths in the years 1999 to 2014.

The updated data shows a large 13.5% increase in firearm-related death from 2019 to 2020. This uptick was largely due to firearm homicides, which had a 33.4% increase from 2019 to 2020; the rate of firearm suicides increased by 1.1%. Due to this data, researchers concluded that, as firearm homicides disproportionately affect younger people in the United States, these results call for an update to the findings of Cunningham, et al., regarding the leading causes of death for children and adolescents in the United States.

The previous analysis examined data through 2016 and showed that firearm-related injuries were second to motor vehicle crashes as the leading cause of death among children and adolescents (1 to 19 years of age). Since 2016, that gap has narrowed. In 2020, firearm-related injuries became the number one cause of death in that age group. Additionally, from 2019 to 2020, the increase of firearm-related deaths of all types (suicide, homicide, unintentional and undetermined) among that age group was 29.5%. This number is more than twice as high as the relative increase in the general population. An increase was seen across most demographic characteristics and types of firearm-related deaths.

Researchers continued to note that drug overdoses and poisoning increased by 83.6% among children and adolescents from 2019 to 2020. Drug overdoses and poisoning became the third leading cause of death for that age group. The increase can be explained largely by the 110.6% increase of unintentional poisonings from 2019 to 2020. The rates of other leading causes of death have remained mostly stable since the prior analysis, suggesting that changes in mortality trends among those 1 to 19 years of age during the early COVID-19 pandemic were firearm-related injury and drug poisoning specific. COVID-19 alone resulted in 0.2 deaths per 100,000 children and adolescents in 2020.

While the new data is consistent with other evidence that firearm violence has increased throughout the COVID-19 pandemic, the reasons for the increase are still unclear. It cannot be assumed that firearm-related mortality will later revert back to pre-pandemic levels. However, the increase in firearm-related mortality reflects a long-term trend. Researchers assert that this data shows that leaders continue to fail to protect children and adolescents from preventable causes of death.

Investments are being made toward the prevention of firearm violence. This includes new funding from the CDC and the National Institutes of Health, as well as funding for the prevention of community violence, which has been proposed in federal legislation. Researchers encourage this funding momentum to continue.

“Comparison of Maternal Labor-Related Complications and Neonatal Outcomes Following Elective Induction of Labor at 39 Weeks of Gestation vs Expectant Management,” JAMA Network, May 12, 2023

In this study, researchers set out to determine the maternal labor-related and neonatal outcomes that are experienced following elective induction of labor at 39 weeks of gestation, compared with expectant management. Researchers conducted a systematic review and meta-analysis of 14 studies with over 1.6 million participants.

It was determined that induction of labor at 39 weeks of gestation was associated with improved maternal labor-related and neonatal complications, such as the reduced likelihood of perineal injury, macrosomia and low five-minute Apgar score after birth. Both multiparous and nulliparous women had a reduced likelihood of an emergency Cesarean section. However, it was also determined that among nulliparous women, induction of labor was associated with an increased likelihood of shoulder dystocia compared with expectant management, although, as the study notes, the explanation for this is not immediately clear.

Researchers concluded that these finding suggest the elective induction of labor at 39 weeks of gestation may be safe and beneficial for some women, but there are potential risks that should be discussed with nulliparous women.

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