INTRODUCTION: A successful vaccination programme forms the cornerstone of controlling coronavirus disease 2019 (COVID-19). The unprecedented speed of COVID-19 vaccine development and lack of long-term data have raised fears regarding its safety and efficacy. Vaccine hesitancy can undermine the uptake, and hence success of the vaccination programme. Given the high complication rates of COVID-19 infections in kidney transplant recipients, it is particularly important to identify and address vaccine hesitancy in this population. METHODS: We conducted a cross-sectional survey among kidney transplant recipients attending transplant clinic between 5 April and 5 May 2021. The survey assessed attitudes towards COVID-19, willingness/hesitancy towards COVID-19 vaccination, vaccination concerns and prompts to vaccination. This was scored on a Likert scale with scores ranging from 'strongly disagree' - 1 point to 'strongly agree' - 5 points. RESULTS: One hundred and one completed responses were captured. Of these, 86% respondents reported to agree or strongly agree to vaccination. This was despite significant concerns of allograft rejection (mean score 4.12, standard deviation [SD] 0.97) and decreased immunosuppressant efficacy (mean score 4.14, SD 0.96) with vaccination. Multivariable model showed a positive association with transplant vintage of ≥ 5 years (median 2.41), lower educational levels of secondary school or less (median 5.82) and healthcare provider advocacy (median 1.88) in predicting vaccine acceptance. CONCLUSIONS Vaccine acceptance rate was high among kidney transplant recipients. Vaccine hesitancy remains a concern in those with a transplant vintage of less than 5 years and those with tertiary educational level. Healthcare provider advocacy is important in improving vaccine acceptance rates.
Humans ; Kidney Transplantation ; Singapore/epidemiology* ; Male ; Cross-Sectional Studies ; Female ; COVID-19 Vaccines ; COVID-19/epidemiology* ; Middle Aged ; Adult ; Transplant Recipients/psychology* ; Patient Acceptance of Health Care/statistics & numerical data* ; Vaccination Hesitancy/psychology* ; Surveys and Questionnaires ; Vaccination/psychology* ; Aged ; SARS-CoV-2

BACKGROUND: Effective interventions during the coronavirus disease 2019 (COVID-19) pandemic require an understanding of patients' knowledge and perceptions that influence their behaviour. Our study assessed knowledge of COVID-19 among kidney transplant recipients and donors, hitherto unevaluated. METHODS: We conducted a cross-sectional survey among 325 kidney transplant recipients and 172 donors between 1 May 2020 and 30 June 2020. The survey questionnaire assessed knowledge levels of COVID-19, sociodemographic data, health status, psychosocial impact of COVID-19 and precautionary behaviours during the pandemic. RESULTS: The mean COVID-19 knowledge score of the study population was 7.5 (standard deviation: 2.2) out of 10. The mean score was significantly higher among kidney recipients compared to kidney donors (7.9 [1.9] vs. 6.7 [2.6]; P <0.001). Younger age (21-49 vs. ≥50 years) and higher education (diploma and higher vs. secondary and lower) were associated with significantly higher knowledge scores in donors, but not among recipients ( P -interactions ≤0.01). In both kidney recipients and donors, financial concerns and/or social isolation were associated with lower knowledge levels. CONCLUSIONS Concerted efforts are needed to improve COVID-19 knowledge in kidney transplant recipients and donors, particularly older donors, donors with lower education and patients with financial concerns or feelings of social isolation. Intensive patient education may mitigate the impact of education levels on COVID-19 knowledge levels.
Humans ; COVID-19/epidemiology* ; Kidney Transplantation ; Middle Aged ; Singapore/epidemiology* ; Male ; Female ; Adult ; Cross-Sectional Studies ; Health Knowledge, Attitudes, Practice ; Transplant Recipients/psychology* ; Surveys and Questionnaires ; Tissue Donors/psychology* ; SARS-CoV-2 ; Young Adult ; Aged ; Pandemics

INTRODUCTIONWe reviewed changes in clinical characteristics, treatment and survival of lung cancer patients in Singapore over the past decade.

MATERIALS AND METHODSWe reviewed all primary lung cancer cases from January 2004 to December 2013. Basic demographic, clinical and treatment data were extracted from the database. Overall survival (OS) was calculated using Kaplan-Meier method; survival curves were compared using log-rank test. Linear regression trend lines were estimated using least squares approach, and Cox regression analyses were performed to identify prognostic factors.

RESULTSAmong 6006 lung cancer patients, the median age was 68 years old, 65% were males, 88% were Chinese, 92% had non-small-cell lung cancer and 76% had advanced stage IIIB/IV. There were proportionally more adenocarcinomas diagnosed over the years, while that of squamous cell carcinoma (SCC) and small-cell-lung cancer (SCLC) have remained stable. The median OS of all patients increased from 9.2 months in 2004 to 11.5 months in 2013. This survival improvement was statistically significant among patients with stage IIIB/IV (6.7 to 8.7 months;= 0.005) and adenocarcinoma (12.7 to 15.4 months;= 0.041). There was no improvement in median OS for SCC or SCLC. The use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) (hazard ratio [HR] 0.68; 95% CI, 0.63 to 0.73) and pemetrexed (HR, 0.69; 95% CI, 0.63 to 0.76) were significantly associated with improved OS.

CONCLUSIONSurvival of patients with advanced stage IIIB/IV lung adenocarcinoma has improved over the past decade, and is potentially associated with the use of EGFR TKI and pemetrexed.

INTRODUCTIONHigh levels of toxicities have been observed when docetaxel is administered at the standard dose of 75 mg/mevery 3 weeks (Q3W) in the real-world treatment of Asian patients with metastatic castrate-resistant prostate cancer (CRPC). This study aimed to evaluate the efficacy and tolerability of 2 attenuated regimens more widely used in an Asian setting to minimise toxicity - 60 mg/mQ3W and weekly docetaxel (20 mg/mto 35 mg/m).

MATERIALS AND METHODSMedical records of 89 CRPC patients between December 2003 and April 2013 were reviewed. Pairwise statistical analysis was performed, comparing efficacy and safety outcomes of 75 mg/mQ3W and weekly docetaxel with 60 mg/mQ3W. Treatment endpoints used were prostate-specific antigen (PSA) response (decrease of ≥50% from baseline), pain improvement after cycle 2, overall survival, time to disease progression and radiological response.

RESULTSPatients who received docetaxel at 75 mg/mQ3W were younger than those who received 60 mg/mQ3W (62 years and 66 years, respectively;= 0.0489). Both groups had similar response rates. Compared with patients on 60 mg/mQ3W, more patients on weekly regimens were symptomatic at baseline (63.2% and 87.5%, respectively;= 0.0173). Longer overall survival was observed in the 60 mg/mQ3W arm than the weekly docetaxel arm (16.9 months and 10.6 months, respectively;= 0.0131), though other measures of response did not differ significantly.

CONCLUSIONOur data supports the use of 60 mg/mQ3W docetaxel which has similar efficacy and an acceptable toxicity profile compared to the standard 75 mg/mQ3W regimen. Weekly docetaxel has significant palliative benefits among symptomatic patients despite lower overall survival.

INTRODUCTIONThis study analysed the tumour attenuation characteristics of different subtypes of renal cell carcinomas (RCCs), including clear cell RCC (ccRCC), papillary RCC (pRCC), mixed RCC, chromophobe RCC (chRCC) and oncocytoma.

METHODSWe randomly selected 100 RCC cases that underwent nephrectomy between 2004 and 2012 from a collaborative database. Of these cases, 36 were excluded due to the absence of available imaging. The remaining 64 cases comprised 35 ccRCCs, 11 pRCCs, eight chRCCs, seven mixed RCCs and three oncocytomas. The cases were classified as computed tomography (CT) kidney, CT urogram (with plain, nephrographic and pyelographic phases) or CT abdomen (with portovenous and delayed phases). A circular region of interest (ROI) ≥ 1 cmwas drawn and the same standard ROI size was used for each phase at the same site; three different circular ROIs were drawn per lesion per phase. Analysis of variance and t-test were used to examine differences in the radiological characteristics.

RESULTSThere was no statistical difference in the attenuation and degree of enhancement between mixed RCCs and ccRCCs. The attenuation and degree of enhancement of the oncocytomas were significantly higher than those of the other RCC subtypes.

CONCLUSIONWhile mixed RCCs did not have attenuation characteristics that differed significantly from those of ccRCCs, oncocytomas can be distinguished from ccRCCs, pRCCs, chRCCs and mixed RCCs by their high radiological density and enhancement. The ability to differentiate oncocytomas from these tumours potentially allows the preoperative selection of patients with small renal masses for conservative management.