Hereditary Breast Cancer: Shared Communication and Care
Bibliographic record
Abstract
To the Editor: We read with great interest the recent article by Penson et al, 1 reporting on general health-related quality of life (HRQOL) outcomes in a cohort of 2,306 assessable patients, diagnosed in 1994 and 1995, 2 years after treatment with either radical prostatectomy (RP), radiotherapy (RT), hormone ablation, or watchful waiting.The main results were that no significant differences between the various treatment modalities were detected, and that impaired urinary and sexual function and the resulting bother were associated with significantly reduced scores in the majority of general HRQOL domains assessed.Such studies comparing quality of life between different modalities of prostate cancer treatment are of great importance, given that the rates of tumor control appear to be remarkably similar between different treatment approaches, as supported by a recent interspecialty comparison of data from leading centers.2 Penson et al 1 confirm prospectively previous findings that the profile of organ toxicity is treatment-specific and that this toxicity has an impact on general HRQOL domains.3,4 Despite repeatedly stating that there are no significant differences in general HRQOL between treatment groups, the article by Penson et al 1 does not convince us that HRQOL was equal after surgery and RT.It appears striking that although they give scores for each HRQOL domain by subgroup (good v poor urinary function, etc), the authors do not present such raw data for the different treatment groups, but rather show only global means for the overall cohort.Also, the different grouping of patients at baseline (eg, "any urinary leak" v "total cohort") and at 2 years ("frequent leakage/no control" v "occasional leakage/total control") prevents the reader from estimating the true impact of each treatment on organ function.Despite this limitation, the effect of RP on urinary function ("any leak" at baseline, 12%; "frequent leakage/no control" at 2 years, 21.5%) compares unfavorably to that of RT ("any leak" at baseline, 25%; "frequent leakage/no control" at 2 years, 3.3%).This observation in conjunction with the impact of urinary function on HRQOL in the overall cohort would make us suspect that there should be at least a trend toward better HRQOL after RT than after RP.Considering the large size of the cohort, it would be of great interest to present the HRQOL data for each treatment modality in order to avoid any bias in data interpretation.Any conclusion from possible HRQOL differences between treatment approaches for current clinical practice will have to be drawn with care, as advances in both surgical and radiotherapeutic techniques since the mid-1990s have been shown to decrease organ toxicity and improve quality of life.5,
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.036 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.014 | 0.023 |
| Insufficient payload (model declined to judge) | 0.009 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".