Discrete Improvement in Racial Disparity in Survival among Patients with Stage IV Colorectal Cancer: a 21-Year Population-Based Analysis

Purpose Recently, multiple clinical trials have demonstrated improved outcomes in patients with metastatic colorectal cancer. This study investigated if the improved survival is race dependent. Patients and Methods Overall and cancer-specific survival of 77,490 White and Black patients with metastatic colorectal cancer from the 1988–2008 Surveillance Epidemiology and End Results registry were compared using unadjusted and multivariable adjusted Cox proportional hazard regression as well as competing risk analyses. Results Median age was 69 years, 47.4 % were female and 86.0 % White. Median survival was 11 months overall, with an overall increase from 8 to 14 months between 1988 and 2008. Overall survival increased from 8 to 14 months for White, and from 6 to 13 months for Black patients. After multivariable adjustment, the following parameters were associated with better survival: White, female, younger, better educated and married patients, patients with higher income and living in urban areas, patients with rectosigmoid junction and rectal cancer, undergoing cancer-directed surgery, having well/moderately differentiated, and N0 tumors (p<0.05 for all covariates). Discrepancies in overall survival based on race did not change significantly over time; however, there was a significant decrease of cancer-specific survival discrepancies over time between White and Black patients with a hazard ratio of 0.995 (95 % confidence interval 0.991–1.000) per year (p=0.03). Conclusion A clinically relevant overall survival increase was found from 1988 to 2008 in this population-based analysis for both White and Black patients with metastatic colorectal cancer. Although both White and Black patients benefitted from this improvement, a slight discrepancy between the two groups remained.

An exploratory study about the perception and justification of violence in Mixed Martial Arts and kickboxing athletes

THE INFLUENCE of combat sport practice on behaviour, attitude, personality and other factors was, and still remains, a research topic of great interest as well as conflicting points of view. Findings are as yet inconclusive since a direct or causal effect is difficult to establish and other factors external to the individual, such as the instructor’s coaching style, also need to be taken into consideration. Furthermore, the wide range of disciplines pertaining to the category combat sports differ from each other on a number of characteristics, such as the extent of physical contact or competition rules, and in fact, attempts have been made to distinguish between various sub-types (e.g. Trulson, 1986). A common distinction made is that between the traditional martial arts, which place emphasis on the art’s philosophy, its traditions and hierarchy (e.g. traditional karate, aikido) and the modern (or Western) combat sports (e.g. boxing, Mixed Martial Arts). An ongoing debate exists about the potential positive and/or negative influence of combat sport practice in comparison to other sport disciplines that do not include this element of fighting and direct aggression. On the one hand, combat sports have been presented by some researchers and sport practitioners as a means of promoting positive social and individual behavior, such as in Theeboom, De Knop and Wylleman’s (2008) evaluation of a martial arts Programme for socially disadvantaged youths in Belgium. Results revealed a positive effect of this project; however, it also highlighted the crucial role played by the instructors or leaders of such programmes. In another intervention using martial arts, Trulson (1986) reported a positive effect of a six month traditional martial art (Korean Tae Kwon Do) intervention with male juvenile delinquents including a reduction in aggressiveness and anxiety, thus confirming the positive influence of such an activity. Nevertheless, this effect was not observed in the other group participating in a modern Adaptation of this martial art led by the same instructor, where the philosophical aspect of this discipline was not emphasised. Moreover, an opposite effect was ascertained in this case where an increased tendency towards delinquency was reported. These results support the distinction between the various types of combat sports together with the way this sport is presented and taught by the instructor.