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Exposure to ambient air pollution has significant adverse health effects; however, whether air pollution is associated with urological cancer is largely unknown. We conduct a systematic review and meta-analysis with epidemiological studies, showing that a 5 μg/m3 increase in PM2.5 exposure is associated with a 6%, 7%, and 9%, increased risk of overall urological, bladder, and kidney cancer, respectively; and a 10 μg/m3 increase in NO2 is linked to a 3%, 4%, and 4% higher risk of overall urological, bladder, and prostate cancer, respectively. Were these associations to reflect causal relationships, lowering PM2.5 levels to 5.8 μg/m3 could reduce the age-standardized rate of urological cancer by 1.5 ~ 27/100,000 across the 15 countries with the highest PM2.5 level from the top 30 countries with the highest urological cancer burden. Implementing global health policies that can improve air quality could potentially reduce the risk of urologic cancer and alleviate its burden. Whether air pollufion is associated with urological cancer is largely unknown. In this study, the authors reveal correlafions between air pollufion and urological cancer risk: an increase of 5 μg/m3 in PM2.5 and 10 μg/m3 in NO2 would raise risks by 6-9% and 3-4%, respecfively; while lowering PM2.5 to 5.8 μg/m3 may reduce urological cancer burden. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions The Oncotype DX Genomic Prostate Score (ODX‐GPS) is a gene expression assay that predicts disease aggressiveness. The objective of this study was to identify sociodemographic and regional factors associated with ODX‐GPS uptake.Data from Surveillance Epidemiology and End Results registries on men with localized prostate cancer with a Gleason score of 3 + 3 or 3 + 4, PSA ≤20 ng/mL, and stage T1c to T2c disease from 2013 through 2017 were linked with ODX‐GPS data. Census‐tract level neighborhood socioeconomic status (nSES) quintiles were constructed using a composite socioeconomic score. Multivariable logistic regression was used to estimate the associations of ODX‐GPS uptake with age at diagnosis, race and ethnicity, nSES, geographic region, insurance type, and marital status, accounting for National Comprehensive Cancer Network risk group, year of diagnosis, and clustering by census tract.Among 111,434 eligible men, 5.5% had ODX‐GPS test uptake. Of these, 78.3% were non‐Hispanic White, 9.6% were Black, 6.7% were Hispanic, and 3.6% were Asian American. Black men had the lowest odds of ODX‐GPS uptake (odds ratio, 0.70; 95% confidence interval [CI], 0.63–0.76). Those in the highest versus lowest quintile of nSES were 1.64 times more likely (95% CI, 1.38–2.94) to have ODX‐GPS uptake. The odds of ODX‐GPS uptake were statistically significantly higher among men residing in the Northeast, West, and Midwest compared to the South.Disparities in ODX‐GPS uptake by race, ethnicity, nSES, and geographical region were identified. Concerted efforts should be made to ensure that this clinical test is equitably available. [ABSTRACT FROM AUTHOR]

1. Identify opportunities to improve perioperative communication about goals for patients with urologic serious illness. 2. Understand the value of having both Palliative Care Specialists and Urologists involved in preoperative conversations about patient goals. A joint Urology-Palliative Care team approach to navigating patient goals is warranted in advance of surgery for patients with urologic serious illness. In coordination, Urologists and PC can offer complementary contributions to different parts of a goals of care conversations, covering both goals of care generally and developing shared understanding of risks and realistic expectations of what surgery can achieve. Care for urologic serious illness often includes surgery; preoperative shared decision making about patient goals is often inadequately implemented in surgical settings. To understand perspectives on improving perioperative communication about goals for patients facing urologic serious illness. We conducted 37 semi-structured interviews with Palliative Care Physicians (PC) (11), Urologists (13) and interdisciplinary clinicians (13) at fourteen geographically distributed Veteran Health Administration (VHA) sites. The analytic approach relied on content analysis with dual review; analysis is conducted separately by provider type and triangulated. 1) In existing pre-operative workflows: "patients are not [always] aware that we might be able to palliate their symptoms without surgery" (URO). 2) Goal of surgery is often something patients really need help understanding, e.g. "It's gonna help temporarily, but it's not gonna help long term" (PC). 3) PC is not in the position to have the part of the goal of care conversation that clarifies the goal of the surgery: "it's very hard for non-surgeon to have a robust goals of care discussion with the patient who's co-managed with surgery unless surgery is able to give you a sense of what to expect." (PC) 4) A team approach to clarifying and navigating patient goals is warranted: "how do we work together to sort of think about prognosis, how to plan ahead for care after the surgery and then setting sort of real realistic expectations and goals for after the surgery?"(PC). 5) In coordination, Urologists and PC can offer complementary contributions to different parts of a goals of care conversation: "the interventionists would better know how effective the intervention is going to be, but PC probably has much better perspective on how the patient is doing overall." (URO) Patients will benefit from a urology-PC team approach to clarifying goals of care and surgery. Shared Decision Making / Advance Care Planning / Surgical / Palliative Care [ABSTRACT FROM AUTHOR]

1. Identify time points along the perioperative continuum where PC and Urology can be better integrated. 2. Understand the importance of the perioperative period as a focus for future interventions to improve quality of care in patients facing urologic serious illness. Stakeholder interviews reveal a general overall need to create a culture change so that palliative care is integrated appropriately for patients with urologic serious illness. Many urologic serious illnesses are treated with surgical procedures, which may put patients at a further risk of diminished quality of life. To understand stakeholder perceptions on integrating perioperative Palliative Care (PC) for patients with serious urologic illness. We conducted semi-structured interviews with purposefully sampled palliative care physicians (11), urologists (13), and clinical team members (13) at eleven geographically distributed Veteran Health Administration sites. Team-based thematic analysis was conducted to consensus with a dual review in Atlas.ti. We identified one general overall theme and three themes representing needs along the perioperative continuum as opportunities for integrating PC and urology. The general overall need was to "change culture" so that PC is not a "last resort" and "ideally, we would be starting palliative [care], when [we] start curative [treatment]." Opportunity 1: Utilizing telehealth and team member role expansion when discussing diagnosis and treatment options, with urologic surgery as a potential treatment, allows for multiple conversations "so they're not rushed in 15 minutes to mentally deal with the new diagnosis of cancer." Opportunity 2: Creating a process to ensure goal of surgery conversations occur with both urologists and PC, since "urologic procedures can have complications that significantly impact quality of life," which "would require changing how our workflow is structured." Opportunity 3: During the pre-operative visits, there can be interdisciplinary input and evaluation of the patient prior to surgery, so that the patient can "have a sort of joint meeting with us and the urologist." This represented the last point in time to de-escalate and offer non-surgical options prior to surgery. The study informs future interventions to improve the quality of care by integrating palliative care with urology. Future work can build on these findings by implementing the opportunities and determining how it impacts patient outcomes. Interdisciplinary Teamwork/Professionalism/Qualitative and Mixed Methods Research [ABSTRACT FROM AUTHOR]