An Analysis of the Potential Benefits of Metformin on Disease Recurrence in Oral and Oropharyngeal Squamous Cell Carcinoma

Objective: Diabetes mellitus type 2 has been associated with increased cancer risk and cancer related mortality. Metformin, one of the most widely used anti-diabetic medications, has been found to have important anticancer properties in addition to hypoglycemic effects. The effects of metformin on clinical outcomes in oral cavity (OC) and oropharyngeal (OP) squamous cell carcinoma (SCC) have not been thoroughly analyzed. The purpose of this study was to evaluate the effects of metformin use on cancer recurrence in diabetic patients with oral cavity and oropharyngeal squamous cell carcinoma. Design: Retrospective review. Setting: Academic tertiary medical center. Patients: Seventy-seven patients with diabetes mellitus type 2 and oral cavity or oropharyngeal squamous cell carcinoma were treated and followed at our tertiary academic institution and the Veterans Affairs Greater Los Angeles Healthcare System from 1998 to 2012. Main Outcome Measure: Cox proportional hazards models and Kaplan-Meier curves were constructed to determine if metformin has an effect on disease recurrence after primary cancer treatment. Results: Metformin does not appear to have a significant effect on disease recurrence in patients with OC/OP SCC and diabetes mellitus type 2 (p = 0.53). Even when including only patients with stage I or II disease, metformin still did not decrease recurrence (p = 0.60). Conclusion: Herein, our data suggest that metformin use does not significantly impact time until recurrence for diabetic patients with OC/OP SCC.

Pediatric interfacility transport effects on mortality and length of stay

Background We aimed to evaluate the effects of interfacility pediatric critical care transport response time,physician presence during transport,and mode of transport on mortality and length of stay(LOS)among pediatric patients.We hypothesized that a shorter response time and helicopter transports,but not physician presence,are associated with lower mortality and a shorter LOS.Methods Retrospective,single-center,cohort study of 841 patients(<19 years)transported to a quaternary pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport records.Multivariate linear and logistic regression analyses adjusted for age,diagnosis,mode of transport,response time,stabilization time,return duration,mortality risk(pediatric index of mortality-2 and pediatric risk of mortality-3),and inotrope,vasopressor,or mechanical ventilation presence on admission.Results Four hundred and twenty-eight(50.9%)patients were transported by helicopter,and 413(49.1%)were transported by ambulance.Physicians accompanied 239(28.4%)transports.The median response time was 2.0(interquartile range 1.4–2.9)hours.Although physician presence increased the median response time by 0.26 hours(P=0.020),neither physician presence nor response time significantly affected mortality,ICU length of stay(ILOS)or hospital length of stay(HLOS).Helicopter transports were not significantly associated with mortality or ILOS,but were associated with a longer HLOS(3.24 days,95%confidence interval 0.59–5.90)than ambulance transports(P=0.017).Conclusions These results suggest response time and physician presence do not significantly affect mortality or LOS.This may reflect the quality of pre-transport care and medical control communication.Helicopter transports were only associated with a longer HLOS.Our analysis provides a framework for examining transport workforce needs and associated costs.