Medical Student Research Fellowship for Summer 2003

Mentor: Thomas Anthony, MS, MD
Department: Surgery (VA Surgical Service)
Room number: A544
Mail Code: 112
Phone number: 214-857-1800
E-mail: Thomas.Anthony@UTSouthwestern.edu
Project title: Health-related quality of life in patients undergoing vascular surgery

Human subjects IRB approved project number (where applicable): VA HSS IRB#02-119

Animal subjects IRB approved project number (where applicable): N/A

Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects) Patient-based

Brief Description of Project 1:
We have begun a long-term project at the VA North Texas Health Care System Hospital that seeks to define quality of life for patients who have undergone surgery to alleviate symptoms associated with peripheral vascular disease. Very little data exists concerning the impact that peripheral vascular disease or its therapy has on quality of life. This is however extremely important clinically, since therapeutic decision-making is currently based on assumptions concerning this outcome. Knowledge of how quality of life varies depending on treatment will allow for better patient selection and outcome. Prospective accrual of the cohort of patients that will help address this issue began in November 2002.
Medical Students interested in this project would be expected to participate in the accrual and data collection aspects of this study. Additionally, it will be possible to design and execute a case-control study based on the accumulated database.
We are also engaged in similar studies exploring the interaction between quality of life, patient-, tumor-, and treatment-related variables and outcomes for patients with colorectal cancer. Utilizing accumulated data, several projects are also possible including an analysis of the influence of pretreatment (i.e. at diagnosis) quality of life on survival.

Brief Description of Project 2: Incidence of Appendiceal Tumors from Patients That Present With Symptoms of Acute Appendicitis

Acute appendicitis is the most common presentation for appendiceal tumors. Appendiceal tumors are rare and often unexpectedly discovered during appendectomy procedures, complicating the procedure and creating a difficult decision-making environment. The rate of patients presenting with acute appendicitis has been stable over the past 50 years, but little is known about how this compares to the rate of appendiceal tumor discovery. Few studies have been performed to date that primarily focus on how the presentation of an appendiceal tumor might differ from that of an acute appendicitis. Most studies have primarily focused on the treatment and prognosis of the various types of appendiceal tumors. We will perform a retrospective analysis of the VA North Texas Health Care System patients who have undergone appendectomies in the last 5 years (1/1/97-4/1/03). The primary purpose of this analysis is to identify possible symptoms that might discriminate the diagnosis of appendiceal tumors from an acute appendicitis of benign etiology. Secondarily, this analysis will examine the treatments that were made and the subsequent actuarial survival rates of those patients with appendicele tumors. The inclusion criteria for the study will be all patients who have had appendectomies over the period defined above, who on pathologic review were shown to have some type of appendiceal tumor, and who have electronic medical record data available. The study will exclude any patient who has not undergone an appendectomy. Preliminary inquires suggest that our patient population will be approximately 75 patients. This number should be sufficient to provide adequate statistical power to minimize type II errors. Stepwise logistic regression will be utilized to identify patient demographic and presentation variables independently associated with appendicele cancer versus acute appendicitis. Strict patient confidentiality will be maintained throughout the study and during presentation and publication. The estimated time for completion is 3 months.

Previous Research Activities or Publications with Medical Students:

Previous/Current Medical Student: Joshua Long (8/1/02-present)
Publications and Accepted Abstracts
1. Anthony T, Long J Measurement of Health Related Quality of Life in Patients with Colon and Rectal Disease. In press Seminars in Colon and Rectal Disease.
2. Anthony T, Long J, Sarosi G, Nwariaku F, Rege R. Surgical complications exert a lasting effect on disease-specific health-related quality of life for patients with colorectal cancer. Accepted for Oral Presentation at 2003 Meeting of Society of University Surgeons and Publication in Surgery.

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