Jessica C. Goodwin

Objective: Assess the impact of adult cochlear implantation on the disability and quality of life (QOL) of communication partners (CP) of cochlear implant (CI) recipients. Databases reviewed: PubMed, MEDLINE, Embase, Cochrane CENTRAL, Science Citation Index Expanded, and Emerging Sources Citation Index were searched. Methods: This study was reported following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Articles included reported on disability or QOL measures of CP of adult CI recipients. Study selection included retrospective, prospective, and randomized controlled studies in English language. Three reviewers independently screened studies for inclusion, extracted data, and evaluated risk of bias. Outcomes included both qualitative and quantitative pre-CI and post-CI measures of CP disability or QOL. Results: Of 1615 screened articles, 9 studies utilizing quantitative and qualitative measures with 504 CP met inclusion criteria. Four of 6 studies assessing only post-CI CP QOL, demonstrated self-reported improvement, while one demonstrated worse CP QOL compared with the general population and one identified CP and CI recipient qualities that correlated with CP QOL scores. Two studies assessing pre-CI to post-CI CP QOL also reported improvements. One study assessing only pre-CI CP QOL suggested that CPs had worse QOL than normal hearing controls. Duration of CI recipient hearing loss did not impact CP QOL in any study. Conclusions: Though homogenous data on the QOL of CPs of CI recipients and the relationship between CI recipient and CP factors is limited, studies suggest that CPs of CI recipients may have worse QOL than the general population but, cochlear implantation may improve CP QOL.

We thank Tavakkoli and colleagues for their interest in our recent review of gastric cancer progress and priorities (1), which included discussion of the higher gastric cancer incidence rates among all racial and ethnic minorities compared with non-Hispanic Whites, and specifically higher mortality rates among Black and Hispanic patients with non-cardia gastric cancer. We concluded that persistent disparities in incidence and mortality warrant risk-stratified prevention and interception strategies. We recognize the point raised by Tavakkoli and colleagues that, while we also reviewed the trend of increasing incidence of early-onset non-cardia gastric cancer among non-Hispanic White women, we did not acknowledge the mounting evidence of a similar trend among Hispanic White persons in the United States. We greatly appreciate Tavakkoli and colleagues bringing our attention to this important aspect of the changing demographics of early-onset non-cardia gastric cancer, and the need for additional research to understand, and ultimately prevent, this highly fatal disease that disproportionately affects racial and ethnic minorities.See the original Letter to the Editor, p. 1270P. Alagesan reports grants from Stead Fellowship during the conduct of the study. J.C. Goodwin reports grants from Emerson Collective outside the submitted work. M. Epplein reports grants from NCI, NIH during the conduct of the study. No disclosures were reported by the other author.This work was supported by Duke Cancer Disparities P20 (CA251657) and the P30 (CA014236) grants through the Duke Cancer Institute.

Gastric cancer, the fifth leading cause of cancer worldwide, is estimated to be responsible for approximately 1.4% of all new cancers and 1.8% of all cancer-related deaths in the United States. Despite declining incidence rates and improved survival rates, however, gastric cancer continues to disproportionately affect racial and ethnic minorities and individuals of lower socioeconomic status at higher rates than the general population. To improve outcomes globally and address disparities within the United States, continued improvements are needed in risk factor modification and biomarker development and to improve access to existing preventative measures such as genetic testing and H. pylori eradication testing, in addition to expanding upon current clinical guidelines for premalignant disease to address gaps in endoscopic surveillance and early detection.