bluuebunny/crossref_metadata_2025 huggingface dataset:
Constructing Lumbersexuality: Marketing an Emergent Masculine Taste Regime
Authors: Rademacher Mark A. , Kelly Casey R.
Published: September 2018

This article examines the online retailer Huckberry.com as a singular, centralized authority responsible for marketing “lumbersexuality” as an emergent, gender-normative taste regime. As an evolution of the devalued hipster marketplace myth, analysis reveals Huckberry promotes an adaptable taste regime to its young, educated, urban, White male clientele that unites goods, meanings, and practices across multiple fields of consumption that reconnect indie consumption and taste with a fantasy of “authentic” masculinity. We argue that Huckberry offers men semiotic resources that merge the urban with the outdoors in a way that enables the enactment of a fraught though seemingly durable masculine identity project that weaves the extraordinary and mythological into the quotidian. Implications of this gendered taste regime are discussed in relationship to the ways in which lumbersexuality is mobilized as a more authentically masculine alternative to the ironic stance of hipsterism and the supposed phoniness of mass culture.
Value of Information Choices that Influence Estimates: A Systematic Review of Prevailing Considerations
Authors: Koffijberg Hendrik , Rothery Claire , Chalkidou Kalipso , Grutters Janneke
Published: September 2018

Background. Although value of information (VOI) analyses are increasingly advocated and used for research prioritization and reimbursement decisions, the interpretation and usefulness of VOI outcomes depend critically on the underlying choices and assumptions used in the analysis. In this article, we present a structured overview of all items reported in literature to potentially influence VOI outcomes. Use of this overview increases awareness and transparency of choices and assumptions underpinning VOI outcomes. Methods. A systematic literature review was performed to identify aspects of VOI analyses that were found to potentially influence VOI outcomes. Identified aspects were grouped to develop a structured overview. Explanations were defined for all items included in the overview. Results. We retrieved 687 unique papers, of which 71 original papers and 8 reviews were included. In the full text of these 79 papers, 16 aspects were found that may influence VOI outcomes. These aspects related to the underlying evidence (bias, synthesis, heterogeneity, correlation), uncertainty (structural, future pricing), model (relevance, approach, population), choices in VOI calculation (estimation technique, implementation level, population size, perspective), and aspects specifically for assessing the value of future study designs (reversal costs, efficient estimator). These aspects were aggregated into 7 items to provide a structured overview. Conclusion. The developed overview should increase awareness of key choices underlying VOI analysis and facilitate structured reporting of such choices and interpretation of the ensuing VOI outcomes by researchers and policy makers. Use of this overview should improve prioritization and reimbursement decisions.
Studying childhood, children, and their rights: The challenge of interdisciplinarity
Authors: Moody Zoe , Darbellay Frédéric
Published: September 2018

This article proposes an epistemological reflection on the multidisciplinary/interdisciplinary fields of Childhood and Children’s Rights Studies. The theoretical backgrounds underlying the claims for interactions between disciplines in these specific fields are investigated, exploring their multidisciplinary or interdisciplinary nature(s). Between specificities, similarities, and complementarities, possibilities of dialogue and integration within and beyond the fields are explored, to identify the conditions for interdisciplinary work on the complex issues of childhood, children, and their rights.
Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery
Authors: Quintanilla-González L , Torres-Villalobos G , Hinojosa-Azaola A
Published: September 2018

Background

We aimed to identify risk factors for early complications in systemic lupus erythematosus (SLE) patients undergoing major surgery.

Methods

We conducted a retrospective comparative cohort study including patients with SLE undergoing major surgery, and non-SLE patients matched 1:1. Main outcomes were development of infectious and noninfectious complications, and 30-day postoperative mortality.

Results

A total of 382 patients (191 SLE and 191 non-SLE) were included. Postoperative complications occurred in 82 (43%) SLE patients and 58 (30%) without SLE, ( p = 0.01). Variables associated with infectious complications in SLE patients: prednisone use (OR 1.81, 95% CI 1.13–2.90), anemia (OR 2.43, 95% CI 1.45–4.08), hypoalbuminemia (OR 2.58, 95% CI 1.55–4.30) and lymphopenia (OR 2.43, 95% CI 1.52–3.89), p < 0.05. Variables associated with noninfectious complications: anemia (OR, 1.93, 95% CI 1.03–3.64) and hypoalbuminemia (OR 2.11, 95% CI 1.16–3.86), p < 0.05. Variables associated with any complication: SLEDAI-2K (OR 1.1, 95% CI 1.01–1.20), nephritis (OR 10.08, 95% CI 1.21–83.63), aspirin use (OR 2.68, 95% CI 1.19–6.02, p = 0.01), low C3 (OR 2.00, 95% CI 1.06–3.80), anemia (OR 2.68, 95% CI 1.39–5.18), hypoalbuminemia (OR 3.49, 95% CI 1.83–6.66) and lymphopenia (OR 2.36, 95% CI 1.30–4.26), p < 0.05. More patients with SLE died (6% vs 1%, p = 0.02).

Conclusions

SLE patients present higher frequency of postoperative complications and mortality compared with non-SLE patients. Hypoalbuminemia, anemia, lymphopenia and aspirin use are independent risk factors.
Micro-RNAS Regulate Metabolic Syndrome-induced Senescence in Porcine Adipose Tissue-derived Mesenchymal Stem Cells through the P16/MAPK Pathway
Authors: Meng Y. , Eirin A. , Zhu X.-Y. , Tang H. , Hickson L.J. , Lerman A. , van Wijnen A.J. , Lerman L.O.
Published: September 2018

Mesenchymal stem cells (MSCs) constitute an important repair system, but may be impaired by exposure to cardiovascular risk factors. Consequently, adipose tissue-derived MSCs from pigs with the metabolic syndrome (MetS) show decreased vitality. A growing number of microRNAs (miRNAs) are recognized as key modulators of senescence, but their role in regulating senescence in MSC in MetS is unclear. We tested the hypothesis that MetS upregulates in MSC expression of miRNAs that can serve as post-transcriptional regulators of senescence-associated (SA) genes. MSCs were collected from swine abdominal adipose tissue after 16 weeks of Lean or Obese diet ( n = 6 each). Next-generation miRNA sequencing (miRNA-seq) was performed to identify miRNAs up-or down-regulated in MetS-MSCs compared with Lean-MSCs. Functional pathways of SA genes targeted by miRNAs were analyzed using gene ontology. MSC senescence was evaluated by p16 and p21 immunoreactivity, H2AX protein expression, and SA-β-Galactosidase activity. In addition, gene expression of p16, p21, MAPK3 (ERK1) and MAPK14, and MSC migration were studied after inhibition of SA-miR-27b. Senescence biomarkers were significantly elevated in MetS-MSCs. We found seven upregulated miRNAs, including miR-27b, and three downregulated miRNAs in MetS-MSCs, which regulate 35 SA genes, particularly MAPK signaling. Inhibition of miR-27b in cultured MSCs downregulated p16 and MARP3 genes, and increased MSC migration. MetS modulates MSC expression of SA-miRNAs that may regulate their senescence, and the p16 pathway seems to play an important role in MetS-induced MSC senescence.
Vitoria’s On the Indians, Legal Subjectivity and the Right to Travel
Authors: Seuffert Nan M
Published: September 2018

This article analyses configurations of legal subjectivity, sexuality and the right to travel at the inception of international law. It commences a project on a genealogy of the legal subject of the right to travel that attends to sexuality and ultimately aims to shed light on legal subjectivity and sexuality in current refugee law and policy debates. In particular, it analyses the key early 16th-century work on the law of nations of the Spanish theologian and jurisprudent, Francisco de Vitoria, which produces Christian Europeans as full legal subjects with the right to world travel, in opposition to Native Americans, who were relegated to the position partial legal subjects with duties of hospitality. It argues that the attribution of the ‘Supersins’ of human sacrifice, cannibalism, bestiality and sodomy to Native Americans, in part through analogy to Spain’s long-time enemies the Muslims, was crucial to this partial legal subjectivity, positioning both indigenous peoples subjected to colonization, and religious others, as marginalized outsiders to the law of nations at its crucial beginnings.
Shaping a ‘pedagogy of interruption’: Theorizing the role of educational agents in democratic education in urban contexts
Authors: Deceur Evelyne , Roets Griet , Rutten Kris , De Bie Maria
Published: September 2018

This article theorises the role of educational agents in democratic education in urban contexts by engaging in the discussion about the relationship between citizenship, democracy and education. Therefore, we confront Gert Biesta’s conceptualisation of a ‘pedagogy of interruption’ with the empirical insights that emerge from a qualitative research project on democratic education in a particular urban context in Ghent (Belgium). We elaborate on the historical developments and origins of the educational practices and interventions in this urban context and reveal three contemporary educational strategies that coincide and complement each other while implementing the democratic ideal of equality in differentiated ways: integration, activation and instigation. Our analysis enables us to reflect on the complexities, ambiguities and dilemmas at stake when educational agents shape a ‘pedagogy of interruption’. This pedagogy entails the constant search to balance the multidimensional purposes of democratic education, that is, between socialisation and subjectification.
Trends in Clinical Characteristics and Short-Term Outcome of HIV-Infected Patients at a Tertiary Care Hospital in South India
Authors: Shamanna Suryanarayana Bettadpura , Matta Kiran Kumar , Hamide Abdoul
Published: September 2018

Background:

Limited information is available on changing trends in HIV positive patients treated with first-line antiretroviral therapy from India.

Methods:

The clinical characteristics and short-term outcome were compared between a retrospective group enrolled between January 2006 and March 2007 (06-07 group—100 patients) and a prospective group enrolled between February 2011 and March 2012 (10-12 group—85 patients).

Results:

Median age was 36 and 38 years in 06-07 and 10-12 groups, respectively. Median baseline CD4 count was 146 cells/mL3 in the 10-12 group, and it was not significantly different from that of 06-07 group. Tuberculosis was diagnosed 3 times more commonly in the 10-12 group. The retention proportion at the end of 10 months was 68% in the 10-12 group when compared to that of 59% in the 06-07 group.

Conclusion:

There was a trend toward improved outcome over the period of time, but the attrition rate remained high.
Can’t We Just Disregard Fake News? The Consequences of Exposure to Inaccurate Information
Authors: Rapp David N. , Salovich Nikita A.
Published: September 2018

People routinely encounter inaccurate information, from fake news designed to confuse audiences, to communications with inadvertent mistakes, to stories made up to entertain readers. The hope is that these inaccuracies can be easily ignored, exerting little influence on our thoughts and actions. Unfortunately, being exposed to inaccuracies leads to problematic consequences. After reading inaccurate statements, readers exhibit clear effects of those contents on their decisions and problem-solving. This occurs even when readers possess appropriate prior knowledge to evaluate and reject the inaccuracies. Exposure to inaccurate information leads to confusion about what is true, doubt about accurate understandings, and subsequent reliance on falsehoods. Interventions and technologies designed to address these effects by encouraging critical evaluation can support effective comprehension and learning.
The influence of yoga on mediational relationships between sleep and cancer-related fatigue: A URCC NCORP RCT in 321 cancer patients.
Authors: Lin Po-Ju , Kleckner Ian , Cole Calvin , Janelsins Michelle Christine , Peppone Luke Joseph , Peoples Anita Roselyn , Culakova Eva , Heckler Charles E. , Gaur Rakesh , Giguere Jeffrey K. , Messino Michael J. , Ruzich Janet C. , Mustian Karen Michelle
Published: September 2018

10007

Background: Cancer-related fatigue (CRF) is one of the most incapacitating adverse effects of cancer and its treatments. CRF co-occurs with impaired sleep quality in cancer survivors, increasing morbidity and mortality. We have previously shown that yoga significantly lowers CRF and improves sleep quality in survivors. However, it is not clear if the effect of yoga on CRF is mediated by improvements in sleep quality. This study assessed the mediating effects of changes in sleep quality stemming from YOCAS yoga on improvements in CRF. Methods: We conducted a secondary analysis on data collected from a multicenter phase III randomized controlled clinical trial with 2 arms (standard care and standard care + a 4-week YOCAS yoga intervention). 321 cancer patients (96% female; mean age, 54 years; 77% had breast cancer) reported both sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), and CRF, evaluated by Multidimensional Fatigue Scale Inventory (MFSI). Causal mediation analyses were used to estimate effects of the changes in global PSQI scores and in each PSQI subscale on the relationship between yoga and CRF. Results: Yoga significantly improved both CRF (p < 0.01) and sleep quality (p < 0.01), compared to standard care, with total reduction in CRF by 6.5 points. Sleep quality significantly mediated the changes in CRF by 1.4 points (p < 0.01) in addition to the direct effect of yoga on CRF reduction (by 5.1 points; p < 0.01), suggesting that 22% (95% CI: 7%-54%) of the reduction in CRF was mediated through improving sleep quality. Among the PSQI subscales, daytime dysfunction had the most mediating effect of yoga on CRF. In this model, yoga directly improved CRF by 4.1 points (p = 0.01) and the mediating effect of yoga on CRF via daytime dysfunction was 2.4 points (p < 0.01), suggesting that 37% (95% CI: 23%-81%) of the improvements in CRF was mediated through decreasing daytime dysfunction. Conclusions: Between 22 and 37% of the improvements in CRF from yoga are due to improvements in sleep quality and reductions in daytime dysfunction. Clinicians should consider prescribing yoga for survivors experiencing CRF in combination with sleep disorders. Funding: NCI UGCA189961, R25 CA102618. Clinical trial information: NCT00397930.
Adherence to geriatric assessment (GA)-based recommendations in older patients (pts) with cancer.
Authors: Decoster Lore , Kenis Cindy , Flamaing Johan , DeBruyne Philip , DeGroof Inge , Focan C. N. J. , Cornelis Frank , Verschaeve Vincent , Vanoverbeke Karen , Libert Yves , Luce Sylvie , Nols Nathalie , Van Den Bulck Heidi , Goeminne Jean Charles. , Baitar Abdelbari , Geboers Katrien , Lobelle Jean Pierre , Milisen Koen , Wildiers Hans
Published: September 2018

10010

Background: In the general older population, GA-guided treatment plans improve overall survival, quality of life and functional status. In geriatric oncology, studies mainly focused on screening and assessment but not on geriatric interventions and follow-up. The aim of this study was to investigate the adherence to recommendations and subsequent interventions based on GA results in older pts with cancer. Methods: A prospective Belgian multicenter (n = 22) cohort study included pts ≥70 years with a malignant tumor when an oncological treatment decision had to be made. Pts with an abnormal G8 (≤14/17) underwent GA and were included in this study. Recommendations for interventions were formulated based on GA results. At follow-up adherence to GA-based recommendations was documented. Results: From 11-2012 till 2-2015, G8 screening was performed in 8451 pts. 5838 pts with an abnormal G8 were included in the study. Geriatric recommendations were given in 79.2% of pts with a median of 2/pt (range 0-10), most frequently consultation of a dietician (73%) for malnutrition, a social worker (54.8%) for social and functional status problems and a geriatrician (42.1%) for general geriatric problems. Follow-up data were available for 4167 pts. In the group of pts where recommendations were given, at least one intervention was performed in 69% with a median of 1/pt (range 0-6), most frequently dietician (43.4%), social worker (26.1%) and geriatrician (22.6%). A total of 7569 actions were undertaken for a total of 5725 geriatric recommendations. Recommendations were most frequently adhered to for malnutrition, social status and functional status problems. The most frequent actions undertaken were nutritional support and supplements, extended home care and psychological support. Conclusions: This large scale Belgian study focusses on the adherence to GA based interventions in older pts with cancer and contributes to the optimization of care for these pts. We identified the domains for which geriatric interventions are most frequently recommended and adhered to and which health care professionals and referrals are essential in the multidisciplinary approach of older pts with cancer.
Randomized trial of a cognitive-behavioral therapy mobile app for anxiety in patients with incurable cancer.
Authors: Greer Joseph , Jacobs Jamie M. , Pensak Nicole , MacDonald James , Fuh Charn-Xin , Perez Giselle Katiria , Ward Alina , Holt Anne , Tallen Colleen , Muzikansky Alona , Traeger Lara N. , Penedo Frank J. , Safren Steven , Pirl William F. , Temel Jennifer S.
Published: September 2018

10022

Background: Patients with incurable cancer often experience marked anxiety that is associated with poor quality of life (QOL), high symptom burden, and complications with medical treatment. The aim of this study was to test the efficacy of a mobile app-based cognitive-behavioral therapy (CBT) intervention to treat anxiety symptoms in patients with incurable cancer. Methods: From 2/15 to 8/16, 145 patients with incurable cancers (e.g., advanced lung, breast, GI/GU, sarcoma, melanoma) who screened positive for at least mild anxiety symptoms (Hospital Anxiety & Depression Scale-Anxiety subscale, HADS-A > 7) were randomized 1:1 at two cancer centers to receive either the CBT mobile app for anxiety or a mobile health education program (control), delivered via tablet computers. The CBT app included 7 modules teaching skills to relax the body, reduce worry, stay present-focused, improve communication, and plan/pace activities, which patients completed over 12 weeks. To assess anxiety, mood, and QOL, we administered the Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression Scale (CGI), HADS, and Functional Assessment of Cancer Therapy-General at baseline and 12 weeks. General linear models were used to assess the effect of the intervention on patient outcomes over time. Results: The sample was predominantly female (73.8%) and white (91.7%), with a mean age of 56.45 ( SD= 11.30) years. Both study groups reported significant improvements in anxiety, depression, and QOL from baseline to post-assessment (all p-values≤002), with no differences in the improved outcomes between groups. Secondary analyses showed interaction effects on anxiety between the intervention and baseline HAM-A scores. Among patients with higher baseline anxiety, those randomized to the CBT app had greater improvements on the HAM-A ( p= .043), CGI ( p= .048), and HADS-A ( p= .001) compared to the health education control group. Conclusions: Patients with incurable cancer who received either a CBT mobile app intervention or mobile health education program reported improvements in anxiety, depression, and QOL. However, the CBT mobile app had better outcomes than health education for patients with higher baseline anxiety. Clinical trial information: NCT02286466.
The PULSES project: Teaching the vital elements of code status discussions to oncology residents.
Authors: Levine Oren Hannun , Menjak Ines B. , Brule Stephanie Yasmin , McConnell Meghan , Dhesy-Thind Sukhbinder K. , Mukherjee Som , Brouwers Melissa C.
Published: September 2018

10024

Background: Discussions with cancer patients around cardiopulmonary resuscitation (CPR), or ‘code status,’ are often led by trainees in oncology, but formal education for this competency is lacking. In this study, we developed and tested a novel communication tool, the PULSES framework, for informed code status decision-making (a six-step approach summarized by the PULSES acronym [Table 1]), through an educational workshop. Methods: A multicentre randomized controlled trial was carried out at 3 academic cancer centres in Ontario, Canada. Residents in medical oncology (MO) and radiation oncology (RO) programs completed a workshop and an observed structured clinical exam (OSCE). Participants were randomized to complete the training before the OSCE (experimental arm) or after the OSCE (control arm). Randomization was stratified for centre and oncology discipline. Expert raters evaluated communication with two rating tools: the novel PULSES scale and the communication skills assessment form (CSAF), a validated benchmark tool that is not specific to oncology content. The primary outcome was improvement in PULSES scores. Results: Forty-six residents consented to participate (28 RO and 18 MO). Groups were well balanced for program and year of training. Participants in the experimental group had higher mean PULSES score than those in the control group (80.4±13.5 vs 63.4±9.7; p < .001; maximum score = 108). There was no significant effect for program and no significant interaction between program and training condition. Scores for the PULSES and CSAF scales were highly correlated (R = 0.864). Conclusions: The PULSES training improved performance among oncology residents for code status discussions. Improved communication scores were not scale-specific. The PULSES framework offers a standardized approach and can be incorporated into competency-based curricula for postgraduate oncology programs. Future work will explore whether communication training in this area impacts patient-level outcomes. [Table: see text]
Early specialist palliative care for all hospitalized, advanced cancer patients (ACP)? Better outcomes with “up-front” versus “on-demand” palliative care.
Authors: Malec Monica , Hlubocky Fay J. , Levine Stacie K. , Wroblewski Kristen , Lane Bradford , Thomas Ashley , Dale William , Daugherty Christopher
Published: September 2018

10026

Background: Palliative care improves outcomes for cancer patients, especially those with advanced disease. Optimal timing for initiation of specialist palliative care remains undetermined. We created a Supportive Oncology inpatient service that integrates immediate “up-front” palliative care (IPC) consultation for selected ACP to supplement our usual oncologic care (UOC) service, which continued to utilize “on-demand” palliative care consultation. Here, we compare ACP populations and selected outcomes between these two versions of in-patient cancer care. Methods: A retrospective cohort analysis of ACP receiving either IPC or UOC between Jan 2015-Dec 2015 (N = 809). ACP were compared for age, gender, race, and ethnicity. Disease severity was determined by APR DRG weight, Risk of Mortality (ROM), and Severity score. Outcomes included examining differences between groups for: Length of stay (LOS), Cost, and 30 day readmission rate. Univariate and multivariate analysis were employed. Results: 468 ACP were admitted to IPC and 341 to UOC. Compared with UOC, ACP assigned to IPC were significantly younger (61.1±13.2 vs 63.3±13.0, p = 0.02); more likely female (50% vs 40%, P = 0.005); and more likely to be AA (47% vs 35%, P = 0.005). After adjusting for gender, age, race, and encounter type, ACP receiving IPC had higher ROM (52% v 47%, p = 0.03). There were no differences in APR DRG weight (p = 0.30) or Severity scores (p = 0.34). IPC had significantly lower costs ($12,050 vs $15,990, p = 0.003), less 30-day readmissions (16% vs 23%, p = 0.03), and a trend toward shorter LOS (5.6 ± 4.9 vs 6.2 ± 6.5, p = 0.10). Conclusions: Our data provides additional evidence for the benefits of earlier specialist palliative care consultation services, including patients traditionally identified as underserved.
Chemotherapy toxicity risk score (CTRS) for treatment decision in older patients with advanced solid cancer.
Authors: Nishijima Tomohiro F. , Deal Allison Mary , Williams Grant Richard , Sanoff Hanna Kelly , Nyrop Kirsten A , Muss Hyman B.
Published: September 2018

10030

Background: The decision whether to treat older patients (pts) with advanced cancer with standard (ST) or reduced therapy (RT) is complicated by heterogeneity in aging. Currently, clinical impression based largely on age and performance status, determines whether a pt is fit or unfit for ST. We evaluated the potential utility of the CTRS (Hurria JCO 2011) for treatment decision in older cancer pts. Methods: This is a prospective observational study of older pts (+65) receiving first-line chemotherapy for locally advanced or metastatic cancer for which combination chemotherapy is the standard of care. CTRS was calculated before therapy initiation assuming the pts received ST (combination therapy at the standard dose). Pts were categorized as high risk (CTRS ≥10; RT (dose reduced combination or single agent chemotherapy) deemed appropriate) or non-high risk (CTRS <10; ST deemed appropriate) for grade 3-5 adverse events (gr3-5 AEs). Treatment decision was left to the treating physician who was blinded to the CTRS result. We estimated the agreement in chemotherapy choice (ST vs RT) between treating physician and CTRS using the kappa statistic. Results: 44 pts (median 71 years) with GI (68%), GU (14%), lung (14%) or HEENT (5%) cancer were enrolled. 29 pts received ST (11 had CTRS ≥10 and 18 had CTRS <10) and 15 pts received RT (10 had CTRS ≥10 and 5 had CTRS <10). The kappa statistic showed only modest agreement in chemotherapy choice (0.26, 95%CI = -0.01 to 0.54) between physician and CTRS. Gr3-4 AEs and hospitalization due to AE occurred in 50% and 29% of 42 pts with follow-up data, respectively. There was no fatal AE. Among pts receiving ST, pts with CTRS ≥10 had a significantly higher incidence of gr3-4 AEs and hospitalization than those with CTRS <10 using Fisher's exact test (Table). In the RT group, there was no significant difference in incidence of gr3-4 AEs or hospitalization between pts with CTRS ≥10 and CTRS <10. Conclusions: Incorporation of CTRS in treatment decision may increase the proportion of elderly pts with advanced cancer who receive tolerable treatment. [Table: see text]
Outcomes for patients ≥75 years with localized gastroesophageal cancer: Experience from the Princess Margaret Cancer Centre.
Authors: Natori Akina , Chan Bryan Anthony , Sim Hao-Wen , Ma Lucy Xiaolu , Yokom Daniel , Chen Eric Xueyu , Liu Geoffrey , Darling Gail Elizabeth , Swallow Carol Jane , Brar Savtaj Singh , Brierley James D. , Ringash Jolie , Wong Rebecca , Kim John , Rogalla Patrik , Hafezi-Bakhtiari Sara , Conner James , Knox Jennifer J. , Elimova Elena , Jang Raymond Woo-Jun
Published: September 2018

10037

Background: The optimal treatment and outcome for elderly patients (pts) with localized gastroesophageal (GE) cancer remains unclear as they are underrepresented in clinical trials. We aimed to assess survival in pts ≥75 years according to treatment received. Methods: A retrospective analysis was performed for all pts aged ≥75 years with GE cancer treated in 2012-2014. Frailty was measured using the Charlson comorbidity index (CCI) and ECOG performance status (PS). Overall survival (OS) and disease-free survival (DFS) were assessed via uni- and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors impacting treatment choices. Results: Of 105 pts, median age was 81 years (range: 75-99), primary sites were esophageal (55%, with 43% squamous histology) and gastric (45%). Baseline characteristics included: PS: 0 (31%), 1 (42%), 2 (16%), 3 (10%), 4 (1%); and CCI: 0 (34%), 1 (25%), 2 (19%), ≥3 (22%). Treatment received included radiotherapy alone (RT) (31%); surgery alone (29%); surgery plus adjuvant chemotherapy (chemo) and/or RT (14%); chemoradiation alone (7%) and supportive care (18%). In univariable analyses; age < 85 (p = 0.003), PS < 2 (p = 0.03) and surgery (p < 0.001) were associated with improved OS. Chemo and RT, either alone or in combination, did not significantly improve OS. In multivariable analyses; surgery (HR 0.38, 95% CI 0.21-0.70, p = 0.002) was the only independent predictor for improved OS. Patients with good PS (p = 0.01), gastric disease site (p = 0.01) and adenocarcinoma histology (p = 0.02) were more likely to undergo surgery. Conclusions: At our institution, relatively few pts ≥75 years received multimodality therapy for localized GE cancers. Those pts ≥75 years who underwent surgery had excellent outcomes, but they were well-selected. Comprehensive assessment should be considered for pts ≥75 years with localized GE cancer to ensure optimal treatment selection, particularly given the potential benefit of surgery.
A randomized control trial of outpatient occupational and physical therapy for older adults with cancer: The CARE program.
Authors: Pergolotti Mackenzi , Deal Allison Mary , Williams Grant Richard , Bryant Ashley Leak , McCarthy Lauren , Coffman Erin , Basch Ethan M. , Reeve Bryce B. , Muss Hyman B.
Published: September 2018

10038

Background: Limitations in functional status and reduced health status are common among older adults with cancer, yet occupational and physical therapy (OT/PT) remain underutilized (Pergolotti, et.al. JGO,2015). For this population, we evaluated an outpatient CAncer REhabilitation (CARE) program and compared it to usual care (UC). Methods: We recruited adults 65 years and older who had a diagnosis of cancer or recurrence within 5 years and had at least one functional limitation as measured by a geriatric assessment (GA). Participants were then randomized to OT/PT (CARE) or UC. CARE delivered individualized outpatient intervention; OT addressed functional activities, and PT strength/endurance needs. UC participants received a brochure on supportive care services. Primary outcome was functional status (Nottingham Extended Activities of Daily Living Scale [NEADL] (range 0-22)) and secondary outcomes were global Mental and Physical Health, and ability to participate in Social Roles (SR) and activities (Patient-Reported Outcomes Measurement Information System [PROMIS] (range 0-100)), for all measures, higher scores indicate better health. We used t-tests to compare groups. Results: 51 adults were randomized: median age 73 years, 55% male, 92% White, 33% with Leukemia/lymphoma, 26% Breast, 22% Colorectal, 67% in active treatment, and 37% with Stage 3 or 4. After 3 months, both groups experienced a significant decline in functional status ( p = .046; p = .005), but change in functional status (-1.5 UC, -1.1 CARE, p = .637) , physical health status (0.0 UC, 2.4 CARE, p = .121) and participation in SR (.11 in UC, 3.71 CARE, p = .088) between UC and CARE were not significant. However, change in mental health (-1.0 in UC, 3.0 CARE, p= .032) significantly different between groups. Conclusions: CARE was associated with a significant improvement in participant’s mental health status compared to a decline in UC. Results suggest CARE may influence ability to participate in social roles and activities and physical health, but further study is needed with larger sample sizes. We demonstrated that for older adults with cancer, OT/PT are promising interventions to improve mental health. Clinical trial information: NCT02306252.
Cancer-related fatigue in breast cancer survivors: A longitudinal analysis compared to matched controls.
Authors: Williams AnnaLynn , Heckler Charles E. , Paterson Carly Lynn , Barton Debra L. , Young Kelley Lynn , Conlin Alison Katherine , Weiselberg Lora Rose , Mustian Karen Michelle , Peppone Luke Joseph , Janelsins Michelle Christine
Published: September 2018

10045

Background: Cancer related fatigue (CRF) is commonly reported among breast cancer survivors and can negatively impact quality of life and treatment adherence. Large, prospective, longitudinal studies assessing CRF in breast cancer survivors compared to matched non-cancer controls are rare. Methods: Breast cancer survivors (n = 581, stage I-IIIBC, mean age 53.4) from community oncology clinics and age-matched controls (n = 364, mean age 52.6) completed the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI, scores range -24 to 96) prior to chemotherapy (T1), at chemotherapy completion (T2) and six-months after chemotherapy (T3). Linear mixed models compared trajectories of CRF over time in survivors compared to controls, adjusting for age, education, race, BMI, marital status, menopausal status, and depressive symptoms. Results: Survivors reported greater CRF compared to controls at all time points (mean total score T1 9.4 vs. -3.7, T2 17.0 vs. -3.3, and T3 8.5 vs. -3.1, all p < 0.001; all subscales p < 0.001). From T1 to T2 survivors experienced a significant increase in CRF as shown in the total score (mean change (MC) = 8.3; effect size (ES) = 0.4 , p < 0.001), and general, mental, and physical sub-scales (MC = 4.3, 2.1, 3.2 , ES = 0.7, 0.5, 0.7, respectively, all p < 0.001), while controls experience minimal changes (MC = 0.1-0.3, ES < 0.09, p > 0.05). At T3 survivors total score returned to T1 values (MC = -0.1, ES = 0.01, p = 0.461), which was, however, still greater than controls ( p < 0.001), while general, mental, and physical CRF subscale scores remained significantly higher than T1 values (MC = 1.2, 1.7, 1.9, ES = 0.2, 0.4, 0.3, respectively, all p < 0.001; controls no change). Group by time interactions indicated changes over time were greater in the survivors than controls (p < 0.001). In multivariate analyses of survivors, age, BMI, performance status, and baseline depression significantly predicted change in CRF. Conclusions: These results from the largest well-controlled study to date showed that breast cancer survivors experience significantly more CRF prior to and after chemotherapy compared to healthy controls. Further research should aim to identify subgroups of survivors most susceptible to CRF.
Psychological and educational outcomes among adolescent survivors of wilms tumor: A report from the Childhood Cancer Survivor study.
Authors: Foster Rebecca Hope , Hayashi Robert J. , Wang Mingjuan , Liu Wei , Mohrmann Caroline , Howell Rebecca M. , Smith Susan A , Gibson Todd M. , Srivastava Deo Kumar , Green Daniel M. , Oeffinger Kevin C. , Leisenring Wendy M. , Robison Leslie L. , Armstrong Gregory T. , Krull Kevin R. , Hardy Kristina K.
Published: September 2018

10049

Background: Little is known about psychological and educational problems experienced by adolescent survivors of Wilms tumor (WT), including the impact of treatment exposures and chronic health conditions. Methods: Parent-reports from the Childhood Cancer Survivor Study were analyzed for 666 adolescent survivors of WT (Mean[SD] age at survey = 15.3[1.65] years; age at diagnosis = 2.8[1.77] years) and 698 siblings (15.4[1.66] years). Adjusting for race and household income, survivors were compared to siblings on the Behavior Problem Inventory and educational services. Among survivors, therapeutic exposures and chronic medical conditions (CTCAE 4.03 coding) were examined via multivariable log binomial regression adjusting for sex, race, income and age at diagnosis to calculate adjusted Relative Risk (aRR) and 95% confidence intervals (CI). Results: Compared to siblings, survivors were more likely to use psychoactive medication (9.4 vs. 5.1%, p = .0002) or be in special education for learning problems, inattention, and/or low test scores (19.1 vs. 11.1%, p = .003) but had similar rates of depression/anxiety, headstrong behavior, inattention, social withdrawal, and antisocial behavior (p’s > .05). Survivors who received radiation therapy (RT) to the abdomen (aRR 1.64, CI 1.03-2.61) or abdomen and chest (aRR 1.95, CI 1.16-3.26) were more likely to be in special education for any reason than those without RT. Those with grade 2-4 cardiovascular conditions were more likely to have anxiety/depression (aRR 2.04, CI 1.26-3.30), headstrong behavior (aRR 1.95, CI 1.30-2.93), or inattention (aRR 1.58, CI 1.04-2.42) compared to survivors with grade 0/1 conditions. Survivors were more likely to be in special education if they had problems with antisocial behavior, anxiety/depression, headstrong behavior, inattention or social withdrawal (p’s < .05). Conclusions: Psychological intervention may be needed for adolescent survivors of WT treated with RT to the abdomen or abdomen and chest or with higher grade cardiovascular conditions. These survivors are more likely to experience behavioral and emotional problems, which in turn increases risk for placement in special education.
Cardiac autonomic dysfunction in breast cancer survivors.
Authors: Payne David , Mahmood Syed , Partridge Ann H. , Nohria Anju , Groarke John
Published: September 2018

10057

Background: Cardiac autonomic dysfunction (AD) has been associated with increased cardiovascular (CV) and all-cause mortality in several diseases. We evaluated the prevalence, functional and prognostic significance of cardiac AD in a cohort of breast cancer (BC) survivors referred for exercise treadmill testing (ETT). Methods: Cardiac AD was defined as the presence of both an elevated resting heart rate (HR ≥ 80 beats per minute) and abnormal HR recovery (HRR ≤ 12 beats per minute if active cool down, or ≤ 18 beats per minute if passive recovery) at 1 minute after peak exercise. Presence of cardiac AD, exercise capacity, and all-cause mortality were assessed in 448 women (age 62.6±10.0 years), 8.7 [range 4.5, 14.3] years from BC diagnosis, compared to 448 cancer-free, age- and sex-matched controls, all of whom were clinically referred for ETT. Results: Elevated resting HR (23.7% vs. 17.0%, p = 0.013), abnormal HRR (25.9% vs. 20.3%, p = 0.048), and cardiac AD (8.0% vs. 4.2%, p = 0.025) were more prevalent in BC survivors than controls. BC survivors with cardiac AD had reduced exercise capacity compared to those without AD (Table). Among controls, cardiac AD was not associated with decreased exercise capacity. Among BC survivors (age-adjusted hazard ratio 1.90 (95% CI 0.78-4.62) and controls (age-adjusted hazard ratio 4.09 (95% CI 0.49-34.18), cardiac AD was not associated with increased all-cause mortality. Conclusions: Among patients referred for ETT, BC survivors have an increased prevalence of cardiac AD relative to controls. Cardiac AD is associated with decreased exercise capacity, but not increased all-cause mortality, in BC survivors. Available strategies to modulate cardiac AD may improve functional capacity in BC survivors. Table: Impact of markers of cardiac AD on exercise capacity. [Table: see text]
Temporal treatments and outcomes following acute myocardial infarction among cancer survivors: A population-based study, 1995-2013.
Authors: Gong Inna Y. , Yan Andrew T , Ko Dennis T , Cheung Winson Y. , Earle Craig , Peacock Stuart , Gale Chris , Hall Marlous , Chan Kelvin K.
Published: September 2018

10058

Background: There is little contemporary information regarding cardiac care and mortality differences following an acute myocardial infarction (AMI) between cancer survivors (CS) and non-cancer patients (NCP). Methods: All patients with AMI (1995-2013) in Ontario, Canada were identified through administrative databases and stratified into CS (solid or hematologic) and NCP. Those with cancer within 1 year of AMI were excluded. We used inverse probability treatment weight of propensity scores to balance confounders. Coronary intervention use and survival following index AMI were compared between CS and NCP using Modified Poisson and Cox modeling, and their temporal trends were examined. Results: Of 270,089 AMI patients (62.1% men; 87.8% >65 yrs old for CS vs. 56.2% for NCP), 22,907 were CS (prostate 26%, colorectal 17%, breast 16%) and 247,182 NCP. From 1995-2013, coronary interventions usage increased similarly for both groups (Table). The overall 30-day use did not differ between CS and NCP (angiogram unadjusted 36% vs. 50%, adjusted RR 0.96, 95% CI 0.96-1.00, p=.21; percutaneous coronary interventions unadjusted 21% vs. 31%, adjusted RR 0.98, 95% CI 0.94-1.01, p=.21; bypass surgery unadjusted 5% vs. 7%, adjusted RR 0.95, 95% CI 0.87-1.04, p=.25). Unadjusted 30-day mortality following AMI decreased similarly for CS and NCP (Table). However, adjusted 30-day mortality was worse in CS (HR 1.09, 95% CI 1.04-1.15, p<0.001). Over median follow-up of 11 yrs, CS had worse survival than NCP (HR 1.22, 95% CI 1.18-1.26, p<0.0001). CS had higher risk of heart failure than NCP (HR 1.10, 95% CI 1.05-1.15, p<0.0001), while myocardial (re)-infarction and stroke were similar (HR 0.99, 95% CI 0.96-1.02, p=.46; HR 1.09, 95% CI 1.00-1.18, p=.052). Conclusions: Following AMI, coronary intervention use increased and early mortality decreased comparably between CS and NCP over time. However, CS had worse short-term and long-term survival, suggesting that continued emphasis on cancer and cardiovascular care is needed to improve outcomes. [Table: see text]
Changes in p16INK4a (p16) expression, a biomarker of aging, in peripheral blood T-cells (PBTC) in patients receiving anthracycline (A) vs non-anthracycline (NoA) chemotherapy (CRx) for early-stage breast cancer (EBC).
Authors: Strulov Shachar Shlomit , Deal Allison Mary , Mitin Natalia , Nyrop Kirsten A , Lee Jordan T , Choi Seul Ki , Pulley Will , Bell Emily Fox , Christopher Nora , Williams Grant Richard , Carey Lisa A. , Anders Carey K. , Jolly Trevor Augustus , Dees Elizabeth Claire , Reeder-Hayes Katherine Elizabeth , Sanoff Hanna Kelly , Sharpless Norman E. , Muss Hyman B.
Published: September 2018

10060

Background: Age-related accumulation of senescent cells plays a causal role in some aspects of mammalian aging. We have shown that the total-body burden of senescent cells can be estimated by measuring the expression of the p16 tumor suppressor, a canonical effector of senescence, in human CD3+ PBTC (Liu et al, Aging Cell, 2009). Expression of p16 increases more than 10-fold over an adult human lifespan, and this rate of accumulation is accelerated by age-promoting exposures such as CRx or stem cell transplant (Sanoff et al, JNCI 2014; Wood et al, EbioMed 2016). Increased molecular age as evidenced by increased expression of p16 prior to CRx predicts a patient’s risk of CRx toxicity independently of chronological age (DeMaria et al, Cancer Discovery, 2017).This study investigates the impact of different types of CRx (A vs NoA) regimens on PBTC p16expression in pts with EBC. Methods: EBC pts who received neoAdj or Adj CRx had blood samples drawn for p16 assay prior to CRx initiation and again between 2 months and 1.5 years after the end of CRx. Expression of p16 mRNA in PBTC was determined using TaqMan real-time quantitative reverse transcription PCR. T-test compared p16change between A and NA groups. Results: 70 pts were evaluable. Pt. characteristics: median age 49 (range 32-76); 52 (74%) White, 14 (20%) black, 4 unknown; 39 (56%) ER or PR+ and HER2 neg, 18 (26%) triple negative, 13 (19%) HER-2 pos (all received trastuzumab). 53 pts (76%) had A (47 AC + taxane, 6 AC no taxane) and 17 (24%) NoA (all TC). Expression of p16 increased 2.0-fold in patients who received A-based CRx compared to 1.2-fold in NoA CRx (p = 0.04). There was no relationship of race, ER, PR or HER-2 status on change in p16expression. Conclusions: This study is ongoing and further results will be presented at the ASCO meeting. In this sample of EBC patients treated with A vs. NoA CRx regimens, A-based CRx is more strongly associated with increased biologic aging of T-cells compared to NoA CRx. These changes are equivalent of increased biologic aging of PBTC of 11 years (A) vs.6 years (NoA) and may have major consequences on the long-term survival of these pts.
NeuroCog-FX study: A multicenter cohort study on cognitive dysfunction in patients with early breast cancer.
Authors: Rick Oliver , Reuß-Borst Monika , Dauelsberg Timm , Hass Holger , König Volker , Caspari Reiner , Götz-Keil Gabriele , Pfitzner Jürgen , Kerschgens Christa , Fliessbach Klaus , Hoppe Christian
Published: September 2018

10061

Background: Many breast cancer patients complain about cognitive dysfunction (CD) with mnestic and attentional deficits. These complaints persist even after completion of therapy in approximately one third of the patients and affects both social life and working capacity. The exact nature and genesis of CD in breast cancer patients is still not fully understood and risk factors are not yet described. Methods: To determine CD and risk factors, we used the computer-based neuropsychological test NeuroCog-FX during a three weeks oncological rehabilitation in breast cancer patients. Eight subtests addressed attention, working memory, verbal and figural memory, and language. Test duration was < 30 minutes. A cognitive deficit was diagnosed if at least one subtest was clearly below average (score < M - 1.5 SD) of the normative age group. The data on cognitive function were correlated with the level of depression (PHQ-9 test), QoL (EORTC QLQ-30) and clinical parameters (nodal status, chemo-/radiotherapy and endocrine therapy). Results: From February 2013 to December 2014 a total of 476 patients were recruited in 9 oncological rehabilitation centers in Germany. NeuroCog-FX was used to examine 439 patients. Median age was 50 years (range: 24-62 years); 93% of patients had early tumor stage (T0-T2) and 67% were node-negative. Sixty-one percent of the patients received chemotherapy while 84% of the subjects underwent radiotherapy. CD was found in 59% and a moderate to severe depression in 38% of the patients. The severity of depression was correlated with slower reaction times and reduced verbal memory performance. These two cognitive parameters were also associated with a reduced global health status and a reduced physical function score on the EORTC-QLQ30 questionnaire suggesting an impact of cognitive deficits on quality of life. Cognitive function was not associated with type of treatment or node status. Conclusions: In this large and homogeneous cohort of breast cancer patients, CD has been shown in most of the subjects using a valid test method. CD was associated with depression and reduced quality of life. Neither tumor therapy nor other clinical parameters had a significant impact on development of CD.