bluuebunny/crossref_metadata_2025 huggingface dataset:
Existence of solutions for Erdélyi–Kober fractional integral boundary value problems with $p ( t )$-Laplacian operator
Authors: Shen Xiaohui , Shen Tengfei
Published: October 2020

This paper aims to consider the solvability for Erdélyi–Kober fractional integral boundary value problems with $p ( t )$
p
(
t
)
-Laplacian operator at resonance. By employing the coincidence degree method, some new results on the existence of solutions are acquired.
Analysis of the stochastic model for predicting the novel coronavirus disease
Authors: Sene Ndolane
Published: October 2020

In this paper, we propose a mathematical model to predict the novel coronavirus. Due to the rapid spread of the novel coronavirus disease in the world, we add to the deterministic model of the coronavirus the terms of the stochastic perturbations. In other words, we consider in this paper a stochastic model to predict the novel coronavirus. The equilibrium points of the deterministic model have been determined, and the reproduction number of our deterministic model has been implemented. The asymptotic behaviors of the solutions of the stochastic model around the equilibrium points have been studied. The numerical investigations and the graphical representations obtained with the novel stochastic model are made using the classical stochastic numerical scheme.
A note on negative λ-binomial distribution
Authors: Ma Yuankui , Kim Taekyun
Published: October 2020

In this paper, we introduce one discrete random variable, namely the negative λ-binomial random variable. We deduce the expectation of the negative λ-binomial random variable. We also get the variance and explicit expression for the moments of the negative λ-binomial random variable.
Analysis of calcareous sand particle shape using fourier descriptor analysis
Authors: Touiti Lamia , Kim Taesik , Jung Young-Hoon
Published: October 2020

Soil particle shape analysis was conducted on two calcareous sands from Dissa and Matmata in Tunisia and one silica sand from Jumunjin in Korea using an image analysis method. This technique uses complex Fourier shape descriptors and image analysis of sand grains SEM photographs to provide accurate quantification of particle morphology and texture. The Fourier descriptors, denoted “Signature Descriptors”, provide measures of Elongation, Triangularity, Squareness, and Asymmetry and identify the overall shape of soil particles. A summary of higher-order descriptors provides textural information linked up to local roughness and texture characteristics. After analyzing the Fourier descriptors, elongation was found to be the major characteristics of the three sands, mainly for the Dissa and Matmata carbonate sands. In addition, the elongation signature descriptors for the Dissa and Matmata sands have very high values compared to those of Ras Alkhair (Saudi Arabia) and Dog’s bay (Ireland) sands. Therefore, the Dissa and Matmata carbonate sands have higher angles of friction and higher critical state angle of friction than Ras Alkhair and Dog’s bay sands. Furthermore, the Dissa and Matmata carbonate sands show higher roughness than Jumunjin’s silica sand.
Correction to: Two infant cases of intraperitoneal arterial hemorrhage due to a duplication cyst: a case report
Authors: Fukuzawa Hiroaki , Kajihara Keisuke , Kuroda Yasuhiro , Fujieda Yuki , Uemura Kotaro , Takeuchi Yuki , Samejima Yoshitomo , Kawahara Insu , Morita Keiichi , Iwade Tamaki , Maeda Kosaku
Published: October 2020

An amendment to this paper has been published and can be accessed via the original article.
Debt choice, growth opportunities and corporate investment: evidence from China
Authors: Ding Ning , Bhat Kalimullah , Jebran Khalil
Published: October 2020

The study aims to investigate how relying on short-term debt may help Chinese listed firms to make efficient investment decisions and reduce overinvestment problem for low-growth firms. The study uses a large set of panel data of non-financial Chinese listed firms over the period 2007–2017 and, using the robust two-stage generalized method of moments, which is robust to unobserved heterogeneity of individual firms and addresses endogeneity issues. Findings show a positive relationship between growth and investment; this association is enhanced by leverage, especially for high-growth firms. This supports the view that short-term debt helps Chinese firms to make optimal use of leverage and therefore make better investment decisions. Furthermore, the results reveal that leverage plays a disciplining and monitoring role to reduce overinvestment incentive for low-growth firms. Overall, the study suggests that shareholders should consider short-term debt to mitigate the debt overhang problem and restrict the opportunistic behavior of managers, which can lead to efficient investment decisions. It also provides foreign investors insights about capital structure in China, and how it can help them make better investment decisions.
Hybrid CT-angiography to facilitate lower extremity sharp venous recanalization: a novel approach to a common procedure
Authors: Matsumoto Monica M. , Nijhawan Karan , Leef Jeffrey A. , Dorsey Chelsea , Ahmed Osman
Published: October 2020

Background

Post-thrombotic syndrome due to chronic venous occlusion is associated with high morbidity and healthcare costs. Sharp venous recanalization has been used with success when conventional techniques fail to cross the occlusion, permitting endovascular reconstruction with angioplasty and stenting. However, manipulation of a needle, especially in extra-anatomic locations, risks damage to adjacent structures, thus necessitating adequate imaging guidance.

Case presentation

This report describes the novel use of hybrid CT-angiography in a successful recanalization of a complex iliofemoral chronic venous occlusion, after multiple failed attempts with traditional recanalization techniques. The procedure was performed without complications, and stent patency was confirmed at three-month follow-up with patient-reported improvement in severe post-thrombotic syndrome.

Conclusions

This case demonstrates effective incorporation of hybrid CT-angiography to facilitate complex sharp venous recanalization for chronic lower extremity thrombosis, as an alternative to standard fluoroscopic techniques requiring multiple projections with or without cone-beam CT. Further studies are needed to understand the implications of this strategy.
Transhepatic endovascular repair for portal vein haemorrhage
Authors: Pescatori Lorenzo Carlo , Kobeiter Hicham , Zaarour Youssef , Herin Edouard , Vitellius Manuel , Tacher Vania
Published: October 2020

Background

Post-surgical bleeding of the main portal vein (PV) is a rare event but difficult to manage surgically. Among the different options of treatment, endovascular stenting of the PV can be considered.

We reported two cases of stent-graft placement in PV with subsequent closure of the portal vein access with two percutaneous closure devices deployed simultaneously.

Cases presentation

The first patient was a 43 years-old woman affected with a pseudoaneurysm of the extrahepatic PV, occurred after a duodenocephalopancreasectomy performed for a neuroendocrine tumour of the pancreatic isthmus. The second patient was a 54 years-old man suffering from multiple episodes of bleeding after liver transplantation, due to a PV fissure.

In both cases, a stent graft was placed into the portal system, between the PV and the superior mesenteric vein through a right trans-hepatic access to the portal system.

In both cases, a final control showed patency of the mesenteric vein and PV and no endoleak detection.

At the end of the procedure, two percutaneous closure devices were loaded, to close the transhepatic portal access. In one case, one of the devices did not work and the entry point was managed with a single device, without further complications.

No bleeding was seen though the entry point nor at the US examination performed right after the procedure.

After procedure, patients were prescribed with low-molecular weight heparin (LMWH) and kept under surveillance. For both patients, CT scan performed within 24h after the procedure, showed a patent stent-graft and no evidence of any venous portal ischemia.

The first patient was then transferred to another hospital, to continue observation and medical management. The second one underwent 2 months of hospitalization, during which he developed a pancreatic fistula and mild renal insufficiency. Then, he left the hospital to its native Country to continue his medical.

Conclusion

PV stent-graft placement seems a feasible option to manage portal bleeding.

Trans-hepatic access is an easy and fast approach. The trans-hepatic portal accesses may be successfully managed with the deployment of percutaneous closure devices.
IVF laboratory COVID-19 pandemic response plan: a roadmap
Authors: Choucair Fadi , Younis Nagham , Hourani Alia
Published: October 2020

Background

The potential of COVID-19 severe pandemic necessitates the development of an organized and well-reasoned plan for the management of embryology/andrology laboratories while safeguarding the wellbeing of patients and IVF staff.

Main body

A COVID-19 pandemic response plan was proposed for embryology and andrology laboratories for pre-pandemic preparedness and pandemic management in anticipation of a possible second coronavirus wave. Preparation involves many plans and logistics before a pandemic risk rises. Many operational changes can be considered during the pandemic. This plan includes logistical arrangements, reducing labor needs, conserving supplies, and protective measures for embryologists and gametes/embryos.

Conclusion

The unpredictable emergence of the COVID-19 pandemic dictates the need for a preparedness plan for embryology/andrology laboratories, which includes an action-oriented plan to secure the safety of all stakeholders.
Messenger RNA (mRNA)-based age determination using skin-specific markers of saliva epithelial cells
Authors: Iroanya Onyekachi Ogbonnaya , Obi Josephine Chioma , Ogunyinka Olabisi Olanike , Bosede Oluwayomi Temidayo , Egwuatu Tochukwu Frank , Adewole Richard Adeniyi
Published: October 2020

Background

Age determination is a vital factor in biological identification in forensics. This study was carried out to determine the expression levels of three target genes (Keratin 9 (KRT9), Loricrin (LOR) and Corneodesmosin (CDSN)) in salivary epithelial cells and how they can be used in age determination using reference gene, β-actin. Thirty young adults participated in the study and were divided into three groups according to their ages (16–20, 21–25, and 26–30). Ribonucleic acid (RNA) extraction, complementary deoxyribonucleic acid (cDNA) synthesis and quantitative polymerase chain reaction (qPCR) were performed. Data analysis was done using IBM SPSS Version 26 and the comparative Ct method (2−∆∆Ct method).

Results

CDSN was detected in all the sampled age groups. Though the age group 16–20 had the highest (0.4237) expression of CDSN among the three age groups, there was no significant difference (p > 0.05) in the expression of the gene among the three age groups. The LOR gene was lowly expressed across all age groups used in the study. The expression of the gene did not significantly differ (p > 0.05) between the control and 26–30 years age group, but they were however significantly higher (F = 36.47, p ≤ 0.05) than the expression of the gene in both 16–20 and 21–25 years age groups. The KRT9 gene was expressed only in age groups 16–20 and 26–30 and the expression of the gene did not significantly (p > 0.05) differ between these age groups. Though the expression of all the target genes was low, it was observed that the LOR gene expression varied among 21–25 and 26–30 age groups; therefore, more data and further analyses are still required since this experimental approach for age determination using gene expression is still at an emerging stage.

Conclusion

Although RNA concentration was low and the expression values of the genes were low and could not be used in comparing the expression levels among the three age groups, it can be concluded that the three messenger ribonucleic acid (mRNA) markers CDSN, LOR and KRT9, as well as the ACTB reference mRNA marker analysed via the described qPCR assays, are suitable for identifying epithelial cells in saliva.
Neuromyelitis optica spectrum standstill in rheumatic systemic autoimmune diseases
Authors: Elnady Basant , Fathy Sabry M. , Elkhouly Tohamy , Ganeb Sahar
Published: October 2020

Background

Neuromyelitis optica spectrum disorders (NMOSD) are considered as an autoantibody-mediated disorder that targets aquaporin-4 (AQP4); other autoantibodies could be detected in such spectrum of diseases, including anti-nuclear antibody and antibodies to extractable nuclear antigens. Systemic autoimmune diseases such as systemic lupus erythematosus (SLE), Sjogren’s syndrome (SS), and other autoimmune diseases can overlap with NMOSD. We aimed in this review to address the current evidence describing the relation of NMOSD to systemic autoimmunity diseases, its controversy of being co-association or the same etiology, and its practical implications.

Main body

The current review was done using a search for related articles or case reports on PubMed until 2019. The keywords included neuromyelitis optica spectrum disorders in combination with autoimmune disease nomenclature. We described the literature background of this controversy, to summarize the evidence of NMOSD relationship to systemic autoimmune diseases.

Conclusion

NMOSD associated with systemic autoimmune diseases is more common in SLE and Sjogren’s syndrome rather than other autoimmune diseases, frequently affects females more than males; AQP4 antibodies should be tested for all NMOSD like manifestations associated with an autoimmune disorder; however, the clinical diagnosis of NMOSD regardless of the cord lesion length and the presence of positive AQP4 antibody can occur in systemic autoimmune diseases.
Accuracy of SIE/SIES/GITMO Consensus Criteria for Unfitness to Predict Early Mortality After Intensive Chemotherapy in Adults With AML or Other High-Grade Myeloid Neoplasm
Authors: Palmieri Raffaele , Othus Megan , Halpern Anna B. , Percival Mary-Elizabeth M. , Godwin Colin D. , Becker Pamela S. , Walter Roland B.
Published: October 2020

PURPOSE

With increasing therapeutic alternatives available, there is growing interest in tools that accurately identify patients most suitable for intensive acute myeloid leukemia (AML) chemotherapy. Nowadays, conceptual criteria proposed by an Italian panel of experts are widely used for this purpose. How accurately these Ferrara criteria predict fitness for intensive chemotherapy is unknown.

PATIENTS AND METHODS

We assessed the fitness of adults undergoing intensive AML therapy based on Ferrara criteria and determined the accuracy of this assessment for early mortality and survival prediction.

RESULTS

Among 655 adults who received curative-intent induction or reinduction chemotherapy with 7 days of standard-dose cytarabine and 3 days of an anthracycline (“7+3”) CLAG-M (cladribine, high-dose cytarabine, granulocyte colony-stimulating factor, and mitoxantrone), or reduced-dose CLAG-M, 197 (30%) met at least one of the criteria defining unfitness for intensive chemotherapy (F-unfit). Compared with F-fit patients, the overall survival of F-unfit patients was significantly shorter (median, 4.8 months; 95% CI, 3.6 to 6.5 months v 36.8 months; 95% CI, 27.4 to 73.0 months; P < .001). When used alone, the Ferrara unfitness assessment was more accurate in predicting day 28 and day 100 mortality than the treatment-related mortality score we developed previously (used binary, ≤ 13.1 v > 13.1), as indicated by area under the receiver operating characteristic curve (AUC) values of 0.76 and 0.79 versus 0.66 and 0.62. The predictive accuracy of the Ferrara unfitness assessment could be significantly improved by including additional covariates such as performance status and albumin, yielding AUCs as high as 0.84-0.85 for the prediction of day 28 or day 100 mortality. Prediction of overall survival was less accurate, yielding a c-statistic value as high as 0.75 in multivariable models.

CONCLUSION

Ferrara unfitness criteria provide a good prediction tool for shorter-term mortality after intensive AML chemotherapy. Our data may serve as a benchmark for expected outcomes with intensive chemotherapy in F-fit and F-unfit patients.
Maintaining treatment volumes during the COVID-19 pandemic.
Authors: Mitchell Rachel L. , Blakely L Johnetta , Schleicher Stephen Matthew , Poole Stacey L , Dickson Natalie R. , Patton Jeffrey , Daniel Davey B.
Published: October 2020

103

Background: Uninterrupted care is essential for optimal outcomes in cancer care. The COVID-19 pandemic presented numerous challenges in providing continuity of care for many facilities. Our practice was able to deliver ongoing treatment for a large volume of our patients while maintaining a safe environment. Methods: A practice-wide effort to continue therapy in cancer patients undergoing active treatment began in March 2020 as the peak of the pandemic was beginning in Tennessee. Those patients who were receiving active treatment continued the planned treatment while reducing non-acute treatment visits. We assessed the volume of patients receiving treatments in our facilities for two periods: JanuaryDecember 2019 and January-May 2020. We compared the aggregate number of chemotherapy infusions, therapeutic infusions and injections as well as total treatments. Results: Overall, treatments remained relatively stable without a significant change in treatment volumes. There was a 3.69% decline in total treatment with therapeutic infusions (-9.68%) and injections (-7.85%) which accounted for the majority of deferred treatments. Chemotherapy infusions remained stable with an average increase (1.90%) in treatments. Conclusions: During the COVID-19 pandemic, our facility was able to maintain stable treatment numbers while providing safe care to our patients. We had no known diagnosed COVID-19 cases from potential exposures in our clinics. Decreases in treatment reflected less critical therapies. There did seem to be a delay for chemotherapy/immunotherapy that seemed to resolve as the peak passed for this region. Offloading of less critical treatments can result in continued treatment of cancer patients during a pandemic. [Table: see text]
An Optimal Care Coordination Model (OCCM) for Medicaid patients with lung cancer: Finalization of the model and implications for clinical practice in the United States.
Authors: Oyer Randall A. , Lathan Christopher S. , Smeltzer Matthew , Kramar Amanda , Boehmer Leigh , Asfeldt Thomas
Published: October 2020

104

Background: In 2016, the Association of Community Cancer Centers (ACCC) launched a 3-year initiative to design, test, and refine an OCCM for Medicaid patients with lung cancer. The aim was to help cancer programs identify and reduce the barriers experienced by Medicaid patients by strengthening lung cancer care delivery systems. Methods: Phase I included Model development. Phases II and III included selection of 7 community-based cancer programs as testing sites to implement quality improvement projects, utilizing qualitative and quantitative assessments. Beta testing demonstrated the Model’s ability to offer practical guidance on improving care coordination to achievable target levels in high-impact areas such as patient access to care, prospective multidisciplinary case planning, and tobacco cessation. Opportunities were identified to improve care coordination beyond lung cancer to other tumor sites. Refinements for clarity of intent, ease of use, specificity, and uniformity across assessment areas were implemented, based on feedback from testing sites. Members of the Technical Expert Panel and the Advisory Committee, ACCC staff, and consultants revised the Model using consensus decision-making. Results: The final OCCM is composed of 12 inter-related assessment areas: patient entry into lung cancer program; multidisciplinary treatment planning; clinical trials; supportive care; survivorship care; financial, transportation, and housing needs; tobacco education; navigation; treatment team integration; physician engagement; electronic health records and patient access to information; and quality measurement and improvement. Each assessment area has 5 levels and corresponding metrics—level 1 represents the most basic provision of care, and level 5 represents optimal care coordination, which may be attainable for some cancer programs and aspirational for others. Progress implies cumulative and sustained fulfillment of lower level criteria. The OCCM can be deployed by cancer programs, regardless of size, setting, resource level, or cancer type. Dissemination to promote wider use is planned through an online benchmarking tool, blogs, a brochure, podcasts, and other resources. Conclusions: The OCCM can be utilized by cancer programs for objective self assessments of care delivery capabilities across 12 high-impact areas. Dissemination can advance multidisciplinary coordinated care delivery and improve clinical outcomes for patients nationwide, regardless of cancer type.
Leveraging performance improvement (PI) strategies to decrease emergency department visits and inpatient admissions of patients receiving IV chemotherapy.
Authors: Barry-Weers Anne Marie , Huibregtse Carol , Mitchell Dorry , Bock Amy L. , Singh Maharaj , Weese James L.
Published: October 2020

11

Background: Per CMS, “in 2011, about 22% of cancer patients receive chemotherapy each year with treatment totaling $34.4 billion.” The number of patients receiving chemo in a hospital outpatient department (HOPD) continually increases. As patients attempt side effect management at home, their symptoms may worsen, and provider access may be limited. These conditions contribute to hospital admissions and ED visits for treatment management. After review of internal data and system patterns, in response, Aurora Cancer Care (ACC)’s leadership developed (market/site-specific) PI strategies focusing on decreasing overall ED utilization and IP admissions for patients actively receiving IV chemotherapy. Methods: The first step of the project was developing a systemized report capturing specific data points, including reason for visit, time of day, day of week, and patient’s cancer type. The population included all payor patients with an ED visit/IP admission within 30 days of receiving chemo. A subcommittee of system operational leaders brainstormed and implemented processes such as enhancing patient triage, restructuring APC workflow, introducing the “Call Us First Campaign” education initiative, re-evaluating clinic access for pain management medications, and distributing free thermometers to patients allowing accurate assessment of symptoms while at home. Results: All chemotherapy infusions were studied for 4Q 2018 and 1Q 2020 totaling 2,018 and 2,064 infusions respectively. The implementation of PI strategies resulted in significant improvements not only in overall IP admissions and ED visits, but also in key areas such as time of day and primary diagnosis (see table). Conclusions: PI strategies have demonstrated an impact on decreasing both IP admissions and ED visits while continuing to evolve. This engagement has contributed to change in practice patterns, aligned our institution with better side effect management at home while relieving the burden to patients during chemotherapy treatment. In addition, as admissions decrease, treatment costs are impacted as well. [Table: see text]
Temporal changes in rural-urban treatment patterns for early-stage non-small cell lung cancer in North Carolina, 2006 to 2015.
Authors: Herb Joshua , Kuo Tzy-Mey , Kumar Vaibhav , Wu Benjamin , Holmes Mark , Lund Jennifer Leigh , Reeder-Hayes Katherine Elizabeth , Baggett Christopher , Stitzenberg Karyn Beth
Published: October 2020

112

Background: Rural-urban disparities in the receipt of surgery for early-stage non-small cell lung cancer (NSCLC) have been noted, but few studies have considered access to other available treatments (i.e. radiation) or examined changes over time. Rural hospital closures, regionalization and workforce changes could lead to temporal changes in treatment access. Therefore, the primary objective was to evaluate geographic disparities in lung cancer treatment modalities in North Carolina and to characterize how practice patterns are changing over time. We hypothesized that rural patients would be less likely to undergo treatment compared to urban patients with widening disparities over time. Methods: North Carolina cancer registry data linked with Medicaid, Medicare, and private insurance claims were used to identify patients with Stage I or II NSCLC from 2006-2015. The primary outcome was first course treatment modality: surgery, radiation, or no treatment. Rural-urban status was defined based on Rural-Urban Commuting Codes. Calendar years were split into early (2006-10) and late (2011-15) periods. Multivariable logistic regression was used to assess the association of rural/urban status and time period with surgery and any treatment (surgery or radiation) while controlling for clinical, demographic, and area-level factors. Results: Among 7532 patients, 4144 (56%) patients underwent surgery, 1991 (27%) received radiation, and 1397 (19%) had no therapy. Rural patients were as likely to undergo treatment in either time period as urban patients. Among rural patients, the odds of surgery decreased over time (2011-15 vs. 2006-10 OR 0.79, 95%CI 0.66,0.94) and the odds of radiation increased (2011-15 vs. 2006-10 OR 1.46, 95%CI 1.40,1.78). Meanwhile urban patients had no significant change in surgery over time, but also had an increase in likelihood of undergoing radiation (2011-15 vs. 2006-10 OR 1.34 95%CI 1.18,1.52). Conclusions: Between 2006-2015, nearly 1 in 5 insured patients in North Carolina did not receive any treatment for potentially curable lung cancer. Over time, rural patients are less likely to undergo surgery, the standard of care, while radiation use is increasing everywhere. As rural patients are less likely to undergo surgery over time, this may have downstream effects on rural-urban disparities in survival. Further work aims to understand the patient and system level drivers behind these trends.
Equitable application of pancreatic cancer treatment guidelines to mitigate racial and insurance disparities at a comprehensive cancer center.
Authors: Schiefelbein Andrea M. , Taylor Amy K , Krebsbach John K. , Zhang Jienian , Puckett Yana , Zhang Xiao , Hampton John M. , Trentham-Dietz Amy , Weber Sharon M. , Skala Melissa C. , Eason John M. , LoConte Noelle K.
Published: October 2020

119

Background: Race and ethnicity-based treatment and survival disparities are documented for pancreatic cancer. Studies cite patient genetic, biological, and social factors and differences across treatment centers and geographical areas that may contribute to disparities. We investigated treatment and survival disparities for a cohort of 1,569 pancreatic cancer (PC) patients at the local level within a National Cancer Institute-designated comprehensive cancer center. Methods: Data from 1,569 PC patients aged over 18 diagnosed with adenocarcinoma, NOS or infiltrating duct carcinoma, NOS from 2004 to 2016 who received some or all of their care at the University of Wisconsin Carbone Cancer Center were included in the study. Sequential models of adjusted Cox proportional hazard regression were performed to describe the association between race/ethnicity and overall survival. Model I included age, sex and race/ethnicity; model II added BMI, Charlson Comorbidity Index and stage; model III added rurality, treatment course and payer. Treatment course, defined as the receipt of chemoradiation, surgery with/without chemoradiation, or no treatment, rurality, and insurance status were factors of interest. Results: 38.6% of patients were diagnosed with metastatic disease. Overall survival was 11.6 months. Non-Hispanic black (NHB) patients experienced an 88% increased risk of death (95% CI: 23%-188%) and patients categorized as other race/ethnicity experienced a 32% (10%-60%) increased risk of death compared to NH white (NHW) patients in model II. After adding treatment course and insurance status, the hazard ratio for NHB patients decreased to 1.41 (0.92-2.17) and other race/ethnicity patients decreased to 1.27 (1.05-1.53) compared to NHW Patients. Medicaid patients had an adjusted hazard ratio of 1.41 (1.01-1.95) and unknown/uninsured patients had an adjusted hazard ratio of 1.62 (1.71-4.02) compared to managed care patients. Incarcerated patients had an adjusted hazard ratio of 1.28 (0.98-1.67) compared to managed care patients. Conclusions: To reduce disparities across race/ethnicity and insurance status, organizations should invest in financial support programs for patients in need and monitor treatment courses for people of color, underinsured or uninsured patients to verify access to treatment, equitable treatment, and adherence to treatment guidelines. Future studies should investigate the contribution of clinician and healthcare system bias to race and ethnicity-based cancer disparities.
“Coming out” against cancer: How local outreach to the LGBT community can reduce cancer disparities.
Authors: Stimpert Tyler
Published: October 2020

131

Background: Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals make up an estimated 4% of the population, qualifying them as a sexual minority. LGBT individuals are also more likely to be a racial or gender minority, to live in poverty, and to have less social support than their heterosexual peers. LGBT populations are disproportionately affected by mental health issues such as depression, which are correlated not only with behavioral risk factors, but with less likelihood to comply with healthcare screening or treatment. Approximately 30% of LGBT adults do not seek health care services or lack a regular health care provider, compared with 10% of heterosexuals. Research studies demonstrate that knowledge about increased risks and need for screening is low in LGBT populations. Sub-populations are less likely to have had a recent mammogram, anal or cervical Pap, or a prostate exam. Methods: We implemented a population-oriented program into our community outreach team in 2019 to address LGBT cancer disparities. A program manager partnered with community resources and leaders, including the Cleveland LGBT Community Center, Plexus LGBT Chamber of Commerce, and Trans Ohio. First year programming included a mammogram clinic for sexual/gender minority (SGM) women, “Cancer is a DRAG” show, and a tobacco-free campaign for LGBT pride month. Results: Creating meaningful partnerships was extremely important to community leaders and organizations. Strategic plans include direct community input and engagement through a community council, in conjunction with the LGBT Community Center, a breast cancer awareness campaign, in conjunction with local entertainers, and a tobacco cessation program, through our Center for LGBT Care. We educated over 150 people and screened over 85 within the first year. Conclusions: When our healthcare institution met local LGBT people within their community, the result was quite impactful. This pilot program proved successful at educating members of the community about their increased cancer risk, which resulted in higher cancer screening rates for LGBT people. More programs tailored to LGBT-specific health concerns are important to continue reaching these populations and eventually decrease health disparities in the community.
Financial toxicity, financial well-being, and quality of life among bladder cancer patients.
Authors: Tucker-Seeley Reginald , Tang Weizhou , Steinberg Leora , Banks Stephanie , Bolton Hilma , Bhanvadia Sumeet
Published: October 2020

133

Background: Due to a long course of surveillance, and for some patients, multimodal therapy with chemotherapy and surgery, bladder cancer (BC) can present a financial burden to the household. Yet, there are several terms used to describe this burden such as financial hardship and financial toxicity (FT); and it is unclear whether different measures of financial circumstances are correlated and whether they are associated with quality of life (QOL). The goal of this study was to determine whether FT and financial well-being (FWB) were correlated and to determine whether FT and FWB were similarly associated with QOL among BC patients. Methods: Patients that had BC treatment in the last 2 years were recruited from two NCI designated cancer centers for our study (N = 100). The Comprehensive Score for Financial Toxicity (COST) was used to assess FT, the Consumer Financial Protection Bureau’s (CFPB) FWB measure was used to assess FWB, and a BC-specific Functional Assessment of Cancer Therapy (FACT) questionnaire was used to assess physical, social, emotional, and functional domains of QOL. Bivariate analyses were conducted to determine the association among FT, FWB, and QOL; and separate logistic regression analyses predicting FT and FWB were used to determine the association between FT and FWB and each domain of QOL. Results: Bivariate results showed that FT and FWB were highly negatively correlated (r = -.76; p < .0001); however, only FWB was correlated with the total QOL score (p < .05). FT was correlated with physical (p < .01), emotional (p < .05), and functional (p < .05) QOL; and FWB was correlated with physical (p < .05) and functional (p < .05) QOL. Logistic regression models adjusted for socioeconomic and demographic characteristics showed that those reporting higher physical QOL (OR = 1.18; CI: 1.04-1.35) and higher functional QOL (OR = 1. 15; CI: 1.03-1.28) had higher odds of reporting high FWB. Conclusions: Given the surveillance and treatment processes for BC patients, it is important to better understand their financial circumstances as they are navigating and managing care. Our results suggest that physical and functional QOL is relevant for predicting FWB, but after considering socioeconomic and demographic characteristics, no domain of QOL was a significant predictor of FT among BC patients.
Communicating the components of informed treatment decision-making in patients with pancreatic cancer receiving preoperative therapy.
Authors: Lee Howard J. , Qian Carolyn L. , Landay Sophia L. , O'Callaghan Deirdre , Kaslow-Zieve Emilia , Azoba Chinenye C. , Fuh Charn-Xin , Temel Brandon , Fong Zhi Ven , Greer Joseph A. , El-Jawahri Areej , Temel Jennifer S. , Traeger Lara , Nipp Ryan David
Published: October 2020

147

Background: Preoperative therapy for localized pancreatic cancer represents an emerging treatment paradigm with the potential to provide significant benefits, yet with complex risks. Research is lacking about whether clinicians effectively communicate key components of informed decision-making for patients considering this treatment. Methods: From 2017-2019, we conducted a two-part, mixed methods study. In part 1, we conducted interviews with clinicians (medical/radiation/surgical oncology, n = 13) and patients with pancreatic cancer who had received preoperative therapy (n = 18) to explore perceptions of information needed to make informed decisions about preoperative therapy, from which we generated a list of key elements. In part 2, we audio recorded the initial multidisciplinary visits of patients with pancreatic cancer eligible for preoperative therapy (n = 20). Two coders (94% concordance) independently identified whether clinicians discussed key elements from part 1. Patients also completed a post-visit survey reporting whether clinicians discussed the key elements. We explored discordance between audio recordings and patient reports using qualitative, explanatory themes. Results: In part 1, we identified 13 key elements of informed treatment decision-making, including treatment logistics, alternatives, and potential risks/benefits. In part 2, recordings showed that most visits included discussions about logistics, such as the chemotherapy schedule (n = 20) and use of a port-a-cath (n = 20), whereas few included discussions about risks, such as the potential for hospitalizations (n = 7), urgent visits (n = 6), or needing help with daily tasks (n = 6). Patients reported hearing about potential benefits, such as likelihood of achieving surgery (n = 10) and cure (n = 7), even when these were not discussed. Qualitative themes across these discordant cases included clinician optimism regarding present day results versus historical findings and mentions of positive outcomes from prior patients without citing specific data or potential adverse outcomes. Conclusions: We identified key elements of information patients with pancreatic cancer need to make informed decisions about preoperative therapy. Although clinicians frequently disclosed much of this information, we found multiple cases of patient-clinician discordance for certain key elements, which underscores the need for interventions to enhance patient-clinician communication regarding pancreatic cancer treatment decisions.
RELEVANT study: Patient (Pt) and physician (PI) perspectives on meaningful outcomes in advanced pancreatic ductal adenocarcinoma (PDAC).
Authors: Pihlak Rille , Frizziero Melissa , Mak Soo Yit Gustin , Nuttall Christina , Lamarca Angela , Hubner Richard , Yorke Janelle , Valle Juan W. , McNamara Mairead Geraldine
Published: October 2020

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Background: PDAC is an aggressive cancer with median overall survival (OS) ~6 months (m). Methods: Pts with advanced PDAC due to start first-line chemo (Chx) completed 1 study survey and 2 quality of life (QoL) questionnaires (QLQ-C30 and PAN26) on 3 time-points: baseline (T1), before (T2) and after (T3) their 1st on-treatment CT scan, PIs filled in paired surveys T1/2/3. Results: 71 Pts and 12 PIs were recruited. 4% Pts died/deteriorated between consent and T1, 28% between T1 - T2 (~2.3m later), 13% between T2 - T3 (~1.3m), only 55% reached T3. 49% Pts preferred to share decision making with their PI, 31% Pts preferred to make the final decision about treatment after considering PI opinion. 86% Pts had personal goals to reach (12% PIs knew of these). 70% Pts were aware that Chx was unlikely to cure cancer however, they had much higher expectations than PIs (%, Table). Choosing between treatment options Pts prioritised: 54% OS, 26% balance between side-effects (SEs) and OS, 15% could not choose and 5% symptom control. These did not match with PIs (p<0.001). Pts who prioritised OS had higher symptom burden (p=0.03). OS was different in these Pts: who prioritised symptom control- OS 2.8m from T1, OS priority- 6.4m, could not choose- 8.7m and balance priority- 9.2m (p=0.01). At T1 Pts had low QoL (57/100, higher better). ‘Future worries’ and ‘planning of activities’ were scored the worst (58 and 56/100, lower better). Clinically significant (+/- 10p) worsening between T1/2/3 were: PF (10p), nausea/vomiting (NV, 12p), body image (18p p=0.01), taste (25p p=0.002). Financially 29% Pts were “a little/ lot” out of pocket at T1, 41% at T2 (p=0.036), 42% at T3 (p=0.034). Acceptability of SEs showed that least acceptable SEs (ranked 1-10, 10-least) were the ones Pts were already struggling with: NV (ranked 9/10, 46p/100 on QLQ), diarrhoea (8/10, 45/100); fatigue (less acceptable T3 (p=0.05), 46/100); appetite loss (7-8/10, 47/100). In contrast, most Pts (97%) were willing to take few/medium and around 50% large amount of SEs as a trade-off for extra time, whilst 9% PIs thought that Pts would accept excess SEs (p<0.001). Conclusions: Pts worry about future, have high symptom burden and high expectations of Chx. Pts want to be involved in decisions, but the contrasting views between Pts and PI show differing aims. [Table: see text]
Health-related quality of life and its predictors in patients receiving first-line treatment for newly diagnosed glioblastoma multiforme in EU5: A real-world study.
Authors: Bennett Bryan , Postema Roelien , Hall Jennifer P. , Bailey Abigail , Massey Lucy , Fu Alex Z
Published: October 2020

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Background: This study describes health-related quality of life (HRQoL) and its predictors including the role of O6-methylguanine DNA methyltransferase promoter (MGMT) testing in first-line (1L) patients (pts) with newly diagnosed glioblastoma multiforme (GBM). Methods: Real-world data were drawn from the GBM Disease-Specific Programme – a cross-sectional study administered to medical and neuro-oncologists who provided information on demographic/clinical status and treatment (tx) patterns for their next 4 consulting 1L GBM pts from May to July 2016 in EU5 countries. Pts voluntarily completed self-completion forms (PSCs), comprising the EORTC QLQ-C30, BN20, and EQ-5D-3L. Linear regressions were conducted using QLQ-C30 global health status (GHS), EQ-5D-3L utility, and EQ-5D visual analogue scale (VAS) scores as dependent variables. Demographic and clinical factors were included as independent variables. Statistically significant results with P<0.05 are presented. Results: 279 1L GBM pts completed a PSC, with a mean age 58.7 years old, 63% were male. 68% (n=189) were MGMT-tested with known results, of which 58% (n=110) were methylated and 42% (n=79) unmethylated. Mean GHS was 45.6 (SD=19.4), utility was 0.57 (SD=0.35), and VAS was 53.5 (SD=18.3). All functional domain scores of the QLQ-C30 were below reference values for general brain cancer population, with differences larger than published thresholds for clinical importance. Age >75 years and ECOG score of 2+ were associated with decreased HRQoL. Longer 1L tx duration, stable/responding disease, and receiving care in Germany, Italy, Spain, or UK (vs France) were associated with increased HRQoL. Results were similar for the subset of pts that was MGMT-tested; however, a greater Charlson index score and not receiving steroids (or RT) were associated with increased HRQoL. MGMT status did not appear to be an independent predictor of HRQoL. Conclusions: HRQoL in pts with GBM receiving 1L treatment is poor. Functional domain scores indicate clinically meaningful problems for these patients. Important predictors of HRQoL include age, performance status, time since tx initiation, country of care, comorbidities, and steroid use alongside RT. Results suggest there remains an unmet need in the tx management of GBM.
Patterns of physical and mental health well-being in older female cancer survivors.
Authors: Sigmund Audrey M , Rosko Ashley Elizabeth , Janse Sarah A , Pisegna Janell , Krok-Schoen Jessica L. , Presley Carolyn J
Published: October 2020

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Background: The majority of cancer survivors are older adults (≥65 years), but their lifestyle behaviors are understudied. Factors associated with improved physical and mental well-being in older female cancer survivors are not well understood. The objective of this study was to evaluate the factors associated with physical and mental well-being in older female cancer survivors, including the role of malnutrition, physical activity, and level of emotional support. Methods: Older female cancer survivors (n=171) completed surveys to assess health related quality of life (HRQoL) using SF-36, malnutrition screening tool (MST), and physical activity. Demographics were also collected. The data was analyzed using descriptive analyses, correlations, and ANCOVAs. Survivors were divided into four phenotypes for analysis using the SF-36 physical and mental composite scores (PCS; MCS) stratified based on the sample’s mean scores (table). Factors associated with the four groups were assessed including demographic characteristics, cancer type, level of emotional support, risk for malnutrition, and physical activity. Results: The majority of the cohort (mean age=74.5 years) were white and highly educated. 68.4% were breast cancer survivors, with 10.5% hematologic malignancy survivors, 5.3% gynecologic malignancy survivors, and 15.8% other. Mean PCS and MCS were 41.94 and 48.47, respectively, comparable to general older adult population means. When divided into four groups based on PCS/MCS, there were no significant differences by demographic characteristics or cancer type. Survivors with higher emotional support scores had significantly higher PCS/MCS scores (p<0.001). There was also a significant difference in risk for malnutrition, as those with high PCS/MCS were at lower risk for malnutrition (p≤0.001). Survivors with low PCS/MCS engaged in less moderate exercise as compared to those with high PCS/MCS (p=0.028). Conclusions: This study suggests that lower risk for malnutrition as well as higher levels of emotional support are associated with higher physical and mental well-being in older female cancer survivors. These are two potential modifiable targets for interventional studies to optimize physical and mental well-being among older cancer survivors. [Table: see text]
A hopefulness survey of SWOG members: Relationships among hope, job stress, and burnout.
Authors: Feldman David B. , O'Rourke Mark Allen , Krouse Robert S. , Bakitas Marie , Deininger Heidi , Hudson Matthew F. , Corn Benjamin W.
Published: October 2020

185

Background: Hope is a cognitive, goal-directed phenomenon that is measurable. It is “a cognitive set that is based on a reciprocally-derived sense of successful agency (goal-directed determination) and pathways (planning to meet goals).” Although hope has been explored in patients, few studies have investigated hope in physicians and other healthcare providers. Low hope has been shown to predict work burnout in other professions. This survey in the SWOG Cancer Research Network tests the relationships among hope, work stress, burnout, and general satisfaction with life. Methods: SWOG members randomly selected and invited to participate by email linked to a 10-minute online survey consisting of the following: The Adult Hope Scale, Satisfaction with Life Scale, demographic questionnaire, and items assessing burnout, work stress, and general social support. Of 1000 invitees, 226 responded to the survey, including physicians ( n = 77) and RNs ( n = 46). Results: On average, respondents reported relatively high work stress ( M = 3.59 out of 5). Levels of work stress were positively associated with burnout ( r = .58, p < .001), but not with general satisfaction with life ( r = .11, p = .08). Hope levels were negatively associated with burnout ( r = -.21, p = .003) and positively associated with satisfaction with life ( r = .58, p < .001). Consistent with past research showing that people with greater availability of general social support suffer from lower rates of burnout and experience higher levels of psychological well-being, we found that social support was negatively associated with burnout ( r = -.18, p = .007) and positively associated with life satisfaction ( r = .38, p < .001). In addition, we tested a meditational model using Hayes’ bootstrapping approach via the PROCESS macro in SPSS. In this model, hope partially mediated the relationships between social support and both burnout and life satisfaction. In the model, job stress also predicted burnout, but, as in the previous correlational analysis, had no relationship with general life satisfaction. Conclusions: Our cross-sectional results suggest that hope may mitigate the effects of burnout. Our data indicate that the particular combination of social support and hope may prove helpful for reducing job burnout and increasing general satisfaction with life. Single-session hope-enhancement workshops that incorporate both of these elements have been shown to increase hope and psychological well-being in non-medical populations. Such interventions for healthcare professionals warrant further study.