bluuebunny/crossref_metadata_2025 huggingface dataset:
The interplay between host genetics and the gut microbiome reveals common and distinct microbiome features for complex human diseases
Authors: Xu Fengzhe , Fu Yuanqing , Sun Ting-yu , Jiang Zengliang , Miao Zelei , Shuai Menglei , Gou Wanglong , Ling Chu-wen , Yang Jian , Wang Jun , Chen Yu-ming , Zheng Ju-Sheng
Published: October 2020

Background

Interest in the interplay between host genetics and the gut microbiome in complex human diseases is increasing, with prior evidence mainly being derived from animal models. In addition, the shared and distinct microbiome features among complex human diseases remain largely unclear.

Results

This analysis was based on a Chinese population with 1475 participants. We estimated the SNP-based heritability, which suggested thatDesulfovibrionaceaeandOdoribacterhad significant heritability estimates (0.456 and 0.476, respectively). We performed a microbiome genome-wide association study to identify host genetic variants associated with the gut microbiome. We then conducted bidirectional Mendelian randomization analyses to examine the potential causal associations between the gut microbiome and complex human diseases. We found thatSaccharibacteriacould potentially decrease the concentration of serum creatinine and increase the estimated glomerular filtration rate. On the other hand, atrial fibrillation, chronic kidney disease and prostate cancer, as predicted by host genetics, had potential causal effects on the abundance of some specific gut microbiota. For example, atrial fibrillation increased the abundance ofBurkholderialesandAlcaligenaceaeand decreased the abundance ofLachnobacterium,Bacteroides coprophilus,Barnesiellaceae, an undefined genus in the familyVeillonellaceaeandMitsuokella. Further disease-microbiome feature analysis suggested that systemic lupus erythematosus and chronic myeloid leukaemia shared common gut microbiome features.

Conclusions

These results suggest that different complex human diseases share common and distinct gut microbiome features, which may help reshape our understanding of disease aetiology in humans.
Giovanni Baronzio's 'Crucifixion': analytical approaches and art historical considerations
Authors: Gasanova Svetlana , Bakirtzis Nikolas , Levif-Martos Dominique , Hermon Sorin
Published: October 2020

The small panel of the ‘Crucifixion’ attributed to Giovanni (da Rimini) Baronzio is a perfect example of the artistic achievements of the so-called School of Rimini. Baronzio, active between 1320 and 1350, was one of the most important painters of a group of artists working in Rimini during the first half of the 14th-century whose work was heavily influenced by the work of Giotto di Bondone (1267–1337), characterized by Gothic and Byzantine influences. The panel, with an estimated date in the end of the 1320 s, represents a popular iconographic theme during this period and was painted in tempera and gold on wood. Non-invasive analytical approaches have revealed a rich history of interventions, re-touching and restorations, which allows for some interesting observations and considerations in regard to the work’s history. The applied analytical methods and the related art historical observations and interpretations are the focus of the present article. In order to avoid micro-sampling, a non-invasive methodological approach integrating spectroscopic (μ-X-ray fluorescence spectroscopy, Fourier transform infrared spectroscopy), imaging (UV, X-ray radiography, infrared reflectography) and digital microscopy techniques was applied. This study aimed at the identification of the work’s original materials and techniques, its state of preservation and the complex history of interventions. Results showed that while original materials of the painting conform with those used by artists in fourteenth century Renaissance Italy, there are multiple later interventions both as small-scale inpainting as well as extensive overpainting of various parts of the original Crucifixion composition. Careful consideration of these interventions can shed light to aspects of the panel’s history of preservation as well as on issues of stylistic or compositional ‘corrections’- always an interesting dimension of the changing perceptions of works of art through time.
Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study
Authors: Baig Muhammad R. , Beck Robert D. , Wilson Jennifer L. , Lemmer Jennifer A. , Meraj Adeel , Meyer Eric C. , Mintz Jim , Peterson Alan L. , Roache John D.
Published: October 2020

Background

Selective serotonergic reuptake inhibitors (SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder (PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury (mTBI) is problematic since SSRIs could exacerbate post-concussion syndrome (PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy.

Methods

We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of mTBI.

Discussion

We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full- scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans.

Trial registration

NCT04280965.
Structural analysis of the Wichita Uplift and structures in the Anadarko Basin, Southern Oklahoma
Authors: Turko Molly , Mitra Shankar
Published: October 2020

We have constructed regional structural transects across the Wichita Uplift and the adjacent Anadarko Basin to show the relationship between thick-skinned basement-involved structures and thin-skinned detached fold-thrust structures. Slip from the basement-involved structures in the Wichita Uplift is transferred along two major detachments into the Anadarko Basin. Our interpretation is that along the northwestern margin, the Wichita Uplift is marked by a zone of frontal imbricates forming a triangular wedge with most of the slip dissipated along the Wichita front. Paleozoic units show tight folding with overturned beds in the frontal zone. The uplift is episodic as indicated by the truncation of major faults along unconformities and their subsequent reactivation. In contrast, along the southeast margin, a significant part of the slip is transferred into structures in the Anadarko Basin. These structures are tight faulted-detachment folds that formed above a major detachment within the Springer Shale, cored by broader structures detaching at the base of the Arbuckle Group. Examples include the Carter-Knox, Cement-Chickasha, and Cruce structures. Oblique faults with normal and strike-slip components cut some of these structures, resulting in more complex geometries. We have determined that preexisting normal faults of Precambrian-Cambrian age were either reactivated along the Wichita Uplift or they controlled the location of the Pennsylvanian-age structures in the Anadarko Basin. Progressive rotation of regional stresses from northeast–southwest to a more east-northeast–west-southwest direction during the Pennsylvanian impacted the tectonic history of the area. We used 2D and 3D seismic, well-log data, and surface geology to evaluate the structural styles and tectonic evolution of the Wichita Uplift and the Anadarko Basin.
Assessing disparities in engagement in a post-discharge virtual visit follow-up program.
Authors: Abdulkareem Abdullateef , Handley Nathan , Burdette Samantha , Binder Adam
Published: October 2020

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Background: Transitions of care are a frequent focus of quality improvement initiatives. In attempt to improve upon the transitions of care for oncology patients, our institution implemented a post discharge virtual visit follow-up program. Previous studies have suggested that socioeconomic status impacts engagement in technology based interventions. Herein, we report the impact of socio-economic status based on area deprivation index (ADI) on engagement with the program. Methods: All patients admitted to the elective chemotherapy service were included. Retrospective analysis of characteristics of each participant was conducted. Data included eligibility (access to the internet, appropriate device, English language proficiency, ability to set up video visit and a patient portal account) for video visit, interest in participating, completion of the visit and any interventions performed during the visit. In addition, ADI was calculated for each individual. Patients were classified into quartiles based on ADI (quartiles increased with ADI). Chi squared testing was performed to assess whether socioeconomic status affected enrollment in video visits. Simple descriptive analysis was also performed. Results: One hundred seven unique patients were included for review. Of these, 33 (31%), 39 (36%), 16 (15%) and 19 (18%) were in quartile(Q) 1, 2, 3 and 4 respectively. Eligibility per quartile was 29 (88%), 34(87%), 13(81%), and 15(83%). ADI quartile did not significantly affect virtual visit eligibility (p = .50). A total of 91 patients (85%) were eligible for video visits; of these, 46 patients declined. Of the 46 patients that declined 9 (19%), 20 (43%), 8 (17%), and 9 (19%) were in Q1, Q2, Q3 and Q4 respectively. Fifteen patients cited technology issues as reasons for declining telehealth visits - 10 (67%) from Q1 and Q2 and 5 (33%) from Q3 and Q4. The vast majority cited lack of interest as reason for declining. Conclusions: ADI as a measure of socioeconomic status did not significantly affect eligibility for or enrollment in video visits. This may be explained by more ubiquitous access to internet services in a large urban setting. Current research is currently being conducted to understand patient barriers to engagement in virtual visits.
Effect of time to treatment and comprehensive care at commission on cancer-accredited practices on survival in rural patients with colorectal cancer.
Authors: Kamath Suneel Deepak , Tullio Katherine , Wei Wei , Cooper Gregory S. , Khorana Alok A.
Published: October 2020

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Background: Rural cancer care in the United States has unique challenges from variable access to care. This study examined differences in time to first treatment (TTT), a surrogate for access, and predictors of overall survival (OS) between rural and non-rural colorectal cancer (CRC) patients. Methods: Patients with stage I-III CRC from 2004-2012 in the National Cancer Database of Commission on Cancer (CoC)-accredited facilities were included and categorized into rural and non-rural groups. Differences in demographic, disease characteristics, socioeconomic (SE) factors and TTT (< 4 weeks, 4-8 weeks and > 8 weeks) between rural and non-rural patients were assessed by Chi-square test. The effect of demographics, SE factors, and TTT on OS were assessed using Cox models. Results: The study population comprised 605,913, 11,649 (2%) of whom were rural. Compared to non-rural patients, rural patients were more likely to be age > 65, male, Caucasian, receive care at non-academic centers, have government insurance, have lower income and less education (p<0.0001 for all). Significant demographic and SE differences are shown in Table. Rural patients had similar mean TTT compared to non-rural patients (2.76 vs. 2.84 weeks, p = 0.35). Slightly more rural patients had TTT < 4 weeks (77% vs. 75%, p <0.0001). Shorter TTT (both <4 weeks vs. 8 weeks and 4-8 weeks vs. > 8 weeks) was associated with improved OS (HR: 0.87, 95% CI: 0.85-0.89, p<0.0001 and HR: 0.74, 95% CI: 0.73-0.76, p<0.0001, respectively). After adjusting for demographic, disease and SE factors, rural status was associated with modestly better OS compared to non-rural status (HR: 0.96, 95% CI: 0.92-0.99, p=0.006). Conclusions: Despite several adverse demographic and socioeconomic factors, rural CRC patients had modestly better OS compared to non-rural patients. Rural and non-rural CRC patients had similar TTT in this cohort. These data suggest the comprehensive cancer care delivered by CoC-accredited practices is associated with rapid TTT and improved OS in rural CRC patients. It is unclear whether our data apply to non-CoC-accredited facilities in rural United States. [Table: see text]
Psychosocial impacts of COVID-19 on oncology workforces: Metro versus regional Australia.
Authors: Ahern Elizabeth Stephanie , Gasper Harry Michael , Chan Bryan , Roberts Natasha Anne , Hughes Brett Gordon Maxwell , Wyld David , Kennedy Glen , Eastgate Melissa A. , Lwin Zarnie
Published: October 2020

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Background: The COVID-19 pandemic poses psychosocial challenges to the oncology workforce. We postulate that these impacts may affect the entire patient-facing workforce. Whether distress is different in varying settings (metro vs regional hospitals) is unknown. Methods: Cancer Care staff were approached via all-staff email for a weekly online survey administered at two hospital sites, Royal Brisbane and Women’s Hospital (RBWH) (metro) and Sunshine Coast Hospital and Health System (SCHHS) (regional). Surveys included Likert-scale items exploring perceptions of departmental preparation, COVID-19 related query burden and staff well-being, and distress thermometer derived from NCCN. Mean and 95% confidence interval were calculated, with non-parametric t-tests adjusted for multiple comparisons (Holm-Sidak); significance was deemed p < 0.05. Results: 117 participants at RBWH and 59 at SCHHS consented. The survey opened April 3, 2020. Data is presented for the initial 6 weeks (COVID-19 preparation phase). Highest survey response was noted in week 1 (87%) and lowest at week 6 (36%). 65% unique responses were from RBWH. 60% participants worked in an outpatient setting, while 37% had inpatient care role. The remainder worked in either community-based or mixed settings. Significant heterogeneity was detected between sites (RBWH vs SCHHS) for some occupational roles: RBWH had more representation of administrative (19% vs 8%, p < 0.001) and ancillary staff (2% vs 0%, p = 0.005) but SCHHS had more allied health (28% vs 17%, p = 0.005). Nursing and medical staff proportions at SCHHS and RBWH were similar (50% vs 45%, and 14% vs 18% respectively). Higher levels of distress were noted early; mean (95% CI) distress thermometer result (0-10) during week 1 was 4.7 (4.3-5.2) at RBWH and 4.9 (4.2-5.5) at SCHHS. Mean distress scores significantly reduced over time: correlative scores during week 6 were 3.2 (2.3-4.1) at RBWH and 2.5 (1.6-3.4) at SCHHS. Distress levels comparing RBWH with SCHHS were similar (p = 0.22-0.76). No significant difference was noted in staff perception of self-support comparing RBWH with SCHHS, and over 80% responders felt well-supported at work most, or all of the time. Concurrently, participants perceived that the Cancer Care department of their site was either “well” or “very well” prepared for COVID-19 over 85% of the time, with no difference between sites. Conclusions: High perceptions of support and preparedness were evident, with no regional difference. Distress scores reduced over time during the COVID-19 preparation phase, in the context of low COVID-19 rates.
Is there any health and geographical disparity in indigenous and non-indigenous women of Western Australia (WA)? A retrospective review with respect to de novo metastasis.
Authors: Khan Azim , Martin Hilary Laura , Spalding Lisa , Redfern Andrew David
Published: October 2020

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Background: Indigenous women with breast cancer have substantially higher mortality then non-Indigenous women. They are more likely to live in more remote communities with potential delays to presentation, investigation and diagnosis as well as slower access to cancer treatment facilities, potentially impacting survival. Here we explore by evaluating the diagnosis of de-novo metastasis and any association of remoteness, highlighting the geographic and possibly early access to treatment. Methods: A cohort of patients was retrospectively selected comprising age- and remoteness matched Indigenous and non-Indigenous women in a 1:1 ratio from the Western Australian Cancer Registry. Further data were collected from medical records and results systems. Remoteness was defined by the ARIA system. In addition, the distance from the nearest treatment center was calculated. The survival analysis was performed by Indigenous status and remoteness. Results: The final cohort comprised 250 Indigenous and 261 non–Indigenous women. Of the total, 7.6% (19/250) and 7.7% (20/261) were identified to have de-novo metastasis. At 10 years of follow up, most de-novo metastatic patients in both groups were from remote communities, distributed as 10.1, 9.1, 7.8, 8.7 and 5.0 % in metropolitan, inner regional, outer regional, remote and very remote areas respectively. In Indigenous group with de-novo metastasis the average distance of patient from treatment center was 1720km for vs 1018 km in Non-Indigenous patient with a p-value of 0.03. In non-metastasis cohort, Indigenous patient has 1065 km v 1241 km in non-indigenous group. Considering outcomes for those developing metastatic disease, median survivals after metastatic diagnosis were shorter for Indigenous patients, 21 v 33 months, p = 0.03. Conclusions: Indigenous women in WA with metastatic breast cancer have inferior survival outcomes from diagnosis of metastases relative to non-Indigenous peers. Most de-novo metastatic patients were from remote locations in both cohorts but no relation between remoteness and de-novo metastasis, identified to be impacting survival. Future studies are needed to better elucidate if any geographical, health care disparities and improve on treatment related outcomes. It is suggested to derive targeted policies to improve survival outcome of all Indigenous cancer patients, particularly those residing in remote areas.
The association of polypharmacy with functional status impairment, frailty, and health-related quality of life in older adults with gastrointestinal malignancy: Results from the Cancer and Aging Resilience Evaluation (CARE) registry.
Authors: Outlaw Darryl Alan , Dai Chen , Al-Obaidi Mustafa , Giri Smith , Bhatia Smita , Williams Grant Richard
Published: October 2020

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Background: The majority of new cancer diagnoses occur in adults greater than 65 years of age. Polypharmacy is a common and potentially devastating problem amongst older adults; however, its prevalence and impact in older adults with gastrointestinal (GI) malignancy is poorly understood. Our objective was to examine the prevalence of polypharmacy and its association with functional status impairments, frailty, and health-related quality of life (HRQoL) in older adults with GI malignancy. Methods: The Cancer and Aging Resilience Evaluation (CARE) registry at the University of Alabama at Birmingham (UAB) is an ongoing prospective cohort study that uses a brief geriatric assessment (CARE survey) in older adults with cancer. We evaluated older adults diagnosed with GI malignancy prior to starting cancer therapy. Our primary outcomes of interest were functional status impairments, including dependence in activities of daily living (ADL) and instrumental activities of daily living (IADL), frailty (as defined by a frailty index derived using the principles of deficit accumulation), and HRQoL (assessed via PROMIS 10 global that includes physical and mental scores). Patients were dichotomized into those taking ≥9 vs. < 9 medications. Multivariable analyses examined associations between polypharmacy and the above-listed outcomes, adjusted for age, sex, race, cancer type, cancer stage, and comorbidities. Results: Overall, 357 patients met eligibility criteria; mean age: 70.1 years; primary diagnoses: colorectal (33.6%), pancreatic (24.6%), hepatobiliary (16.2%), gastroesophageal (10.9%), other (14.6%). Patients reported taking a mean of 6.2 medications: 27.7% with 0-3 medications, 48.2% with 4-8 medications, and 24.1% with ≥ 9 medications. Patients taking ≥ 9 medications were more likely to report limitations in ADL (adjusted odds ratio [aOR] 3.29, 95% CI 1.72-6.29) and IADL (aOR 2.86, 95% CI 1.59-5.14). Polypharmacy was also associated with frailty (aOR 3.06, 95% CI 1.73-5.41) and lower physical (aOR 2.82, 95% CI 1.70-4.69) and mental (aOR 1.73, 95% CI 1.03-2.91) HRQoL. Conclusions: Independent of comorbid conditions, polypharmacy was associated with functional status limitations, frailty, and reduced HRQoL in older adults with GI malignancy. Further study of specific medications and interactions is warranted in order to reduce the negative consequences of polypharmacy in this growing and vulnerable population.
Variations in recommended surveillance in colorectal cancer survivorship care plans.
Authors: Chodoff Alaina , Smith Katherine Clegg , Shukla Aishwarya , Blackford Amanda L. , Ahuja Nita , Johnston Fabian McCartney , Peairs Kimberly S. , Ngaiza Justinian R. , Warczynski Tam , Nettles Brenda , Stotsky-Himelfarb Eden , Murphy Adrian Gerard , Mayonado Nancy , DeSanto Jennifer , Snyder Claire Frances , Choi Youngjee
Published: October 2020

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Background: Survivorship care plans (SCPs) outline pertinent information about a cancer survivor’s treatment and follow-up care. We describe the content of colorectal cancer (CRC) SCPs, completed as part of a randomized controlled trial of SCPs, and evaluate whether follow-up recommendations are guideline concordant. Methods: We analyzed 74 CRC SCPs from an academic and community cancer center. Frequency distributions and descriptive statistics were calculated for the entire cohort and separately by recruiting site. Follow-up recommendations were compared to American Cancer Society (ACS), American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines (Table). Results: Content routinely provided in SCPs (>80%) included patient demographics, cancer diagnosis, treatment details (surgery, chemotherapy, radiation therapy) as well as treatment-related side effects. SCP content specified less frequently included cancer stage, cancer risk (predisposing conditions), and recommendations for genetic counseling/testing and health promotion. Nearly all SCPs from the community site provided uniform, guideline-concordant follow-up. At the academic site, on average, more than 15 follow-up recommendations were listed for each surveillance modality, except colonoscopy. Among the SCPs that specified the frequency of follow-up care, the rate of guideline-concordant recommendations was 15/42 (36%) for follow-up visits, 29/43 (67%) for imaging, 12/45 (27%) for laboratory and 39/39 (100%) for colonoscopy. Conclusions: SCPs consistently provided information about CRC diagnosis and treatment, but often omitted information about cancer risk, staging and prognosis. There was considerable variation between cancer centers in the follow-up recommendations suggested for CRC survivors. Future work to improve the consistency of SCP follow-up recommendations with guidelines may be needed. Clinical trial information: NCT03035773 . [Table: see text]
Long-term impact of patient navigation (PN) for breast cancer (BCA) screening in an urban academic medical center.
Authors: Phuong Lisa , Anampa Mesias Jesus Del Santo , Lozada Melanie , Makower Della F.
Published: October 2020

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Background: PN improves BCA screening rates in underserved women, and decreases health care disparities. However, there is limited data regarding the ability of PN effect sustained change. We evaluated the long-term impact of PN for BCA screening at our institution, by assessing the rate at which women who underwent screening mammogram (SM) in 2017, with the aid of PN, completed subsequent (f/u) SM within guideline-concordant time frames. Methods: Patients (pts) consisted of women seen by our institution’s primary care providers, with referral for SM in the electronic medical record (EMR), but without scheduled appointment, who received PN between June 1 and September 30, 2017, and successfully completed SM in 2017. Pts were identified from the screening navigation database. EMR was reviewed to obtain demographic data, rate of f/u SM, and time from 2017 SM to prior and f/u SM. Wilcoxon signed-rank test was used for analysis. Results: 179 pts completed SM with the aid of PN in 2017. Median age was 58 (range 37-77), 52.5% were Hispanic, 26.8% Black; and 2.8% Asian. Preferred languages were English (70.4%) and Spanish (25.7%). 6 pts had never had prior SM; 30 had no prior SM at our institution. Median time between 2017 SM and prior SM was 29 months (mo) (range 12-104); only 20 pts (11.2%) had a prior SM within 24 mo. 177 pts were eligible for f/u SM in 2018 and 2019 (1 diagnosed with BCA on 2017 SM; 1 died in 2017). 85 pts (48%) completed f/u SM; 68 (39%) completed within 24 mo. Only 2 pts required PN to complete f/u SM. In pts with time to screening data available for both 2017 SM and f/u SM (n = 80), median time to SM improved from 24 to 16 mo (p < 0.01). Decreases were seen in Black (22 to 14 mo, p < 0.01), White (31 to 16 mo, p = 0.03), and Hispanic pts (28 to 18.5 mo, p < 0.01), and in English (22 to 15 mo, p < 0.01) and Spanish speakers (26 to 20 mo, p < 0.01). Conclusions: A single episode of PN for BCA screening had a sustained impact on pts at our institution, leading to improved compliance with future SM. Improvement was seen in pts of diverse races, ethnicities, and language preferences. Focused PN for pts who did not complete f/u SM is planned.
Disparities in advanced-stage breast cancer: The socioeconomic and geographic contributions.
Authors: Clemons Kelli , Forehand William , Xu Hongyan , Zhang Li Fang , Raval Priyanka
Published: October 2020

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Background: Socioeconomic disparities in healthcare have been well documented in America, with cancer being a critical area. One in four deaths are caused by cancer, and the effects on different communities are not equal. Clinical observations suggest that poorer socioeconomic circumstances lead to more frequent, later stage diagnoses and worse outcomes. The aim of this project was to quantify the sociodemographic and geographic contributions to disparities in advanced, metastatic breast cancer within the Augusta population and surrounding areas. Methods: Records of patients managed for breast cancer at the Georgia Cancer Center between Jan 2009- Jun 2019 were reviewed. 80 patients who presented with early stage breast cancer (clinical stage I) without positive lymph nodes were compared with 80 patients who presented with advanced, metastatic disease (clinical stage III-IV). Their race, breast cancer characteristics, insurance status, geographic proximity to a mammography site or major healthcare facility, and time interval between diagnosis and treatment were compared. Results: Results show that 73.75% early stage patients had private insurance, while 41.25% late stage patients had private insurance (p value < 0.0001). Results also show that 25.0% of late stage patients had annual mammography screenings, while 77.78% of early stage patients had regular screening for mammograms (p value < 0.0001). 80.6% of patients that received regular mammograms had private insurance, while the remaining 19.4% of those patients had public insurance. No statistical difference was shown in late and early stage presentation based on HER2 and/or triple negative (ER-, PR-, HER2-) status. Conclusions: There is a significant outcome of advanced, metastatic breast cancer in patients that do not have private insurance and in those that do not receive regular mammograms. Our findings support the importance of investing resources into alleviating differences in various socioeconomic populations as they relate to the amount and quality of cancer healthcare available. While the incidence of mortality in breast cancer is decreasing nationwide, disparities in morbidity and mortality will most likely continue unless there is an aggressive effort towards addressing said differences.
Assessing the demographics of fertility preservation discussions in cancer patients.
Authors: Auster Michael E , Janania Martinez Michelle , Blaize Jean-Pierre , Djoufack Djoumessi Lakene Raissa , Warnecke Brian , Pandya Abhishek , Lathrop Kate Ida
Published: October 2020

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Background: Young adults undergoing cancer treatment often face increased risk of infertility. Despite current ASCO guidelines recommending prompt fertility preservation education, knowledge about prevalence and barriers to oncofertility care is lacking. This is particularly true for patients in medically underserved and minority communities. This study sought to characterize the utilization of oncofertility counseling in a major Hispanic serving institution. Methods: Retrospective chart review was performed at the University of Texas Mays Cancer Center San Antonio and included patients diagnosed with testicular, early stage breast cancer or leukemia/lymphoma between age 18-40 from 2015-2019. Demographic data including ethnicity, race, funding, zip code were collected. Chart reviewed determined if fertility counseling was provided and which patients elected for oncofertility treatments. Results: Of 304 evaluable patients, only 120 had documented fertility discussions. There was no significant difference in the odds of counseling between gender, funding, or race. However, the odds of receiving fertility discussions was higher in non-Hispanic whites compared to Hispanic whites with an odds ratio of 1.94 (P value of 0.032). For those who opted for fertility treatment there was no statistically significant difference between diagnosis, race, ethnicity, or payment status. Conclusions: Our study demonstrates oncofertility discussions occur in a relatively small proportion of eligible patients. Additionally, patients who self -identify as Hispanic were less likely to receive fertility discussions. This study demonstrates that more research is necessary to evaluate the barriers to fertility discussion and treatment, and how these barriers result in decreased oncofertility education in Hispanic young adults with curable malignancies. [Table: see text]
Cumulative incidence of financial hardship in metastatic colorectal cancer (mCRC) patients (pts): Primary endpoint results for SWOG S1417CD.
Authors: Shankaran Veena , Unger Joseph M. , Darke Amy , Suga Jennifer Marie , Wade James Lloyd , Kourlas Peter , Chandana Sreenivasa R , O'Rourke Mark Allen , Satti Suma , Liggett Diane , Hershman Dawn L. , Ramsey Scott David
Published: October 2020

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Background: Despite evidence that rising cancer care costs contribute to “financial toxicity” in cancer pts, no studies, to our knowledge, have prospectively assessed the financial impact of cancer diagnosis (dx) using both self-reported and objective financial measures. S1417CD, led by the SWOG Cancer Research Network and conducted in the NCI Community Oncology Research Program (NCORP), was the first national prospective cohort study to evaluate time-to-first evidence of major financial hardship (MFH) in pts with newly diagnosed mCRC. We present results of the primary endpoint analysis. Methods: Pts age ≥ 18 within 120 days of mCRC dx receiving systemic treatment completed surveys every 3 months (mo) for 12 mo. MFH was defined as ≥ 1 occurrence of self-reported increase in debt, new loans, selling home, refinancing home, or ≥ 20% income decline during the 12 mo study period. Cumulative incidence (CI) of MFH was estimated to account for competing risk of death. Multivariate logistic regression was used to evaluate the association between pt characteristics with development of MFH. Results: 380 pts (median age 59.9) across 126 clinic sites were enrolled. Most pts were white (78%), male (61%), and insured (98%), with annual income ≤ $50,000 (56%). Cumulative incidence of MFH at 12 mo was 71.5% (95% CI: 65.9%-76.3%), with 24.6%, 52.4%, and 61.8% at 3, 6, and 9 mo; 104 (41%) pts reported ≥ 2 elements of MFH. Age, race, marital status, employment, and annual income (≤ vs. > $50K) were not significantly associated with MFH. In a post hoc analysis, income <$100,000 and total assets <$100,000 were both adversely associated with MFH. Each increase in number of these 2 risk factors from 0 to 1 and 1 to 2 was associated with a 49% increased risk of MFH (p<.001). Conclusions: In a national sample of mCRC pts on systemic tx, financial hardship, most commonly in the form of increased debt, accumulates progressively over time. Nearly 3 out of 4 pts experiencing MFH at 12 mo despite access to health insurance coverage. These findings underscore the need for clinic and policy solutions such as early financial navigation and elimination of cost sharing to protect pts from financial devastation as they continue with tx. [Table: see text]
Effects of a geriatric assessment (GA) intervention on symptomatic toxicity burden reported by older adults with advanced cancer during treatment.
Authors: Culakova Eva , Mohile Supriya Gupta , Xu Huiwen , Patil Amita , Plumb Sandy , Mohamed Mostafa , Pan Zhi , Meng Sixu , Gilmore Nikesha , Wells Megan , Ritterman Rebecca , Magnuson Allison , Ramsdale Erika E. , Peppone Luke Joseph , Loh Kah Poh , Flannery Marie Anne
Published: October 2020

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Background: GA evaluates aging-related domains (e.g., function) known to be associated with cancer treatment toxicity. We found that providing a GA summary with management recommendations to oncologists reduces clinician-rated toxicity in older patients with advanced cancer receiving high risk treatment (presented at ASCO2020). Herein, we report on the effects of the GA intervention on symptomatic toxicities measured by Patient-Reported Outcomes Common Terminology Criteria for Adverse Events [PRO-CTCAE]. Methods: In the national cluster randomized clinical trial eligible patients (n=718) had age>70, advanced solid tumors or lymphoma, 1+ GA impairment, and were initiating a new treatment regimen with high risk of toxicity. Severity grade of 24 PRO-CTCAE items was collected on a 0-4 scale at enrollment, 4-6 weeks, 3, and 6 months. Of 24 items, 11 (e.g. fatigue, dyspnea) were classified as core (Reeve 2014). Baseline adjusted method (Basch 2016) was used to determine symptomatic toxicities: if the severity of any item increased after baseline to grade 2 or higher, the patient was classified as experiencing grade ≥2 event (similarly for grade ≥ 3 events). The effects of GA intervention on symptomatic toxicities were assessed using generalized linear mixed model (GLMM) with random effect for the practice cluster. Results: Mean age was 77 years (range 70-96); 43% female, 87% white; 34% had gastrointestinal and 25% had lung cancer; 27% received prior chemotherapy. 710 patients provided PRO-CTCAE data (366 usual care, 344 intervention), 85.6% reported grade ≥2 and 49.4% grade ≥3 events at baseline. After baseline, compared to usual care, patients in the GA intervention arm reported fewer grade ≥2 overall symptomatic toxicities (76.5% vs. 84.7%) and fewer core symptomatic toxicities (grade ≥2: 71.8% vs. 82.0%; grade ≥3: 46.2% vs. 53.6%). Specifically, less dyspnea and less fatigue was reported in GA-arm (Table). Conclusions: GA intervention resulted in fewer symptomatic toxicities as evaluated by PRO-CTCAE. Clinical trial information: NCT02054741 . [Table: see text]
The association of patient fatigue and outcomes in advanced cancer: An analysis of four SWOG treatment trials.
Authors: Mo Julia , Darke Amy , Guthrie Katherine A , Sloan Jeff A. , Unger Joseph M. , Hershman Dawn L. , O'Rourke Mark Allen , Bakitas Marie , Krouse Robert S.
Published: October 2020

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Background: Prior studies have suggested that patient-reported outcomes may be associated with cancer outcomes. We evaluated the association between clinically significant fatigue (CSF) and adverse events (AEs), quality of life (QOL), and overall survival (OS) during cancer treatment. Methods: Four phase II or III chemotherapy trials, two each in advanced non-small cell lung cancer (NSCLC) and advanced hormone-refractory prostate cancer (HRPC), were used to compare patients with or without baseline CSF. Baseline CSF was defined as a rating of 2 or greater on the FACT fatigue survey question or an EORTC QLQ-C30 fatigue symptom score of 50% or greater. Change in QOL from baseline, AE rates, and survival were compared according to baseline CSF with linear regression models, equality of proportions chi-squared tests, and Kaplan-Meier survival estimates and Cox regression models, respectively, separately for each trial. Results: Of 1,994 participants, 1,907 had complete baseline QOL survey data, with 52% reporting CSF at baseline. Baseline CSF was associated with an increased incidence of grade 3-5 constitutional (16.5% vs 9.4%, p = 0.002 and 13.9% vs 6.3%, p = 0.002) and neurological (11.7% vs 6.1%, p = 0.006 and 9.0% vs 3.9%, p = 0.01) AEs, respectively, in two studies of advanced HRPC. Overall, patients with baseline CSF had significantly lower baseline QOL across all four domains (p < 0.01). Across all four studies, baseline CSF was associated with higher mortality rates, with adjusted hazard ratios (95% confidence interval, p-value): 1.34 (1.14, 1.57, p < .001) and 1.30 (1.02, 1.66, p = 0.03) in NSCLC studies, 1.49 (0.95, 2.35, p = 0.09) and 1.53 (1.12, 2.11, p = 0.008) in HRPC studies. Conclusions: Oncology trial participants with baseline CSF had significantly lower baseline QOL, experienced more adverse events and had poorer survival compared to participants without CSF. We have confirmed previous work indicating that fatigue is an important baseline stratification factor that should be considered in all oncology treatment trials. Consistent with other research, our results indicate that fatigue should be measured and ameliorated wherever possible among advanced cancer patients.
Caregiver-oncologist concordance in patient prognosis, caregiver depression, and caregiver mastery.
Authors: Loh Kah Poh , Culakova Eva , Xu Huiwen , Kadambi Sindhuja M , Magnuson Allison , Flannery Marie Anne , Duberstein Paul , Epstein Ronald M. , McHugh Colin , Nipp Ryan David , Trevino Kelly Marie , Sanapala Chandrika , Canin Beverly , Gayle Arlene Angela , Conlin Alison Katherine , Bearden James , Mohile Supriya Gupta
Published: October 2020

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Background: Caregivers of older adults with advanced cancer often have a different understanding of the patient’s prognosis compared with their oncologist. Among patients, accurate prognostic awareness is associated with greater depressive symptoms, except when patients utilize more adaptive coping skills. We examined the relationship between caregiver-oncologist prognostic concordance and caregiver depressive symptoms and explored whether this relationship differed by caregiver mastery, the capacity to cope, adjust, and adapt to problems. Methods: We utilized data from a national geriatric assessment cluster-randomized trial (URCC 13070: PI Mohile) that recruited patients aged ≥70 with incurable cancer considering any line of cancer treatment at community oncology practices, their caregivers, and oncologists. At enrollment, caregivers and oncologists estimated the patient’s prognosis (0-6 months, 7-12 months, 1-2 years, 2-5 years, > 5 years); same response was considered concordant. Caregivers completed Ryff’s mastery subscale (range 7-35, higher is better) at enrollment and depression screen (the Patient Health Questionnaire (PHQ)-2 (range 0-6) 4-6 weeks later. To assess the association of prognostic concordance with caregiver depressive symptoms, we used generalized estimating equations in models adjusted for cancer type, study arm, practice sites, and caregiver demographics. We then assessed moderation effect of caregiver mastery on this association. Results: Among 410 caregiver-oncologist dyads, mean caregiver age was 66.5, 75% were female, and 26% were caregivers of patients with lung cancer. Mean mastery score at enrollment was 27.6 (SD 4.7) and 19% screened positive on PHQ-2 at week 4-6. Among dyads who provided response (N = 370), 28% were concordant. Prognostic concordance was associated with higher caregiver depressive symptoms (β = 0.30; p = 0.04). Significant moderation effect was found between concordance and mastery for caregiver depressive symptoms (p = 0.02). Among caregivers with low mastery ( < median), prognostic concordance was associated with higher depressive symptoms (β = 0.68; p = 0.003). Among caregivers with high mastery (≥median), concordance was not associated with depressive symptoms (β = -0.06; p = 0.67). Conclusions: There is a need to study how prognostic understanding might lead to depression in at-risk caregivers. Interventions targeting caregiver prognostic understanding need to consider its relationship with depressive symptoms, while seeking to increase caregiver mastery.
Patient-centered communication: Collaborative learning and communication strategies for patient and healthcare providers in the new normal of COVID-19.
Authors: Raymond Martha Ann , Simonetta Margaret-Ann
Published: October 2020

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Background: Data from the National Cancer Institute’s Surveillance, Epidemiology & End Results (SEER) program estimates in 2020 over 1.8 million new cancer diagnoses will occur. SEER data also indicates that over 15.5 million patients/survivors are currently living with a cancer diagnosis in the United States. Amid COVID-19, transitioning care beyond the clinic to minimize exposure for patients and healthcare providers is essential. Now more than ever, new and evolving ways to communicate openly and effectively are crucial for patients and their healthcare team. Methods: March-May 2020 the Raymond Foundation hosted nationwide virtual focus groups and town halls for cancer patients, survivors, and caregivers to gain a better understanding of how COVID-19 is affecting their cancer care, communication with their healthcare team, and shared decision-making. Primary goals included reaching patients in rural, urban, and community oncology settings to gain perspective from diverse populations. Results: 489 patients, survivors, and caregivers (54% female, 46% male) provided the following insights: 89% reported communication with their healthcare team had deteriorated since the pandemic; 94% indicated the need for increased communication with their healthcare team; 42% had a general knowledge of telehealth while 58% had little to no knowledge; 98% indicated they would like to learn more about telehealth options and would try this advanced class of service if offered by their healthcare team; 64% reported they were not able to accurately communicate treatment adverse effects leading to increased suffering; 96% reported increased isolation and fear of the unknown care landscape. Conclusions: Cancer patients realize the importance of patient-centered communication to facilitate a personalized dialogue to actively participate in their care. Empowering patients with the skills they require to comprehensively perceive telemedicine, virtual care, and remote monitoring will help minimize patient risk and provide an opportunity for patients to engage with their healthcare team throughout the care continuum. Implementing strategies to skillfully serve patients via telemedicine and teleconferencing may be the new normal as we virtually revive the classic house call.
Baseline cancer worry and tumor marker testing among earlier-stage breast cancer patients participating in a Choosing Wisely pilot.
Authors: Kreizenbeck Karma L. , Egan Kathryn , Wong Tracy , Jagels Barbara , Jensen Barbara , Smith Julie C. , Irwin Blair Billings , Noble Heather , Ramsey Scott David
Published: October 2020

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Background: We developed a patient-facing video aimed at raising early breast cancer survivors’ adherence to ASCO’s Choosing Wisely recommendation against surveillance tumor marker testing. To understand the impact of the video on cancer worry regarding recurrence, we surveyed breast cancer survivors before and after viewing the video. Methods: Women with stage I-IIIA breast cancer (N=246) treated at six regional community clinics were surveyed prior to viewing a video at the start of surveillance, then again at follow-up one year later (N=171). Both surveys included the Cancer Worry Scale (CWS-8 items, 4-point Likert scale). Tumor marker (TM) testing during surveillance was collected for 728 patients and linked to surveys among those who provided consent (N=105). Results: Most women (77%) were white age 50+. Among women who completed both questionnaires (N=153), the average CWS summary score was 17.1 at baseline (range=9-29) and 16.9 at follow-up ( p=0.48, range=8-30). Women who did not view the video (A) and those with high baseline cancer worry (B) who viewed the video had similar rates of TM testing (19%) compared to patients with low baseline cancer worry (C) who viewed the video (3%). Cancer worry is highly correlated with the decision to use of TM testing. Viewing an informational video that provided evidence-based advice on follow-up and testing did not impact cancer worry. Enrollment among eligible patients was impacted by challenges to proactively identify and consent patients during their transition to surveillance. Conclusions: Patients with high baseline cancer worry may need different or additional guidance beyond an educational video during their transition to surveillance for breast cancer. [Table: see text]