bluuebunny/crossref_metadata_2025 huggingface dataset:
Totally neoadjuvant chemoradiation therapy with mFOLFOX6 in locally advanced rectal cancer: A single arm phase II study (FOTAC).
Authors: Zhang Jianwei , Cai Yue , Hu Huabin , Xiao Jian , Chen Dianke , Ling Jiayu , Huang Meijin , Wang Lei , Kang Liang , Lan Ping , Wang Jianping , Deng Yanhong
Published: March 2017

TPS816

Background: Preoperative 5-Fluorouracil based chemoradiotherapy is the standard of treatment for locally advanced rectal cancer. About 15% to 18% of patients would achieve pathologic complete response (pCR) after 5-Fluorouracil based chemoradiation. And the survival outcome of patients with pCR was much better than that of non-pCR. In our previous FOWARC study, in the group of preoperative systemic chemotherapy with mFOLFOX6 combined with radiation, the pCR rate was up to 27.5%. In another study, adding mFOLFOX6 after neoadjuvant chemo radiation in locally advanced rectal cancer improve the pCR rate to 38%. This phase II study aimed to explore whether totally neoadjuvant chemoradiation therapy with mFOLFOX6 could further improve the pCR rate in locally advanced rectal cancer. Methods: The primary endpoint is the pathologic complete response rate (pCR).The secondary endpoint included 3-year disease free survival rate, 3-year local recurrence rate, and safety. We hypothesized that totally neoadjuvant chemoradiation therapy with mFOLFOX6 could improve the pCR rate from 18% to 45% with 5% type I error and 80% power. Fifty patients met inclusion criteria will be enrolled in the trial. All patients will receive long term radiation for 25 times and 50Gy before surgery. Four cycles of mFOLFOX6 would be performed every 2 weeks during radiotherapy, and another 4-6 cycles would be added after radiotherapy and before operation. Totally, the patients will receive 8-10 cycles of chemotherapy before surgery. MRI of the pelvic will be performed every 4 cycles of the therapy to assess clinical response. Then the patient will receive total mesorectal excision at least 8 weeks after radiotherapy. The post-operative chemotherapy will be omitted and all the patients go to surveillance. Clinical trial information: NCT02887313.
Steroid-free regimen with aprepitant in preventing chemotherapy-induced nausea and vomiting in patients with colorectal cancer receiving FOLFOX chemotherapy: A randomized phase III trial.
Authors: Wang Wenjing , Ling Jiayu , Cai Yue , Zhang Jianwei , Hu Huabin , Li Shanshan , Xiao Jian , Deng Yanhong
Published: March 2017

TPS820

Background: Addition of aprepitant, an NK1 receptor antagonist to a 5-HT3 receptor antagonist and dexamethasone regimen was shown to be effective for prevention of chemotherapy-induced nausea and vomiting (CINV) with moderately emetogenic chemotherapy (MEC). Little is known about the efficacy of aprepitant when used without dexamethasone. Dexamethasone is widely used to prevent both acute and delayed nausea and vomiting induced by chemotherapy. However, multi-period use of dexamethasone could be associated with side effect, such as hyperglycemia, dyspepsia and insomnia. This randomized phase III trial studies antiemetic therapy with aprepitant and tropisetron to see how well they work compared to dexamethasone plus tropisetron in preventing chemotherapy-induced nausea and vomiting in patients with colorectal cancer receiving FOLFOX (oxaliplatin, leucovorin and 5-fluorouracil) chemotherapy. Methods: This trial is an open-label, single-center, randomized phase 2 study. Eligibility criteria include histologically confirmed colorectal cancer, no prior chemotherapy and scheduled to receive FOLFOX, Age ≥ 18 years, ECOG Performance Status 0, 1 or 2. Up to 298 patient will be enrolled and randomized 1:1 to receive aprepitant (125 mg orally on day 1 and 80 mg orally on days 2 and 3) plus tropisetron (5mg IV of day1) or dexamethasone (10 mg IV on day 1 and 5 mg IV on days 2, 3) plus Tropisetron (5mg IV of day1). The primary objective of this study is complete response defined as no emetic episodes and no use of rescue medication. The second objectives include nausea score, time to first vomiting episode or use of rescue medication, frequency of rescue medication and functional Living Index -Emesis (FLIE). Clinical trial information: NCT02909478.
Barriers to care in two differing models of follow-up for long-term childhood cancer survivors.
Authors: Russell Brooke , Reynolds Kathleen , Spavor Maria , Giese-Davis Janine
Published: March 2017

100

Background: Long-term childhood cancer survivors (CCSs) require lifetime medical follow-up to screen for and treat adverse health outcomes related to cancer and its treatment. In Alberta, primary-care providers (PCPs) are involved in this follow-up care, though differently so in Northern and Southern regions of the province. Our aim was to identify potential province-wide and region-specific preferences and care barriers that may impact medical and quality-of-life outcomes for patients. Methods: Forty-four PCPs following CCSs completed surveys about knowledge gaps, communication, and health-system barriers. Knowledge gaps were assessed using a hypothetical case vignette followed by three multiple-choice questions regarding appropriate follow-up, based on available guidelines. Communication barriers were measured using a 6-item 5-point scale. Health-system barriers were measured using a 12-item 5-point scale. Results: PCPs were 54.54% female, age 31-72 ( m=51.36) with 1-50 years of practice ( m=22.49). These preliminary results suggest PCPs across Alberta are experiencing moderate communication barriers (scale: 0-24, m=10.85, SD=6.59) but fewer health-system barriers (scale: 0-48, m=14.58, SD=5.11). Scores on the case vignette were markedly low province-wide (scale: 0-3, m=0.65, SD=0.65), indicating considerable knowledge gaps regarding long-term oncology-related care follow-up. No statistically significant differences were observed between regions. Conclusions: Albertan PCPs are experiencing barriers to care and knowledge gaps when following ASCCs. This is of primary concern for PCPs in Southern Alberta, currently tasked with the sole responsibility of providing oncology-related follow-up care. These data will be linked with data collected from their patients to explore the relationship between PCPs’ barriers and knowledge, and the symptoms, quality of life, and unmet needs of their patients.
Understanding and improving knowledge of cancer survivorship care among college providers.
Authors: Psihogios Alexandra M , Schwartz Lisa , Pauly-Hubbard Helen , Ginsberg Jill P. , Hobbie Wendy , Szalda Dava
Published: March 2017

101

Background: Young adult survivor (YAS) engagement in follow-up care is often compromised by competing developmental transitions, including attending college away from home and pediatric oncology team, as well as community providers’ deficits in knowledge related to caring for YAS. The aims were to assess college providers’ basic knowledge of the risks of YAS and related care guidelines and determine whether an educational in-service is an effective platform for increasing college health providers’ knowledge about survivorship. Methods: During Phase 1, 40 college health and office of disability staff members from public and private colleges/universities (90.0% female) completed a 41-question survey on their experiences with students who were YAS. In Phase 2, a one-hour educational in-service was provided to 18 health center medical providers (94.1% female) at a private university. In-service content was informed by the original survey. Providers completed pre- and post-test assessments of knowledge about late effects, knowledge of resources, and comfort with caring for YAS. Results: While most providers indicated that YAS are at risk of chronic health conditions because of their cancer treatment (70.6%), nearly all were unfamiliar with the published long-term follow-up guidelines for cancer survivorship (93.8%). Over half of providers did not have knowledge of cancer survivorship services in their area (58.8%). All respondents were interested in more survivorship education. Attendees of the in-service had higher knowledge of survivorship follow-up guidelines at the post-test assessment ( M=4.19) compared to the pre-test ( M=1.81), t=-5.56, p < .001. They endorsed higher awareness of local resources at post-test ( M = 3.67) compared to the pre-test ( M=2.13), t=-3.62, p < .01. Attendees reported higher comfort with caring for cancer survivors at post-test ( M=3.00) compared to the pre-test ( M=2.00), t=-3.42, p< .01. Conclusions: College providers had little baseline knowledge of cancer survivorship guidelines, but were motivated to obtain more information. An in-service improved college health providers’ knowledge of caring for YAS, awareness of published guidelines, and comfort in providing care.
Risk of coronary heart disease and ischemic stroke in thyroid cancer patients taking levothyroxine.
Authors: Shin Dong Wook , Suh Beomseok , Yoon Jae Moon , Park Youngmin
Published: March 2017

105

Background: Many thyroid cancer patients are exposed to long-term TSH suppression, in many cases as lifetime treatment, and are consequently subjected to risk for cardiovascular disease. We investigated incidence of CHD and ischemic stroke among thyroid cancer patients and explored possible pathophysiological mechanisms involved. Methods: A total of 182,419 subjects who received thyroidectomy for thyroid cancer during 2004-2012 were selected from the Korean National Health Insurance data, which covers approximately 97% of the entire Korean population. Propensity score matching was used to select non-cancer controls. Cox proportional hazards regression analysis was used to determine relative risk of coronary heart disease (CHD), and ischemic stroke. Mean follow-up was 4.32 years. Results: Thyroid cancer patients had elevated risk for CHD and ischemic stroke with HR 1.15 (95% CI 1.10-1.22), and 1.15 (1.09-1.22), respectively. This risk was marked in those who received total thyroidectomy and in those who took higher dosage of levothyroxine (HR 1.47, 95% CI 1.34-1.60 for CHD and HR 1.56, 95% CI 1.42-1.72 for ischemic stroke among those who took ≥ 170mcg/d). Atrial fibrillation risk was dose-dependently associated with levothyroxine dosage; however, once patients developed atrial fibrillation, ischemic stroke risk was not significantly greater in those who took higher dosage. Conclusions: The risk for CHD and ischemic stroke was higher in thyroid cancer patients who received thyroidectomy, and the dosage of levothyroxine administered appears to play a major role. More caution is suggested for the choice of thyroidectomy and TSH suppression therapy, as well as proper management for cardiovascular disease prevention.
Development of a decision aid for young canadians diagnosed with breast cancer who are at risk of infertility following cancer treatment.
Authors: Speller Brittany , Facey Marcia , Sissons Amanda , Daly Corinne , Kennedy Erin Diane , Metcalfe Kelly A. , Baxter Nancy N.
Published: March 2017

108

Background: Young breast cancer patients are at risk of temporary or permanent infertility following the administration of gonadotoxic cancer treatments. Currently patients do not feel they receive enough information to make informed fertility decisions before treatment. We aim to determine the fertility-related information health care providers and breast cancer survivors consider valuable to include in a Canadian decision aid (Can-DA) for young breast cancer patients by reviewing existing decision support resources. Methods: A qualitative descriptive approach was used to evaluate 6 decision support resources created in other jurisdictions. Using purposeful sampling, 8 multi-disciplinary health care providers and 8 breast cancer survivors from across Canada evaluated 1 to 2 decision support resources in structured interviews. Interviews were conducted in-person and by telephone from March to June 2016 and ranged in length from 30 to 90 minutes. Interviews were transcribed verbatim, organized in NVivo, and analyzed deductively using the pre-defined sections of the interview guide as a framework. Results: Each decision support resource had valuable components to adapt for the Can-DA. Participants valued the inclusion of Canadian-specific and accurate information on resources for additional support and the success rates and cost ranges of fertility preservation procedures. There were mixed views on the impact and value of including in-depth fertility information such as adoption and other fertility-related options after treatment. Discrepancies were also seen on the value of personal stories and an explicit values clarification exercise. There was consensus on the inclusion of only pertinent fertility-related information that does not replicate information in supplementary patient education material to avoid overwhelming patients. Conclusions: The evaluation provided valuable insight on the information and design features to consider for the Can-DA. Findings will be used in combination with the International Patient Decision Aid Standards criteria to ensure the Can-DA meets the fertility information needs of young breast cancer patients in Canada.
Preserving fertility for adolescent and young adult cancer survivors: A community model.
Authors: Lawrence Stephanie L. , Albritton Karen H. , Berry Emily , Rodriguez Aurelio , Argenbright Keith Edward
Published: March 2017

109

Background: Loss of fertility is a significant late effect of cancer treatment for those patients diagnosed during their reproductive years. This loss is a source of considerable distress for patients who have not yet started or completed building their families. Fertility preservation counseling to discuss reproductive concerns regardless of treatment phase can ease this burden. However, due to access- and health-related barriers, approximately half of oncologists report having never referred a patient for a fertility consultation, and as many as 60% of cancer survivors do not recall receiving this information from their healthcare team at time of diagnosis. Methods: The Moncrief Cancer Institute (MCI) Fertility Preservation Program synchronizes services between oncology care providers and fertility specialists. This model is designed to remove discomfort associated with discussing options while enhancing access to care by arranging physician and patient education opportunities specific to fertility preservation and the treatment options available, patient care coordination for fertility preservation treatment, and financial assistance for fertility preservation treatment for underinsured and uninsured adolescent and young adult cancer patients. Results: Referrals for fertility counseling have been provided from 5 institutions through an established referral network comprised of non-profit organizations, local hospitals, and private practice providers. MCI partners with 2 reproductive specialty care groups who offer treatment at reduced rates, which MCI further subsidizes based on financial need. No patients are turned away for inability to pay. The institutions that MCI has targeted for education and partnerships support an environment that meet the distinct needs of adolescent and young adult patients with cancer. Conclusions: Program impact is evaluated by the number of patients and providers receiving education, and the number of patients receiving care coordination and/or financial support for fertility preservation treatment. In the fight against cancer, MCI is assisting patients to protect their future families through fertility preservation education and care coordination.
Risk for pulmonary late effects in childhood Hodgkin lymphoma survivors.
Authors: Agrusa Jennifer Elise , Brown Austin L , Kothari Viral , Lewis Gary , Teh Bin S. , Paulino Arnold , Allen Carl E. , Lupo Philip , Gramatges Maria Monica
Published: March 2017

112

Background: Survivors of Hodgkin lymphoma (HL) are at risk for pulmonary late effects, including pulmonary fibrosis (PF). Established risk factors such as younger age at diagnosis and specific therapeutic exposures explain a fraction of the risk for these outcomes. Notably, systemic inflammation and impaired telomere maintenance are associated with adverse pulmonary outcomes in adult populations, but have not been explored in cancer survivors. Our aim was to identify pulmonary diffusion defects in HL survivors, and evaluate the impact of short lymphocyte telomere length (LTL) and systemic inflammation on these outcomes. Methods: Blood samples, demographic and treatment data, and lung carbon monoxide diffusion capacity corrected for hemoglobin and alveolar volume (DLCO) were obtained from HL survivors ≥6 months off therapy and without history of relapse or transplant. LTL was measured by telomere flow FISH (Repeat Diagnostics), and age-based percentiles determined from population controls. Plasma elevations in pro-inflammatory cytokines (HCYTMAG panel, EMD Millipore) were detected on a Luminex platform. Associations between clinical features and most recent DLCO were determined by linear regression, adjusted for age, sex, radiation, and race/ethnicity. In a subset of subjects, cytokine levels and LTL were compared in survivors with DLCO above or below the mean using a Student t-test or Fisher’s Exact test, respectively. Results: Seventy-two HL survivors met inclusion criteria (mean age at diagnosis=14 years, range: 3-18 years). Mean off-therapy DLCO was 75% (range: 52-98%), below the lower limit of normal (76%) in healthy populations. DLCO was inversely associated with female sex (p = 0.002). Five of 24 survivors (21%) had LTL ≤10th percentile for age, but there was no difference in LTL relative to DLCO. Survivors with DLCO ≤75% had higher IL1α and IL1β levels (n = 30, p = 0.07). Conclusions: HL survivors had lower than expected DLCO, with females at highest risk for impaired pulmonary diffusion. Twice as many survivors as expected had LTL ≤10th percentile, and PF-related cytokine profiles were observed in survivors with lower DLCO, suggesting inflammation and telomere maintenance defects may contribute to late effects in HL survivors.
Identifying characteristics of women cancer survivors with a recent history of falls.
Authors: Winters-Stone Kerri M. , Reis Thais , Stoyles Sydnee , Dieckmann Nathan
Published: March 2017

113

Background: Epidemiologic data suggest that fall rates are increased among women with a history of cancer compared to women never diagnosed with cancer. However, the unique characteristics of women cancer survivors who fall are not completely understood. Our study aimed to identify the demographic, clinical and physical attributes of women treated for cancer and who experienced falling in the past year. Methods: Secondary data analysis of baseline data from aging women cancer survivors (greater than 50 years of age) about to participate in clinical exercise trials (n = 611). Based on self-report of having fallen in the last year (yes/no), women were compared on the following: age, cancer type (breast vs. other), cancer stage, time since diagnosis, presence of neuropathy or pain, comorbidities, BMI, physical activity, maximal leg press strength, chair stand time, walk speed, gait patterns, and the short physical performance battery (sPPB). Stepwise regression was run to determine attributes significantly associated with fall history. Results: 28% of women reported falling in the last year (n = 173) and 79% of fallers experienced a related injury. Women cancer survivors who fell were significantly more likely than women who did not fall to have: not received chemotherapy (25% vs. 13%), higher morbidity scores (2.2 vs. 1.8), higher BMI (30.6 vs. 29.2 kg/m2), more neuropathy (49 vs. 39%), wider base of support (10.0 vs. 8.8 cm), more of the gait cycle spent in the stance phase (64 vs. 63%), longer chair stand times (12.8 vs. 11.9 sec.), and lower PPB scores (10.3 vs. 10.8). In stepwise regression models, receipt of chemotherapy, comorbidities, maximal leg strength, neuropathy, base of support, and % time in the stance phase of gait were significantly associated with the odds of having fallen in the last year. Conclusions: Women cancer survivors over 50 years old have a prevalence of falls approaching the 33% reported by the general population of women over 65; however, the rate of injurious falls is much higher in our sample of women cancer survivors. Fall prevention should be considered in women cancer survivors at an earlier age than usual for older women, particularly for survivors at higher risk for falls, and focus on exercise to improve gait and leg strength.
Post-transplantation long-term outcomes in 43 HIV-positive patients affected by high-risk or relapsed lymphoma.
Authors: Zanet Ernesto , Balsalobre Pascual , Taborelli Martina , Diez-Martin Jose , Re Alessandro , Ribera Josep M. , Rupolo Maurizio , Genet Philippe , Serraino Diego , Guillerm Gaelle , Mazzucato Mario , Durante Cristina , Gabriel Ian , Cwynarski Kate , Conde Garcia Eulogio , Varela Gomez Maria Rosario , Ciancia Rosanna , Tirelli Umberto , Michieli Mariagrazia
Published: March 2017

121

Background: The advent of highly active antiretroviral therapy (HAART) allowed to extend autologous stem cell transplantation (ASCT) to HIV-positive patients affected by lymphoma. In the literature, data are lacking on long-term events developed by this population. Methods: Herein we are reporting the preliminary analysis of long-term data of 43 pts out of 61 pts, affected by high-risk or relapsed lymphoma and treated by ASCT in different European countries. These 61 pts reached a complete response after ASCT and received HAART concomitantly to chemotherapy. We considered the following events after ASCT: lymphoma relapses, second cancers, opportunistic infections (OIs) and cardiovascular events. Results: Thirteen pts experienced OIs, after 0.36 years from ASCT (IQR: 0.12 -2.91). Twelve pts had a secondary malignancy and 6 pts had a lymphoma relapse, at a median time of 4.90 years (IQR: 2.56 – 9.90) and 2.88 years (IQR: 0.57 – 4.27) from ASCT, respectively. Six pts developed a cardiovascular event at 6.29 years (IQR: 4.84 – 9.32) from ASCT. Eight pts died: 3 of lymphoma relapse, 3 of second malignancy, 1 of acute myocardial infarction and 1 of car accident. With a median of 9.18 years of follow-up, (IQR: 5.99-12.43) the OS, PFS and EFS of the entire sample of pts were 82%, 75% and 35% at 10 years, respectively. Conclusions: Thirty-five out of 43 pts are still alive and in long-term complete remission after ASCT. These data confirm the long-term dramatic efficacy of ASCT. We support surveillance of OIs early after ASCT and of second cancers, lymphoma relapses and cardiovascular events from ASCT. Secondary malignancies developed by our pts are non-AIDS-defining cancers and a majority are linked to a viral pathogenesis or lifestyle behaviours (i.e. smoking). Secondary cancers and lymphoma relapses are the main causes of death in this population. Cardiovascular events may represent a cause of death but also a major reason of disability.
Sexual function in adult cancer survivors.
Authors: Rajotte Emily Jo , Baker K. Scott , Heron Leslie , Syrjala Karen Leslie
Published: March 2017

123

Background: Sexual dysfunction is a common treatment sequela across numerous cancer diagnoses and treatments, causing increased distress, discomfort and negatively impacting quality of life. Methods: Before their survivorship-focused clinic appointment, adult cancer survivors were asked to complete a comprehensive patient -eported outcomes survey that included detailed questions on their health status including sexual function. Results: Between April 2015 to July 2016, 94 patients completed the survey. They were 66% female, mean age 45 years (SD 16, range 21-82) and 34% leukemia/lymphoma, 18% breast cancer, and 12% genitourinary cancer survivors. Patients were a mean of 6.7 years (SD 7.9, range 0-42) from their cancer diagnosis at the time of clinic appointment. Nearly half (48%) were married or living with a partner and 49% were living alone (single, divorced, widowed). 70.2% reported being sexually active (alone or with a partner) in the last year: of these only half (55.3%) reported being sexually active in the last month. For those who were not sexually active the most commonly cited reasons included lack of interest (24.5%) and not having a partner (30.9%), with 12.8% reporting not being sexually active due to a physical problem. Survivors rated their sexual satisfaction in the past month as a 5.0 (SD 3.7; scale of 0-10, 0=not at all satisfying 10=extremely satisfying). An independent samples t-test revealed a statistically significant difference in sexual satisfaction between survivors under 45 years in age and ≥45 years in age (t=4.4, df=68.0, p < 0.05). Older survivors (mean=3.71, SD=3.7) reported significantly lower levels of sexual satisfaction than did younger survivors (mean=7.11, SD=2.8). The most commonly reported sexual function issues for women included vaginal dryness (23.4%) and for men included difficulty getting an erection (7.4%). Conclusions: Sexual dysfunction is a common long-term effect of cancer across diagnoses and most treatments, warranting widespread implementation of targeted interventions to manage sexual dysfunction and improve quality of life for these survivors.
Symptom burden in long-term head and neck cancer survivors.
Authors: Pocobelli Gaia , Ziebell Rebecca , Fujii Monica , McClure Jennifer , Chubak Jessica
Published: March 2017

124

Background: The symptom burden faced by long-term head and neck cancer survivors could inform clinical decision making but it is not well understood. Methods: In 2016 we surveyed current enrollees of Group Health (an integrated health care delivery system in Washington State) who were aged ≥18 years when diagnosed with head and neck cancer in 2011 (n = 54). Symptoms experienced in the past 24 hours were assessed using the validated MD Anderson Symptom Inventory head and neck cancer module (MDASI-HN). Survivors were asked to report on a 10-point scale the severity of the problem at its worst (“not present” to “as bad as you can imagine”). Self-reported risk factor and demographic information were also collected. Results: Eighty percent of persons responded to the survey (n = 43) via web questionnaire (n = 12), mailed questionnaire (n = 26) or telephone interview (n = 5). One person who reported to have not been diagnosed with head and neck cancer was excluded, leaving 42 participants. Overall, 29% had no more than mild symptoms (all MDASI-HN symptoms rated <5 ), 43% had no more than moderate symptoms (all MDASI-HN symptoms rated <7 ), 57% had one or more symptoms rated as severe (at least one MDASI-HN symptom rated ≥7 ), and 45% had two or more symptoms rated as severe. The symptoms most commonly rated as severe were: dry mouth (38%), difficulty swallowing or chewing (17%), pain (17%), fatigue (17%), disturbed sleep (15%), feeling sad (15%), choking or coughing (15%), problems with tasting food (15%), problems with teeth or gums (15%), problems with mucus in the mouth or throat (12%), and feeling distressed (12%). Persons who rated one or more symptom as severe were more likely than those who did not to have had cancer recurrence (44% versus 6%), receipt of cancer treatment in the previous three years (36% versus 17%), age ≥65 years at diagnosis (63% versus 17%), non-white race (21% versus 6%), no more than high school education (33% versus 17%), current unemployment/disability/retirement (71% versus 44%), and annual household income <$100,000 (71% versus 56%). Conclusions: In the context of limited data on this topic, in this small study we found that it was not uncommon for five-year survivors of head and neck cancer to experience one or more symptoms which they rated as being a severe problem.
Systematic evaluation of risk factors for acquired heart disease in sarcoma survivors.
Authors: Baker Laurence H. , Murthy Venkatesh Locharla , Weinberg Richard Lawrence , Bobowski Nina Pagadala
Published: March 2017

127

Background: Sarcoma survivors are at high risk for severe heart disease at a young age. The study objective is to evaluate risk factors for cardiac disease in sarcoma survivors receiving more than 300 mg/m2 of Doxorubicin. Left ventricular ejection fraction is a routinely used test but is not predictive. It is imperative to determine which modifiable cardiovascular risk factors increase cardiac risk. Methods: Our unique Sarcoma Survivorship Clinic was established to evaluate high risk sarcoma patients for the long-term and late effects of cancer and its treatment. Each patient regularly electronically completes NIH’s PROMIS questionnaires developed for this clinic. Family medical history is reviewed. Chemotherapy doses are abstracted from original medical records. Data collected includes: blood pressure, lipid profile, high-sensitivity C-reactive protein (hs-CRP), basic metabolic panel, chemistries, renal and pulmonary function, echocardiography. We will compare standardized cardiac risk assessments with mediastinal calcification and epicardial fat on serial chest CT scans. All patients signed an informed consent. Results: The 24 patient cohort had a cumulative dose of > 300 mg/m2 of Doxorubicin. No patient had chest radiation. All patients had normal left ejection fractions (median= 60%). Eight patients (33%) had an elevated hs-CRP (>3) and 10 patients (42%) had elevated blood pressure. Framingham risk may underestimate risk in this relatively young population and other metrics may be required. Conclusions: Our findings suggest high risk sarcoma survivors' follow-up management requires a comprehensive approach to establish the patient's overall cardiac risk profile. Symptoms may be discounted and/or attributed to other causes, leading to delayed and/or inappropriate treatment of cardiovascular disease. We must improve our knowledge of the long-term cardiac risk associated with surviving a bone or soft tissue sarcoma to effectively counsel survivors and offer effective intervention strategies to prevent or minimize the impact of adverse late effects.
Effect of chemotherapy-induced peripheral neuropathy on postural control in cancer survivors.
Authors: Herman Haley K. , Monfort Scott M. , Pan Xueliang Jeff , Chaudhari Ajit M.W. , Lustberg Maryam B.
Published: March 2017

128

Background: Advances in screening and treatment have significantly improved the survival of cancer patients. However, chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity of curative treatment; many patients either cannot complete planned course of treatment or have long standing effects on quality of life. CIPN has been shown to lead to pain, falls, and difficulty walking. Balance changes have been reported with other neuropathies but have not been investigated in depth in cancer patients. This study aims to improve our understanding of changes in postural control associated with CIPN. We hypothesize that patients who report more significant CIPN symptoms will perform more poorly on balance testing. Methods: Eleven cancer patients were enrolled (9 female/ 2 male; 9 breast cancer/ 2 GI cancer; 1.67 ± 0.05 m; 85.8 ± 19.3 kg; 56.5 ± 14.5 yrs). These patients included cases (n = 7), tested within 6 weeks of finishing taxane or oxaliplatin chemotherapy, and controls (n = 4) who did not receive chemotherapy. Patients’ sensory symptoms were assessed by EORTC QLQ-CIPN20. Standing on a balance plate, patients were instructed to close their eyes and remain still while their center of pressure (CoP) was recorded. Medial-lateral root mean squared CoP excursion (RMS) was calculated to provide a measure of postural stability, with higher values indicating poorer control of CoP position and being predictive of falls. Results: Groups were not statistically different in terms of height, mass, or age (p > 0.1). Cases had an average of 3.8 mm (95% CI: 1.7 mm, 6.0 mm) increase in RMS over controls (p = 0.004). Furthermore, cases scored an average of 37.6 points (95% CI: 19.5 points, 55.7 points) lower on a normalized CIPN 20 scale, suggesting worse sensory symptoms (p = 0.002). Conclusions: Patients with CIPN symptoms displayed significantly poorer control of their CoP. This supports the hypothesis that CIPN symptoms associate with poorer balance. The balance deficits reported here are consistent with increased risk of falls and negative post-treatment sequelae. This further suggests a need for closer monitoring and even targeted balance-focused rehabilitation following chemotherapy.
Protection from late-occurring anthracycline-related cardiotoxicity among childhood cancer survivors with a RARG coding variant.
Authors: Tonorezos Emily S. , Joseph Vijai , Barnea Dana , Villano Danylo , Satagopan Jaya , Friedman Danielle Novetsky , Sklar Charles A. , Oeffinger Kevin C. , Offit Kenneth
Published: March 2017

130

Background: Susceptibility to late-occurring anthracycline-related left ventricular (LV) dysfunction is poorly understood. While higher dose of anthracyclines, radiation therapy, and younger age at exposure are relevant, heterogeneity persists. A recent report suggests that survivors with the rs2229774 retinoic acid receptor γ (RARG) variant represent a high-risk group. We sought to replicate this finding in our population of adult survivors of childhood and young adult cancer. Methods: We collected germline DNA among 455 survivors of childhood and young adult cancer seen in the Memorial Sloan Kettering Long-Term Follow-Up Programs. Participants were 48% male and more that 90% were white, non-Hispanic. Median age at diagnosis was 15 years and median time from diagnosis was 17.8 years. The most common diagnosis was Hodgkin Lymphoma (31%) followed by sarcoma (29%) and leukemia (10%). Initial genetic testing was performed using a low density SNP array (Illumina Exomearray), followed by full gene analysis by LD block testing. LV dysfunction was defined as ventricular ejection fraction less than 55%. Bonferroni-adjusted p values were used to determine significance in a multivariate model. Results: Of 455 participants, 120 did not have a history of anthracycline exposure, 1 was excluded for lack of echo data, and 17 were excluded due to poor genotyping quality control. Out of the remaining 317 participants, 41 had LV dysfunction. On initial testing, survivors with the rs2229774 variant were at lower risk for LV dysfunction (OR 0.14; 95% CI 0.02-0.99; p = 0.02), compared to survivors with other variants. Of note, the allele frequency in those without LV dysfunction was similar to reported studies and public data. In full gene analysis, those with a missense variant in ESPL1 (separase), within LD block but upstream of RARG, were at significantly increased risk of LV dysfunction (OR 5.61; 95% CI 1.48-21.3; p=0.005) compared to those without the ESPL1 variant. Conclusions: Based on these findings, rs2229774 RARG variant does not appear to confer genetic susceptibility to left ventricular dysfunction. ESPL1, a nearby candidate, may be the risk-conferring variant. Replication efforts are ongoing.
Developing a cardiac monitoring plan in at-risk cancer survivors.
Authors: Veneruso Aubri , Slocum Megan Rae , Kircher Sheetal Mehta , Akhter Nausheen , Murtagh Gillian , Strauss Jonathan Blake
Published: March 2017

133

Background: Improvements in early detection, screening, and treatment of cancer translate into survivors living longer, highlighting the need for guidelines to address the late and long-term effects of cancer treatment. A particularly concerning effect is Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD). Cancer treatments can result in a range of cardiovascular toxicity including left ventricular dysfunction, heart failure and radiation-induced heart disease (RIHD). Various consensus statements related to cardiovascular care for adult cancer survivors exist; however there are no globally accepted follow-up guidelines. Our purpose is to create a protocol to stratify a survivor’s cardiac risk and provide a basis for follow-up recommendations. Methods: We first evaluated existing resources within our institution and identified key stakeholders who were recruited to form a multidisciplinary workgroup (2 survivorship advanced practice providers, an oncologist, a radiation oncologist, and 2 cardio-oncologists). We then reviewed current research and literature on cardiotoxic cancer therapies and identified two consensus statements from the American Society of Echocardiography and the European Association of Cardiovascular Imaging which helped inform our protocol. Finally, we created a cardiac assessment that could be applied in the pre-treatment phase and extend into the post-treatment phase. Results: Two assessment tools were developed. The first is an algorithm initiated in the pre-treatment setting by an oncologist when a Type I or Type II cardiotoxic agent is planned. The second is a risk assessment tool that is initiated in the post-treatment setting to stratify cardiac risk and provide follow-up recommendations. Conclusions: Development of standardized guidelines for assessment and treatment of late and long-term effects of treatment is critical. This protocol has been developed to account for the many factors that contribute to overall cardiac risk after various anti-cancer therapies. Further data is needed to evaluate long-term cardiac and survival outcomes based on this protocol.
Exercise physiology in cancer care.
Authors: Sangermano Sarah , Pugh Terrence , Yaguda Susan I
Published: March 2017

135

Background: Cancer survivors can benefit from exercise at many points in the cancer care continuum. The Exercise Physiology Internship was developed by the University of North Carolina at Charlotte and Levine Cancer Institute (LCI) to address the exercise needs of patients with cancer. Although the interns had a background in physical fitness, they required training regarding the medical complexity of this population and how this affects their ability to exercise. To bridge this gap, LCI approached Carolinas Rehabilitation to assist in providing safe and effective exercises to cancer survivors. Methods: The intern program was modified to include cancer rehabilitation. Education was performed by the rehabilitation team, with emphasis on treatment-related side effects, contraindications for exercise, cancer-related fatigue, and safety considerations. Interns assisted therapists with impairment based rehabilitation to learn how physical fitness integrates with rehabilitation. Prior to 1:1 intern consults, the therapist and intern reviewed the most recent oncology notes, and the intern consulted the therapist regarding safety considerations or exercise modifications. The intern also worked with a clinical nurse specialist at LCI who provided information regarding disease processes, treatment side effects and potential residual implications of treatment and disease. Results: Following modification of the program, interns reported feeling more prepared and confident when providing 1:1 consults to survivors. Referrals from providers within LCI grew, with 5 consults in Spring 2016, 13 consults in Summer 2016, and at least 19 consults to be completed this semester. Interns also became more integrated into the cancer center, providing consults during infusion and in physician clinics. Conclusions: Exercise physiology interns are an asset to the cancer survivorship and rehabilitation teams. By collaborating with the rehabilitation team, interns can provide safe and effective exercise prescriptions to cancer survivors. Interns can also provide rehabilitation referrals for patients who require impairment-based therapy. With continued program development, opportunities for intervention may present throughout the continuum of care.
Measuring the impact of provider education to referral rate in survivorship care.
Authors: Canli Ursula S , Hershberger Patricia E. , Schaeffer Cathleen M. , Hoskins Kent , Danciu Oana Cristina
Published: March 2017

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Background: There will be an estimated 19 million cancer survivors by 2024. Survivors are often lost to follow-up after active treatment due to poor coordination of care between clinical oncologist and primary care providers. Lack of awareness of survivor needs including insufficient monitoring of late effects after oncologic care contribute to poor care coordination. While cancer centers have gradually introduced survivorship care, it remains challenging for some providers to refer their patients to a survivorship visit once their cancer treatment is completed. Continuing education is known to improve provider knowledge and may lead to an increased number of patients referred to survivorship. Methods: Survivorship starts when completing the initial treatment (surgery, chemotherapy or radiation therapy). The project will implement the review of an education module regarding survivorship through the National Comprehensive Cancer Network (NCCN) education website by breast cancer (BC) medical oncologists and their fellows in training at a cancer center in the Midwest. Providers are to complete “Comprehensive Care for Cancer Survivors”, a free continuing education module, on the NCCN continuing education website. Pre intervention data was retrospectively collected, including all BC cases from June 2016 to August 2016. Post intervention data will be prospectively collected over 1 month. Pre and post intervention referral rates will be compared using descriptive statistical methods. Results: A baseline 3 months review of 349 encounters noted 22 of 28 (78.6%) BC survivors were referred to the breast cancer survivorship visit. Results for this project are ongoing, and will include the analysis of referral rates by medical oncologists or fellows during the 1 month post completion of the NCCN education module. These results will be compared to the previous 3 months Conclusions: While data collection is pending, we hope to show that providers who have completed formal education regarding survivorship are more likely to refer breast cancer survivors to a survivorship visit. If the project is effective it will help increase the number of cancer patients seen in the BC survivorship clinic and improve the health outcome of BC survivors.
Utility of annual screening serum testosterone level in men on surveillance for clinical stage I testicular cancer.
Authors: Winquist Eric , Rowe Alexandra , VanUum Stan , Ernst D. Scott , Potvin Kylea R. , Quinn Maureen , Bradish Grace
Published: March 2017

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Background: Testicular cancer occurs in young men and is usually cured leaving survivors with many life years at risk from long term treatment effects. Risks increase with treatment intensity and include cardiovascular disease associated with the metabolic syndrome (Haugnes 2012, de Haas 2013). Testosterone deficiency (TD) is associated with metabolic syndrome & reduced QoL (Huddart 2005). Serum testosterone levels (STLs) are also influenced by underlying testicular dysgenesis & the effects of ageing (Skakkebaek 2001, Oldenburg 2016). We added annual screening STL to our surveillance protocols in 2013 & reviewed the value of this practice. Methods: Men followed in our Testicular Surveillance Clinic from 01 Jan 2006 to 31 Dec 2015 were identified electronically & data extracted retrospectively. Men eligible for this analysis had clinical stage I (CS I) testicular cancer treated with unilateral orchiectomy alone. Outcomes of interest were STLs, Endocrinology referral (Endo) & treatment with androgen replacement therapy (ART). TD was defined by 3 cutoffs of most recent screening STL: < 8.6 nmol/L [age 20-49] (or < 6.7 nmol/L [age > 50]) (local laboratory), < 10.1 nmol/L (Huddart 2005), or < 12.1 nmol/L (EAA & EAU). Results: 77 eligible men were identified: median age 34 years (range, 15-65), seminoma/nonseminoma/mixed/other (45/27/4/1). By the 3 STL cutoffs, TD was present in 13 (16.9% [95%CI, 9.3-27.1%), 22 (28.6% [18.8-40.0%] & 37 (48.1% [36.5-59.7%]); respectively. Nine men (11.4%) were referred to Endo, 1 had morning STL pending & 1 was using OTC ART. Of 8 men assessed by Endo, 5 (6.5%) were prescribed ART. Six men had no screening STL done (3 nonadherent, 1 prostate cancer & 2 unknown). Two men were discharged from clinic with unequivocal low STL. Conclusions: Annual screening STL appears to be useful and may be necessary. 15 CS I men (19.5%) in our clinic had unequivocal TD &/or were referred to an Endo. An additional 20 men (26%) had STLs in a range associated with reduced QoL. Almost half had STLs considered suitable for ART in the presence of symptoms. Two men (2.6%) were discharged with low STLs unaddressed. Guidelines for the optimal assessment and management of men with positive screening for TD are needed.
Immediate-term chemotherapy-related cognitive impairment (CRCI) following administration of intravenous (IV) chemotherapy.
Authors: Khan Omar Farooq , Cusano Ellen R. , Raissouni Soundouss , Pabia Mica , Haeseker Johanna , Bosma Nicholas , Ko Jenny J. , Kumar Aalok , Vickers Michael M. , Tang Patricia A.
Published: March 2017

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Background: The acute impact of chemotherapy on cognition is unknown. This study utilized performance on the psychomotor vigilance task (PVT) and trail-making test B (TMT) to assess CRCI immediately following chemotherapy administration. Methods: Patients aged 18-80 years receiving first-line IV chemotherapy for any stage of breast or colorectal cancer were eligible. Patients with brain metastases, neurologic disorders or allergic reactions to chemotherapy were excluded. Patient symptoms, peripheral neuropathy and Stanford Sleepiness Scale were assessed. A five-minute PVT and TMT were completed on a tablet computer pre-chemotherapy and immediately post-chemotherapy. Paired Wilcoxon Rank Sum tests were used to assess changes in median PVT reaction time, TMT completion time, TMT errors and PVT lapses. A priori, increases of 20 ms or over in median PVT reaction times (approximating reaction time changes with blood alcohol concentrations of 0.04 to 0.05 g%) were considered clinically relevant. Results: 144 patients (74 breast, 70 colorectal, median age 55.5 years) were tested. Post-chemotherapy, median PVT reaction time slowed by an average of 12.4 ms (p = 0.01). Post-chemotherapy median PVT times slowed by over 20 ms in 59 patients (40.9%). TMT completion post-chemotherapy was faster by an average of 6.1 seconds (p < 0.001). No differences were seen in TMT errors (p = 0.417) or PVT lapses (p = 0.845). Change in median PVT reaction time was not associated with age, gender, number of prior chemotherapy cycles, use of paclitaxel (which contains alcohol), peripheral neuropathy grade, or self-reported anxiety, fatigue or depression. Conclusions: Median PVT reaction time was significantly slower immediately after chemotherapy compared to a pre-chemotherapy baseline, and impairment correlating to effects of alcohol was seen in 41% of patients. This effect appears independent of age, self-reported symptoms or prior chemotherapy cycles. Further studies assessing the functional implications of immediate-term CRCI are warranted.