bluuebunny/crossref_metadata_2025 huggingface dataset:
High-Dose Chemotherapy in Adult Patients with Germ Cell Tumors
Authors: De Giorgi Ugo , Papiani Giorgio , Severini Giuseppe , Fiorentini Giammaria , Marangolo Maurizio , Rosti Giovanni
Published: August 2017

Background

Approximately 80% of patients with advanced germ cell tumors (GCTs) can be cured with cisplatin-based chemotherapy. Patients with poor-prognosis disease have a cure rate of only 50%, whereas patients with first relapse have only a 25% chance of prolonged survival and potential cure following standard therapy. High-dose chemotherapy (HDC) is being investigated in patients with GCTs to improve the results of salvage treatment and in first-line setting for poor prognosis disease.

Methods

The authors review the results of the clinical trials that have evaluated the role of HDC in GCT patients. Data were obtained using a computer-assisted MEDLINE search, and meeting abstracts with clinical relevance in this field were hand-searched. Open randomized phase III studies are described and examined.

Results

Several phase II studies have shown a possible benefit for patients with recurrent disease, but the preliminary results of a phase III randomized trial did not demonstrate a survival advantage for HDC after three courses of standard-dose chemotherapy in the salvage therapy of patients in whom first-line treatment has failed. Three prospective, randomized trials are evaluating the role of HDC in a first-line setting.

Conclusions

New HDC strategies are emerging, involving new drugs (eg, paclitaxel), intensive induction regimens, and upfront and/or multiple courses of HDC. The evaluation of mature data of randomized trials will better define the role of HDC in this disease.
Palliative Care in Pancreatic Cancer
Authors: Brescia Frank J.
Published: August 2017

Background

Pancreatic cancer is a formidable health problem, representing the 10th most common malignancy in the United States and the 4th most common cause of all cancer deaths. The overall 5-year survival rate is 4%, making this disease a model tumor in which to address the specialized care issues of palliative medicine.

Methods

General considerations in both medical decision-making and symptom management are reviewed. Treatment of patients with locally unresectable, recurrent, or metastatic disease is individualized, based on considerations that include patient age, patient wishes, family influence, insurance constraints, and geographic practice variations.

Results

Success in managing progressive symptoms is needed to palliate patients with advanced pancreatic cancer. Common problems include biliary obstruction, depression, pain, intestinal obstruction, and fatigue.

Conclusions

Relief of pain and suffering associated with critical illness is required in managing patients with cancer. Pancreatic cancer is a model illness that mandates this need.
Current Status of Aromatase Inhibitors in the Management of Breast Cancer and Critique of the NCIC MA-17 Trial
Authors: Baum Michael
Published: August 2017

Background

The third-generation aromatase inhibitors reduce circulating estrogen levels in postmenopausal women and are well tolerated orally for breast cancer. Their role in the management of advanced breast cancer has already been recognized. This article reviews the evidence for their role in the adjuvant treatment of early-stage disease.

Methods

Three large multicenter trials are reviewed. The ATAC trial compared anastrozole and tamoxifen or a combination of the two, for 5 years from the point of diagnosis. The NCIC trial published the results of letrozole compared with placebo after the completion of 5 years of tamoxifen. Most recently, the Intergroup Exemestane Study reported a comparison of 5 years of tamoxifen vs 2 years of tamoxifen followed by 3 years of exemestane.

Results

The aromatase inhibitor arm in each of these studies was associated with improved disease-free survival and good tolerability. Because of the three different settings, cross-trial comparisons of the different aromatase inhibitors are impossible, but in each case the novel therapy appears promising.

Conclusions

This review is critical of the early stopping of the NCIC study and recommends more mature follow-up in each case until distant disease-free or overall survival rates can be measured and then correlated with adverse events. The late onset of osteoporotic fractures is a concern that must be addressed before tamoxifen can be abandoned in favor of the aromatase inhibitor in each of the three clinical points: at diagnosis, at midway through a course of tamoxifen, and as an extension to the conventional 5-year period of endocrine therapy.
Decreased Breast Cancer Tumor Size, Stage, and Mortality in Rhode Island: An Example of a Well-Screened Population
Authors: Coburn Natalie G. , Chung Maureen A. , Fulton John , Cady Blake
Published: August 2017

Background

Since the 1980s, Rhode Island has achieved one of the highest mammography screening rates in the nation. The objective of this study was to determine the effect of high mammography rates on breast cancer presentation and outcomes.

Methods

Using the Rhode Island Cancer Registry, the incidence of DCIS and invasive cancer, tumor size, stage, rate of BCS and mortality from breast cancer were determined from 1987 to 2001.

Results

Over 80% of Rhode Island women report routine mammography. From 1987 to 2001, there were 1,660 cases of DCIS and 11,301 cases of invasive breast cancer. Although the overall incidence of invasive cancer was stable, the median diameter decreased from 2 cm to 1.5 cm with a significant decrease in the incidence of stage III and IV cancers. There was an increase in BCS for women 50 to 64 years of age with stage I and II disease and for women older than 65 years with stage I disease. Disease-specific mortality decreased by 25%.

Conclusions

High mammography rates in Rhode Island are associated with smaller and earlier-stage breast cancers. This largely accounts for the decreased mortality from breast cancer and the increased rate of BCS.
Bladder Preservation Protocols in the Treatment of Muscle-Invasive Bladder Cancer
Authors: TorresRoca Javier F.
Published: August 2017

Background

Over the last 3 decades, we have seen a paradigm shift in our approach to the treatment of malignancy. During that time, organ conservation protocols have become standard in the treatment of breast cancer, laryngeal cancer, esophageal cancer, anal cancer and soft tissue sarcomas.

Methods

Data from reports of bladder preservation protocols were reviewed to evaluate organ preservation approaches in muscle-invasive bladder cancer.

Results

These trials have shown equivalent disease control rates when compared to radical surgery, with the advantage of organ function preservation. In spite of this, organ preservation efforts in muscle-invasive bladder cancer have lagged behind this overall trend in clinical oncology. However, efforts by several investigators over the last 2 decades have shown that for a number of selected patients with muscle-invasive bladder cancer, bladder preservation is feasible without an apparent compromise of overall survival.

Conclusions

Bladder preservation therapy with a trimodality approach for a carefully selected patient population is safe and effective. Formal randomized trials comparing radical cystectomy and trimodality bladder-sparing therapy are justified.
Management of Androgen-Independent Prostate Cancer
Authors: Diaz Michael , Patterson Stephen G.
Published: August 2017

Background

Although androgen withdrawal can control prostate cancer for long periods in many patients, controversy exists regarding management when the tumor becomes androgen independent. Several options are now available.

Methods

A review of the pertinent literature of the last 20 years was conducted to provide guidance in defining and managing hormone-refractory prostate cancer.

Results

Stage D prostate cancer can be subclassified to correlate tumor biology with disease stage. Secondary hormone manipulations may induce responses in patients after failure of initial androgen suppression, and chemotherapy with docetaxel has prolonged survival in patients with androgen-independent prostate cancer (AIPC). The weight of evidence supports the maintenance of castrate levels of testosterone in metastatic AIPC. Bisphosphonates decrease skeletal complications.

Conclusions

Secondary hormone therapy, chemotherapy, and bisphosphonate therapy may provide benefits for selected patients. Correlation of disease stage with biologic characteristics of the tumor and host facilitates proper choices of interventions. Docetaxel-based chemotherapy regimens should be considered for first-line treatment of patients with progressive metastatic AIPC.
Imaging Gastrointestinal Stromal Tumors
Authors: Hersh Marla R. , Choi Junsung , Garrett Chris , Clark Robert
Published: August 2017

Background:

Because of the recent reclassification of mesenchymal tumors, which was based on a better understanding of the genetics and immunophenotype of gastrointestinal stromal tumors (GISTs), only a limited number of studies have described the radiologic appearance of GISTs.

Methods:

This study reviews the imaging characteristics of GISTs, with an emphasis on differentiating benign and malignant tumors using positron emission tomography (PET), computed tomography (CT), and magnetic resonance imaging (MRI). We reviewed the data from 53 cases of GISTs treated at our institute. The imaging studies from these cases, which were recorded at our institute from January 1998 through June 2003, included PET, CT, and MRI.

Results:

Of the 53 GIST cases, stomach and small bowel tumors accounted for 80% of the tumors. Malignant lesions were larger and more heterogeneous, had ulcerations, and were PET positive. Peritoneal and liver metastases were most common.

Conclusions:

PET, CT, and MRI appear to be useful in differentiating nonmetastasizing from malignant GISTs.
Acculturation and Mammography Screening among Hispanic Women Living in Farmworker Communities
Authors: Palmer Richard C. , Fernandez Maria E. , Tortolero-Luna Guillermo , Gonzales Alicia , Mullen Patricia Dolan
Published: August 2017

The relationship between acculturation and mammography screening practices among Hispanic women is unclear due to inconsistent study findings. The purpose of this research was to further investigate the effect of acculturation on mammography screening practices among Hispanic women and to explore the effect of biculturalism on mammography screening. Hispanic female farmworkers (N = 716) who were 50 years of age and older living in communities in Texas, New Mexico, and California were interviewed at their homes. Data collection was conducted from November 2001 to February 2002. Logistic regression models showed no significant effect for acculturation for the entire sample. Post hoc stratified analysis found that bicultural study participants in California were 3 times more likely to be adherent to screening compared to those with low acculturation. Study findings suggest that distinct differences might exist for Hispanic women living in farmworker communities in California, and perhaps other communities not on the United States-Mexico border. Women in such communities with low levels of acculturation can be targeted for interventions to increase mammography adherence.
A Comparison of Two Native American Navigator Formats: Face-to-Face and Telephone
Authors: Dignan Mark B. , Burhansstipanov Linda , Hariton Judy , Harj Lisa , Rattler Terri , Lee Rose , Mason Mondi
Published: August 2017

The study was designed to test the relative effectiveness of a Navigator intervention delivered face-to-face or by telephone to urban Native American women. The effectiveness of the intervention was evaluated using a design that included a pretest, random assignment to face-to-face or telephone group, and posttest. The Social Cognitive Theory- based intervention was a tailored education program developed to address individual risk factors for breast cancer. At posttest, self-reported mammograms in the past year increased from 29% to 41.3% in the telephone group and from 34.4% to 45.2% in the face-to-face group. There was no difference in change from pretest to posttest between the telephone and face-to-face groups. Navigators can be effective in increasing adherence to recommendations for screening mammography among urban American Indian women.
A Culturally Targeted Intervention to Promote Breast Cancer Screening among Low-Income Women in East Baltimore, Maryland
Authors: Garza Mary A. , Luan Jingyu , Blinka Marcela , Farabee-Lewis Reverend Iris , Neuhaus Charlotte E. , Zabora James R. , Ford Jean G.
Published: August 2017

In Maryland, outreach initiatives have been unsuccessful in engaging low-income African American women in mammography screening. This study aimed to identify factors influencing screening rates for low-income African American women. Based on the Health Belief Model, a modified time series design was used to implement a culturally targeted intervention to promote a no-cost mammography-screening program. Data were collected from women 40 years of age and older on their history of mammography use and their knowledge and beliefs about breast cancer. A 50% screening rate was achieved among 119 eligible participants. Significant predictors of screening behaviors were perceived barriers, lack of insurance, and limited knowledge. This culturally targeted intervention resulted in an unprecedented screening rate among low-income African American women in Baltimore, Maryland.
Cervical Cancer Educational Pamphlets: Do They Miss the Mark for Mexican Immigrant Women's Needs?
Authors: Hunter Jennifer L.
Published: August 2017

The rate of invasive cervical cancer in US Hispanic women is nearly doubled that of non-Hispanics. Using in-depth interviews and content/grade level analysis of educational materials, this study explores the relevance of cervical cancer education materials to the needs of Mexican immigrant women. It also addresses health literacy issues that create barriers to learning. Findings show aspects of language, content, reading level, structure, and visual images in 22 cervical cancer pamphlets from 11 health care sites in a Midwest city were not relevant to the learning needs or health literacy levels of local Mexican immigrant women. Further research is recommended to establish an evidence base regarding optimal presentation of key elements of the cervical cancer educational message for Mexican immigrant women.
Race/Ethnicity, Smoking Status, and Self-Generated Expected Outcomes from Smoking among Adolescents
Authors: Vidrine Jennifer Irvin , Anderson Cheryl B. , Poliak Kathryn I. , Wetter David W.
Published: August 2017

Racial/ethnic differences in adolescent smoking suggest that different factors may motivate smoking among various racial/ethnic groups. This study examined relations among race/ethnicity, self-generated smoking outcome expectancies, and smoking status. Our findings noted that current smoking was highest among Hispanics, whereas African Americans and Asians were least likely to ever smoke. African Americans were most likely to experiment but least likely to smoke currently. Five expectancies differed significantly by race/ethnicity: reduce tension, image, negative aesthetics, addiction, and cost. However, none were significant mediators or moderators. Racial/ethnic groups most susceptible to smoking initiation and with the highest rates of current smoking should be targeted for prevention and cessation. Research is needed to examine more thoroughly racial/ethnic differences in expectancies.
A Review of Breast, Cervical, and Colorectal Cancer Screening Interventions in Older Women
Authors: Bowie Janice V. , Curbow Barbara A. , Garza Mary A. , Dreyling Erin K. , Scott Lisa A. Benz , Mcdonnell Karen A.
Published: August 2017

Although cancer-screening guidelines recommend periodic testing for women 50 years of age and older, these tests are underused. A search of databases identified 156 community-based breast, cervical, and colorectal cancer screening intervention studies published before April 2003. Most were conducted in the United States. More than half used randomization procedures or pre-post measures, and one third used both. Most reported significant intervention effects. Cervical and combined cervical and breast studies had higher rates of pre-post designs, and breast studies had the highest percentage using randomization. Although effective community-based breast and cervical interventions have been conducted, there is an urgent need for amplification of colorectal cancer screening.
Laparoscopic Surgery in Urologic Oncology
Authors: Rodriguez Alejandro , Pow-Sang Julio M.
Published: August 2017

Background

Techniques in genitourinary oncologic surgery have evolved over the past several years, shifting from traditional open approaches toward minimally invasive routes by laparoscopy.

Methods

We reviewed the literature on laparoscopic surgery for genitourinary cancer, with emphasis on contemporary indications, complications, and oncologic outcome of laparoscopic surgery for urologic malignancies.

Results

All urologic oncology procedures have been performed laparoscopically. Laparoscopic radical nephrectomy is becoming the preferred approach for managing kidney cancer. The initial experience with nephroureterectomy is encouraging. Laparoscopic radical prostatectomy is rapidly becoming the standard in Europe and is the procedure of choice in many centers in the United States.

Conclusions

When following the open oncologic principles for the surgical treatment of malignancies, laparoscopy offers similar oncologic clinical outcomes, less morbidity, improved operative precision, and reduced convalescence time.
Overall and Progression-Free Survival in Metastatic Melanoma: Analysis of a Single-Institution Database
Authors: Khan M. Aleem , Andrews Stephanie , Ismail-Khan Roohi , Munster Pamela N. , Brem Steven , King Jeff , Reintgen Douglas S. , Sondak Vernon K. , Daud Adil I.
Published: August 2017

Background

Many new agents are currently in trial in melanoma. It remains unclear, however, what the benefit of a given therapy may be since information on progression-free and overall survival of untreated patients is limited. Since few trials in melanoma have had a non-treated cohort, it remains unclear what survival can be expected in patients who are not treated with chemotherapy.

Methods

To help develop parameters for future trials, we analyzed treatment history and survival in 212 patients with metastatic melanoma seen at our institution between January 1998 and September 2003. A retrospective analysis was done using a database created for melanoma patients at our center. Patient survival information was determined from this database, tumor registry, Social Security index, and direct patient calls. Patient staging information was determined according to the 2001 guidelines. Non–chemotherapy-treated patients with M1c disease were used as “controls.”

Results

The median survival of stage M1c melanoma was 6.0 months. Survival was longer for stage M1a and M1b and shorter in older patients. No significant differences were found in survival based on gender. Among chemotherapy-treated patients, those with progressive disease on treatment or with increased lactate dehydrogenase (LDH) fared worse than those with a clinical response or normal LDH, respectively. Patients treated with either biochemotherapy or temozolomide and thalidomide survived longer than those who received no chemotherapy treatment. Dacarbazine (DTIC) treatment did not prolong survival.

Conclusions

In this retrospective review of patients treated at a single institution, those treated with multiagent chemotherapy but not with single-agent DTIC appeared to have had a survival benefit.
Biology of Aging and Cancer
Authors: Anisimov Vladimir N.
Published: August 2017

Background

The incidence of cancer increases with age in both humans and laboratory animals. A clear understanding of the causes of the age-related increase in cancer incidence is needed to develop a strategy for primary cancer prevention.

Methods

We summarized the data available in the literature and our own experience in hormonal metabolic shifts in organisms and disturbances at tissue and cellular levels observed in natural aging and in different types of carcinogenesis in vivo.

Results

There are incongruent patterns of age-related distribution of tumors in different organs and tissues. Aging may increase or decrease the susceptibility of various tissues to initiation of carcinogenesis and usually facilitates promotion and progression of carcinogenesis. Aging may predispose to cancer by at least two mechanisms: tissue accumulation of cells in late stages of carcinogenesis and alterations in internal homeostasis, in particular, alterations in immune and endocrine system. Increased susceptibility to the effects of tumor promoters is found in both aged animals and aged humans, as predicted by the multistage model of carcinogenesis.

Conclusions

Aging is associated with a number of events at the molecular, cellular and physiologic levels that influence carcinogenesis and subsequent cancer growth. A clearer understanding of these events will help in predicting and treating cancer more effectively.
Pharmacokinetics of Chemotherapy in the Older Patient
Authors: Hurria Arti , Lichtman Stuart M.
Published: August 2017

Background

The number of individuals aged 65 years and older is growing rapidly, and the majority of cancers are diagnosed in this age group. Age-related changes in physiology can affect chemotherapy pharmacokinetics and pharmacodynamics in older patients.

Methods

We review the literature regarding the impact of age on the pharmacokinetics of commonly used chemotherapy drugs and discuss age-related changes in physiology and pharmacology that can affect chemotherapy tolerance in older patients.

Results

The data on age-related changes in chemotherapy pharmacokinetics are conflicting. While a few studies report age-related differences in chemotherapy pharmacokinetics, most found no significant difference or subtle differences in pharmacokinetics with aging. A difference in pharmacodynamics was commonly seen, however, with older patients at increased risk of myelosuppression and toxicity from age-related decline in organ function. The majority of these studies were performed in a small cohort of patients, thus limiting the generalizability of these results.

Conclusions

Additional studies are needed to address the pharmacokinetics and pharmacodynamics of cancer therapies in the older patient. Multicenter pharmacokinetic studies of adequate sample size, which include a thorough evaluation of physiologic factors and geriatric assessment parameters, would provide further insight into the factors affecting treatment tolerance. These studies would also help to guide appropriate chemotherapy dosing and interventions in order to maximize efficacy and minimize toxicity in the older patient.
Adjuvant Chemotherapy in Elderly Patients with NonSmall-Cell Lung Cancer
Authors: Gridelli Cesare , Maione Paolo , Comunale Daniela , Rossi Antonio
Published: August 2017

Background

More than two thirds of patients who die of lung cancer in the United States are over 65 years of age. More than 50% of lung cancer patients are diagnosed over the age of 65 and about 30% over the age of 70.

Methods

The authors review recent data from large randomized trials on adjuvant chemotherapy in patients with NSCLC. They discuss age-related changes in organ function, comorbidities and frailty in the elderly, and chemotherapy treatment in elderly patients with NSCLC.

Results

Randomized trials suggest that postoperative chemotherapy improves survival after surgery in patients with stage IB to IIIA NSCLC, and awareness of the efficacy of this approach is growing in the scientific community. Clinical data obtained in the young population cannot be automatically adopted in the elderly counterpart. Elderly patients tolerate chemotherapy poorly because of comorbidity and organ failure, and after lung surgery they are considered at higher risk of chemotherapy-induced toxicity. The survival benefit obtained with platin-based chemotherapy may vanish or decrease in the elderly due to a potential higher toxic death rate or lower compliance to treatment.

Conclusions

Modified schedules or attenuated dose of platin-containing chemotherapy should be investigated in the adjuvant setting by specifically designed trials. Specifically designed prospective trials are needed to elucidate the role of this approach in the elderly.
Use of Adjuvant Systemic Therapy for Early Breast Cancer among Women 65 Years of Age and Older
Authors: Balasubramanian Bijal A. , Gandhi Sampada K. , Demissie Kitaw , August David A. , Kohler Betsy , Osinubi Omowunmi Y. , Rhoads George G.
Published: August 2017

Background

The National Institutes of Health (NIH) consensus statement recommends adjuvant therapy for early breast cancer irrespective of age. However, the actual use of such therapy is not well documented among women over 65 years of age.

Methods

We studied the frequency of use of adjuvant therapy and report the receipt of this therapy among 200 women aged ≥65 years diagnosed with early breast cancer who were identified from the New Jersey State Cancer Registry.

Results

In this population, 28% of patients received chemotherapy alone or in combination with hormonal therapy, whereas 42% received hormonal therapy alone. Less than half of the women with estrogen receptor-negative tumors received chemotherapy alone or in combination with hormonal treatment. Adjuvant therapy was not prescribed in 30% of patients.

Conclusions

Despite NIH recommendations, the frequency of use of adjuvant therapy in New Jersey is low among women over 65 years of age, regardless of their receptor status.
Diseases of Large Granular Lymphocytes
Authors: Alekshun Todd J. , Sokol Lubomir
Published: August 2017

Background

Clonal diseases of large granular lymphocytes (LGLs) are rare lymphoproliferative malignancies that arise from either mature T-cell (CD3+) or natural killer (NK)-cell (CD3-) lineages. They manifest a distinct biologic behavior that ranges from indolent to very aggressive.

Methods

We discuss four distinct diseases involving LGLs: indolent T-cell LGL leukemia, aggressive T-cell LGL leukemia, chronic NK-cell leukemia, and aggressive NK-cell leukemia. Furthermore, we present an up-to-date systematic review of therapies for each entity.

Results

Sustained LGLs, characteristic immunophenotype, clonal origin of leukemic cells, and clinical presentation are the most important features that distinguish indolent from aggressive subtypes of LGL leukemia and guide the selection of therapy. Patients with symptomatic indolent T-cell or NK-cell LGL leukemia are usually treated with immunosuppressive therapies in contrast to aggressive T-cell and NK-cell LGL leukemia, which require intensive chemotherapy induction regimens. Novel targeted therapies using monoclonal antibodies against receptors, including CD2, CD52, the β subunit of the interleukin-2 receptor, and small molecules such as tipifarnib, are undergoing evaluation in clinical trials.

Conclusions

Future scientific advances focusing on the delineation of molecular pathogenic mechanisms and the development of new targeted therapies for each distinct LGL leukemia entity should lead to improved outcomes of patients with these disorders.
The Diagnosis, Management, and Role of Hematopoietic Stem Cell Transplantation in Aggressive Peripheral T-Cell Neoplasms
Authors: Rezania Dorna , Cualing Hernani D. , Ayala Ernesto
Published: August 2017

Background

Peripheral T-cell neoplasms (PTCNs) comprise a group of uncommon and heterogeneous lymphoid malignancies. They are more difficult to diagnose and treat and have a worse prognosis than B-cell lymphomas. Although PTCNs initially show a significant degree of chemosensitivity, the outcome of treatment with conventional dose chemotherapy remains poor.

Methods

We reviewed the literature on the diagnosis, treatment, and collective transplant reports regarding PTCNs.

Results

The correct diagnosis of peripheral T-cell lymphoma requires a combination of clinical presentation, morphology, immunophenotype, and molecular study. While no specific treatment other than conventional dose chemotherapy is currently available for aggressive PTCN, histone acetylase inhibitors and monoclonal antibodies such as anti-CD7 and anti-CD52 are being studied in T-cell malignancies. The role of autologous and allogeneic transplantation is being investigated for high-risk, relapsed, and refractory PTCNs with some promising results.

Conclusions

Access to hematopathology expertise in a tertiary care setting may lead to earlier and more accurate diagnoses of these diseases. PTCNs comprise a heterogeneous group of diseases with no widely accepted standard of care, and accurate determination of their histologic subtypes correlates with prognosis. Patients in first complete remission with poor risk features and patients with relapsed and refractory disease should be considered for bone marrow transplant due to the poor outcomes obtained with conventional chemotherapy.
Physician and Staff Perceptions of Barriers to Colorectal Cancer Screening in Appalachian Kentucky
Authors: Kelly Kimberly M. , Phillips Clarenda M. , Jenkins Crystal , Norling Gretchen , White Carol , Jenkins Todd , Armstrong Debra , Petrik Joe , Steinkuhl Amy , Washington Regina , Dignan Mark
Published: August 2017

Background

Data indicate that in 1997 to 1999, only 44% of Appalachian Kentuckians underwent colorectal cancer screening consistent with guidelines. We investigated the reasons for, barriers to, and follow-up of colorectal cancer (CRC) screening recommendations in primary care practices seeing patients from Appalachian Kentucky.

Methods

A mixed-methods [qualitative (focus group) and quantitative (survey)] approach was used to gather and analyze data in five primary care practices. A total of 34 participated in the focus groups.

Results

In focus groups, physicians and office staff reported a number of indicators for CRC screening; physician, patient, and procedural barriers to CRC screening; and strategies to overcome these barriers to screening. Most physicians used personal experience to guide screening, but it was unclear what was meant by personal experience. Commonly cited patient barriers to screening were fear and embarrassment. Physicians reported several approaches to overcome these barriers, including establishing trust and educating patients. Survey data identified a number of resources to assist practices in promoting screening, most commonly, patient educational materials. Finally, fecal occult blood test was most commonly recommended because it is inexpensive and easy to administer.

Conclusions

Our mixed methods approach not only helped to understand the physicians’ perceptions of the problems and barriers to CRC screening in Appalachian Kentucky, but also elucidated how practices endeavor to overcome these barriers and identified the additional resources practices would like in order to promote CRC screening.
Caregiver Role Stress: When Families Become Providers
Authors: Teschendorf Bonnie , Schwartz Carolyn , Ferrans Carol Estwing , O'mara Ann , Novotny Paul , Sloan Jeff
Published: August 2017

Background

In view of the large number of families engaged in caregiving, this study was initiated to describe informal cancer care provision from the perspective of the caregiver.

Methods

A professional data collection site was used to convene focus groups in four cities. Participants included 63 caregivers, 87% of whom were female, mean age of 56 years. Caregivers responded to an open-ended question regarding the challenges of providing care. The study utilized qualitative analysis of verbatim transcripts. Transcript coding with four independent raters, using an iterative process, achieved a high inter-rater reliability.

Results

The project elucidates self-reported concerns confronted in cancer caregiving. Five primary themes emerged: supportive care demands, emotional toll, impact on health status, coping strategies, and rewards and affirmation. Providing supportive care introduced a balancing act in caregivers’ lives as they attempted to address complex and overlapping roles. They felt alone in their decisions, were under-prepared for tasks they assumed, and tried to shield the care recipient.

Conclusions

This qualitative approach confirmed past research while identifying novel concepts related to maintaining well-being and a sense of purpose despite caregiving hardships. Some aspects of caregiver suffering were identified. Caregiver self-regulation strategies revealed by this work suggest ideas for psychosocial interventions caregivers could use to protect themselves and the care recipient from impending distress.
Educational Intervention for Women Undergoing Image-Guided Breast Biopsy: Results of a Randomized Clinical Trial
Authors: Walker Mark S. , Farria Dione , Schmidt Maria , Monsees Barbara , Wiele Kim , Bokern Jill , Swatske Mary Ellen
Published: August 2017

Background

The process of informed consent has been examined for patients undergoing various procedures but not breast biopsy. Our study was a randomized trial that examined the effect of an educational flip chart as part of the informed consent.

Methods

A total of 122 patients referred for stereotactic or ultrasound-guided core breast biopsy were randomly assigned to receive an informed consent discussion with or without an illustrated flip chart. The chart included information about breast anatomy, pathology, and diagnostic procedures. Outcome measures included objective knowledge, subjective knowledge, anxiety, and satisfaction.

Results

Analysis showed few significant main effects of the intervention. However, results showed interactions between experimental condition and race/ethnicity, indicating that the intervention was effective in enhancing objective and subjective knowledge for African American but not Caucasian patients. Anxiety after consultation was higher among patients assigned to the flip chart condition, possibly because they were better informed about the risks of the procedure. Patients who underwent biopsy sooner after learning they needed one were more satisfied with their care.

Conclusions

The usual care consent process is effective for many but not all patients. Informed consent that employs visual aids may help overcome characteristics of the consent process that are ineffective for some patients.
The Impact of Education and Literacy Levels on Cancer Screening among Older Latin American and Caribbean Adults
Authors: Reyes-Ortiz Carlos A. , Camacho Maria E. , Amador Luis F. , Velez Luis F. , Ottenbacher Kenneth J. , Markides Kyriakos S.
Published: August 2017

Background

There is limited information related to the effects of education and literacy on cancer screening practices among older adults in Latin American and Caribbean countries.

Methods

To determine the association between education and cancer screening use, we developed a cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study. The sample included 4,183 men and 6,708 women aged 60 years and older from seven cities. The outcomes are mammogram and Pap smear use in women and prostate examination use in men within the last 2 years.

Results

In general, illiterate or lower-educated older men and women have the lowest rates of cancer screening use compared with higher-educated counterparts. Multivariate logistic models, by city and in a combined sample of six cities showed that high education is associated with higher odds of having a mammogram or a Pap smear in women and a prostate examination in men.

Conclusions

Older adults with low educational or literacy levels should be targeted for screening programs in these populations.
Spinal Radiosurgery for Metastatic Disease of the Spine
Authors: Finn Michael A. , Vrionis Frank D. , Schmidt Meic H.
Published: August 2017

Background

Metastatic tumor in the spinal column is common, causing symptomatic spinal cord compression in approximately 25,000 patients annually. Although surgical treatment of spinal metastases has become safer, less invasive, and more efficacious in recent years, there remains a subset of patients for whom other treatment modalities are needed. Stereotactic radiosurgery, which has long been used in the treatment of intracranial lesions, has recently been applied to the spine and enables the effective treatment of metastatic lesions.

Methods

We review the evolution of stereotactic radiosurgery and its applications in the spine, including a description of two commercially available systems.

Results

Although a relatively new technique, the use of stereotactic radiosurgery in the spine has advanced rapidly in the past decade. Spinal stereotactic radiosurgery is an effective and safe modality for the treatment of spinal metastatic disease.

Conclusions

Future challenges involve the refinement of noninvasive fiducial tracking systems and the discernment of optimal doses needed to treat various lesions. Additionally, dose-tolerance limits of normal structures need to be further developed. Increased experience will likely make stereotactic radiosurgery of the spine an important treatment modality for a variety of metastatic lesions.
Cultural Values and Secondary Prevention of Breast Cancer in African American Women
Authors: Beckjord Ellen Burke , Klassen Ann C.
Published: August 2017

Background

Improving mammography initiation and maintenance among African American women has been suggested as a strategy for reducing breast cancer mortality in this population.

Methods

We examined cultural values in relation to self-reported breast cancer screening among 572 low-income, urban, African American women. Cultural values examined included time orientation, family authority, employment aspirations, value of past vs modern life, and reliance on medical professionals. Also, implications for continued development of culturally tailored health interventions and opportunities for the consideration of cultural values in health communication are discussed.

Results

Bivariate analyses showed that more traditional values were associated with worse screening histories and lower intentions for future screening. In multivariate analyses, two interactions were observed between cultural values and age: for younger women, more traditional values were associated with lower odds of having ever received a mammogram, and for older women, more traditional values were associated with lower odds of intentions to receive a mammogram in the next 2 years.

Conclusions

This study adds to the evidence that cultural constructs, such as values, are associated with secondary prevention of breast cancer and supports the consideration of cultural constructs as important in increasing mammography and reducing breast cancer disparities for African American women.
Transcatheter Arterial Chemoembolization and Percutaneous Ethanol Injection for Hepatocellular Carcinoma: A Retrospective Review of the Veterans Affairs Caribbean Healthcare System
Authors: Narvaez-Lugo Jessica , Cáaceres William W. , Toro Doris H. , Péarez-Gonzáalez Manuel R. , Almodovar Alvin A. , Maldonado-Mercado Awilda M. , Salgado Norma , Rivera-Sanfeliz Gerant M.
Published: August 2017

Background

Hepatocellular carcinoma (HCC) is a common malignancy worldwide and has a poor prognosis. Although surgery and liver transplantation provide better outcomes, most patients are not candidates due to advanced disease, lack of donor availability, or presence of comorbidities. Several percutaneous approaches such as transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection therapy (PEIT) have been developed for local control and can potentially increase survival in these patients.

Methods

We retrospectively reviewed 33 patients with HCC who were treated with TACE, PEIT, or both from 2000 to 2005 at the VA Caribbean Healthcare System in Puerto Rico to evaluate tolerability, response, and survival. Patients were evaluated with cross-sectional computed tomography imaging to determine response using response evaluation criteria in solid tumors (RECIST).

Results

Thirty-three men with a mean age of 66 years were treated. Mean tumor size was 5.6 cm, ranging from 2 cm to 16 cm. All patients had cirrhosis, with alcohol abuse and hepatitis C as the most common etiologies. Objective radiographic partial response was observed in 28% of patients and 48% had disease stabilization. Most of the patients had a therapeutic response demonstrated by necrosis of the tumor and decreased contrast enhancement. Patients who underwent both TACE and PEIT had a higher response rate and disease stabilization but no difference in survival compared with those who received TACE or PEIT alone. Median survival for the whole group was 2 years. Causes of death included tumor progression, hepatic failure, gastrointestinal bleeding, and infections. The initial tumor size and Child-Pugh class did not confer a significant difference in survival rate.

Conclusions

In Puerto Rico, where liver transplantation is not performed at present, percutaneous treatments are effective local therapies for patients who are not candidates for surgery and who have disease limited to the liver.
Radiation Therapy as Primary and Adjuvant Treatment for Local and Regional Melanoma
Authors: Berk Lawrence B.
Published: August 2017

Background

The role of radiation therapy as primary and adjuvant therapy for localized or locally advanced melanoma is controversial.

Methods

To develop evidence-based guidelines, PubMed was searched using the keywords melanoma AND (radiation OR radiotherapy). These references were reviewed and the relevant articles selected. The articles were then reviewed for further references. Because of the paucity of prospective or randomized trials, no attempt was made to classify the quality of the results.

Results

No phase III trials of nodal irradiation for prevention of regional recurrence are available. A phase III trial is being completed by the Tasman Radiation Oncology Group. A phase II trial has been completed by the group. Multiple retrospective series have been published. The available data appear to confirm that nodal radiation therapy is effective in preventing nodal recurrence. No dose response or fraction size response was found. According to generally accepted guidelines, radiation therapy should be offered for patients who have nodes greater than 3 cm, more than 3 involved nodes, or extracapsular extension. For radiation therapy for the treatment of metastatic disease, a phase III trial showed that 50 Gy in 2.5-Gy fractions was as effective as 32 Gy in 8-Gy fractions, with 25% complete remission and 35% partial remission. In contrast, the retrospective studies support that larger fraction sizes, at least 4 Gy, are more effective.

Conclusions

Adjuvant nodal irradiation appears to be effective for the prevention of nodal recurrence. Radiation therapy can also be effective for treatment of local disease, if surgery is not an option.
Establishing a Patient Navigator Program to Reduce Cancer Disparities in the American Indian Communities of Western South Dakota: Initial Observations and Results
Authors: Petereit Daniel G. , Molloy Kevin , Reiner Mary L. , Helbig Petra , Cina Kristin , Miner Raylene , Tail Caroline Spotted , Rost Catherine , Conroy Patricia , Roberts Chester R.
Published: August 2017

Background

American Indians (AIs) in the Northern Plains region suffer disproportionately high cancer mortality rates compared with the general US population and with AIs from other regions in the United States.

Methods

The National Cancer Institute developed the Cancer Disparity Research Partnership to address these inequities. This initiative in Rapid City, South Dakota, attempts to lower cancer mortality rates for AIs by access to innovative clinical trials, behavioral research, and a genetic study. Patient navigation is a critical part of the program. Two navigation strategies are described: navigators at the cancer center and navigators on each reservation. A retrospective analysis was performed to determine if navigated patients (n = 42) undergoing potentially curative radiotherapy had fewer treatment interruptions compared with nonnavigated patients (n = 74).

Results

A total of 213 AIs with cancer have undergone patient navigation. For those undergoing cancer treatment, the median number of patient navigation interactions was 15 (range 1 to 95), whereas for those seen in follow-up after their cancer treatment, the median number of contacts was 4 (range 1 to 26). AIs who received navigation services during curative radiation treatment had on average 3 fewer days of treatment interruptions compared to AIs who did not receive navigation services during curative radiation treatment (P = .002, N = 116).

Conclusions

Early findings suggest that patient navigation is a critical component in addressing cancer disparities in this population. The program has established trust with individual cancer patients, with the tribal councils, and with the general population on each of the three reservations of western South Dakota.
The Role of Comprehensive Surgical Staging in Patients with Endometrial Cancer
Authors: Frederick Peter J. , Straughn J. Michael
Published: August 2017

Background

The cornerstone of the management of patients with endometrial cancer is hysterectomy. Since 1988, the role of lymphadenectomy for patients with endometrial cancer has been debated. Patients who undergo pelvic and para-aortic lymphadenectomy are more likely to be accurately staged and are less likely to receive adjuvant radiation therapy.

Methods

The authors perform a narrative review of the recent literature. Overall survival, utilization of radiation therapy, impact on quality of life, and alternative approaches to surgical staging are discussed.

Results

Although a survival benefit from comprehensive surgical staging has not been clearly demonstrated in patients diagnosed with endometrial cancer, surgical staging allows one to determine the need for adjuvant therapy. Preoperative and intraoperative assessment of lymph node metastasis and tumor grade lacks accuracy. Unstaged patients are more likely to receive postoperative radiation therapy.

Conclusions

Comprehensive surgical staging with lymphadenectomy allows patients to be classified accurately into risk categories. Risk status can be definitively determined only with final pathology. Surgically staged patients are more likely to receive appropriate adjuvant therapy or observation when warranted.
Pediatric Melanoma: A Review
Authors: Mills Omie , Messina Jane L.
Published: August 2017

Background

Malignant mela-noma is a rare neoplasm in the pediatric population, but its incidence has risen in recent years.

Methods

The literature was reviewed to define the current clinical and pathologic features of pediatric melanoma, highlighting the similarities and differences between adult and pediatric melanoma.

Results

Distinctive features of this disease, including frequency and type of genetic abnormalities, predisposing conditions, clinical presentation, stage at diagnosis, prognostic features, and frequency of sentinel lymph node positivity are emphasized. Treatment strategies, extrapolated from adult mela-noma trials, are also discussed.

Conclusions

Despite the differences between pediatric and adult melanoma, survival rates are similar and are improving in both populations. Further studies will help delineate the pathogenesis of both adult and pediatric melanoma, with the goal of contributing to early detection and improved survival.