bluuebunny/crossref_metadata_2025 huggingface dataset:
Pre-diagnostic circulating sex hormone levels and risk of prostate cancer by TMPRSS2:ERG status.
Authors: Graff Rebecca E , Meisner Allison , Ahearn Thomas , Fiorentino Michelangelo , Sesso Howard D. , Giovannucci Edward L. , Mucci Lorelei A. , Pettersson Andreas
Published: February 2017

93

Background: Experimental studies have shown that androgen receptor stimulation can facilitate formation of the TMPRSS2:ERG gene fusion in prostate cell lines. No study has tested whether higher pre-diagnostic circulating sex hormone levels in men increase the risk of developing TMPRSS2:ERG positive prostate cancer specifically. Methods: We conducted a nested case-control study of 200 prostate cancer cases and 1,057 controls from the Physicians’ Health Study and Health Professionals Follow-up Study. We examined associations between pre-diagnostic circulating levels of total testosterone, free testosterone, DHT, androstanediol glucuronide, estradiol, and SHBG and risk of prostate cancer by TMPRSS2:ERG status. TMPRSS2:ERG was assessed by ERG immunohistochemistry. We used multivariable unconditional polytomous logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of fusion-positive (n = 94) and, separately, fusion-negative (n = 106) disease. Results: Free testosterone was significantly associated with the risk of ERG-positive prostate cancer (OR: 1.37, 95% CI: 1.05-1.77), but not ERG-negative prostate cancer (OR: 1.09, 95% CI: 0.86-1.38) (p-diff: 0.17). None of the remaining hormones evaluated showed clear differential associations with ERG-positive versus ERG-negative disease. Conclusions: These findings provide some suggestive evidence that higher pre-diagnostic free testosterone levels are associated with an increased risk of developing TMPRSS2:ERG positive prostate cancer but are not associated with prostate cancer that lacks TMPRSS2:ERG.
Copy number alterations of DNA mismatch repair (MMR) genes as novel prognostic markers in localised prostate cancer (CaP).
Authors: Chua Melvin , Lalonde Emilie , Mahamud Osman , Berlin Alejandro , Dal Pra Alan , Orain Michèle , Picard Valerie , Hovington Helene , Bergeron Alain , Fradet Yves , Têtu Bernard , Meng Alice , Zhang Junyan , Zafarana Gaetano , Livingstone Julie , Pintilie Melania , van der Kwast Theodorus , Fraser Michael , Boutros Paul , Bristow Robert G. ,   CPC-GENE
Published: February 2017

96

Background: To investigate the prognostic significance of CNA of genes involved in the MMR pathway in localised CaP. Methods: We studied CNA of genes involved in MMR, namely MSH2, MSH3, MSH6, MLH1, PMS2, in 284 patients with intermediate-risk CaP (Toronto cohort), and compared our findings against three public databases (MSKCC and Cambridge cohorts) that included 375 low- to high-risk CaP. The Toronto cohort comprised of 143 and 141 individuals who underwent image-guided radiotherapy (IGRT) and radical prostatectomy (RadP), respectively, while all patients from the public databases underwent RadP. Information on genome-wide copy number alterations (Toronto) was obtained using Affymetrix Oncoscan array. Biochemical relapse-free survival (bRFS) was assessed for clinical outcome. Results: CNA of MSH2, MSH3, MSH6, MLH1, PMS2 were observed in 3.9% (n = 11), 7.7% (n = 22), 3.9% (n = 11), 4.6% (n = 13) and 13.0% (n = 37) of the Toronto cohort, respectively. Distinct patterns of allelic gain and loss were observed for the gene set; gains only for MLH1 and PMS2, and losses only, in all but 1 case, for MSH2, MSH3 and MSH6. In the Toronto cohort, allelic losses of MSH2, MSH3 and MSH6 were determined to be prognostic for poorer bRFS in IGRT patients (HR 2.04, 95% CI 1.01, 4.12, p = 0.048), but not for patients who underwent RadP (HR 1.08, 95% CI 0.49, 2.39, p = 0.84); while gains in MLH1 and PMS2 were not prognostic in either IGRT or RadP patients. A pooled analysis of these genes for all RadP patients from the Toronto and public databases (n = 516) did however indicate that allelic losses of MSH2, MSH3 and MSH6 were significant predictors of poorer bRFS (HR 2.48, 95% CI 1.64-3.77, p < 0.001), but not MLH1 and PMS2 gains. On multi-variable modelling that includes percent genome aberration and pre-treatment PSA levels, allelic losses of MSH2, MSH3 and MSH6remained significant predictors of bRFS for the pooled RadP cohort (HR 1.96, 95% CI 1.27, 3.01, Wald's p < 0.001), but not for IGRT patients (HR 1.50, 95% CI 0.72, 3.12, p = 0.28). Conclusions: We identified a distinct pattern of copy number loss of MSH2, MSH3 and MSH6 genes in localised CaP that appears to be a novel biomarker of failure to definitive treatment.
Salvage image-guided radiotherapy to the prostate after cryotherapy failure.
Authors: Hopper Austin B , Einck John Paul , Sandhu Ajay Pal
Published: February 2017

e637

Background: Cryotherapy is used in increasing frequency for the primary treatment of localized prostate cancer. While it is known that local recurrence can occur in > 20% of patients treated with primary cryotherapy there is a paucity of data on salvage treatments after failure. The use of external beam radiation therapy is an attractive option after cryotherapy failure but there is little data on efficacy and toxicity. We evaluate our data on a group of patients treated with image-guided dose-escalated radiotherapy (IGRT) at our institution. Methods: An IRB-approved database of patients treated with IGRT for prostate cancer from 2005 to 2013 was used to identify patients who underwent primary cryotherapy followed by salvage IGRT. Patients’ EMR were reviewed for age, cryotherapy-to-salvage interval, pre/post-salvage PSA and Gleason score (GS). All patients were treated with dose-escalated IGRT using standard treatment margins of 3 mm posterior and 7 mm in all other directions and daily CBCT or kv imaging to implanted fiducial markers. Narrative notes were used to identify GU/GI toxicity and scored according to CTCAE v4.03. The Phoenix definition of nadir + 2 was used to determine disease control following RT. Results: 5 patients were identified within the study period as having received salvage RT after primary cryotherapy. Mean age at the time of salvage RT was 74 (range 65-80). Median cryotherapy-salvage interval was 49 months (range 25-97) and prior to RT patients had GS of 7 (n = 3) or 8 (n = 2) and mean PSA of 8.1 ng/mL (range 4.2-14.38). Median total dose and follow-up were 76.7 Gy (range 75.6 – 81.0) and 52 months (range 6-63). One patient’s PSA did not decline post-RT and developed metastases while four patients responded post-RT with one experiencing biochemical recurrence after 30 months. No patients had acute GU/GI toxicities grade 2 or higher; one experienced late grade 2 GU toxicity (dysuria) which resolved with medication. There were no late grade 3 toxicities. Conclusions: High-dose radiotherapy as salvage treatment after cryotherapy failure is tolerated without significant GU or GI toxicities. Additionally, salvage IGRT is a viable option for long-term biochemical control in cases of local recurrence and warrants additional study.
Oncologist and primary care physician attitudes and practices toward cancer survivor follow-up care in an integrated health system.
Authors: Balasubramanian Bijal A. , Jetelina Katelyn K , Lee Simon Craddock
Published: February 2017

105

Background: Previous research using nationally representative data showed significant differences between primary care physician (PCP) and oncologists’ attitudes and practices with respect to care of cancer survivors and called for more effective communication and coordination to improve care. This study compared PCP and oncologists’ attitudes and practices for follow-up cancer care within an integrated health system sharing a common electronic health record and clinical infrastructure to examine whether the integrated setting facilitated communication and coordination between PCPs and oncologists. Methods: 41 PCPs and 24 oncologists (response rate = 52%) affiliated with an integrated safety-net health system completed a validated survey. The survey assessed PCP and oncologists’ preferred models for delivering care, attitudes towards follow-up care, and cancer surveillance practices in this setting. Results: 41% of PCPs preferred an oncologist-led care delivery model as compared to 21% of oncologists. More PCPs than oncologists (73% vs 58%) agreed that PCPs have the skills necessary to initiate cancer surveillance. Yet, PCPs more often disagreed (56% vs 42% of oncologists) that they should have primary responsibility for providing cancer follow-up care. PCPs and oncologists differed significantly over cancer surveillance practices. Oncologists more consistently reported that PCPs ordered tests for cancer surveillance, evaluated patients for cancer recurrence and for adverse physical and psychological effects of cancer or its treatment, as well as managed pain and adverse outcomes of cancer treatment. PCPs, however, did not report equivalent ordering for these services. Conclusions: Even within an integrated health system, we found significant uncertainty as to who is responsible for care of cancer survivors. Oncologists more commonly assigned responsibility for cancer survivorship care to PCPs than PCPs recognized. This imbalance indicates many cancer survivors may not be receiving recommended care. Consensus guidelines are needed to delineate shared responsibilities for cancer survivors between primary care and oncology specialty care physicians.
Patterns of health care-related multimorbidity among breast cancer survivors.
Authors: McBride Mary L , Li Dongdong
Published: February 2017

115

Background: Breast cancer survivors may experience multiple health conditions, both pre-existing and related to the cancer and its treatment. The objective of this study is to evaluate the total burden of healthcare-related morbidity and multimorbidity among breast cancer survivors, in the first five years from diagnosis. Methods: A population-based cohort of 6,944 female five-year breast cancer survivors, diagnosed at 18 years or older from 2000-2003, was identified from the Cancer Registry of the province of British Columbia, Canada, and followed to end 2008. Subjects were linked to all their provincial healthcare records of hospitalizations and outpatient physician service claims, excluding oncology and emergency visits, from diagnosis to 5 years post-diagnosis. International Classification of Disease (ICD) diagnostic codes for “reason for service” were extracted, then assigned to one of 32 diagnosis groups (Aggregated Diagnosis Groups (ADGS)) of the Johns Hopkins Adjusted Clinical Group (ACG) System. The ACG system aggregates diagnoses with similar expected demand for healthcare, primarily based on level of severity and persistence of disease. ADG distributions were generated. Results: Only 380(5.5%) of the survivors were < 40 years old at diagnosis; 1670(24.1%) were > 70 years. The majority (5648(81.3%)) were Stage I or II. In the 5 year period from diagnosis, most patients had at least one type of morbidity, with 47% having 11-15 different types of morbidities. Over 90% of survivors had reports of major ( = very high expected healthcare resource use) signs or symptoms, 3258 (46.9%) survivors experienced major adverse effects/injuries, 3232 (46.5%) had unstable chronic medical conditions, and 2696 (38.8%) had major time-limited infections. Approximately 49.3% had stable or unstable psychosocial conditions. Conclusions: Breast cancer patients experience extensive multimorbidity within five years of diagnosis, with high expected healthcare utilization. These results highlight the importance of comprehensive multimorbidity assessment, with care recommendations, included in cancer survivorship care plans.
Progesterone to improve neurocognitive outcomes following cranial irradiation.
Authors: Okwan-Duodu Derick , Atif Fahim , Yu David S. , Yousuf Seema , Bruner Deborah , Curran Walter John , Stein Donald G
Published: February 2017

128

Background: Neurocognitive functional decline is a common sequalae of cranial irradiation (CI) that significantly impacts quality of life. Preclinical studies and randomized clinical trials show that following traumatic brain injury and cerebrovascular accidents, premenopausal women demonstrate decreased mortality and improved neurocognitive function, with these benefits presumed to be derived from progesterone. We hypothesized that progesterone may serve similar role in neuroprotection following cranial irradiation. Methods: Adult non-tumor bearing wild type C57BL/6 male mice were treated with two separate fractionated radiation therapy regimen (9 Gy and 15 Gy) to the brain. Cohorts of these mice were administered progesterone (16mg/kg daily) as a pretreatment for 3 days and concurrent with the radiotherapy for a total of 14 days with tapering during the last two days. The animals were then tested using different behavioral measures for cognitive function including morris water maze (MWM) for assessing spatial and related forms of learning and memory, elevated plus maze (EPM), , and spontaneous locomotor activity (SLA) tests. Mice were tested for cognitive function on day 10 and after 30 days of treatment for short and long-term effects of (CI) on memory function. Results: All irradiated mice showed statistically significant decline in MWM, EPM, and SLA measures. There were no significant differences in the 9 Gy versus 15 Gy cohorts. Progesterone administration produced a statistically significant group effect (F (4, 25) = 8.553; P<0.001) in the improvement of long-term memory function over 5 days of learning process. Progesterone administration also demonstrated a significant group effect (F (4, 25) = 8.613; P<0.001) in the probe trial, and a significant beneficial effect (F (4, 25)= 7.993; P<0.001) in short-term memory functional latency to reach the platform. Conclusions: The preclinical data show that progesterone improves radiation-induced deficits in short-and long-term memory functions in adult mice. Further work is required to show if progesterone may show similar clinical benefit in neuroprotection for adults undergoing prophylactic CI or definitive CI for brain metastases or benign intracranial processes such as AVM.
Falls and frailty in prostate cancer survivors on androgen deprivation therapy.
Authors: Moe Esther L , Borsch Carolyn , Garg Bharti , Dobek Jessica C , Doggett Rumen , Graff Julie Nicole , Beer Tomasz M. , Winters-Stone Kerri M
Published: February 2017

134

Background: Androgen deprivation therapy (ADT) treatment for prostate cancer is associated with muscle loss, weakness and weight gain that could lead to falls and frailty, but the prevalence of these conditions in prostate cancer survivors (PCS) is poorly understood. The aim of this study is to describe the prevalence of falls and frailty in PCS on ADT and their associations with modifying factors, such as age and timing of ADT. Methods: Health history, cancer treatment and falls were self-reported by 146 PCS on ADT (mean age: 74+8 years). ADT usage and current versus past usage was confirmed against electronic medical records. Frailty was determined by self-report to 5 questions asking about presence or absence of fatigue, weakness, mobility difficulty, comorbidities, and weight loss, which could represent sarcopenia. Presence of each condition was summed to categorize men into one of three frailty phenotypes: frail (3-5), pre-frail (1-2) or not frail (0) groups. Since fat gain, rather than weight loss, is common with ADT and can impact function we also recalculated frailty as an “obese frailty” phenotype substituting obesity (BMI > 30 kg/m2) for weight loss. Comparisons were performed using chi-square. Results: 38% of PCS on ADT experienced a fall in the past year and among fallers, 61% experienced a fall that resulted in an injury. Using the frailty phenotype, 29% of PCS were pre-frail and 10% were frail; however, using the obese frailty phenotype, 47% of PCS were pre-frail and 15% were frail. The absence of frailty was significantly less in older men than younger men using the frail (p = 0.013), but not obese frail phenotype (p = 0.54). Fall and frailty rates did not significantly differ between PCS who were current versus past users of ADT (p = 0.65 and 0.26 for falls and frailty, respectively). Conclusions: Regardless of the frailty phenotype used, the rate of falls and prevalence of frailty among PCS on ADT was greater than fall rate (25%) and the frailty prevalence (4%) reported in large community-based samples of similarly aged men. These data also suggest that falls and frailty may continue after men stop ADT use. Research to identify risk factors for falls and frailty in PCS on ADT is warranted so that effective interventions can be developed and tested.
Primary care nurse practitioners providing survivorship cancer care.
Authors: Rosenzweig Margaret Quinn , Klein Sara , Connolly Mary , Hoffmann Rose
Published: February 2017

14

Background: The Oncology Nurse Practitioner Web Education Resource (ONc-PoWER) is an online course developed specifically for nurse practitioners (NPs) in their first year of oncology practice paired with an onsite mentor (physician, nurse practitioner or physician assistant). Based on the Oncology Nursing Society’s Competencies for Entry to Practice, the course consists of 5 interactive modules: 1) the new patient visit 2) presenting a patient with cancer 3) cancer visits across the continuum of care 4) palliative and hospice care 5) self-care and professional development. The purpose of this study was to examine the NPs and mentors experience with the learning activities and to what degree the learning objectives were met. Methods: Dyads of NPs and mentors completed the course over 4-6 months. There are items for course evaluation with Likert scaled responses of 1) did not meet objective 2) somewhat met objective 3) met objective 4) more than met objective 5) exceeded objective expectation. Results: Enrollment is ongoing. Thirty NPs new to practice and 22 oncology mentors have completed evaluations thus far. Responses overall are favorable. Conclusions: The ONcPoWER web enhanced oncology orientation program was favorably evaluated by nurse practitioners new to cancer care and their mentors. This method of electronic orientation could standardize the exposure of essential basic cancer care competencies at entry to oncology nurse practitioner practice and, with some edits to content, for community based primary care nurse practitioners caring for cancer survivors. [Table: see text]
The increasing role of breast cancer lymphedema screening, diagnosis, and management as part of evidence-based breast cancer survivorship.
Authors: Shah Chirag , Vicini Frank A.
Published: February 2017

145

Background: With improved outcomes across all stages, breast cancer survivorship represents an increasingly significant oncologic issue. One major facet of breast cancer survivorship is assessment and management of sequelae of treatment including breast cancer related lymphedema (BCRL) which has an incidence of 5-40% depending on locoregional and systemic treatment. BCRL represents a complication associated with physical changes as well as reduction in quality of life and continues to increase in prevalence with new diagnostics (ex. L-Dex, perometry) increasing the sensitivity for detection. Methods: Review of current evidence based guidelines from the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), and the American Cancer Society. Results: Evidence based treatment guidelines for breast cancer have evolved in 2015. For the first time, the NCCN guidelines include a reference to BCRL as part of routine treatment stating “to educate, monitor, and refer for lymphedema management” represents a standard component of breast cancer treatment and survivorship and allows for the early diagnosis and treatment of BCRL. At this time, neither the ASCO Breast Cancer nor ASCO survivorship guidelines incorporate BCRL management into routine practice. At this time, BCRL management is not part of ACS survivorship protocols. Conclusions: At this time, due to increasing data on BCRL diagnosis and treatment, evidence based guidelines are beginning to incorporate BCRL education, diagnosis, and treatment into standard breast cancer management plans. With increasing focus on survivorship, prospective BCRL programs are being developed that begin evaluation prior to treatment with screening in place and early intervention to help prevent progression by using diagnostics with increased sensitivity (ex. L-Dex, perometry).
Fractures in association with breast and endometrial cancer survival in the Women’s Health Initiative.
Authors: Newcomb Polly A. , Adams Scott V. , Passarelli Michael N , Lane Dorothy , Li Wenjun , Chlebowski Rowan T. , Crandall Carolyn , Tinker Lesley
Published: February 2017

148

Background: Postmenopausal fracture rates appear to be an integrated marker of usual estrogen levels and have been associated with decreased risk of breast and endometrial cancer. The association between fractures and cancer mortality has been difficult to assess, as fractures are a consequence of both the pathological process and the treatment of cancer. Due to the reduced proliferative effects of the hormonal milieu, pre-diagnosis fractures may be a hallmark of decreased cancer mortality. Methods: We evaluated a cohort of breast (N = 6,458) and endometrial (N = 1,138) cancer cases who were diagnosed with cancer during the Women’s Health Initiative (WHI; 1992-2010). Fracture history was assessed by combining baseline reports of fractures prior to WHI and after age 50; with fractures ascertained during WHI follow-up, but prior to cancer diagnosis. We used Cox proportional hazards models based on time since cancer diagnosis to estimate hazard ratios (HR) with 95% confidence intervals for overall and cancer-specific mortality, comparing women with prior fractures to those without fractures. Clinical factors, including bisphosphonate and hormone use, were in the model. Results: Among breast cancer cases, during the average 6.2 years of follow-up, 1,464 had a prior fracture and 905 deaths occurred (415 due to breast cancer). Among endometrial cancer cases, during follow-up, 267 had a prior fracture and 192 deaths occurred (83 due to endometrial cancer). Any pre-diagnosis fracture was associated with increased all-cause mortality (breast HR: 1.39 (1.20, 1.62); endometrial HR: 1.41 (1.02, 1.95)). Among breast cancer cases, the strongest association was with hip fracture (HR: 2.76 (1.80, 4.25)). Associations with cancer-specific mortality were similar in direction and magnitude, but did not reach statistical significance. Conclusions: A history of pre-diagnostic fractures was associated with increased overall but not cancer-specific mortality. Fracture history may be indicative of frailty or other co-morbidities. Breast and endometrial cancer cases with a fracture history may benefit from concurrent supportive care to mediate risk of death due to co-morbid health conditions.
Development and evaluation of the TrueNTH-Prostate Cancer Canada electronic Library for Improved (urinary and bowel) Function post Treatment (TrueNTH-PCC-eLIFT).
Authors: Tangen-Steffins Kristin , Leong Nelson , Hodgson Sally , Wambolt Elizabeth , Hildebrand Catherine , Willie Chantalle , Siddiqui Khurram , Chan Garson , Leong Hon , Chin Joseph , Goulart Jennifer
Published: February 2017

161

Background: The TrueNTH program is a Movember-funded, pan Canadian effort to develop a comprehensive patient-centered online portal in English and French that will cover a full spectrum of prostate cancer survivor needs. Through the support of Prostate Cancer Canada, the TrueNTH-PCC-eLIFT resource, as part of the TrueNTH program, is being developed by a multi-disciplinary team of urologists, radiation oncologists, gastroenterologists, researchers, nurses and survivors at pilot sites in Victoria, BC and London, ON. eLIFT will address urinary and bowel side effects that may be experienced after curative intent treatment by External Beam Radiation Therapy (EBRT), Brachytherapy (BT), combined EBRT + BT or Radical Prostatectomy (RP). Methods: eLIFT includes a didactic electronic library, symptom assessment tool and content tailored to treatment or symptoms experienced. A sequential prospective cohort study is underway to evaluate the impact of the resource. A baseline cohort of eighty patients per site receiving standard of care is currently open. A second cohort of eighty patients per site will be accrued to receive the eLIFT intervention. The study measurespatient self-efficacy, knowledge, Health Related Quality of Life (HRQoL), urinary and bowel function, health resource usage and satisfaction. Results: eLIFT content, with a total of 22 video modules is complete and in production. Preliminary results from the first cohort of patients, receiving standard care, confirm a need for a reliable, online resource in Canada. Patients note that the oral information provided by their oncologist at their preliminary consultation, while informative, is not easily retained. Information that was provided as print varied and was often outdated. Further, patients deem websites outside of Canada as the most reliable and helpful, which may not reflect Canadian recommendations. Conclusions: eLIFT will provide a unique and scalable centralized resource that will allow for expansion to a National level and increase access to a scientifically-sound library of information with the goal of improving the quality of care for prostate cancer patients across Canada.
Financial toxicity in thyroid cancer: An analysis from the North American Thyroid Cancer Survivorship study.
Authors: De Souza Jonas A. , Grogan Raymon , Aschebrook-Kilfoy Brisa
Published: February 2017

17

Background: Financial toxicity (FTox) has been associated with worse health-related quality-of-life (HRQoL), compliance, and even survival in cancer patients (pts). Measuring FTox and understanding its predictors are of paramount importance when planning intervention strategies, the value of care, and healthcare policies. We report FTox and its predictors in a large cohort of thyroid cancer pts and survivors. Methods: Pts with thyroid cancer were surveyed in the North American Thyroid Cancer Survivorship Study. FTox was assessed by the previously validated COmprehensive Score for financial Toxicity (COST), as well as by questions related to financial distress (out-of-pocket costs, loss of income and bankruptcy). Data on sociodemographics, income, type of disease, length of diagnosis (LOD), and prior therapies were collected. Predictors of FTox were assessed in multivariate analyses, controlling for potential confounders, such as HRQoL (as measured by the thyroid cancer-specific City of Hope instrument), type of treatment received, and LOD. Results: 591 pts with thyroid cancer within the past 6 years were surveyed in 2 countries: 553 (93.5%) in the United States (U.S.), and 38 (6.5%) in Canada. Most were women (n = 518 pts, 88%). The median LOD was 857 days (range 105-2176 days), and 430 pts (72.8%) had papillary thyroid cancer. There were 61 pts (10.3%) with Stage IV, and 11 (1.9%) were on tyrosine kinase inhibitors. Overall, 234 pts (39.5%) stated that their out-of-pocket costs were higher than previously thought; 207 pts (35%) felt their disease resulted in loss of income; 44 pts (7.4%) were unable to meet their monthly expenses; and 7 pts (1.2%) declared bankruptcy after diagnosis. The median COST value was 24 (range 0-44). In multivariate analyses, the independent predictors of worse FTox were lower income (p < 0.001), female gender (p = 0.01), lower educational level (p = 0.002), healthcare delivery in the U.S., (p = 0.002), and worse HRQoL (p < 0.001). Conclusions: A significant proportion of thyroid cancer pts experience FTox. We identified pts characteristics (gender, education, income), as well as geographical differences (healthcare delivery in the U.S.) as predictors of FTox.
Correlation of body mass index with female survival benefit among a single-institution cohort of cutaneous melanomas >1 mm thick following wide-local excision and sentinel lymph node biopsy.
Authors: Jackson Laura K. , Bulloch Kaleigh Joy , Narayan Deepak , Ariyan Stephan , Gould Rothberg Bonnie Elyssa
Published: February 2017

172

Background: As the 10-year mortality for localized cutaneous melanomas (CMMs) > 1.00 mm is 40%, non-therapeutic interventions to supplement active surveillance following resection may be beneficial. Data describing the impact of lifestyle choices on survival in this population are limited. Methods: 837 consecutive patients who underwent wide local excision and sentinel lymph node biopsy (WLE + SLNB) at Yale during 1997-2012 for CMMs > 1.00 mm thick were enrolled. Smoking, alcohol use and caffeine consumption were assessed by questionnaire at diagnosis and were each categorized according to quantity used with never-users as the reference. Body mass index (BMI) was calculated from height and weight measured at surgery. Crude and multivariable marginal relationships between lifestyle factors and disease free survival (DFS), the latter adjusted for age, sex, thickness (mm), ulceration, mitotic count, and SLN status, were assessed using Cox proportional hazards. Interactions with clinicopathologic factors were conducted. Results: A female survival benefit (HRFEMALE= 0.69; 95% CI: 0.49-0.97; p = 0.04) was observed on multivariable analysis. While BMI was not independently associated with DFS (p = 0.31), we noted a significant interaction between sex and BMI (p = 0.01). Compared with referent normal weight (BMI < 25) men, normal weight women had similar survival (HRBMI < 25= 0.91; 95% CI: 0.52-1.57, p = 0.74) but a progressive survival advantage was observed among women with increasing BMI (HROVERWT= 0.62; 95% CI: 0.33-1.14, HROBESE= 0.23; 95% CI: 0.07-0.58, ptrend= 0.01). A similar relationship was not observed among men (ptrend= 0.51). Neither the marginal effects nor those modified by sex for each of alcohol, tobacco or caffeine were associated with DFS (p > 0.15). Conclusions: Following WLE+SLNB, increasing BMI may improve survival among women but not among men. Research to identify contributory molecular mechanisms in the context of the female survival benefit is warranted.
Impact of Young and Strong on physical activity in young breast cancer survivors.
Authors: Ligibel Jennifer A. , Barry William Thomas , Ruddy Kathryn Jean , Greaney Mary , Rosenberg Shoshana M. , Sprunck-Harrild Kim , Morgan Evan , Walsh Sarah , Emmons Karen , Partridge Ann H.
Published: February 2017

175

Background: Inactivity is common in breast cancer survivors and has been linked to poor outcomes. Few trials have tested physical activity (PA) interventions in young women with breast cancer, who may face unique PA barriers due to demands of jobs and young families. Methods: Young and Strong was a cluster-randomized study evaluating the effect of education interventions for young breast cancer survivors.Sites were randomized 1:1 to a young women’s intervention (YWI), focused on fertility and other issues facing young women, or to a physical activity intervention (PAI). At PAI sites, providers were instructed to discuss PA with patients, and participants were given materials to encourage PA. PA was measured with the modified Godin Leisure Score Index at baseline, and 3, 6, and 12 months. Medical records were reviewed to assess provider attention to PA. Changes in weekly min of PA were compared between the PAI and YWI groups using general estimating equations to evaluate clustered binary and Gaussian data. Results: 467 patients enrolled between 7/12 -12/13 across 54 sites. Median age at dx was 40yrs (range 22-45). At baseline, participants were moderately active. PA increased in both groups over time (Table); there was no significant difference in PA between groups at any time (all p > 0.1). Provider attention to PA was documented in 74% of participants on PAI and 61% on YWI (p = 0.15), and correlated with PA at 12 months (median 100 min/wk of PA in participants with provider attention to PA vs. 60 min/wk in those without, p = 0.016). Participants who reported reading all or most the PAI materials reported higher levels of PA vs. those who read less (78% vs. 64%, p = 0.05) Conclusions: Young breast cancer survivors assigned to a PA intervention did not increase PA more than those assigned to an intervention focused on young women’s issues. However, the higher levels of PA among women who engaged with the PAI materials and those whose oncology providers addressed PA suggests the importance of enhancing patient and provider engagement with healthy lifestyle information and recommendations. Clinical trial information: NCT01647607. [Table: see text]
Community experience with a cancer survivor smoking cessation program.
Authors: O'Rourke Mark Allen , Hoopes Stephanie , Franco Regina A , Summey Julie Frances , Mayo Rachel
Published: February 2017

182

Background: In 2014, GHS began a smoking cessation program for cancer survivors staffed by nurse practitioners and nurse navigators who are certified smoking cessation providers. The program is four scripted visits plus telephone support. Patients learn to become smoke-free by nicotine weaning and replacement, medication management, and integrative coping skills such as hypnosis. The purpose of this descriptive analysis is 1) to determine program smoking cessation rates and 2) to profile patients who completed the program successfully (nonsmoker status). Methods: Patient records from the first 12 months were mined for the following variables: demographics, primary insurance type, primary diagnosis, number of visits, number of cigarettes smoked per day at enrollment, alcohol use, and depression. Data was analyzed using Stata13. The GHS IRB approved the study. Results: Of the 143 patients referred to CIOS for smoking cessation during the first year, 70 (49%) enrolled in the program. 29 (20%) patients completed the program, and 11 (8%) others are in the process of completing the program. 23 (79%) of the 29 completers achieved non-smoker status at the time of program completion. Two months after program completion, only two nonsmoking completers reverted to smoking status. When stratifying completers by key demographic, clinical, and behavioral characteristics, the most successful were females (93% vs. 67% for males), Caucasians (82% vs. 71% for African-Americans), married individuals (100% success rate for married vs. 50% for divorced), and those with private insurance (100% vs. 79% Medicare and 67% Medicaid). Logistic regression did not reveal an increased probability of smoking cessation success with any of the key independent variables. Conclusions: This smoking cessation program using nicotine weaning and replacement, medication management, and integrative coping skills in a cancer survivor population has an encouraging success rate for those who complete the four-visit program. The relative success of married persons and females warrants further study as do the low enrollment rate of those referred, the low completion rate of those enrolled, and the continuing nonsmoking success rates for completers.
Elimination of second-hand smoke (SHS) exposure after a lung or head and neck (HN) cancer diagnosis and subsequent patient smoking cessation.
Authors: Eng Lawson , Alton Devon , Song Yuyao , Farzanfar Delaram , Krys Olivia , Yoannidis Tom , Milne Robin , Habbous Steven , Brown M Catherine , Vennettilli Ashlee , Shepherd Frances A. , Leighl Natasha B. , Hope Andrew J. , Howell Doris , Jones Jennifer M. , Selby Peter , Xu Wei , Goldstein David Paul , Giuliani Meredith Elana , Liu Geoffrey
Published: February 2017

183

Background: Exposure to SHS after a cancer diagnosis is associated with continued smoking in lung and HN cancer patients (PMID: 24419133, 23765604). However, smoking is a social activity. We evaluated whether elimination of SHS exposure around and after a diagnosis of lung or HN cancer is associated with smoking cessation in the cancer patient. Methods: Lung and HN cancer patients from Princess Margaret Cancer Centre (2006-12) completed questionnaires at diagnosis and follow-up (median 2 years apart) that assessed smoking history and SHS exposures (cohort study). Multivariate logistic regression analysis evaluated the association of elimination of SHS exposure after a diagnosis of cancer with subsequent smoking cessation, adjusted for significant covariates. A cross-sectional study (2014-15) of 183 lung and HN smoking patients assessed consistency in associations and interest in SHS cessation programs. Results: For the cohort study, 261/731 lung and 145/450 HN cancer patients smoked at diagnosis; subsequent quit rates were 69% and 50% respectively. 91% of lung and 94% of HN cancer patients were exposed to SHS at diagnosis while only 40% (lung) and 62% (HN) were exposed at follow-up. Elimination of SHS exposure was associated with smoking cessation in lung (aOR = 4.76, 95% CI [2.56-9.09], P< 0.001), HN (aOR = 5.00 [1.61-14.29], P< 0.001), and combined cancers (aOR = 5.00 [3.03-8.33], P< 0.001). The cross-sectional study has similar cessation and SHS exposure rates and a similar association for elimination of SHS with smoking cessation (aOR = 3.42 [1.16-10.10], P= 0.03). However when asked directly, only 26% of patients quit smoking with another individual and 13% of patients exposed to SHS had at least 1 interested party in joining a SHS cessation program. Conclusions: Elimination of SHS exposure around patients is significantly associated with smoking cessation in lung and HN cancer patients, but few patients quit smoking together with others around them, despite the ‘teachable moment’ with a cancer diagnosis. Clinicians should encourage patients and their household/friends to quit smoking together to improve cessation rates in cancer patients and those around them.
Psychosocial distress screening in cancer care.
Authors: Mullai N
Published: February 2017

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Background: Distress is a multifactorial, emotional experience that may interfere with patients’ ability to cope with cancer and its treatment. Recognizing and managing distress may benefit patients. The Commission on Cancer requires implementation of Standard 3.2, Psychosocial Distress Screening in 2015 and integrating distress intervention in cancer care. This study evaluates patients’ perception on benefits in this regard. Methods: Patients were screened at least once at a pivotal medical visit using a questionnaire that included various aspects of stress. NCCN’s Psychosocial Distress Screening Tool was used to measure seriousness of distress. Patients marked their distress level on a scale of 1 to 10. A threshold of 5 was set as a trigger point to start addressing distress. Results: Answers from 311 cancer patients (male 61%; female 39%) were evaluated since January 2015. A majority of patients had breast cancer (29%), followed by lung (18%), GI (18%), and hematological (12%) malignancies. The mean distress score was 3.72 (male 3.14; female 3.97). 131 patients had a score above five. Age group, 40-49 years had a higher distress (4.79) compared to others. Esophageal cancer (1%) had the highest mean score 7.33 followed by head & neck cancer (4%) with 5.67. In most patients, anxiety about cancer and its treatment was the cause of distress. However, they did not want any additional psychosocial intervention except for talking to their oncologist and primary physician. The distress of some patients was family related and they were unsure of the help needed. Two patients refused screening stating the questions were intrusive. Conclusions: Coordinated psychosocial care may benefit cancer patients with significant distress. NCCN tool helps to assess the severity of patients’ distress and to determine the need for intervention. The results (mean score of 3.72) suggest most cancer patients need no major intervention or special psychosocial counseling other than discussing with their physician and family, which is done routinely in most oncology practices. However, when stress is expressed, this tool does help the treating physicians to determine the specific area and degree of stress, to focus on the type of help needed for the patient, and to channel resources appropriately.
Survivor guilt: The secret burden of cancer survivorship.
Authors: Perloff Tara , Shen Megan Johnson , Rigney Maureen , King Jennifer C.
Published: February 2017

192

Background: The 5-year observed survival rate for a stage IV non-small cell lung cancer patient is one percent. Such a small survival rate begs the questions of how these survivors might feel. Society implies that these now “survivors” should feel relieved; lucky; even ecstatic, but many survivors feel a deep-seated sense of guilt. This feeling of objective guilt is a phenomenon known as survivor guilt. There has been little research done to identify the existence of survivor guilt among any group of cancer patients, and no research has examined the associations between survivor guilt and potential burdens in survivorship. The goal of the present study was to identify the prevalence of survivor guilt among lung cancer patients, while also pinpointing themes among those who are affected. Methods: A questionnaire containing a subset of the published IGQ-67 Interpersonal Guilt Questionnaire was completed via Survey Monkey by 108 respondents. After completing the IGQ questions, respondents were given a definition of survivor guilt with an open-ended question on their feelings toward surviving lung cancer when others did not. Additionally, 20 respondents were interviewed via telephone to further expand on their responses which supported the quantitative data. Results: Results indicate that a significant amount of survivor guilt is experienced among lung cancer survivors. A total of 55% of respondents identified as having experienced survivor guilt, yet 63.9% of respondents scored above average on the IGQ-67 Survivor Guilt Scale. Data analysis is ongoing to establish recurring demographic and clinical themes among those who experienced survivor guilt, including factors such as: type and stage of lung cancer and smoking history. Conclusions: This study determines the prevalence of survivor guilt in a sample of lung cancer patients, indicating that survivor guilt is a common psychosocial challenge. Further research across all cancer types must be explored in order to determine the overall prevalence of survivor guilt as well as to develop effective interventions. However, this study represents the first step in examining the prevalence of survivor guilt and the need for creating tools to identify, assess, and ultimately treat patients who suffer.
Healthcare utilization and quality among survivors of adolescent and young adult cancer.
Authors: Kirchhoff Anne C. , Kaul Sapna , Fluchel Mark , Parmeter Christopher F , Spraker Holly Lynn
Published: February 2017

21

Background: To evaluate perceived health care quality among a national sample of survivors of adolescent and young adult (AYA) cancer relative to individuals from the general population. Methods: Using the Medical Expenditure Panel Surveys from 2008-2012, we identified 1,163 survivors diagnosed with cancer ages 15-39 who were at least five years from diagnosis and currently ages of 20-64. A comparison group with no history of cancer was created via propensity score matching on sex, age at study, race/ethnicity, census-region, and survey year. Participants with one or more health care visit in the past 12 months were asked to rate health care quality from all providers (0 = worst to 10 = best), which we categorized as low (0-4), moderate (5-7) and high (8-10). Among survivors, we identified factors such insurance and health status associated with health care quality using ordinal logistic regression. Results: Mean time since diagnosis was 18.3 years. A total of 18% of survivors of AYA cancer reported no health care visits in the previous 12 months compared to 25% of the comparison group (p < 0.001). Survivors rated their health care quality lower than the comparison group (low/moderate: 30.8% vs. 22.5%, respectively, p = 0.003). Among survivors, those who were publicly insured (odds ratio (OR) = 0.62, 95% confidence interval (CI): 0.39-0.97, p = 0.04) and uninsured (OR = 0.25, 95% CI: 0.13-0.48, p < 0.001) were more likely to provide lower health care quality ratings than privately insured survivors. Survivors in fair/poor health also reported poorer quality compared to those in excellent/very good/good health (OR = 0.43, 95% CI, p < 0.001). Conclusions: Survivors of AYA cancer reported greater health care use and poorer health care quality compared to individuals without cancer. Our results call for targeted interventions to meet AYA cancer survivors’ health care needs and expectations.
Predicting patterns of distress in adult survivors of childhood cancer: A latent profile analysis from the Childhood Cancer Survivor Study.
Authors: D'Agostino Norma Mammone , Edelstein Kim , Zhang Nan , Recklitis Christopher J. , Brinkman Tara M. , Srivastava Deokumar , Leisenring Wendy M. , Robison Leslie L. , Armstrong Gregory T. , Krull Kevin R.
Published: February 2017

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Background: Although most survivors are emotionally healthy, subgroups report elevated or increasing distress over time. Distress often involves comorbid symptoms, which are difficult to treat. Predictors of comorbidity have not been examined in survivors. This study identifies patterns of distress and examines disease, treatment and demographic predictors in long-term survivors diagnosed between 1970-99. Methods: Latent profile analyses were used to identify clusters of survivors (N = 16079) and siblings (N = 3085) based on symptoms of somatization, anxiety, and depression from the Brief Symptom Inventory – 18. Bayesian information criterion & Lo-Mendell-Rubin adjusted likelihood ratio test were used to select cluster number. Multinomial logistic regression was used to identify predictors of cluster membership stratified by sex. Results: Four clusters were identified: low distress on all subscales (asymptomatic); high distress on all subscales (global distress); primary somatization (somatic distress); primary depression (affective distress). Compared to siblings, fewer survivors were asymptomatic (62% v. 74%) and more had global distress (11% v. 5%), p’s < 0.0001. More male (66%) than female (58%) survivors were asymptomatic, and more females reported somatic (17% vs 10%) and global (12% vs 9%) distress, all p’s < 0.0001. Among females, fair/poor perceived health (OR 30.9, 95% CI 19.4-49.1); pain (OR 3.4, 95% CI 2.4-4.8), divorced/separated (OR 2.3, 95% CI 1.7-3), less than college education (OR 1.9, 95% CI 1.5-2.3), and antimetabolite therapy (OR 1.3, 95% CI 1.1-1.6) were associated with global distress. Fair/poor perceived health (OR 26.2, 95% CI 17.6-38.9), pain (OR 5.1, 95% CI 3.8- 6.8), divorced/separated (OR 3.0, 95% CI 2.2-4), and anthracycline therapy (OR 1.2, 95% CI 1.0-1.4) were associated with global distress in males. Diagnosis, age at or time since diagnosis, and radiation were not significant predictors. Conclusions: Results support the conceptual distinction between somatic versus affective symptoms of distress and highlight sex differences and health-related predictors of distress, all which have implications for treatment approaches.