bluuebunny/crossref_metadata_2025 huggingface dataset:
A Surgically Treated Case of Ureterovesical Amyloidosis of the Bladder in a Patient with Idiopathic Thrombocytopenia
Authors: Kim Sung Han , Park Weon Seo , Joung Jae Young , Lee Kang Hyun , Chung Jinsoo , Seo Ho Kyung
Published: September 2018

Idiopathic thrombocytopenia (ITP) is a bleeding disorder involving the destruction of platelets by the immune system. Systemic amyloidosis is another bleeding disorder involving amyloid deposits that create defects in coagulation and increased prothrombin and thrombin times. We report a 52-year-old man with ITP and new two-month-duration, painless gross hematuria without clot formation resulting in amyloidosis involving the ureterovesical area of the bladder. He had osteopenia, hypertension, and moderate thrombocytopenia due to ITP diagnosed 7 years previously. Cystoscopic examination with urine cytology and computed tomography imaging detected a 2-cm protruding solid bladder mass involving the left ureteral orifice and trigone and left mild hydroureteronephrosis, suggesting bladder cancer. Transurethral resection of the bladder mass was performed to confirm amyloidosis involvement in the ureterovesical junction of the bladder and ureter. Four weeks postoperatively, intermittent gross hematuria remained; hence, left ureteroneocystostomy was performed. Regular follow-up showed no signs of hematuria or intravesical recurrences for 14 months.
Onset to Reperfusion Time Was Not Important in Mechanical Thrombectomy for Elderly Patients: A Retrospective Multicenter Study in Tama Area, Tokyo
Authors: Koizumi Satoshi , Ota Takahiro , Shigeta Keigo , Amano Tatsuo , Ueda Masayuki , Matsumaru Yuji , Shiokawa Yoshiaki , Hirano Teruyuki
Published: September 2018

Background: Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke with large vessel occlusion; however, evidence remains insufficient for MT for elderly patients, especially with respect to factors affecting their outcomes. Methods: This study was a retrospective analysis of a multicenter registry of MT, called Tama Registry of Acute Endovascular Thrombectomy. Patients were divided by their age into 2 groups: Nonelderly (NE; < 80) and elderly (E; ≥80). Factors related to a good outcome (modified Rankin scale score ≤2) were examined in each group. Onset to reperfusion time (OTR) was stratified into 4 categories: category 1, 0 – ≤180 min; category 2, > 180 – ≤360 min; category 3, > 360 min or onset time not identified; and category 4, effective recanalization not achievable. Results: 143 NE patients and 78 E patients were included in this study. The E group had less chance of achieving a good outcome (NE group 51%, E group 35%; p = 0.024). In the NE group, lower OTR category was an independent prognostic factor for good outcome (p = 0.037, OR = 1.09). However, in the E group, OTR category was not a significant predictor on multivariate analysis. Instead, effective recanalization (p = 0.0081, OR 1.40) and lower National Institute of Health Stroke Scale score at presentation (p = 0.0032, OR 1.02) were the independent predictors. Conclusions: In MT for elderly patients, effective recanalization improved the patients’ outcome but OTR affected less. Further studies are warranted to establish the appropriate patient selection and treatment strategies.
Discovery of a new species of Inocelliidae (Insecta: Raphidioptera) in an altitude of nearly 3500 m in China
Authors: LIU XINGYUE , LYU YANAN , ASPöCK HORST , ASPÖCK ULRIKE
Published: September 2018

A new snakefly species of the family Inocelliidae is described from China: Inocellia occidentalis sp. nov. The new species belongs to the Inocellia crassicornis species group.
Validation and redescription of the hyperiidean amphipod Brachyscelus rapacoides Stephensen, 1925 (Crustacea: Amphipoda: Hyperiidea: Brachyscelidae), a new record of association with the scyphozoan jellyfish Rhopilema nomadica Galil, 1990 (Scyphozoa: Rhizostomeae: Rhizostomatidae) in the Mediterranean Sea
Authors: ZEIDLER WOLFGANG , DOUEK JACOB , RINKEVICH BARUCH , GEVILI ROY , GOREN MENACHEM , GALIL BELLA S.
Published: September 2018

The hyperiidean amphipod Brachyscelus rapacoides Stephensen, 1925 is recorded from the scyphozoan jellyfish Rhopilema nomadica Galil, 1990, a new record of association for the genus Brachyscelus, as well as the first record of hyperiid infestation of a non-indigenous scyphozoan host. Because of some past confusion concerning the status of B. rapacoides and the closely related species B. rapax (Claus, 1871) a redescription of B. rapacoides and molecular analysis are provided in order to validate it as a species distinguished from B. rapax.
Does the mode of delivery in routine cardiac rehabilitation have an association with cardiovascular risk factor outcomes?
Authors: Harrison Alex S , Doherty Patrick
Published: September 2018

Aims

Cardiac rehabilitation is one of the most cost-effective interventions for patients with cardiovascular disease. Worldwide supervised group-based cardiac rehabilitation is the dominant mode of delivery followed by facilitated self-managed (FSM), which is emerging as part of a cardiac rehabilitation menu. Modern research evidence, using trials and well-resourced interventions, suggests FSM is comparable to supervised rehabilitation in its outcomes for patients; however, this is yet to be established using routine clinical practice data.

Methods

Including 81,626 patients from routine clinical data in the National Audit of Cardiac Rehabilitation, this observational study investigated whether mode of delivery, supervised or FSM, was associated with similar cardiac rehabilitation outcomes. Hierarchical regression models included patient and service covariates such as age, gender, cardiac rehabilitation duration and programme staff type.

Results

The results showed 85% of the population received supervised cardiac rehabilitation. The FSM group were significantly older, female and predominantly in lower socioeconomic groups. The results showed that all patients on average benefit from cardiac rehabilitation, independently of mode of delivery, across all risk factors. Additional benefit of 13% and 11.4% increased likelihood of achieving the target state for physical activity and body mass index respectively when using FSM approaches.

Conclusion

This is the first study to investigate traditional cardiovascular risk factors with cardiac rehabilitation mode of delivery using routine clinical data. Both modes of delivery were associated with comparable statistically significant positive outcomes. Despite having equivalent outcomes, FSM cardiac rehabilitation continues to be underutilised, with less than 20% of patients receiving this mode of delivery in the UK.
At the Intersection of Disadvantage: Socioeconomic Status Heightens Ethnic Group Differences in Trust in the Police
Authors: Panditharatne Senuri , Chant Lisa , Sibley Chris G. , Osborne Danny
Published: September 2018

Although trust in, and cooperation with, the police is critical to effective crime prevention, the relationship between citizens and police can be tenuous, especially for ethnic minorities. However, the impact that membership in multiple marginalised groups has on attitudes toward the police has received limited attention. We address this oversight using a national probability sample of New Zealand adults ( N = 11,669) to examine how the intersection between ethnicity and socioeconomic status (SES) affects trust in, and willingness to cooperate with, the police. As hypothesised, minorities trusted the police less than did ethnic majority group members. However, ethnic group differences in trust in the police were heightened at low (vs. high) levels of SES. In turn, trust in the police mediated the relationship between minority status and willingness to cooperate with the police. These results demonstrate that (low) SES exacerbates the already fragile relationship between ethnic minorities and the police.
Comparison of International Prognostic Scoring System (IPSS) and Revised IPSS (IPSS-R) in myelodysplastic syndromes (MDS).
Authors: Mushtaq Muhammad Umair , Ali Abdullah , Morita Kiyomi , Pinheiro Ronald , Baig Muhammad , Raza Azra
Published: September 2018

e18549

Background: IPSS and IPSS-R stratifies MDS patients into low- to high-risk groups based on karyotype, bone marrow myeloblasts and cytopenias. We report the comparison of IPSS and IPSS-R in predicting overall survival (OS) in MDS patients. Methods: A retrospective review of 282 MDS patients, from Columbia University Medical Center Tissue Repository, was conducted. Karyotype and clinical factors were ascertained at the time of referral. Kaplan-Meier and cox regression analyses were conducted to correlate factors with OS. Median OS (mOS) and Hazard ratios (HR) with 95% confidence intervals (CI) were obtained. Results: Median age was 73 years with mOS of 105 months (95% CI 90.5-119.5). Median values for clinical factors were: myeloblasts 2%, hemoglobin (HGB) 9.6 g/dL, platelets (PLT) 109,000 cells/uL and neutrophils (ANC) 1895 cells/uL. Karyotype was good (65%), intermediate (20%) and poor (15%).As compared to ≤ 2% myeloblasts, 3-4% (HR 1.92, 95% CI 1.11-3.34, P = 0.021), 5-10% (HR 4.04, 95% CI 2.45-6.67, P < 0.001) and 11-19% myeloblasts (HR 5.62, 95% CI 3.11-10.17, P < 0.001) predicted poor OS.Poor karyotype vs. good karyotype (HR 2.87, 95% CI 1.81-4.55, P < 0.001), HGB < 10 g/dL (HR 1.84, 95% CI 1.18-2.85, P = 0.007), PLT < 50,000 cells/uL (HR 2.09, 95% CI 1.38-3.15, P < 0.001) and ANC < 800 cells/uL (HR 1.74, 95% CI 1.13-2.67, P = 0.013) predicted poor OS. Median IPSS and IPSS-R scores were 0.5 (scale 0-3.0) and 3 (scale 0-9.5) respectively.As per IPSS, 79% patients had low- (low and intermediate-I) and 21% had high-risk disease (intermediate-II and high). IPSS high-risk (mOS 40 months, 95% CI 16-64) vs. low-risk patients (mOS 125 months, 95% CI 102-148) had poor OS (HR 2.92, 95% CI 1.94-4.38, P < 0.001). As per IPSS-R, 57% patients were low- (very low and low), 18% were intermediate- and 24.5% were high-risk (high and very high). IPSS-R high- (mOS 40 months, 95% CI 19-61; HR 4.83, 95% CI 3.06-7.62, P < 0.001) and intermediate-risk patients (mOS 67 months, 95% CI 5-129; HR 2.72, 95% CI 1.59-4.65, P < 0.001) had poor prognosis vs. low-risk patients (mOS 165 months, 95% CI 109-221). Conclusions: IPSS-R low-, intermediate- and high-risk groups were better predictors of OS as compared to IPSS risk groups in MDS patients.
Effect of inpatient palliative care during hematopoietic stem cell transplantation (HCT) hospitalization on psychological distress at six months post-HCT.
Authors: El-Jawahri Areej , Traeger Lara , VanDusen Harry , Greer Joseph A. , Jackson Vicki A. , Pirl William F. , Telles Jason , Fishman Sarah , Rhodes Alison , Spitzer Thomas R. , McAfee Steven L. , Chen Yi-Bin Albert , Temel Jennifer S.
Published: September 2018

10005

Background: Patients’ experience during HCT hospitalization leads to significant psychological distress post-HCT. Inpatient palliative care integrated with transplant care improves patient-reported QOL and symptom burden during hospitalization for HCT. We assessed the impact of the inpatient palliative care intervention on patients’ QOL, mood, and post-traumatic stress disorder (PTSD) at 6 months post-HCT. Methods: We randomized 160 patients with hematologic malignancies admitted for autologous or allogeneic HCT to an inpatient palliative care intervention (n=81) integrated with transplant care compared to transplant care alone (n=79). At baseline and 6 months post-HCT, we assessed QOL, mood, and PTSD symptoms using the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire (PHQ-9), and the PTSD checklist, respectively. To assess symptom burden during HCT hospitalization, we used the Edmonton Symptom Assessment Scale. We utilized linear regression models controlling for baseline values to analyze the intervention effects on outcomes at 6 months. We conducted causal mediation analyses to examine whether symptom burden during HCT mediated the effect of the intervention on o utcomes at 6 months. Results: Between 8/14 and 1/16, we enrolled 160/186 (86%) of potentially eligible patients. At 6 months post-HCT, the intervention led to improvements in depression and PTSD symptoms, but not QOL or anxiety [Table]. Improvement in symptom burden during HCT hospitalization partially mediated the effect of the intervention on patient-reported outcomes at six months post-HCT. Conclusions: Inpatient palliative care integrated with transplant care leads to improvements in depression and PTSD symptoms at 6 months post-HCT. Addressing symptom burden during HCT hospitalization partially accounts for the effect of the intervention on these long-term outcomes. Clinical trial information: NCT02207322. [Table: see text]
Korean red ginseng to improve cancer-related fatigue in colorectal cancer patients with FOLFOX chemotherapy: A randomized, double-blind, placebo-controlled, parallel, multicenter trial, NCT02039635.
Authors: Kim Yeul Hong , Lim Yoojoo , Cho Jae Yong , Chung Ik-Joo , Kim Jong Gwang , Lee Kyung Hee , Park Keon Uk , Baek Sun Kyung , Oh Sang Cheul , Lee Myung Ah , Oh Doyeun , Shim Byoungyong , Kim Jin Won , Ahn Joong Bae , Shin Dongbok
Published: September 2018

10008

Background: Cancer-related fatigue(CRF) is a common and severe symptom in patients with cancer. The purpose of this study is to evaluate the anti-fatigue effect of Korean Red Ginseng(Steamed Panax ginseng C.A. Meyer) on patients with colorectal cancer. Methods: 438 colorectal cancer patients in treatment with mFOLFOX-6 regimen were randomly assigned to either the Korean Red Ginseng[KRG](n = 219) or placebo(n = 219) group and received 2,000 mg/day test substances for 16 weeks. The primary endpoint was the Area Under Curve(AUC) of Brief Fatigue Inventory(BFI) over 16 weeks. The AUC and change from the baseline were calculated. The frequency and types of adverse events were determined by the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 4.0. Results: 438 colorectal cancer patients were enrolled from 15 institutions. Changes from the baseline in the global BFI were 78.54(Standard deviation [SD] = 16.91) in KRG group vs. 75.89(SD = 16.85) in placebo group at 16 weeks(P = 0.0363). Changes from the baseline in the Usual Fatigue were 76.15 (SD = 17.08) in KRG group vs. 73.08(SD = 17.03) in placebo group at 16 weeks(P = 0.0454). Changes from the baseline in the Mood were 80.46(SD = 17.16) in KRG group vs. 77.88(SD = 17.59) in placebo group at 16 weeks(P = 0.0086). Changes from the baseline in the Relations with Others were 82.09(SD = 17.49) in KRG group vs. 78.67(SD = 17.90) in placebo group at 16 weeks(P = 0.0080). Changes from the baseline in the Walking ability were 82.70(SD = 17.28) in KRG group vs. 80.77(SD = 16.47) in placebo group at 16 weeks(P = 0.0090). Changes from the baseline in the Enjoyment of life were 79.53(SD = 19.53) in KRG group vs. 77.51(SD = 18.02) in placebo group at 16 weeks(P = 0.0150). Toxicities per self-report and CTCAE grading did not differ statistically significantly between the groups. Conclusions: The data supports benefits of consuming 2,000 mg KRG water extract powder daily on CRF over 16-week period. There were no discernible toxicities associated with the treatment. More studies on mechanisms of KRG to guide its role in CRF improvement are needed. Clinical trial information: NCT02039635.
Anti-dementia and anti-hyperlipidemic medication use at end of life in elderly lung cancer patients: Analysis of SEER-Medicare data.
Authors: Kim Min Ji , Duan Zhigang , Zhao Hui , Holmes Holly Michelle , Manzano Joanna-Grace Mayo , Giordano Sharon Hermes , Suarez-Almazor Maria E.
Published: September 2018

10027

Background: Despite risk for polypharmacy, elderly cancer patients may receive drugs whose time to benefit likely exceeds life expectancy. This study aims to describe use of drugs considered potentially unnecessary, namely anti-hyperlipidemics and anti-dementia drugs, and to identify factors associated with their use in Stage 3 or 4 non-small cell lung cancer (NSCLC) patients approaching end of life. Methods: We identified all patients older than 65 diagnosed with primary Stage 3 or 4 NSCLC between 2006 and 2011 in the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Information on drug prescriptions was extracted from Medicare Part D files. First-time hospice enrollment or death date was used as the final endpoint in analysis. The primary outcome was use of drugs of interest at 4 months before NSCLC diagnosis, 6 months and 3 months before death or hospice. Associations with demographic or other factors were tested using the Pearson χ2 test. Results: Of all 7983 patients, 45.1% were taking statins before diagnosis, while 40.7% and 30.9% were still taking statins at 6 and 3 months before death or hospice. Use of bile acid sequestrants, fibric acid derivatives, and cholesterol absorption inhibitors were found to decrease toward death or hospice. In contrast, anti-dementia drug use did not decrease, with 3.4% before diagnosis and 4.2% and 3.5% at 6 and 3 months before death or hospice. Approximately 30% of anti-dementia medications were newly prescribed at 6 and 3 months before study endpoint. Having a higher number of prescriptions at 3 months before death or hospice was associated with higher rates of drug use both before and after cancer diagnosis. Having a higher Charlson comorbidity index correlated with greater anti-dementia drug use before diagnosis. Demographic, socioeconomic, and treatment factors were not found to be correlated with drug use. Conclusions: A high prevalence of statin use persists while a notable proportion of anti-dementia drugs are newly prescribed toward death or hospice. Our findings suggest an opportunity for clinicians to re-evaluate risks and benefits of potentially unnecessary medications in elderly patients nearing end of life.
Do elderly and young patients derive similar relative survival benefits from novel oncology drugs? A systematic review and meta-analysis.
Authors: Arciero Vanessa Sarah , Cheng Sierra , McDonald Erica , Qureshi Mahin Iqbal , Saluja Ronak , Chan Kelvin K.
Published: September 2018

10029

Background: Elderly patients are commonly believed to derive less benefit from cancer drugs, even if they fulfil clinical trial eligibility. We aim to examine if novel oncology drugs provide differential treatment outcomes for elderly and young patients on clinical trials. Methods: A systematic review of randomized control trials (RCTs) cited for clinical efficacy evidence in novel oncology drug approvals by the Food and Drug Administration, European Medicines Agency, and Health Canada between 2006 and 2015 was conducted. Studies reporting age-based subgroup analyses for overall or progression free survival (OS/PFS), were considered. Independent reviewers extracted survival hazard ratios (HRs) and confidence intervals (CIs) for age-based subgroups. Meta-analyses based on an inverse variance random effects model were performed to examine patient subgroups < 65 and ≥ 65 years separately, and pooled HRs were compared to examine if differences in relative survival benefits existed between patient subgroups. Sensitivity analyses were conducted specific to cancer type, primary endpoint, and the type of systemic treatment. Results: Eighty-five RCTs, including 55,512 patients, reported age-based survival outcomes and were included. One study reported age-based toxicity and no studies age-based quality of life results. Pooled HRs [95% CIs] for patients < 65 and ≥ 65 years were 0.60 [0.56-0.65] and 0.66 [0.61-0.72], respectively with no difference between the two subgroups ( P= 0.08). All sensitivity analyses revealed similar results. Conclusions: Our results suggest that elderly and young patients derive similar relative survival benefits from novel oncology drugs. In settings where there is no other direct high-level evidence of elderly patients deriving less benefit than younger patients, it is reasonable to consider offering novel oncology drugs to elderly patients who fulfil trial eligibility. There is, however, a need to report age-based toxicity and quality of life results to support patient discussions regarding the balance of treatment benefit and harm, to encourage informed individualized decision-making.
Polypharmacy and potentially inappropriate medication use in older patients with aggressive non-Hodgkin lymphoma (NHL) leads to inferior survival and increased treatment-related toxicities.
Authors: Lin Richard Jirui , Ma Helen , Guo Robin , Grossbard Michael L. , Troxel Andrea B. , Magid Diefenbach Catherine S.
Published: September 2018

10039

Background: Survival outcomes for older patients with aggressive NHL are disproportionally inferior to those of younger patients. While differences in tumor biology may play a role, older patients are often frail with comorbidities, polypharmacy, and use potentially inappropriate medications (PIM) such as anticholinergics and benzodiazepines. Methods: Using Cox proportional hazard and logistic regression models, we analyzed all aggressive NHL patients age ≥60 treated at our two affiliated hospitals from 2009-2014 to examine the association of polypharmacy and PIM use with progression-free survival (PFS), overall survival (OS), and treatment-related toxicities. Results: In this updated and final analysis, we included 171 patients with complete records from these two hospitals. They share similar demographic, clinical, and laboratory characteristics except for higher International Prognostic Index (IPI) in patients from one hospital. The median age was 70 years (range 65-77). At the time of diagnosis, 46% of patients used more than 4 medications (polypharmacy) and 47% used at least one PIM. Only 43% of patients received first-line chemotherapy of adequate relative dose intensity (>85% dosage), and 65% experienced ≥grade 3 toxicities. Polypharmacy and PIM use were associated with shortened PFS and OS by log-rank test. Most importantly, PIM use remained an independent predictor of PFS, OS, and ≥ grade 3 toxicities in multivariable analyses (Table). Conclusions: This is the first report of significantly adverse survival impacts of polypharmacy and PIM use in older patients with aggressive NHL, presumably from drug-drug interactions that increase toxicities and impair the delivery of adequate chemotherapy dosage. Our findings support the use of evidence-based geriatric principles to guide meticulous medication management to improve outcome disparity for these patients. [Table: see text]
Unmet supportive care needs of older adults with advanced cancer.
Authors: Temel Brandon , Ruddy Margaret , Olson Emily , Moran Samantha M.C. , Fuh Charn-Xin , Hashmi Ardeshir , Scott Erin , Jackson Vicki , El-Jawahri Areej , Temel Jennifer S. , Nipp Ryan David
Published: September 2018

10040

Background: Cancer disproportionately affects older adults, yet research defining the supportive care needs of these patients is lacking. We sought to examine associations between geriatric impairments, quality of life (QOL), and physical and psychological symptom burden in older adults with newly diagnosed incurable gastrointestinal (GI) cancer. Methods: We prospectively enrolled patients age ≥70 within 8 weeks of diagnosis of incurable GI cancer at Massachusetts General Hospital from 10/2015-11/2016. We used surveys to assess geriatric impairments (Vulnerable Elders Survey-13 [range 0-10, scores ≥3 identify patients with impairments), QOL (EORTC QLQ-C30 [range 0-100, higher scores indicate better QOL]), physical symptoms (Edmonton Symptom Assessment System [range 0-10, higher scores indicate greater symptom burden]) and psychological symptoms (Geriatric Depression Scale, [range 0-15, higher scores indicate greater depression symptoms]). We used descriptive statistics to determine differences in patient characteristics by the presence or absence of geriatric impairments. We used linear regression adjusted for age, employment, cancer type, and comorbidity to examine associations between geriatric impairments, QOL, and physical and psychological symptom burden. Results: We enrolled 50 of 58 (86%) patients approached (mean age = 78.7; 52% with pancreatic cancer). Nearly half (46%) screened positive for geriatric impairments; these patients were older (81.7 vs 76.1, p < .01) and had more comorbid conditions (2.4 vs 1.2, p = .01). On linear regression, patients with geriatric impairments reported worse QOL across all domains (General QOL: B = -28.3, p < .01; Physical: B = -36.8, p < .01; Role: B = -36.8, p < .01; Emotional: B = -30.1, p < .01; Cognitive: B = -17.8, p = .03; Social: B = -39.7, p < .01), higher depression scores (B = 5.1, p < .01) and worse fatigue (B = 4.6, p < .01), drowsiness (B = 4.0, p < .01), appetite (B = 3.8, p < .01), and pain (B = 2.7, p = .02). Conclusions: Older adults with advanced cancer experience considerable unmet supportive care needs, particularly those with geriatric impairments. Future research is needed to assess older patients for geriatric impairments and address their unique palliative and supportive care needs.
Association between glycemic control, age, and outcomes among intensively treated patients with acute myeloid leukemia (AML).
Authors: Kuhlman Patrick , Isom Scott , Pardee Timothy S. , Burns Cynthia , Tawfik Bernard , Lamar Zanetta S. , Powell Bayard L. , Klepin Heidi D.
Published: September 2018

10043

Background: Hyperglycemia and increased glycemic variability are associated with infection and increased mortality. We evaluated the relationship between glycemic control during AML induction and outcomes by age. Methods: We retrospectively evaluated outcomes in 262 consecutive patients (pts) with newly diagnosed AML hospitalized for intensive induction at Wake Forest Baptist Hospital (2002-2009). Data on mean blood glucose (BG) (mg/dL) during hospitalization and standard deviation (SD) of BG (measure of glycemic variability, GV), complete remission ± incomplete count recovery (CR+CRi), and overall survival (OS) were collected. Modified Charlson Comorbidity Index (CCI), diabetes, age, gender, race, cytogenetics, hemoglobin, WBC, LDH, body mass index, and insurance were used in uni- and multi-variate models. We used logistic regression to evaluate CR+CRi, and Cox proportional hazard models for OS, stratified by age ( < 60 vs ≥60 yrs). Results: 124 pts were < 60 (median age 47, median OS 23.1 months), 138 were ≥60 yrs (median age 70, median OS 7.9 months). Older pts had higher baseline comorbidity (CCI > 1 60.1% vs 25.8%) and a higher prevalence of diabetes (20.3% vs 7.3%). The mean ±SD number of BG values obtained per patient during hospitalization was 61±71. The mean ±SD of each individuals mean BG during hospitalization was 111.6±16.4 in younger versus 121.7±25.9 older pts. The mean SD of BG values [GV] was 26.8±18.6 in younger versus 33±22.8 in older pts. In multivariable analysis higher mean BG was associated with lower odds of CR+CRi in younger (odds ratio (OR) 0.67, 95% CI 0.48-0.93) and older pts (OR 0.78, 95% CI 0.65-0.93) per 10 mg/dL BG increase. Higher mean BG was associated with shorter OS in older adults (HR 1.12, 95% CI 1.04-1.21). Higher GV was associated with lower odds of CR+CRi in younger (OR 0.73, 95% CI 0.56-0.96) and older (OR 0.71, 95% CI 0.57-0.88), as well as shorter OS in older pts (HR 1.17, 95% CI 1.08-1.26) for each 10 mg/dL SD increase in GV. Conclusions: Hyperglycemia and GV during intensive induction are associated with lower CR+CRi rates (all ages) and shorter OS among older adults.Glycemic control during induction may be a modifiable factor to improve AML outcomes.
The importance of recognizing and addressing depression in patients with advanced cancer.
Authors: Wong Risa , El-Jawahri Areej , Irwin Kelly , D'Arpino Sara , Moran Samantha M.C. , Johnson Connor , Lage Daniel , Ruddy Margaret , Temel Brandon , Traeger Lara , Lennes Inga Tolin , Cashavelly Barbara J. , Martinson Holly S , Jackson Vicki , Greer Joseph A. , Ryan David P. , Hochberg Ephraim P. , Pirl William F. , Temel Jennifer S. , Nipp Ryan David
Published: September 2018

10050

Background: Patients with cancer often experience depression, which is associated with worse outcomes, including longer hospital length of stay (LOS). Although antidepressant medication can improve depressive symptoms in patients with cancer, it is unclear whether their use translates into better outcomes. We sought to clarify the relationship between depressive symptoms, antidepressant medication, and hospital LOS in patients with advanced cancer. Methods: We enrolled hospitalized patients with advanced cancer from 9/2014 to 4/2016 as part of a longitudinal data repository. We examined patients’ medical records to obtain information about documented depressive symptoms in the 3 months prior to admission and use of antidepressant medication at the time of admission. Using descriptive statistics, we compared differences in patient characteristics and hospital LOS across these groups. We used linear regression to examine associations and moderation effects between depressive symptoms, use of antidepressant medication, and hospital LOS. Results: Of 1,036 enrolled patients (89.9% of approached), 126 (12.2%) had documented depressive symptoms in the 3 months prior to admission and 288 (27.8%) were taking an antidepressant medication at the time of admission. Patients with depressive symptoms were more likely to be on antidepressant medication at admission than those without depressive symptoms (48.4% vs 24.9%, p < .001). Patients taking antidepressant medication were younger (62.4 vs 64.4 years, p = .026) and more likely to be female (55.2% vs 47.2%, p = .021). Depressive symptoms were associated with longer hospital LOS (7.3 vs 6.1 days, p = .036), and antidepressant medication was a moderator of this relationship. Among patients not on antidepressant medication, depressive symptoms were associated with longer hospital LOS (7.9 vs 6.1 days, p = .025), but among those on antidepressant medication, depressive symptoms were not associated with hospital LOS (6.6 vs 6.2 days, p = .588). Conclusions: Antidepressant medication moderated the relationship between depressive symptoms and longer hospital LOS. Our results support the need to recognize and address depressive symptoms in patients with advanced cancer.
Treatment decisions and employment of breast cancer patients: Results of a population-based survey.
Authors: Jagsi Reshma , Abrahamse Paul , Lee Kamaria , Wallner Lauren P. , Janz Nancy K. , Hamilton Ann S. , Ward Kevin C. , Morrow Monica , Kurian Allison W. , Friese Christopher Ryan , Hawley Sarah T. , Katz Steven J.
Published: September 2018

10052

Background: Many patients with breast cancer work for pay at time of diagnosis, and the treatment plan may threaten their livelihood. Given rapidly evolving policies, evidence, and treatment options, we evaluated work experiences in a contemporary population-based sample of breast cancer patients to inform initiatives to reduce the burden of cancer care. Methods: We surveyed women aged 20-79 years diagnosed with stages 0-II breast cancer as reported to the SEER registries of Georgia and Los Angeles in 2014-15. Of 3672 eligible women, 2502 responded (68%); we analyzed 1006 who reported working prior to diagnosis. Multivariable models evaluated correlates of missing > 1 month and stopping work altogether vs missing ≤1 month. Results: In this diverse sample (48% white, 19% black, 20% Latina, 11% Asian), most pts (62%) received lumpectomy; 16% had unilateral mastectomy (8% with reconstruction); 23% had bilateral mastectomy (19% with reconstruction). One third (33%) received chemotherapy. The vast majority (84%) worked full time at diagnosis, but only 50% had paid sick leave, 39% disability benefits, and 38% flexible work schedules. Surgical treatment was strongly associated with missing > 1 month of work (OR 7.8 for bilateral mastectomy with reconstruction vs lumpectomy) and with stopping altogether (OR 3.1 for bilateral mastectomy with reconstruction vs lumpectomy). Chemotherapy receipt (OR 1.3 for missing > 1 month; OR 3.9 for stopping altogether) and race (OR 2.0 for missing > 1 month and OR 1.7 for stopping altogether, blacks vs whites) also correlated. Those with paid sick leave were less likely to stop working (OR 0.5), as were those with flexible schedules (OR 0.3). Those with disability benefits were more likely to stop working (OR 1.6) or miss > 1 month of work (OR 2.7). Conclusions: Working patients who received more aggressive treatments, particularly surgery, were much more likely to experience substantial employment disruptions. Given the growing choice of bilateral mastectomy by patients seeking peace of mind, particularly among young women with years of potential employment ahead, these findings suggest the importance of discussing impact of treatment decisions on employment. Funded by NCI P01CA163233.
Patterns of osteoporosis (OP) in survivors of colorectal cancer (CRC) enrolled on SWOG trials.
Authors: Barzi Afsaneh , Hershman Dawn L. , Till Cathee , Lenz Heinz-Josef , Hochster Howard S. , Unger Joseph M.
Published: September 2018

10056

Background: There are currently 1.5 million CRC survivors in US and this number will continue to rise with advancements in treatment. The risk of OP in CRC survivors has not been well described. Methods: We used data from 3 SWOG CRC treatment trials, all of which were phase III and had long term follow-up. Enrollees were linked to Medicare claim files for identification of OP and fractures using HCPCS and ICD9 codes. First, we compared patterns of osteoperosis and fracture risk by sex in colorectal cancer patients. To assess whether patterns of fracture risk by sex differed between patients with vs. without colorectal cancer, we compared the difference in fracture risk by sex in colorectal cancer patients to the difference in fracture risk by sex in the general U.S. population, using data from the National Health Interview Survey (NHIS) and the National Hospital Discharge Survey (NHDS). Finally, we assessed whether absolute estimates of osteoperosis and fracture risk differed between men with colorectal cancer and men without colorectal cancer. Comparison data for men without colorectal cancer were obtained from the placebo arm of the Prostate Cancer Prevention trial (PCPT). Results: We linked 1233 CRC cases with Medicare claims. The median age at CRC diagnosis was marginally higher for women (65 vs 64 ys, p = 0.03). 47% of females, 15% of men with CRC, and 19% of men without CRC had a OP diagnosis. The female to male ratio of osteoporotic fracture in general U.S. population was 1.67, while the same ratio in CRC survivors was 2.84, an increase of 70% (p-value < 0.001). Conclusions: Our study indicates that the risk disparity for OP fracture for females is much greater in CRC survivors than in the general U.S. population. This may be due to more OP diagnoses for female CRC survivors, but not for male CRC survivors.
Survivorship needs after head and neck cancer treatment.
Authors: Berkowitz Callie , Allen Deborah H. , Tenhover Jennifer , Zullig Leah L. , Fischer Jonathan E. , Pollak Kathryn I. , Hicks Minoka R. , Hillson John V. , Koontz Bridget F.
Published: September 2018

10062

Background: Head and neck cancer (HNC) survivors experience significant sequelae of treatment, including long-term physical side effects and ongoing surveillance for recurrence and secondary malignancy. Given the complicated trajectory of HNC survivors, survivorship care plans educating patients and their caregivers about treatment and recovery may be beneficial. However, little is known about patients’ knowledge gaps related to survivor issues. Methods: Through a prospective anonymous self-administered survey, we evaluated the baseline knowledge of HNC survivors regarding common post-treatment issues and mediating factors. Forty-one HNC patients within 3 months of completing treatment participated between July-November 2016. Descriptive statistics were used to characterize patient responses. Results: Patients had undergone a variety of treatment modalities: radiation (97%), chemotherapy (71%), and surgery (39%). 85% of patients had primary care providers, 56% had regular dental care, and 44% had dental insurance. 78% had caregivers. HNC survivors’ correct responses to side-effect (SE) knowledge questions were lowest for items regarding hearing loss (15%), sleep (33%), tiredness (38%), and anxiety (49%). Only 28% correctly identified cancer risk with alcohol intake. 87% correctly linked tobacco products to cancer recurrence. Patients were most interested in learning via discussions with nurse or doctor (76%) followed by reading written materials (61%), and researching online (32%). Most patients desired to learn more about their cancer (73%), short-term SE (80%), and long-term SE (77%). Conclusions: Our study demonstrated clear gaps in knowledge and healthcare access that may inform targeted, individualized survivorship care plans. Patients had the largest knowledge deficits for alcohol use and recurrence, hearing loss after treatment, and a variety of emotional effects of cancer treatment. These topics should be addressed during delivery of survivorship care plans and surveillance encounters to improve survivorship knowledge.
Pregnancy after breast cancer: Results from a prospective cohort study.
Authors: Poorvu Philip Daniel , Gelber Shari I. , Rosenberg Shoshana M. , Ruddy Kathryn Jean , Tamimi Rulla M , Peppercorn Jeffrey M. , Schapira Lidia , Borges Virginia F. , Come Steven E. , Partridge Ann H.
Published: September 2018

10065

Background: Prospective data regarding fertility and pregnancy after breast cancer are limited. Many young survivors are interested future fertility, but pregnancy rates among women attempting and not attempting pregnancy have not been studied prospectively. Methods: As part of a multicenter cohort study, women diagnosed age ≤40 with stage 0-3 breast cancer are surveyed at baseline then annually regarding fertility interest, attempts, and pregnancies. Chi-square tests were used to compare proportions attempting and achieving pregnancy. Results: At least once in the 5 years (yrs) after Dx, 334/959 (35%) women reported interest in future biologic children. The percent interested was stable in the first 3 yrs then declined: 256 (27%, baseline), 244 (27%, 1 year), 209 (25%, 2 yrs), 176 (25%, 3 yrs), 106 (18%, 4 yrs), and 72 (16%, 5 yrs). Pregnancy was attempted by 104/334 (31%) of women who reported interest and 4/625 (1%) who did not. Pregnancy occurred in 118 women (12%), including 76/108 (70%) who attempted and 42/851 (5%) who did not. Attempts and achieving pregnancy were associated with younger age, partnered status, and not having children prior to Dx (table). Lower stage was associated with attempting pregnancy and ER negative disease with achieving pregnancy. Conclusions: A substantial number of young women become pregnant in the 5 years after a breast cancer diagnosis. Given that over 1/3 of pregnancies were among women who did not report attempting, additional attention to contraception counseling should be considered. Further evaluation of assisted reproductive technology use, pregnancy and disease outcomes in this cohort, and the POSITIVE Trial (NCT02308085) will shed light on the feasibility and safety of pregnancy after breast cancer. [Table: see text]
The effect of loneliness on cancer mortality.
Authors: D'ippolito Simona , Ambrosini Ettore , Shams Malihe , Calì Giuseppe , Pastorelli Davide
Published: September 2018

10070

Background: Convergent findings indicate the need of broadening the vision of cancer beyond known prognostic factors, as many variables of different nature equally affect the course of disease. Loneliness has been found to be associated with various health outcomes, but its relationship with cancer remains unclear. Here we aimed to investigate the specific effect of loneliness and other demographic, psychological, and clinical variables on cancer mortality and to validate the Italian UCLA Loneliness Scale in cancer patients. Methods: This descriptive and correlational study was conducted at the Veneto Institute of Oncology in Padua. 400 patients undergoing chemotherapy from 01/2014 to 06/2015 were enrolled. The sample was stratified by sex and age (4 groups, 40-80 y). We collected demographic, clinical (site and stage of cancer, type of chemotherapy, death date), and psychosocial [self-esteem (RSE), perceived social support (MSPSS), social interaction anxiety (SIAS), personality (EPQR), and depression (BDI)] data. Results: GLM analyses: loneliness was higher in women than men (F(1,398) = 7.5, p = .006) and it linearly increased with age (F(1,398) = 10.9, p = .001). Loneliness was also influenced by marital status (F(3,396) = 2.9, p = .037), cohabitant offspring (F(1,398) = 7, p = .008), and educational level (F(3,396) = 4.7, p = .003), but not by clinical variables (all ps > .05). Correlation analyses: loneliness was inversely related to RSE (r = -.51), MSPSS (r = -.52), and extroversion (r = -.32), and directly related to SIAS (r = .46), neuroticism (r = .43), and BDI (r = .44). More importantly, a hierarchical binomial logistic regression revealed that patients’ mortality was reliably predicted by gender, stage of cancer at diagnosis, time from diagnosis to UCLA collection, BDI, and UCLA (HL χ2(8) = 3.53, p = .90). In particular, high BDI predicted higher mortality (Wald = 11.6, p < .001); surprisingly, after controlling for BDI and other effects, high loneliness predicted lower mortality (Wald = 7, p = .008). Conclusions: Our results replicate prior research and reveal a surprising association between loneliness and mortality risk after partialling out the impact of, especially, depression. This suggests the role of loneliness on cancer course as an important health concern.
The impact of the Affordable Care Act (ACA) on cancer survivorship.
Authors: Leopold Christine , Park Elyse , Nekhlyudov Larissa
Published: September 2018

10072

Background: The ACA of 2010 has been recognized by the cancer community as an important step forward in insurance and payment reform, aiming to expand the number of insured patients, control costs and incentivize health care delivery system changes. In this review, we outline the ACA provisions relevant to cancer survivorship, provide available evidence for their impact, and offer insights for future research. Methods: We conducted a literature search in the PubMed database and grey literature. We searched the terms ‘ACA and cancer survivors’, which resulted in 17 articles and expanded the search to ‘ACA and cancer’ and found 213 articles, of which 75 were relevant for this review. We categorized the ACA provisions into three categories, 1) access to preventive care, 2) access to quality, coordinated care, and 3) coverage expansion and increased affordability. Results: Positive effects of the ACA were: an increased uptake of preventive services and cancer screening; a reduction in hospital admissions, increased guidelines concordance and generic prescribing through the implementation of cancer-specific Accountable Care Organizations; a reduction of unnecessary resource use (e.g. emergency visits) through the implementation of oncology patient-centered medical home models and decreases in costs though bundle payments. These results focus on the general population/cancer patients; specific studies targeting at the effects on cancer survivors are missing. In addition, evidence from literature showed that knowledge about the benefits of the ACA is low among childhood cancer survivors; while insurance coverage rates of cancer survivors, especially for childhood cancer survivors, increased. Conclusions: Evidence regarding the effects of the ACA on cancer survivorship care is limited, though point to greater access to preventive services and screening programs. Effects of provisions focusing on quality, coordinated care as well as coverage expansion and affordability may have beneficial effects. Whether the ACA remains or is reformed, it is critically important that decisions take into account the potential intended and unintended consequences of the ACA provisions on health outcomes and quality of life of this growing population.
The association between mindfulness and post-operative pain in gynecologic oncology patients undergoing minimally invasive hysterectomy.
Authors: Weston Erica , Raker Christina , Huang David , Mathews Cara Amanda
Published: September 2018

10079

Background: Studies demonstrate an inverse relationship between mindfulness and chronic pain. However, the relationship between mindfulness and acute post-operative pain has not yet been thoroughly investigated. The objective of this study is to determine if there is an association between pre-operative level of mindfulness and post-operative pain outcomes in women undergoing minimally invasive hysterectomy. Methods: For this prospective cohort study, women planning to undergo laparoscopic or robotic hysterectomy were prospectively recruited at the gynecologic oncology outpatient clinic at our institution. Baseline mindfulness was assessed at the pre-operative clinic visit using the Five Facet Mindfulness Questionnaire (FFMQ). Post-operative pain, using the Visual Numeric Rating Scale (VNRS-11), and opiate pain medication usage were evaluated via chart review and post-operative surveys completed at 1 to 2 week and 4 to 6 week post-operative clinic visits. Results: One hundred twenty four women completed the 6 week post-operative follow-up period, of which 80% were undergoing surgery for malignancy. Baseline mindfulness was inversely correlated with post-operative pain as measured by both the average and highest reported VNRS-11 values during the inpatient stay (r = -0.21, p = 0.019; r = -0.21, p = 0.016). At the 1 to 2 week post-operative visit, self-reported pain score was also inversely correlated with pre-operative mindfulness score (r = -0.24, p = 0.009). This relationship was not observed at the 4 to 6 week post-operative visit (r = -0.08, p = 0.403). Higher pre-operative mindfulness was also associated with lower opiate usage (r = -0.16, p = 0.077), though this relationship was not statistically significant. Conclusions: Higher pre-operative mindfulness is associated with more favorable post-operative pain outcomes, including lower reported numeric pain scores, in gynecologic oncology patients undergoing minimally invasive hysterectomy. This relationship provides an opportunity to target the modifiable personality characteristic of mindfulness, to improve post-operative pain in women planning gynecologic surgery.