bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative frailty assessment with Robinson Frailty Score (RFS) and Edmonton Frail Scale (EFS) in older surgical patients with cancer.
Authors: Nishijima Tomohiro F. , Esaki Taito , Morita Masaru , Toh Yasushi 
Published: May 2020

e24033 Background: In general geriatric surgical patients, frailty has been shown to predict higher rates of postoperative adverse outcomes. A little is known about how to optimally assess older adults with cancer for preoperative frailty. We evaluated the potential utility of the RFS [Robinson Am J Surg. 2013], EFS [Rolfson Age Ageing. 2006] and Geriatric 8 (G8) for prediction of postoperative adverse events. Methods: This cohort study included older adults who were prospectively evaluated by geriatric oncology service at Kyushu Cancer Center in Japan before undergoing oncological surgery between September 2018 and December 2019. The RFS measures cognition, function (activities of daily living (ADLs) and Timed Up & GO (TUG)), history of falls, comorbidity, albumin and hematocrit (score 0 to 1: fit (n = 71), 2 to 3: prefrail (n = 30) and 4 to 7: frail (n = 13)). The EFS evaluates cognition, function (IADLs and TUG), incontinence, self-perceived health, mood, nutrition, polypharmacy and social support (score 0 to 3: fit, 4 to 7: prefrail and 8 to 17: frail). G8 was dichotomized at previously studied cut-off value of 14. The primary outcome was composite adverse events (AEs), including 30-day postoperative complications (Clavien-Dindo grade ≥ 2) and discharge to an institutional care facility. Severity of surgery was assessed using the Operative Stress Score (OSS) [Shinall JAMA Surg. 2019]. Results: Of 114 patients (median age 80 years, range 72-96), surgery type was GI in 62%, HEENT in 20%, GYN in 8%, and other in 10%. 100 patients had ECOG PS 0 to 1. Using the OSS, surgical procedures were classified as very low to low stress (9%), moderate stress (31%), high stress (46%) and very high stress (15%). 45 patients had AEs. After adjusting for the OSS, preoperative frailty based on the RFS was associated with the occurrence of AEs (fit: 25%, prefrail: 49%, frail: 77%; p < 0.01). However, neither the EFS (fit: 30%, prefrail: 37%, frail: 60%; p = 0.14) nor G8 was significantly associated with a risk of AEs (score > 14: 17%, score ≤ 14: 41%; p = 0.07). Conclusions: Preoperative frailty status defined by the RFS is predictive of postoperative adverse outcomes in older adults undergoing elective surgery for cancer.
Effects of community-based supervised exercise in the quality of life, physical fitness, and functioning of breast cancer survivors.
Authors: Alves Alberto , Viamonte Sofia , Amarelo Anabela , Garcia Catarina , Antunes Pedro , Duarte Barbara , Vieira Micael , Teixeira Madalena , Tavares Ana , Lopes Ricardo , Mendanha Patricia , Martins Maria , Leão Inês Isabel , Marinho Joana Catarina Lima , Helguero Luisa , Capela Andreia , Joaquim Ana 
Published: May 2020

e24035 Background: Physical exercise is recommended to cancer patients. We aim to evaluate the efficacy of a low-cost community-based supervised exercise program in early breast cancer survivors after primary treatment. Methods: A single-arm clinical trial, controled by a run-in period, of a 16-weeks intervention consisting of 3 weekly sessions of combined aerobic and strength exercise at moderate to vigorous intensity in group classes of no more than 20 participants. Participants were evaluated at weeks 1, 8 and 16 (M1, M2 and M3) of the run-in period and 8 and 16 of the experimental phase (M4 and M5) for quality of life (QoL) (EORTC QLQ-C30), handgrip strength, sit-to-stand (STS) test and maximal aerobic capacity. Results: Of the 82 participants, 25 completed the program and evaluations. Median age was 58 years (39-73), 64% underwent mastectomy, 48% had axillary lymph node dissection, 80% was treated with radiotherapy, 80% with chemotherapy and 84% with hormonotherapy. Median time from surgery was 13 months (4-107). Physical functioning domain of QoL improved significantly following 8 (p = 0.04) and 16 weeks (p = 0.03) of exercise training. Handgrip strength in surgical and non-surgical limbs increased after 8 weeks and maintained after 16 weeks of control phase, further increasing after 8 weeks (p = 0.01) and 16 weeks of exercise (p = 0.00). Lower-limb strength also increased after 16 weeks of exercise (p = 0.01), and maintained during control (p = 0.09). Additionally, maximal aerobic capacity tended to further increase after exercise training (p = 0.06), after increasing during control phase (p = 0.02). Conclusions: A low-cost community-based supervised exercise program improves physical fitness and functioning in breast cancer survivors after primary treatment. Clinical trial information: NCT04024280 . [Table: see text]
Unmet supportive care needs and health behaviors in Hispanic/Latino cancer survivors with cardiometabolic comorbidities.
Authors: Moreno Patricia , Ramirez Amelie G. , Penedo Frank J. 
Published: May 2020

e24038 Background: Cardiometabolic illness is a leading cause of death among cancer survivors previously treated for early-stage breast, prostate, and colorectal cancer. Despite the fact that Hispanics/Latinos in the U.S. are at a significantly elevated risk for poor cardiometabolic health, there is a paucity of research examining cardiometabolic comorbidities in Hispanic/Latino cancer survivors. The aim of this study was to examine unmet supportive care needs and health behaviors in Hispanic/Latino cancer survivors with and without comorbid peripheral vascular disease and diabetes. Methods: Hispanics/Latinos diagnosed with breast, prostate, or colorectal cancer (N = 288) were assessed using the Charlson Comorbidity Index, Supportive Care Needs Survey, and ACS Lifestyle Behavior Scale within 15 months of treatment completion in an NCI-funded project. Logistic regression analyses were conducted adjusting for sociodemographic and medical covariates. Results: Most survivors had a high school education or less (65.6%) and a household income less than $50,000 (68.4%) and were foreign-born (59.4%) and either monolingual Spanish-speaking (54.2%) or English-Spanish bilingual (26.0%). One-quarter (24.7%) were diagnosed with comorbid diabetes and one-fifth (20.8%) were diagnosed with comorbid peripheral vascular disease. Survivors with peripheral vascular disease were more likely to have unmet health system and information needs (OR 2.29, p = .011) and unmet sexuality needs (OR 2.07, p = .020) and marginally more likely to have unmet psychological care needs (OR 1.71, p = .099) than those without peripheral vascular disease. Survivors with diabetes were more likely to have unmet sexuality needs (OR 2.06, p = .015) than those without diabetes. Survivors reported increasing some positive health behaviors following their diagnosis of cancer, including regular health check-ups (61.5%) and consumption of healthy foods like fruits and vegetables (61.8%). However, attempts to lose weight (45.1%), exercise (40.6%), and avoid alcohol (26.0%) and cigarettes (17.0%) were less common. Health behaviors did not vary between survivors with and without peripheral vascular disease and diabetes (p > .05). Conclusions: Comorbid peripheral vascular disease and diabetes are highly prevalent among Hispanic/Latino cancer survivors and are associated with greater unmet supportive care needs. Targeted efforts are needed to increase exercise and weight loss as well as reduce smoking and alcohol consumption in Hispanic/Latino cancer survivors.
Dashboard directed decision support to increase cancer survivorship care plan adherence.
Authors: Rizeq Yazan , Brackett Casey , Yousef Rawan , Hebal Ferdynand , Budds Susan , Rao Ruta D. , Levy Mia Alyce 
Published: May 2020

e24043 Background: Oncology practices face multiple challenges when trying to implement the Commission on Cancer (CoC) Survivorship Care Plan (SCP) documentation standard. First, it is difficult to systematically identify patients who qualify for a SCP from the electronic medical record (EMR). Second, SCP documentation must be completed within a specific timeframe that does not always align with clinical encounters for routine care. Finally, as practices participate in more regulatory programs, such as the Oncology Care Model (OCM), the burden of meeting the unique but often overlapping documentation standards becomes burdensome. Our goal was to improve adherence to SCP documentation through enhanced clinical documentation workflows and clinical decision support. Methods: To meet CoC SCP standards, SCP templates were built into the EPIC EMR at a single multi-centered institution. These templates allowed the user to indicate on the problem list if the SCP was needed. Likewise, Institute of Medicine (IOM) care plan documentation templates and reminders were built to meet OCM standards. Population dashboards were developed in Tableau to track SCP documentation adherence and provide support regarding eligible patients who required SCP documentation. Patients were eligible who had a cancer diagnosis codes on the problem list, and MC in the EMR. Patients greater than 12 months from being marked curative were considered eligible to complete SCP. Results: Between 2015-2019, 2763 cancer patients were MC by 31 providers, where 806 (30%) were OCM patients. Overall, 1372 (70%) non-OCM patients required an SCP, where 563 (41%) were completed. When examining the OCM patients, 689 (85%) required a SCP, where 552 (80%) were completed. For patients MC in 2018, 163/439 (37%) and 137/190 (72%) of patients received a SCP for the non-OCM and OCM group respectively. For patient MC in 2019 after implementation of the decision support dashboard, 115/145 (79%) and 144/148 (97%) of eligible patients had completed SCP for the non-OCM and OCM group respectively (Table). Conclusions: During the study period, adherence to SCP documentation doubled concordant with CoC standards at that time. Integration of IOM and SCP documentation improved adherence among OMC compared to non-OCM patients. The decision support dashboard helped prioritize cases for SCP documentation for care teams. This is an example of a decision support framework that could be used for other standards driven documentation requirements in cancer.
Health behaviors (HBs) among head and neck cancer (HNC) survivors.
Authors: Jacobs Linda A. , Blauch Abigail N. , Pucci Donna A. , Palmer Steven C 
Published: May 2020

e24044 Background: HNC affects more than 59,000 Americans annually and is mediated by HBs both in terms of etiology and long term outcomes. Health behaviors in this population, however, have not been well described. This project describes HBs as a first step in developing appropriate interventions to improve health and, ultimately, outcomes among HNC survivors. Methods: Potential participants were identified through the tumor registry at the Abramson Cancer Center as well as affiliated sites. Eligibility included: a) Diagnosis and treatment of HNC; b) Aged 18 to 70 years; c) more than 1 year post-diagnosis; d) Confirmation of human papillomavirus (HPV) status; e) Ability to understand written English. Potential participants were sent an explanation of the study, informed consent, a self-reported questionnaire, and a self-addressed stamped envelope for return of materials. HBs included items recommended by Glasgow et al. assessing diet, aerobic activity, strength-flexibility, leisure time activity, smoking, alcohol consumption, and access to a physician. Results: 451 individuals were found to be eligible and approached. 102 (23%) agreed to participate and usable data were collected from 93 participants. The sample was predominantly white (96%), male (80%), middle aged (M = 59 yrs), married (82%), college educated (63%), and 63% reported an annual income of greater than $100,000. 74% were HPV positive. Although current smoking was rare (7%), historical use of tobacco was common (48%). Current alcohol use was also common (65%) with an average of 12 days per month in which alcohol was consumed. Participants reported an average of 2.1 drinks per day. Binge drinking was reported by 22% of those who drank, with an average of 3.5 binge drinking sessions per month. Scores on our measure of nutritional behavior range from 0-16 with lower scores indicating better nutrition. The sample mean was 7.1. According to body mass index (BMI) 59% were overweight or obese. With respect to the overall sample, 59% reported adequate aerobic exercise and 64% adequate strength and flexibility. In terms of leisure time activity, 18% would be classified as sedentary, 19% as moderately active, and 64% as active. All participants reported having a current primary care physician and 92% reported having had a physical examination in the previous 12 months. Conclusions: Binge drinking and BMI appear to be the most common negative HBs in this population, although there remain opportunities to improve dietary and exercise behaviors, as well.
Improve, a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and non-hispanic white breast cancer survivors from diverse socioeconomic backgrounds: Recruitment strategies and baseline characteristics.
Authors: Owusu Cynthia , Nock Nora , Hergenroeder Paul F. , Austin Kris , Bennett Beth , Cerne Stephen , Moore Halle C. F. , Petkac Jean , Schluchter Mark D. , SCHMITZ KATHRYN H. , Webb-Hooper Monica , Wimbley Leonard , Coccia Sarah , Nagy Caitlin , Berger Nathan A. 
Published: May 2020

e24052 Background: We conducted an exercise study to IMPROVE health outcomes in older breast cancer survivors (BCS) from diverse racial and socioeconomic backgrounds. Here, we report cohort recruitment strategies and baseline characteristics. Methods: ‘IMPROVE’ is a randomized trial, designed to evaluate a group-based exercise intervention compared to support group. Participants were ≥ 65 years, had stage I-III breast cancer and within five years of treatment completion. Enrollment target was 220 participants, 25% in each of four strata defined by race (AA versus Non-Hispanic Whites [NHW]) and SES (low vs. high). Participants were recruited through hospital-based tumor registries, the state tumor registry or direct referrals. Results: Between October 2016 and November 2019, 7487 patients were screened, 4790 were potentially eligible, 230 were consented and 213 randomized into the study. The Eligible-to-Randomization rates were 4.4% overall, and 84%, 8%, and 2% for recruitment utilizing direct referrals, hospital and state registries, respectively. Median age of the randomized cohort was 70 years (range: 65-88 years) and included 25% AA/Low SES, 20% AA/High SES, 19% NHW/Low SES and 36% NHW/High SES Older BCS. Compared with registry-eligible patients, directly referred patients were more likely to be AA vs. NHW (41% vs. 19%, p = 0.003) and to accept study participation (88% vs. 16%, p < 0.0001). Conclusions: Direct referrals resulted in the highest recruitment yield and was the most effective strategy for recruiting AA patients. Behavioral intervention studies seeking to target older BCS from racial minority and SES disadvantaged backgrounds should focus on strategies that foster direct referrals to study participation. Clinical trial information: NCT02763228 .
Impact of breast cancer chemotherapy on ovarian damage and recovery.
Authors: Goldfarb Shari Beth , Bedoschi Giuliano , Turan Volkan , Crown Angelena , Abdo Nadia , Dickler Maura N. , Oktay Kutluk 
Published: May 2020

e24059 Background: As societal shifts have led to more women delaying childbearing, a diagnosis of breast cancer is increasingly more likely to occur prior to the completion of family building. Therefore, understanding impact of chemo on future fertility is of the utmost importance. This study evaluates the trends in AMH over time in women receiving different chemo regimens for breast cancer. Methods: This is an IRB approved prospective study of 164 women, < 45 years old with non-metastatic breast cancer who were enrolled at time of diagnosis. Patients received chemo and had prospective serum AMH measured at baseline,12, 18 & 24 mos post-chemo. Of those, 99/164 completed 2-yr follow up. Pts were divided according to their chemotherapy regimen: ddAC-T, CMF and other (e.g. TH). Results: Mean age in ddAC-T (n = 118), CMF (n = 22) and other (n = 23) chemo groups were 37.1±4.6, 41.1±3.2 and 37.6±4.3 yrs, respectively (p = 0.001). AMH sharply declined between baseline & 12 mos post-chemo in all groups (p = 0.005). There was no difference in rate of decline between the groups, after adjusting for age. Age was an important predictor of AMH. Older age at study entry was associated with lower AMH with a decrease of 9% per life year (p = 0.0005). AMH recovered from 12 to 18 mos post-chemo in all groups. 18 mos after chemo, AMH recovery was observed in 61%, 59% & 65% in ddAC-T, CMF & other groups, respectively. In the ddAC-T arm there was a 1.9 fold increase in AMH while there was a 1.4 and 3.3 fold increase in the CMF and other arms, respectively. At 2-yrs post-chemo, AMH recovery rate reached 67%, 69% & 77% in ddAC-T, CMF & other groups, respectively. However, 12% in ddAC-T and 23% in CMF had undetectable AMH. Baseline AMH was 1.59 fold higher in pts whose AMH increased compared to those whose AMH decreased between 12 & 18 mos (p = 0.035). AMH recovery was associated with higher baseline AMH. Age, BMI & chemo type did not correlate with AMH recovery and tamoxifen treatment did not impact AMH recovery. Conclusions: Our data show that anthracycline plus taxane, taxane-based and CMF chemo regimens compromise ovarian reserve in breast cancer patients in similar fashion. As surviving ovarian follicles resume production of AMH, most of ovarian reserve recovery occurs by 18 mos post-chemo with some minor recovery from 18-24 mos. Baseline AMH level is the most important predictor of AMH recovery. Hence in women undergoing gonadotoxic chemo, ovarian reserve should be assessed by AMH before and 12 months after treatment to determine extent of damage. The novel information provided in this study is valuable for counseling cancer pts about fertility preservation. Clinical trial information: NCT00823654 .
Association between tamoxifen and cataract risk in breast cancer patients: Analysis of a national health insurance database.
Authors: Chou Cheng-wei , Lin Ching-Heng , Teng Chieh-Lin , Sher Yuh-Pyng 
Published: May 2020

e24072 Background: Tamoxifen is often used for hormone-positive breast cancer. Recent trials suggested that ten years of tamoxifen use improves recurrence rate and death. Ocular side effects and cataracts were reported in previous trials. We revealed the risk of cataracts from real-world data of the Taiwan national health insurance research database. Methods: We retrieved data from the Taiwan National health insurance research database. Female breast cancer patients from 2000-2005 were enrolled in this study. Patients receiving cataract surgery were enrolled and matched with non-cataract surgery patients for comparison in the analysis. Age, cumulative days, chemotherapy, and the time interval between breast cancer and index date were included and as controlled variables. Results: Among 23,957 female breast cancer patients, a total of 1,578 patients receiving cataract surgery were enrolled and matched with patients without cataract surgery until the end of 2013. Age in patients undergoing cataract surgery group was significantly higher than the non-surgery group (59.9 and 58.3, respectively, P < 0.001). Multiple regression analyses showed an adjusted odds ratio of 1.02 (95% CI:1.01-1.03, P< 0.001). However, more prolonged exposure of tamoxifen (≧3 years) also had a higher risk of cataract development requiring surgery (adjusted odds ratio=1.32, 95% CI: 1.03–1.70, P = 0.030). Conclusions: Besides age, there is a significantly higher risk of cataract development requiring surgery among female breast cancer patients with long term tamoxifen use. Information from this study may provide further clinical surveillance efforts in cancer survivors. [Table: see text]
Matrix metalloproteinases 9 and 14 polymorphisms and long-term complications in surgically treated breast cancer patients.
Authors: Besic Nikola , Goricar Katja , Piber Petra , Vavpetic Neza , Dolzan Vita , Strazisar Branka 
Published: May 2020

e24074 Background: Matrix metalloproteinases (MMPs) are zinc-containing endopeptidases that are involved in tissue remodeling. They can regulate interactions of cells with extracellular matrix and can play a role in wound healing. High levels of metalloproteinases have been correlated with significantly delayed wound healing in wounds of a variety of etiologies. The aim of our present study was to evaluate the association of MMP9 and MMP14 genetic polymorphisms with long-term complications of surgical treatment in breast cancer patients. Methods: The study included 99 breast cancer patients treated with either 75 or 37.5 mg of tramadol for pain relief after axillary breast cancer surgery as part of a randomized clinical trial KCT 04/2015-DORETAonko/si at Institute of Oncology Ljubljana. All patients were genotyped for MMP9 polymorphisms rs2250889, rs17577, rs17576, and rs20544 as well as MMP14 rs1042703, rs1042704, and rs743257. The association of genetic factors with long-term complications was evaluated using logistic regression. Results: One year after surgery, 24 (24.2%) patients had lymphedema, 25 (25.3%) experienced neuropathic pain and 21 (21.1%) experienced chronic pain. Carriers of polymorphic MMP9 rs2250889 allele experienced significantly more lymphedema compared to carriers of two wild-type alleles (OR = 3.45, 95% CI = 1.10-10.84, P = 0.034), even after adjustment for tramadol dose (OR = 3.76, 95% CI = 1.16-12.18, P = 0.027). Carriers of polymorphic MMP14 rs1042704 allele experienced more neuropathic pain compared to carriers of two wild-type alleles (OR = 3.21, 95% CI = 1.26-8.20, P = 0.015), even after adjustment for tramadol dose (OR = 3.80, 95% CI = 1.42-10.17, P = 0.008). Conclusions: MMP genetic variability was associated with long-term complications after axillary surgery in breast cancer patients, suggesting that MMPs may have an important role as modulators of wound healing.