bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inadequate family history assessment by oncologists as a physician barrier to referral for cancer genetics evaluation.
Authors: Ow Samuel Guan Wei , Yong Yvonne Fong Ling , Chieng Wei Shieng , Phyu Pyar Soe , Lee Soo-Chin 
Published: March 2020

1535 Background: Cancer genetics programs have been established in tertiary cancer centers in Asia for more than a decade. However, the proportion of high-risk patients who are referred for genetic evaluation remains low, and may be attributed to physician and patient barriers. Methods: We reviewed 3-generation genograms of 6301 cancer (CA) patients constructed by a trained cancer genetics counselor at our centre between 2001 and 2012, and identified 1092 (17.3%) patients with suspected hereditary cancer syndromes. 618 patients were estimated to have ≥10% chance of carrying a BRCA1/2 mutation. Their case records were reviewed to determine the referral pattern to the cancer genetics clinic. Results: Of the 618 high risk patients, 420 (68%) had young onset CA (age <40), 112 (18.1%) were breast CA families, and 58 (9.4%) were breast and ovarian CA families; only 164 (26.5%) were seen in the cancer genetics clinic. Of the 391 records reviewed so far, 132 cases (33.8%) were referred for genetic evaluation. A good family history (FH), defined by obtaining CA history in 3 consecutive generations, was obtained by the primary oncologist in 52.2%, compared to adequate smoking and drinking history in 64.7% of cases (p<0.001). Taking a good FH increased the likelihood of oncologists suspecting hereditary breast and ovarian CA syndrome (50% vs 32.1%; p<0.001), with 79% (128/162) of physician-suspected cases referred for genetic counseling. Young onset CA was more likely to arouse physician suspicion (46.9%) compared to other indications (30.5%, p=0.002). Of the 259 high-risk cases that were not referred, lack of FH evaluation by the oncologist was the most common reason (41.3 %), followed by lack of suspicion despite taking a FH (34.7 %), patient refusal (8.6%), and planned but no formal action (1.6%). Conclusions: Failure to take a good FH and failure to recognize high-risk CA patients despite taking a FH are important physician barriers that resulted in only a third of high-risk breast or ovarian CA patients being referred for cancer genetics evaluation at a tertiary cancer center in Asia. Systematic FH screening by genetic counselors, clinic-based protocols, and continued physician education may rectify this barrier.
A randomized trial of telephone versus in-person disclosure of BRCA 1/2 results.
Authors: Bradbury Angela R. , Patrick-Miller Linda J. , Egleston Brian , Smith Kyle , Fetzer Dominique , Forman Andrea , Bealin Lisa , Rybak Christina , Rainey Kim , Cherry Carol , Montgomery Susan , Daly Mary Beryl 
Published: March 2020

1538 Background: While some providers use telephone to share genetic test results, there is limited data on the efficacy and impact on patient cognitive and emotional responses. Methods: Patients who completed in-person genetic counseling for BRCA 1/2 testing were randomized to telephone (TD) or in-person (IPD) disclosure. Baseline (BL) and post-disclosure (PD) surveys assessed knowledge, satisfaction and psychological factors. We used T-tests and multiple linear regressions. Results: 179 patients (68% of approached),126 (72%) agreed to be randomized; 36 (28%) declined randomization (Self-select IPD). Patient characteristics did not differ between arms. Change in knowledge, satisfaction and psychological factors did not differ between TD and IPD (Table). Self-select IPD participants had greater declines in depression and state anxiety (Table). In multivariable models, history of cancer was associated with greater declines in general anxiety (coef -1.4, p=0.01). BRCA+ results were associated with greater increases in knowledge (coef 3.2, p 0.02) and state anxiety (coef 12.0, p<0.01), and declines in satisfaction (coef -6.6, p<0.01). Having a mutation in the family was associated with greater declines in intrusive thoughts (coef -4.8, p<0.01). Conclusions: In general,telephone disclosure of BRCA1/2 results does not appear to negativelyimpact psychological outcomes but outcomes among carriers (BRCA+) differ. Larger studies are needed to understand the impact among subgroups and more diverse populations. Some patients preferred in-person communication and had different outcomes, suggesting more data is needed before telephone disclose is universally adopted. [Table: see text]
R497K of EGFR and BIM deletion polymorphisms as predictive biomarkers to EGFR TKIs in NSCLCs harboring wild-type EGFR.
Authors: Kang Jin Hyoung , Shin Jung-Young , Kim Jeong-Oh , Oh Ji-Eun , Jeon Eun Kyoung , Hong Sook Hee , Chun Sang Hoon 
Published: March 2020

1540 Background: Activating EGFR mutations are strongly predictive of EGFR tyrosine kinase inhibitor (TKI) activity in NSCLCs, however, some patients having wild type EGFRdo not infrequently show clinically favorable outcome to EGFR TKIs. The key proapoptotic proteins have been reported to be involved in TKI-induced cell death. The up-regulation of BIM, a pro-apoptotic protein of BCL2 family, is required for TKIs to induce apoptosis in cancers. Methods: For 150 advanced or metastatic NSCLC pts. receiving gefitinib or erlotinib, we assayed mutation status of EGFR in paraffin embedded tumor tissue using PNA clamping (PANAGENE, Korea) and direct sequencing. Six different genetic variants of EGFR (-191C>A, -216 G>T, CA repeat number, R497K, 2607G>A, and D994D) and BIMdeletion in genomic DNA extracted from peripheral blood were analyzed. Results: M:F ratio was 72:78 and median age was 63 (35~82). Histological subtypes are as follows: 131 adenocarcinoma (87.3%), 16 squamous cell ca. (10.7%) and 3 large cell ca. (1.3%). Objective tumor response (CR+PR) was observed in 60 pts. (40.0%) and SD in 44 pts. (29.3%). Median PFS and OS were 4.3 (0.4~67.4) and 18.6 (0.9~78.1) months, respectively. Of 129 pts. in whom EGFR mutation could be analyzed, 41 pts. (31.8%) had activating EGFR mutation. In univariate analysis, only gender was associated with objective response to EGFR TKI in activating EGFR mutant group (P=0.048). In wild type EGFR group (n=88), R497K (P=0.04) and BIM (P=0.04) as well as gender (P=0.05) were significantly correlated with objective response. In addition, multivariate analysis demonstrated that gender, R497K and BIM were associated with objective response to EGFR TKIs in wild type EGFR group with statistical significance (P=0.023, 0.027 and 0.018, repectively). Neither six EGFR polymorphisms nor BIM was correlated with PFS and OS in activating EGFR mutant group. Meanwhile, in wild type EGFR group, R497K was significantly associated with OS (P=0.028). Conclusions: Taken together, our data suggest that R497K of EGFR and BIM deletion polymorphisms are useful pharmacogenetic biomarkers to predict objective tumor response for EGFR TKIs in advanced NSCLC pts. harboing wild type EGFR.
Unique genetic characteristics of BRCA mutation carriers in a cohort of Arab American women.
Authors: Shatavi Seerin Viviane , Dohany Lindsay , Chisti Mohammad Muhsin , Jaiyesimi Ishmael A. , Zakalik Dana 
Published: March 2020

1541 Background: Worldwide ethnic variations in the distribution of BRCA1 and BRCA2 mutations of breast cancer patients have been recently recognized. This has led to investigations of the epidemiology, genetics and clinical characteristics of BRCA positive individuals within specific populations. This study aims to describe the findings of BRCA genetic testing in a cohort of Arab American women. Methods: A total of 73 women of Arab ancestry were evaluated in the Beaumont Cancer Genetics Program from Jan 2008 to Jan 2013. Criteria for genetic testing included a personal or family history suggestive of Hereditary Breast and Ovarian Cancer Syndrome (HBOC). Patients underwent comprehensive genetic counseling, followed by full sequence analysis for germline mutations in BRCA1 and BRCA2. Results: 63 women of Arab ancestry underwent genetic testing for BRCA1 and BRCA2. 13 (21%) patients were found to be mutation carriers, of whom 10 (16%) of the 63 had deleterious mutations (7 in BRCA2, and 3 in BRCA1), and 3 (5%) had variants of undetermined significance (VUS) in BRCA2. Of the 10 patients with deleterious mutations, 4 (40%) unrelated individuals had the same mutation, 5804del4, in exon 11 of BRCA2. The remaining patients had deleterious mutations in exon 2, exon 20, and exon 13 of BRCA2; one patient had a BRCA1 and BRCA2 mutation (exon 18). 7 of 10 patients with deleterious mutations had a cancer diagnosis, of which 5 had breast cancer, 1 had ovarian cancer, 1 had pancreatic cancer, and 3 were unaffected. Conclusions: This study demonstrates that BRCA mutations (predominantly in BRCA2) were seen in a significant proportion of Arab American women undergoing genetic testing for HBOC. A mutation in BRCA2, 5804del4, was seen in nearly half (4/10) of the carriers of deleterious mutations. This mutation, in exon 11, has not previously been associated with Arab ethnicity and may represent a founder mutation. Knowledge of the genetic spectrum, frequency, and clinical characteristics of BRCA mutation carriers will lead to greater understanding of hereditary cancer in Arab American women.
BRCA1/2 mutation prevalence among triple-negative breast cancer patients from a large commercial testing cohort.
Authors: Zonno Kristilyn Dillman , Kaldate Rajesh R. , Arnell Christopher , Saam Jennifer , Abbott Brian , Hartman Anne-Renee 
Published: March 2020

1544 Background: BRCA1/2 deleterious mutation identification among triple-negative breast cancer (TNBC) patients has gained importance due to cancer-risk management implications for patients and their relatives, and also has an emerging role in guiding treatment selection for therapies such as PARP inhibitors. The National Comprehensive Cancer Network (NCCN) currently recommends BRCA1/2 testing for TNBC patients diagnosed at age <60. Mutation prevalence among TNBC patients has previously been studied only in small regionalized cohorts. A recent study in unselected patients using the updated definitive criteria for TNBC reported mutation prevalence as 10.6%. Methods: Following the 2011 NCCN Hereditary Breast and Ovarian Cancer (HBOC) Testing Criteria update, serial cohorts of > 5,000 Ashkenazi Jewish and > 65,000 non-Ashkenazi Jewish breast cancer patients undergoing commercial BRCA1/2 testing were analyzed. Age at diagnosis, ethnicity, and provider-reported TN status were obtained from test requisition forms completed by ordering providers, and correlated with test results. Neither the accuracy nor definitive criteria used for TN status reported was independently verified. Results: Incidence of TNBC was reported as 9.7% among non-Ashkenazi patients and 16.5% within the subset with African ancestry. Incidence of TNBC was reported as 4.5% among Ashkenazi patients, but this is likely affected by test ordering for this population. The Table displays the BRCA1/2mutation rates classified by ethnicity and age-group. Conclusions: This study provides the most robust estimate to date of BRCA1/2 mutation prevalence among TNBC patients of all ages. The mutation rates seen among TNBC patients diagnosed after age 60 also illustrate the importance of testing such patients who may not meet the current NCCN HBOC testing criteria. [Table: see text]
Risk of hospital-related morbidity among survivors of breast cancer in British Columbia, Canada.
Authors: Simmons Christine E. , Wai Elaine , Tyldesley Scott , Lorenzi Maria , Li Dongdong , McBride Mary L 
Published: March 2020

1551 Background: Long-term consequences of cancer diagnosis and treatment are of increasing concern, as therapeutic interventions improve survival. Various survivorship programs exist; few address the importance of bridging oncology and primary care. This study assesses risk of late hospital-related morbidity among a population-based cohort of 39,436 3-year survivors of female breast cancer in British Columbia, Canada and compares the risk of morbidity to a similarly-aged comparison group. Methods: Demographic and clinical records of breast cancer survivors diagnosed between 1986 and 2005 were linked to inpatient records from provincial administrative databases. A comparison group from the provincial health insurance plan registry, frequency-matched by birth cohort was identified. Morbidity was ascertained from diagnosis codes listed on hospital records, and categorized by organ system. Poisson regression was used to assess the relative risk of morbidity, adjusting for sociodemographic factors. Results: Compared to controls, non-relapsed survivors diagnosed age 18-39 (N=1158) had more than twice the risk of morbidity (RR 2.57, 95%CI 2.21-2.98); those with a relapse (N=580) had eight times the risk (95% CI 6.78-9.44). Among those diagnosed age ≥40, non-relapsed survivors (N=20473) had a 62% increase in risk RR 1.62, 95% CI 1.57-1.68; relapsed survivors (N=5223) had triple the risk of morbidity (RR 2.89, 95% CI 2.78-3.01). In both cohorts, excess risks were statistically significant for most types of non-neoplastic morbidity, with highest rates seen for disorders of the blood, endocrine, skin and circulatory systems. Among survivors, those diagnosed with a higher stage cancer had increased risk of morbidity. Type of treatment received did not correlate with increased risk of morbidity (RR 1.05, 95% CI 1.00–1.11 for combination of surgery, radiation and systemic therapy vs surgery alone); majority of the risk increase is likely related to the impacts of cancer itself rather than treatment. Conclusions: Survivors of breast cancer are at an increased risk of a wide range of morbidities years after diagnosis. This underscores calls for improved models of survivorship care and continued survivorship research.
Increasing dietary rice bran consumption for colorectal cancer prevention and control.
Authors: Borresen Erica , Weir Tiffany , Doyle-Gundlach Kerry , Wdowik Melissa , Brown Regina J. , Marschke Robert Frederick , Dickson Erica , O'Malia Joanne , Bazan Marlon , Ryan Elizabeth 
Published: March 2020

1558 Background: Emerging evidence supports that dietary rice bran (RB) exhibits colorectal cancer (CRC) control and prevention activity, yet a significant knowledge gap exists for feasibility of increased RB intake in humans. BENEFIT (Bran Enriching Nutritional Eating For Intestinal health Trial), is a community-academic partnership for dietary chemoprevention research. Our main objectives were to pilot the feasibility of increased RB consumption in healthy adults, with and without a history of CRC, and to examine changes in gut microflora and fecal metabolite profiles following RB consumption. Methods: Seven meals and six snacks were developed for inclusion of dietary RB (30g/day). A total of 15 adults (7 non-cancer and 8 CRC survivors) completed the randomized-controlled, dietary intervention trial. Participants were blinded to their study group (placebo-control or RB) and consumed one study meal and snack daily for 28 days. Blood, urine, saliva and stool samples were collected at baseline, 2-week, and 4-week timepoints for metabolomic and microbiome analyses. Participants recorded weekly 3-day dietary food logs. Results: Adding RB (30g) into prepared foods provided 4-8% daily caloric intake with 95.5% intervention compliance. Inclusion of RB or control diet intervention in our non-cancer cohort did not result in a major shift of the fecal microbiome after 2- and 4-weeks. For CRC survivors, we observed that 19% of the total variation in the fecal microbiome was due to the rice bran intervention. At the genus level, we saw changes in Bacteroides, Bifidobacterium, and Ruminococcus. Principal Components Analyses of fecal metabolome detected using liquid-chromatography mass spectrometry revealed 16% variation between time points and 8% variation when comparing RB and control groups at 4 weeks. Candidate metabolites from ~50 features will be determined by spectral libraries and database matches. Conclusions: The accessibility, affordability, and availability of RB support the global public health impact potential for novel RB “phytochemical teamwork” based CRC control and prevention strategies. These findings warrant further evaluation of increased RB intake in a larger cohort for CRC control and prevention.
Addressing tobacco use and cessation in cancer patients: Practices, perceptions, and barriers reported by oncology providers.
Authors: Warren Graham Walter , Marshall James Roger , Cummings K. Michael , Toll Benjamin A , Gritz Ellen R. , Hutson Alan , Dibaj Shiva , Herbst Roy S. , Mulshine James L. , Hanna Nasser H. , Dresler Carolyn 
Published: March 2020

1561 Background: Tobacco use is associated with adverse outcomes in cancer patients, but there are limited data on tobacco cessation support by oncology providers. Methods: Duplicate surveys were sent to the membership of the International Association for the Study of Lung Cancer (IASLC) and the American Society of Clinical Oncology (ASCO) asking about tobacco assessment and cessation practices, perceptions of tobacco use by cancer patients, and barriers to implementing tobacco cessation. The results of 1,507 responses from IASLC and 1,197 responses from ASCO are reported. Results: At initial consult, most respondents asked about tobacco use (90% in both surveys), asked if smokers would quit tobacco use (79-80%), advised patients to stop smoking (81-82%). Most respondents felt that tobacco affects cancer outcomes (87-92%) and that tobacco cessation should be a standard part of clinical care (86-90%). However, few discussed medication options (40-44%) or actively provided smoking cessation assistance (39% in both surveys). Fewer respondents asked about tobacco use at follow-up and few reported adequate tobacco cessation training (29-33%). Dominant barriers to providing cessation interventions included patient resistance to cessation treatment (67-74%) and inability to get patients to quit tobacco use (58-72%), but very few believed tobacco cessation was a waste of time (8-12%). Lack of time, reimbursement, lack of training, and lack of resources were reported as barriers in less than 50% of respondents. Conclusions: Oncology providers feel tobacco affects cancer outcomes and cessation should be a standard part of clinical care. Most assess tobacco use, but few discuss medication options or provide active cessation support. Efforts are needed to improve cessation methods in cancer patients and to improve access to tobacco cessation support for cancer patients.
Patients’ reactions to a decision aid about lung cancer screening with low-dose spiral computed tomography: An uncontrolled trial.
Authors: Volk Robert J. , Linder Suzanne K. , Leal Viola , Rabius Vance A. , Cinciripini Paul M. , Kamath Geetanjali R. , Munden Reginald F. , Bevers Therese Bartholomew 
Published: March 2020

1564 Background: Results from the National Lung Screening Trial (NLST) and a recent ASCO-supported systematic review concluded that screening with low-dose spiral computed tomography (LDCT) reduces lung cancer deaths among selected heavy smokers. Yet, this mortality benefit must be weighed against the potential harms of screening (e.g., high false positive rate). In anticipation of LDCT screening becoming a reimbursable preventive health service, we developed and evaluated a brief, video-based patient decision aid designed for use in clinical settings. Methods: Patients from a tobacco treatment program who were 45 to 75 years of age and had no history of lung cancer participated in the study. Measures of acceptability and ratings of the aid were included. We assessed effectiveness of the aid via knowledge about lung cancer and the benefits and risks of screening, and clarity of values using the Decisional Conflict Scale. Results: Fifty-two patients completed the study (mean age=58.5 years; mean average years smoking=34.8 years). Over 94% of patients watched the entire video, would recommend it to others, felt it held their interest, rated the content favorably, and wanted to view similar video-based aids. Acceptability was high, although 23.3% wanted more information about the NLST findings and evidence base. After viewing the aid, knowledge about lung cancer screening increased significantly (before viewing aid, 25.5% of questions answered correctly; after viewing aid, 74.8%; P<.01). The majority of patients continued to have difficulty with the question about whether all current and former smokers should be screened for lung cancer (23.1% answered correctly). Patients reported being clear about which benefits and harms of screening mattered most to them (94.1% and 86.5% were clear, respectively). Conclusions: Our decision aid was rated favorably by tobacco treatment patients. Large gains in knowledge about lung cancer screening were observed, highlighting the important informational function of the aid. Additional features under consideration for the aid include screening eligibility assessment and information about the evidence behind the screening recommendations.
Increasing access to tobacco cessation support for cancer patients: Results of an institution-wide screening and referral program in an NCI-designated comprehensive cancer center.
Authors: Reid Mary E. , Dobson Amato Katharine , Zevon Michael , Reed Robert , Hysert Pat , Hysert Robert , Segal Stephanie , Mahoney Martin , Nwogu Chukwumere E. , Hyland Andrew , Marshall James Roger , Cummings K. Michael , Warren Graham Walter 
Published: March 2020

1566 Background: Guidelines from ASCO and other national organizations recommend assessment of tobacco use and structured tobacco cessation support for cancer patients. However, most oncology providers fail to provide cessation assistance to cancer patients who use tobacco. Reported are results of a systematic approach to assessing tobacco use and delivering cessation support for cancer patients in a comprehensive cancer center. Methods: A standard set of evidence based tobacco assessment questions were incorporated into an automated electronic medical record based system delivered by nursing at initial consult and follow-up. Patients eligible for tobacco cessation support (i.e. patients self-reporting tobacco use within 30 days) were automatically referred to a dedicated tobacco cessation service providing primarily phone based cessation support. Results: Of approximately 11,900 patients screened over 26 months, 2,978 patients were automatically triaged for cessation support. Contact priority was given to newly diagnosed patients in tobacco related disease sites. Using 1.25 full time cessation specialists, 1,531 received only a standard tobacco cessation mailing and no further contacts were attempted by the cessation service. In 1447 patients with attempted phone contact by the cessation service, 1189 (82.2%) were reached within 5 contact attempts. In 1,189 patients contacted, 52 (4.4%) were inappropriate referrals, 245 (20.6%) were in an active quitting phase, 465 (39.1%) were willing to prepare, and only 24 (2.0%) refused any intervention at initial contact. At the most recent follow-up, 44 patients (3.7%) requested no further contact and 90 additional patients (7.6%) were lost to follow-up. In the 1,045 remaining patients, 338 (32.3%) reported quitting tobacco use. Notably, in the 1,531 patients with no phone contact by the cessation service, only 14 proactively contacted the cessation service for assistance. Conclusions: An institution wide program to automate the delivery of tobacco cessation services was feasible with high patient contact rates, low patient refusal, and moderately high tobacco cessation rates.