bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence, screening, treatment, and complications of osteoporosis and osteopenia in Medicare patients with chronic lymphocytic leukemia (CLL).
Authors: Brander Danielle M. , Oeffinger Kevin C. , Greiner Melissa A. , Dinan Michaela Ann 
Published: May 2020

e24050 Background: Despite treatment advances, patients (pts) with CLL, a common chronic cancer affecting the elderly, often experience adverse outcomes due to their comorbidities and frequent lack of routine health maintenance. We examined osteoporosis/osteopenia (OSTEO) prevalence, rates of bone mineral density (BMD, g/cm2) screening by dual-energy x-ray absorptiometry (DXA), use of bisphosphonates, and fragility fractures among Medicare pts with CLL. Methods: We identified a cohort of CLL pts >65 years with Medicare fee-for-service between 1/1/2011-12/31/2015 using the Medicare 5% national sample. Controls (5:1) were matched based on age, sex, race, and year of eligibility. Among those with OSTEO, we compared rates of bisphosphonates. Chi-square tests for categorical variables and Wilcoxon Rank-sum tests for continuous variables were used to compare CLL vs controls. Cumulative incidence of BMD screening and fragility fractures were estimated using the cumulative incidence function and compared to controls using Gray tests. For fragility fractures, we compared among subgroups with and without OSTEO. Results: Baseline characteristics are in the Table. Compared to controls, CLL pts were more likely to have OSTEO (p < .001) but less bisphosphonate use (p = .006). The 3-yr cumulative incidence of fragility fractures was higher among CLL pts (8.0%, 95% CI 7.5%-8.6%) vs controls (7.2%, 6.9%-7.4%; p = .002) as well as among those without an OSTEO diagnosis (p = .02). Cumulative 3-yr DXA use was higher among CLL pts vs controls ( < .001); however, DXA 3-yr incidence was lower in CLL pts who had chemotherapy (13.2%, 11.4%-15.4%) vs none (17.0%, 16.2%-17.9%, p = .002). Conclusions: It appears that CLL pts may have a higher risk of osteoporosis and higher rates of fragility fractures than non-CLL individuals. Fragility fractures are higher even in the subgroup of CLL pts without OSTEO, suggesting that pts may be underdiagnosed. [Table: see text]
Patterns in progression from early stage melanoma to late stage melanoma: Implications for survivorship follow up.
Authors: Switzer Benjamin , Savage David James , Song Jung Min , Stanek Carolyn , Funchain Pauline 
Published: May 2020

e24055 Background: Despite an encouraging 99% five-year survival in patients diagnosed with early-stage melanoma, a higher proportion of fatal melanomas initially present with thin ( < 1mm) rather than thick ( > 4mm) melanoma.1 Therefore, early-stage melanoma survivorship remains a topic of high interest. We examined a cohort of early-stage melanomas which progressed to stage IV to inform survivorship and risk-stratification approaches in this large, understudied population. Methods: From a retrospective single-center study of 880 consecutive melanoma patients from 2016-2020, we identified new, non- de novo diagnoses of stage IV melanoma which progressed from an initial early-stage (IA-IIA) diagnosis. Descriptive data were collected via chart review on demographics, clinical features, presentation at time of progression, and follow up prior to progression. Results: A total of 50 patients met the inclusion criterion of an initial stage IA-IIA diagnosis with subsequent progression to stage IV melanoma. Primary early stage melanomas were diagnosed an average of 6.1 years prior to metastatic disease progression, with 46% (n = 23) diagnosed within 3 years, 22% (n = 11) between 4-6 years, 12% (n = 6) between 7-10 years, 8% (n = 4) between 10-12 years, and 12% (n = 6) beyond the 12 year mark from their initial early-stage diagnosis. Average age at time of diagnosis was 57.7 (median 60, range 21-68), and 62% (n = 31) were male. The two most common early-stage diagnostic sites were lower extremities (27.5%, n = 14) and back (23.5%, n = 12). The two most common sites of metastatic disease were lung (46%, n = 23) and brain (28%, n = 14). A total of 30% (n = 15) and 34% (n = 17) of this cohort maintained follow up with oncology and dermatology, respectively, prior to their stage IV diagnosis. Symptomatic disease lead to 80% (n = 40) of stage IV diagnoses, while 14% (n = 7) were diagnosed through routine oncologic or dermatologic follow up, and the final 6% were diagnosed incidentally. Conclusions: Early stage melanoma patients who develop stage IV disease exhibit wide ranges in onset of disease progression, thus survivorship plans for this group could include a combination of early provider screening and patient education for later presentations of metastatic disease. Due to relatively common metastatic involvement of the lung and brain, a high suspicion to screen for metastatic disease with symptoms involving these organs may be appropriate.
Human sperm cryopreservation prior cancer treatment: Follow up of 480 males for 23 years.
Authors: Teloken Isadora B , Petracco Alvaro , Fay Andre P. , Teloken Claudio , Badalotti Mariangela 
Published: May 2020

e24061 Background: Cancer treatment represents a potential risk for spermatogenesis and may compromise male fertility. Semen freezing has become a routine process for male patients prior to cancer treatment to preserve their fertility. We sought to provide information regarding what happens to the cryopreserved material and the fertility in cancer treated patients. Using a cohort from a 23-year cryopreservation program. Methods: Patients whom cryopreserved sperm to preserve fertility due to diagnosis of cancer between 1995 and 2018 in a single private center of reproductive medicine in south of Brazil were selected. A retrospective analysis of medical records was performed and clinico-pathological characteristics were collected using standard templates. Results: A total of 480 patients were evaluated for sperm cryopreservation before cancer treatment. Testis cancer was the most prevalent (59.3%), followed by hematologic malignancies (21.4%) and prostate cancer (5.4%). The age at cryopreservation varied from 14 to 72 y/o. Among them, 61.3% were up to 30 years old, and 10.8% more than 40 y/o. 8 patients decided to not cryopreserve The mean time between the freezing and the beginning of cancer treatment was 5.5 days. Eleven patients presented azoospermia; 3 of them froze testicular tissue. A shorter time between cancer diagnosis and sperm banking was observed for hematologic malignancies ( p=0.044). Out of the 472 patients, 46.8% still keep the sperm cryopreserved, 34.3% decided to discard it, 1.9% transferred it to another clinic, 8,5% abandon the specimen and 8,5% died without using it. The main reason for discard the sample was pregnancy and/or normal sperm count after treatment. The mean age of discarding was 35.7±10.3 years old. The period of maintenance cryopreservation was 5 years (min 1 month, max 23 years). The mean time of freezing before abandoning was 7.5±4.4 years Eighty-two patients achieved pregnancy. Spontaneous pregnancies occurred in 53 cases, and 47 underwent assisted reproduction with the cryopreserved sample, with 61,7% of pregnancy (n=29).15.3% of those that have children still keep the sperm cryopreserved; 11.4% gave up on having children. Out of the 133, 66.9% authorized the use of their specimen post-mortem. Conclusions: Only one third of the patients have maintained fertility after cancer treatment and 35% of pregnancies after cancer treatment were possible due to sperm preservation. Considering the high pregnancy rate with assisted reproduction techniques in patients that lost testicular functionsemen cryopreservation is warranted.
The impact of socioeconomic factors and survivorship on radiation induced hypothyroidism in a single institution cohort study.
Authors: Milas Zvonimir , Carrizosa Daniel R. , Brickman Daniel , Frenkel Catherine , Stewart Ashley , Sumrall Ashley Love , Neelands Brittany , Trufan Sally Jeanne , Sudhakar Shwetha , Ward Matthew Christopher 
Published: May 2020

e24065 Background: To determine factors associated with the development of post-treatment hypothyroidism (HY) in the head and neck (HN) population as well as evaluate the impact of socio-economic factors and survivorship program. Methods: We collected demographics, insurance coverage, disease staging, treatment characteristics, and details of thyroid function measurement as well as supplementation for all HN oncology patients (n = 608) who presented between January 2011 and January 2019 at Levine Cancer Institute, Charlotte, North Carolina. Insurance was categorized as Government (Medicaid or Medicare), Private, or Uninsured. Patient malignancies were grouped as oropharynx, oral cavity, larynx/hypopharynx, nasopharynx, nasal cavity/sinus, or primary salivary gland. Thyroid function was evaluated by use of laboratory thyroid stimulating hormone (TSH) values. Timing of thyroid supplementation was standardized to start of treatment. Details of thyroid hormone supplementation was collected. Data was analyzed with Chi-square and ANOVA methods, using SAS 9.4 (Cary, NC). Results: 483 patients (79%) had post treatment surveillance with TSH. The patients (n = 125, 21%) with no identifiable thyroid surveillance did not have any racial or socioeconomic disparities identified. Caucasian and African American thyroid surveillance rates were similar at 79% and 81%, respectively. There was no difference based on insurance: Government 81%, Uninsured 81%, and Private 76%. Of patients with thyroid surveillance, 203 (42%) developed post-treatment HY. The mean and median time frame until HY identification was 544 days and 450 days, respectively. A mean and median dose of thyroid hormone supplementation of 75 mcg of levothyroxine. Most patients had lower rates of thyroid dysfunction with TSH levels between 5-10. Fewer African Americans (24%) developed HY than Caucasians (47%). Patients with laryngeal cancer were at greatest risk to develop HY (57%), followed by oropharynx (40%) and oral cavity (40%). Staging did not demonstrate a significant difference between development of HY. Conclusions: This study is the largest cohort of HN patients to be evaluated for post HN treatment induced HY. Oncology team providers and primary care physicians should be aware of the significant rates of HY. In our institution we identified a consistency of care provided regardless of socioeconomic and racial factors.
Feasibility and acceptability of yoga to improve psychosocial and physical function among patients with lung cancer: A pilot study.
Authors: Medysky Mary E , Sullivan Donald Richard , Tyzik Anna , Thomas Charles R. , Winters-Stone Kerri M. 
Published: May 2020

e24068 Background: Patients with lung cancer suffer from depression symptoms, reduced quality of life (QOL), and declines in physical function during and after cancer treatment. Since yoga is a low energy demand form of exercise, we hypothesized that yoga is a feasible, safe, and efficacious strategy to mitigate these problems in lung cancer patients. Purpose: 1) Determine the feasibility, acceptability, and safety of a yoga program in patients (pts) with lung cancer during or soon after cancer treatment; 2) Determine the preliminary efficacy of yoga to improve depressive symptoms, quality of life, and physical function among pts with lung cancer. Methods: This study was a single group 12-week (wk) pilot trial of low-moderate intensity yoga among pts with stages I-IV lung cancer (n = 20) during (n = 14) or after (n = 6) cancer treatment. Assessments conducted at baseline, 6- and 12-wks included the Patient Health Questionnaire-8, Functional Assessment of Chronic Illness Therapy-Lung (FACT-L), 6-minute walk distance (6MWD), hand grip strength, chair stand time, and flexibility (back scratch and sit-reach) tests. Results: At baseline, 20 pts, including those with metastatic disease (n = 8), enrolled and 7 pts (35%) withdrew by 6-wks due to poor/worsening health. No further withdrawals occurred at 12-wks. Among pts (n = 13) who completed the study, adherence to the intervention was 75% and 78% at 6 and 12-wks, respectively. No moderate or serious adverse events were reported. Over 12 wks, depressive symptoms (average = -1.8 ±1.23, 43.9% change) decreased, improvements in QOL improved (average = +4 ±2.9, 6.5% change),6MWD (average = +22.6m ±15.9, 6.5% change), hand grip strength (average = +1.6kg ±1.2, 5.7% change), chair stand time (average = -3sec ±2.1, 5.8% change), and upper (average = -10.8cm ±7.5, 49.4% change) and lower (average = -11.9cm ±8.4, 74.6% change) body flexibility occurred. Conclusions: In this sample of lung cancer pts, a 12-week yoga program was modestly feasible, was shown to be safe and potentially beneficial for psychosocial and physical function. Though retention was lower than expected due to early pt withdrawal for poor health, adherence to supervised practice among those pts who were able to complete the intervention exceeded the target goal. Among pts with stage I-IV lung cancer yoga may be a useful strategy to improve psychosocial outcomes and physical functioning, though alternate delivery approaches for pts with advanced disease deserves further exploration. Clinical trial information: NCT03649737 .
Pectoralis muscle wasting during chemotherapy.
Authors: Wiederin Jason , Gu Christina , Jewett Patricia , Blaes Anne Hudson 
Published: May 2020

e24069 Background: Chemotherapy is often followed by muscle mass loss which has been associated with frailty. We explored factors associated with change in pectoralis muscle mass after chemotherapy. We hypothesized greater muscle loss with time would be associated with poorer overall survival. Methods: We identified individuals with breast cancer (N = 221), sarcoma (N = 115), and lymphoma (N = 216) who received chemotherapy at the University of Minnesota MHealth Fairview and had CT scans before and after chemotherapy. Right pectoralis muscle area was measured using CORESLICER and indexed to body surface (right pectoralis muscle area [cm2] / body surface [m2]). We calculated quartiles of the indexed pectoralis measure. We restricted our analyses to participants who received a follow-up CT within two years after starting chemotherapy. In a multivariate linear regression, we explored associations of sex, age, BMI, ever-smoking, time since start of chemotherapy, indexed baseline muscle area, stage, type of diagnosis, and cumulative anthracycline dose with relative (%) change in muscle area. In a Cox regression we tested the association of relative muscle change with overall mortality. We used cubic splines to test for nonlinear effects. Results: Of 477 participants (66% female; mean age 61.3 (10.1) years), 366 received anthracyclines, 61 Trastuzumab, and 60 both. The average loss in right pectoral muscle area was -10% for women and -12% for men. We detected nonlinear effects of indexed baseline muscle area, P = 0.03. In a model using quartiles of indexed baseline muscle area, significant predictors of muscle loss included sex (women vs. men, -9.0%, 95% confidence interval (CI) -14.2- -3.7%, P = 0.0008), larger indexed baseline muscle area (quartiles 2, 3, 4 compared with quartile 1, change range -7 - -24%, 95% CI range, -2 - -30%, P-range < 0.0001 – 0.006), smoking (ever vs. never, -4.1%, 95% CI -7.6 - -0.7%, P = 0.02), and diagnosis (sarcoma vs breast cancer, -5.7%, 95% CI -11.1 - -0.3%, P = 0.04). There was no significant association between muscle change and overall survival (median follow-up time 4.1). Conclusions: Being female, larger baseline muscle mass (per m2 body surface), ever-smoking, and a sarcoma diagnosis were associated with greater relative muscle loss after chemotherapy. More data is needed to understand the course of sarcopenia in terms of recovery and survivorship. [Table: see text]
Characterization of chemotherapy-induced peripheral neuropathy (CIPN) using patient-reported outcomes (PRO) and quantitative sensory testing (QST).
Authors: Bao Ting , Zhi Wanqing Iris , Chen Connie , Baser Raymond E , Li Qing Susan , Panageas Katherine , Harte Steven , Mao Jun J. 
Published: May 2020

e24078 Background: CIPN is a common, potentially debilitating, and dose-limiting side effect experienced by cancer survivors. CIPN encompasses symptoms such as pain, numbness, and tingling, which can be measured subjectively by PRO, or semi-objectively by QST; however, little is known about how QST measures differ among patients with and without CIPN, or if QST outcomes correlate with symptom profiles measured by PRO. Methods: CIPN is a common, potentially debilitating, and dose-limiting side effect experienced by cancer survivors. CIPN encompasses symptoms such as pain, numbness, and tingling, which can be measured subjectively by PRO, or semi-objectively by QST; however, little is known about how QST measures differ among patients with and without CIPN, or if QST outcomes correlate with symptom profiles measured by PRO. Results: 116 patients with CIPN and 10 control patients without CIPN were analyzed. NRS and FACT/GOG-Ntx scores were significantly worse in the CIPN group compared to controls (all p< 0.001). The mean (Standard Deviation) TT for CIPN and control patients was 3.61 (0.43) and 3.38 (0.32), respectively (p = 0.059), in hands; and 3.86 (0.70) and 3.38 (0.56), respectively (p = 0.043), in feet. The mean VT was 6.06 (3.45) and 3.87 (1.01), respectively (p=0.032), in hands; and 19.14 (11.09) and 8.43 (3.22), respectively (p<0.001), in feet. There was no significant difference in THT between groups. The correlation coefficients between PRO with QST measures in all patients are listed in the table below. Conclusions: Our study suggested that patients with CIPN have significantly worse symptoms and tactile and vibratory threshold measured by QST when compared with controls. Mild to moderate correlations were observed between PROs and QST, suggesting that CIPN symptoms severity correspond to sensory sensitivity. As CIPN presents a diverse range of symptoms, improved quantification of subjective and objective measures for CIPN can help the incorporation of these tools into future clinical trials. Clinical trial information: NCT03183037 and NCT03292328 . [Table: see text]
Factors associated with frequent insomnia among breast cancer survivors.
Authors: Kwak Agnes , McDonough Allison L. , Jimenez Rachel , Lei Yvonne Y. , Haggett Dana , Johnston Katherine T. , Spring Laura , Moy Beverly , Peppercorn Jeffrey M. 
Published: May 2020

e24098 Background: Insomnia is common among breast cancer (BC) survivors and often goes unrecognized and untreated. We sought to evaluate the association between frequent insomnia and potentially modifiable contributing factors to inform development of a comprehensive clinical program to address insomnia among patients with breast cancer. Methods: We adapted a 1-page survey from the National Comprehensive Cancer Network Guidelines for Survivorship, which was administered to BC survivors at oncology or primary care follow-up visits at our academic center and community based sites. The survey included 23 plain-language statements regarding symptoms, lifestyle concerns, and financial worries. Patients reported the frequency of concerns using a 5-point Likert scale (0 = never to 5 = always). We evaluated the frequency of insomnia and association between insomnia and 6 common concerns hypothesized to contribute among this population: emotional distress, fatigue, pain, hot flashes, fear of cancer recurrence, and healthcare-related financial stress. Prevalence of symptoms was dichotomized, grouping “very often” and “always” as “frequent”, and “sometimes,” “rarely”, and “never” as “infrequent”. Descriptive analysis was performed and associations between insomnia and other concerns were evaluated with Fisher’s exact test. Results: Among 192 patients (median age 59, range 34-92), 46 (24%) reported frequent insomnia (“I have problems falling or staying asleep”). Most patients (58%) reported experiencing insomnia at least “sometimes”, while 20% answered “rarely” and 23% “never”. Overall, 14% of survivors reported frequent anxiety/depression, 15% fatigue, 27% pain, 19% hot flashes, and 23% fear of recurrence. Only 6% of patients reported frequent financial worries due to healthcare costs. Emotional distress (p=0.016), fatigue (p≤0.001), pain (p≤0.001), hot flashes (p=0.017), and fear of recurrence (p≤0.01) were each associated with frequent insomnia. Conclusions: BC survivors who experience frequent insomnia are more likely to report emotional distress, fatigue, pain, hot flashes, and fear of recurrence, compared to those with infrequent insomnia. A clinical program designed for the management of insomnia may benefit from targeting these potentially contributing factors.
Diabetes mellitus in childhood and young adult cancer survivors: A meta-analysis.
Authors: Kushnir Igal , Bhatia Dominika , Srikanthan Amirrtha , Lega Iliana 
Published: May 2020

e24101 Background: Diabetes mellitus (DM) has emerged as a possible late sequela after successfully treating pediatric and young adult (YA) malignancies. We conducted a systematic review and meta-analysis in order to quantify this risk and assess possible risk factors. Methods: We searched MEDLINE and EMBASE databases from inception to April 2019. We included cohort or case-control studies that reported the risk of DM (hazard ratio [HR], relative risk, or odds ratio, and 95% confidence interval [CI]) among childhood and YA cancer survivors ( < age 21 years) compared to those without a history of childhood or YA cancer. We used the Newcastle-Ottawa Score (NOS) to assess risk of bias and study quality. Study effect estimates were pooled using random-effects meta-analyses. Heterogeneity was assessed using the I2 statistic. Results: After applying our exclusion/inclusion criteria, we included 6 articles in our meta-analysis, with a median follow-up time of 11 (range 10-23) years. The median NOS score was 8 (range 7 – 8), indicating high study quality. The risk of DM was significantly higher in childhood and YA cancer survivors relative to controls (HR 1.66, 95% CI 1.54 to 1.79, I2 = 1%). Among cancer types, the highest risk for DM was reported after treatment for leukemia (HR 2.91, 95% CI 2.01 to 4.22 I2 = 75%), lymphoma (HR 1.63, 95% CI 1.37 to 1.94, I2 = 0%) and central nervous system malignancies (HR 1.77, 95% CI 1.30 to 2.39, I2 = 49%), relative to controls. Receiving total body irradiation or abdominal radiation was associated with a DM risk of 4.52 (95% CI 2.29 to 8.93, I2 = 87%), relative to controls. Conclusions: Our meta-analysis demonstrated an increased risk of developing DM among childhood and YA cancer survivors. More emphasis on screening for DM and prevention among this population should be offered.