bluuebunny/crossref_metadata_2025_split huggingface dataset:
Empowering lung cancer survivors and family members to “breathe easier”: Adaptation and evaluation of a m-health intervention.
Authors: McDonnell Karen Kane , Owens Otis L , Beer Jenay M , Smith Kasey , Kennedy Taylor , Acena Dane , Gallerani David 
Published: May 2019

e23046 Background: Survivors of lung cancer often experience a myriad of symptoms that have devastating effects on their physical and psychological functioning such as dyspnea, fatigue, and stress. To combat these symptoms, the American College of Chest Physicians has recommended the use of complementary therapies. Mindfulness-based Cancer Recovery (MBCR) can empower survivors, and caregivers who often cope with their own health problems and the stress related to caring for a survivor. Our goal is to deliver a tailored, culturally sensitive, MBCR intervention to survivors and family members via a mHealth app. Methods: This research was comprised of four phases. Phase I was the development and testing of an 8-week in-person intervention called Breathe Easier with survivors and family members (dyads). Phase II adapted Breathe Easier into a mHealth app prototype utilizing user-centered design. Phase III was a focus-group evaluation of the usability and acceptance of the mHealth app prototype by survivors and family members. Phase IV was comprised of additional interviews with an African-American subset of survivors and family members to assess the cultural sensitivity of the mHealth app. Results: Findings from the in-person intervention (n = 62) showed that all agreed the intervention materials were acceptable, different levels of yoga, breathing exercises, and meditations helped them, and involving a family member was important. Preliminary analyses showed survivors had less dyspnea and perceived stress over time (T1 vs T2). Both groups had improved fatigue and sleep scores. Findings from the mHealth app design and acceptance evaluation were organized into two primary categories: usefulness and ease of use. User-friendly design recommendations included aesthetic appeal, navigation layout, and display of content. Furthermore, potential health outcomes, privacy concerns, and comparison to in-person interventions also influenced app usefulness and acceptance. Lastly, findings from our cultural sensitivity assessment demonstrated that the mHealth app was culturally sensitive for African-Americans, but some changes were recommended. Conclusions: MBCR interventions hold great promise for improving the lives of racially diverse survivors of lung cancer and family members. An mHealth app will increase accessibility. However, special consideration of app design is needed to ensure future acceptance and longer-term usage.
Preliminary result of phase II study of megestrol combined with 5-hydroxytryptamine 3 inhibitor and dexamethasone for the prevention of nausea and vomiting induced by high emetogenic chemotherapy.
Authors: Wu Qiong , Luo Suxia , Li Ning , Deng Wenying , Ma Yijie , Yang Xinyi 
Published: May 2019

e23049 Background: Chemotherapy-induced nausea and vomiting (CINV) is one of the most distressing treatment-related side effects and have a strong impact on treatment adherence. A triplet antiemetic regimen, which is composed of neurokinin-1 receptor antagonist (NK1 RA), 5-hydroxytryptamine 3 (5-HT3) inhibitor and dexamethasone, is recommended by current antiemetic guidelines. However, NK1 RA is not available in hospital and more expensive for Chinese patients. Megestrol is currently known as more effective appetite stimulants in patients with cachexia or loss of appetite, but its antiemetic properties are less well known. Therefore, the aim of this study was to further evaluate the efficacy and safety of megestrol for the prevention of CINV. Methods: Patients treated with high emetogenic chemotherapy (HEC) were randomly divided into experimental group and control group. The antiemetic regimen of control group: 5-HT3 inhibitor 5mg/d, dexamethasone 12mg/d1, 8mg/d2-4. The regimen of experimental group: the use of 5-HT3 inhibitor and dexamethasone was the same as that of control group, and each patient took megestrol 160mg orally from the first day of chemotherapy for 10 days. Digestive tract reactions were daily evaluated after beginning of HEC. Primary end point was rate of complete response to vomiting and nausea. Results: From September 7 to December 31, 2018, 60 patients were enrolled and randomized in the study. The delayed nausea and vomiting rates were significantly lower in experimental group than control group (nausea: 63.3% vs 83.3%; vomiting: 13.3% vs 33.3%; p< 0.00). The control group was significantly higher rate of Grade 3-4 vomiting than that of the experimental group (20% vs 0%, p< 0.01). Conclusions: Megestrol, combined with dexamethasone and 5-HT3 inhibitor, has been shown to be able to successfully control CINV and no increase side effects during HEC. Clinical trial information: ChiCTR1800017953. [Table: see text]
Implementing a web-based patient reported outcomes (PRO) assessment: Uptake, usability, and lessons learned.
Authors: Jacobs Linda A. , Blauch Abigail N. , Pucci Donna A. , DeMichele Angela , Palmer Steven C 
Published: May 2019

e23062 Background: PRO assessment has the potential to improve patient-provider communication, yet has been difficult to implement in practice. We developed and pilot-tested a web-based PRO assessment (Assessing Concerns at End of Treatment, ACE) within an existing cancer survivorship clinic to ascertain practicality, usability, and uptake by both patients and providers. Methods: ACE is a brief PRO assessment that interfaces with the patient-portal and delivers results into the electronic medical record (EMR). Prior to visit eligible patients were asked to complete a series of measures including a 19-item instrument assessing severity of physical and emotional difficulties and desire for assistance. These results were then made available to providers during the visit through the EMR. Patients were provided up to 3 reminder calls/emails to prompt completion. Eligibility included a breast cancer (BC) diagnosis up to 5 years prior to a scheduled survivorship visit, no current cancer treatment aside from hormonal therapies, and access to the internet. Results: Over 27-months 779 eligible BC survivors were approached and asked to participate, and 566 (73%) agreed. The ACE survey was completed by 332 (59%) of these patients prior to their visit. The most common difficulties reported were Fatigue (86.6%), Worry (75.4%), Difficulty Sleeping (74.8%), and Pain (72.2%). Patients most commonly requested assistance for Aching Joints (31.2%), Fatigue (29%), Difficulty Sleeping (28.6%), and Weight Gain (25.7%). Providers reported being burdened by the information provided and few referrals were made in response to ACE. Technical difficulties were encountered frequently and required more maintenance than initially anticipated. Conclusions: Most eligible patients agreed to complete ACE, however a minority actually did so despite repeated contacts. Lack of buy-in from providers was an obstacle, as were technical difficulties. Difficulties with physical and emotional issues were common, but desire for assistance was less so, and resulted in few referrals. Although practicable, questions remain about the cost vs. benefit of a web-based PRO assessment with survivors.
Implementing strain imaging to identify early childhood cancer survivors at risk for cardiovascular disease.
Authors: Bottinor Wendy , Godown Justin , Coburn Gary , Soslow Jonathan , Borinstein Scott C. 
Published: May 2019

e23070 Background: In patients receiving active chemotherapy, myocardial strain has prognostic utility for risk of subsequent cardiomyopathy. We hypothesized a decrement in strain in early off-treatment childhood cancer survivors (CCS) is prognostic for developing cardiomyopathy. Methods: Retrospective analysis was performed in 22 CCS. Global longitudinal strain (GLS) and global circumferential strain (GCS) were assessed at baseline and on the first end-of-treatment study with adequate imaging quality. Parametric methods assessed the association between changes in GLS/GCS and cardiovascular outcomes. Results: All CCS had normal echocardiograms at baseline and on the first end-of-treatment study . On long-term follow up 5/22 developed echocardiographic abnormalities defined as either left ventricular ejection fraction < 55% (n = 4) and/or left ventricular mass Z score < -2.0 (n = 4). Mean age at diagnosis was (mean ± SEM) 13.0 ± 1.3 and 10.7 ± 1.2, p = 0.37 for those without and with long-term abnormalities respectively. Patients who developed long-term echocardiographic abnormalities had a greater decrement in GCS between baseline and fist end-of-treatment echocardiograms (-6.9 ± 0.9% vs -0.7 ± 1.2%, p = 0.011) and a trend towards greater decrement in GLS (-1.5 ± 1.3% vs 1.2 ± 0.7%, p = 0.069). In early off-therapy CCS an absolute change in GCS of 7% was associated with subsequent cardiovascular dysfunction within 10 years. Conclusions: Change in GCS of 7% or greater from baseline to first end-of-treatment echocardiogram may identify CCS at risk for cardiomyopathy on long-term follow up and offer a window for early intervention. Strain imaging may provide an early method of identifying CCS at higher risk for developing cardiomyopathy on long-term follow up. These survivors may benefit from increased surveillance or early intervention with cardioprotective therapies.
Knowledge and attitudes of permanent chemotherapy-induced alopecia among health care providers.
Authors: Stoehr Jenna Rose , Kosche Cory , Choi Jennifer N. 
Published: May 2019

e23074 Background: Reports of permanent chemotherapy-induced alopecia (PCIA) are increasing in the field of oncodermatology, but there is a dearth of information regarding how it is recognized and managed by health care providers (HCPs) across different medical specialties. Methods: An electronic survey was distributed to HCPs (resident physicians, attending physicians, and nurse practitioners) in the departments of dermatology, oncology, and general internal medicine (GIM) within one Midwestern hospital system. Results: Of the 60 participants (response rate: 12%), there were 19 from dermatology, 18 from oncology, and 23 from GIM. Responses were analyzed with descriptive statistics and chi-square tests. There was a significant difference in the number of subjects that had heard of PCIA prior to starting the survey (Derm: 79%, Onc: 28%, GIM: 26%, p < 0.05). A larger percentage of Dermatology and Oncology HCPs knew the correct definition of the condition (alopecia persisting > 6 months) than GIM (42% and 44% vs. 17%) and had encountered patients with the condition (47% and 44% vs. 22%). More providers in Dermatology and GIM knew how to diagnose PCIA compared to Oncology (84% and 83% vs. 67%). Dermatology HCPs were the only participants who had attempted to treat patients with PCIA. HCPs across the three specialties believed that patients would accept PCIA treatment that was topical, oral, injectable, and required frequent administration or monitoring, but not treatment that was expensive or high risk. A majority of HCPs surveyed (93%) agreed that the diagnosis of PCIA is important. However, there was a significant difference in the confidence of HCPs in diagnosing and managing PCIA. A minority of dermatology HCPs (2/19) specified that they would refer to an alopecia or oncodermatology specialist, while a majority of oncology and GIM HCPs would refer to dermatology. Conclusions: The results of this survey identify significant knowledge gaps about PCIA amongst HCPs. Therefore, education and multidisciplinary engagement should be pursued in order to improve awareness, diagnosis, referral, and management of PCIA in the survivorship care of cancer patients.
A prospective study of anti-mullerian hormone (AMH) as a predictor of chemotherapy-induced menopause.
Authors: Koczwara Bogda , Ullah Shahid , Abbas M Nazim , Scott-Hoy Alex , Young Fiona , Kichenadasse Ganessan , Karapetis Christos Stelios , Roy Amitesh Chandra , Sukumaran Shawgi , Ross David M. , Khattak Muhammad Adnan , Atkinson Elinor , Martin Hilary 
Published: May 2019

e23076 Background: Chemotherapy-induced premature menopause is a distressing side effect of cancer treatment. Currently there are no validated tools to predict the loss of ovarian function. Anti-Mullerian hormone (AMH) in healthy women correlates with ovarian reserve and predicts menopause but its utility in chemotherapy-treated patients is underexplored. We examined the utility of AMH levels as a predictor of chemotherapy-induced amenorrhea at 1-year post chemotherapy - a reliable surrogate for chemotherapy-induced menopause. Methods: Premenopausal women, 45 years or younger, about to receive curative chemotherapy for breast cancer or lymphoma, without ovarian suppression, were assessed for menopausal symptoms using Menopausal Symptom Score (MSS), quality of life (QOL) using EORTC – QLQ-C30 questionnaire, and had serum AMH, oestradiol, FSH, LH collected prior to first chemo, and at 3 and 6 weeks, at completion and 12 months after chemotherapy. Results: Twenty-two premenopausal women, median age 40.5 (37-43) were enrolled. Twenty became amenorrhoeic during chemotherapy and four had return of menses at 1 year after treatment completion. Median AMH level at baseline was 12.9 pmol/L (IQR 5.2 – 26.5), fell sharply following first chemotherapy and remained low at < 3pmol/L (IQR < .3 ) at 1 year with only 2 subjects with AMH levels above 3 pmol/L. Women who regained menses at 12 months had higher baseline AMH than those who remained amenorrheic (p < 0.001). Older age was associated with lower AMH at baseline and at 1 year. Median MSSs increased significantly at 1 year: 0.8 (IQR 0.5-1.8) versus 0.3 (IQR 0-0.4) (p = 0.5). While there was no significant change in QOL scores between baseline and 1 year, there was a significant negative correlation between menopausal symptom score and QOL at 1 year (p = 0.03). Conclusions: In this small study, pre-treatment AMH correlated with amenorrhea at 1-year post chemotherapy suggesting potential role of AMH levels in counselling women regarding their reproductive potential post chemotherapy. Further research in a larger sample of women is needed.
Development of the patient-reported outcomes (PRO) based survival prediction model for survivors who underwent lung cancer surgery.
Authors: Sim Jin-Ah , Kim Young Ae , Lee Jong Mog , Kim Moon Soo , Zo Jae Ill , Shim Young Mog , Yun Young Ho 
Published: May 2019

e23084 Background: To construct a prognostic model of 5-year survival among disease-free survivors who underwent lung cancer surgery using socio-clinical and patient-reported outcomes (PRO), and to compare its predictive performance with that of a traditional model based on known clinical variables. Methods: Data on 809 survivors who underwent lung cancer surgery between 2001 and 2006 in two Korean tertiary teaching hospitals were used. The training data set was utilized to generate the prediction model and the remaining 20% was employed as a testing set to estimate the model’s accuracy. Three Cox proportional hazard regression models were constructed and compared that of 5-year survival prediction ability through the evaluation of their performance in terms of discriminative and calibration ability. The three models were constructed with: 1) only clinical and socio-demographic variables, 2) only PROs, and 3) variables from model 1 and 2 considered altogether. The performance of each 5-year survival prediction model was evaluated using C-statistics and Hosmer-Lemeshow-type χ2-statistical analyses. Results: From the validation set, the C-statistics for the model 1, 2, and 3 were 0.70 (95% confidence interval [CI], 0.67−0.73), 0.77 (95% CI, 0.74−0.80), and 0.81 (95% CI, 0.78−0.84), respectively. In this study, model 3 (including PRO and other variables together) showed the highest discriminative and calibration ability compared to others. Conclusions: The findings suggested that the PRO included model in addition to clinical and socio-demographic variables, is more accurate in the survival prediction of lung cancer survivors than models constructed with only well-known socio-clinical variables.
Cancer survivors’ challenges with ostomy appliances and self-management.
Authors: Sun Virginia , Bojorquez Octavio , Raza Sabreen , Grant Marcia , Hornbrook Mark C , Krouse Robert S. 
Published: May 2019

e23091 Background: Ostomies adversely affect health-related quality of life among cancer survivors. Survivors and their families must engage in ostomy self-management, make substantial behavior changes, and adjust to the consequences of their condition. We explored long-term cancer survivors’ challenges with ostomy appliances and ostomy self-management. Methods: Pooled qualitative data from two studies were used. These included 1) written responses from long-term (≥5 years) rectal cancer survivors describing their greatest challenges with ostomy appliances and associated repercussions; and 2) intervention session notes and greatest challenge responses from an ongoing RCT of a telehealth intervention with ostomy survivors. Using content analysis, several coauthors reviewed all responses related to ostomy wafers/appliances and self-management techniques, and coded each by theme. The themes were reviewed and agreed upon by the research team. Counts were tallied for each theme based on the number of times they were mentioned by respondents. Results: Eight themes emerged: bleeding, pain, leakage, skin problems/irritation/rash, wafer-related issues, materials getting under the wafer, time needed to care for ostomy, and solutions to clean the stoma. Collectively, the eight themes were mentioned 106 times by respondents. Overall, the most commonly mentioned ostomy appliance problem was leakage (27%), followed by skin problems (20%), and pain (14%). For these common problems, respondents described challenges with successfully fitting the wafer to prevent leakages, poor wafer adherence to the skin area surrounding the stoma, allergic reactions to adhesives, and painful sores around the stoma site. Respondents described how their anxiety related to leakage, odor, and/or skin irritation greatly inhibited their social activities and self-confidence with ostomy self-management. Conclusions: Cancer survivors living with an ostomy experience multiple obstacles with ostomy appliances and self-management. These obstacles undermine their ability to gain confidence in caring for their ostomy. Interventions to improve self-management and self-efficacy may ease the psychological and social burden of living with an ostomy.
Incidence of Infection-related mortality in cancer patients: Trend and survival analysis.
Authors: Elfaituri Muhammed Khaled , Morsy Sara , Tawfik Gehad Mohamed , Abdelaal Abdelaziz , El-Qushayri Amr Ehab , Faraj Hazem Abdelkarem , Hieu Truong Hong , Huy Nguyen Tien 
Published: May 2019

e23095 Background: Infectious diseases are the second leading cause of death in the field of oncology. Around 60% of deaths are infection related to cancer patients, especially with underlying hematological malignancies. This study assesses the changing trends of mortality in cancer patients from infectious causes in the past 40 years. Methods: This is a retrospective analysis on 151440 cancer patients who died from infectious causes between 1973 and 2014, identified in the Surveillance, Epidemiology, and End Results (SEER) Program database. Results: Pneumonia and influenza were the most common infections (n = 72133) followed by parasitic diseases and other infections (n = 47310) and septicemia (n = 31119), respectively. The average survival was 65.31 months, while pneumonia and influenza had the highest survival of all. Prostate cancer was the most common cancer associated with infectious diseases (n = 20068) followed by breast cancer (n = 16676) and Kaposi sarcoma (n = 13046), respectively. During 1998-2001, an overshoot in infection-related mortality was significantly noted (APC = 26.74%; 95%CI = 3.7:54.9). However, since 1973, the greatest reduction in infection-related mortality was recorded during 2012-2014 (APC = -37.15; 95%CI = -48.6: -23.2). Compared to other infectious diseases, ‘parasitic and other infections including HIV’ accounted for the highest incidence (SIR = 1.77; 95% CI = 1.69:1.84), where blood vessel tumors occurred the most in this category (SIR = 88.83; 95%CI = 2.25:494.9). Afterward, septicemia was the second most common infectious disease (SIR = 0.84; 95%CI = 0.81:0.88). Except for leukemia, lymphoma, plasma cell tumors, and mast cell tumors, hematologic tumors revealed the highest incidence of septicemia (SIR = 51.9; 95%CI = 1.31:289.16). Gender, race, marital status, an infectious organism, and tumor characteristics (behavior and grade); all accounted for significant differences in survival (P < 0.0001). The nomogram has outstanding discrimination ability (c-index = 0.85) with very minimal differences from the actual observations of 1-, 3-, and 5-year survival probabilities. Conclusions: Infection-related mortality in cancer patients declined from 1973 to 2014. The most common infections in cancer patients were Pneumonia and influenza, followed by parasitic diseases, other infections, and septicemia. Prostate cancer was the most common cancer associated with infectious diseases, followed by breast cancer and Kaposi sarcoma.
Investigation of the efficacy of imidazolyl ethanamide pentandioic acid (IEPA) to reduce chemotherapy-induced myelosuppression (CIM) in breast cancer patients.
Authors: Mayer Frank , Pleimes Dirk , Schmidt Marcus , Fasching Peter A. , Jackisch Christian , Flunkert Kathrin , Asang Corinna , Razoux Florence , Moebus Volker 
Published: May 2019

e23098 Background: Neutropenia is a major toxicity of myelosuppressive chemotherapy (CTX). Treatment and prophylaxis of CTX-induced neutropenia with granulocyte colony-stimulating factors is mainly recommended in patients with high risk of febrile neutropenia. IEPA, a hemoprotective small molecule for oral use, may constitute a safe alternative. The main objective of the study was to assess the efficacy of IEPA in reducing CIM in breast cancer patients. Methods: Randomized, double-blind, placebo-controlled, parallel group study in female adults diagnosed with invasive breast cancer receiving epirubicin/cyclophosphamide CTX. Patients took one tablet daily of IEPA 100 mg or placebo starting 5 days prior to the first CTX cycle until 3 days prior to the second CTX cycle. Two batches of study medication were used sequentially in the study. Hematologic and other variables were tightly measured during the first CTX cycle. Results: After no significant treatment effect was observed in the total study results, post-hoc analyses revealed a significant batch effect. Treatment with Batch 1 IEPA was superior to placebo in treating CIM (Table). Conclusions: Although the presence of a batch effect precludes final conclusions and calls for a formulation optimization of the compound, the efficacy of Batch 1 IEPA in reducing CIM consistent with prior non-clinical and clinical studies invites further investigation of the hemoprotective properties of IEPA. Area over the curve (AOC) integrates extent and duration of decreased absolute neutrophil counts [(ANC/nL)*days] below thresholds corresponding to grade 1 (ANC < 2.0x10^9/L) and 3 neutropenia (ANC < 1.0x10^9/L); CI: confidence interval; LS: least squares; DN3: duration of grade 3 neutropenia in [days]. Clinical trial information: NCT02692742. [Table: see text]