bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survivorship needs after head and neck cancer treatment.
Authors: Berkowitz Callie , Allen Deborah H. , Tenhover Jennifer , Zullig Leah L. , Fischer Jonathan E. , Pollak Kathryn I. , Hicks Minoka R. , Hillson John V. , Koontz Bridget F. 
Published: September 2018

10062 Background: Head and neck cancer (HNC) survivors experience significant sequelae of treatment, including long-term physical side effects and ongoing surveillance for recurrence and secondary malignancy. Given the complicated trajectory of HNC survivors, survivorship care plans educating patients and their caregivers about treatment and recovery may be beneficial. However, little is known about patients’ knowledge gaps related to survivor issues. Methods: Through a prospective anonymous self-administered survey, we evaluated the baseline knowledge of HNC survivors regarding common post-treatment issues and mediating factors. Forty-one HNC patients within 3 months of completing treatment participated between July-November 2016. Descriptive statistics were used to characterize patient responses. Results: Patients had undergone a variety of treatment modalities: radiation (97%), chemotherapy (71%), and surgery (39%). 85% of patients had primary care providers, 56% had regular dental care, and 44% had dental insurance. 78% had caregivers. HNC survivors’ correct responses to side-effect (SE) knowledge questions were lowest for items regarding hearing loss (15%), sleep (33%), tiredness (38%), and anxiety (49%). Only 28% correctly identified cancer risk with alcohol intake. 87% correctly linked tobacco products to cancer recurrence. Patients were most interested in learning via discussions with nurse or doctor (76%) followed by reading written materials (61%), and researching online (32%). Most patients desired to learn more about their cancer (73%), short-term SE (80%), and long-term SE (77%). Conclusions: Our study demonstrated clear gaps in knowledge and healthcare access that may inform targeted, individualized survivorship care plans. Patients had the largest knowledge deficits for alcohol use and recurrence, hearing loss after treatment, and a variety of emotional effects of cancer treatment. These topics should be addressed during delivery of survivorship care plans and surveillance encounters to improve survivorship knowledge.
Pregnancy after breast cancer: Results from a prospective cohort study.
Authors: Poorvu Philip Daniel , Gelber Shari I. , Rosenberg Shoshana M. , Ruddy Kathryn Jean , Tamimi Rulla M , Peppercorn Jeffrey M. , Schapira Lidia , Borges Virginia F. , Come Steven E. , Partridge Ann H. 
Published: September 2018

10065 Background: Prospective data regarding fertility and pregnancy after breast cancer are limited. Many young survivors are interested future fertility, but pregnancy rates among women attempting and not attempting pregnancy have not been studied prospectively. Methods: As part of a multicenter cohort study, women diagnosed age ≤40 with stage 0-3 breast cancer are surveyed at baseline then annually regarding fertility interest, attempts, and pregnancies. Chi-square tests were used to compare proportions attempting and achieving pregnancy. Results: At least once in the 5 years (yrs) after Dx, 334/959 (35%) women reported interest in future biologic children. The percent interested was stable in the first 3 yrs then declined: 256 (27%, baseline), 244 (27%, 1 year), 209 (25%, 2 yrs), 176 (25%, 3 yrs), 106 (18%, 4 yrs), and 72 (16%, 5 yrs). Pregnancy was attempted by 104/334 (31%) of women who reported interest and 4/625 (1%) who did not. Pregnancy occurred in 118 women (12%), including 76/108 (70%) who attempted and 42/851 (5%) who did not. Attempts and achieving pregnancy were associated with younger age, partnered status, and not having children prior to Dx (table). Lower stage was associated with attempting pregnancy and ER negative disease with achieving pregnancy. Conclusions: A substantial number of young women become pregnant in the 5 years after a breast cancer diagnosis. Given that over 1/3 of pregnancies were among women who did not report attempting, additional attention to contraception counseling should be considered. Further evaluation of assisted reproductive technology use, pregnancy and disease outcomes in this cohort, and the POSITIVE Trial (NCT02308085) will shed light on the feasibility and safety of pregnancy after breast cancer. [Table: see text]
The effect of loneliness on cancer mortality.
Authors: D'ippolito Simona , Ambrosini Ettore , Shams Malihe , Calì Giuseppe , Pastorelli Davide 
Published: September 2018

10070 Background: Convergent findings indicate the need of broadening the vision of cancer beyond known prognostic factors, as many variables of different nature equally affect the course of disease. Loneliness has been found to be associated with various health outcomes, but its relationship with cancer remains unclear. Here we aimed to investigate the specific effect of loneliness and other demographic, psychological, and clinical variables on cancer mortality and to validate the Italian UCLA Loneliness Scale in cancer patients. Methods: This descriptive and correlational study was conducted at the Veneto Institute of Oncology in Padua. 400 patients undergoing chemotherapy from 01/2014 to 06/2015 were enrolled. The sample was stratified by sex and age (4 groups, 40-80 y). We collected demographic, clinical (site and stage of cancer, type of chemotherapy, death date), and psychosocial [self-esteem (RSE), perceived social support (MSPSS), social interaction anxiety (SIAS), personality (EPQR), and depression (BDI)] data. Results: GLM analyses: loneliness was higher in women than men (F(1,398) = 7.5, p = .006) and it linearly increased with age (F(1,398) = 10.9, p = .001). Loneliness was also influenced by marital status (F(3,396) = 2.9, p = .037), cohabitant offspring (F(1,398) = 7, p = .008), and educational level (F(3,396) = 4.7, p = .003), but not by clinical variables (all ps > .05). Correlation analyses: loneliness was inversely related to RSE (r = -.51), MSPSS (r = -.52), and extroversion (r = -.32), and directly related to SIAS (r = .46), neuroticism (r = .43), and BDI (r = .44). More importantly, a hierarchical binomial logistic regression revealed that patients’ mortality was reliably predicted by gender, stage of cancer at diagnosis, time from diagnosis to UCLA collection, BDI, and UCLA (HL χ2(8) = 3.53, p = .90). In particular, high BDI predicted higher mortality (Wald = 11.6, p < .001); surprisingly, after controlling for BDI and other effects, high loneliness predicted lower mortality (Wald = 7, p = .008). Conclusions: Our results replicate prior research and reveal a surprising association between loneliness and mortality risk after partialling out the impact of, especially, depression. This suggests the role of loneliness on cancer course as an important health concern.
The impact of the Affordable Care Act (ACA) on cancer survivorship.
Authors: Leopold Christine , Park Elyse , Nekhlyudov Larissa 
Published: September 2018

10072 Background: The ACA of 2010 has been recognized by the cancer community as an important step forward in insurance and payment reform, aiming to expand the number of insured patients, control costs and incentivize health care delivery system changes. In this review, we outline the ACA provisions relevant to cancer survivorship, provide available evidence for their impact, and offer insights for future research. Methods: We conducted a literature search in the PubMed database and grey literature. We searched the terms ‘ACA and cancer survivors’, which resulted in 17 articles and expanded the search to ‘ACA and cancer’ and found 213 articles, of which 75 were relevant for this review. We categorized the ACA provisions into three categories, 1) access to preventive care, 2) access to quality, coordinated care, and 3) coverage expansion and increased affordability. Results: Positive effects of the ACA were: an increased uptake of preventive services and cancer screening; a reduction in hospital admissions, increased guidelines concordance and generic prescribing through the implementation of cancer-specific Accountable Care Organizations; a reduction of unnecessary resource use (e.g. emergency visits) through the implementation of oncology patient-centered medical home models and decreases in costs though bundle payments. These results focus on the general population/cancer patients; specific studies targeting at the effects on cancer survivors are missing. In addition, evidence from literature showed that knowledge about the benefits of the ACA is low among childhood cancer survivors; while insurance coverage rates of cancer survivors, especially for childhood cancer survivors, increased. Conclusions: Evidence regarding the effects of the ACA on cancer survivorship care is limited, though point to greater access to preventive services and screening programs. Effects of provisions focusing on quality, coordinated care as well as coverage expansion and affordability may have beneficial effects. Whether the ACA remains or is reformed, it is critically important that decisions take into account the potential intended and unintended consequences of the ACA provisions on health outcomes and quality of life of this growing population.
The association between mindfulness and post-operative pain in gynecologic oncology patients undergoing minimally invasive hysterectomy.
Authors: Weston Erica , Raker Christina , Huang David , Mathews Cara Amanda 
Published: September 2018

10079 Background: Studies demonstrate an inverse relationship between mindfulness and chronic pain. However, the relationship between mindfulness and acute post-operative pain has not yet been thoroughly investigated. The objective of this study is to determine if there is an association between pre-operative level of mindfulness and post-operative pain outcomes in women undergoing minimally invasive hysterectomy. Methods: For this prospective cohort study, women planning to undergo laparoscopic or robotic hysterectomy were prospectively recruited at the gynecologic oncology outpatient clinic at our institution. Baseline mindfulness was assessed at the pre-operative clinic visit using the Five Facet Mindfulness Questionnaire (FFMQ). Post-operative pain, using the Visual Numeric Rating Scale (VNRS-11), and opiate pain medication usage were evaluated via chart review and post-operative surveys completed at 1 to 2 week and 4 to 6 week post-operative clinic visits. Results: One hundred twenty four women completed the 6 week post-operative follow-up period, of which 80% were undergoing surgery for malignancy. Baseline mindfulness was inversely correlated with post-operative pain as measured by both the average and highest reported VNRS-11 values during the inpatient stay (r = -0.21, p = 0.019; r = -0.21, p = 0.016). At the 1 to 2 week post-operative visit, self-reported pain score was also inversely correlated with pre-operative mindfulness score (r = -0.24, p = 0.009). This relationship was not observed at the 4 to 6 week post-operative visit (r = -0.08, p = 0.403). Higher pre-operative mindfulness was also associated with lower opiate usage (r = -0.16, p = 0.077), though this relationship was not statistically significant. Conclusions: Higher pre-operative mindfulness is associated with more favorable post-operative pain outcomes, including lower reported numeric pain scores, in gynecologic oncology patients undergoing minimally invasive hysterectomy. This relationship provides an opportunity to target the modifiable personality characteristic of mindfulness, to improve post-operative pain in women planning gynecologic surgery.
Exploration of risk factors for osteoporotic fracture following hematopoietic stem cell transplantation.
Authors: Lu Huifang , Murphy William A , Ebede Chidinma Chizoba , Karim Erfan , Rondon Gabriela , Leung Cheuk Hong , Liu Suyu , Champlin Richard E. , Pundole Xerxes 
Published: September 2018

10080 Background: The incidence of fractures following hematopoietic stem cell transplantation (HSCT) ranges from 5% to 12% and the rates are up to 10 times greater than in the general population. The risk factors involved in osteoporotic fracture development following HSCT are incompletely understood. Methods: We conducted a retrospective cohort study of patients > 18 years that received a HSCT at MD Anderson Cancer Center, from January 1, 2001 to December 31, 2010. Patients were followed until December 31, 2013 for assessment of osteoporotic fracture occurrence using ICD-9 codes and confirmed by chart review. Cox regression model was used to identify independent risk factors for osteoporotic fractures. Factors included individual risk factors included in the World Health Organization Fracture Risk Assessment Tool FRAX and type of HSCT, type of preparatory regimen and underlying indication for HSCT. Results: A total of 5,170 patients received a HSCT during the 10-year study period, of which 527 (10%) patients developed an osteoporotic fracture. The median time of follow up was 3.2 years. A multivariate Cox regression model considering all clinical and malignancy specific risk factors was fitted. With the control of all other variables, the risk of developing fracture was 1.20 (95% confidence interval (CI):1.02-1.41) times higher for every 20 years increase in age at HSCT; female patients had a 1.24 (95% CI: 1.05-1.48) times higher risk compared to male patients; patients with a fracture prior to HSCT had a 2.01 (95% CI: 1.62-2.51) times higher risk compared to patients without a prior fracture; patients receiving an allogeneic HSCT had a 1.57 (95% CI: 1.20-2.05) times higher risk compared to patients receiving an autologous HSCT; and patients with multiple myeloma had a 2.62 (95% CI: 1.97-3.49) times higher risk compared to patients without multiple myeloma. Conclusions: Age at HSCT, gender, prior fracture status, type of HSCT, and underlying indication were identified to be statistically significantly associated with fracture. This is one of the first large scale studies assessing a comprehensive set of risk factors. To develop a risk model for fracture, we should consider these factors.
Cardiovascular disease and preventive care among cancer survivors: A population-based study.
Authors: Pearlstein Kevin A. , Basak Ramsankar , Chen Ronald C. 
Published: September 2018

10081 Background: Cardiovascular disease (CVD) has been identified as a leading cause of mortality among cancer survivors, particularly long-term survivors. However, studies examining the prevalence of CVD risk factors and CVD-specific preventive care among US cancer survivors are lacking. We utilize the National Health Interview Survey (NHIS) data to address this knowledge gap. Methods: NHIS is an annual survey among roughly 88,000 individuals across the US, and its data are representative of US population-based estimates of health status, healthcare behavior, and healthcare utilization. 15,747 individuals surveyed from 2011 to 2015 who reported a history of cancer (except non-melanomatous skin cancer) were included in this study. Prevalence of CVD risk factors and preventive care received were calculated incorporating NHIS sample weights. A multivariable logistic regression model was used to evaluate factors associated with risk factor monitoring. Results: 55% of the cohort was ≥6 years out from cancer diagnosis and 53% were 65 years or older. CVD risk factors were prevalent across the entire cohort (Table). Among survivors < 50 years, 30% were active smokers, and 35% obese. Among survivors ≥65, 40% had known CVD. Among survivors with each risk factor, rates of monitoring and management of each is reported in Table. On multivariable analysis, seeing a generalist was strongly associated with monitoring of blood pressure (OR 18), cholesterol (OR 8), and fasting glucose (OR 3). Conclusions: This study provides the current status of preventive care among US cancer survivors, illustrating that CVD and its risk factors are common. Rates of monitoring of hypertension and hyperlipidemia are high, but there is room for improvement in interventions targeting obesity and smoking cessation. [Table: see text]
Effect of prophylactic fentanyl buccal tablet (FBT) on exertional dyspnea in patients with cancer: A pilot double-blind, placebo-controlled, randomized trial.
Authors: Hui David , Kilgore Kelly L. , Frisbee-Hume Susan , Park Minjeong , Liu Diane D , Bruera Eduardo 
Published: September 2018

10085 Background: Exertional dyspnea is one of the most common, debilitating and difficult-to-treat symptoms in cancer patients. Few clinical trials have been conducted. We tested the hypothesis that FBT, a rapid onset opioid, given prophylactically prior to exertion can improve exertional dyspnea. Methods: In this double-blind parallel (1:1) RCT, we asked cancer patients who were opioid-tolerant and had exertional dyspnea to complete a 6 minute walk test (6MWT) at baseline, and then randomly assigned them to either FBT proportional to 20-50% of daily dose or placebo 30 minutes before a second 6MWT. The primary outcome was a validated 11-point dyspnea NRS assessing dyspnea “now” (where 0 = none and 10 = worst possible) every minute during each 6MWT. Secondary outcomes included walk distance, vital signs and neurocognitive testing, adverse effects, and global impression. Ten evaluable patients in the FBT provided 80% power to detect an effect size as small as 1.0 using a two-sided paired t-test with a significance level of 5% to compare the change of dyspnea between the first and second walk tests. We compared the outcomes between the first and second 6MWTs using paired t-test. Results: Among 22 patients enrolled, 20 (91%) completed the study (9 FBT, 11 placebo). FBT was associated with a significant within-arm reduction in dyspnea NRS between 0 and 6 minutes (mean change -2.4, 95% confidence interval [CI] -3.5, -1.3) and respiratory rate (mean change -2.6, 95% CI -4.7, -0.4). Placebo was also associated with a non-statistically significant decrease in dyspnea (mean change -1.1). Between arm comparison of dyspnea scores in the second 6MWT favored FBT, albeit not statistically significant (estimate -0.25, P = 0.068). Global impression revealed more patients in the FBT group than placebo group reporting their dyspnea was at least “somewhat better” in the second 6MWT (4/9 vs. 0/11, P = 0.03). The other secondary outcomes did not differ significantly between arms. Conclusions: These data support our hypothesis that proportionally dosed FBT was associated with improvement in exertional dyspnea, and highlights the need for larger confirmatory trials. Clinical trial information: NCT01856114.
The effect of pain self-management based on pain control diary on breakthrough pain.
Authors: Fan Zu-Yan , Lin Jin-Xiang , Li Xing , Chen Xiang-Wei , Huang Xiu-Yan 
Published: September 2018

10107 Background: Most patients suffer from cancer pain, especially breakthrough pain. The overall incidence of breakthrough pain is estimated to be 65%. Self-management makes patients actively participating in the use of drugs, transforming their roles and adjusting their moods in order to better cure their own diseases. Therefore, the aim of the study is to discuss the effect of reducing cancer pain patients' breakthrough pain through self-management based on pain control diary. Methods: From October, 2015 to October, 2016, a total of 200 patients treated with opioids for cancer pain were randomly divided into groups. Patients in the control group were given general management including the Standard "the three steps analgesic ladder treatment for cancer pain", the traditional form of health education and psychological care; While the intervention group in addition to conventional cancer pain management, self-management based on pain control diary was applied. Through repeated intensive training, patients learned how to do self-assessment, to master the feature of their own pain, problem-solving skills and formal report to their oncologists in charge. Results: After six weeks of intervention , 10% patients in the intervention group had suffer breakthrough pain compared with 54% patients in the control group (P < 0.05). The whole processing management model is a whole process, specialization and humanization Care model for patients with advanced cancer pain management, can effectively improve patient medication compliance, reduce the cancer breakthrough pain's incidence, improve the patients,s life quality with cancer pain. The medication compliance of the intervention group was significantly higher than that of the control group(X2= 46.606, P<0.001), and in intervention group the incidence of breakthrough pain was significantly lower than that of the control group (X2= 44.148, P<0.001) Conclusions: The self management based on pain control diary is a whole process, specialization and humanization Care model for patients with advanced cancer pain management, can effectively improve patient medication compliance, reduce the cancer breakthrough pain's incidence, improve the patients's life quality with cancer pain.
LCCC 1025: Phase II study of everolimus, trastuzumab, and vinorelbine for HER2+ breast cancer brain metastases (BCBM).
Authors: Anders Carey K. , Deal Allison Mary , Van Swearingen Amanda Elyse Day , Siegel Marni , Hayes David N. , Jo Heejoon , Little Paul , Dees Elizabeth Claire , Muss Hyman B. , Jolly Trevor Augustus , Zagar Timothy , Smith J Keith , Fisher Julie Gottlieb , Shah Nikita C. , Nabell Lisle , Nanda Rita , Dillon Patrick Michael , Puhalla Shannon , Abramson Vandana Gupta , Carey Lisa A. 
Published: September 2018

1011 Background: HER2+ BC is an aggressive subset of BC with high rates of BM and poor survival. Two-thirds of BCBM demonstrate activation of the PI3K/mTOR pathway driving resistance to anti-HER2 therapy (Rx). This phase II study evaluated everolimus (E), a brain permeable mTOR inhibitor, added to trastuzumab (T) and vinorelbine (V) in patients (pts) with HER2+ BCBM. Methods: Eligible pts had progressing HER2+ BCBM. Pts received E (5mg PO QD), T (2mg/kg IV weekly) and V (25mg/m2 IV d1, 8 of 21d cycle). The primary endpoint was intracranial response rate (RR [CR+PR], modified RECIST); secondary objectives (CNS clinical benefit rate [CBR, CR+PR+SD], extracranial RR, time to progression (TTP), overall survival (OS), and correlative studies). Targeted DNA sequencing of 20 tissues from 18 pts was performed. We used a two-stage design to distinguish ORR of 5% vs 20%. Results: 32 pts were evaluable for toxicity; 26 for efficacy. Median age was 53 (28–70 yrs). 31/32 pts had prior radiation: 13 (42%) WBRT, 8 (26%) radiosurgery, 9 (29%) both. Median prior lines of metastatic Rx was 2 (0–7). 30 (94%) received anti-HER2 Rx: 91% T, 69% lapatinib, 38% pertuzumab, 25% TDM1. Intracranial RR was 4% (1 PR, 6 SD > 6 mos, 10 SD > 3 mos, 9 PD). CNS CBR (6 mos) was 27%; CNS CBR (3 mos) was 65%. Extracranial RR was 46%. Median TTP was 4 mos (95% CI, 2.2 –5). OS was 12.2 mos (95% CI, 0.6 – 20.2). Grade 3-4 toxicities included neutropenia (41%), anemia (16%), and stomatitis (16%). DNA sequencing showed heterogeneous HER2 copy number amplification (CN amp): only 11/20 show HER2 CN amp (median 40X v 0.7X; 5/11 BC, 4/4 BCBM, 1/2 liver mets, 1/3 LN). BCBM exhibited high-level HER2 CN amp (median 49X) vs other sites (16X). While 11/20 show both HER2 CN amp and PI3K pathway mutation, this was not associated TTP; RAD21 CN amp was associated with TTP < 3 mos. Lack of HER2 CN amp plus a HER2 Tyr-kinase domain mutation was seen in a pt with nonresponse and short OS. Conclusions: While intracranial RR to ETV was low in pts with HER2+ BCBM, a substantial proportion had CNS CBR; OS was 1 year for this pt population. No new toxicity signals were observed. Further evaluation of DNA heterogeneity, including degree of HER2 CN amp in HER2+ BCBM, and association with outcome is warranted. Clinical trial information: NCT01305941.