bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of modifiable risk factors on clinical outcomes in geriatric patients with breast cancer.
Authors: Manthri Sukesh , Iqbal Muhammad , Desai Meghna R. , Mocharnuk Robert S. , Robinson Kathy 
Published: September 2018

e21546 Background: Tobacco use remains the single largest contributor to preventable death in the U.S. Women who consume alcohol have a 15% higher risk of hormone-receptor-positive breast cancer and obese women are at higher risk of developing breast cancer compared to non-obese women after menopause. There is limited information about the combined impact of smoking, alcohol and BMI on clinical outcomes among elderly patients . The purpose of this study was to analyze the effects of smoking, alcohol and BMI on clinical outcomes in geriatric breast cancer patients. Methods: Among 1659 patients in the institutional Breast Cancer Registry database, a total of 269 patients with histologically confirmed invasive or in-situ breast cancer with age 65 years or older at the time of diagnosis were reviewed in an IRB approved fashion. Clinical outcomes included assessment of the following risk factors: current/former smoking, current/former alcohol usage and BMI at time of diagnosis. Kaplan-Meyer and Cox proportional hazards methods were used to calculate clinical outcomes which included overall survival (OS) and disease free survival (DFS). Results: There were 110 (40.9%) never smokers, 41 (15.2%) current smokers and 80 (29.7%) former smokers. A total of 129 (48%) of women had never consumed alcohol, 73 (27.1%) currently consumed alcohol, and 19 (17.1%) previously consumed alcohol. Mean BMI at the time of diagnosis was 30.62. The OS and DFS was longer among patients who were never smokers compared to current and former smokers (P = 0.0125, P = .0.0077) (P = 0.0107, P = 0.0146). There was also no statistically significant decrease in OS, DFS among those who never consumed alcohol compared to current and former alcoholic users (P = 0.7516, P = 0.2027) (P = 0.8892, P = 0.2432). Neither was there a statistically significant decrease in OS, DFS based on BMI at time of diagnosis (P = 0.5045) (P = 0.5233). In patients with combined cigarette and alcohol usage with BMI > 25, there was also no statistically significant decrease in OS (P = 0.3572). Conclusions: In patients 65 years old or older diagnosed with breast cancer, prognosis for current or former smokers is worse compared to never smokers. Alcohol consumption and BMI have no impact on DFS or OS.
Functional trajectories before and after a new cancer diagnosis among community-living older adults.
Authors: Presley Carolyn Jean , Hurria Arti , Han Ling , Leo-Summers Linda S , Gross Cary Philip , Allore Heather G , Davidoff Amy J. , Gill Thomas M 
Published: September 2018

e21547 Background: We characterized distinct functional trajectories among older adults in the year before and after a new cancer diagnosis and identified factors associated with functional decline. Methods: Among a cohort study of persons 70+ y, we identified 170 participants (lung (15.7%), breast (12.4%), prostate (7.8%); 31.8% incurable at diagnosis)) with an incident cancer diagnosis from 1998-2014. We followed their functional course using 13 basic, instrumental, and mobility activities measured during monthly interviews. To identify functional trajectories, we fit a group-based trajectory model of the 13-item disability scale 12-months before and 12-months after the cancer diagnosis. Regression modeling determined predictors of functional decline, defined as a higher count on the 13-item disability scale. Results: Three pre-cancer functional trajectories were identified (mean age at diagnosis: 83 y (73-105 y); similarly, 3 post-cancer functional trajectories were identified among the 158 non-decedents. Participants with severe disability pre-diagnosis remained severely disabled post-diagnosis. Approximately 40% of participants with mild or moderate disability pre-diagnosis transitioned to a worse functional trajectory post-diagnosis (see Table). Moderate and severe disability pre-diagnosis were significantly associated with functional decline post-diagnosis (moderate vs. mild aRR: 3.10; 95% CI: 2.24-4.30; severe vs. mild aRR: 5.71; 95% CI: 3.60-9.07). Depressive symptoms (RR, 1.40; 95% CI: 1.02-1.91), and incurable stage (RR, 2.16; 95% CI: 1.54-3.03) were also associated with functional decline. Conclusions: Approximately 40% of older adults experienced functional decline after a new cancer diagnosis. Pre-cancer diagnosis functional trajectory, depressive symptoms, and incurable stage were significant predictors of post-diagnosis functional decline. [Table: see text]
Patients making potentially life threatening delays in reporting neutropenic sepsis: Grounded theory study.
Authors: Oakley Catherine Mary , Taylor Cath , Ream Emma , Metcalfe Alison 
Published: September 2018

e21560 Background:Internationally the mortality rate for neutropenic sepsis (NS) is 2-21% (in patients who develop it). Within the United Kingdom NS causes around 700 deaths annually. Clinicians are concerned about patient delayed reporting of NS which may increase healthcare costs, mortality and chemotherapy delays, which can affect prognosis. Methods: Constructivist grounded theory was used to gain insight into the reasons for patient delays. Observations (n = 13 hours) of women with breast cancer being provided with information about NS by oncology doctors and nurses and 31 in-depth interviews. Analysis (and development of categories and supporting properties) commenced with the earliest data gathered and a rich theoretical picture was built through comparing perspectives, pursuing areas of inquiry and recruiting participants who became of interest. Data were collected until saturation. A coding framework was applied to examine and explain connections between categories. Results: 35 participants. 13 women with breast cancer (median age, 56 years, 8 Caucasian, 9 adjuvant, 4 metastatic), 9 carers (partners, family or friends, 50% lived with patients) and 13 clinicians (4 oncologists, 7 chemotherapy nurses, 2 emergency department clinicians, most doctors were male, most nurses were female). The majority of patients and carers were highly educated ( > degree level). All patients except 1, delayed reporting NS symptoms (2.5 hours - 8 days), sometimes repeatedly. The final grounded theory suggests patient delays are due to an interplay of behaviours between clinicians, patients and carers where they subconsciously collude to underplay the seriousness and possibility of NS occurring.Moderators of delay included metastatic disease, bereavement, fatalism, religious beliefs and quality of relationships with clinicians. Conclusions: Relationships with clinicians directly impacted on delayed patient reporting of NS.Findings have implications for health risk communication, development of holistic service models and the design of future research to develop interventions, to promote earlier recognition and treatment for this important chemotherapy complication.
Cancer-related distress screening in a radiation oncology clinic: A snapshot view of a Veterans Administration (VA) institution screening program.
Authors: Lomauro Timothy A. , Dawson George Anthony , Magda Lori , Tobias Kristen , Kelly Maria D. 
Published: September 2018

e21562 Background: The emotional and psychosocial stress experienced by cancer patients are significant factors impacting cancer treatment outcomes and quality of life. Increased emphasis upon programmatic approaches to identifying distress has evolved to current evidenced-based treatment guidelines as reflected by American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have identified distress screening standards of care. This report is a snapshot of the results of a distress screening program in a VAMC Radiation Oncology clinic. Methods: Calendar year 2016 data was chosen for this quality improvement review. We wanted to assess the effectiveness of psychosocial distress screening process now routinely done in Radiation Oncology. Distress screening was completed utilizing the NCCN Distress Thermometer. The program’s goal was to administer distress screening to all patients at the time of their initial consultation and to follow up screening as appropriate. Results: The mean age of the patients was 68.6 years; 98% were male. The treatment population was 58% Caucasian, 38% African-American, 2% Hispanic, and 2% other. The most prevalent cancer diagnoses were: Prostate, 52%; Lung, 13.9%; Head & Neck Cancer, 7.2%, Skin, 4.6%; Esophageal or Gastric Cancer, 3.1%; Brain, 2.0%; and Breast, 2.0% Screenings were completed on 161 of 193 (83%) new consults in Radiation Oncology; 47.6% of patients screened scored at or above the established cut score of 4. Referrals to Oncology Psychology were initiated for 29.5% of total sample. Significant mental health co-morbidities were identified in the treatment population studied; 58.5% of patients had at least one mental disorder diagnosis. Examples: PTSD, Major Depressive Disorder, Substance Use Disorder, and Adjustment Disorder. Conclusions: Results reflect the usefulness of the distress screening process in identifying adjustment issues specific to cancer patients' experience, as well as exacerbations of existing mental health conditions. The screening process facilitated referral to specialty (Oncology Psychology) and general (Mental Health Clinic) services.
Patient-reported distress in myelodysplastic syndromes and its relationship with clinical outcomes.
Authors: Troy Jesse D , deCastro Carlos , Pupa Mary Ruth , Samsa Greg P. , Abernethy Amy Pickar , LeBlanc Thomas William 
Published: September 2018

e21564 Background: The National Comprehensive Cancer Network (NCCN) defines distress as an unpleasant emotional experience associated with the psychosocial complications of cancer. Patients with myelodysplastic syndromes (MDS) are at risk for distress given the largely incurable nature of this hematopoietic malignancy and its symptom burden, yet associations with clinical outcomes are unknown. Methods: We retrospectively reviewed patient-reported distress from ambulatory adult MDS patients visiting a single tertiary care medical center from July 2013-Sept 2015. Demographic, diagnostic, treatment, and comorbidity information were abstracted from records along with the NCCN Distress Thermometer (DT) and Problem List (PL). Survival was analyzed using the Kaplan-Meier method and Cox proportional hazards regression, controlling for age and risk stratification at diagnosis (Low or Intermediate/High Risk by IPSS, IPSS-R, or WPSS), ever use of therapy (hypomethylating agents/lenalidomide/growth factors/transfusions/chelation), Charlson comorbidity score, ever-report of fatigue, and frequency of fatigue. Results: We abstracted 376 DT (median = 1, range = 0-10) from 606 visits and 110 patients (median = 2 DT/patient, range = 1-16). NCCN guidelines suggest DT > = 4 should be evaluated for referral to specialty services to address unmet needs. Fifty-four patients (49%) had at least 1 DT > = 4 and 20 (18%) had 2 or more DT > = 4. Ninety-eight patients (89.1%) reported 1,379 problems during 23,613 person-days of follow-up (median = 4 problems/patient/visit, range = 1-23). The 5 most frequent were fatigue (181 times; 78 patients), pain (95 times; 46 patients), worry (80 times; 45 patients), sleep (78 times; 41 patients), and tingling hands/feet (68 times; 33 patients). After adjustment for risk stratification, a single-point increase on the DT was associated with an increased risk of death (HR = 1.18, 95% confidence interval: 1.01, 1.36). Conclusions: The distress burden is high inMDS, and patient-reported distress scores are associated with clinical outcomes after controlling for typical prognostic variables. Distress should be further studied as a marker of prognosis and of unmet needs in this population.
Sexual function, anxiety, and surgical decision making in BRCA mutation carriers.
Authors: Oliver Matthew T. , Kwait Rebecca , Kent Laprise Jessica , Scalia Wilbur Jennifer , Spinette Sarah , Raker Christina , Gutierrez Julia , Robison Katina , Legare Robert Duffy , Gass Jennifer S. , Stuckey Ashley 
Published: September 2018

e21572 Background: To describe BRCA mutation carriers’ perspectives on quality of life from prophylactic surgical decision making. Methods: A cross-sectional survey of BRCA mutation carriers identified from a genetic counseling database at an academic women’s oncology program was conducted using Research Electronic Data Capture. Survey items included Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale, and investigator-generated questions. Statistical analysis was performed using Fisher’s exact test and Wilcoxon rank-sum or Kruskal-Wallis tests. Results: 66 BRCA mutation carriers completed the survey (39% response rate) with a median age of 50 (range 18 to 79); 23% of respondents were pre- or perimenopausal and 11% reported a history of ovarian/fallopian tube cancer. Overall, 25% of respondents reported anxiety regarding the timing of bilateral salpingo-oophorectomy (BSO) or mastectomy. Women who had a BSO were less likely to be sexually active and had lower total FSFI scores, with arousal and desire approaching significance compared to women without BSO (p = 0.05). Women who had a BSO had slightly higher median total anxiety scores, but were not more likely to have abnormal levels of anxiety. Women who were < 40 years of age at discovery of mutation were more likely to have had a discussion regarding preimplantation genetic diagnosis (p < 0.0001), more likely to have anxiety regarding prophylactic surgery and childbearing (p < 0.0001), and more likely to say BRCA mutation impacted their decisions about childbearing (p = 0.001) compared to women > 40. 57% of women age 18-39 at time of mutation diagnosis delayed BSO for childbearing as compared to none of the women > 40 (p < 0.0001). Only 20% of the pre- or perimenopausal women used hormone replacement therapy after BSO. Conclusions: BRCA mutation carriers face challenging decisions concerning prophylactic surgical management. Counseling sessions often focus on effective risk reducing surgeries but may not directly address other emotional and physical consequences of prophylactic surgery. Counseling regarding use of hormone replacement therapy is an area identified in this study that may improve quality of life issues seen in women undergoing prophylactic BSO.
Health promotion after breast cancer treatment.
Authors: Gopalakrishnan Dharmesh , Goraya Shazia Tanvir , Banjac Svetlana , Yanda Courtney , Abraham Jame , Grobmyer Stephen R. , Pederson Holly Jane 
Published: September 2018

e21586 Background: With significant advances in breast cancer (BC) treatment and improvements in long-term survival, high-quality, coordinated survivorship care is important. Methods: In this retrospective study of patients who were diagnosed with BC (Stages 0 to 3) in 2012 and had > 1 year of follow-up within our network (mean follow-up 3.2 yrs), we analyzed BMI trends and compliance with age appropriate health measures. One-sample t-test was used to compare average BMI at diagnosis and year 3. p < 0.05 was considered as statistically significant. Results: Of 643 patients studied, 99.5% were female, 83% were Caucasian, and 27% were ≤ 50 years of age at diagnosis (mean age 59 yrs). 17% had DCIS and 83% had invasive cancer (Stage I – 40%, II – 33%, III- 10%). 40% had a BMI > 30 Kg/m2. BC Surveillance: 89.4% of patients with residual breast tissue or tissue flaps had surveillance mammograms during 3 years of follow-up (Year 1 - 90.0%, 2 - 89.8%, 3 - 88.3%), in compliance with current guidelines. Weight management: There was a statistically significant increase in BMI from diagnosis to year-3. This trend was consistent across different age, race, and baseline BMI groups (See Table). Colon cancer screening: 49% of eligible patients had completed age appropriate screening colonoscopies either prior to diagnosis or during the course of follow-up. Bone health: Among patients who were on aromatase inhibitors, 76% had a documented DEXA scan. Vaccination: Vaccine coverage for eligible patients was low – 63% for pneumococcal, 38% for herpes zoster, and 30% for annual influenza vaccines. Conclusions: While compliance with BC surveillance is high among patients following treatment for BC, adherence to many other important health maintenance practices is low. Renewed focus on these measures, such as weight management, bone health, vaccination and screening for other cancers, represents an important opportunity to improve not only cancer-related outcomes but also the overall health and well-being of BC survivors. [Table: see text]
Changes in sperm banking rates within the first seven months of a formal male oncofertility program.
Authors: Lopategui Diana Maria , Ibrahim Emad , Yechieli Raphael , Brackett Nancy , Ramasamy Ranjith 
Published: September 2018

e21587 Background: Oncofertility counseling is an essential part of the care for cancer patients with risk of infertility. In June 2016, our institution formally initiated a standardized program for fertility preservation, including nursing and physician education. After the first 7 months of functioning, we here examine the sperm banking rates amongst male cancer patients, and its variation respect previous years. Methods: We retrospectively reviewed the charts of men newly diagnosed with cancer at our institution. We assessed the rates of sperm banking amongst this patient population before the implementation of a standardized fertility preservation program, and again after: from January 2011 to May 2016 and from June 2016 to December 2016, respectively. Results: Sperm banking rate amongst male cancer patients before the initiation of the program was 3.3% (30 out of 902 patients). Along the 7 months after initiation of the program, rate of fertility preservation increased 6.2 folds, up to 20.6% (21 out of 102). Patients undergoing sperm banking through the fertility preservation program were aged 14 to 62 years old; mean ± standard deviation = 25.9± 6.9 years. Two of the patients were minors under care of Pediatric Oncology department. 76.7% of the samples (17 patients) were obtained by masturbation. In the other 4 patients, viable sperm could not be preserved from ejaculation, but it was successfully obtained by testicular or epidydimal sperm extraction. Conclusions: The initiation of a formal fertility preservation program at our institution quickly increased the rate of sperm banking; in more than 6 folds within its first 7 months of functioning. Oncofertility is an essential component of the care of oncologic patients in reproductive age or younger, and our results manifest the benefit of a standardized program at academic institutions. Counseling in fertility preservation should be offered to all patients at risk prior to initiation of oncologic treatment.
Impact of perioperative blood transfusion on survival among women with breast cancer.
Authors: Nadeem Rashid , Cha Mina , Arafeh Dinah , Khan Hiba , Yousaf Muhammad , Turkman Banan , Memon Raheel , Nadeem Amin , Sajid Hassan , Jawed Shafaq 
Published: September 2018

e21591 Background: Blood transfusion has immune-modulating effect which may affect outcome in women with breast cancer including cancer recurrence and survival. Methods: PubMed, Embase and Cochrane libraries were searched by utilizing different combinations of keywords: blood transfusion, survival, mortality and breast cancer. Inclusion criteria were: (1) English articles and (2) studies with an adult population with the diagnosis of breast cancer undergoing resection which may or may not have received blood transfusion. Four hundred and seventy studies were reviewed, 13 studies meeting inclusion criteria were pooled for Meta-analysis. Results: Twenty five datasets from 13 studies with total N = 7384 subjects (transfused 2264, not transfused 5120) were pooled. Survival rates recorded at a specified time frame, this range from 4-12 years. Major confounding factors effecting survival in this population may include age, presence of other chronic illnesses, spread of breast cancer to lymph nodes, stage of cancer and extent of cancer treatment. Type, group and number of blood units transfused may also play a role. Survival rates among not transfused group range from 34% to 79% while in transfused group range from 41% to 78%. Significant heterogeneity was detected among studies; therefore random effect model was used. Comparing women without blood transfusion, women with transfusion have Odd ratio of overall survival 0.79 (0.72 to 0.86, I2= 47.3, P = 0.001). we also performed sensitivity and subgroup analysis. Conclusions: Perioperative blood transfusion appears to adversely impact survival among women with breast cancer
Sexual activity and function in male cancer patients receiving targeted an immune therapies.
Authors: Tsai Katy K. , Kamal Puneet , Ramstein Joris , Algazi Alain Patrick , Daud Adil , Smith James F 
Published: September 2018

e21594 Background: Survivorship concerns–including sexual function–move increasingly to the foreground in cancer patient care as systemic therapies improve response and survival. Patients are often committed to long-term treatment with tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) despite poor characterization of their effects on sexual function. We sought to assess sexual activity and function in patients receiving TKI or ICI. Methods: A cohort of men receiving TKI/ICI at the UCSF Helen Diller Family Comprehensive Cancer Center were retrospectively identified. Eligible men were on ongoing TKI/ICI therapy. Detailed questionnaires addressing cancer history, treatment history, and sexual activity/function while receiving therapy were completed. Results: Between January 2013 to September 2016, 51 men completed questionnaires. Mean age was 46 years (SD 12, range 21-72). Most (61%) were CML patients, with 12% RCC, 10% GIST, 6% melanoma, and NET, oligodendroglioma, and HCC comprising remaining histologies. 96% were treated with TKI, and 4% with ICI (pembrolizumab). 32% identified as being married or in a domestic partnership, and 18% identified as single. Only 14% reported no attempted sexual activity. Sexual desire was described as low or very low to none in 29%, average in 39%, and high or very high in 29%. Since cancer diagnosis, 21 (41%) of patients noted a reduced amount of semen upon ejaculation, and all but 5 of those patients noted this as at least somewhat bothersome. 35% of patients reported feeling at least somewhat distressed from sexual experiences since cancer diagnosis, including concern that their time to ejaculation may leave their partners feeling unfulfilled (45%), decreased sensation of orgasm (35%), difficulty maintaining erection until completion of intercourse (23%), and pain/discomfort upon ejaculation (12%). Conclusions: The majority of men on TKI or ICI remain sexually active, with a significant portion reporting sexual dysfunction. These findings highlight the need for oncology care providers to proactively manage sexual dysfunction to improve quality of life for cancer patients. Retrospective and prospective studies are ongoing to further characterize this cohort.