bluuebunny/crossref_metadata_2025_split huggingface dataset:
Terlipressin for variceal bleeding induces large plasma sodium fluctuations in patients without cirrhosis
Authors: Eriksen Peter Lykke , Hartkopf-Mikkelsen Anne Luise , Ott Peter , Vilstrup Hendrik , Aagaard Niels Kristian 
Published: May 2018

BackgroundTerlipressin is used as pharmacological treatment for variceal bleeding. The drug's physiological effect favours hyponatremia, and rapid changes in plasma sodium (PNa) may cause brain injury. Cirrhosis patients seem to be largely protected against this effect but patients without cirrhosis may not be so.ObjectiveThe objective of this study was to examine whether terlipressin treatment of patients without cirrhosis leads to more serious fluctuations in PNa than in cirrhosis.MethodsIn a retrospective cohort design, during a 39‐month period, 11 patients with prehepatic portal hypertension and no cirrhosis and 134 patients with cirrhosis received a minimum cumulative terlipressin dose of 4 mg during at least 24 hours for variceal bleeding. The groups’ PNa changes were compared.ResultsDuring terlipressin, the non‐cirrhotic patients developed a greater reduction in PNa [mean 8.3 (95% confidence interval (CI) 1.9–14.6) vs. 1.8 (1.0–2.7) mmol/l; p = 0.048], a lower nadir PNa [129 (123–135) vs. 133 (132–134) mmol/l; p = 0.06], and within 48 hours after terlipressin a greater increase in PNa [12.6 (3.4–21.7) vs. 2.3 (1.5–3.0) mmol/l; p = 0.03]. Severe (>10 mmol/l change) hyponatriemia or PNa rebound were seen in 27% of these patients but in only 4% of those with cirrhosis (p = 0.02). One non‐cirrhotic patient developed permanent brain damage.ConclusionTerlipressin treatment of bleeding varices carries a high risk of potentially dangerous PNa fluctuations in patients with non‐cirrhotic prehepatic portal hypertension.
Comparison of pediatric allogeneic transplant outcomes using myeloablative busulfan with cyclophosphamide or fludarabine
Authors: Harris Andrew C. , Boelens Jaap J. , Ahn Kwang Woo , Fei Mingwei , Abraham Allistair , Artz Andrew , Dvorak Christopher , Frangoul Haydar , Freytes Cesar , Gale Robert Peter , Hong Sanghee , Lazarus Hillard M. , Loren Alison , Mineishi Shin , Nishihori Taiga , O’Brien Tracey , Williams Kirsten , Pasquini Marcelo C. , Levine John E. 
Published: May 2018

Key Points
Children receiving BuFlu for nonmalignant conditions experienced less toxicity than those receiving BuCy, but survival was comparable. Children with malignancy had shorter postrelapse survival with BuFlu than BuCy; transplant-related mortality and relapse were similar.
Activation of the vitamin D receptor transcription factor stimulates the growth of definitive erythroid progenitors
Authors: Barminko Jeffrey , Reinholt Brad M. , Emmanuelli Alexander , Lejeune Alannah N. , Baron Margaret H. 
Published: May 2018

Key Points
Activation of the Vdr pathway stimulates proliferation of early, but not late, mouse erythroid progenitors in a cell autonomous manner. Vdr and Gr signaling cooperate to increase the growth of mouse erythroid progenitors.
Spontaneous regression of mantle cell lymphoma: a report of four cases
Authors: Ye Haige , Desai Aakash , Gong Tiejun , Zeng Dongfeng , Nomie Krystle , Chen Wendy , Wang Wei , Romaguera Jorge , Wang Michael L. 
Published: May 2018

AbstractBackgroundSpontaneous regression has been reported in some indolent forms of lymphoma. Mantle cell lymphoma (MCL) is an aggressive lymphoid neoplasm and has a poor prognosis. However, approximately 30% of MCL patients can exhibit indolent clinical behavior. To date, complete spontaneous regression of MCL has not been reported.Case presentationWe describe four cases of spontaneous regression of MCL. At the time of presentation, these patients were asymptomatic, with lymph node enlargement and mild to moderate fluorodeoxyglucose (FDG) uptake on FDG‐positron emission tomography combined with computed tomography. One of the possible mechanisms of spontaneous regression of the tumor could be due to the host immune response through humoral and cellular immunity, which may have a role in the clearance of tumor cells.ConclusionsIn this report, we support the use of a “wait and watch” strategy for MCL patients with no risk factors and indolent behavior. This strategy helps spare patients from further potentially harmful chemotherapy. In addition, we describe the phenomenon of spontaneous regression in MCL patients who are asymptomatic and have low‐volume disease.
Dasatinib Plus Intensive Chemotherapy in Children, Adolescents, and Young Adults With Philadelphia Chromosome–Positive Acute Lymphoblastic Leukemia: Results of Children’s Oncology Group Trial AALL0622
Authors: Slayton William B. , Schultz Kirk R. , Kairalla John A. , Devidas Meenakshi , Mi Xinlei , Pulsipher Michael A. , Chang Bill H. , Mullighan Charles , Iacobucci Ilaria , Silverman Lewis B. , Borowitz Michael J. , Carroll Andrew J. , Heerema Nyla A. , Gastier-Foster Julie M. , Wood Brent L. , Mizrahy Sherri L. , Merchant Thomas , Brown Valerie I. , Sieger Lance , Siegel Marilyn J. , Raetz Elizabeth A. , Winick Naomi J. , Loh Mignon L. , Carroll William L. , Hunger Stephen P. 
Published: May 2018

Purpose Addition of imatinib to intensive chemotherapy improved survival for children and young adults with Philadelphia chromosome–positive acute lymphoblastic leukemia. Compared with imatinib, dasatinib has increased potency, CNS penetration, and activity against imatinib-resistant clones. Patients and Methods Children’s Oncology Group (COG) trial AALL0622 (Bristol Myers Squibb trial CA180-204) tested safety and feasibility of adding dasatinib to intensive chemotherapy starting at induction day 15 in patients with newly diagnosed Philadelphia chromosome–positive acute lymphoblastic leukemia age 1 to 30 years. Allogeneic hematopoietic stem-cell transplantation (HSCT) was recommended for patients at high risk based on slow response and for those with a matched family donor regardless of response after at least 11 weeks of therapy. Patients at standard risk based on rapid response received chemotherapy plus dasatinib for an additional 120 weeks. Patients with overt CNS leukemia received cranial irradiation. Results Sixty eligible patients were enrolled. Five-year overall (OS) and event-free survival rates (± standard deviations [SD]) were 86% ± 5% and 60% ± 7% overall, 87% ± 5% and 61% ± 7% for standard-risk patients (n = 48; 19% underwent HSCT), and 89% ± 13% and 67% ± 19% for high-risk patients (n = 9; 89% underwent HSCT), respectively. Five-year cumulative incidence (± SD) of CNS relapse was 15% ± 6%. Outcomes (± SDs) were similar to those in COG AALL0031, which used the same chemotherapy with continuous imatinib: 5-year OS of 81% ± 6% versus 86% ± 5% ( P = .63) and 5-year disease-free survival of 68% ± 7% versus 60% ± 7% ( P = 0.31) for AALL0031 versus AALL0622, respectively. IKZF1 deletions, present in 56% of tested patients, were associated with significantly inferior OS and event-free survival overall and in standard-risk patients. Conclusion Dasatinib was well tolerated with chemotherapy and provided outcomes similar to those with imatinib in COG AALL0031, where all patients received cranial irradiation. Our results support limiting HSCT to slow responders and suggest a potential role for transplantation in rapid responders with IKZF1 deletions.
Evaluating the impact of survivorship models on health system resources and costs.
Authors: Mittmann Nicole , Beglaryan Hasmik , Liu Ning , Seung Soo Jin , Rahman Farah , Gilbert Julie , Ross Jillian , De Rossi Stephanie , Earle Craig , Grunfeld Eva , Sussman Jonathan 
Published: May 2018

1 Background: The provincial cancer agency in Ontario developed and implemented a model of care (MOC) for breast cancer (BC) survivors to transition from oncology-lead care to primary care in a publically funded health care environment (2010-2013). Transition options included direct to primary care and stepped transition. The objective of our study was to examine the health system resources used by the women in the MOC group and compare them to those used by women who did not transition. Methods: A propensity score matched, quasi-experimental approach was used to compare the healthcare resource utilization and costs between BC survivors in the MOC program (case) and those receiving usual care (control). All MOC cases were linked using unique identifiers and linked into the provincial health system databases. Cases and controls were matched 1:1 on year of diagnosis and location of care and were followed from an index date to the earliest of her death date, date of last contact in the database, one day before another cancer diagnosis or the end of study available databases. The primary study outcome was overall health system utilization and mean cost during the follow-up period. Results: There were 2324 women in the MOC program. Demographic information (age, region, stage) were well balanced between cases and controls. Transitioned cases had lower hospitalizations (20.1% vs. 24.4%, p<0.05), fewer cancer clinic visits (6.0% vs. 15.1%, p<0.05), fewer medical oncologist visits (0.39 vs. 1.29, p<0.05) and fewer diagnostics (CT, MRI, ultrasound, x-rays) over an average of 25 months of follow-up. There was a trend for fewer family practice (7.35 vs. 7.91, p=0.08) and internal medical and hematology visits (0.81 vs. 1.03, p=0.08). Annual emergency visits were similar between the two groups (0.76 vs. 0.82, p=0.2). There was a $4300 (2012 $CAN) difference in the mean annual cost between cases and controls. Conclusions: Survivors in the MOC transition program used fewer health system resources and had lower health system costs when compared to controls. These findings provide real world evidence to inform transition policies for cancer survivors.
Knowledge, attitudes, barriers, and practice of oncologists in promoting physical activity to cancer survivors: An international survey.
Authors: Hardcastle Sarah Jane , Kane Robert , Chivers Paola , Hince Dana , Dean Andrew , Cohen Paul Andrew 
Published: May 2018

103 Background: Few Survivors are meeting the American Cancer Society recommendations of 150-minutes of moderate-intensity physical activity (PA) per week. Despite patients' wishing to receive PA information from their oncologist, many do not receive PA guidance. Given that oncologists review their patients regularly and are perceived as authority figures, they are in a unique position to promote the uptake of durable PA. Future interventions that bypass the oncologist are unlikely to be scalable and hence there is a need to support oncologists to promote PA. The study aim was to investigate knowledge, attitudes, barriers and practices of oncologists toward PA in survivors, and the association between oncologists' own PA behaviour and PA promotion. Methods: Oncologists (n = 123) completed a survey based on the Theory of Planned Behavior (TPB). Participants reported PA promotion behaviour, PA involvement, attitudes, intentions, social norm, perceived behavioural control (PBC), confidence and knowledge of exercise prescription. Structural equation modelling (SEM) evaluated these associations. Results: Less than half of oncologists reported regularly promoting PA to patients (46%). Only 26% were physically active. TPB SEM pathways explained 54.6% of the variance in PA promotion (CFI = 0.905, SRMR = 0.040). Social norm, was the only significant pathway to intention, but also a significant indirect pathway to PA promotion (p = .007). Confidence to promote PA, PBC and intentions were direct significant pathways to PA promotion (p < .05). Exploratory SEM pathways explained 19.6% of the variance in PA behaviour, which in turn explained 13.1% social norm, 10.7% attitude, 10.0% confidence and 17.8% PA promotion behaviour (CFI = 0.921, SRMR = 0.076). PA behaviour was a direct significant pathway to social norm, attitude, confidence, and PA promotion (p < .05). Conclusions: Oncologists reported a modest ability to promote PA, low PA promotion rates and limited knowledge of exercise prescription. Patient PA promotion may be improved through strategies that increase oncologists' PBC, confidence and their own personal PA participation.
Smoking cessation among cancer survivors: United States, 2015.
Authors: Gallaway Michael Shayne , Glover-Kudon Rebecca , Momin Behnoosh , Puckett Mary , Natasha Buchanan Lunsford , Ragan Kathleen , Rohan Elizabeth , Babb Stephen 
Published: May 2018

111 Background: The prevalence of smoking among persons with a history of cancer (cancer survivors) is similar to the general population. However, there is a paucity of evidence on the prevalence of specific smoking cessation behaviors among adult cancer survivors. Methods: Data from the 2015 National Health Interview Survey (NHIS) were analyzed to examine the prevalence of smoking cessation behaviors (interest in quitting, recent quit attempt, advised to quit by a healthcare professional visited in the past year) and treatments (counseling, medication) among cancer survivors. Weighted self-reported prevalence estimates and 95% confidence intervals were calculated, and chi-square test statistics were used to assess between group differences. Results: The sample included 2,541 cancer survivors, of which 12% were current smokers, 37% were former smokers, and 51% were never smokers. Compared with former and never smokers, cancer survivors who were current smokers were younger (less than 65 years), less educated, and reported being uninsured or reported having Medicaid health insurance less often (p < 0.01). Fewer female cancer survivors reported being a former smoker than a current or never smoker. Most current smokers reported wanting to quit smoking (57%), a past year quit attempt (49%), or that a health professional advised them to quit smoking in the past 12 months (66%). Current smokers reported the use of smoking cessation counseling (8%), medication (38%), or either (41%). Conclusions: Approximately half of current smokers reported a recent quit attempt and more than half wanted to quit smoking. Less than 1 of 2 current smokers reported using any cessation assistance. The Centers for Disease Control and Prevention’s National Comprehensive Cancer Control Program supports increasing knowledge and availability of evidence-based tobacco cessation services among cancer survivors. Health professionals could consistently highlight the increased risks associated with continued smoking among cancer survivors, provide them with cessation counseling and/or medication, refer them to other free cessation resources, and inform them of cessation treatments covered by their health insurance. Population-level interventions may also be impactful.
Effects of a lymphedema prevention intervention on range of motion among women receiving lymph node dissection for breast cancer treatment (Alliance) CALGB 70305.
Authors: Paskett Electra D. , Liu Heshan , Oliveri Jill , Seisler Drew K. , Schwartz Michael A , Le-Rademacher Jennifer , Sloan Jeff A. , Armer Jane M. 
Published: May 2018

123 Background: Lymph node dissection, axillary or sentinel, often results in restrictions of arm movement, including range of motion (ROM), either temporarily or permanently. The objective of this secondary analysis was to determine if a lymphedema (LE) prevention program would also impact ROM in both the affected arm as well as the unaffected arm. Methods: As part of the Lymphedema Education and Prevention study (CALGB 70305), women from participating sites (N=41) were randomized to either the “education only” (n=253) arm (information about LE signs and symptoms and risk reduction strategies) or “education + exercise” (n=315) arm (education plus arm stretching and breathing exercises and a visit with a physical therapist). Self-administered surveys asking for how high the patient can reach with each arm at pre-surgery, 12 and 18 months after surgery were used to assess self-reports of ROM for each arm (5 categories in total: very little, about half, nearly full, overhead, and full). Differences in ROM between study groups for each arm were compared using chi-square tests before surgery, and 12 and 18 months after surgery. Results: Before surgery, women in the “education + exercise” group were less likely to report full ROM for both arms (left: 58% vs 75%; right: 57% vs 76%; p=0.0004 for both arms) compared to women in the “education only” group, while at 12 months, women in the “education + exercise” group reported greater ROM (left: 91% vs 84% p=0.16; right: 90% vs 83%; p=0.02) compared to women in the “education only” group. By 18 months, both groups approached 93% with full ROM for both arms. Conclusions: Women who participated in a LE prevention intervention that included exercise and a visit to a physical therapist regained full ROM in both arms sooner than women who did not receive the exercise intervention. All women receiving lymph node dissection should receive physical therapy to regain ROM quickly after surgery and to help maintain physical functioning. Support: UG1CA189823, UG1CA189817, UG1CA189819, U10CA180790, U10CA180836, U10CA180850, and UL1TR001409; Clinical trial information: NCT00376597.
Usability of an adapted electronic health record (EHR)-based cardiovascular health application in the oncology setting: Perceptions of oncologists and cancer survivors.
Authors: Weaver Kathryn E. , Klepin Heidi D. , Avery Tiffany P. , Lamar Zanetta S. , Pajewski Nicholas , Hundley William G , Wells Brian J , Johnson Aimee , Foraker Randi E 
Published: May 2018

129 Background: Cardiovascular health (CVH) is of increasing concern to cancer survivors and their healthcare providers, since survivors of many early-stage cancers are more likely to die of cardiovascular disease than cancer. Our team adapted an existing EHR-based CVH data visualization application designed for the primary care setting to be used in the community oncology setting. We evaluated the acceptability of the Automated Heart-Health Application (AH-HA) among oncology providers and cancer survivors. Methods: We queried oncologists, physician assistants, and nurse practitioners (n=20) who provide care to survivors regarding their perceived usability of AH-HA. Oncologists’ responses were assessed on a 7-point Likert scale from strongly disagree (1) to strongly agree (7); we categorized responses of 5-7 as “agreeing”. We additionally asked cancer survivors (N=48) for their opinions of AH-HA. Patients’ responses were assessed on a 5-point Likert scale from strongly disagree (1) to strongly agree (5); responses of 4 or 5 were categorized as “agreeing”. Results: The majority (60%) of oncology providers (60% female, 65% medical oncologists) had been practicing for more than 5 years. Breast cancer survivors comprised the majority of the survivor sample (98%). Usability data are presented below. 85% of providers reported they would use the tool most or all of the time when providing survivorship care. 94% of patients thought oncologists should discuss heart health during survivorship care; 69% would like to use AH-HA with their oncologist. Conclusions: These usability data demonstrate acceptability and feasibility of implementing the AH-HA application in oncology practices and suggest that oncology providers and survivors would value the integration of such applications in survivorship care. [Table: see text]
Feasibility of a sexual health program for women receiving pelvic radiation therapy for gynecologic and lower GI cancers.
Authors: Drapek Lorraine C. 
Published: May 2018

135 Background: Long term effects of pelvic radiation for women include vaginal stenosis, leading to distress regarding sexual function. The NCCN guidelines recommend asking patients about sexual function at frequent intervals. NCCN recommends the use of vaginal dilators for women who have had pelvic radiation. Vaginal dilators have been widely recommended to minimize these long term effects. However, current evidence demonstrates poor adherence (less than 50%) of vaginal dilator use. Methods: A sexual health clinic was implemented at the radiation oncology department of a large academic medical center. This initiative consisted of three visits with a nurse practitioner over a twelve week period. The first visit was completed prior to the start of radiation, consisted of sexual history, completion of the PROMIS sexual health survey, and education regarding vaginal stenosis. The importance of the use of vaginal dilators following the completion of radiation was emphasized.. The second visit occurred at the completion of radiation and consisted of the PROMIS sexual health survey, and reinforcement of the use of vaginal dilators. Patients were instructed to begin use of vaginal dilators two weeks later. Each patient was given a set of four vaginal dilators, and a vaginal dilator diary. The third visit was completed six to eight weeks post treatment and consisted of completion of the PROMIS sexual health survey, review of the vaginal dilator diary, discussion of patient progress, and reinforcement of education. Results: From August 2016 to September 2017, 38 patients were approached and all completed the first visit (100%). Twenty-three patients completed the second visit (61%). Thirteen patients have completed all three visits (35%). At the end of three visits 11 (85%) of 13 patients were using vaginal dilators, and three had become sexually active. Conclusions: This program demonstrates a high enrollment and completion rate, as well as an important survivorship issue for women undergoing pelvic radiation. The reinforcement of long term effects of radiation enabled patients to understand the importance of using vaginal dilators in to maintain vaginal health and maintain sexual function.
Developing a survivorship specific curriculum for an advanced practice provider fellowship.
Authors: Hatfield Rachée , Ghosh-Berkebile Rupa , Schimming Denise , Browning Kristine , Mathey Kristina , Klemanski Dori 
Published: May 2018

14 Background: Holistic oncology care combines cancer treatment with supportive care to meet the physical and psychosocial needs of the cancer survivor. Advanced Practice Providers (APPs) are prepared to deliver high-quality, comprehensive oncology care and are vital to survivorship care as the number of cancer survivors continues to rise. At a Midwest Comprehensive Cancer Center (CCC), an APP oncology-specific fellowship is an innovative year-long postgraduate clinical training program. For the first time, a 2 week rotation through this CCC’s survivorship department will be piloted to provide the fellow with a basic immersion into survivorship care. Methods: APP oncology fellowship graduates completed an open ended survey. They were asked to reflect on their experiences during the fellowship and provide feedback on how to improve course content, and resources that are essential to the delivery of survivorship care. APPs within the survivorship department and the APP fellowship lead educator were asked what objectives they thought were important to be met. Results: APPs fellowship graduates desired to learn more about the philosophy of survivorship care, latent and long term side effect management, creation and delivery of a treatment summary and survivorship care plan (TS/SCP), and specific strategies for executing a meaningful survivorship care visit. Networking with oncology providers was also important. Survivorship department APPs and the fellowship lead thought it was important to know how to do a holistic and supportive care assessment, create a TS/SCP, interpret and manage a distress screening tool and make appropriate supportive care referrals. Conclusions: Cancer survivorship is an integral part of holistic oncology care. As the number of cancer survivors continues to increase, so does the need for supportive care services throughout the cancer continuum. Feedback from those surveyed was used to help develop a survivorship specific curriculum for APP oncology fellows. Educating future APPs in the principles of survivorship care and available supportive care services will result in expert clinicians in survivorship care, and improve overall well-being and quality of life of cancer survivors.