bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes for patients ≥75 years with localized gastroesophageal cancer: Experience from the Princess Margaret Cancer Centre.
Authors: Natori Akina , Chan Bryan Anthony , Sim Hao-Wen , Ma Lucy Xiaolu , Yokom Daniel , Chen Eric Xueyu , Liu Geoffrey , Darling Gail Elizabeth , Swallow Carol Jane , Brar Savtaj Singh , Brierley James D. , Ringash Jolie , Wong Rebecca , Kim John , Rogalla Patrik , Hafezi-Bakhtiari Sara , Conner James , Knox Jennifer J. , Elimova Elena , Jang Raymond Woo-Jun 
Published: September 2018

10037 Background: The optimal treatment and outcome for elderly patients (pts) with localized gastroesophageal (GE) cancer remains unclear as they are underrepresented in clinical trials. We aimed to assess survival in pts ≥75 years according to treatment received. Methods: A retrospective analysis was performed for all pts aged ≥75 years with GE cancer treated in 2012-2014. Frailty was measured using the Charlson comorbidity index (CCI) and ECOG performance status (PS). Overall survival (OS) and disease-free survival (DFS) were assessed via uni- and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors impacting treatment choices. Results: Of 105 pts, median age was 81 years (range: 75-99), primary sites were esophageal (55%, with 43% squamous histology) and gastric (45%). Baseline characteristics included: PS: 0 (31%), 1 (42%), 2 (16%), 3 (10%), 4 (1%); and CCI: 0 (34%), 1 (25%), 2 (19%), ≥3 (22%). Treatment received included radiotherapy alone (RT) (31%); surgery alone (29%); surgery plus adjuvant chemotherapy (chemo) and/or RT (14%); chemoradiation alone (7%) and supportive care (18%). In univariable analyses; age < 85 (p = 0.003), PS < 2 (p = 0.03) and surgery (p < 0.001) were associated with improved OS. Chemo and RT, either alone or in combination, did not significantly improve OS. In multivariable analyses; surgery (HR 0.38, 95% CI 0.21-0.70, p = 0.002) was the only independent predictor for improved OS. Patients with good PS (p = 0.01), gastric disease site (p = 0.01) and adenocarcinoma histology (p = 0.02) were more likely to undergo surgery. Conclusions: At our institution, relatively few pts ≥75 years received multimodality therapy for localized GE cancers. Those pts ≥75 years who underwent surgery had excellent outcomes, but they were well-selected. Comprehensive assessment should be considered for pts ≥75 years with localized GE cancer to ensure optimal treatment selection, particularly given the potential benefit of surgery.
A randomized control trial of outpatient occupational and physical therapy for older adults with cancer: The CARE program.
Authors: Pergolotti Mackenzi , Deal Allison Mary , Williams Grant Richard , Bryant Ashley Leak , McCarthy Lauren , Coffman Erin , Basch Ethan M. , Reeve Bryce B. , Muss Hyman B. 
Published: September 2018

10038 Background: Limitations in functional status and reduced health status are common among older adults with cancer, yet occupational and physical therapy (OT/PT) remain underutilized (Pergolotti, et.al. JGO,2015). For this population, we evaluated an outpatient CAncer REhabilitation (CARE) program and compared it to usual care (UC). Methods: We recruited adults 65 years and older who had a diagnosis of cancer or recurrence within 5 years and had at least one functional limitation as measured by a geriatric assessment (GA). Participants were then randomized to OT/PT (CARE) or UC. CARE delivered individualized outpatient intervention; OT addressed functional activities, and PT strength/endurance needs. UC participants received a brochure on supportive care services. Primary outcome was functional status (Nottingham Extended Activities of Daily Living Scale [NEADL] (range 0-22)) and secondary outcomes were global Mental and Physical Health, and ability to participate in Social Roles (SR) and activities (Patient-Reported Outcomes Measurement Information System [PROMIS] (range 0-100)), for all measures, higher scores indicate better health. We used t-tests to compare groups. Results: 51 adults were randomized: median age 73 years, 55% male, 92% White, 33% with Leukemia/lymphoma, 26% Breast, 22% Colorectal, 67% in active treatment, and 37% with Stage 3 or 4. After 3 months, both groups experienced a significant decline in functional status ( p = .046; p = .005), but change in functional status (-1.5 UC, -1.1 CARE, p = .637) , physical health status (0.0 UC, 2.4 CARE, p = .121) and participation in SR (.11 in UC, 3.71 CARE, p = .088) between UC and CARE were not significant. However, change in mental health (-1.0 in UC, 3.0 CARE, p= .032) significantly different between groups. Conclusions: CARE was associated with a significant improvement in participant’s mental health status compared to a decline in UC. Results suggest CARE may influence ability to participate in social roles and activities and physical health, but further study is needed with larger sample sizes. We demonstrated that for older adults with cancer, OT/PT are promising interventions to improve mental health. Clinical trial information: NCT02306252.
Cancer-related fatigue in breast cancer survivors: A longitudinal analysis compared to matched controls.
Authors: Williams AnnaLynn , Heckler Charles E. , Paterson Carly Lynn , Barton Debra L. , Young Kelley Lynn , Conlin Alison Katherine , Weiselberg Lora Rose , Mustian Karen Michelle , Peppone Luke Joseph , Janelsins Michelle Christine 
Published: September 2018

10045 Background: Cancer related fatigue (CRF) is commonly reported among breast cancer survivors and can negatively impact quality of life and treatment adherence. Large, prospective, longitudinal studies assessing CRF in breast cancer survivors compared to matched non-cancer controls are rare. Methods: Breast cancer survivors (n = 581, stage I-IIIBC, mean age 53.4) from community oncology clinics and age-matched controls (n = 364, mean age 52.6) completed the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI, scores range -24 to 96) prior to chemotherapy (T1), at chemotherapy completion (T2) and six-months after chemotherapy (T3). Linear mixed models compared trajectories of CRF over time in survivors compared to controls, adjusting for age, education, race, BMI, marital status, menopausal status, and depressive symptoms. Results: Survivors reported greater CRF compared to controls at all time points (mean total score T1 9.4 vs. -3.7, T2 17.0 vs. -3.3, and T3 8.5 vs. -3.1, all p < 0.001; all subscales p < 0.001). From T1 to T2 survivors experienced a significant increase in CRF as shown in the total score (mean change (MC) = 8.3; effect size (ES) = 0.4 , p < 0.001), and general, mental, and physical sub-scales (MC = 4.3, 2.1, 3.2 , ES = 0.7, 0.5, 0.7, respectively, all p < 0.001), while controls experience minimal changes (MC = 0.1-0.3, ES < 0.09, p > 0.05). At T3 survivors total score returned to T1 values (MC = -0.1, ES = 0.01, p = 0.461), which was, however, still greater than controls ( p < 0.001), while general, mental, and physical CRF subscale scores remained significantly higher than T1 values (MC = 1.2, 1.7, 1.9, ES = 0.2, 0.4, 0.3, respectively, all p < 0.001; controls no change). Group by time interactions indicated changes over time were greater in the survivors than controls (p < 0.001). In multivariate analyses of survivors, age, BMI, performance status, and baseline depression significantly predicted change in CRF. Conclusions: These results from the largest well-controlled study to date showed that breast cancer survivors experience significantly more CRF prior to and after chemotherapy compared to healthy controls. Further research should aim to identify subgroups of survivors most susceptible to CRF.
Psychological and educational outcomes among adolescent survivors of wilms tumor: A report from the Childhood Cancer Survivor study.
Authors: Foster Rebecca Hope , Hayashi Robert J. , Wang Mingjuan , Liu Wei , Mohrmann Caroline , Howell Rebecca M. , Smith Susan A , Gibson Todd M. , Srivastava Deo Kumar , Green Daniel M. , Oeffinger Kevin C. , Leisenring Wendy M. , Robison Leslie L. , Armstrong Gregory T. , Krull Kevin R. , Hardy Kristina K. 
Published: September 2018

10049 Background: Little is known about psychological and educational problems experienced by adolescent survivors of Wilms tumor (WT), including the impact of treatment exposures and chronic health conditions. Methods: Parent-reports from the Childhood Cancer Survivor Study were analyzed for 666 adolescent survivors of WT (Mean[SD] age at survey = 15.3[1.65] years; age at diagnosis = 2.8[1.77] years) and 698 siblings (15.4[1.66] years). Adjusting for race and household income, survivors were compared to siblings on the Behavior Problem Inventory and educational services. Among survivors, therapeutic exposures and chronic medical conditions (CTCAE 4.03 coding) were examined via multivariable log binomial regression adjusting for sex, race, income and age at diagnosis to calculate adjusted Relative Risk (aRR) and 95% confidence intervals (CI). Results: Compared to siblings, survivors were more likely to use psychoactive medication (9.4 vs. 5.1%, p = .0002) or be in special education for learning problems, inattention, and/or low test scores (19.1 vs. 11.1%, p = .003) but had similar rates of depression/anxiety, headstrong behavior, inattention, social withdrawal, and antisocial behavior (p’s > .05). Survivors who received radiation therapy (RT) to the abdomen (aRR 1.64, CI 1.03-2.61) or abdomen and chest (aRR 1.95, CI 1.16-3.26) were more likely to be in special education for any reason than those without RT. Those with grade 2-4 cardiovascular conditions were more likely to have anxiety/depression (aRR 2.04, CI 1.26-3.30), headstrong behavior (aRR 1.95, CI 1.30-2.93), or inattention (aRR 1.58, CI 1.04-2.42) compared to survivors with grade 0/1 conditions. Survivors were more likely to be in special education if they had problems with antisocial behavior, anxiety/depression, headstrong behavior, inattention or social withdrawal (p’s < .05). Conclusions: Psychological intervention may be needed for adolescent survivors of WT treated with RT to the abdomen or abdomen and chest or with higher grade cardiovascular conditions. These survivors are more likely to experience behavioral and emotional problems, which in turn increases risk for placement in special education.
Cardiac autonomic dysfunction in breast cancer survivors.
Authors: Payne David , Mahmood Syed , Partridge Ann H. , Nohria Anju , Groarke John 
Published: September 2018

10057 Background: Cardiac autonomic dysfunction (AD) has been associated with increased cardiovascular (CV) and all-cause mortality in several diseases. We evaluated the prevalence, functional and prognostic significance of cardiac AD in a cohort of breast cancer (BC) survivors referred for exercise treadmill testing (ETT). Methods: Cardiac AD was defined as the presence of both an elevated resting heart rate (HR ≥ 80 beats per minute) and abnormal HR recovery (HRR ≤ 12 beats per minute if active cool down, or ≤ 18 beats per minute if passive recovery) at 1 minute after peak exercise. Presence of cardiac AD, exercise capacity, and all-cause mortality were assessed in 448 women (age 62.6±10.0 years), 8.7 [range 4.5, 14.3] years from BC diagnosis, compared to 448 cancer-free, age- and sex-matched controls, all of whom were clinically referred for ETT. Results: Elevated resting HR (23.7% vs. 17.0%, p = 0.013), abnormal HRR (25.9% vs. 20.3%, p = 0.048), and cardiac AD (8.0% vs. 4.2%, p = 0.025) were more prevalent in BC survivors than controls. BC survivors with cardiac AD had reduced exercise capacity compared to those without AD (Table). Among controls, cardiac AD was not associated with decreased exercise capacity. Among BC survivors (age-adjusted hazard ratio 1.90 (95% CI 0.78-4.62) and controls (age-adjusted hazard ratio 4.09 (95% CI 0.49-34.18), cardiac AD was not associated with increased all-cause mortality. Conclusions: Among patients referred for ETT, BC survivors have an increased prevalence of cardiac AD relative to controls. Cardiac AD is associated with decreased exercise capacity, but not increased all-cause mortality, in BC survivors. Available strategies to modulate cardiac AD may improve functional capacity in BC survivors. Table: Impact of markers of cardiac AD on exercise capacity. [Table: see text]
Temporal treatments and outcomes following acute myocardial infarction among cancer survivors: A population-based study, 1995-2013.
Authors: Gong Inna Y. , Yan Andrew T , Ko Dennis T , Cheung Winson Y. , Earle Craig , Peacock Stuart , Gale Chris , Hall Marlous , Chan Kelvin K. 
Published: September 2018

10058 Background: There is little contemporary information regarding cardiac care and mortality differences following an acute myocardial infarction (AMI) between cancer survivors (CS) and non-cancer patients (NCP). Methods: All patients with AMI (1995-2013) in Ontario, Canada were identified through administrative databases and stratified into CS (solid or hematologic) and NCP. Those with cancer within 1 year of AMI were excluded. We used inverse probability treatment weight of propensity scores to balance confounders. Coronary intervention use and survival following index AMI were compared between CS and NCP using Modified Poisson and Cox modeling, and their temporal trends were examined. Results: Of 270,089 AMI patients (62.1% men; 87.8% >65 yrs old for CS vs. 56.2% for NCP), 22,907 were CS (prostate 26%, colorectal 17%, breast 16%) and 247,182 NCP. From 1995-2013, coronary interventions usage increased similarly for both groups (Table). The overall 30-day use did not differ between CS and NCP (angiogram unadjusted 36% vs. 50%, adjusted RR 0.96, 95% CI 0.96-1.00, p=.21; percutaneous coronary interventions unadjusted 21% vs. 31%, adjusted RR 0.98, 95% CI 0.94-1.01, p=.21; bypass surgery unadjusted 5% vs. 7%, adjusted RR 0.95, 95% CI 0.87-1.04, p=.25). Unadjusted 30-day mortality following AMI decreased similarly for CS and NCP (Table). However, adjusted 30-day mortality was worse in CS (HR 1.09, 95% CI 1.04-1.15, p<0.001). Over median follow-up of 11 yrs, CS had worse survival than NCP (HR 1.22, 95% CI 1.18-1.26, p<0.0001). CS had higher risk of heart failure than NCP (HR 1.10, 95% CI 1.05-1.15, p<0.0001), while myocardial (re)-infarction and stroke were similar (HR 0.99, 95% CI 0.96-1.02, p=.46; HR 1.09, 95% CI 1.00-1.18, p=.052). Conclusions: Following AMI, coronary intervention use increased and early mortality decreased comparably between CS and NCP over time. However, CS had worse short-term and long-term survival, suggesting that continued emphasis on cancer and cardiovascular care is needed to improve outcomes. [Table: see text]
Changes in p16INK4a (p16) expression, a biomarker of aging, in peripheral blood T-cells (PBTC) in patients receiving anthracycline (A) vs non-anthracycline (NoA) chemotherapy (CRx) for early-stage breast cancer (EBC).
Authors: Strulov Shachar Shlomit , Deal Allison Mary , Mitin Natalia , Nyrop Kirsten A , Lee Jordan T , Choi Seul Ki , Pulley Will , Bell Emily Fox , Christopher Nora , Williams Grant Richard , Carey Lisa A. , Anders Carey K. , Jolly Trevor Augustus , Dees Elizabeth Claire , Reeder-Hayes Katherine Elizabeth , Sanoff Hanna Kelly , Sharpless Norman E. , Muss Hyman B. 
Published: September 2018

10060 Background: Age-related accumulation of senescent cells plays a causal role in some aspects of mammalian aging. We have shown that the total-body burden of senescent cells can be estimated by measuring the expression of the p16 tumor suppressor, a canonical effector of senescence, in human CD3+ PBTC (Liu et al, Aging Cell, 2009). Expression of p16 increases more than 10-fold over an adult human lifespan, and this rate of accumulation is accelerated by age-promoting exposures such as CRx or stem cell transplant (Sanoff et al, JNCI 2014; Wood et al, EbioMed 2016). Increased molecular age as evidenced by increased expression of p16 prior to CRx predicts a patient’s risk of CRx toxicity independently of chronological age (DeMaria et al, Cancer Discovery, 2017).This study investigates the impact of different types of CRx (A vs NoA) regimens on PBTC p16expression in pts with EBC. Methods: EBC pts who received neoAdj or Adj CRx had blood samples drawn for p16 assay prior to CRx initiation and again between 2 months and 1.5 years after the end of CRx. Expression of p16 mRNA in PBTC was determined using TaqMan real-time quantitative reverse transcription PCR. T-test compared p16change between A and NA groups. Results: 70 pts were evaluable. Pt. characteristics: median age 49 (range 32-76); 52 (74%) White, 14 (20%) black, 4 unknown; 39 (56%) ER or PR+ and HER2 neg, 18 (26%) triple negative, 13 (19%) HER-2 pos (all received trastuzumab). 53 pts (76%) had A (47 AC + taxane, 6 AC no taxane) and 17 (24%) NoA (all TC). Expression of p16 increased 2.0-fold in patients who received A-based CRx compared to 1.2-fold in NoA CRx (p = 0.04). There was no relationship of race, ER, PR or HER-2 status on change in p16expression. Conclusions: This study is ongoing and further results will be presented at the ASCO meeting. In this sample of EBC patients treated with A vs. NoA CRx regimens, A-based CRx is more strongly associated with increased biologic aging of T-cells compared to NoA CRx. These changes are equivalent of increased biologic aging of PBTC of 11 years (A) vs.6 years (NoA) and may have major consequences on the long-term survival of these pts.
NeuroCog-FX study: A multicenter cohort study on cognitive dysfunction in patients with early breast cancer.
Authors: Rick Oliver , Reuß-Borst Monika , Dauelsberg Timm , Hass Holger , König Volker , Caspari Reiner , Götz-Keil Gabriele , Pfitzner Jürgen , Kerschgens Christa , Fliessbach Klaus , Hoppe Christian 
Published: September 2018

10061 Background: Many breast cancer patients complain about cognitive dysfunction (CD) with mnestic and attentional deficits. These complaints persist even after completion of therapy in approximately one third of the patients and affects both social life and working capacity. The exact nature and genesis of CD in breast cancer patients is still not fully understood and risk factors are not yet described. Methods: To determine CD and risk factors, we used the computer-based neuropsychological test NeuroCog-FX during a three weeks oncological rehabilitation in breast cancer patients. Eight subtests addressed attention, working memory, verbal and figural memory, and language. Test duration was < 30 minutes. A cognitive deficit was diagnosed if at least one subtest was clearly below average (score < M - 1.5 SD) of the normative age group. The data on cognitive function were correlated with the level of depression (PHQ-9 test), QoL (EORTC QLQ-30) and clinical parameters (nodal status, chemo-/radiotherapy and endocrine therapy). Results: From February 2013 to December 2014 a total of 476 patients were recruited in 9 oncological rehabilitation centers in Germany. NeuroCog-FX was used to examine 439 patients. Median age was 50 years (range: 24-62 years); 93% of patients had early tumor stage (T0-T2) and 67% were node-negative. Sixty-one percent of the patients received chemotherapy while 84% of the subjects underwent radiotherapy. CD was found in 59% and a moderate to severe depression in 38% of the patients. The severity of depression was correlated with slower reaction times and reduced verbal memory performance. These two cognitive parameters were also associated with a reduced global health status and a reduced physical function score on the EORTC-QLQ30 questionnaire suggesting an impact of cognitive deficits on quality of life. Cognitive function was not associated with type of treatment or node status. Conclusions: In this large and homogeneous cohort of breast cancer patients, CD has been shown in most of the subjects using a valid test method. CD was associated with depression and reduced quality of life. Neither tumor therapy nor other clinical parameters had a significant impact on development of CD.
Neurocognitive functions and psychological distress in young adults with cancer (YAC): A prospective, longitudinal study.
Authors: Edelstein Kim , D'Agostino Norma Mammone , Pond Gregory Russell , Kavan Petr , Gupta Abha A. , Aubin Sylvie , Matthew Andrew , Wahl Kate , Crump Michael , Hodgson David C. , Bedard Philippe L. , Muanza Thierry , Batist Gerald , Bernstein Lori J. 
Published: September 2018

10064 Background: Non-CNS cancer and treatments are associated with neurocognitive sequelae in older adults; whether YAC (age 18-39 yrs) are protected from these effects is unknown. In YAC, cancer interferes with education and occupational attainment and is associated with psychological distress. This prospective, inception-cohort study characterizes neurocognitive functions and psychological distress in YAC. Methods: YAC completed a 2-hr battery of standardized neurocognitive tests and questionnaires 1.7 ± 1 months after diagnosis prior to chemotherapy (mean ± SD, T1) and 8.2 ± 1.2 (T2) and 14.2 ± 1.6 (T3) months later. Healthy YA with no cancer history (HYA) were tested at similar time points. Tests were scored using published norms, transformed to T-scores, and grouped into neurocognitive domains. Results: YAC (n = 108; lymphoma, breast, gyne, GI, GU, sarcoma) were grouped according to whether they required chemotherapy (n = 70) or not (n = 38), and compared to 63 HYA. At baseline, there were no group differences in neurocognitive performance, number of impaired tests, or neurocognitive complaints (Kruskal Wallis, all p-values > .4). About 70% of each group completed assessments at T2 and T3. Mean performance improved over time (random effects models, all p-values < .01), but there were no group differences or interactions between group and time. There were also no differences in proportions of participants in each group whose test scores improved ( > 10 points) or declined ( < 10 points) from T1 to T2 or T3. Adjusting for psychological distress, fatigue, or neurocognitive complaints did not change these results, despite higher symptoms of somatic distress, anxiety and fatigue in YAC compared to healthy YA over time (all p-values < .03). Conclusions: Before chemotherapy and up to about 14 months later, YAC have elevated distress and fatigue, but do not demonstrate the cognitive decline reported in older cancer patients. Our findings are consistent with research suggesting that aging brains are more vulnerable to neurotoxic insult. Whether the effects of cancer treatment emerge later in YAC, placing them at risk for accelerated aging as reported in older patients, remains to be examined.