bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer survivorship in the primary care setting: A new medical school elective.
Authors: Fogarasi Miklos C. , Berg Gerald R , Eichengreen Roy P 
Published: March 2017

15 Background: Responding to calls for education in Cancer Survivorship, the Frank H. Netter MD School of Medicine introduced new content using an interactive student elective for Y2 medical students with the goal of improving medical knowledge and confidence in caring for survivors. Methods: Learning objectives and course content were developed based upon the ASCO curriculum (ASCO Core Curriculum for Cancer Survivorship Education Shapiro, CL et al, Journal of Oncology Practice Feb 2016 Vol. 12 (2) p 145-e117). Seven medical and one biomedical science student enrolled to complete the Sep-Dec 2016 course. Weekly sessions, facilitated by an Oncologist, utilize independent and collaborative learning, small group role playing, concept maps, algorithms and multiple case scenarios to identify and analyze key issues of survivorship. Co-facilitators with varied expertise and cancer survivors are invited weekly. Successful completion requires active participation, reading and discussion of required articles, contributing to a Glossary, and constructing a Survivorship Care Plan after independently interviewing a cancer survivor. A pre/post course questionnaire and reflective writing is used to assess change in knowledge and attitudes. Results: Weekly attendance was excellent, and students remained highly engaged. Sessions involving a geneticist, social worker, hospice nurse or APRN were well received. Students built a Glossary of cancer-terms, and practiced “Skills of the Week”. Pass/fail data and questionnaire data are pending, as the course is ongoing. Conclusions: Teaching cancer survivorship is feasible for Y2 students. Motivation and interest in the topic is high for this self-selected course. Based upon early observations and feedback the small group setting is valuable for interactions with survivors and inter-professional staff. Students recognize complex social factors influencing survivors’ care and combine knowledge from prior molecular biology, genetics, and physiology classes with the humanistic aspects of patient-centered care. If course evaluation data confirms its value, this curriculum may serve as one element of a multi-level graduate/post-graduate curriculum in Survivorship education.
Behavioral adjustments, supplements, and medications to manage bowel dysfunction in rectal cancer survivors.
Authors: Sun Virginia , Wendel Christopher , Grant Marcia , Bulkley Joanna E , McMullen Carmit K. , Hornbrook Mark C. , Herrinton Lisa J. , Krouse Robert S. 
Published: March 2017

150 Background: Bowel dysfunction is a common long-term treatment effect that adversely impacts the quality of life (QOL) of rectal cancer (RC) survivors. Research suggests that self-care strategies such as behavioral adjustments and supplements/medications are used to achieve bowel control. Evidence describing the specific types of self-care strategies is lacking. The purpose of this study is to describe behavioral adjustments and supplement/medications use in long-term ( ≥ 5 years) RC survivors for managing bowel dysfunction. Methods: Long-term RC survivors with or without permanent ostomies who were enrolled in two Kaiser Permanente Regions completed a survey that included questions eliciting behavioral adjustments and supplements/medications used for bowel control. Written comments from the questions were coded for content and themes. The themes were reviewed and agreed upon by the research team. Responses mentioned < 9 times were combined into broader categories; those mentioned ≥ 9 times were coded separately. Results: A total of 577 RC survivors responded to the survey. 118 survivors (20.4%) responded to the behavioral adjustment question, while 248 (43%) responded to the helpful supplements/medications question. Behavioral adjustments included controlling meal portions (38.9%), eating meals at regular times (19.4%), not eating late or before bedtime (10.1%), and grazing (8.4%); they mitigated constipation, obstruction, bloating, frequency, urgency, and improved bowel predictability. Other behavioral adjustments include not eating before or after activities (5.9%), not eating (5.1%), snacking at regular times (2.5%), and eating less when traveling (1.6%). Helpful supplements/medications include anti-diarrheals (23.6%), dietary fiber supplements (16.6%), stool softeners (15.0%), laxatives (12.6%), antacid (5.6%), probiotics (5.0%), and opioids (3.6%). Conclusions: RC survivors used multiple behavioral adjustments and supplements/medications to achieve bowel control. The specific adjustments and strategies varied greatly. Findings will aid in developing personalized strategies to manage bowel symptoms during survivorship.
Cancer-related side effects and diabetes self-management.
Authors: Murari Keerti , Brown Jordonna , Wisnivesky Juan P. , Lin Jenny J 
Published: March 2017

152 Background: Cancer survivors often experience cancer and treatment-related side effects and may also have comorbidities that may further impact their quality of life. Little is known about how cancer-related side effects and health status impact survivors’ beliefs and management of comorbidities. We undertook this study to assess the relationship between cancer-related side effects and diabetes (DM) self-management behaviors (SMB) and beliefs in cancer survivors with comorbid diabetes. Methods: We recruited diabetes patients recently diagnosed with early-stage breast or prostate cancer who were taking at least one oral hypoglycemic agent. Side effects for prostate cancer survivors were assessed using the Expanded Prostate Cancer Index Composite; side effects for breast cancer survivors were assessed using a standardized questionnaire for hormonal therapy-related side effects. Patients were asked to rate their overall health status and about the perceived impact of cancer treatment on DM. We measured DM medication adherence using the 8-item Morisky Medication Adherence Scale, and DM SMB were evaluated using the Summary of Diabetes Self-Care Activities. Descriptive and univariate analyses were used to assess factors associated with DM SMB. Results: Of the 52 patients recruited, 32 (62%) were male. Twenty-four (46%) patients reported cancer or treatment related side effects, with most (21, 88%) being moderately or severely bothered by these symptoms. Of these patients, 20 (83%) reported non-adherence to their DM medications and 18 (71%) reported checking their fingersticks < 5 times a week. Yet most patients (20, 84%) felt that their diabetes care was at least equally as important as their cancer care. Neither the presence nor severity of side effects was associated with DM SMB. However, patients who reported poorer overall health status were more likely to be worried about the impact of cancer treatment on diabetes management (75% vs. 25%, p < 0.01). Conclusions: Many cancer survivors report moderate to severe treatment-related side effects, although severity of side effects was not found to be associated with DM SMB. Further effort should focus on addressing survivors’ concerns about the impact of cancer treatment on comorbid disease management.
Subgroups of survivors with distinct aggravating factors associated with chemotherapy-induced neuropathy (CIN) in the hands.
Authors: Mausisa Grace , Mastick Judy , Mazor Melissa , Paul Steven M. , Cooper Bruce A. , Smoot Betty , Topp Kimberly , Abrams Gary , Chen Lee-may , Chesney Margaret , Kober Kord , Conley Yvette , Levine Jon , Miaskowski Christine 
Published: March 2017

157 Background: CIN is the most prevalent neurologic complication of cancer treatment. Inter-individual variability exists in survivors’ reports of the factors that aggravate CIN in their hands. The purpose of this study was to identify groups of survivors with CIN in their hands based on distinct aggravating factors and evaluate for differences in demographic, clinical, symptom characteristics and quality of life (QOL) based on group membership. Methods: Cancer survivors (n = 307) who received a platinum and/or a taxane and rated their altered sensation/pain in their hands at > 3 on 0-10 scale were enrolled and completed study questionnaires, including a list of 22 factors that could make pain worse. Medical records were reviewed and sensory and motor tests were done. Latent class analysis was used to identify groups of survivors based on the occurrence rates for aggravating factors. Differences among the groups were evaluated using parametric and nonparametric statistics. Results: Three groups were identified based on occurrence rates for aggravating factors in the hands (i.e., Activity and Temperature (41.0%), Activity (8.7%), Few Factors (52.2%)). No differences were found among the groups in demographic characteristics, or sensory (light touch, temperature, pain, vibration) and motor (grip strength, pegboard) tests. Compared to the Few Factors group, the Activity and Temperature group had more comorbidities, poorer sleep, greater fatigue, and more anxious and depressive symptoms. Survivors who received a platinum compound were more likely to be in the Activity and Temperature group. Those who received a taxane compound were more likely to be in the Few Factors or Activity groups. Conclusions: Survivors who reported a higher occurrence of aggravating factors had a higher symptom burden and poorer QOL. Most differences were found between the Few Factors group and the Activity and Temperature group which may be due to the small sample size of the Activity group. Objective measures did not differ among the groups. Findings suggest that subgroups of survivors can be identified based on their reports of CIN aggravating factors.
Prevalence of sarcopenia and predictors of body composition among women with early-stage breast cancer.
Authors: (Cespedes) Feliciano Elizabeth , Caan Bette Jane , Prado Carla , Kroenke Candyce , Alexeeff Stacey , Bradshaw Patrick T , Weltzien Erin , Castillo Adrienne , Chen Wendy Y. 
Published: March 2017

160 Background: Body mass index (BMI) does not accurately reflect body composition, particularly among cancer survivors. Sarcopenia (low skeletal muscle mass) and low muscle radio-density (MD; suggesting fat infiltration into muscle, compromising function) increase risk of surgical complications and chemotherapy toxicity and are associated with worse survival in advanced cancer. Little is known about the prevalence or predictors of sarcopenia and low MD in early-stage breast cancer. Methods: We studied 2,914 Kaiser Permanente members diagnosed with Stage I-III breast cancer from 2005-2013. Using computed tomography (CT) scans of the third lumbar vertebra from clinical care, we determined sarcopenia (skeletal muscle index < 41 muscle [cm2]/height [m2]) and low MD ( < 25-Hounsfield Units for non-obese; < 33 for obese) using published cut points. We assessed associations with characteristics including age, race, BMI, age, stage, lifestyle and co-morbidities with logistic regression. We also examined moderate/vigorous physical activity among a subset of 672 women with activity questionnaires. Results: At diagnosis, mean age was 56 years and time to CT was 1 month. Both sarcopenia and low MD were common among early-stage breast cancer survivors (40% and 38% respectively). In multivariate analyses, the odds of sarcopenia and low MD increased with age (per 5 years, Odds Ratio [OR] 95% Confidence Interval [CI] of OR = 1.33; 95%CI: 1.27, 1.39 and OR = 1.41; 95%CI: 1.35, 1.47 respectively). The odds of sarcopenia decreased with greater BMI (OR = 0.80; 95%CI: 0.78, 0.82 per kg/m2), while the odds of low MD increased (OR = 1.03; 95%CI: 1.01, 1.04 per kg/m2). Black race was associated with lower odds of sarcopenia and low MD, while physical activity levels were associated with lower odds of sarcopenia and more favorable MD. Conclusions: Sarcopenia and low MD are highly prevalent among breast cancer survivors. While older age is strongly associated with these conditions, they occur across ages and stages. Differences in body composition by race and age may underlie differences in the association of BMI with cancer outcomes; understanding these may help guide clinical interventions.
Milk and other dairy foods in relation to prostate cancer progression: Data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CAPSURE).
Authors: Tat David , Van Blarigan Erin , Kenfield Stacey A. , Broering Jenny , Cowan Janet E. , Carroll Peter , Chan June M. 
Published: March 2017

168 Background: Recent research suggests a positive relationship between intake of high-fat dairy, particularly whole milk, and prostate cancer (PC) mortality. However, data are limited in men after PC diagnosis. Methods: We conducted a prospective cohort study among 1336 men with non-metastatic PC in CaPSURE. The men answered a food frequency questionnaire (FFQ) in 2004-2005 (median time from diagnosis to the FFQ: 2 y) and were followed for PC progression until April 2016. PC progression was defined as: prostate cancer death, bone metastasis from PC, biochemical recurrence, or secondary treatment. Multivariate Cox Proportional Hazards regression was used to calculate hazards ratios (HR) and 95% confidence intervals (CI) for associations between total, whole fat, and low-fat milk; total, high-fat, and low-fat dairy; and specific dairy items and PC progression. We adjusted for time from diagnosis to FFQ, calories, age at diagnosis, CAPRA score, smoking, BMI, walking pace, and primary PC treatment. Results: 314 events were observed (mean follow-up: 7.2 y). Whole milk was associated with an increased risk of PC progression when adjusting for age, calories, and time since diagnosis (HR ≥1 vs. <1 serving/wk: 1.37; 95% CI: 1.03, 1.84; p-value: 0.03). This association was slightly attenuated, and not statistically significant, when adjusting for clinical and other lifestyle factors (HR: 1.27; 95% CI: 0.91, 1.77; p-value: 0.15). High-fat dairy intake also appeared associated with an increased risk of PC progression, but the association was not statistically significant (adjusted HR ≥4 vs. <1 servings/day: 1.40; 95% CI: 0.92, 2.13; p-trend: 0.18). Post-diagnostic intakes of low-fat milk and other dairy foods were not associated with PC progression. Conclusions: Post-diagnostic intake of milk and other dairy foods was not associated with PC progression. Research in populations with greater intake of whole milk is warranted to further investigate whether post-diagnostic whole milk intake increases risk of PC progression. Funding: This work was funded by the DOD Prostate Cancer Research Program (W81XWH-13-2-0074) and the NIH (K07CA197077).
Mind-body medicine epigenetic technique (MET), cognitive flexibility, and brain-derived neurotrophic factor (BDNF) gene expression.
Authors: Munoz Francisco Ventura 
Published: March 2017

172 Background: This is a pilot study update on the potential of MET to up-regulate BDNF gene expression with breast cancer patients assessed with high cognitive flexibility. MET is a technique developed to manage chronic stress and anxiety. BDNF gene expression is associated with learning and memory. Cognitively flexibility is defined as the ability to focus and sustain attention. It also implies vivid imagination and holistic thinking. Methods: The selection process for the study participants was nonrandom. The following was the eligibility criteria. 1. Inclusion Criteria: Breast Cancer, Stages II, III 2. Exclusion Criteria: Cognitively impaired, weak or ill. The study utilized two groups. Each group was assigned two research participants. Group One received one session of MET. Group Two received two sessions of MET. Each MET session was approximately 25-35 minutes in duration. Blood samples were taken at baseline and post-MET sessions to provide evidence in gene expression changes. For Group Two, the post-MET session blood draw was done 7 days after baseline. 1. Primary Endpoint: To determine whether MET can up-regulate BDNF gene expression. 2. Secondary Endpoint:To determine whether there is a correlation between up-regulated BDNF gene expression and cognitive flexibility. The blood samples were sent to genomics labs at the Children’s Hospital of Los Angeles and the University of Nevada Las Vegas for mRNA extraction and microarray analysis. The gene expression was measured by DNA microarray results using the “PrimeView gene chip” and “Partek Genomics Suite” statistical software. Results: One participant from Group 1 evidenced a biologically significant up-regulation of BDNF gene expression. This participant was assessed with high cognitive flexibility. One major limitation of these findings is the statistical insignificance of the results due to the small number of participants. Conclusions: This pilot study evidenced the up-regulation of BDNF gene expression potentially due to MET and provided evidence for the potential correlation of BDNF gene expression and cognitive flexibility. This study also provided a foundation for a larger study with more participants.
Complementary and alternative medicine (CAM) use among patients with cancer undergoing palliative care: A pilot study of a single institution in Poland.
Authors: Wojtacki Janusz , Pawlowski Leszek , Pawlowska Iga , LichodziejewskaNiemierko Monika 
Published: March 2017

178 Background: Real life observations suggest CAM is frequently used by cancer patients. The profound knowledge of CAM use details is crucial for both efficacy and safety of anticancer and supportive therapy. Methods: Semi-structured pilot questionnaire about details of CAM use was presented to all 202 consecutive patients of Palliative Care Outpatient Clinic, E. Dutkiewicz SAC Hospice, Gdańsk, Poland (April-22 and September-30/2016). After excluding 112 patients (no-responders group = N-RES) due to low performance status (N = 64), lack of written agreement (n = 10), diagnosis of non-malignant disease (N = 26), others (N = 12), the final analysis included 90 patients (female: 72,0%, median age: 63,5, range: 24-94 yrs) with advanced cancer (responders = RES). Demographic and clinical data were collected at the same time, then statistically related to CAM use details. Results: RES patients were significantly younger (p = 0,0045) and in better performance status (p < 0,05) as compared to N-RES group (no difference with regard to gender, education level, primary cancer location, duration of malignant disease, marital status). Since the primary cancer diagnosis, CAM was used by 56 (62,2%) RES patients and mostly included vitamin/mineral formulations (36,7%), herbs (32,2%), alternative nutrition (24,4%), music therapy (11,1%) and Chinese medicine (5,6%). The main reasons for CAM use were: to enhance the effects of anticancer therapy (48,9%), to treat its side-effects (15,6%) or the lack of conventional therapy possibilities (5,6%). CAM was used more frequently by patients who experienced weight loss since diagnosis of cancer (p = 0,0028) or those who used CAM methods to control symptoms not related to cancer (p = 0,0109); age, gender, education level, marital status, religious practices frequency were not significantly related to CAM use. Conclusions: 1) CAM use is common among patients with advanced cancer under palliative care; 2) some factors might be in relation to higher CAM use (weight loss, CAM use to control symptoms not related to cancer); 3) further research is required to investigate better different aspects of CAM use such as safety, efficacy and outcomes in this population.
What I wish I had known: Young breast cancer survivors reflect on their experiences after breast cancer surgery.
Authors: Rosenberg Shoshana M. , Greaney Mary , Patenaude Andrea Farkas , Meyer Meghan E , Partridge Ann H. 
Published: March 2017

180 Background: Breast cancer (BC) surgery can have a profound impact on aspects of quality of life (QOL) particularly for young breast cancer survivors, given their life stage. Using a series of focus groups (FG), we explored post-surgical experiences of young survivors who had elected lumpectomy, unilateral or bilateral mastectomy. Methods: Women who had surgery for their stage 0-3 BC and who were 1-3 years from their diagnosis (dx) at age ≤ 40 were recruited to participate. We conducted 4 FG: 2 with women who had bilateral mastectomy, 2 with women who kept their contralateral breast. FG were recorded and transcribed with identifiers removed. FG transcripts were coded using NVivo, and emergent themes were identified by thematic content analysis. At the end of the FG, participants completed a demographic/medical history survey. Results: Of 20 participants (4-6 per FG), median age at dx was 37 yrs; 10% (2/20) identified as Hispanic; most (19/20) were married/partnered; 70% had Stage 1 (4/20) or 2 (10/20) disease. Almost all women who had mastectomies also had reconstruction. Emergent themes included: the unexpectedness of certain physical experiences post-surgery (e.g., surgical drains, pain, numbness), psychological impact of surgery (e.g., vulnerability, self image changes), and short and long-term adjustment to a “new normal”, irrespective of which surgery they had. While participants generally felt their doctors communicated key information about surgery and recovery, some expressed dissatisfaction with how this information was communicated, including feeling pressured to choose a particular surgical option. Conclusions: Young BC survivors have many physical and emotional concerns after BC surgery for which they may not feel prepared. Communicating balanced and relevant information prior to surgery about what to expect afterwards is essential and can potentially help survivors with their transition to a “new normal,” as they move from active treatment to survivorship. Informational resources and decision aids may enhance patient-doctor communication in this setting and help young survivors manage expectations surrounding short and longer-term physical and emotional effects after surgery.