bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges in accessing reproductive health care in young cancer survivors.
Authors: Thom Bridgette , Benedict Catherine , Friedman Danielle Novetsky , Diotallevi Debbie , Raghunathan Nirupa Jaya , Pottenger Elaine , Kelvin Joanne Frankel 
Published: March 2017

107 Background: Infertility and early menopause are well-established late and long-term effects of many cancer treatments. Fertility preservation (FP) before (and in some cases after) treatment allows many survivors to achieve their family building goals despite gonadotoxic treatment. FP, however, is costly, and there is inconsistent, incomplete, or absent coverage across insurances. Furthermore, as many young survivors are un- or underinsured, disparities in referrals and service utilization have emerged. This presentation provides an overview of reproductive health care-related financial issues affecting young adult survivors, including cost of care, access to services, and relevant advocacy efforts, and highlights an analysis of the impact of income on FP decisions in a national sample of female survivors. Methods: We recruited female survivors aged 18-35 via social media and collected data using a web-based survey. Analyses included bivariate statistics and multiple logistic regression. Outcomes were receiving a fertility intervention (undergoing evaluation and/or fertility preservation of any sort) and freezing eggs/embryos before or after treatment. Results: 346 survivors, who were an average of 4.9 years (sd = 5.4) post-treatment, participated. 296 (86%) reported income: 35% <$50K; 39% $50K-100K; and 26% over 100K. Of 259 respondents who did not undergo FP, 27% reported cost as a barrier. In logistic regression, income was significantly related with receiving an intervention and freezing eggs/embryos. Controlling for age and nulliparity, high-income survivors were more likely to receive a fertility intervention (OR = 3.0, 95% CI: 1.3, 6.9) and to freeze eggs/embryos (OR = 3.4, 95% CI: 1.2, 9.5) than low-income survivors. Conclusions: Our findings of disparity in utilization of reproductive health care among cancer survivors were similar to the published literature, with income impacting respondents’ receipt of fertility intervention and freezing of eggs/embryos. Clinical interventions and policy initiatives must address this service gap. Health care providers can help ensure that cancer survivors have access to available financial resources to assist with cost to facilitate their reproductive health care.
Late effects among young thyroid cancer survivors.
Authors: Blackburn Brenna , Ganz Patricia A. , Rowe Kerry G. , Wan Yuan , Deshmukh Vikrant , Newman Michael , Fraser Alison M , Smith Ken R , Kim Jaewhan , Kirchhoff Anne C. , Poruznik Christina , Hanson Heidi , Monroe Marcus , Hashibe Mia 
Published: March 2017

111 Background: Thyroid cancer is the most rapidly increasing cancer with over 600,000 thyroid cancer survivors in the U.S. Thyroid cancer affects a young population and the 5-year survival rate is over 98%. There have been few studies on the late effects of thyroid cancer, especially in younger populations. The aim of this study was to examine if thyroid cancer survivors diagnosed < 40 years experience greater risks of late effects than older age groups for diseases associated with aging. Methods: Up to 5 cancer free individuals were matched to each thyroid cancer survivor based on birth year, sex, birth state, and follow up time from case diagnosis date, within the Utah Population Database. Electronic medical records, statewide ambulatory surgery and inpatient discharge data were used to identify late effects stratified over three time periods: 1-5, 5-10, and > 10 years after cancer diagnosis. Cox proportional hazards models were used to estimate hazard ratios (HR) with adjustment on matching factors, race, BMI at diagnosis, and Charlson Comorbidity Index at diagnosis. Results: There were 4,060 thyroid cancer survivors and 18,557 matched cancer free individuals (1,407 cases diagnosed ages < 40 years, 2,076 cases diagnosed ages 40-65 years). The risk for hypertension was significantly increased in both younger (HR = 1.54, 95%CI = 1.18, 2.01) and older patients (HR = 1.30, 95%CI = 1.11, 1.53) > 10 years after cancer diagnosis. For heart disease, increased risks persisted for the young patients > 10 years after cancer diagnosis for heart valve disorders (HR = 2.43, 95%CI = 1.36, 4.33) and for peri-, endo- or myocarditis (HR = 5.12, 95%CI = 1.04, 25.14), while corresponding HRs for the older age group did not suggest increased risks. For osteoporosis, the younger patients had a higher risk (HR = 8.77, 95%CI = 3.18, 24.18) than the older population (HR = 2.55, 95%CI = 2.07, 3.13) 1-5 years after cancer diagnosis. Conclusions: Thyroid cancer survivors diagnosed at < 40 years had increased risks for diseases associated with aging such as hypertension, heart disease, and osteoporosis. As thyroid cancer affects a young population, understanding what late effects may result from the treatment can lead to better surveillance and disease management.
Racial disparities in breast cancer mortality among women with diabetes mellitus.
Authors: Gegechkori Nana , Pak Pamela , Wisnivesky Juan P. , Lin Jenny J 
Published: March 2017

116 Background: Multiple reasons have been cited for racial disparities in breast cancer survival, including differences in screening, tumor biology, estrogen receptor status, stage at presentation, treatment and comorbidities. Recent studies suggest that minority women are more likely to have diabetes and diabetes has been shown to increase breast cancer risk and worsen cancer prognosis. We sought to evaluate whether there is disparity in breast cancer mortality among breast cancer survivors with comorbid diabetes. Methods: We identified women >65 years diagnosed with primary breast cancer between 2007 and 2010 from the SEER-Medicare database and followed them for 36 months after cancer diagnoses. Our primary outcome was breast cancer mortality. We excluded patients for whom diagnoses were obtained from death certificates or at autopsy, with incomplete data with regards to the stage at diagnosis and those without Part B coverage. The association between race and breast cancer mortality was assessed using a multivariable Cox regression with competing risk analysis. Results: A total of 9,545 breast cancer survivors with pre-existing diabetes were included in the analysis. Black women were more likely to be diagnosed at later stage and to be younger (p<0.001). There were no differences in cancer treatment by race. After a median follow-up of 36 months, 68.9% of black vs. 73.9% of white patients were still alive (p< .0001). After censoring women who died from other causes and adjusting for age, year of diagnosis, stage, cancer treatment (surgery, chemotherapy and/or radiation) and Charlson comorbidity score, black race remained associated with increased breast cancer mortality (Hazard Ratio 1.45 (95% CI, 1.20-1.73). Conclusions: Even after controlling for cancer-related treatment factors, black breast cancer survivors with diabetes have significantly worse breast cancer survival. Further research should investigate how to improve care for minority women who are at higher risk for breast cancer mortality.
Sinoatrial node dysfunction after stereotactic ablative radiation therapy in the chest.
Authors: Qian Yushen , Dudley Sara Aileen , Kumar Kiran , Chaudhuri Aadel , Chin Alexander , Harris Jeremy Phillip , Prionas Nicolas , Nwachukwu Chika , Bagshaw Hilary , Pollom Erqi L. , Durkee Ben , Shultz David Benjamin , Gensheimer Michael F. , Diehn Maximilian , Loo Billy W. 
Published: March 2017

132 Background: Sinoatrial node (SAN) injury following stereotactic ablative radiation therapy (SABR) in the chest has not been reported in the literature. We report SAN dysfunction as a potential toxicity of SABR in the chest. Methods: We examined the clinical courses and SABR plans of 47 patients treated for T1 or T2 non-small cell lung cancer of the right upper lobe, middle lobe, lower lobe, or hilum. After developing a contouring atlas for the SAN, based upon the junction between the superior vena cava and the right atrium, dose to the SAN was retrospectively determined for each patient. We identified 13 patients whose treatment imparted significant dose to the SAN, as defined by the SAN encompassed within the 10% prescription isodose (IDL) line. Biologically effective doses (BED), acute and chronic, were correlated with SAN toxicity. Results: Patients underwent SABR to the right lung to a dose of 40-50 Gy in 4 or 5 fractions, with mean acute BED (alpha/beta ratio = 10) of 100.2 Gy and late BED (alpha/beta ratio = 3) of 222.7 Gy. Mean volume of the GTV and PTV were 26.1 and 75.1 mL, respectively. Mean follow-up was 25.5 months. The mean volume of the SAN was 0.37 mL. Average max dose and mean dose to the SAN were 24.7 and 70.7 Gy, respectively. Of the 13 patients whose treatment imparted significant dose to the SAN, one patient without prior arrhythmia developed symptomatic SAN dysfunction requiring pacemaker placement at 6 months after completion of treatment. The sinoatrial node of the patient received a maximum dose of 44.8 Gy in 4 fractions, correlated with an acute BED (alpha/beta ratio = 10) of 90 Gy and late BED (alpha/beta ratio = 3) of 194.1 Gy, and a mean dose of 35.5 Gy in 4 fractions, correlated with an acute BED (alpha/beta ratio = 10) of 71 Gy and late BED (alpha/beta ratio = 3) of 153.8 Gy. This was the third highest max dose and second highest mean dose to SAN in the cohort. Conclusions: We report sinoatrial node dysfunction as a potential toxicity of SABR in the chest for non-small cell lung cancer. Caution is advised when treatment imparts significant dose to the sinoatrial node.
Development of a senior oncology clinic for geriatric cancer patients.
Authors: Sangermano Sarah , Caprio Anthony James , Cormier Shannon , Cooper Markecia 
Published: March 2017

134 Background: By 2030, more than 70% of all new cancer diagnoses will affect patients older than 65. The National Comprehensive Cancer Network recommends performing a Comprehensive Geriatric Assessment for elderly patients with cancer. Levine Cancer Institute (LCI) has developed a Senior Oncology Clinic to address the unique needs of geriatric oncology patients. Methods: Prior to the clinic visit, the patient completes a standardized questionnaire. During the visit, the patient is evaluated by a pharmacist, physical or occupational therapist, geriatrician and oncologist. The pharmacist reviews the vaccination history, prescription and non-prescription medications, and supplements. The therapist assesses balance, strength, and fatigue. The geriatrician assesses cognition, medical comorbidities, and geriatric syndromes. The oncologist screens for depression, and reviews oncologic treatment options. Final recommendations are sent by the team to the referring provider and primary care physician. Results: The Senior Oncology Clinic at LCI saw 31 survivors in 2015, and has seen 24 survivors in 2016. Patients receive referrals to a variety of services such as outpatient therapy, nutrition services, and social work. Recommendations are shared with referring providers to address common conditions in older adults as well as cancer-specific treatment recommendations. Due to the success of the program, the clinic has recently been expanded to a second site, LCI-Albemarle. This site utilizes a telemedicine model to provide the clinic at a rural location. Challenges to the program’s effectiveness include provider scheduling, clinic space, data management, and administrative management. A Program Coordinator was recently hired to oversee these aspects of the clinic. Patient challenges include transportation, medical complexity of the population, and missed appointments. Conclusions: A Senior Oncology Clinic is an effective way to perform a multidisciplinary assessment to guide cancer treatment in the geriatric population. These assessments can improve treatment decisions, detect geriatric syndromes, and recommend interventions to help improve the quality of life.
Ongoing needs in 625 women living beyond early breast cancer.
Authors: Capelan Marta , Battisti Nicolo Matteo Luca , McLoughlin Anne , Snuggs Nikki , Maidens Vivienne , Slyk Patrycia , Peckitt Clare , Stanway Susannah Jane , Doyle Natalie , Wiseman Theresa , Ring Alistair E. 
Published: March 2017

139 Background: In some healthcare systems people with a diagnosis of early invasive breast cancer (BC) are discharged from hospital-based follow-up after completion of initial treatment. However there are limited data on the prevalence of specific ongoing physical and psychological needs in such people. Methods: We conducted a retrospective study involving survivors of BC who entered into the Open Access Follow-Up (OAFU) program at The Royal Marsden Hospital (UK) from January to December 2015. The ongoing needs were assessed using the Holistic Needs Assessment (HNA) (a checklist questionnaire regarding physical, emotional, family, practical and spiritual needs) or extracted directly from the Electronic Patient Record (EPR). Results: Six hundred and twenty-five invasive survivors of BC were seen for the first time in the OAFU program after completing their initial treatment. Ongoing needs were identified in 214 (34%) from their returned HNA and in 411 (66%) direct from EPR. Demographic and treatment characteristics were not significantly different between the two groups. The median age was 59 year-old. Median time from diagnosis to assessment was 8.9 months. Ongoing needs were categorized in 3 different groups: 0, 1-4 and ≥ 5 needs. 513 (82%) survivors of BC had 0-4 ongoing needs and 18% had ≥ 5 needs. Physical and emotional needs were the most frequently reported (55% and 24% respectively). Rates of ongoing needs were more frequently identified using formal HNA assessment than extraction from EPR: overall physical needs: 79% vs. 43% (p < 0.001) and emotional needs 50% vs. 10% (p < 0.001). The most frequent specific ongoing needs were: hot flushes (23%), fatigue (21%), pain (19%), worry, fear and anxiety (16%), sleep problems (14%), tingling in hands/feet (11%), dry, itchy or sore skin (11%) sadness and depression (10%), changes in weight (10%) and memory or concentration problems (10%). Conclusions: Fifty-five percent survivors of BC reported at least one physical need and 24% an emotional need. Consistently higher levels of ongoing needs were identified using the HNA formalized checklist. The HNA enables people self-reflection and promotes discussion with the health professional in order to identify ongoing needs and provide on-going supportive care.
Risk assessment for lymphedema in breast cancer survivors.
Authors: Lyman Martha Bonney , Truax Marita Ferro 
Published: March 2017

141 Background: Breast cancer patients are receiving survivorship care plans that describe potential late effects of treatment. The potential for lymphedema ranges from 5% to 53% and is a serious long term problem. In the past, water displacement was the “gold standard” for measuring lymphedema; this involves placing the arm into a large graduated cylinder filled with water to measure displacement compared with the opposite arm. This method is inconvenient for both patient and practitioner and can cause significant anxiety. Methods: In 2010 we began assessing women undergoing unilateral axillary surgery for preclinical and clinical lymphedema using a method that measures bioimpedance, using the L-Dex U400 analyzer. L-Dex uses a mild electrical current to assess fluid levels in the extracellular compartment, earlier than a patient might feel a change in size or weight. One hundred thirty -seven patients were assessed using both volume displacement and L-Dex preoperatively, as a baseline and repeating at 3 to 6 month intervals for three years. Results: Of the patients followed, 83% had sentinel node excision only and 17% had completion axillary dissection. Our study identified an overall lymphedema rate of 7%. Of the patients with full axillary dissection the lymphedema rate was 9% and those with sentinel node excision were found to have no clinical lymphedema (0%). In every case where the patients developed lymphedema the L-Dex bioimpedance measurement identified a change 100% of the time before fluid volume displacement became out of range. Conclusions: Based on our results and the ease of use of the bioimpedance analysis, we have added lymphedema assessment using the L-Dex analyzer to our survivorship process. Patients with invasive cancer undergoing unilateral axillary node surgery are assessed at the same time they receive their sentinel node tracer injection. If there is a sentinel node excision only they are checked once or with any symptom. Patients who have a complete axillary dissection are to be followed for three years. This modest intervention should reduce anxiety surrounding one of the most serious late effects of breast cancer.
Risk-assessed exercise and diet in prostate cancer survivors: Consequences of cancer treatment on cardiopulmonary fitness and cardiovascular risk.
Authors: Faithfull Sara , Aning Jonathan , Poole Karen , Saxton John , Griffin Bruce , Manders Ralph , Lemanska Agnieszka , Gasson Sophie , Langley Stephen , Wainwright Joe , Marshall John , Heyworth John , Winters-Stone Kerri M. 
Published: March 2017

142 Background: Evidence from large observational studies suggests that men with prostate cancer have a higher risk of cardiovascular events due to accelerated atherosclerosis linked to androgen deprivation therapy (ADT). Adults > 70 years of age have poorer outcomes from cancer treatment in the UK. However, it is not yet clear what might be contributing to poorer outcomes among older men with prostate cancer. Thus the purpose of this study was to assess the health and fitness of a cohort of prostate cancer survivors, from 2 regions in the UK, and identify factors that may influence cardiovascular health. Methods: Baseline assessments from 83 men with prostate cancer with no evidence of distant disease particpated. Men undertook a Cardiopulmonary Exercise Test (CPET), sit to stand, step test, grip strength, hip to waist ratio, self-reported exercise questionnaire (Godin), and co-morbidity index. Men were 1-3 years post diagnosis. Age-group comparisons were made using analysis of covariance against cardiac risk profile (QRisk2). Results: Men who were older ( > 75) were more likely to have poorer cardiopulmonary fitness, as measured by VO2 Peak , and worse grip strength than age standardised values. Increased obesity across all groups (raised BMI) and higher B/P all contributed to a raised QRisk2 (mean: 36.9±6.1), which is higher than men of a similar age. Older men perceived themselves to be less physically active and were more likely to be on ADT. Conclusions: In our sample, men older than 75 had greater CVD risk, poorer physical function and lower strength. Improvements in diet and physical activity could improve physical function and reduce cardiovascular risk factors. Older men were more likely to be on ADT so to reduce long term co-morbidities other risk factors need to be addressed. More comprehensive functional health assessment at point of treatment could help clinicians optimise therapy to reduce long term comorbidities. [Table: see text]
Patient reported symptom severity in cancer survivors.
Authors: Bugos Kelly , Foran Jessica , Pose Sabati Katrina , Valdez Andre , Petree Janis M. , Wellman Caitlin , Blayney Douglas W. 
Published: March 2017

143 Background: At Stanford Health Care, patient-reported symptom severity is routinely assessed during cancer survivorship visits. Aim: Our objective is to identify the proportion of moderate to severe symptoms reported during first visit by patient group (breast cancer, lymphoma, allogeneic BMT recipients). Methods: Our cohort were unique patients evaluated in a cancer survivorship clinic between 9/1/15 and 8/31/16. Cohort patient report of presence and severity of 23 symptoms using a six-point Likert scale on a paper-based written instrument were collected and analyzed (0 = absent, 1-2 = mild, 3-4 = moderate, 5 = severe). Symptoms include fatigue, pain, constipation, diarrhea, uncontrolled loss of urine, limb swelling, shortness of breath, oral problems, trouble swallowing, muscle weakness, unusual sweating, ability to exercise, numbness in limbs, depression, fear, changes in sleep, body image, skin/hair, appetite, weight, sexual health, cognition and/or balance. Results: 337 unique patients (median age 50, female 64%) were a median of 140 days and mean of 851 days after treatment completion. Overall, the symptoms that have the highest responses in the moderate to severe range (score 3-5) are fatigue (31%), sleep change (23%), memory change (17%), depression (14%) and fear (19%). Breast cancer survivors had similar symptoms overall, but lymphoma survivors reported a higher rate of moderate to severe fatigue (49%), sleep change (38%), memory change (33%) and fear (29%), and the alloBMT group reported a higher rate of moderate to severe fatigue (39%), depression (20%) and fear (25%). Conclusions: Standard use of patient-reported symptom severity assessment shows a high prevalence of moderate to severe physical and psychological symptoms among patients seen in a cancer survivorship clinic. These findings can help focus management on the most prevalent and severe symptoms based on cancer type and time from treatment.
Does menopausal status influence the symptom experience of women prior to breast cancer surgery?
Authors: Mazor Melissa , Paul Steven M. , Miaskowski Christine 
Published: March 2017

149 Background: Breast cancer treatments can change women’s hormonal milieu and alter their symptom experience. Little is known about associations between menopausal status and menopausal symptoms in women with breast cancer prior to treatment with surgery, chemotherapy, and/or hormonal therapy. The purpose of this study was to evaluate for differences in menopausal symptom experience between pre- and post-menopausal women prior to breast cancer surgery. Methods: A total of 312 women with breast cancer completed the Menopausal Symptoms Scale, a self-report measure that evaluates the occurrence, severity, and distress of 46 common symptoms associated with menopause. Results: Of the 312 patients enrolled, 37.4% (n=116) were premenopausal and 62.6% (n=196) were postmenopausal. No differences were found in the total number of symptoms reported between premenopausal (x̅ = 13.3±7.8) and postmenopausal (x̅ = 12.0±8.6; t = 1.35, p=.177) patients. Premenopausal patients reported higher occurrence rates for tearful/crying spells, painful/tender breasts, anxiety, lost interest in things, anger, tension, lost sexual interest, fatigue or tiredness, impatience, headache, and nervousness (p<.05 for all). Premenopausal patients reported lower occurrence rates for joint pain/stiffness (p=.011), difficulty falling asleep, vaginal dryness, daytime sweats, and hot flashes (p<.01 for all). A significant interaction was found between age and menopausal status. In the premenopausal group, as age increased, these women were significantly more likely to have hot flashes (p=.033). In the postmenopausal group, as age increased, these women were significantly less likely to have hot flashes, wake during the night, have headaches, and report nervousness (p<.01 for all). In the bivariate and multivariate analyses, none of the symptom severity or distress scores were significantly different between the pre- and post-menopausal patients. Conclusions: Findings from this study suggest that, regardless of menopausal status, women report a high occurrence of menopausal symptoms. The association between menopausal symptom occurrence and menopausal status depends on the specific menopausal symptom and the patient’s age. Clinical trial information: NCT00769821.