bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient reported outcomes (PROs) in patients with human papilloma virus (HPV) positive versus negative head and neck cancer (HNC).
Authors: Bauman Jessica Ruth , El-Jawahri Areej , Quinn Karen , Arcikowski Lisa , Chan Gina , Viscosi Elene , Doherty Carol , Clark John Ross , Wirth Lori J. , Temel Jennifer S. 
Published: February 2017

87 Background: HNC caused by HPV has become an epidemic. Treatment for HNC results in a tremendous symptom burden. The impact of HPV-status on quality of life (QOL) and how this effects illness perception and mood has not been described. We sought to explore differences in PROs in patients with HPV + vs. - HNC. Methods: This is a secondary analysis of data from a prospective, longitudinal intervention study of 60 patients with newly diagnosed HNC undergoing concurrent chemoradiation. 30 control patients received standard care followed by 30 intervention patients who received an educational intervention. Satisfaction (information satisfaction questionnaire (ISQ)), mood (Hospital Anxiety and Depression Scale (HADS)), illness perception (Brief Illness Perception Questionnaire (IPQ)), and QOL (MD Anderson Symptom Inventory- Head and Neck (MDASI-HN)) were evaluated at baseline and 3 weeks. Data were analyzed using linear regression models controlling for the effect of the intervention to assess the association between HPV status and changes in PROs. Results: From 8/2014 to 10/2015, we enrolled 60 patients (2 excluded for hospitalization or care elsewhere). 29/58 (50%) had HPV + HNC. 40 (69%) were men. 54 (93%) had stage III/IV disease. Compared to patients with HPV - HNC, patients with HPV + HNC reported an increase in symptom burden, symptom interference, and depressive symptoms, as well as a more threatening illness perception from baseline to 3 weeks. There were no differences in anxiety or satisfaction. Table 1 details the regression models. Conclusions: Patients with HPV + HNC have a larger decrement in QOL during treatment than patients with HPV - HNC, which corresponds to a more threatening illness perception and more depressive symptoms. Interventions tailored to symptom management and mood should be developed for this unique population. [Table: see text]
Oncologists' dispositional affect and likelihood of end-of-life discussions.
Authors: Pirl William F. , Lerner Jennifer , Traeger Lara , Greer Joseph A. , El-Jawahri Areej , Temel Jennifer S. 
Published: February 2017

9 Background: Oncologist-patient end-of-life (EOL) discussions are associated with less aggressive care at EOL. Prior research on EOL discussions has not explored the role of oncologists’ dispositional affect, trait patterns of emotional responses. Affect could possibly facilitate or hinder broaching difficult EOL topics. We examined associations between oncologists’ disposition for experiencing positive and negative affect and likelihood of EOL discussions reported by their patients with advanced cancers. Methods: 350 patients with incurable lung and GI cancers were enrolled in a randomized trial of early palliative care within 8 weeks of diagnosis. Oncologists providing care for participants completed a measure of dispositional affect, Positive and Negative Affect Schedule (PANAS). Positive and negative affect scales were analyzed dichotomously (above/below sample median). At 24 weeks in the trial, patients reported if they had ever discussed with their oncologist the care they would want to receive if they were dying (yes/no). Associations between oncologists’ affect and patient-reported EOL discussions were tested with multilevel models clustered by oncologist, adjusting for patient age, cancer type, and randomization. Results: At 24 weeks, 57/242 (23.6%) patients reported having had EOL discussions. The PANAS was completed by 17/19 (89%) oncologists with patients in the trial. Patients treated by oncologists with higher negative affect reported more EOL conversations, but this did not reach statistical significance: OR = 1.76 [.81, 3.83], p = .15. Patients treated by oncologists with higher positive affect also reported more EOL conversations, but this did not reach statistical significance: OR = 1.66 [.83, 3.35], p = .15. However, patients treated by oncologists with both higher positive and higher negative affect were over 3 times as likely to report having had EOL discussions: OR = 3.22 [1.02, 10.23], p = .046. Conclusions: Patients treated by oncologists with greater propensity to experience both positive and negative affect were more likely to report EOL discussions compared to those treated by oncologists who experience lower levels of affect. More research is needed to better understand these relationships.
Factors associated with quality of life in a cohort of patients with palliative advanced cancer from a developing country: Relevance of perception of cancer curability.
Authors: Perez-Cruz Pedro Emilio , Langer Paola , Carrasco Escarate Cecilia , Bonati Pilar , Batic Bogomila , Tupper Satt Laura , Gonzalez Otaiza Marcela 
Published: February 2017

93 Background: Improving quality of life (QOL) is a key goal in palliative care for patients with advanced cancer. Most studies about QOL in palliative care patients have been performed in the developed world. However, little is known about the factors that influence patients QOL in developing countries. The aim of this study is to describe factors associated with QOL in a cohort of patients with advanced cancer who were enrolled in the outpatient clinic public hospital in Santiago, Chile. Methods: Patients with advanced cancer admitted to the National Program of Palliative Care at a public Hospital in Santiago, Chile were prospectively enrolled in a study to assess QOL longitudinally. QOL was assessed with the EORTC-QLQ-PAL 15 questionnaire. Demographics, symptom intensity, depression and anxiety were assessed. Descriptive statistics and regression analysis were performed. Information about cancer curability and perception of personal health were also included. Results: In this preliminary report, the first 37 patients were included. Baseline characteristics were: mean patient age was 64, 21 (57%) females, 14 (38%) had GI cancer, 7 (19%) lung cancer, 4 (11%) breast cancer and 12 (22%) other. Mean (SD) QOL was 63 (34) in a 0 to 100 scale. QOL was not associated with age, gender, functionality, depression, anxiety, spiritual pain or financial distress. QOL was negatively associated with total symptom burden (coef -.53, p = .48), and positively associated with believing that cancer was curable (coef 33.3, p = .003). In a multivariate analysis, QOL was independently associated with both lower overall symptom burden (coef -.55, p = .38) and believing that cancer was curable (coef 28.6, p = .009). Conclusions: In palliative care patients with advanced cancer from a developing country, QOL was associated with lower overall symptom burden and with believing that cancer was curable. Further studies are needed to explore whether clarifying prognostic information about cancer curability in developing countries may impact patients’ QOL.
Post-prostatectomy salvage radiation therapy in prostate cancer upon identification of biochemical failure.
Authors: Peddada Suneal Gopal , Oliver Craig , Phelps Angela , Stokes Steven H. , Adkison Jarrod Bartlett 
Published: February 2017

127 Background: Prostate Specific Antigen (PSA) values post-prostatectomy are used as an indication for salvage radiation therapy. It has been suggested that initiation of therapy at lower PSA values lead to better outcomes. This study investigates outcomes of salvage radiation therapy at specific PSA thresholds. Methods: One hundred two prostate cancer patients were treated with salvage radiotherapy at our institution with curative intent, 19 of whom had Gleason score ≤6, 52 of whom had Gleason 7, and 31 with Gleason ≥8. Median follow-up after radiotherapy was 51 months. The median PSA prior to salvage radiotherapy was 0.33 ng/mL, and the median time from prostatectomy to radiotherapy was 24.6 months. Positive margins were identified in 52 patients, and perineural invasion was positive in 83. The median dose delivered was 64.8 Gy. Results: The 5-year actuarial freedom from biochemical failure rates for NCCN low, intermediate, and high risk groups were 100%, 77%, and 62%, p=0.2449. The 5-year actuarial freedom from biochemical failure rates for Gleason score ≤6, Gleason 7, and Gleason ≥8 patients were 87%, 72%, and 49%, p=0.0187. Patients with pre-radiotherapy PSA ≤0.5 ng/mL had better 5-year biochemical control relative to patients with higher pre-radiotherapy PSA, 76% versus 51%, p=0.0211. The pathological margin status did not predict for biochemical control after salvage radiation across the different Gleason grades. Very few interval biochemical failures are observed after the 5-year point of follow-up. The 5-year overall survival for the entire cohort is 92%, with prostate cancer specific survival of 96%. Conclusions: Salvage radiotherapy demonstrated favorable efficacy with durable PSA control and few failures 5 years post radiation. Initiation of salvage radiotherapy for PSA ≤0.5 ng/mL demonstrated improved biochemical control, supporting the adoption of early referral to radiation oncology once post-prostatectomy biochemical failure is identified. [Table: see text]
Risk factors for significant prostate cancer in radical cystoprostatectomy specimen: A retrospective analysis.
Authors: Thissen Andrea Katharina , Porres Daniel , Pfister David J. K. P. , Heidenreich Axel 
Published: February 2017

136 Background: Prostate cancer (Pca) has been found incidentally in radical cystoprostatectomy (RCP) specimens in 27-70%. We evaluated histopathological features and clinical outcome of patients with incidental Pca undergoing RCP for urothelial bladder cancer and identified potential risk factors for the presence of significant Pca, being defined as Gleason Score ≥7b, primary tumor ≥T2c or Pca volume ≥0.5cm3. Methods: A retrospective analysis of patients who underwent RCP between 01/2005-03/2015 was performed with regard to clinical data and pathohistological features. Whole mount serial sections of specimens were examined in the same urological and pathological institution. Pca grade, p-stage, cancer volume and surgical margins were recorded. Preoperative PSA values and follow-up were analysed. Results: We identified 71 patients with incidental Pca with a mean age of 71.7 years (47-84 years). 33/71 patients (46.5%) had significant Pca (28.2% ≥T2c, 4.2% GS ≥7b [+≥T2c], 14.1% cancer volume ≥0.5cm3[+≥T2c]). Other features were as follows: pT2a, n=36 (50.7%); pT2b, n=2 (2.8%); GS 6, n=50 (70.4%); GS 7a, n=18 (25,3%). All patients were R0 and N0 for Pca. Mean preoperative PSA level was 2.7ng/ml. None of the patients developed biochemical recurrence (median follow-up: 29.5 [1-124 months]). Patients with significant Pca were older than those with insignificant Pca (median age 71.2 years vs 70.1 years) and had higher preoperative PSA levels: 90% of patients with a PSA level of 4-10ng/ml had a ≥T2c Pca, while 81.5% of patients with PSA levels of 0-1ng/ml had a pT2a Pca. P-stages in patients with PSA values between 1-4ng/ml were found to be equally distributed between pT2a-pT2c. Conclusions: The occurence of incidental Pca is a common finding in patients undergoing RCP, with a considerable proportion having the characteristics of significant Pca. Potential risk factors for significant Pca are older age and PSA levels >4ng/ml. However, none of the patients experienced biochemical relapse or Pca-related death during the follow-up. In line with published data, incidental Pca does not impact on the oncological outcome of patients undergoing RCP. The prognosis is primarily determined by bladder cancer.
Active surveillance: How to measure, manage, and improve.
Authors: Gaylis Franklin , Cohen Edward , Calabrese Renee , Prime Hillary , Dato Paul , Kane Christopher J. 
Published: February 2017

137 Background: Active surveillance (AS) is an important strategy to limit the overtreatment of low risk prostate cancer (PCa). A best practice was established for AS inclusion criteria and follow-up, aimed to measure past AS adoption rates, institute the best practice, then measure AS adoption. Methods: Patient biopsy and treatment data was retrieved from an integrated EMR (Allscripts). AS adoption rates were calculated using 4 methods: 1) All newly diagnosed PCa patients; 2) Newly diagnosed PCa patients treated at Genesis Healthcare Partners (GHP); 3) Patients eligible for AS treatment according to the National Comprehensive Cancer Network (NCCN) (very low risk and low risk categories) guidelines and treated at GHP; and 4) Patients eligible for AS treatment according to the UCSD/GHP best practice and treated at GHP, according to the following inclusion criteria: Stage T1c; PSA Density (PSAD) < 0.15 ng/mL/cc and absolute PSA level < 10 ng/mL; Gleason ≤6; ≤3 cores (+); No individual core with >50% involvement. Between 2013 and 2014, GHP physicians underwent an educational training program on the UCSD/GHP best practice. Comparative report cards on AS adoption were sent to all physicians. Results: See Table. Conclusions: AS adoption improved in those patients considered most eligible (according to evidence based guidelines) for AS following institution of an educational program and comparative reporting in a community practice. Selection criteria appear to significantly impact AS adoption rates. [Table: see text]
Does variation in prostate volume calculated with MRI versus TRUS lead to reclassification of men based on current PSA density threshold for active surveillance criteria? Result from a prospective cohort.
Authors: Rai Samarpit , Patel Amil , Pavan Nicola , Soodana-Prakash Nachiketh , Balise Raymond R , Nahar Bruno , Satyanarayana Ramgopal , Parekh Dipen , Punnen Sanoj 
Published: February 2017

138 Background: PSA density (PSAD) is a strong predictor of aggressive prostate cancer (PCa) and is often used as a selection criterion for active surveillance. However, measurement of PSAD can vary depending on the modality used to estimate prostate volume (PV). We analyzed a prospective cohort of men undergoing MRI−US fusion biopsy to assess the variation in PV obtained with both imaging modalities, and investigate the impact of this variation on PSAD measurement in order to determine if it led to re-classification of patients above or below the current threshold of PSAD used in clinical practice (0.15 ng/mL/cc). Methods: All men were consecutively enrolled in this prospective study and had their PV measured on MRI prior to prostate biopsy (PB), and on Trans-Rectal Ultrasound (TRUS) at the time of PB. PSAD was calculated by dividing the last PSA prior to biopsy by the PV ascertained with each imaging modality. We used paired t-tests and Wilcoxon signed−rank tests to compare the difference in PV and PSAD obtained with TRUS and MRI. We also categorized PSAD measurements on each imaging modality above and below a cut-off of 0.15 ng/mL/cc. We used the McNemar’s test for paired proportions to estimate the significance of discordance in PSAD categorization based on each imaging modality. Results: Of the 124 men, the mean PV assessed with MRI (70 cc) was 7 cc more on average (SD: 11, median = 4 cc) than that obtained with TRUS (63 cc) (P < 0.0001). Furthermore, the mean PSAD obtained with MRI (0.17 ng/mL/cc), was 0.01 ng/mL/cc lower (SD: 0.07, median = 0.01) than that obtained with TRUS (0.18 ng/mL/cc) (P < 0.0001). 118 (95%) men had concordant PSAD values assessed with either imaging modality using the cut-off of 0.15 ng/mL/cc. All 6 (5%) men with discordant PSAD values who were above the cut-off with PV obtained via TRUS were reclassified as being below the cut-off with PV assessed via MRI (P < 0.01). Conclusions: MRI can overestimate PV compared to TRUS. This may translate to reclassification of men around the currently used PSAD threshold and have implications for treatment decision making and selection of patients for active surveillance.
Gene expression profiling of prostate tissue based on variable expression of 5-alpha reductase 2.
Authors: Salari Keyan , Bechis Seth , Ge Rongbin , Hong Jian , Otsetov Aleksander , Wang Zongwei , Wu Chin-Lee , Tabatabaei Shahin , Olumi Aria F. 
Published: February 2017

143 Background: Androgen signaling plays a central role in the pathophysiology of both benign and malignant prostatic disease. We previously showed that some men carry epigenetic modifications of the 5-alpha reductase (AR) promoter that modulate gene expression, raising the hypothesis that there may be molecular heterogeneity underlying the variability in clinical response to 5-AR inhibitors for management of benign and malignant prostatic diseases. In this study, we performed whole-genome expression profiling of prostatic tissue based on variable expression of 5-AR2 to determine whether molecular subtypes of clinical relevance could be identified. Methods: Prostatic tissue specimens were obtained from 22 patients with symptomatic BPH undergoing prostate debulking surgery. 5-AR2 protein expression was measured by immunohistochemistry, and 5-AR2 promoter methylation determined by PCR. RNA was extracted from each specimen and whole-genome expression profiling was performed using Illumina Human BeadChip Arrays. Gene expression data was analyzed by unsupervised hierarchical clustering and Gene Set Enrichment Analysis. Results: Unsupervised hierarchical clustering identified two subtypes of patients with distinct gene expression signatures. Among the most differentially expressed genes were several notable androgen-regulated genes, including TMPRSS2, NKX3-1, AZGP1, KLK3 (encoding the PSA protein) and multiple other members of the kallikrein family of serine proteases (all P< 0.001, FDR < 0.02). Multiple gene sets composed of androgen-regulated genes and androgen receptor target genes were found to be significantly enriched in one of the two subtypes. Interestingly, patients from this Androgen-Up subtype were also noted to have a higher frequency of 5-AR2 promoter methylation (though not statistically significant). Conclusions: Our findings suggest that there are distinct molecular subtypes among prostatic tissues with variable expression of 5-AR2, driven by differences in androgen gene regulation. These differences may partially explain the variable response to 5-AR inhibitors and thereby inform clinical strategies for devising therapies for benign and malignant prostatic disease.
A treatment planning comparison of proton therapy and intensity-modulated radiotherapy (IMRT) for prostate cancer using the normal tissue complication probability (NTCP).
Authors: Fischer-Valuck Benjamin Walker , Olsen Lindsey , Mazur Thomas , Altman Michael , Bottani Beth , Gay Hiram Alberto , Michalski Jeff M. 
Published: February 2017

153 Background: The volume of rectum receiving high-dose (i.e. > or = 60 Gy) is consistently associated with the risk of Grade > or = 2 rectal toxicity or rectal bleeding based on common terminology criteria for adverse events (CTCAE). Our goal was to compare intensity-modulated photon radiotherapy (IMRT) with proton radiotherapy in regard to the rectal dose using the normal tissue complication probability (NTCP). Methods: Between July 2014 and September 2015 the first 10 consecutive low or intermediate risk prostate cancer patients were treated with proton therapy at our institution. All 10 patients were planned with three-dimensional conformal proton therapy (3D-CPT) using two parallel opposed fields as well as comparison IMRT plans. A rectal balloon filled with water was used in all patients treated. Prescribed dose to the prostate was 79.2 Gy or cobalt Gy equivalent (CBE) for protons. Dose-volume histograms were compared. The Lyman-Kutcher-Burman model (n = 0.09, m = 0.13, and TD50 = 76.9 Gy) was used to generate NTCP estimates for both IMRT and proton plans. Results: At least 95% of the planning target volume received the prescription dose for both proton and IMRT plans. Dose constraints placed on the rectum included volume receiving 65 Gy (V65) less than 17% and V40 less than 35%. The mean dose to the rectum was 24.5 Gy (range, 19.5-30.1 Gy) and 31.7 Gy (range, 23.7-39.4 Gy) for the proton and IMRT plans, respectively. The V65 constraint was unachievable in 3 of the proton plans and 3 of the IMRT plans. The mean V70 and V75 for proton plans was 8.4% and 5.4% compared to 7.5% and 4.8% for the IMRT plans. The mean NTCP for proton treatment plans was 7.72% (range, 2.7-11.7%) and 7.92% (range, 1.7-15.3%) for IMRT (P = 0.45). After median follow-up of 6 months, no grade 2 or higher toxicity has been reported. Conclusions: Utilizing NTCP estimations, proton therapy and IMRT have similar predicted rates of rectal toxicity. Currently, a Phase III randomized clinical trial is underway comparing proton therapy and IMRT with regards to rectal toxicity and quality of life.
Magnetic resonance image-guided radiation therapy (MR-IGRT) for the treatment of prostate cancer: Initial clinical experience and patient selection.
Authors: Fischer-Valuck Benjamin Walker , Michalski Jeff M. 
Published: February 2017

156 Background: Magnetic resonance image-guided radiation therapy (MR-IGRT) has been implemented at our institution since 2014. We report on the initial clinical experience and patient selection in treating prostate cancer utilizing the first commercially-implemented MR-IGRT system. Methods: A total of 13 patients with prostate cancer have been treated with intensity-modulated radiation therapy (IMRT) using an MR-IGRT system. Of those treated, 6 patients received definitive radiation therapy (RT) for low, intermediate or high risk prostate cancer, 5 patients were treated with salvage RT after biochemical failure following surgery, and 1 patient was treated for the boost portion of definitive RT. Results: Patients were selected for MR-IGRT based on various clinical decisions. Four patients had co-morbidities requiring anticoagulation for which fiducial marker placement was contraindicated and soft tissue visualization via MR imaging was thought to be beneficial for daily set-up. Three patients were referred from outside institutions with concerns of radiation dose to the small bowel, and daily MR monitoring of bowel anatomy could be performed with plans for treatment adaptation if anatomy changed. One patient had received prior RT for rectal cancer and dose to organs at risk was of concern. The remainder of patients were post-operative salvage cases selected based on physician concern of accurate and reproducible daily localization with fiducial markers alone. Daily volumetric MR was monitored with the ability for treatment adaptation should small bowel dose increase, and no treatment changes were required. For all cases, onboard sagittal cine MR was visually monitored for bladder and target motion, and qualitative evaluation demonstrated no significant intra-fraction motion. Conclusions: MR-IGRT provides unique advantages when fiducial markers are contraindicated or when daily visualization of dose to the small bowel or other organs at risk is required to monitor and potentially prevent normal tissue toxicity. Clinical trials are in development to formally evaluate MR-IGRT for the treatment of intact and salvage prostate cancer.