bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interpretation of an online surgeon scorecard by the general public and its effect on adults changing cancer surgeons even when presented with complication rates that are statistically equivalent.
Authors: Weight Christopher J. , Labine Lucas , Palma Isaac , Dixon Colby 
Published: February 2017

83 Background: Recently Pro-Publica, an independent, non-profit newsroom, created a surgeon scorecard. This scorecard reports calculated death and complication rates for surgeons performing elective procedures in Medicare patients, including radical prostatectomy. We wanted to understand how the general population would interpret these data and whether it would influence surgeon choice. Methods: 265 adults at the Minnesota State Fair were recruited to participate in a survey requiring interpretation of a representative output graphic from the Pro-Publica website surgeon scorecard ( https://projects.propublica.org/surgeons ). The complication point estimate and 95% confidence intervals (CI) of a hypothetical surgeon, with whom survey participants were to assume that cancer surgery was already scheduled, were presented. They were also shown a graphic with 13 other surgeons point-estimate, complication rates, all of which fell within the index surgeon’s complication rate CI. Another surgeon, with a 0.6% lower point estimate, but statistically equivalent complication rate to the first surgeon, was indicated on the graphic. Participants were asked, based on this graphic alone, would they recommend switching surgeons? Results: The surveyed population was educated with 89% having attended, or graduated from college or higher (n = 235). Median age of participants was 50 years (Range 20-74). There were 179 females (68%) and 86 males (32%). Participants were from 136 different zip codes predominantly in the upper Midwest. 124 or 46.8% (95% CI 41-53) of respondents would recommend switching surgeons based on this single graphic. Conclusions: Nearly half of adults surveyed would recommend switching cancer surgeons for genitourinary malignancies based on data graphically presented on an online website, even though the point estimates between the two surgeons are not statically significantly different. This type of data display may lead to changes in medical decision-making based on random error of measurement of true complication rates not true differences in surgeon quality.
Application of active surveillance threshold to series of samples submitted for commercial testing.
Authors: Scardino Peter T. , Cuzick Jack M. , Stone Steve , Evans Brent , Jorgensen Matthew R , Eastham James Andrew , Keane Thomas E. , Davis John W. , Lin Daniel W. , Moul Judd W. , Brawer Michael K. , Crawford E. David 
Published: February 2017

84 Background: Active surveillance (AS) is an increasingly popular treatment modality for men with localized prostate cancer. Recently, we developed a method to select men for AS based on a score that combines cell cycle progression (CCP) with CAPRA (combined clinical CCP risk (CCR) score). Here, we apply our validated AS threshold to a series of samples submitted for commercial testing. Methods: Formalin-fixed prostate biopsy samples from 7,881 patients were submitted by their physicians to Myriad Genetic Laboratories for CCP analysis. Patient clinicopathological data was obtained from the test request form. The CCP score was calculated based on RNA expression of 31 CCP genes normalized to 15 housekeeping genes, and combined with CAPRA to generate the CCR score. The clinicopathological data of patients with a CCR score meeting the AS threshold were analyzed focusing on their PSA, % positive cores, Gleason, stage, AUA risk classification, and CAPRA score. Results: Of the 7,881 patients included in the analysis, 4,758 (60.4%) qualified for AS based on their CCR score. A substantial number of these patients, 2,213 (46.5%), would not have qualified for AS based on their clinical characteristics alone according to the following criteria: Gleason ≤ 3+4, PSA < 10, clinical stage ≤ T2a, and < 25% positive cores. A summary of the patients’ clinicopathological characteristics is shown below. Conclusions: This analysis showed that 60.4% of commercially tested patients qualified for AS, nearly half of which would not have qualified for AS based on their clinicopathological characteristics. For patients considering deferred treatment, the CCR score provides significant prognostic information at disease diagnosis. [Table: see text]
Pre-diagnostic circulating sex hormone levels and risk of prostate cancer by TMPRSS2:ERG status.
Authors: Graff Rebecca E , Meisner Allison , Ahearn Thomas , Fiorentino Michelangelo , Sesso Howard D. , Giovannucci Edward L. , Mucci Lorelei A. , Pettersson Andreas 
Published: February 2017

93 Background: Experimental studies have shown that androgen receptor stimulation can facilitate formation of the TMPRSS2:ERG gene fusion in prostate cell lines. No study has tested whether higher pre-diagnostic circulating sex hormone levels in men increase the risk of developing TMPRSS2:ERG positive prostate cancer specifically. Methods: We conducted a nested case-control study of 200 prostate cancer cases and 1,057 controls from the Physicians’ Health Study and Health Professionals Follow-up Study. We examined associations between pre-diagnostic circulating levels of total testosterone, free testosterone, DHT, androstanediol glucuronide, estradiol, and SHBG and risk of prostate cancer by TMPRSS2:ERG status. TMPRSS2:ERG was assessed by ERG immunohistochemistry. We used multivariable unconditional polytomous logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of fusion-positive (n = 94) and, separately, fusion-negative (n = 106) disease. Results: Free testosterone was significantly associated with the risk of ERG-positive prostate cancer (OR: 1.37, 95% CI: 1.05-1.77), but not ERG-negative prostate cancer (OR: 1.09, 95% CI: 0.86-1.38) (p-diff: 0.17). None of the remaining hormones evaluated showed clear differential associations with ERG-positive versus ERG-negative disease. Conclusions: These findings provide some suggestive evidence that higher pre-diagnostic free testosterone levels are associated with an increased risk of developing TMPRSS2:ERG positive prostate cancer but are not associated with prostate cancer that lacks TMPRSS2:ERG.
Copy number alterations of DNA mismatch repair (MMR) genes as novel prognostic markers in localised prostate cancer (CaP).
Authors: Chua Melvin , Lalonde Emilie , Mahamud Osman , Berlin Alejandro , Dal Pra Alan , Orain Michèle , Picard Valerie , Hovington Helene , Bergeron Alain , Fradet Yves , Têtu Bernard , Meng Alice , Zhang Junyan , Zafarana Gaetano , Livingstone Julie , Pintilie Melania , van der Kwast Theodorus , Fraser Michael , Boutros Paul , Bristow Robert G. ,   CPC-GENE
Published: February 2017

96 Background: To investigate the prognostic significance of CNA of genes involved in the MMR pathway in localised CaP. Methods: We studied CNA of genes involved in MMR, namely MSH2, MSH3, MSH6, MLH1, PMS2, in 284 patients with intermediate-risk CaP (Toronto cohort), and compared our findings against three public databases (MSKCC and Cambridge cohorts) that included 375 low- to high-risk CaP. The Toronto cohort comprised of 143 and 141 individuals who underwent image-guided radiotherapy (IGRT) and radical prostatectomy (RadP), respectively, while all patients from the public databases underwent RadP. Information on genome-wide copy number alterations (Toronto) was obtained using Affymetrix Oncoscan array. Biochemical relapse-free survival (bRFS) was assessed for clinical outcome. Results: CNA of MSH2, MSH3, MSH6, MLH1, PMS2 were observed in 3.9% (n = 11), 7.7% (n = 22), 3.9% (n = 11), 4.6% (n = 13) and 13.0% (n = 37) of the Toronto cohort, respectively. Distinct patterns of allelic gain and loss were observed for the gene set; gains only for MLH1 and PMS2, and losses only, in all but 1 case, for MSH2, MSH3 and MSH6. In the Toronto cohort, allelic losses of MSH2, MSH3 and MSH6 were determined to be prognostic for poorer bRFS in IGRT patients (HR 2.04, 95% CI 1.01, 4.12, p = 0.048), but not for patients who underwent RadP (HR 1.08, 95% CI 0.49, 2.39, p = 0.84); while gains in MLH1 and PMS2 were not prognostic in either IGRT or RadP patients. A pooled analysis of these genes for all RadP patients from the Toronto and public databases (n = 516) did however indicate that allelic losses of MSH2, MSH3 and MSH6 were significant predictors of poorer bRFS (HR 2.48, 95% CI 1.64-3.77, p < 0.001), but not MLH1 and PMS2 gains. On multi-variable modelling that includes percent genome aberration and pre-treatment PSA levels, allelic losses of MSH2, MSH3 and MSH6remained significant predictors of bRFS for the pooled RadP cohort (HR 1.96, 95% CI 1.27, 3.01, Wald's p < 0.001), but not for IGRT patients (HR 1.50, 95% CI 0.72, 3.12, p = 0.28). Conclusions: We identified a distinct pattern of copy number loss of MSH2, MSH3 and MSH6 genes in localised CaP that appears to be a novel biomarker of failure to definitive treatment.
Salvage image-guided radiotherapy to the prostate after cryotherapy failure.
Authors: Hopper Austin B , Einck John Paul , Sandhu Ajay Pal 
Published: February 2017

e637 Background: Cryotherapy is used in increasing frequency for the primary treatment of localized prostate cancer. While it is known that local recurrence can occur in > 20% of patients treated with primary cryotherapy there is a paucity of data on salvage treatments after failure. The use of external beam radiation therapy is an attractive option after cryotherapy failure but there is little data on efficacy and toxicity. We evaluate our data on a group of patients treated with image-guided dose-escalated radiotherapy (IGRT) at our institution. Methods: An IRB-approved database of patients treated with IGRT for prostate cancer from 2005 to 2013 was used to identify patients who underwent primary cryotherapy followed by salvage IGRT. Patients’ EMR were reviewed for age, cryotherapy-to-salvage interval, pre/post-salvage PSA and Gleason score (GS). All patients were treated with dose-escalated IGRT using standard treatment margins of 3 mm posterior and 7 mm in all other directions and daily CBCT or kv imaging to implanted fiducial markers. Narrative notes were used to identify GU/GI toxicity and scored according to CTCAE v4.03. The Phoenix definition of nadir + 2 was used to determine disease control following RT. Results: 5 patients were identified within the study period as having received salvage RT after primary cryotherapy. Mean age at the time of salvage RT was 74 (range 65-80). Median cryotherapy-salvage interval was 49 months (range 25-97) and prior to RT patients had GS of 7 (n = 3) or 8 (n = 2) and mean PSA of 8.1 ng/mL (range 4.2-14.38). Median total dose and follow-up were 76.7 Gy (range 75.6 – 81.0) and 52 months (range 6-63). One patient’s PSA did not decline post-RT and developed metastases while four patients responded post-RT with one experiencing biochemical recurrence after 30 months. No patients had acute GU/GI toxicities grade 2 or higher; one experienced late grade 2 GU toxicity (dysuria) which resolved with medication. There were no late grade 3 toxicities. Conclusions: High-dose radiotherapy as salvage treatment after cryotherapy failure is tolerated without significant GU or GI toxicities. Additionally, salvage IGRT is a viable option for long-term biochemical control in cases of local recurrence and warrants additional study.
Oncologist and primary care physician attitudes and practices toward cancer survivor follow-up care in an integrated health system.
Authors: Balasubramanian Bijal A. , Jetelina Katelyn K , Lee Simon Craddock 
Published: February 2017

105 Background: Previous research using nationally representative data showed significant differences between primary care physician (PCP) and oncologists’ attitudes and practices with respect to care of cancer survivors and called for more effective communication and coordination to improve care. This study compared PCP and oncologists’ attitudes and practices for follow-up cancer care within an integrated health system sharing a common electronic health record and clinical infrastructure to examine whether the integrated setting facilitated communication and coordination between PCPs and oncologists. Methods: 41 PCPs and 24 oncologists (response rate = 52%) affiliated with an integrated safety-net health system completed a validated survey. The survey assessed PCP and oncologists’ preferred models for delivering care, attitudes towards follow-up care, and cancer surveillance practices in this setting. Results: 41% of PCPs preferred an oncologist-led care delivery model as compared to 21% of oncologists. More PCPs than oncologists (73% vs 58%) agreed that PCPs have the skills necessary to initiate cancer surveillance. Yet, PCPs more often disagreed (56% vs 42% of oncologists) that they should have primary responsibility for providing cancer follow-up care. PCPs and oncologists differed significantly over cancer surveillance practices. Oncologists more consistently reported that PCPs ordered tests for cancer surveillance, evaluated patients for cancer recurrence and for adverse physical and psychological effects of cancer or its treatment, as well as managed pain and adverse outcomes of cancer treatment. PCPs, however, did not report equivalent ordering for these services. Conclusions: Even within an integrated health system, we found significant uncertainty as to who is responsible for care of cancer survivors. Oncologists more commonly assigned responsibility for cancer survivorship care to PCPs than PCPs recognized. This imbalance indicates many cancer survivors may not be receiving recommended care. Consensus guidelines are needed to delineate shared responsibilities for cancer survivors between primary care and oncology specialty care physicians.
Patterns of health care-related multimorbidity among breast cancer survivors.
Authors: McBride Mary L , Li Dongdong 
Published: February 2017

115 Background: Breast cancer survivors may experience multiple health conditions, both pre-existing and related to the cancer and its treatment. The objective of this study is to evaluate the total burden of healthcare-related morbidity and multimorbidity among breast cancer survivors, in the first five years from diagnosis. Methods: A population-based cohort of 6,944 female five-year breast cancer survivors, diagnosed at 18 years or older from 2000-2003, was identified from the Cancer Registry of the province of British Columbia, Canada, and followed to end 2008. Subjects were linked to all their provincial healthcare records of hospitalizations and outpatient physician service claims, excluding oncology and emergency visits, from diagnosis to 5 years post-diagnosis. International Classification of Disease (ICD) diagnostic codes for “reason for service” were extracted, then assigned to one of 32 diagnosis groups (Aggregated Diagnosis Groups (ADGS)) of the Johns Hopkins Adjusted Clinical Group (ACG) System. The ACG system aggregates diagnoses with similar expected demand for healthcare, primarily based on level of severity and persistence of disease. ADG distributions were generated. Results: Only 380(5.5%) of the survivors were < 40 years old at diagnosis; 1670(24.1%) were > 70 years. The majority (5648(81.3%)) were Stage I or II. In the 5 year period from diagnosis, most patients had at least one type of morbidity, with 47% having 11-15 different types of morbidities. Over 90% of survivors had reports of major ( = very high expected healthcare resource use) signs or symptoms, 3258 (46.9%) survivors experienced major adverse effects/injuries, 3232 (46.5%) had unstable chronic medical conditions, and 2696 (38.8%) had major time-limited infections. Approximately 49.3% had stable or unstable psychosocial conditions. Conclusions: Breast cancer patients experience extensive multimorbidity within five years of diagnosis, with high expected healthcare utilization. These results highlight the importance of comprehensive multimorbidity assessment, with care recommendations, included in cancer survivorship care plans.
Progesterone to improve neurocognitive outcomes following cranial irradiation.
Authors: Okwan-Duodu Derick , Atif Fahim , Yu David S. , Yousuf Seema , Bruner Deborah , Curran Walter John , Stein Donald G 
Published: February 2017

128 Background: Neurocognitive functional decline is a common sequalae of cranial irradiation (CI) that significantly impacts quality of life. Preclinical studies and randomized clinical trials show that following traumatic brain injury and cerebrovascular accidents, premenopausal women demonstrate decreased mortality and improved neurocognitive function, with these benefits presumed to be derived from progesterone. We hypothesized that progesterone may serve similar role in neuroprotection following cranial irradiation. Methods: Adult non-tumor bearing wild type C57BL/6 male mice were treated with two separate fractionated radiation therapy regimen (9 Gy and 15 Gy) to the brain. Cohorts of these mice were administered progesterone (16mg/kg daily) as a pretreatment for 3 days and concurrent with the radiotherapy for a total of 14 days with tapering during the last two days. The animals were then tested using different behavioral measures for cognitive function including morris water maze (MWM) for assessing spatial and related forms of learning and memory, elevated plus maze (EPM), , and spontaneous locomotor activity (SLA) tests. Mice were tested for cognitive function on day 10 and after 30 days of treatment for short and long-term effects of (CI) on memory function. Results: All irradiated mice showed statistically significant decline in MWM, EPM, and SLA measures. There were no significant differences in the 9 Gy versus 15 Gy cohorts. Progesterone administration produced a statistically significant group effect (F (4, 25) = 8.553; P<0.001) in the improvement of long-term memory function over 5 days of learning process. Progesterone administration also demonstrated a significant group effect (F (4, 25) = 8.613; P<0.001) in the probe trial, and a significant beneficial effect (F (4, 25)= 7.993; P<0.001) in short-term memory functional latency to reach the platform. Conclusions: The preclinical data show that progesterone improves radiation-induced deficits in short-and long-term memory functions in adult mice. Further work is required to show if progesterone may show similar clinical benefit in neuroprotection for adults undergoing prophylactic CI or definitive CI for brain metastases or benign intracranial processes such as AVM.
Falls and frailty in prostate cancer survivors on androgen deprivation therapy.
Authors: Moe Esther L , Borsch Carolyn , Garg Bharti , Dobek Jessica C , Doggett Rumen , Graff Julie Nicole , Beer Tomasz M. , Winters-Stone Kerri M 
Published: February 2017

134 Background: Androgen deprivation therapy (ADT) treatment for prostate cancer is associated with muscle loss, weakness and weight gain that could lead to falls and frailty, but the prevalence of these conditions in prostate cancer survivors (PCS) is poorly understood. The aim of this study is to describe the prevalence of falls and frailty in PCS on ADT and their associations with modifying factors, such as age and timing of ADT. Methods: Health history, cancer treatment and falls were self-reported by 146 PCS on ADT (mean age: 74+8 years). ADT usage and current versus past usage was confirmed against electronic medical records. Frailty was determined by self-report to 5 questions asking about presence or absence of fatigue, weakness, mobility difficulty, comorbidities, and weight loss, which could represent sarcopenia. Presence of each condition was summed to categorize men into one of three frailty phenotypes: frail (3-5), pre-frail (1-2) or not frail (0) groups. Since fat gain, rather than weight loss, is common with ADT and can impact function we also recalculated frailty as an “obese frailty” phenotype substituting obesity (BMI > 30 kg/m2) for weight loss. Comparisons were performed using chi-square. Results: 38% of PCS on ADT experienced a fall in the past year and among fallers, 61% experienced a fall that resulted in an injury. Using the frailty phenotype, 29% of PCS were pre-frail and 10% were frail; however, using the obese frailty phenotype, 47% of PCS were pre-frail and 15% were frail. The absence of frailty was significantly less in older men than younger men using the frail (p = 0.013), but not obese frail phenotype (p = 0.54). Fall and frailty rates did not significantly differ between PCS who were current versus past users of ADT (p = 0.65 and 0.26 for falls and frailty, respectively). Conclusions: Regardless of the frailty phenotype used, the rate of falls and prevalence of frailty among PCS on ADT was greater than fall rate (25%) and the frailty prevalence (4%) reported in large community-based samples of similarly aged men. These data also suggest that falls and frailty may continue after men stop ADT use. Research to identify risk factors for falls and frailty in PCS on ADT is warranted so that effective interventions can be developed and tested.
Primary care nurse practitioners providing survivorship cancer care.
Authors: Rosenzweig Margaret Quinn , Klein Sara , Connolly Mary , Hoffmann Rose 
Published: February 2017

14 Background: The Oncology Nurse Practitioner Web Education Resource (ONc-PoWER) is an online course developed specifically for nurse practitioners (NPs) in their first year of oncology practice paired with an onsite mentor (physician, nurse practitioner or physician assistant). Based on the Oncology Nursing Society’s Competencies for Entry to Practice, the course consists of 5 interactive modules: 1) the new patient visit 2) presenting a patient with cancer 3) cancer visits across the continuum of care 4) palliative and hospice care 5) self-care and professional development. The purpose of this study was to examine the NPs and mentors experience with the learning activities and to what degree the learning objectives were met. Methods: Dyads of NPs and mentors completed the course over 4-6 months. There are items for course evaluation with Likert scaled responses of 1) did not meet objective 2) somewhat met objective 3) met objective 4) more than met objective 5) exceeded objective expectation. Results: Enrollment is ongoing. Thirty NPs new to practice and 22 oncology mentors have completed evaluations thus far. Responses overall are favorable. Conclusions: The ONcPoWER web enhanced oncology orientation program was favorably evaluated by nurse practitioners new to cancer care and their mentors. This method of electronic orientation could standardize the exposure of essential basic cancer care competencies at entry to oncology nurse practitioner practice and, with some edits to content, for community based primary care nurse practitioners caring for cancer survivors. [Table: see text]