bluuebunny/crossref_metadata_2025_split huggingface dataset:
The increasing role of breast cancer lymphedema screening, diagnosis, and management as part of evidence-based breast cancer survivorship.
Authors: Shah Chirag , Vicini Frank A. 
Published: February 2017

145 Background: With improved outcomes across all stages, breast cancer survivorship represents an increasingly significant oncologic issue. One major facet of breast cancer survivorship is assessment and management of sequelae of treatment including breast cancer related lymphedema (BCRL) which has an incidence of 5-40% depending on locoregional and systemic treatment. BCRL represents a complication associated with physical changes as well as reduction in quality of life and continues to increase in prevalence with new diagnostics (ex. L-Dex, perometry) increasing the sensitivity for detection. Methods: Review of current evidence based guidelines from the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), and the American Cancer Society. Results: Evidence based treatment guidelines for breast cancer have evolved in 2015. For the first time, the NCCN guidelines include a reference to BCRL as part of routine treatment stating “to educate, monitor, and refer for lymphedema management” represents a standard component of breast cancer treatment and survivorship and allows for the early diagnosis and treatment of BCRL. At this time, neither the ASCO Breast Cancer nor ASCO survivorship guidelines incorporate BCRL management into routine practice. At this time, BCRL management is not part of ACS survivorship protocols. Conclusions: At this time, due to increasing data on BCRL diagnosis and treatment, evidence based guidelines are beginning to incorporate BCRL education, diagnosis, and treatment into standard breast cancer management plans. With increasing focus on survivorship, prospective BCRL programs are being developed that begin evaluation prior to treatment with screening in place and early intervention to help prevent progression by using diagnostics with increased sensitivity (ex. L-Dex, perometry).
Fractures in association with breast and endometrial cancer survival in the Women’s Health Initiative.
Authors: Newcomb Polly A. , Adams Scott V. , Passarelli Michael N , Lane Dorothy , Li Wenjun , Chlebowski Rowan T. , Crandall Carolyn , Tinker Lesley 
Published: February 2017

148 Background: Postmenopausal fracture rates appear to be an integrated marker of usual estrogen levels and have been associated with decreased risk of breast and endometrial cancer. The association between fractures and cancer mortality has been difficult to assess, as fractures are a consequence of both the pathological process and the treatment of cancer. Due to the reduced proliferative effects of the hormonal milieu, pre-diagnosis fractures may be a hallmark of decreased cancer mortality. Methods: We evaluated a cohort of breast (N = 6,458) and endometrial (N = 1,138) cancer cases who were diagnosed with cancer during the Women’s Health Initiative (WHI; 1992-2010). Fracture history was assessed by combining baseline reports of fractures prior to WHI and after age 50; with fractures ascertained during WHI follow-up, but prior to cancer diagnosis. We used Cox proportional hazards models based on time since cancer diagnosis to estimate hazard ratios (HR) with 95% confidence intervals for overall and cancer-specific mortality, comparing women with prior fractures to those without fractures. Clinical factors, including bisphosphonate and hormone use, were in the model. Results: Among breast cancer cases, during the average 6.2 years of follow-up, 1,464 had a prior fracture and 905 deaths occurred (415 due to breast cancer). Among endometrial cancer cases, during follow-up, 267 had a prior fracture and 192 deaths occurred (83 due to endometrial cancer). Any pre-diagnosis fracture was associated with increased all-cause mortality (breast HR: 1.39 (1.20, 1.62); endometrial HR: 1.41 (1.02, 1.95)). Among breast cancer cases, the strongest association was with hip fracture (HR: 2.76 (1.80, 4.25)). Associations with cancer-specific mortality were similar in direction and magnitude, but did not reach statistical significance. Conclusions: A history of pre-diagnostic fractures was associated with increased overall but not cancer-specific mortality. Fracture history may be indicative of frailty or other co-morbidities. Breast and endometrial cancer cases with a fracture history may benefit from concurrent supportive care to mediate risk of death due to co-morbid health conditions.
Development and evaluation of the TrueNTH-Prostate Cancer Canada electronic Library for Improved (urinary and bowel) Function post Treatment (TrueNTH-PCC-eLIFT).
Authors: Tangen-Steffins Kristin , Leong Nelson , Hodgson Sally , Wambolt Elizabeth , Hildebrand Catherine , Willie Chantalle , Siddiqui Khurram , Chan Garson , Leong Hon , Chin Joseph , Goulart Jennifer 
Published: February 2017

161 Background: The TrueNTH program is a Movember-funded, pan Canadian effort to develop a comprehensive patient-centered online portal in English and French that will cover a full spectrum of prostate cancer survivor needs. Through the support of Prostate Cancer Canada, the TrueNTH-PCC-eLIFT resource, as part of the TrueNTH program, is being developed by a multi-disciplinary team of urologists, radiation oncologists, gastroenterologists, researchers, nurses and survivors at pilot sites in Victoria, BC and London, ON. eLIFT will address urinary and bowel side effects that may be experienced after curative intent treatment by External Beam Radiation Therapy (EBRT), Brachytherapy (BT), combined EBRT + BT or Radical Prostatectomy (RP). Methods: eLIFT includes a didactic electronic library, symptom assessment tool and content tailored to treatment or symptoms experienced. A sequential prospective cohort study is underway to evaluate the impact of the resource. A baseline cohort of eighty patients per site receiving standard of care is currently open. A second cohort of eighty patients per site will be accrued to receive the eLIFT intervention. The study measurespatient self-efficacy, knowledge, Health Related Quality of Life (HRQoL), urinary and bowel function, health resource usage and satisfaction. Results: eLIFT content, with a total of 22 video modules is complete and in production. Preliminary results from the first cohort of patients, receiving standard care, confirm a need for a reliable, online resource in Canada. Patients note that the oral information provided by their oncologist at their preliminary consultation, while informative, is not easily retained. Information that was provided as print varied and was often outdated. Further, patients deem websites outside of Canada as the most reliable and helpful, which may not reflect Canadian recommendations. Conclusions: eLIFT will provide a unique and scalable centralized resource that will allow for expansion to a National level and increase access to a scientifically-sound library of information with the goal of improving the quality of care for prostate cancer patients across Canada.
Financial toxicity in thyroid cancer: An analysis from the North American Thyroid Cancer Survivorship study.
Authors: De Souza Jonas A. , Grogan Raymon , Aschebrook-Kilfoy Brisa 
Published: February 2017

17 Background: Financial toxicity (FTox) has been associated with worse health-related quality-of-life (HRQoL), compliance, and even survival in cancer patients (pts). Measuring FTox and understanding its predictors are of paramount importance when planning intervention strategies, the value of care, and healthcare policies. We report FTox and its predictors in a large cohort of thyroid cancer pts and survivors. Methods: Pts with thyroid cancer were surveyed in the North American Thyroid Cancer Survivorship Study. FTox was assessed by the previously validated COmprehensive Score for financial Toxicity (COST), as well as by questions related to financial distress (out-of-pocket costs, loss of income and bankruptcy). Data on sociodemographics, income, type of disease, length of diagnosis (LOD), and prior therapies were collected. Predictors of FTox were assessed in multivariate analyses, controlling for potential confounders, such as HRQoL (as measured by the thyroid cancer-specific City of Hope instrument), type of treatment received, and LOD. Results: 591 pts with thyroid cancer within the past 6 years were surveyed in 2 countries: 553 (93.5%) in the United States (U.S.), and 38 (6.5%) in Canada. Most were women (n = 518 pts, 88%). The median LOD was 857 days (range 105-2176 days), and 430 pts (72.8%) had papillary thyroid cancer. There were 61 pts (10.3%) with Stage IV, and 11 (1.9%) were on tyrosine kinase inhibitors. Overall, 234 pts (39.5%) stated that their out-of-pocket costs were higher than previously thought; 207 pts (35%) felt their disease resulted in loss of income; 44 pts (7.4%) were unable to meet their monthly expenses; and 7 pts (1.2%) declared bankruptcy after diagnosis. The median COST value was 24 (range 0-44). In multivariate analyses, the independent predictors of worse FTox were lower income (p < 0.001), female gender (p = 0.01), lower educational level (p = 0.002), healthcare delivery in the U.S., (p = 0.002), and worse HRQoL (p < 0.001). Conclusions: A significant proportion of thyroid cancer pts experience FTox. We identified pts characteristics (gender, education, income), as well as geographical differences (healthcare delivery in the U.S.) as predictors of FTox.
Correlation of body mass index with female survival benefit among a single-institution cohort of cutaneous melanomas >1 mm thick following wide-local excision and sentinel lymph node biopsy.
Authors: Jackson Laura K. , Bulloch Kaleigh Joy , Narayan Deepak , Ariyan Stephan , Gould Rothberg Bonnie Elyssa 
Published: February 2017

172 Background: As the 10-year mortality for localized cutaneous melanomas (CMMs) > 1.00 mm is 40%, non-therapeutic interventions to supplement active surveillance following resection may be beneficial. Data describing the impact of lifestyle choices on survival in this population are limited. Methods: 837 consecutive patients who underwent wide local excision and sentinel lymph node biopsy (WLE + SLNB) at Yale during 1997-2012 for CMMs > 1.00 mm thick were enrolled. Smoking, alcohol use and caffeine consumption were assessed by questionnaire at diagnosis and were each categorized according to quantity used with never-users as the reference. Body mass index (BMI) was calculated from height and weight measured at surgery. Crude and multivariable marginal relationships between lifestyle factors and disease free survival (DFS), the latter adjusted for age, sex, thickness (mm), ulceration, mitotic count, and SLN status, were assessed using Cox proportional hazards. Interactions with clinicopathologic factors were conducted. Results: A female survival benefit (HRFEMALE= 0.69; 95% CI: 0.49-0.97; p = 0.04) was observed on multivariable analysis. While BMI was not independently associated with DFS (p = 0.31), we noted a significant interaction between sex and BMI (p = 0.01). Compared with referent normal weight (BMI < 25) men, normal weight women had similar survival (HRBMI < 25= 0.91; 95% CI: 0.52-1.57, p = 0.74) but a progressive survival advantage was observed among women with increasing BMI (HROVERWT= 0.62; 95% CI: 0.33-1.14, HROBESE= 0.23; 95% CI: 0.07-0.58, ptrend= 0.01). A similar relationship was not observed among men (ptrend= 0.51). Neither the marginal effects nor those modified by sex for each of alcohol, tobacco or caffeine were associated with DFS (p > 0.15). Conclusions: Following WLE+SLNB, increasing BMI may improve survival among women but not among men. Research to identify contributory molecular mechanisms in the context of the female survival benefit is warranted.
Impact of Young and Strong on physical activity in young breast cancer survivors.
Authors: Ligibel Jennifer A. , Barry William Thomas , Ruddy Kathryn Jean , Greaney Mary , Rosenberg Shoshana M. , Sprunck-Harrild Kim , Morgan Evan , Walsh Sarah , Emmons Karen , Partridge Ann H. 
Published: February 2017

175 Background: Inactivity is common in breast cancer survivors and has been linked to poor outcomes. Few trials have tested physical activity (PA) interventions in young women with breast cancer, who may face unique PA barriers due to demands of jobs and young families. Methods: Young and Strong was a cluster-randomized study evaluating the effect of education interventions for young breast cancer survivors.Sites were randomized 1:1 to a young women’s intervention (YWI), focused on fertility and other issues facing young women, or to a physical activity intervention (PAI). At PAI sites, providers were instructed to discuss PA with patients, and participants were given materials to encourage PA. PA was measured with the modified Godin Leisure Score Index at baseline, and 3, 6, and 12 months. Medical records were reviewed to assess provider attention to PA. Changes in weekly min of PA were compared between the PAI and YWI groups using general estimating equations to evaluate clustered binary and Gaussian data. Results: 467 patients enrolled between 7/12 -12/13 across 54 sites. Median age at dx was 40yrs (range 22-45). At baseline, participants were moderately active. PA increased in both groups over time (Table); there was no significant difference in PA between groups at any time (all p > 0.1). Provider attention to PA was documented in 74% of participants on PAI and 61% on YWI (p = 0.15), and correlated with PA at 12 months (median 100 min/wk of PA in participants with provider attention to PA vs. 60 min/wk in those without, p = 0.016). Participants who reported reading all or most the PAI materials reported higher levels of PA vs. those who read less (78% vs. 64%, p = 0.05) Conclusions: Young breast cancer survivors assigned to a PA intervention did not increase PA more than those assigned to an intervention focused on young women’s issues. However, the higher levels of PA among women who engaged with the PAI materials and those whose oncology providers addressed PA suggests the importance of enhancing patient and provider engagement with healthy lifestyle information and recommendations. Clinical trial information: NCT01647607. [Table: see text]
Community experience with a cancer survivor smoking cessation program.
Authors: O'Rourke Mark Allen , Hoopes Stephanie , Franco Regina A , Summey Julie Frances , Mayo Rachel 
Published: February 2017

182 Background: In 2014, GHS began a smoking cessation program for cancer survivors staffed by nurse practitioners and nurse navigators who are certified smoking cessation providers. The program is four scripted visits plus telephone support. Patients learn to become smoke-free by nicotine weaning and replacement, medication management, and integrative coping skills such as hypnosis. The purpose of this descriptive analysis is 1) to determine program smoking cessation rates and 2) to profile patients who completed the program successfully (nonsmoker status). Methods: Patient records from the first 12 months were mined for the following variables: demographics, primary insurance type, primary diagnosis, number of visits, number of cigarettes smoked per day at enrollment, alcohol use, and depression. Data was analyzed using Stata13. The GHS IRB approved the study. Results: Of the 143 patients referred to CIOS for smoking cessation during the first year, 70 (49%) enrolled in the program. 29 (20%) patients completed the program, and 11 (8%) others are in the process of completing the program. 23 (79%) of the 29 completers achieved non-smoker status at the time of program completion. Two months after program completion, only two nonsmoking completers reverted to smoking status. When stratifying completers by key demographic, clinical, and behavioral characteristics, the most successful were females (93% vs. 67% for males), Caucasians (82% vs. 71% for African-Americans), married individuals (100% success rate for married vs. 50% for divorced), and those with private insurance (100% vs. 79% Medicare and 67% Medicaid). Logistic regression did not reveal an increased probability of smoking cessation success with any of the key independent variables. Conclusions: This smoking cessation program using nicotine weaning and replacement, medication management, and integrative coping skills in a cancer survivor population has an encouraging success rate for those who complete the four-visit program. The relative success of married persons and females warrants further study as do the low enrollment rate of those referred, the low completion rate of those enrolled, and the continuing nonsmoking success rates for completers.
Elimination of second-hand smoke (SHS) exposure after a lung or head and neck (HN) cancer diagnosis and subsequent patient smoking cessation.
Authors: Eng Lawson , Alton Devon , Song Yuyao , Farzanfar Delaram , Krys Olivia , Yoannidis Tom , Milne Robin , Habbous Steven , Brown M Catherine , Vennettilli Ashlee , Shepherd Frances A. , Leighl Natasha B. , Hope Andrew J. , Howell Doris , Jones Jennifer M. , Selby Peter , Xu Wei , Goldstein David Paul , Giuliani Meredith Elana , Liu Geoffrey 
Published: February 2017

183 Background: Exposure to SHS after a cancer diagnosis is associated with continued smoking in lung and HN cancer patients (PMID: 24419133, 23765604). However, smoking is a social activity. We evaluated whether elimination of SHS exposure around and after a diagnosis of lung or HN cancer is associated with smoking cessation in the cancer patient. Methods: Lung and HN cancer patients from Princess Margaret Cancer Centre (2006-12) completed questionnaires at diagnosis and follow-up (median 2 years apart) that assessed smoking history and SHS exposures (cohort study). Multivariate logistic regression analysis evaluated the association of elimination of SHS exposure after a diagnosis of cancer with subsequent smoking cessation, adjusted for significant covariates. A cross-sectional study (2014-15) of 183 lung and HN smoking patients assessed consistency in associations and interest in SHS cessation programs. Results: For the cohort study, 261/731 lung and 145/450 HN cancer patients smoked at diagnosis; subsequent quit rates were 69% and 50% respectively. 91% of lung and 94% of HN cancer patients were exposed to SHS at diagnosis while only 40% (lung) and 62% (HN) were exposed at follow-up. Elimination of SHS exposure was associated with smoking cessation in lung (aOR = 4.76, 95% CI [2.56-9.09], P< 0.001), HN (aOR = 5.00 [1.61-14.29], P< 0.001), and combined cancers (aOR = 5.00 [3.03-8.33], P< 0.001). The cross-sectional study has similar cessation and SHS exposure rates and a similar association for elimination of SHS with smoking cessation (aOR = 3.42 [1.16-10.10], P= 0.03). However when asked directly, only 26% of patients quit smoking with another individual and 13% of patients exposed to SHS had at least 1 interested party in joining a SHS cessation program. Conclusions: Elimination of SHS exposure around patients is significantly associated with smoking cessation in lung and HN cancer patients, but few patients quit smoking together with others around them, despite the ‘teachable moment’ with a cancer diagnosis. Clinicians should encourage patients and their household/friends to quit smoking together to improve cessation rates in cancer patients and those around them.
Psychosocial distress screening in cancer care.
Authors: Mullai N 
Published: February 2017

187 Background: Distress is a multifactorial, emotional experience that may interfere with patients’ ability to cope with cancer and its treatment. Recognizing and managing distress may benefit patients. The Commission on Cancer requires implementation of Standard 3.2, Psychosocial Distress Screening in 2015 and integrating distress intervention in cancer care. This study evaluates patients’ perception on benefits in this regard. Methods: Patients were screened at least once at a pivotal medical visit using a questionnaire that included various aspects of stress. NCCN’s Psychosocial Distress Screening Tool was used to measure seriousness of distress. Patients marked their distress level on a scale of 1 to 10. A threshold of 5 was set as a trigger point to start addressing distress. Results: Answers from 311 cancer patients (male 61%; female 39%) were evaluated since January 2015. A majority of patients had breast cancer (29%), followed by lung (18%), GI (18%), and hematological (12%) malignancies. The mean distress score was 3.72 (male 3.14; female 3.97). 131 patients had a score above five. Age group, 40-49 years had a higher distress (4.79) compared to others. Esophageal cancer (1%) had the highest mean score 7.33 followed by head & neck cancer (4%) with 5.67. In most patients, anxiety about cancer and its treatment was the cause of distress. However, they did not want any additional psychosocial intervention except for talking to their oncologist and primary physician. The distress of some patients was family related and they were unsure of the help needed. Two patients refused screening stating the questions were intrusive. Conclusions: Coordinated psychosocial care may benefit cancer patients with significant distress. NCCN tool helps to assess the severity of patients’ distress and to determine the need for intervention. The results (mean score of 3.72) suggest most cancer patients need no major intervention or special psychosocial counseling other than discussing with their physician and family, which is done routinely in most oncology practices. However, when stress is expressed, this tool does help the treating physicians to determine the specific area and degree of stress, to focus on the type of help needed for the patient, and to channel resources appropriately.
Survivor guilt: The secret burden of cancer survivorship.
Authors: Perloff Tara , Shen Megan Johnson , Rigney Maureen , King Jennifer C. 
Published: February 2017

192 Background: The 5-year observed survival rate for a stage IV non-small cell lung cancer patient is one percent. Such a small survival rate begs the questions of how these survivors might feel. Society implies that these now “survivors” should feel relieved; lucky; even ecstatic, but many survivors feel a deep-seated sense of guilt. This feeling of objective guilt is a phenomenon known as survivor guilt. There has been little research done to identify the existence of survivor guilt among any group of cancer patients, and no research has examined the associations between survivor guilt and potential burdens in survivorship. The goal of the present study was to identify the prevalence of survivor guilt among lung cancer patients, while also pinpointing themes among those who are affected. Methods: A questionnaire containing a subset of the published IGQ-67 Interpersonal Guilt Questionnaire was completed via Survey Monkey by 108 respondents. After completing the IGQ questions, respondents were given a definition of survivor guilt with an open-ended question on their feelings toward surviving lung cancer when others did not. Additionally, 20 respondents were interviewed via telephone to further expand on their responses which supported the quantitative data. Results: Results indicate that a significant amount of survivor guilt is experienced among lung cancer survivors. A total of 55% of respondents identified as having experienced survivor guilt, yet 63.9% of respondents scored above average on the IGQ-67 Survivor Guilt Scale. Data analysis is ongoing to establish recurring demographic and clinical themes among those who experienced survivor guilt, including factors such as: type and stage of lung cancer and smoking history. Conclusions: This study determines the prevalence of survivor guilt in a sample of lung cancer patients, indicating that survivor guilt is a common psychosocial challenge. Further research across all cancer types must be explored in order to determine the overall prevalence of survivor guilt as well as to develop effective interventions. However, this study represents the first step in examining the prevalence of survivor guilt and the need for creating tools to identify, assess, and ultimately treat patients who suffer.