bluuebunny/crossref_metadata_2025_split huggingface dataset:
Among men with low-grade prostate cancer on prostate biopsy, the 4Kscore to predict prostate cancer aggressiveness at prostatectomy.
Authors: Nahar Bruno , Punnen Sanoj , Zappala Stephen M , Sjoberg Daniel , Parekh Dipen 
Published: February 2017

65 Background: Most men diagnosed with prostate cancer in the United States have low-grade tumors. While many of these men are good candidates for active surveillance, a proportion will have a bad outcome due to the presence of a more aggressive prostate cancer that was missed on initial biopsy. A recent study confirmed the 4Kscore accurately predicts the likelihood of aggressive cancer on prostate biopsy. We analyzed if the 4Kscore could predict the presence of more significant cancer in men with low-grade tumors on the diagnostic biopsy. Methods: A recent prospective validation of the 4Kscore was conducted at 26 sites throughout the United States. We selected men who were found to have low-grade (Gleason 6) cancer on biopsy for this analysis. The 4Kscore calculates the risk of aggressive prostate cancer on prostate biopsy by a blood test that measures levels of four kallikrein biomarkers (total PSA, free PSA, intact PSA, and human kallikrein-2) plus age, DRE findings, and prior biopsy status. We investigated whether the 4Kscore was associated with more significant cancer among men found to have Gleason 6 cancer on prostate biopsy. We also looked at a subset of these men who underwent radical prostatectomy to see if the 4Kscore was associated with prostate cancer being upgraded in the surgical specimen. Results: Among the 1,312 men enrolled in this trial, 306 men were found to have Gleason 6 cancer on prostate biopsy. The 4Kscore was significantly associated with the number of positive cores (p=0.001) and the millimeters of cancer seen (p=0.0002), with higher 4Kscores relating to more extensive cancer present on biopsy. In the subpopulation of 51 men who underwent radical prostatectomy, the median 4Kscore was significantly higher among men who had an upgrade to Gleason 7 or higher [15% (8,25)] compared to men who did not experience an upgrade [7% (4,14)] (p=0.032) in their final pathology. Conclusions: Among men with Gleason 6 prostate cancer on biopsy, the 4Kscore was associated with the prostate cancer being upgraded in the surgical specimen at radical prostatectomy. The 4Kscore test may facilitate the selection of men who can be observed versus those who should undergo immediate treatment.
Effects of PSA screening guidelines on trends of diagnosis and treatment for prostate cancer: Analysis from the National Cancer Data Base (NCDB).
Authors: Aragon-Ching Jeanny B. , Hussey Heather M. , Chen Dechang , Nguyen Hong , Henson Donald , Simmens Samuel 
Published: February 2017

74 Background: The initial iteration of the USPSTF ‘Screening for Prostate Cancer’ guideline published in 2008 made recommendations against PSA screening for men > 75 years followed by an updated recommendation published in 2012 against PSA screening altogether. However, two large studies that formed the basis of these recommendations, the European ERSPC and the US-led PLCO trials, have published conflicting results. Currently, active surveillance is often offered as an approach to manage early stage prostate cancer. The NCDB was used to determine the uptake and efficacy of the USPSTF screening recommendations as well as their impact on the treatment of clinical T1c disease, which by definition, is cancer identified via screening to inform clinical practice. Methods: A de-identified dataset was acquired from NCDB. Frequencies were calculated for demographic variables; correlation coefficients and chi-square statistics were generated to assess any significant correlations between potential predictors (e.g. age, race, year of diagnosis, and tumor size) and time to treatment to determine whether treatment decisions, including active surveillance increased following the guideline recommendations. Results: The NCDB included 1,802,596 patients diagnosed with prostate cancer between 1998 and 2012; the majority of whom were white (82%) followed by black (13%), and other (5%). The highest number of patients was diagnosed in 2007 and the lowest number of patients was diagnosed in 2012, although no clear decline in the diagnosis across time periods was observed. A negative correlation was identified between age and year of diagnosis (r = -0.09, p < 0.0001), indicating a potential decline in diagnosis among older men. Alternatively, a positive correlation was found between year of diagnosis and days until treatment began (r = 0.09 p < 0.0001) indicating a potential increase in alternatives to treatment such as active surveillance. Conclusions: Preliminary results suggest no major changes in the patterns of diagnosis. However, active surveillance as an alternative to treatment may be increasing perhaps as an early indication of adherence to the guideline.
Comparative effectiveness of intensity-modulated radiation therapy versus three-dimensional conformal radiation for localized prostate cancer.
Authors: Shaikh Talha , Ruth Karen , Zaorsky Nicholas George , Hallman Mark , Geynisman Daniel M. , Kutikov Alexander , Smaldone Marc C. , Chen David Y. T. , Sobczak Mark L. , Horwitz Eric M. 
Published: February 2017

89 Background: Intensity-modulated radiation therapy (IMRT) has become the standard radiation delivery option for patients (pts) with localized (PCa) prostate cancer despite limited prospective data and increased cost relative to three-dimensional conformal radiation therapy (3D-CRT). The purpose of this study was to compare the treatment outcomes and toxicities of pts undergoing definitive dose-escalated radiation therapy using either 3D-CRT or IMRT for localized PCa. Methods: We identified men with clinically localized PCa treated with definitive external beam radiation at a single institution using >74 Gy between 1997-2013. Within each NCCN risk group, propensity score matching of 3D-CRT pts with one or two IMRT pts was performed accounting for age, race, diabetes, hypertension, Gleason score, T-stage, PSA, and hormone use. Conditional logistic and conditional Cox proportional hazards models were used to adjust for matched groups, with dose included as a separate covariate. Results: After matching,1,253 men (474 3D-CRT, 779 IMRT) were included. There were no significant differences between the IMRT and 3D-CRT pts according to clinical or treatment factors. There was no difference in biochemical failure (BCF), distant metastasis (DM), cancer specific survival (CSS), or overall survival (OS) amongst the low or intermediate risk subgroups. When examining the high-risk subgroup, pts receiving IMRT had higher rates of DM (HR 2.21 95% CI 1.04-4.74 p=0.040). There was a trend towards increased rates of BCF in pts receiving IMRT for high-risk disease (HR 1.60 95% CI 0.96-2.66 p=0.072). There was no difference in CSS or OS in the high-risk subset. In the intermediate risk group, patients receiving IMRT had increased rates of acute grade 3+ genitourinary toxicity versus 3D-CRT patients (OR 8.30 95% CI 2.13-2.15 p=0.002). There were otherwise no differences in acute or late grade 3+ genitourinary or gastrointestinal toxicity amongst IMRT versus 3D-CRT pts. Conclusions: Despite the widespread adoption of IMRT for localized PCa, our results do not demonstrate an improvement in outcomes or toxicity versus 3D-CRT. Further research is warranted to explain these findings.
The change in prostate cancer presentation and diagnosis coinciding with screening recommendations.
Authors: Gaylis Franklin , Choi Jae , Dato Paul , Cohen Edward , Calabrese Renee , Prime Hillary , Kader A. Karim 
Published: February 2017

95 Background: The controversy surrounding prostate cancer (PCa) screening resulted in the United States Preventative Services Task Force (USPSTF) and several primary care societies to recommend against this practice. We examined the characteristics of men evaluated in a large urology practice for an elevated prostate specific antigen (PSA) and the subsequent PCa diagnoses since the USPTF recommendation. Methods: Characteristics of all men presenting for an elevated PSA from August 2011 to August 2014 were prospectively collected in a database. Age at the time of biopsy, self-declared race, insurance status, family history, digital rectal examination findings, PSA within 6 months of biopsy, biopsy history, prostate volume, number of cores sampled, pathologic read (number and percent cores positive, Gleason grading) were all recorded. Kruskall-Wallis rank sum tests were used to compare across all years with post-hoc Dunn’s tests for pairwise multiple comparisons using Bonferroni adjustment. Results: The number of men referred for elevated PSA dropped from 933 in year 1 to 754 by year 3 (19%) with a concomitant drop in the number of biopsies performed in newly referred men from 461 to 370 (20%). The group’s prostate biopsy volume decreased by 15% (1,133 biopsies in year 1 compared to 958 in year 3). Median pre-biopsy PSA increased across all years from 7.0 ng/ml to 8.1 ng/ml (p = 0.0006) with a rise in the proportion of men having PSAs > 10 from 28% to 38%. In the post-hoc analysis, median pre-biopsy PSA was significantly different between years 1 and 3 (p = 0.0002) and years 2 and 3 (p = 0.017) but not years 1 and 2 (p = 0.33). The biopsy positivity rate increased slightly from 46% to 50% across all years with a rise in the proportion of men having Gleason scores (GS) ≥ 8 from 21% to 30% (p = 0.0001). In the post-hoc analysis, median GS was significantly different between year 1 and year 3 (p < 0.0001) and year 2 to year 3 (p = 0.0004) but not year 1 to year 2 (p = 0.12). Conclusions: Our findings suggest a significant grade migration coincident with recommendations against PSA screening. While possibly desirable in the short term, should this trend continue we may miss the window of curability for many men.
Modified Kegel exercise regimen following definitive and adjuvant prostate cancer radiotherapy.
Authors: Eapen Libni , Ionescu John , Eapen Amira 
Published: February 2017

e629 Background: 5-15% of patients treated with curative radiotherapy for prostate cancer experience some degree of urinary or fecal leakage. We hypothesized that a regimen of postradiotherapy perineal exercises would reduce this problem of sphincter dysfunction Methods: Upon completion of either conformal- or intensity-modulated radiotherapy to 76 Gy in 38 fractions (definitive) or 66 Gy in 33 fractions (postprostatectomy) patients were advised to commence a life-long program of daily perineal strengthening exercises. This consisted of a modified Kegel regimen for 5 minutes at a time, four times daily, and continued indefinitely. Patients have been monitored in regard to compliance and sphincter dysfunction at scheduled cancer clinic followup visits as well as by telephone survey. Results: 530 patients have been engaged in this postradiotherapy sphincter conditioning program. Parameters being analyzed are compliance with the regimen, frequency of exercise performance, urinary and fecal incontinence rates Conclusions: Pending the final tabulation of results the practical feasibility of such a prophylactic perineal exercise regimen as well as its impact on post radiotherapy sphincter integrity will be ascertained.
Integrating the primary care physician into cancer follow-up.
Authors: Salner Andrew L. , Walker Deborah , Seltzer Amanda , Panzer SarahLena , Stricker Carrie , Dornelas Ellen A 
Published: February 2017

102 Background: After a diagnosis of breast cancer, it can be difficult for patients to understand the role their primary care physician (PCP) should play in their follow up care. Methods: 65 women (mean age 60 years, SD = 10) with breast cancer (stage 0-III) were seen by a nurse practitioner for a 60-90 minute consultative survivorship visit and received a treatment summary and personalized survivorship care plan (SCP) utilizing Carevive Care Planning Systems software. The Carevive system incorporates patient-reported and clinical data to create tailored care plans with personalized recommendations for follow up care and supportive referrals, including direction to follow up with primary care for specific care and health maintenance activities. Approximately 6 weeks following their survivorship care visit, patients completed a survey assessing their use of and satisfaction with the SCP. Patients were advised that the SCP would be mailed to their referring oncologist and primary care physician. Results: Out of 65 sent, 35 surveys have been completed to date. Survivors were diagnosed approximately 10 months prior, and all were within 6 months following completion of treatment. All patients (100%) reported that they read, or planned to read, their survivorship care plan packet carefully. While all care plans included a recommendation to follow up with their PCP, only (71%) of survivors remembered receiving this recommendation. Of those who did, most (74%) had either seen or scheduled an appointment with their PCP. Patients who reported higher anxiety at the time of the survivorship visit were more likely to report that the follow up care plan helped them take action about seeing their PCP (p = .03). Conclusions: Coordination between primary and oncology care providers has previously been shown to improve the quality of care for cancer survivors. SCPs that emphasize the importance of and activities to be undertaken in primary care may help to improve this coordination. Continuation of this research will help to better understand how to integrate the primary care physician into cancer follow up care. Updated data will be shared at time of presentation.
Insulin and glucose homeostasis in childhood cancer survivors treated with abdominal radiation: A pilot study.
Authors: Friedman Danielle Novetsky , Wolden Suzanne L. , Antal Zoltan , Moskowitz Chaya S. , Hilden Patrick , Cheung Nai-Kong V. , Kushner Brian H. , Tonorezos Emily S. , Carlow Dean , Oeffinger Kevin C. , Sklar Charles A. 
Published: February 2017

108 Background: Previous reports have suggested an increased risk of Type I and Type II diabetes mellitus (DM) in childhood cancer survivors exposed to abdominal radiotherapy (RT). The mechanisms leading to DM in this population, however, remain unknown. We sought to clarify the pathophysiology leading to these derangements by performing dynamic testing of glucose and insulin in survivors previously treated with abdominal RT. Methods: Cross-sectional pilot study of 2-year survivors of childhood cancer treated with abdominal RT at Memorial Sloan Kettering between 1975 – 2009. Eligible participants were < 21 years of age at exposure to abdominal RT; those with a known diagnosis of DM or prior exposure to brain or total body RT were excluded. Survivors underwent formal 2-hour glucose tolerance testing; auto-antibodies (insulin auto-antibodies, islet cell autoantibody, glutamic acid decarboxylase) typically present in patients with Type I DM and hemoglobin A1c levels were assessed. Insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) and Matsuda index. Results: 21 survivors were enrolled (male: 47.6%; median age at RT: 3.3 years; median age at study: 14.4 years [range: 8.3 – 46.9]; median time from abdominal RT: 10.7 years). Primary diagnoses included neuroblastoma (n = 15), rhabdomyosarcoma (n = 3), Wilms (n = 1), Hodgkin lymphoma (n = 1), rhabdoid tumor (n = 1). None of the participants were obese (body mass index [BMI] range: 14.7 – 23.2 kg/m2). Five participants (23.8%, 95% confidence interval: 8% – 47%) had glucose derangements at a median of 8.4 years after RT (one with impaired fasting glucose [fasting glucose ≥ 100 mg/dl) and four with impaired glucose tolerance [2-hour glucose 140-199 mg/dl]). Two additional participants with normal glucose tolerance had impaired insulin sensitivity based on an abnormal Matsuda Index and HOMA-IR. None of the participants had abnormal autoantibodies, insulinopenia, or hemoglobin A1c levels. Conclusions: These findings suggest that nonobese childhood cancer survivors treated with abdominal RT may be at high-risk for subclinical derangements of glucose and insulin. Further study is warranted in larger survivor cohorts. Clinical trial information: NCT02248779.
Fertility preservation for cancer patients: Role of nursing attitudes.
Authors: Grabowski Maria C. , Spitzer Deborah , Rezale Shaghayegh , Close Catherine , Stutzman Sonja , Olson Daiwai 
Published: February 2017

110 Background: Nurses play a pivotal role in ensuring adherence to quality guidelines. The 2006 American Society of Clinical Oncology - Quality Oncology Practice Initiative guidelines state that infertility risks should be discussed prior to initiation of fertility-reducing therapies for patients in their reproductive years. Despite this guideline on fertility preservation (FP), national compliance is only 6% (Tallent, 2013). Research is lacking in the understanding of nurses’ attitudes and behaviors towards FP and no tools exist from which to examine this problem. The purpose of this study is to gain increased understanding of potential barriers for nurses to recommend FP as an option for newly diagnosed patients. Methods: This instrument development study was developed by content experts and field tested with staff nurses. Next, an online survey method was used to examine factors associated with nursing recommendation for FP of newly diagnosed cancer patients. An anonymous online survey was sent to oncology nurses at UT Southwestern and members of the Oncology Nursing Society (Dallas Fort Worth Chapter). The endpoint of the study is a sound survey to assess nursing behaviors toward FP in diagnosed cancer patients. Standardized descriptive measures of central tendency were used to describe baseline characteristics for the sample. Factor analysis was completed using SAS v9.3 with orthogonal rotation. Scree plot was examined for factors and loading > 0.30 were retained. Results: Analysis of the first 67 returned surveys (Phase 1) supports a 15-item (5-factor) survey tool. Preliminary results suggested the need for education, referral availability, and system refinement. Phase 2 surveys of additional 200 was initiated in August 2015, with an expected close of enrollment date of December 2015. Conclusions: Cancer patients of childbearing age worry how treatment will affect their ability to have a child. This survey may be beneficial in identifying nursing attitudes regarding FP. All members of the care team should be sensitive to this concern and should recommend appropriate action. This study will identify nursing barriers to patient education, and will support system-wide implementation of a comprehensive FP program.
Predictors of positive test results in patients with cancer undergoing hepatitis B screening before chemotherapy.
Authors: Hwang Jessica , Lok Anna S. F. , Cantor Scott B. , Fisch Michael , Barbo Andrea G. , Lin Heather Y. , Suarez-Almazor Maria E. 
Published: February 2017

116 Background: Optimal hepatitis B virus (HBV) screening strategies for patients with cancer awaiting chemotherapy are unknown. We aimed to identify predictors of HBV infection in a large cohort of patients with cancer who were systematically screened for HBV before chemotherapy. Methods: In this prospective observational study, patients with cancer at MD Anderson Cancer Center awaiting first administration of chemotherapy in an outpatient chemotherapy unit were identified and approached for HBV screening. Enrolled patients completed a CDC risk survey and had blood tests to screen for HBV (HBsAg, anti-HBc) and hepatitis C virus (anti-HCV) infection. We developed a logistic regression model to identify clinical predictors of either chronic (HBsAg+/anti-HBc+) or resolved (HBsAg-/anti-HBc+) HBV infection. Model fit was assessed using the Hosmer-Lemeshow goodness-of-fit test. Results: From July 2013 to December 2014, 2124 patients (mean [SD] age, 58 [13] years) completed the risk survey and had HBV screening. Of these, 54% were women, 11% Hispanic, 77% non-Hispanic white, 8% black, and 4% Asian. Nearly 20% had a hematologic malignancy, 1% liver cancer, and 79% had a solid tumor other than liver cancer. Almost 12% of patients were born outside of the US. Seven patients (0.3%) had chronic and 128 (6%) had resolved HBV infection. Among the latter, 13 patients were also anti-HCV+. Predictors (odds ratio [OR]; 95% CI) of having either HBsAg+ or anti-HBc+ result included black race (4; 3-7), Asian race (4; 2-7), birthplace outside the US (5; 3-9), and having lived with someone with HBV (2; 1-4). Older age and lower education level were also predictive of positive HBV test results. Patients who reported ever injecting drugs (OR 10; 5-22) or being a man currently having sex with another man (OR 28; 6-135) had a high risk of HBsAg+ or anti-HBc+ result. The area under the curve for the model predicting positive HBV tests was 0.80. Conclusions: Known HBV risk factors are predictive of chronic or resolved HBV infection in patients with cancer. Future model validation using bootstrapping will allow varying levels of sensitivity in order to develop best HBV screening strategies.
Cardio-oncology interventions in outpatients referred for autologous bone marrow transplantation.
Authors: Pituskin Edith , Cox-Kennett Nanette , Becher Harald , Sandhu Irwindeep , Venner Chris , Paterson Ian 
Published: February 2017

137 Background: Cancer patients (PTS) referred for autologous bone marrow transplantation (autoBMT) are frequently pre-treated with established cardiotoxins and as a result may not have adequate cardiac function to meet eligibility criteria for autoBMT. Furthermore, mobilizing and consolidation chemotherapy result in additional serial exposures with acute and long-term negative cardiac sequelae. Accordingly, these PTS represent a population with a major unmet need for appropriate cardiovascular screening and interventions. Aim: to evaluate the need and effectiveness of prospective multidisciplinary cardio-oncology assessment and intervention in an unselected outpatient population referred for autoBMT. Methods: From January 1, 2013 – December 31, 2013, PTS referred for autoBMT were systematically screened for comorbid conditions, cardiovascular risk factors and eligibility for transplant. Physical exam, laboratory (ECG, complete profile) and transthoracic echocardiogram with contrast were performed. Those with EF < 50%, increased IVsd/LVpWd, ECG abnormalities +/- significant cardiac history underwent proBNP and high sensitivity troponin testing. PTS with abnormal findings or decreased left ventricular (LV) function were referred to the Edmonton Cardio-Oncology REsearch (ENCORE) program. Results: 73 unique PTS were screened by the Edmonton autoBMT program. Of these, 16 (20%) were reviewed by ENCORE. Reasons for referral included: decreased LV function (n = 6, 38%); increased IVsd (n = 5, 31%); arrhythmia (n = 4, 25%); angina (n = 1, 5%). Pharmacotherapy was initiated for 6 PTS; additional modality or serial cardiac imaging for 12 PTS; urgent stent for 1 PT. 100% proceeded to autoBMT without adverse cardiovascular outcomes or mortality. Conclusions: With systematic screening, a high proportion of PTS referred for autoBMT required cardio-oncology assessment and interventions, with 100% proceeding safely as a result. ENCORE represents a novel approach in the provision of cardio-oncology expertise for autoBMT PTS acutely during the mobilizing and transplantation period. Future examination of our prospective dataset will elucidate the longer term effects of our interventions.