bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protection from late-occurring anthracycline-related cardiotoxicity among childhood cancer survivors with a RARG coding variant.
Authors: Tonorezos Emily S. , Joseph Vijai , Barnea Dana , Villano Danylo , Satagopan Jaya , Friedman Danielle Novetsky , Sklar Charles A. , Oeffinger Kevin C. , Offit Kenneth 
Published: March 2017

130 Background: Susceptibility to late-occurring anthracycline-related left ventricular (LV) dysfunction is poorly understood. While higher dose of anthracyclines, radiation therapy, and younger age at exposure are relevant, heterogeneity persists. A recent report suggests that survivors with the rs2229774 retinoic acid receptor γ (RARG) variant represent a high-risk group. We sought to replicate this finding in our population of adult survivors of childhood and young adult cancer. Methods: We collected germline DNA among 455 survivors of childhood and young adult cancer seen in the Memorial Sloan Kettering Long-Term Follow-Up Programs. Participants were 48% male and more that 90% were white, non-Hispanic. Median age at diagnosis was 15 years and median time from diagnosis was 17.8 years. The most common diagnosis was Hodgkin Lymphoma (31%) followed by sarcoma (29%) and leukemia (10%). Initial genetic testing was performed using a low density SNP array (Illumina Exomearray), followed by full gene analysis by LD block testing. LV dysfunction was defined as ventricular ejection fraction less than 55%. Bonferroni-adjusted p values were used to determine significance in a multivariate model. Results: Of 455 participants, 120 did not have a history of anthracycline exposure, 1 was excluded for lack of echo data, and 17 were excluded due to poor genotyping quality control. Out of the remaining 317 participants, 41 had LV dysfunction. On initial testing, survivors with the rs2229774 variant were at lower risk for LV dysfunction (OR 0.14; 95% CI 0.02-0.99; p = 0.02), compared to survivors with other variants. Of note, the allele frequency in those without LV dysfunction was similar to reported studies and public data. In full gene analysis, those with a missense variant in ESPL1 (separase), within LD block but upstream of RARG, were at significantly increased risk of LV dysfunction (OR 5.61; 95% CI 1.48-21.3; p=0.005) compared to those without the ESPL1 variant. Conclusions: Based on these findings, rs2229774 RARG variant does not appear to confer genetic susceptibility to left ventricular dysfunction. ESPL1, a nearby candidate, may be the risk-conferring variant. Replication efforts are ongoing.
Developing a cardiac monitoring plan in at-risk cancer survivors.
Authors: Veneruso Aubri , Slocum Megan Rae , Kircher Sheetal Mehta , Akhter Nausheen , Murtagh Gillian , Strauss Jonathan Blake 
Published: March 2017

133 Background: Improvements in early detection, screening, and treatment of cancer translate into survivors living longer, highlighting the need for guidelines to address the late and long-term effects of cancer treatment. A particularly concerning effect is Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD). Cancer treatments can result in a range of cardiovascular toxicity including left ventricular dysfunction, heart failure and radiation-induced heart disease (RIHD). Various consensus statements related to cardiovascular care for adult cancer survivors exist; however there are no globally accepted follow-up guidelines. Our purpose is to create a protocol to stratify a survivor’s cardiac risk and provide a basis for follow-up recommendations. Methods: We first evaluated existing resources within our institution and identified key stakeholders who were recruited to form a multidisciplinary workgroup (2 survivorship advanced practice providers, an oncologist, a radiation oncologist, and 2 cardio-oncologists). We then reviewed current research and literature on cardiotoxic cancer therapies and identified two consensus statements from the American Society of Echocardiography and the European Association of Cardiovascular Imaging which helped inform our protocol. Finally, we created a cardiac assessment that could be applied in the pre-treatment phase and extend into the post-treatment phase. Results: Two assessment tools were developed. The first is an algorithm initiated in the pre-treatment setting by an oncologist when a Type I or Type II cardiotoxic agent is planned. The second is a risk assessment tool that is initiated in the post-treatment setting to stratify cardiac risk and provide follow-up recommendations. Conclusions: Development of standardized guidelines for assessment and treatment of late and long-term effects of treatment is critical. This protocol has been developed to account for the many factors that contribute to overall cardiac risk after various anti-cancer therapies. Further data is needed to evaluate long-term cardiac and survival outcomes based on this protocol.
Exercise physiology in cancer care.
Authors: Sangermano Sarah , Pugh Terrence , Yaguda Susan I 
Published: March 2017

135 Background: Cancer survivors can benefit from exercise at many points in the cancer care continuum. The Exercise Physiology Internship was developed by the University of North Carolina at Charlotte and Levine Cancer Institute (LCI) to address the exercise needs of patients with cancer. Although the interns had a background in physical fitness, they required training regarding the medical complexity of this population and how this affects their ability to exercise. To bridge this gap, LCI approached Carolinas Rehabilitation to assist in providing safe and effective exercises to cancer survivors. Methods: The intern program was modified to include cancer rehabilitation. Education was performed by the rehabilitation team, with emphasis on treatment-related side effects, contraindications for exercise, cancer-related fatigue, and safety considerations. Interns assisted therapists with impairment based rehabilitation to learn how physical fitness integrates with rehabilitation. Prior to 1:1 intern consults, the therapist and intern reviewed the most recent oncology notes, and the intern consulted the therapist regarding safety considerations or exercise modifications. The intern also worked with a clinical nurse specialist at LCI who provided information regarding disease processes, treatment side effects and potential residual implications of treatment and disease. Results: Following modification of the program, interns reported feeling more prepared and confident when providing 1:1 consults to survivors. Referrals from providers within LCI grew, with 5 consults in Spring 2016, 13 consults in Summer 2016, and at least 19 consults to be completed this semester. Interns also became more integrated into the cancer center, providing consults during infusion and in physician clinics. Conclusions: Exercise physiology interns are an asset to the cancer survivorship and rehabilitation teams. By collaborating with the rehabilitation team, interns can provide safe and effective exercise prescriptions to cancer survivors. Interns can also provide rehabilitation referrals for patients who require impairment-based therapy. With continued program development, opportunities for intervention may present throughout the continuum of care.
Measuring the impact of provider education to referral rate in survivorship care.
Authors: Canli Ursula S , Hershberger Patricia E. , Schaeffer Cathleen M. , Hoskins Kent , Danciu Oana Cristina 
Published: March 2017

14 Background: There will be an estimated 19 million cancer survivors by 2024. Survivors are often lost to follow-up after active treatment due to poor coordination of care between clinical oncologist and primary care providers. Lack of awareness of survivor needs including insufficient monitoring of late effects after oncologic care contribute to poor care coordination. While cancer centers have gradually introduced survivorship care, it remains challenging for some providers to refer their patients to a survivorship visit once their cancer treatment is completed. Continuing education is known to improve provider knowledge and may lead to an increased number of patients referred to survivorship. Methods: Survivorship starts when completing the initial treatment (surgery, chemotherapy or radiation therapy). The project will implement the review of an education module regarding survivorship through the National Comprehensive Cancer Network (NCCN) education website by breast cancer (BC) medical oncologists and their fellows in training at a cancer center in the Midwest. Providers are to complete “Comprehensive Care for Cancer Survivors”, a free continuing education module, on the NCCN continuing education website. Pre intervention data was retrospectively collected, including all BC cases from June 2016 to August 2016. Post intervention data will be prospectively collected over 1 month. Pre and post intervention referral rates will be compared using descriptive statistical methods. Results: A baseline 3 months review of 349 encounters noted 22 of 28 (78.6%) BC survivors were referred to the breast cancer survivorship visit. Results for this project are ongoing, and will include the analysis of referral rates by medical oncologists or fellows during the 1 month post completion of the NCCN education module. These results will be compared to the previous 3 months Conclusions: While data collection is pending, we hope to show that providers who have completed formal education regarding survivorship are more likely to refer breast cancer survivors to a survivorship visit. If the project is effective it will help increase the number of cancer patients seen in the BC survivorship clinic and improve the health outcome of BC survivors.
Utility of annual screening serum testosterone level in men on surveillance for clinical stage I testicular cancer.
Authors: Winquist Eric , Rowe Alexandra , VanUum Stan , Ernst D. Scott , Potvin Kylea R. , Quinn Maureen , Bradish Grace 
Published: March 2017

144 Background: Testicular cancer occurs in young men and is usually cured leaving survivors with many life years at risk from long term treatment effects. Risks increase with treatment intensity and include cardiovascular disease associated with the metabolic syndrome (Haugnes 2012, de Haas 2013). Testosterone deficiency (TD) is associated with metabolic syndrome & reduced QoL (Huddart 2005). Serum testosterone levels (STLs) are also influenced by underlying testicular dysgenesis & the effects of ageing (Skakkebaek 2001, Oldenburg 2016). We added annual screening STL to our surveillance protocols in 2013 & reviewed the value of this practice. Methods: Men followed in our Testicular Surveillance Clinic from 01 Jan 2006 to 31 Dec 2015 were identified electronically & data extracted retrospectively. Men eligible for this analysis had clinical stage I (CS I) testicular cancer treated with unilateral orchiectomy alone. Outcomes of interest were STLs, Endocrinology referral (Endo) & treatment with androgen replacement therapy (ART). TD was defined by 3 cutoffs of most recent screening STL: < 8.6 nmol/L [age 20-49] (or < 6.7 nmol/L [age > 50]) (local laboratory), < 10.1 nmol/L (Huddart 2005), or < 12.1 nmol/L (EAA & EAU). Results: 77 eligible men were identified: median age 34 years (range, 15-65), seminoma/nonseminoma/mixed/other (45/27/4/1). By the 3 STL cutoffs, TD was present in 13 (16.9% [95%CI, 9.3-27.1%), 22 (28.6% [18.8-40.0%] & 37 (48.1% [36.5-59.7%]); respectively. Nine men (11.4%) were referred to Endo, 1 had morning STL pending & 1 was using OTC ART. Of 8 men assessed by Endo, 5 (6.5%) were prescribed ART. Six men had no screening STL done (3 nonadherent, 1 prostate cancer & 2 unknown). Two men were discharged from clinic with unequivocal low STL. Conclusions: Annual screening STL appears to be useful and may be necessary. 15 CS I men (19.5%) in our clinic had unequivocal TD &/or were referred to an Endo. An additional 20 men (26%) had STLs in a range associated with reduced QoL. Almost half had STLs considered suitable for ART in the presence of symptoms. Two men (2.6%) were discharged with low STLs unaddressed. Guidelines for the optimal assessment and management of men with positive screening for TD are needed.
Immediate-term chemotherapy-related cognitive impairment (CRCI) following administration of intravenous (IV) chemotherapy.
Authors: Khan Omar Farooq , Cusano Ellen R. , Raissouni Soundouss , Pabia Mica , Haeseker Johanna , Bosma Nicholas , Ko Jenny J. , Kumar Aalok , Vickers Michael M. , Tang Patricia A. 
Published: March 2017

146 Background: The acute impact of chemotherapy on cognition is unknown. This study utilized performance on the psychomotor vigilance task (PVT) and trail-making test B (TMT) to assess CRCI immediately following chemotherapy administration. Methods: Patients aged 18-80 years receiving first-line IV chemotherapy for any stage of breast or colorectal cancer were eligible. Patients with brain metastases, neurologic disorders or allergic reactions to chemotherapy were excluded. Patient symptoms, peripheral neuropathy and Stanford Sleepiness Scale were assessed. A five-minute PVT and TMT were completed on a tablet computer pre-chemotherapy and immediately post-chemotherapy. Paired Wilcoxon Rank Sum tests were used to assess changes in median PVT reaction time, TMT completion time, TMT errors and PVT lapses. A priori, increases of 20 ms or over in median PVT reaction times (approximating reaction time changes with blood alcohol concentrations of 0.04 to 0.05 g%) were considered clinically relevant. Results: 144 patients (74 breast, 70 colorectal, median age 55.5 years) were tested. Post-chemotherapy, median PVT reaction time slowed by an average of 12.4 ms (p = 0.01). Post-chemotherapy median PVT times slowed by over 20 ms in 59 patients (40.9%). TMT completion post-chemotherapy was faster by an average of 6.1 seconds (p < 0.001). No differences were seen in TMT errors (p = 0.417) or PVT lapses (p = 0.845). Change in median PVT reaction time was not associated with age, gender, number of prior chemotherapy cycles, use of paclitaxel (which contains alcohol), peripheral neuropathy grade, or self-reported anxiety, fatigue or depression. Conclusions: Median PVT reaction time was significantly slower immediately after chemotherapy compared to a pre-chemotherapy baseline, and impairment correlating to effects of alcohol was seen in 41% of patients. This effect appears independent of age, self-reported symptoms or prior chemotherapy cycles. Further studies assessing the functional implications of immediate-term CRCI are warranted.
Early post-therapy prescription drug usage among survivors of childhood cancers.
Authors: Smitherman Andrew Brian , Mohabir Danielle , Wilkins Tania , Blatt Julie , Nichols Hazel , Dusetzina Stacie 
Published: March 2017

147 Background: Childhood cancer survivors often develop treatment-associated morbidities. We hypothesized that emerging treatment-related medical morbidities would be reflected in patterns of prescription drug usage among survivors in the first three years after therapy completion. Methods: Using the Truven Health MarketScan Commercial Claims database, we identified survivors of childhood (0-21 years-old at diagnosis) leukemia, lymphoma, central nervous system (CNS), bone, or gonadal tumors who completed therapy during 2000 - 2011. Patients were identified using diagnosis codes and cancer-specific procedure codes for chemotherapy, surgery, or radiation therapy. Prescription fills during the first three years following therapy completion were examined and categorized by drug class. Median numbers of prescriptions per survivor were compared to age- and sex-matched children without cancer. Relative risks (RR) for any prescription and for prescriptions by drug class were calculated comparing survivors to children without cancer. Results: We identified 1,414 survivors and 14,140 children without cancer. The median number of unique drug class prescriptions among survivors ranged from 4 [gonadal] to 8 [CNS] in year 1 and from 2 [gonadal] to 6 [CNS] in year 3 compared to a median of 1 among children without cancer (p < 0.001 for all comparisons). Increased risks for fills of antibiotics (RR in year 1: 1.5 [CNS, gonadal], 1.7 [bone], and 1.8 [leukemia, lymphoma]) and opioids (RR in year 1: 2.4 [lymphoma], 2.7 [gonadal], 4.0 [CNS], and 4.8 [leukemia, bone]) persisted throughout the three years among all cancer groups. Survivors of leukemia, lymphoma, CNS, and bone tumors had 2-4 times the risk for antidepressant prescriptions and 4-10 times the risk for anxiolytics. Survivors of leukemia, lymphoma, and bone tumors had 8-10 times the risk for ACE inhibitor prescriptions by the third year off therapy. Conclusions: Compared to children without cancer, childhood cancer survivors have higher rates of prescription drug use across many drug classes indicative of their higher burden of medical morbidities. Careful attention should be given to emerging morbidities during the early off-therapy period.
A multidisciplinary clinic to mitigate the toxicity of therapy for newly diagnosed metastatic prostate cancer undergoing chemohormonal therapy: A feasibility study.
Authors: Hough Jeffrey , Rodvelt Tammy J. , Thomas Miles , Ma Brian , Rabow Michael W. , Weinberg Rami , Macaire Greta , Shepard Nancy , Chan June M. , Van Blarigan Erin , Choque-Gonzales Gonzalo , Lee Mina , Friedlander Terence W. , Kim Won , Ryan Charles J. , Small Eric Jay , Aggarwal Rahul Raj 
Published: March 2017

153 Background: Chemohormonal therapy is standard of care for newly diagnosed metastatic prostate cancer (mPC) patients (pts) but is associated with significant adverse effects and negative metabolic changes. We performed a pilot study to investigate whether participation in a multi-disciplinary clinic to mitigate adverse effects of treatment is feasible. Methods: Pts with recently diagnosed mPC who were planning to start or had recently started chemohormonal therapy were prospectively enrolled in a multi-disciplinary clinic that included individualized monthly counseling from a physical therapist, oncology dietitian, and palliative care specialist on a rotating basis for 12 months. Patients were assessed quarterly for changes in % body fat, weight, serum levels of 25-OH vitamin D, fasting lipids/glucose/insulin, and quality of life (QOL). DXA bone density scans were performed at baseline and end of 12 months. The primary endpoint was the completion rate of scheduled visits. Results: 7 pts were enrolled between September 2015 and June 2016. All patients had extensive disease ( > 4 bone metastases and/or visceral metastases) at the time of study entry, and all 7 patients completed six cycles of docetaxel-based chemotherapy, and remained on hormone therapy for the duration of study. The percentage of completed visits was 98% (54/55 planned visits). The percentage of completed assessments including QOL questionnaires was 81%. No skeletal-related complications were observed. Median percent increase from baseline in body weight and % body fat was 3.51% and 20%, respectively. Four of the seven patients had osteopenia at baseline. Patient reported satisfaction was high and positive impact on psychosocial well-being was observed. Conclusions: Participation in a multi-disciplinary clinic by men receiving intensive chemohormonal therapy for metastatic prostate cancer was feasible. Patients are at risk for adverse metabolic and bone toxicity with therapy, underscoring the potential positive impact of a multi-disciplinary clinic. A randomized study to detect objective improvements in health outcomes is underway. Clinical trial information: NCT02168062.
Integrating the patient (pt) voice with clinician reports to identify cancer-specific subsets of symptomatic adverse events (SymAE).
Authors: Shaw Jim , Speck Rebecca , Lenderking William , Quach Caroleen 
Published: March 2017

155 Background: The Pt-Reported Outcomes Version of the Common Terminology Criteria for AE (PRO-CTCAE) was developed for pts to report on the frequency, severity, and interference of SymAE. A study was conducted to identify a hepatocellular carcinoma (HCC)-relevant subset of the PRO-CTCAE's 124 items to enhance evaluation of SymAE in HCC trials and long-term effects in survivorship. Methods: Qualitative and quantitative data were collected from medical oncologists specializing in HCC and pts diagnosed with HCC stratified by Child-Pugh class and treatment. Oncologists were asked about HCC diagnosis, treatment, and SymAE and provided ratings (ranging from 0 = unimportant to 10 = very important) of the following: 1) importance to pts of 34 prevalent SymAE from past HCC trials (all phases); 2) importance to pts of each PRO-CTCAE item; and 3) their own perceived importance of each PRO-CTCAE item with regard to tolerability. Pts were asked about their diagnosis, treatment, and experience of SymAE after which they completed the PRO-CTCAE and were debriefed on the importance of each item. Results: Four medical oncologists from Spain, Taiwan, Korea, and Hong Kong with ≥ 20 years of experience completed interviews. SymAE from prior trials rated highly important to pts (mean rating across oncologists ≥ 7) included hand-foot syndrome, diarrhea, fatigue, decreased appetite, rash, vomiting, and weight loss. PRO-CTCAE items rated highly important to pts included diarrhea, vomiting, shivering or shaking chills, hand-foot syndrome, rash, fatigue, difficulty swallowing, and loss of control of bowel movements. Items rated highly for tolerability included diarrhea, shivering or shaking chills, and hand-foot syndrome. Pt interviews (planned up to 24) are ongoing. Conclusions: Oncologists identified 10 clinically relevant items from sponsor SymAE data and the PRO-CTCAE for use in HCC trials. Findings from pt interviews will compare provider and pt perspectives about SymAE and strengthen the set of selected items. Combining clinician and pt ratings with clinical trial data may be a promising method for identifying cancer-specific PRO-CTCAE item sets for use throughout the cancer care continuum.
Using the NCCN survivor assessment questionnaire as a tool to tailor educational needs of cancer survivors.
Authors: Crabbe Wendy , Iruku Praveena 
Published: March 2017

156 Background: Survivor care after cancer treatment includes assessment of fatigue, pain, cognitive dysfunction, cardiac toxicity, sexual function, and the patient’s habits related to nutrition, physical activity, sleep and stress management. Using a tool to evaluate these symptoms and lifestyle habits is needed to determine the educational needs of the cancer survivor for the survivor treatment summary visit. Methods: We have used the National Comprehensive Cancer Network (NCCN) Survivorship Assessment tool for the past 12 months to develop a survivor care plan. It is a pre-visit 25 question survey completed by the patient. The patient responses help focus education based on current symptoms and lifestyle habits. A total of 50 questionnaires were completed over the past year. Results: Of the 50 patients, 46 were women, 45 had breast cancer, 3 colorectal and 2 other. The average age was 56 years old, 70% were Hispanic, 86% received chemotherapy and there were 4 recurrences. The average time from finishing adjuvant therapy to the survivor treatment summary visit was 7 months. Fifty percent of patients were on adjuvant hormonal therapy (Aromatase Inhibitor or Tamoxifen). Persistent symptoms at the time of the survivor visit are detailed in the table below. Regarding nutrition and physical activity, 44% of survivors were obese with 44% who said they get regular physical activity. Of the 44% who get regular physical activity, it can be further broken down to 1-3 days a week (10%), 4-7 days a week (28%) and 46% of patients said they ate 2.5 cups of fruits and vegetables per day. Conclusions: At the time of the survivor treatment summary visit there are still residual side effects from treatment including cognitive dysfunction, pain, fatigue, trouble sleeping and problems with sexual function. The NCCN Survivor Assessment questionnaire is a good tool to determine persistent side effects from treatment and educational needs of cancer survivors.[Table: see text]