bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional consequence of cognitive impairment in survivors of childhood acute lymphoblastic leukemia (ALL): The role of cancer symptoms as mediators.
Authors: Huang I-Chan , Brinkman Tara M. , Cheung Yin Ting , Pui Ching-Hon , Hudson Melissa M. , Krull Kevin R. 
Published: February 2017

235 Background: Although cognitive impairment of childhood cancer survivors affects daily functional status, the mechanisms are less understood. This study aimed to examine the role of cancer symptoms on the association of cognitive impairment with functional status in childhood ALL survivors treated on a chemotherapy only protocol. Methods: 213 survivors (mean age = 14.8 years) were assessed at > 5 years post-diagnosis. Testing included measures of executive function (Delis-Kaplan Executive Function System; Wechsler Intelligence Scale for Children-IV [WISC-IV]), processing speed (WISC-IV; Grooved Pegboard), visual-spatial processing (Wechsler Abbreviated Scale of Intelligence), memory span (WISC-IV), and attention (Conners CPT-II). Symptoms (e.g., pain, worry, cognitive, communication) and daily functional status (physical, emotional, social, school) were reported by parents using the PedsQL. Association of cognitive impairment with symptoms and functional status was tested using regression analyses. The extent to which cognitive impairment influences functional status through symptoms was tested using mediation analyses. Results: Cognitive impairment ( > 1SD below age-adjusted norm) was identified in 18-41% of the survivors. Impaired executive function, processing speed, and memory span were associated with high cancer symptoms (all p’s < 0.05), typically driven by perceived cognitive and communication problems. Impaired executive function, processing speed, visual-spatial processing, and memory span were associated with poor functional status (all p’s < 0.05). In each cognitive domain, impairment was related to poor school function (all p’s < 0.05). Impact of cognitive function (except attention) on overall functional status was mediated by overall cancer symptoms (all p’s < 0.05). Conclusions: Although the frequency of impairment in survivors treated with chemotherapy was less than that seen with cranial irradiation, cognitive impairment is related to elevated cancer symptoms and decreased functional status. Mediation analyses suggest that cognitive function works through cancer symptoms to impact functional status.
Health-related quality of life in underserved patients with hematologic malignancies.
Authors: Mushtaq Muhammad Umair Umair , Mangla Ankit , Hamad Hussein , Khurana Sharad , Catchatourian Rosalind 
Published: February 2017

238 Background: Patients diagnosed with hematologic malignancies have poor general health and the issues faced by vulnerable population segments further aggravate the situation. We aimed to explore the health-related quality of life (HRQoL) among underserved patients with hematologic malignancies. Methods: A cross-sectional study, including 95 patients diagnosed with hematologic malignancy, was conducted at Cook County Hospital, Chicago from Dec. 2014 to July 2015. European Organization for Research and Treatment of Cancer questionnaire was used to ascertain HRQoL. A standardized score (scale 0-100) was calculated for all variables and mean scores (MS) are reported. Higher score for HRQoL and functional scales and lower score on symptom scales indicated good health. Bivariate analysis, using t-test and ANOVA, was conducted to explore predictors of HRQoL. Results: The study included 48% Hispanics, 27% Afro-Americans, 14% Asians and 7% Caucasians. Median age was 53.8 years and 55% were males. Demographic analysis showed- 47% were fluent in english, 40% had insurance, 56% were US citizens, 14% were employed, 33% were high school graduates and 79% had good social support. Primary diagnosis were non-Hodgkin lymphoma (29.5%), AML (26%), ALL (17%), CML (9.5%), Hodgkin lymphoma (9.5%), CLL (4%) and multiple myeloma (4%). Median time since diagnosis was 2 years where 35% patients were in remission, 16% had relapsed disease and 58% were on chemotherapy. Overall HRQoL was poor (MS 62). Functional impairment was noted (MS 69) in all aspects including physical (MS 72), role (MS 66), emotional (MS 70), cognitive (MS 74) and social functioning (MS 65). Financial difficulties (MS 54), insomnia (MS 35), pain (MS 32), dyspnea (MS 24), poor appetite (MS 24), constipation (MS 23), fatigue (MS 17) and diarrhea (MS 14) were reported (symptom scale MS 29). Age, gender, socio-demographics, cancer type and treatment status did not significantly affect HRQoL, functional and symptom scores. Information regarding the disease was poor (MS 41). Conclusions: Poor HRQoL amongst underserved patients was observed which should be addressed. Our findings warrant large-scale studies to explore resources amongst the urban underserved blood cancer patients.
Associations between morning–evening chronotype, fatigue, and QOL in breast cancer survivors.
Authors: Palesh Oxana , Packer M. Melissa , George Holly , Koopman Cheryl , Innominato Pasquale F. 
Published: February 2017

246 Background: Emerging evidence suggests that circadian disruption is associated with cancer and cancer treatments. Chronotype is defined as a behaviorally manifested preference for a certain timing of sleep and activity. Previous studies have revealed that living out of sync from one’s innate chronotype can have detrimental effects on one’s health. Although there has been research examining the associations between chronotype and health, not much is known about the relationship between chronotype, fatigue, and QOL in cancer survivors. Methods: 68 Breast cancer survivors completed questionnaires to assess their chronotype (Horne-Ostberg), to rate their fatigue (MDASI), and to evaluate their QOL (FACIT). The Horne-Ostberg questionnaire yields a range of values indicating survivors’ preference for early or late activity. The study sample was divided by terciles according to survivors’ “morningness” or “eveningness” preferences (i.e., chronotypes). Results: Morning chronotype was associated with significantly less severe tiredness and drowsiness as well as significantly better physical well-being and fatigue subscale scores as compared to evening chronotype. Tiredness median (M) scores were highest for evening chronotype (M=5.5), moderate for mid-range chronotype (M=4.5), and lowest for morning chronotype (M=3.0), a significant difference (p=0.046). Drowsiness scores were highest for evening chronotype (median=6.0), moderate for mid-range chronotype (M=4.0), and lowest for morning chronotype (M=3.0), p=0.046. The median score for physical well-being was significantly lower for evening compared to morning chronotypes (22.5 vs. 25.0, p=0.038) and morning types reported significantly better health in respect to fatigue compared to evening types (40.5 vs. 35.5, p=0.045). Conclusions: Survivors with early chronotype (early to bed, early to rise) reported less fatigue, drowsiness, and better overall physical well-being. While chronotype is believed to be genetically driven, certain behavioral, pharmacological, and bright light modifications can be used to help patients shift their circadian rhythm towards earlier morning type and may experience improvements in physical well-being.
Evaluation of the adoption, acceptance, and satisfaction of SurvivorLink as a communication tool for pediatric cancer survivors.
Authors: Mertens Ann , Williamson Rebecca , Gilleland-Marchak Jordan , Meacham Lillian R. , Cherven Brooke , Edwards Paula 
Published: February 2017

89 Background: With the number of cancer survivors growing, focus on early recognition and treatment of late effects is even more imperative for life-long survivorship care. Electronic personal health records (PHR) potentially offer self-management and e-learning support which can empower the survivor, as well be used as a communication tool with healthcare providers (HCP). Methods: We developed a PHR, SurvivorLink (www.cancersurvivorlink.org), as a patient-centered tool to support pediatric cancer survivors, increase knowledge of late effects and survivor care, and promote communication between patients/parents and providers. Measures of success for a sustainable PHR implementation include adoption/use, acceptance, satisfaction and usability. The objectives of this feasibility study are to determine characteristics that predict the success of this PHR tool. An online pre-/post survey was administered to young adult survivors and parents of child survivors who registered on SurvivorLink. Results: Overall, 155 parents and 93 survivors completed the pre-test survey; 75% and 86% respectively have subsequently logged into SurvivorLink after initial registration. Individuals who used this PHR were more likely to be survivors (vs. parents; Odds Ratio (OR): 2.2, 95% CI: 1.1, 4.2). Other demographic variables were analyzed but no significant differences were found between users and non-users. Among users not aware of their need for specialized survivor care at the pre-survey, 52% reported awareness of the need for survivor care in the post-survey (vs 0% of non-users). Parents/survivors also reported high acceptance: 90% would use in the future, 82% stated it would help with advocating for survivor's health; and usability: 96% would recommend to other survivors/parents, 95% would recommend to their healthcare provider. Conclusions: SurvivorLink can improve knowledge around the importance of survivor care, and is both adopted and accepted by survivors/ parents independent of demographic differences. Research is underway to establish SurvivorLink's effectiveness as an advocacy/communication tool for survivor/parent with HCP in the self-management of their healthcare.
A model for coordinated delivery of individualized complementary and integrative medicine care for cancer survivors.
Authors: Niesley Michelle , Doran Kathryn , Huynh Nhu , Winters Marie 
Published: February 2017

e286 Background: Cancer survivors may experience both physical and psychosocial sequelae as a result of cancer treatment. Many patients consult either their oncologist or primary care physician for lifestyle interventions to address survivorship issues. While studies demonstrate complementary and integrative medicine (CIM) therapies may reduce the risk of both all-cause mortality and cancer-specific mortality by 50% (Frenkel M et al. Curr Oncol Rep. 2015 May;17(5):445), the most effective method to ensure compliance with individualized dietary counseling, exercise, or nutritional supplement information to the patient is unknown. Here we present a multidisciplinary survivorship care model to increase compliance with CIM practices that positively impact survivorship outcomes. Methods: Each Patient Empowered Care (PEC) team at our hospital consists of a medical oncologist, naturopathic doctor, nurse care manager, and a nutritionist, who discuss the assessment and plan for each patient they will see that day. Additional integrative services include chiropractic care, acupuncture, and Oncology Rehab (physical, occupational, speech, and massage therapy). Naturopathic doctors recommend nutritional supplements specific to both the patient’s oncology regimen and other comorbidities, and also ensure these supplements do not interfere with metabolism of other active medications. Oncology Rehab encourages exercise via our Motion for Life program, where physical fitness programs are tailored to the patient’s individual needs. The Nutrition program provides individualized coaching and nutritional management. Patients continue CIM therapies long after oncology care has concluded. Results: Patients satisfaction and outcomes are improved by facilitating compliance with individualized lifestyle recommendations. Conclusions: This model increases compliance with CIM recommendations by facilitating transparent communication among PEC team members, while providing the patient with a single facility that individualizes their wellness regimen.
Patterns of failure and survival in patients with nasopharyngeal carcinoma treated with intensity modulated radiation therapy in Saudi Arabia.
Authors: Maklad Ahmed M , Bayoumi Yasser , Senosy Mohamed Abdalaziz , Elawadi AbuSaleh A. , AlHussain Hussain , Elyamany Ashraf , AlDahri Saleh , AL-Qahtani Khalid Hussain , Alqahtani Mubarak Shaie , Tunio Mutahir A. 
Published: February 2017

e295 Background: We aimed to investigate the patterns of failure (locoregional and distant metastasis), associated factors, treatment outcomes in nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiation therapy (IMRT) combined with chemotherapy, results of reirradiation in recurrent cases and its toxicity. Methods: From April 2006 to December 2011, 68 NPC patients were treated with IMRT and chemotherapy at our hospital. Median radiation doses delivered to gross tumor volume (GTV) and positive neck nodes were 66–70 Gy/33-35fractions. For recurrent cases reirradiation was given by SRS 25 -30 Gy/5 fractions or IMRT 50-60 Gy/25-30 fractions according to volume of recurrence and surrounding critical structures. The clinical toxicities, patterns of failures, locoregional control (LRC), distant metastasis control (DMC), disease free survival (DFS) and overall survival (OS) were observed. Results: The median follow up time was 52.2 months (range: 11-87). EBV infection positive was 63.2%.There were 7 locoregional recurrences, 3 regional recurrences with distant metastases and 11 distant metastases. The median interval from the date of diagnosis to failure was 26.5 months (range, 16-50 months). 6/10 (60%) locoregional recurrences were treated with re-irradiation +/- concurrent chemotherapy. Acute grade 3 and 4 mucositis were observed in 2 patients (28.6%); however no significant late toxicities were seen after reirradiation. Nodal recurrences were salvaged by neck dissection. The 5-year LRC, DMC, DFS and OS rates of whole cohort were 81.1%, 74.3%, 60.1% and 73.4% respectively. Cox regression analyses revealed that neoadjuvant chemotherapy, age and Epstein-Barr virus (EBV) were independent predictors for DFS. Conclusions: Distant metastasis is the most common pattern of failure after IMRT with SIB technique with or without neoadjuvant and concurrent chemotherapy in Saudi patients with NPC. Early detection of local and locoregional recurrences is important as reirradiation with IMRT or SRT with or without chemotherapy is still feasible option with acceptable toxicity. However, efforts should be made for proper patient selection.
Retrospective comparison of long-term outcomes in patients with stage II/III (UICC-TNM6th) esophageal squamous cell carcinoma treated with 60 Gy or 50.4 Gy of definitive chemoradiotherapy with fluorouracil and platinum.
Authors: Hirano Hidekazu , Kato Ken , Nakamura Shoko , Sasaki Yusuke , Takahashi Naoki , Iwasa Satoru , Honma Yoshitaka , Okita Natsuko , Takashima Atsuo , Hamaguchi Tetsuya , Ito Yoshinori , Itami Jun , Boku Narikazu 
Published: February 2017

109 Background: Deﬁnitive chemoradiotherapy (dCRT) is one of the treatment options for stage II/III esophageal squamous cell carcinoma (ESCC). RTOG9405 demonstrated that a higher dose of radiation (64.8 Gy) offered no additional survival benefit over the standard dose (50.4 Gy). We compared the long-term outcomes of dCRT with radiation doses of 60 Gy and 50.4 Gy for ESCC. Methods: Selection criteria included thoracic ESCC, stage II/III (non T4), performance status (PS) 0-2, age 20-75 years, adequate organ function and no other active malignancy. We retrospectively analyzed patients who received dCRT as a first-line therapy between Jan. 2000 and Nov. 2011 in our hospital. Group A (n = 180) received 2 cycles of cisplatin (C) (40 mg/m2 on day 1 and 8) with fluorouracil (F) infusion (400 mg/m2/day on day 1-5 and 8-12), or 2 cycles of C (70 mg/m2 on day 1) with F infusion (700 mg/m2/day on day 1-4) repeated every 4 weeks and concurrent radiotherapy at a dose of 60 Gy. Group B (n = 62) received 2 cycles of C (75 mg/m2 on day 1) with F infusion (1000 mg/m2/day on days 1–4) repeated every 4 weeks and concurrent radiotherapy at a dose of 50.4 Gy. Overall survival (OS) and progression free survival (PFS) were estimated with the Kaplan-Meier method and compared with log-rank test. The Cox regression model was used for multivariate analysis to assess the prognostic factors for OS. Results: Characteristics of both groups were as follows (Group A: Group B): median age, 64:62; male/female, 154/26:55/7; PS 0/1/2, 81/98/1:46/16/0; T1/2/3, 39/27/114:19/9/34; N0/1, 41/139:6/56. Median follow-up period was longer than 40 months for both groups. 5-year survival rates were 44.5% for Group A and 60.0% for Group B. Median PFS and median OS were 16.5 months and 36.2 months for Group A, 41.1 months and 98.3 months for Group B. By multivariate analysis, Group B (hazard ratio [HR] 0.617: 95% confidence interval [CI]:0.400-0.951, p = 0.029), T1/2([HR] 0.383: 95% [CI]: 0.260-0.566, p < 0.001) were significant prognostic factors for OS. Conclusions: CRT with 50.4 Gy showed better long-term survival than with 60 Gy.
Phase I study of DKN-01, an anti-DKK1 antibody, in combination with paclitaxel (pac) in patients (pts) with DKK1+ relapsed or refractory esophageal cancer (EC) or gastro-esophageal junction tumors (GEJ).
Authors: Bendell Johanna C. , Murphy Janet E. , Mahalingam Devalingam , Halmos Balazs , Sirard Cynthia A. , Landau Steven B. , Ryan David P. 
Published: February 2017

111 Background: DKK1, a secreted protein, is an indirect inhibitor of canonical Wnt signaling and was recently shown to directly activate non-canonical Wnt pathways including Rho, ROCK and JNK. High DKK1 concentrations in EC tumor tissue correlate with shorter overall survival (OS); published data suggests increased activity of non-canonical signaling by DKK1 may be a reason for shortened OS. DKN-01 is a humanized monoclonal antibody to DKK1 with demonstrated activity in non-small cell lung cancer. This study evaluated the MTD, safety and early activity of DKN-01 in combination with pac in EC and GEJ cancer pts. Methods: In Part A, pts with DKK1+ EC or GEJ cancer by IHC staining received DKN-01 in two dose escalation cohorts (150 or 300 mg) with pac 80 mg/m2 on days 1, 8, 15 and 22 of each 28 day cycle. Part B (dose expansion) is ongoing. Responses were assessed using RECIST version 1.1. Results: > 90% of screened EC (70 pts) had DKK1+ tumor tissue. In Part A, 9 pts with advanced EC or GEJ cancer were enrolled: 3 in Cohort 1 (150 mg) and 6 in Cohort 2 (300 mg); 5 pts had a diagnosis of EC [3 with adenocarcinoma (AC); 2 with squamous cell] and 4 pts with GEJ AC. Median number of prior therapies was 2 (range 1, 8). One DLT, G3 peripheral neuropathy, was seen at 300 mg. Frequent adverse events (AEs) were cough (5 pts), alopecia, leukopenia, neutropenia and peripheral/sensory neuropathy (each 4 pts) and fatigue, anemia, and nausea (each 3 pts); AEs were mostly Grade 1/2. The MTD of DKN-01 + pac was determined to be 300 mg. Among the 7 AC pts, 3 pts had a partial response (one having had prior pac); 3 pts had stable disease. Responders were on therapy between 3 and 10 mos. Conclusions: Part A is complete. Most EC and GEJ pts express tumor DKK1 and have obviated the need for evaluation of tumor DKK1+ expression as a study entry prerequisite. Combination of DKN-01+ pac is well-tolerated; the addition of DKN-01 to pac does not appear to alter the known pac safety profile. There are initial signs of enhanced clinical activity with DKN-01; further investigation is ongoing. Clinical trial information: NCT02013154. Clinical trial information: NCT02013154.
Outcomes of surgical intervention in gastric carcinoid disease.
Authors: Callahan Ann Falor , White Michael , Ituarte Philip HG , Woo Yanghee , Singh Gagandeep , Fong Yuman , Melstrom Laleh 
Published: February 2017

112 Background: Gastric carcinoids are rare entities, representing 8.7% of all gastrointestinal carcinoids. Although this disease is often stratified into subtypes with differing clinical courses, the prognosis is generally improved by surgical resection. We evaluated the outcomes of patients with gastric carcinoids in a large cancer registry. Methods: We queried the California Cancer Registry (CCR), merged with the California Office of Statewide Health Planning and Development (OSHPD) database, for patients with a diagnosis of gastric carcinoid disease. Demographic, clinicopathologic characteristics, surgical treatment, and outcomes were analyzed. Results: Among the 1,012 patients who met our criteria, 64% had localized disease (644), 9.4% (95) had regional disease and 13.4% (133) had distant metastases. Most of these patients underwent gastric surgery (56.7%, n = 574 vs 43.2%, n = 438). Surgery at the primary site conferred a survival advantage in patients with local and regional disease (regional disease: 27 months with surgery vs 5 months without, p = 0.007; local disease: median survival was not reached, p < 0.0001). Patients who underwent resection of the primary tumor and any hepatic metastases showed a similar median survival to patients without hepatic metastases (26 vs 27 months, p = 0.8). Conclusions: Although the biology of the disease is the most significant predictor of overall outcome, aggressive surgical intervention, including resection of the primary tumor and any metastatic disease in the liver, should be offered when it is technically feasible. Surgical intervention in patients with hepatic metastases results in a survival similar to surgically managed patients without distant disease.
Multidisciplinary approach for cT1bN0 esophageal cancer.
Authors: Iizuka Toshiro , Kikuchi Daisuke , Hoteya Shu , Kaise Mitsuru , Udagawa Harushi 
Published: February 2017

133 Background: The standard treatment for cT1bN0 esophageal squamous cell carcinoma (ESCC) was once surgery, but endoscopic submucosal dissection (ESD) following by additional treatment (ESD+α) are now being applied. Accordingly, we examined treatment outcomes for cT1bN0 ESCC to assess the validity of these treatments in terms of diagnostic accuracy and post-treatment prognosis. Methods: A total of 174 patients with ESCC were diagnosed as cT1b by endoscopic ultrasound (EUS) and white-light imaging between January 2008 and December 2014. Twenty-six patients diagnosed as cN+ by EUS or CT/PET were excluded. The diagnostic accuracy of invasion depth and lymph node metastasis was analyzed along with the post-treatment prognosis. Results: Initial treatment was ESD for 102 patients (ESD group) and surgery for 46 patients (surgery group). The histological diagnosis was T1a in 63 patients and T1b in 85 patients, meaning that 57.4% of the patients were accurately diagnosed. In the surgery group, 30 patients (65.2%) were accurately diagnosed as cN0. In the ESD group, 80 patients had an invasion depth of T1a-MM or deeper, which has a potential risk of metastasis. Additional surgery was performed for 15 patients, additional chemotherapy or chemoradiotherapy was performed for 43 patients, and follow-up without additional treatment was for 22 patients. Recurrence during follow-up was observed in 8 patients (lymph nodes in5 patients; other organs in 3 patients). Of the 16 patients with histological lymph node metastasis in the surgery group, 10 underwent adjuvant chemotherapy. Recurrence was noted in 3 patients (lymph nodes in 1 patient; other organs in2 patients). The mean follow-up period was 39 months for the ESD group and 45.8 months for the surgery group. Three- and five-year survival rates were respectively 93.1% and 79.3% in the ESD group and 89.8% and 85.1% in the surgery group, with no significant differences between the groups. Conclusions: Accuracy of preoperative diagnosis of invasion depth is still not high, which makes the ESD+α strategy an acceptable. As mid- to long-term outcomes were favorable in both groups, it appears that favorable outcomes can be obtained by performing multidisciplinary therapy based on the histological diagnosis.