bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diseases of Large Granular Lymphocytes
Authors: Alekshun Todd J. , Sokol Lubomir 
Published: August 2017

Background Clonal diseases of large granular lymphocytes (LGLs) are rare lymphoproliferative malignancies that arise from either mature T-cell (CD3+) or natural killer (NK)-cell (CD3-) lineages. They manifest a distinct biologic behavior that ranges from indolent to very aggressive. Methods We discuss four distinct diseases involving LGLs: indolent T-cell LGL leukemia, aggressive T-cell LGL leukemia, chronic NK-cell leukemia, and aggressive NK-cell leukemia. Furthermore, we present an up-to-date systematic review of therapies for each entity. Results Sustained LGLs, characteristic immunophenotype, clonal origin of leukemic cells, and clinical presentation are the most important features that distinguish indolent from aggressive subtypes of LGL leukemia and guide the selection of therapy. Patients with symptomatic indolent T-cell or NK-cell LGL leukemia are usually treated with immunosuppressive therapies in contrast to aggressive T-cell and NK-cell LGL leukemia, which require intensive chemotherapy induction regimens. Novel targeted therapies using monoclonal antibodies against receptors, including CD2, CD52, the β subunit of the interleukin-2 receptor, and small molecules such as tipifarnib, are undergoing evaluation in clinical trials. Conclusions Future scientific advances focusing on the delineation of molecular pathogenic mechanisms and the development of new targeted therapies for each distinct LGL leukemia entity should lead to improved outcomes of patients with these disorders.
The Diagnosis, Management, and Role of Hematopoietic Stem Cell Transplantation in Aggressive Peripheral T-Cell Neoplasms
Authors: Rezania Dorna , Cualing Hernani D. , Ayala Ernesto 
Published: August 2017

Background Peripheral T-cell neoplasms (PTCNs) comprise a group of uncommon and heterogeneous lymphoid malignancies. They are more difficult to diagnose and treat and have a worse prognosis than B-cell lymphomas. Although PTCNs initially show a significant degree of chemosensitivity, the outcome of treatment with conventional dose chemotherapy remains poor. Methods We reviewed the literature on the diagnosis, treatment, and collective transplant reports regarding PTCNs. Results The correct diagnosis of peripheral T-cell lymphoma requires a combination of clinical presentation, morphology, immunophenotype, and molecular study. While no specific treatment other than conventional dose chemotherapy is currently available for aggressive PTCN, histone acetylase inhibitors and monoclonal antibodies such as anti-CD7 and anti-CD52 are being studied in T-cell malignancies. The role of autologous and allogeneic transplantation is being investigated for high-risk, relapsed, and refractory PTCNs with some promising results. Conclusions Access to hematopathology expertise in a tertiary care setting may lead to earlier and more accurate diagnoses of these diseases. PTCNs comprise a heterogeneous group of diseases with no widely accepted standard of care, and accurate determination of their histologic subtypes correlates with prognosis. Patients in first complete remission with poor risk features and patients with relapsed and refractory disease should be considered for bone marrow transplant due to the poor outcomes obtained with conventional chemotherapy.
Physician and Staff Perceptions of Barriers to Colorectal Cancer Screening in Appalachian Kentucky
Authors: Kelly Kimberly M. , Phillips Clarenda M. , Jenkins Crystal , Norling Gretchen , White Carol , Jenkins Todd , Armstrong Debra , Petrik Joe , Steinkuhl Amy , Washington Regina , Dignan Mark 
Published: August 2017

Background Data indicate that in 1997 to 1999, only 44% of Appalachian Kentuckians underwent colorectal cancer screening consistent with guidelines. We investigated the reasons for, barriers to, and follow-up of colorectal cancer (CRC) screening recommendations in primary care practices seeing patients from Appalachian Kentucky. Methods A mixed-methods [qualitative (focus group) and quantitative (survey)] approach was used to gather and analyze data in five primary care practices. A total of 34 participated in the focus groups. Results In focus groups, physicians and office staff reported a number of indicators for CRC screening; physician, patient, and procedural barriers to CRC screening; and strategies to overcome these barriers to screening. Most physicians used personal experience to guide screening, but it was unclear what was meant by personal experience. Commonly cited patient barriers to screening were fear and embarrassment. Physicians reported several approaches to overcome these barriers, including establishing trust and educating patients. Survey data identified a number of resources to assist practices in promoting screening, most commonly, patient educational materials. Finally, fecal occult blood test was most commonly recommended because it is inexpensive and easy to administer. Conclusions Our mixed methods approach not only helped to understand the physicians’ perceptions of the problems and barriers to CRC screening in Appalachian Kentucky, but also elucidated how practices endeavor to overcome these barriers and identified the additional resources practices would like in order to promote CRC screening.
Caregiver Role Stress: When Families Become Providers
Authors: Teschendorf Bonnie , Schwartz Carolyn , Ferrans Carol Estwing , O'mara Ann , Novotny Paul , Sloan Jeff 
Published: August 2017

Background In view of the large number of families engaged in caregiving, this study was initiated to describe informal cancer care provision from the perspective of the caregiver. Methods A professional data collection site was used to convene focus groups in four cities. Participants included 63 caregivers, 87% of whom were female, mean age of 56 years. Caregivers responded to an open-ended question regarding the challenges of providing care. The study utilized qualitative analysis of verbatim transcripts. Transcript coding with four independent raters, using an iterative process, achieved a high inter-rater reliability. Results The project elucidates self-reported concerns confronted in cancer caregiving. Five primary themes emerged: supportive care demands, emotional toll, impact on health status, coping strategies, and rewards and affirmation. Providing supportive care introduced a balancing act in caregivers’ lives as they attempted to address complex and overlapping roles. They felt alone in their decisions, were under-prepared for tasks they assumed, and tried to shield the care recipient. Conclusions This qualitative approach confirmed past research while identifying novel concepts related to maintaining well-being and a sense of purpose despite caregiving hardships. Some aspects of caregiver suffering were identified. Caregiver self-regulation strategies revealed by this work suggest ideas for psychosocial interventions caregivers could use to protect themselves and the care recipient from impending distress.
Educational Intervention for Women Undergoing Image-Guided Breast Biopsy: Results of a Randomized Clinical Trial
Authors: Walker Mark S. , Farria Dione , Schmidt Maria , Monsees Barbara , Wiele Kim , Bokern Jill , Swatske Mary Ellen 
Published: August 2017

Background The process of informed consent has been examined for patients undergoing various procedures but not breast biopsy. Our study was a randomized trial that examined the effect of an educational flip chart as part of the informed consent. Methods A total of 122 patients referred for stereotactic or ultrasound-guided core breast biopsy were randomly assigned to receive an informed consent discussion with or without an illustrated flip chart. The chart included information about breast anatomy, pathology, and diagnostic procedures. Outcome measures included objective knowledge, subjective knowledge, anxiety, and satisfaction. Results Analysis showed few significant main effects of the intervention. However, results showed interactions between experimental condition and race/ethnicity, indicating that the intervention was effective in enhancing objective and subjective knowledge for African American but not Caucasian patients. Anxiety after consultation was higher among patients assigned to the flip chart condition, possibly because they were better informed about the risks of the procedure. Patients who underwent biopsy sooner after learning they needed one were more satisfied with their care. Conclusions The usual care consent process is effective for many but not all patients. Informed consent that employs visual aids may help overcome characteristics of the consent process that are ineffective for some patients.
The Impact of Education and Literacy Levels on Cancer Screening among Older Latin American and Caribbean Adults
Authors: Reyes-Ortiz Carlos A. , Camacho Maria E. , Amador Luis F. , Velez Luis F. , Ottenbacher Kenneth J. , Markides Kyriakos S. 
Published: August 2017

Background There is limited information related to the effects of education and literacy on cancer screening practices among older adults in Latin American and Caribbean countries. Methods To determine the association between education and cancer screening use, we developed a cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study. The sample included 4,183 men and 6,708 women aged 60 years and older from seven cities. The outcomes are mammogram and Pap smear use in women and prostate examination use in men within the last 2 years. Results In general, illiterate or lower-educated older men and women have the lowest rates of cancer screening use compared with higher-educated counterparts. Multivariate logistic models, by city and in a combined sample of six cities showed that high education is associated with higher odds of having a mammogram or a Pap smear in women and a prostate examination in men. Conclusions Older adults with low educational or literacy levels should be targeted for screening programs in these populations.
Spinal Radiosurgery for Metastatic Disease of the Spine
Authors: Finn Michael A. , Vrionis Frank D. , Schmidt Meic H. 
Published: August 2017

Background Metastatic tumor in the spinal column is common, causing symptomatic spinal cord compression in approximately 25,000 patients annually. Although surgical treatment of spinal metastases has become safer, less invasive, and more efficacious in recent years, there remains a subset of patients for whom other treatment modalities are needed. Stereotactic radiosurgery, which has long been used in the treatment of intracranial lesions, has recently been applied to the spine and enables the effective treatment of metastatic lesions. Methods We review the evolution of stereotactic radiosurgery and its applications in the spine, including a description of two commercially available systems. Results Although a relatively new technique, the use of stereotactic radiosurgery in the spine has advanced rapidly in the past decade. Spinal stereotactic radiosurgery is an effective and safe modality for the treatment of spinal metastatic disease. Conclusions Future challenges involve the refinement of noninvasive fiducial tracking systems and the discernment of optimal doses needed to treat various lesions. Additionally, dose-tolerance limits of normal structures need to be further developed. Increased experience will likely make stereotactic radiosurgery of the spine an important treatment modality for a variety of metastatic lesions.
Cultural Values and Secondary Prevention of Breast Cancer in African American Women
Authors: Beckjord Ellen Burke , Klassen Ann C. 
Published: August 2017

Background Improving mammography initiation and maintenance among African American women has been suggested as a strategy for reducing breast cancer mortality in this population. Methods We examined cultural values in relation to self-reported breast cancer screening among 572 low-income, urban, African American women. Cultural values examined included time orientation, family authority, employment aspirations, value of past vs modern life, and reliance on medical professionals. Also, implications for continued development of culturally tailored health interventions and opportunities for the consideration of cultural values in health communication are discussed. Results Bivariate analyses showed that more traditional values were associated with worse screening histories and lower intentions for future screening. In multivariate analyses, two interactions were observed between cultural values and age: for younger women, more traditional values were associated with lower odds of having ever received a mammogram, and for older women, more traditional values were associated with lower odds of intentions to receive a mammogram in the next 2 years. Conclusions This study adds to the evidence that cultural constructs, such as values, are associated with secondary prevention of breast cancer and supports the consideration of cultural constructs as important in increasing mammography and reducing breast cancer disparities for African American women.
Transcatheter Arterial Chemoembolization and Percutaneous Ethanol Injection for Hepatocellular Carcinoma: A Retrospective Review of the Veterans Affairs Caribbean Healthcare System
Authors: Narvaez-Lugo Jessica , Cáaceres William W. , Toro Doris H. , Péarez-Gonzáalez Manuel R. , Almodovar Alvin A. , Maldonado-Mercado Awilda M. , Salgado Norma , Rivera-Sanfeliz Gerant M. 
Published: August 2017

Background Hepatocellular carcinoma (HCC) is a common malignancy worldwide and has a poor prognosis. Although surgery and liver transplantation provide better outcomes, most patients are not candidates due to advanced disease, lack of donor availability, or presence of comorbidities. Several percutaneous approaches such as transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection therapy (PEIT) have been developed for local control and can potentially increase survival in these patients. Methods We retrospectively reviewed 33 patients with HCC who were treated with TACE, PEIT, or both from 2000 to 2005 at the VA Caribbean Healthcare System in Puerto Rico to evaluate tolerability, response, and survival. Patients were evaluated with cross-sectional computed tomography imaging to determine response using response evaluation criteria in solid tumors (RECIST). Results Thirty-three men with a mean age of 66 years were treated. Mean tumor size was 5.6 cm, ranging from 2 cm to 16 cm. All patients had cirrhosis, with alcohol abuse and hepatitis C as the most common etiologies. Objective radiographic partial response was observed in 28% of patients and 48% had disease stabilization. Most of the patients had a therapeutic response demonstrated by necrosis of the tumor and decreased contrast enhancement. Patients who underwent both TACE and PEIT had a higher response rate and disease stabilization but no difference in survival compared with those who received TACE or PEIT alone. Median survival for the whole group was 2 years. Causes of death included tumor progression, hepatic failure, gastrointestinal bleeding, and infections. The initial tumor size and Child-Pugh class did not confer a significant difference in survival rate. Conclusions In Puerto Rico, where liver transplantation is not performed at present, percutaneous treatments are effective local therapies for patients who are not candidates for surgery and who have disease limited to the liver.
Radiation Therapy as Primary and Adjuvant Treatment for Local and Regional Melanoma
Authors: Berk Lawrence B. 
Published: August 2017

Background The role of radiation therapy as primary and adjuvant therapy for localized or locally advanced melanoma is controversial. Methods To develop evidence-based guidelines, PubMed was searched using the keywords melanoma AND (radiation OR radiotherapy). These references were reviewed and the relevant articles selected. The articles were then reviewed for further references. Because of the paucity of prospective or randomized trials, no attempt was made to classify the quality of the results. Results No phase III trials of nodal irradiation for prevention of regional recurrence are available. A phase III trial is being completed by the Tasman Radiation Oncology Group. A phase II trial has been completed by the group. Multiple retrospective series have been published. The available data appear to confirm that nodal radiation therapy is effective in preventing nodal recurrence. No dose response or fraction size response was found. According to generally accepted guidelines, radiation therapy should be offered for patients who have nodes greater than 3 cm, more than 3 involved nodes, or extracapsular extension. For radiation therapy for the treatment of metastatic disease, a phase III trial showed that 50 Gy in 2.5-Gy fractions was as effective as 32 Gy in 8-Gy fractions, with 25% complete remission and 35% partial remission. In contrast, the retrospective studies support that larger fraction sizes, at least 4 Gy, are more effective. Conclusions Adjuvant nodal irradiation appears to be effective for the prevention of nodal recurrence. Radiation therapy can also be effective for treatment of local disease, if surgery is not an option.
Establishing a Patient Navigator Program to Reduce Cancer Disparities in the American Indian Communities of Western South Dakota: Initial Observations and Results
Authors: Petereit Daniel G. , Molloy Kevin , Reiner Mary L. , Helbig Petra , Cina Kristin , Miner Raylene , Tail Caroline Spotted , Rost Catherine , Conroy Patricia , Roberts Chester R. 
Published: August 2017

Background American Indians (AIs) in the Northern Plains region suffer disproportionately high cancer mortality rates compared with the general US population and with AIs from other regions in the United States. Methods The National Cancer Institute developed the Cancer Disparity Research Partnership to address these inequities. This initiative in Rapid City, South Dakota, attempts to lower cancer mortality rates for AIs by access to innovative clinical trials, behavioral research, and a genetic study. Patient navigation is a critical part of the program. Two navigation strategies are described: navigators at the cancer center and navigators on each reservation. A retrospective analysis was performed to determine if navigated patients (n = 42) undergoing potentially curative radiotherapy had fewer treatment interruptions compared with nonnavigated patients (n = 74). Results A total of 213 AIs with cancer have undergone patient navigation. For those undergoing cancer treatment, the median number of patient navigation interactions was 15 (range 1 to 95), whereas for those seen in follow-up after their cancer treatment, the median number of contacts was 4 (range 1 to 26). AIs who received navigation services during curative radiation treatment had on average 3 fewer days of treatment interruptions compared to AIs who did not receive navigation services during curative radiation treatment (P = .002, N = 116). Conclusions Early findings suggest that patient navigation is a critical component in addressing cancer disparities in this population. The program has established trust with individual cancer patients, with the tribal councils, and with the general population on each of the three reservations of western South Dakota.
The Role of Comprehensive Surgical Staging in Patients with Endometrial Cancer
Authors: Frederick Peter J. , Straughn J. Michael 
Published: August 2017

Background The cornerstone of the management of patients with endometrial cancer is hysterectomy. Since 1988, the role of lymphadenectomy for patients with endometrial cancer has been debated. Patients who undergo pelvic and para-aortic lymphadenectomy are more likely to be accurately staged and are less likely to receive adjuvant radiation therapy. Methods The authors perform a narrative review of the recent literature. Overall survival, utilization of radiation therapy, impact on quality of life, and alternative approaches to surgical staging are discussed. Results Although a survival benefit from comprehensive surgical staging has not been clearly demonstrated in patients diagnosed with endometrial cancer, surgical staging allows one to determine the need for adjuvant therapy. Preoperative and intraoperative assessment of lymph node metastasis and tumor grade lacks accuracy. Unstaged patients are more likely to receive postoperative radiation therapy. Conclusions Comprehensive surgical staging with lymphadenectomy allows patients to be classified accurately into risk categories. Risk status can be definitively determined only with final pathology. Surgically staged patients are more likely to receive appropriate adjuvant therapy or observation when warranted.
Pediatric Melanoma: A Review
Authors: Mills Omie , Messina Jane L. 
Published: August 2017

BackgroundMalignant mela-noma is a rare neoplasm in the pediatric population, but its incidence has risen in recent years.MethodsThe literature was reviewed to define the current clinical and pathologic features of pediatric melanoma, highlighting the similarities and differences between adult and pediatric melanoma.ResultsDistinctive features of this disease, including frequency and type of genetic abnormalities, predisposing conditions, clinical presentation, stage at diagnosis, prognostic features, and frequency of sentinel lymph node positivity are emphasized. Treatment strategies, extrapolated from adult mela-noma trials, are also discussed.ConclusionsDespite the differences between pediatric and adult melanoma, survival rates are similar and are improving in both populations. Further studies will help delineate the pathogenesis of both adult and pediatric melanoma, with the goal of contributing to early detection and improved survival.
Diagnosis and Treatment of mela-noma Brain Metastasis: A Literature Review
Authors: Sloan Andrew E. , Nock Charles J. , Einstein Douglas B. 
Published: August 2017

Background Brain metastasis is common in patients with malignant mela-noma and represents a significant cause of morbidity and mortality. Nearly 37% of patients with malignant mela-noma eventually develop brain metastasis, and autopsy reports show that 75% of those who died of this disease developed brain metastasis. Methods We review the level I and level II evidence that guides indications for treatment with surgery, stereotactic radiosurgery, chemotherapy, and immunotherapy for patients with mela-noma brain metastasis. Results Level I evidence supports the role of whole brain radiotherapy, microsurgery, and radiosurgery alone or in combination for the treatment of patients with mela-noma brain metastasis. Chemotherapy has been ineffective. Ongoing studies continue to assess the effects of immunotherapy and agents in development. Conclusions Brain metastasis is a common and formidable challenge in patients with malignant melanoma. Although there have been no randomized controlled trials exclusively in patients with mela-noma brain metastasis, care can be guided by the application of level I evidence for the treatment of brain metastasis in general and phase II studies focusing specifically on mela-noma brain metastasis. Promising new agents and approaches are needed and will hopefully be identified in the near future.