bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between tumor stage of first non-metastatic breast cancer and second contralateral breast cancer.
Authors: Raghavendra Akshara , Sinha Arup Kumar , Hsu Limin , Patangan Modesto , Le-Petross Huong T. , Bevers Therese Bartholomew , Tripathy Debu , Bedrosian Isabelle , Barcenas Carlos Hernando 
Published: February 2017

260 Background: Female breast cancer survivors have an average lifetime risk of 4-8% to develop a contralateral breast cancer (CBC).It is unclear if the tumor stage of the first breast cancer is associated with the development of a second CBC. Methods: We performed a retrospective analysis of women who had a presenting diagnosis of non–metastatic breast cancer treated at MD Anderson Cancer Center between January 1997 and December 2013. Demographic, clinical, pathologic and treatment information were obtained from an institutional database. We excluded male patients, those treated outside MD Anderson, patients who underwent bilateral mastectomy, and those with unknown tumor characteristics. The primary endpoint was the development of CBC. The time to CBC was measured from the date of diagnosis of the first breast cancer. Patients who did not develop CBC were censored at death, or if alive, at the most recent follow-up visit. Index tumor stages were categorized as 0, I, II and III. Results: We analyzed 8,770 patients (median follow-up of 5.4 years), among whom 259 (3.0%) developed a CBC. The median follow-up time for stages 0-III was 4.9, 7.2, 5.2 and 3.9 years, respectively. The proportion of patients who developed a CBC by the stage of the index breast cancer was: stage 0: 0/403 (0.0%); stage I: 115/2,143 (5.4%); stage II: 110/4,220 (2.6%); stage III: 34/2,004 (1.7%). The overall median [quartile (Q) 1, Q3] time to the development of CBC was 3.2 (1.2, 6.3) years (stage 0: 0 (0.0, 0.0); stage I: 3.0 (1.2, 6.3); stage II: 4.4 (1.3, 6.9); stage III: 1.6 (0.8, 5.1) years). Conclusions: Patients with stage 0 breast cancer appear to have lower risk of developing a second CBC compared to women presenting with invasive disease. A more detailed analysis of this observation, including incorporation of hormone receptor status and receipt of endocrine therapy, is warranted to determine whether this observation suggests differing biologic risks or treatment/selection bias.
Impact of hereditary multigene panel testing for cancer survivors.
Authors: Kapoor Nimmi S. , Swisher Jennifer , McFarland Rachel E. , Patrick Mychael , Curcio Lisa D. 
Published: February 2017

261 Background: Recently, genetic testing for hereditary cancer syndromes has seen numerous advances in testing spectrum, capability, and efficiency. This may have important implications for cancer survivors and their families. The purpose of this study is to evaluate the impact of reflex genetic testing with newer multi-gene panels on patients with prior negative BRCA1/2 tests. Methods: Data was collected retrospectively from patients who underwent multi-gene panel testing at one of three sites from a single institution between 8/2013-6/2015. Those with a personal history of breast or ovarian cancer and a prior negative BRCA1/2 test were included. Results: Of 914 patients who underwent multi-gene panel tests, 187 met study inclusion criteria. Ten patients (5.3%) were found to carry 11 pathogenic mutations, including 6 patients with mutations in CHEK2, 2 patients with mutations in PTEN, and 1 patient each with mutations in the following genes: BARD1, NF1, and RAD51C. One patient had two pathogenic mutations identified—CHEK2 and BARD1. Of 10 patients with mutations, 9 had a personal history of breast cancer diagnosed at a median age of 43 (range 35-52) and 1 had ovarian cancer diagnosed at age 65. A majority of mutation carriers underwent panel testing years after their cancer diagnosis (median 6 years, range 0.5-32 years) and none with delayed testing had undergone prophylactic contralateral mastectomy prior to the discovery of their gene mutation. All patients with mutations had a family history of at least one cancer, with most having a variety of cancer diagnoses in multiple relatives. Positive panel testing results altered clinical management in most patients, including addition of breast MRI, colonoscopy, or thyroid ultrasound depending on the gene mutation. After discovery of a PTEN mutation 19 years after her initial cancer treatment, one woman underwent bilateral prophylactic mastectomy and was found to have occult ductal carcinoma in situ. Conclusions: Cancer survivorship must incorporate advances in technology that may be beneficial even years after treatment has ended. Multi-gene panel testing can be applied in survivorship settings as a useful tool to guide screening recommendations.
Cancer survivors in Mexico: Analyzing their experience.
Authors: Suchil-Bernal Laura , Rodriguez-Velazquez Ana , Galindo-Vazquez Oscar , Meneses-Garcia Abelardo 
Published: February 2017

262 Background: Every year the number of people diagnosed with cancer increases due to aging, population growth, and the increasing life expectancy rate in the general population. Survivors have to deal with the long-term side effects of treatment, as well as psychological disturbances, such as fear of cancer recurrence. Herein we present the results of a research project about the treatment side effects and psychosocial problems that cancer survivors in Mexico experience. Methods: In order to explore their experience as cancer survivors, 1240 participants from different parts of the country voluntarily replied a 32-item questionnaire. Results: Participants were primarily women (81%), with an average age of 55 years (20 to 91 years). 18% of the survivors were younger than 40 years old, whereas only 15% were 70 years or older. Most participants had a level of education beyond high-school (46%). The three types of cancer that were most commonly reported were: breast cancer (48%), cervical cancer (11%) and lymphoma (6.8%). The majority of the participant survivors (67%) were diagnosed with cancer 5 years ago or longer. Fatigue was the most common side effect (55%), followed by bone pain (45%) and skin changes (42%). 26% of the population experienced sexual dysfunction; 50% reported diminished interest in sex and 19% of female survivors expressed having pain during intercourse. Fear of cancer recurrence (60%) was the chief psychosocial concern of survivors; depression (55%) and anxiety (44%) were also reported. Furthermore, 55% of survivors indicated they had felt discriminated. Conclusions: This is the first report about matters affecting cancer survivors in Mexico. Further studies are required to explore survivors' main health problems in order to treat them within a multidisciplinary approach and to create specific assistance programs.
Evidence table development as a novel teaching tool in cancer survivorship education.
Authors: Shayne Michelle , Culakova Eva , Milano Michael T. , Constine Louis S. 
Published: February 2017

3 Background: We established a novel curriculum in Cancer Survivorship Education (CSE), as a collaborative effort between our accredited training programs in Hematology/Oncology and Radiation Oncology. The conceptual framework for all our coursework in cancer survivorship was grounded in the recommendations from the Institute of Medicine report from 2006. As a means of refining our CSE curriculum, we introduced Evidence Table (ET) development. ETs are formatted summaries of methods, data, and outcomes from related studies used to answer specific questions. ETs facilitate the development of recommendations and standards of care. ET development was proposed to enhance the CSE experience allowing trainees to: 1) understand data supporting survivorship recommendations, 2) practice grading the evidence, 3) become more critical in appraisal of published studies, and 4) discover areas where further research is needed to substantiate cancer survivorship care plans. Methods: A total of 19 trainees participated in academic year 2013-2014 and 18 trainees in 2014-2015. Trainees were required to define key questions pertaining to survivorship, probe the literature for available data addressing these questions, and develop ETs in which the evidence was then graded. To ascertain the value of this experience from the trainees’ perspectives, anonymous and voluntary pre- and post-Workshop surveys were administered. The course was modified after the first academic year based on results of a trainee feed-back. Results: Following course modification in 2014-2015, 92% of trainees responded that they used some of the learned course information in their clinics. This represents significant improvement from 45% the previous year (p = 0.02). Significant improvement was observed (from 18% to 67%) in the perception that the course influenced trainees' approach to the medical literature. Ninety-two percent responded that they learned more about survivorship as a result of the CSE Workshop. All trainees reported that, to some extent, CSE has helped to make them better oncologists. Conclusions: ET development is a feasible, meaningful, and novel approach to fostering independent learning in cancer survivorship.
Prevalence of cognitive impairment in patients with hematologic cancers preceding stem cell transplantation: Program for healthy aging.
Authors: Edwards Beatrice Jara-Almonte , Holmes Holly Michelle , Valladarez Heather , Sun Ming , Khalil Peter , Nguyen Vu , Song Juhee , Champlin Richard E. 
Published: February 2017

32 Background: Older adults, 65 years of age and older, with hematologic cancers may be at higher risk for cognitive impairment. It is postulated that the etiology of cognitive impairment in cancer may a combination of age-related and chemotherapy related cognitive impairment. Methods: We conducted a retrospective cohort analysis, of older adult patients 65 years and older evaluated at the Program for Healthy Aging at MD Anderson from January 1, 2013 through March 31, 2015. Cognitive assessment was evaluated through personal interview, and the Montreal cognitive assessment, functional assessment utilizing ADLs and IADLs. Screening for depression was conducted with the PHQ-9. Patients were interviewed regarding risk factors for dementia including depression, concussions, alcohol abuse, and family history of dementia. Level of education was assessed. Patients were euthymic. Cognitive impairment was defined as an abnormal MOCA without functional impairment, dementia was defined as an abnormal MOCA with functional impairment. Imaging and assessment for reversible factors of memory loss was conducted. SAS 9.4 (SAS Institute INC, Cary, NC) was used for data analysis. Results: The majority of these 62 patients had received chemotherapy for more than 2 years. Cognitive impairment and/or dementia were identified in 50 (80.6%) patients. Types of dementia included Alzheimer’s disease (n = 4, 8%), vascular dementia (n = 5, 10 %), and mixed dementia (n = 15, 30%).Mild cognitive impairment was evidenced in 14 cases (28%) The majority of cases of dementia with known stage were early stage dementia (n = 13, 72.2%), moderate stage dementia (n = 3, 16.7%), and advanced or severe dementia (n = 2, 11.1%). Brain imaging was performed identifying white matter microischemic changes, cerebrovascular accidents and brain atrophy in some cases. No significant thyroid abnormalities, B12 deficiency or other reversible causes were identified. Conclusions: Cognitive impairment and dementia are prevalent in older patients with hematologic malignancies. Identification and management of this condition may prevent delirium and hospital complications during stem cell transplantation.
Physician office visits for cancer survivors: Results from a national survey.
Authors: Halpern Michael T. , Vincent Brenda , Wollins Dana 
Published: February 2017

33 Background: Cancer survivors may require specialized medical care to address their unique needs. However, there are few reports of nationally-representative outpatient-care patterns among survivors. Methods: We examined adult cancer survivors’ outpatient medical visits using data from the 2010 & 2012 National Ambulatory Medical Care Survey (NAMCS), a survey of U.S. physician office-based visits. Survivors were identified as individuals with medical visits related to cancer (based on physician diagnosis codes or patient-supplied reasons for visit) but who did not currently have cancer. Weights from the NAMCS were used to produce results corresponding to the overall U.S. population. Results: The NAMCS data included 477 survivor visits, corresponding to a two-year nationally-representative weighted total of 7,435,753 visits. Most survivors were White (75%); 13% were Black and 8% Hispanic. Most survivors had private insurance (49%) or Medicare (40%); 4% had Medicaid. Almost all (99%) saw a physician during the recorded visit. Only 20% of survivor’s outpatient visits were with oncologists; 20% were with primary care physicians, 12% with OB/GYN physicians, 5% with general surgeons, and more than one-third (35%) with other physician specialties. The most common services received during survivors' visits include general physical exams (57%) and imaging studies (20%). Visits with oncologists were less likely to include depression screening or counseling regarding nutrition, exercise, stress management, tobacco use, or weight reduction than were visits with other types of physicians. Conclusions: Cancer survivors experience diverse outpatient medical care interactions; only a minority of these are with oncologists. Oncologist visits are less likely to involve important counseling services. The NAMCS represents an important data source for examining outpatient care patterns among survivors.
Community survivorship program: Kansas Hope in the Valley program.
Authors: Chauhan Cynthia , Tan Winston 
Published: February 2017

34 Background: Patient run community based survivorship programs are rare; most are affiliated with clinics and hospitals. Aim: To highlight a community based non-hospital affiliated program that had operated successfully for 32 years and review their best practices and challenges. Methods: Data collected from Hope in the Valley support group program. In Wichita, Kansas there is a patient formed community based support group/survivorship program supported and operated privately by survivors. Results: Todate a total of 16 disease specific and 13 general cancer support groups are affiliated with the organization and all the services are housed in a building. The support groups meet in different places and are grouped according to their proximity to their residences. Services provided include lodging assistance, women's boutique, support group meetings, transportation, patient assistance program, and a hospitality center. Every new patient with cancer in the community was given a referral to the center. Cancer support groups include breast, gynecologic, lung, kidney, gastrointestinal, lymphoma, leukemia, adolescent, childhood and general cancer group. In 2014 67, 709 patients attended support groups meetings and 2000 patients attended between January- April 2015. The hospitality center had 20, 160 visits and 19,877 physician's office treatment visits were conducted in 2014. There are 3 full time staff, 7 part time staff and 200 volunteers run the organization. Challenges include recruitment of volunteers, funding for the organization, existing as an independent program from churches, hospital, clinics, or national organizations, public awareness of the program, the governance and structure of the organization. Details of the challenges and how their organization is run will be presented. Many of the patients used their services often give back as volunteers, facilitators and others. Conclusions: This is a survivorship program run by patients, actively addressing patients concerns and issues. This could provide a framework for future groups that want to form a community based patient centered cancer support group.
A model for survivorship care plans (SCP) at a large academic institution.
Authors: Ward Andrew Joseph , Bell John Lawrence , Jerkins Lindsey 
Published: February 2017

35 Background: In 2014, the American College of Surgeons Commission on Cancer mandated in Standard 3.3 that SCP be provided for all patients at the completion of active treatment. Minimum requirements for what SCP should include were provided; however, no standardized model was proposed. We outline how a large academic medical center approached this as an opportunity instead of an obstacle. Methods: A pilot for developing SCP for the University of Tennessee Medical Center Cancer Institute (UTMC, CI), where 2700 new cancer cases per year are seen, was created. Initially approached by the Division of Surgical Oncology, SCPs were established for all patients. This approach allowed the UTMC, CI to determine all best practices for meeting Standard 3.3. This pilot identified all major stake holders including mid-level providers who see follow-up patients, a physician champion, and the survivorship care plan that best fit our organizational challenges and work flow. Results: The described approach allowed us to exceed our goal of providing SCP for 10% of patients seen in 2015 prior to the conclusion of the third-quarter. By keeping the pilot small, we were able to pinpoint the “best practice” for identifying patients, completing the SCP, delivery of the SCP, and providing care in an efficient way. By creating SCP that can be adapted by the entire UTMC, CI, we were able to ensure that we are meeting all of our stakeholder’s needs. Conclusions: Compliance with Standard 3.3 for SCP does not have to be a daunting task. The process can be adapted to be efficient while utilizing already stressed financial and personnel resources. A successful survivorship program can be developed as a pilot prior to being adapted by an entire organization. We recommend identifying the appropriate stake holders, defining a physician champion, and identifying SCP that best serve the mission of each organization while meeting all regulatory requirements.
Survivorship model of care at a large National Cancer Institute.
Authors: Pabbathi Smitha , Morgan Mary Ann 
Published: February 2017

37 Background: There is a lack of existing evidence on survivorship care models and their advantages and disadvantages when it comes to improving health outcomes. We describe the evolution of a Survivorship Care model at a large NCI designated Cancer Institute. Our model is closest to ASCO’s description of General Survivorship Clinic/Shared Care. The Clinic is led by a full time nurse practitioner and two part time internists. Initial start-up expenses were provided by Foundation funds Methods: Aggregate data was requested from Information Shared Services. Data was extracted from both Billing from Transmed-HRI and the Cancer Registry from the time period of May 2011 to August 2015 to identify patients who have been followed in the long-term Survivorship clinic. Results: Our program initially focused on breast and prostate cancer populations based on SEER data of cancer survivors and risk-stratification. Twelve other cancer types are now referred resulting in steady growth. A review of our patient population revealed 924 unique patients of which 619 were female and 305 male. Fifty-nine patients fell in the age range 20-44, 445 in the age range 45-65, and 420 > 65 age. Over fifty percent of our patients are from the Breast Program; the next largest population is Genito-Urinary and third largest group is Digestive. The patients racially identified as white are 89%, 6.3% black, 2.7% as other, 2% unknown. This is consistent with the center population. Eighty patients had recurrences or new primaries. Conclusions: The number of referrals has grown every year and the majority of patients continue to be followed annually. Patients do not feel lost in transition because we have a team based approach as the parent program exists within the institution. Our model not only allows our oncologists to focus on new patients and those with recurrent or metastatic disease but it can help bridge survivorship care from the oncologist to primary care physicians in the community. This type of clinic will also facilitate evaluation and treatment of late effects such as anthracyclines and pelvic radiation across diseases for management of symptoms.
Cancer survivorship care in the rural community: A mobile model.
Authors: Argenbright Keith Edward , Berry Emily , Mazour Tracy , Lawrence Stephanie L. 
Published: February 2017

38 Background: As survival rates continue to improve, many forms of cancer are now regarded as chronic diseases requiring long-term follow-up. This survivorship phase of care represents a distinct opportunity to improve the health and quality of life for cancer survivors, addressing the lingering medical and psychosocial effects of illness, recurrent or new cancers, and promoting health behavior changes. Evidence-based cancer survivorship programs are typically limited in scope and only found in large cancer centers because they are costly and poorly reimbursed. As a result, UT Southwestern Moncrief Cancer Institute (UTSW-MCI) mobilized its clinic to provide essential survivorship services to the estimated 15,000 underserved cancer survivors in geographically remote areas of North Texas. Methods: UTSW-MCI provides survivorship care to Medicaid-enrolled and uninsured patients within a nine county service area using a custom-built mobile health unit. Staffed with an experienced team of nurses, social workers, dietitians, exercise specialists and physician assistant, services on the mobile clinic include: cancer screening and surveillance; medical management of long-term side effects of treatment; treatment summary and care plans; dietary evaluations and healthy lifestyle education; psychosocial evaluations, care coordination and navigation to financial assistance; and assessments for balance, immobility, range of motion, and safe physical activity. In-house providers with the ambulatory clinic are also able to see patients on the mobile unit using telemedicine. These services include genetic counseling, physician assistant evaluations, and psychological counseling. Results: After six months, mobile clinic enrollments represent more than 10% (N = 28) of the survivorship program patient population and nearly 15% (N = 130) of completed encounters, including 28 RN assessments, 26 Social Work evaluations, 21 Dietitian assessments, 53 Exercise sessions, and 3 PA consultations. Conclusions: This innovative survivorship care model addresses barriers that impede access to care to improve both the health of medically underserved cancer survivors and the experience of care while reducing the cost of care without compromising quality.