bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chest CT findings among adult survivors of childhood and young adult cancer with a history of chest radiation.
Authors: Tonorezos Emily S. , Barnea Dana , Khan Amber , Chou Joanne F. , Moskowitz Chaya S. , Kaplan Rana , Oeffinger Kevin C. 
Published: March 2017

103 Background: While survivors of childhood and young adult cancer with a history of radiation therapy (RT) to the chest are known to be at increased risk for lung cancer, whether a CT-based lung cancer screening program is appropriate for this population is unknown. We sought to describe CT findings in a clinic-based population of childhood and young adult cancer survivors. Methods: We performed a detailed review of all diagnostic chest CT scans performed among patients seen in the Adult Long-Term Follow-Up Program at Memorial Sloan Kettering between August 2005 and May 2016. Included survivors were at least 5 years from diagnosis and had a history of RT to the mediastinum, mantle, axilla, lung, thoracic spine, or total body irradiation fields. Results were reviewed by at least two authors (ET, DB, or AK) and discrepancies were resolved by consultation with a pulmonologist (RK). Results: We identified 620 survivors with a history of chest field RT who were at least 5 years from diagnosis. The population was 48% male, with a median age at diagnosis of 17.2 years. Approximately half were survivors of Hodgkin Lymphoma (N=306; 49.5%) and almost one-third had undergone hematopoietic cell transplant (N=188; 31%); other diagnoses included non-Hodgkin Lymphoma and sarcoma. The most frequently cited RT field was mantle (N=219; 36%), followed by total body irradiation (N=142; 24%) and whole lung (N=110;18%). Among 351 survivors with at least one chest CT, 206 (59%) had at least one pulmonary nodule, 174 (50%) had fibrosis, and 132 (38%) had a ground glass opacity. Among those with a pulmonary nodule, the large majority (91% of those with a nodule) were followed expectantly or underwent repeat imaging; these patients were spared biopsy or resection. Among 18 patients who underwent biopsy, wedge resection, fine needle aspiration, or bronchoscopy, 4 were diagnosed with lung adenocarcinoma, 3 with metastatic sarcoma, and one with marginal zone lymphoma (MALT). Conclusions: Benign pulmonary nodules among adults with a history of RT for childhood or young adult cancer are common. Any strategy for lung cancer screening in this population will need to account for a high likelihood of benign findings on chest CT.
Total and cancer-attributable phase-based costs for childhood cancer care: A population-based study in British Columbia, Canada.
Authors: McBride Mary L , Duncan Ross , Bremner Karen , De Oliveira Claire , Liu Ning , Nathan Paul C. , Rogers Paul C. , Peacock Stuart , Krahn Murray Dale 
Published: March 2017

11 Background: Childhood cancer presents unique issues regarding treatment, late effects, and long-term survival, but few studies have reported costs. Childhood cancer-specific costs are useful for economic evaluation and planning care. This study estimates total and cancer-attributable (net) medical costs for a population-based childhood cancer cohort in British Columbia, Canada, by phase of care. Methods: Patients diagnosed with cancer at ages 91 days to 14 years between 1995-2009 were identified from the British Columbia Cancer Registry, and followed to December 31, 2010. Data were linked with clinical and provincial administrative healthcare databases covering all medically-necessary costs. Total resource-specific costs (Canadian $ 2012) were estimated overall and for patients with leukemia, lymphoma, central nervous system (CNS), and “other” cancers. Net costs were calculated by subtracting healthcare costs for propensity-score-matched provincial samples of children without cancer from cancer patient costs. Results: Of the 1,440 cases, 33% had leukemia, with 23% CNS tumours, 10% lymphoma, 34% other cancers; 93% survived >=1 year. Overall pre-diagnosis mean costs per patient were $4,633, of which $4,555 was attributable to the cancer. Overall initial (first-year) mean costs were $97,780 ($97,254). Overall continuing phase mean costs were $12,441 ($12,006). Overall final year of life mean costs were $284,201 ($283,652). Cancer types with highest costs were CNS (pre-diagnosis), leukemia (first-year), “other” cancers (continuing), and lymphoma (end-of-life). Virtually all inpatient hospitalizations were cancer-related, representing ~41% of pre-diagnosis, ~71% of first-year, ~57% of continuing, and ~73% of end-of-life costs. Conclusions: Management of childhood cancer is costly, and is higher than for adolescent cancer in all phases of care, reflecting greater morbidity and treatment complexity. Hospitalizations were the largest driver of costs in all post-diagnosis phases of care. Costs in the continuing phase, including surveillance and care for late effects, were 13% of first-year phase costs.
Increased late mortality in underweight survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.
Authors: Tonorezos Emily S. , Meacham Lillian R. , Chou Joanne F. , Moskowitz Chaya S. , Leisenring Wendy M. , Friedman Danielle Novetsky , Sklar Charles A. , Dilley Kimberley Jo , Hudson Melissa M. , Mertens Ann C , Armstrong Gregory T. , Robison Leslie L. , Oeffinger Kevin C. 
Published: March 2017

110 Background: Approximately one-in-ten adult survivors of childhood cancer are underweight. While the consequences of being overweight or obese have been well-described, outcomes among underweight childhood cancer survivors are unknown. Methods: Underweight was defined as a body mass index (BMI)< 18.5 kg/m2, calculated from self-reported height and weight on either the baseline or the first follow-up questionnaire from the Childhood Cancer Survivor Study (CCSS). National Death Index provided death data and self-reported subsequent malignant neoplasm were validated by pathology report. Chi-square test was used to examine the association between underweight status (< 8.5 kg/m2 vs ≥ 18.5 kg/m2) and baseline demographic characteristics. Marginal models with generalized estimating equations were used to evaluate the associations between BMI and outcomes. Results: Of 9454 survivors (median age 35 years old, range 17-58, with an average of 17.5 years from diagnosis), 627 (6.6%) participants were underweight at baseline and had at least two years of additional follow-up. 29 of 184 deaths were among underweight survivors. In univariate analysis, underweight status was more common among females (9.1% vs 4.5 %, p<0.01) and participants with younger age (8.2% for <5 yrs vs. 6.1% for >=5yr, p<.01), lower household income (8.9% for <$20,000 vs. 6.0% for >=$20,000, p<0.01), and a history of a grade 3 to 4 chronic condition (p = 0.05). After adjustment for these factors, in addition to race/ethnicity, prior smoking, and a history of radiation therapy, the odds of all-cause mortality within two years of BMI report was 2.82 (95% CI: 1.64-2.2; p<0.01) for underweight survivors, compared to normal weight survivors. The risk of subsequent malignant neoplasms within two years of BMI report among underweight survivors compared to normal weight survivors was not significantly increased (OR 1.31; 95% CI: 0.60-2.85; p = 0.49). Conclusions: Childhood cancer survivors who are underweight are at significant risk for late mortality that is unrelated to smoking status, chronic illness, or second malignancy. Whether targeted nutritional interventions would ameliorate this risk is unknown.
Changes in arm tissue composition with slowly-progressive weight-lifting among women with breast cancer-related lymphedema.
Authors: Zhang Xiaochen , Brown Justin C. , Paskett Electra D. , Zemel Babette , Cheville Andrea L. , SCHMITZ KATHRYN H. 
Published: March 2017

114 Background: We evaluated baseline differences in arm tissue composition (fat mass, lean mass, bone mineral content [BMC] and bone mineral density [BMD]) between the affected and unaffected arms in women with breast cancer-related lymphedema (BRCL). We compared changes in arm tissue composition and self-reported lymphedema symptoms after one-year of weight-lifting vs. usual-care. Methods: We utilized data from the PAL trial that included 141 women with BRCL. Arm tissue composition was quantified using dual-energy x-ray absorptiometry. The severity of lymphedema was quantified using self-report survey. Weight-lifting was performed at community fitness facilities. Results: At baseline, the affected arm had more fat (D= 89.7±21.0g; P < 0.001) and lean mass (D= 149.1±25.3g; P < 0.001), but less BMC (D= -3.2±0.9g; P < 0.001) than the unaffected arm. No difference was observed in BMD. After 12-months of weight-lifting, composition of the affected arm was improved: lean mass (71.2±27.9g; P = 0.01) and BMD (0.01±0.01g; P = 0.02) increased, arm fat percentage decreased (0.01±0.01; P = 0.003). No changes observed in fat mass and BMC. Baseline body mass index and BCRL grade modified the relationship between weight-lifting and tissue composition changes. Increases in lean mass were associated with less severe BCRL symptoms. With every one-percent decrease in arm fat percentage, affected limb volume reduced 13.81mL. Conclusions: Among women with BRCL, affected and unaffected arms differ in tissue composition. These differences may be improved with weight-lifting. Changes in arm tissue composition correlate with improved BCRL symptoms. Investigating the combined effects of exercise and weight-loss on arm tissue composition and BCRL symptoms may provide additional insight to the benefits of lifestyle modification on lymphedema biology. Clinical trial information: NCT00194363.
Long-term outcome of patients with lower extremity Ewing sarcoma.
Authors: Ranft Andreas , Winter Corinna , Hoffmann Christiane , Rosenbaum Dieter , Rossig Claudia , Juergens Herbert , Dirksen Uta 
Published: March 2017

117 Background: With improved survival rates of patients with Ewing sarcoma the quality of long-term survivorship needs to be addressed. In this study, general recovery and restitution of function following intensive bone tumor treatment were analyzed by assessing the clinico-functional outcome and physical activity using self-reporting and objective measurement tools. Methods: Long-term outcome of 224 former patients with lower extremity Ewing sarcoma, registered between 1980 and 2009 in consecutive clinical trials of the GPOH, were assessed using the TESS, SF-36, BSI, and RSES questionnaire scales, and the accelerometric StepWatch Activity Monitor (SAM). To compare results with healthy subjects, 111 non-random peer controls were selected. Median observation time was 13.8 years from primary diagnosis (range 4.1-31.2). Results: Absolute values from the questionnaire scores indicated no major clinical findings in former patients. Compared to controls, unfavorable outcomes were however seen on physical TESS (d=-0.85), PCS (SF-36) (d=-1.08) and BSI-S scores (d=0.65) (P<0.001), in contrast to mental MCS (SF-36), BSI-A, BSI-D, RSES scores (d<0.40). Former patients were less active than the control group (10067 vs. 12430 steps per day; d=-0.56; P<0.001), but on average did reach the recommended level for an active life-style (>10000 steps). Comparing local therapy modality, physical scores for SAM, TESS, PCS were 10978, 91.2, T=50.2 for patients treated with surgery (N=101), 11097, 90.0, T=48.6 in patients with combined modality treatment (N=108), and 10093, 92.8, T=50.0 for patients with definite radiotherapy (N=15) (P=0.648; P=0.580; P=0.368). Conclusions: Survivors of primary lower extremity Ewing sarcoma exhibited moderately reduced self-reported and objectively measured physical outcome scores. Continuous long-term observation will be important in order to identify disease-specific prognostic factors for these patient-oriented outcomes.
Prospective surveillance using l-dex monitoring results in significant reductions in the chronic rate of breast cancer related-lymphedema (BCRL) in high-risk breast cancer patients.
Authors: Laidley Alison L. , Anglin Beth V. 
Published: March 2017

118 Background: Survivorship represents an increasing focus in the management of breast cancer with chronic toxicities including breast cancer-related lymphedema (BCRL). This study looked at prospective surveillance using bioimpedance spectroscopy (BIS) to reduce risks of chronic BCRL requiring referral for complete decongestive therapy (CDT). Methods: 132 patients at high-risk for the development of BCRL were prospectively followed using BIS with serial monitoring. This included a pre-operative baseline assessment and a minimum of two post-operative follow up assessments. Interventions were initiated when the L-Dex score increased by greater than 10 units from baseline and consisted of conservative treatment with a compression sleeve for four weeks. Patients were also clinically monitored for the development of BCRL. Results: Median follow-up was 19.3 months (range 4-54 mos). Of the 132 patients evaluated, 24 (18.1%) were subsequently diagnosed with elevated L-Dex scores and underwent intervention. Of the 24 that underwent treatment, 14 (58%) had resolution of their elevated L-Dex scores following four weeks of therapy with 10 having persistent elevations and clinical BCRL which necessitated referral to physical therapy for CDT. A further 7 subjects were diagnosed and not treated for elevated L-Dex scores, but had complete resolution (return to baseline) at last visit. At last follow-up, only 10 patients (7.6 %) had unresolved, clinical stage 1, BCRL. Conclusions: The use of L-Dex to prospectively follow our high-risk patients and prescribe intervention with a compression sleeve for 4 weeks when scores are elevated resulted in only a 7.6 % rate of stage 1, chronic BCRL. This rate of BCRL has been reported as 15-20%, suggesting that a prospective program of screening and intervention using L-Dex does result in clinically meaningful reductions in this long-term sequelae of treatment.
Total and cancer-attributable phase-based costs for adolescent cancer care: A population–based study in British Columbia, Canada.
Authors: McBride Mary L , Duncan Ross , Bremner Karen , De Oliveira Claire , Liu Ning , Nathan Paul C. , Rogers Paul C. , Peacock Stuart , Krahn Murray Dale 
Published: March 2017

12 Background: Cancer among adolescents presents unique issues regarding diagnosis, treatment, late effects, and survival; but little is known about their healthcare costs, which are useful for economic evaluations and planning care. This study estimates total and cancer-attributable (net) medical costs for a population-based adolescent cancer cohort in British Columbia, Canada, by phase of care. Methods: Patients diagnosed with cancer aged 15 to 19 years from 1995 to 2009 were identified from the British Columbia Cancer Registry, and followed to December 31st2010. Data were linked with clinical and provincial administrative healthcare databases covering all medically-necessary costs. Total resource-specific costs (Canadian $ 2012) by phase of care were estimated for all patients and specific common cancers. Net costs were calculated by subtracting healthcare costs for propensity-score-matched provincial samples of adolescents without cancer from cancer patient costs. Results: Of the 750 cases, approximately 26% had lymphoma, 17% germ cell, 14% bone and soft tissue sarcomas, 12% central nervous system (CNS), and 11% leukemia; 94% survived > = 1 year. Total mean pre-diagnosis costs per patient were $3657, of which $3554 was attributable to the cancer. First-year mean costs were $60,531 ($59,826). Continuing phase mean costs were $8,413 ($7,708). Final year of life mean costs were $224,243 ($221,018). Cancer types with highest costs were CNS (pre-diagnosis), leukemia (first-year); bone and soft tissue (continuing), and leukemia (end-of-life). Virtually all inpatient hospitalizations were cancer-related, representing ~40% of pre-diagnosis, ~62% of first-year, ~56%of continuing, and ~72%of end-of-life costs respectively. Conclusions: Management of adolescent cancer is costly, but is lower than for childhood cancer in all phases of care. Total costs, cancer-attributable costs, and inpatient activity were highest in the end-of-life period. Hospitalizations were the largest driver of costs in all post-diagnosis phases of care. Costs in the continuing phase, including surveillance and care for late effects, were 14% of first-year phase costs.
Visual functioning in adult survivors of retinoblastoma.
Authors: Friedman Danielle Novetsky , Chou Joanne F. , Ford Jennifer , Francis Jasmine , Sklar Charles A. , Li Yuelin , McCabe Mary S. , Robison Leslie L. , Kleinerman Ruth , Marr Brian , Abramson David H. , Oeffinger Kevin C. , Dunkel Ira J. 
Published: March 2017

122 Background: Retinoblastoma (Rb) survivors are at risk for adverse oculo-visual outcomes. Limited data are available regarding long-term visual functioning among adult Rb survivors. Methods: Rb survivors, diagnosed from 1932–1994 and treated in New York, completed a comprehensive questionnaire that included the National Eye Institute Visual Function Questionnaire (VFQ-25), which measures self-reported vision-targeted health in individuals with chronic eye diseases. Items are scored from 0–100 with 100 representing the best possible score. Results: 470 adult Rb survivors participated (53.6% with bilateral disease; mean age at study 43.3 yrs, standard deviation [SD] 11); 86% had at least one eye removed (one eye: 74.5%; both eyes: 11.5%) and 53.4% were treated with radiotherapy. 61.3% rated their eyesight as excellent/good while 16.5% reported complete blindness. Among Rb survivors with some vision, 4% described staying home “most of the time” due to their eyesight and 12% reported often feeling frustrated due to their visual status. The overall VFQ composite score for all Rb survivors was 89.2 (SD 10.1) [unilateral Rb survivors: 92.2 (SD 6.3); bilateral Rb survivors: 84.1 (SD 13.0); p < 0.001).Survivors with bilateral disease were significantly more likely to report inferior visual functioning in all domains when compared to those with unilateral disease (Table 1). Conclusions: Rb-related ocular problems continue to impact survivors’ functional status into adulthood, particularly among those with bilateral disease. [Table: see text]
The effect of cerebellar tumor resection on pain perception in pediatric patients.
Authors: Silva Katie E. , Rosner Julia , Ullrich Nicole A. , Chordas Christine , Becerra Lino , Manley Peter E. , Moulton Eric A. 
Published: March 2017

126 Background: Acute cerebellar infarctions have been shown to lead to affective and cognitive deficits in pediatric patients. However, the consequences of cerebellar insult on pain processing are unknown. Recent evidence not only suggests that the cerebellum plays a role in affective processing, but it also demonstrates increased activity in this area when individuals experience experimental or clinical pain, particularly in the posterior cerebellum. The goal of this study is to evaluate the effect of cerebellar resection of low-grade astrocytomas in children on pain perception. Describing the impact of this treatment may be of particular importance in children, as it may alter sensory development into adulthood. Methods: Twelve pediatric patients treated with surgery only for non-malignant astrocytomas (mean age = 13.78 ± 5.64) and ten age-, gender-, race- and handedness-matched healthy controls (mean age = 14.52 ± 5.96) were evaluated using quantitative sensory testing and magnetic resonance imaging, comprising diffusion tensor imaging, resting state and event-related functional MRI scans. Five of these patients had tumors localized to the posterior cerebellar hemispheres. The psychophysical measures assessed included heat and cold detection thresholds (HDT, CDT), heat and cold pain thresholds (HPT, CPT), and cold pain tolerance using a cold pressor task. Results: Patients with lesions in the posterior cerebellum (n = 5) were shown to have a significantly lower tolerance to the cold pressor test than controls (n = 10). No significant differences were detected for the threshold measures. This suggests increased pain sensitivity in these patients to suprathreshold noxious stimuli compared to controls. Patients with lesions that did not include the posterior cerebellar hemispheres (n = 7) did not show significant differences with controls in terms of cold pain tolerance or thresholds. Conclusions: The differences in cold pain tolerance between patients and controls are presumed to result from damage to the posterior cerebellar hemispheres, potentially interfering with the modulation of pain pathways. Analysis of the preliminary imaging data is underway and recruitment is ongoing. Support: NIH/R21CA185870(EM)
A novel strategy to build research capacity in survivorship science.
Authors: Rodriguez Maria Alma , Suarez-Almazor Maria E. , Lewis-Patterson Paula A. , Palos Guadalupe R. 
Published: March 2017

13 Background: The steady increase in cancer survivors supports the need for robust clinical and translational survivorship research. Yet, supportive environments and infrastructures to accelerate progress in survivorship research remains relatively limited. This abstract describes the implementation and initial outcomes of an institution’s unique approach to enhance their research capacity in survivorship science. Methods: An executive leadership team championed the formation of a research infrastructure based on the survivorship translational science model. Initial funding from a philanthropic foundation supported a doctoral prepared researcher and staff to provide administrative support. A 30-member Faculty Advisory Workgroup comprised of experts from different disciplines developed a conceptual and sustainability plan. Key components focused on seed money awards, trainee and professional education, and faculty development. Outcomes were measured in 5 groups: 1) seed money - number of $50,000 seed money grants awarded, external funding obtained, publications in peer-reviewed journals, and poster presentations, 2) professional and trainee educational events, i.e. number of symposia, grand rounds, trainees, participants, 3) number and type of faculty development events, and 5) infrastructure sustainability. Descriptive statistics summarize data. Results: Accomplishments achieved from 2011 – 2016 included a return on investment of a 16:1 ratio, 16 awards granted to new investigators totaling $953, 000, funding for 9 external awards resulting in a total of $15, 437, 441, 31 peer-reviewed publications, and 54 podium/oral presentations. Professional events included 8 professional symposia (784 and 325 posters), 6 institutional grand rounds, and 25 undergraduate trainees completed a research internship. Funding to sustain this program was recently awarded. Conclusions: This approach designed to build research capacity appears effective in supporting researchers in generating new evidence which can improve survivors’ outcomes.