bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a decision aid for young canadians diagnosed with breast cancer who are at risk of infertility following cancer treatment.
Authors: Speller Brittany , Facey Marcia , Sissons Amanda , Daly Corinne , Kennedy Erin Diane , Metcalfe Kelly A. , Baxter Nancy N. 
Published: March 2017

108 Background: Young breast cancer patients are at risk of temporary or permanent infertility following the administration of gonadotoxic cancer treatments. Currently patients do not feel they receive enough information to make informed fertility decisions before treatment. We aim to determine the fertility-related information health care providers and breast cancer survivors consider valuable to include in a Canadian decision aid (Can-DA) for young breast cancer patients by reviewing existing decision support resources. Methods: A qualitative descriptive approach was used to evaluate 6 decision support resources created in other jurisdictions. Using purposeful sampling, 8 multi-disciplinary health care providers and 8 breast cancer survivors from across Canada evaluated 1 to 2 decision support resources in structured interviews. Interviews were conducted in-person and by telephone from March to June 2016 and ranged in length from 30 to 90 minutes. Interviews were transcribed verbatim, organized in NVivo, and analyzed deductively using the pre-defined sections of the interview guide as a framework. Results: Each decision support resource had valuable components to adapt for the Can-DA. Participants valued the inclusion of Canadian-specific and accurate information on resources for additional support and the success rates and cost ranges of fertility preservation procedures. There were mixed views on the impact and value of including in-depth fertility information such as adoption and other fertility-related options after treatment. Discrepancies were also seen on the value of personal stories and an explicit values clarification exercise. There was consensus on the inclusion of only pertinent fertility-related information that does not replicate information in supplementary patient education material to avoid overwhelming patients. Conclusions: The evaluation provided valuable insight on the information and design features to consider for the Can-DA. Findings will be used in combination with the International Patient Decision Aid Standards criteria to ensure the Can-DA meets the fertility information needs of young breast cancer patients in Canada.
Preserving fertility for adolescent and young adult cancer survivors: A community model.
Authors: Lawrence Stephanie L. , Albritton Karen H. , Berry Emily , Rodriguez Aurelio , Argenbright Keith Edward 
Published: March 2017

109 Background: Loss of fertility is a significant late effect of cancer treatment for those patients diagnosed during their reproductive years. This loss is a source of considerable distress for patients who have not yet started or completed building their families. Fertility preservation counseling to discuss reproductive concerns regardless of treatment phase can ease this burden. However, due to access- and health-related barriers, approximately half of oncologists report having never referred a patient for a fertility consultation, and as many as 60% of cancer survivors do not recall receiving this information from their healthcare team at time of diagnosis. Methods: The Moncrief Cancer Institute (MCI) Fertility Preservation Program synchronizes services between oncology care providers and fertility specialists. This model is designed to remove discomfort associated with discussing options while enhancing access to care by arranging physician and patient education opportunities specific to fertility preservation and the treatment options available, patient care coordination for fertility preservation treatment, and financial assistance for fertility preservation treatment for underinsured and uninsured adolescent and young adult cancer patients. Results: Referrals for fertility counseling have been provided from 5 institutions through an established referral network comprised of non-profit organizations, local hospitals, and private practice providers. MCI partners with 2 reproductive specialty care groups who offer treatment at reduced rates, which MCI further subsidizes based on financial need. No patients are turned away for inability to pay. The institutions that MCI has targeted for education and partnerships support an environment that meet the distinct needs of adolescent and young adult patients with cancer. Conclusions: Program impact is evaluated by the number of patients and providers receiving education, and the number of patients receiving care coordination and/or financial support for fertility preservation treatment. In the fight against cancer, MCI is assisting patients to protect their future families through fertility preservation education and care coordination.
Risk for pulmonary late effects in childhood Hodgkin lymphoma survivors.
Authors: Agrusa Jennifer Elise , Brown Austin L , Kothari Viral , Lewis Gary , Teh Bin S. , Paulino Arnold , Allen Carl E. , Lupo Philip , Gramatges Maria Monica 
Published: March 2017

112 Background: Survivors of Hodgkin lymphoma (HL) are at risk for pulmonary late effects, including pulmonary fibrosis (PF). Established risk factors such as younger age at diagnosis and specific therapeutic exposures explain a fraction of the risk for these outcomes. Notably, systemic inflammation and impaired telomere maintenance are associated with adverse pulmonary outcomes in adult populations, but have not been explored in cancer survivors. Our aim was to identify pulmonary diffusion defects in HL survivors, and evaluate the impact of short lymphocyte telomere length (LTL) and systemic inflammation on these outcomes. Methods: Blood samples, demographic and treatment data, and lung carbon monoxide diffusion capacity corrected for hemoglobin and alveolar volume (DLCO) were obtained from HL survivors ≥6 months off therapy and without history of relapse or transplant. LTL was measured by telomere flow FISH (Repeat Diagnostics), and age-based percentiles determined from population controls. Plasma elevations in pro-inflammatory cytokines (HCYTMAG panel, EMD Millipore) were detected on a Luminex platform. Associations between clinical features and most recent DLCO were determined by linear regression, adjusted for age, sex, radiation, and race/ethnicity. In a subset of subjects, cytokine levels and LTL were compared in survivors with DLCO above or below the mean using a Student t-test or Fisher’s Exact test, respectively. Results: Seventy-two HL survivors met inclusion criteria (mean age at diagnosis=14 years, range: 3-18 years). Mean off-therapy DLCO was 75% (range: 52-98%), below the lower limit of normal (76%) in healthy populations. DLCO was inversely associated with female sex (p = 0.002). Five of 24 survivors (21%) had LTL ≤10th percentile for age, but there was no difference in LTL relative to DLCO. Survivors with DLCO ≤75% had higher IL1α and IL1β levels (n = 30, p = 0.07). Conclusions: HL survivors had lower than expected DLCO, with females at highest risk for impaired pulmonary diffusion. Twice as many survivors as expected had LTL ≤10th percentile, and PF-related cytokine profiles were observed in survivors with lower DLCO, suggesting inflammation and telomere maintenance defects may contribute to late effects in HL survivors.
Identifying characteristics of women cancer survivors with a recent history of falls.
Authors: Winters-Stone Kerri M. , Reis Thais , Stoyles Sydnee , Dieckmann Nathan 
Published: March 2017

113 Background: Epidemiologic data suggest that fall rates are increased among women with a history of cancer compared to women never diagnosed with cancer. However, the unique characteristics of women cancer survivors who fall are not completely understood. Our study aimed to identify the demographic, clinical and physical attributes of women treated for cancer and who experienced falling in the past year. Methods: Secondary data analysis of baseline data from aging women cancer survivors (greater than 50 years of age) about to participate in clinical exercise trials (n = 611). Based on self-report of having fallen in the last year (yes/no), women were compared on the following: age, cancer type (breast vs. other), cancer stage, time since diagnosis, presence of neuropathy or pain, comorbidities, BMI, physical activity, maximal leg press strength, chair stand time, walk speed, gait patterns, and the short physical performance battery (sPPB). Stepwise regression was run to determine attributes significantly associated with fall history. Results: 28% of women reported falling in the last year (n = 173) and 79% of fallers experienced a related injury. Women cancer survivors who fell were significantly more likely than women who did not fall to have: not received chemotherapy (25% vs. 13%), higher morbidity scores (2.2 vs. 1.8), higher BMI (30.6 vs. 29.2 kg/m2), more neuropathy (49 vs. 39%), wider base of support (10.0 vs. 8.8 cm), more of the gait cycle spent in the stance phase (64 vs. 63%), longer chair stand times (12.8 vs. 11.9 sec.), and lower PPB scores (10.3 vs. 10.8). In stepwise regression models, receipt of chemotherapy, comorbidities, maximal leg strength, neuropathy, base of support, and % time in the stance phase of gait were significantly associated with the odds of having fallen in the last year. Conclusions: Women cancer survivors over 50 years old have a prevalence of falls approaching the 33% reported by the general population of women over 65; however, the rate of injurious falls is much higher in our sample of women cancer survivors. Fall prevention should be considered in women cancer survivors at an earlier age than usual for older women, particularly for survivors at higher risk for falls, and focus on exercise to improve gait and leg strength.
Post-transplantation long-term outcomes in 43 HIV-positive patients affected by high-risk or relapsed lymphoma.
Authors: Zanet Ernesto , Balsalobre Pascual , Taborelli Martina , Diez-Martin Jose , Re Alessandro , Ribera Josep M. , Rupolo Maurizio , Genet Philippe , Serraino Diego , Guillerm Gaelle , Mazzucato Mario , Durante Cristina , Gabriel Ian , Cwynarski Kate , Conde Garcia Eulogio , Varela Gomez Maria Rosario , Ciancia Rosanna , Tirelli Umberto , Michieli Mariagrazia 
Published: March 2017

121 Background: The advent of highly active antiretroviral therapy (HAART) allowed to extend autologous stem cell transplantation (ASCT) to HIV-positive patients affected by lymphoma. In the literature, data are lacking on long-term events developed by this population. Methods: Herein we are reporting the preliminary analysis of long-term data of 43 pts out of 61 pts, affected by high-risk or relapsed lymphoma and treated by ASCT in different European countries. These 61 pts reached a complete response after ASCT and received HAART concomitantly to chemotherapy. We considered the following events after ASCT: lymphoma relapses, second cancers, opportunistic infections (OIs) and cardiovascular events. Results: Thirteen pts experienced OIs, after 0.36 years from ASCT (IQR: 0.12 -2.91). Twelve pts had a secondary malignancy and 6 pts had a lymphoma relapse, at a median time of 4.90 years (IQR: 2.56 – 9.90) and 2.88 years (IQR: 0.57 – 4.27) from ASCT, respectively. Six pts developed a cardiovascular event at 6.29 years (IQR: 4.84 – 9.32) from ASCT. Eight pts died: 3 of lymphoma relapse, 3 of second malignancy, 1 of acute myocardial infarction and 1 of car accident. With a median of 9.18 years of follow-up, (IQR: 5.99-12.43) the OS, PFS and EFS of the entire sample of pts were 82%, 75% and 35% at 10 years, respectively. Conclusions: Thirty-five out of 43 pts are still alive and in long-term complete remission after ASCT. These data confirm the long-term dramatic efficacy of ASCT. We support surveillance of OIs early after ASCT and of second cancers, lymphoma relapses and cardiovascular events from ASCT. Secondary malignancies developed by our pts are non-AIDS-defining cancers and a majority are linked to a viral pathogenesis or lifestyle behaviours (i.e. smoking). Secondary cancers and lymphoma relapses are the main causes of death in this population. Cardiovascular events may represent a cause of death but also a major reason of disability.
Sexual function in adult cancer survivors.
Authors: Rajotte Emily Jo , Baker K. Scott , Heron Leslie , Syrjala Karen Leslie 
Published: March 2017

123 Background: Sexual dysfunction is a common treatment sequela across numerous cancer diagnoses and treatments, causing increased distress, discomfort and negatively impacting quality of life. Methods: Before their survivorship-focused clinic appointment, adult cancer survivors were asked to complete a comprehensive patient -eported outcomes survey that included detailed questions on their health status including sexual function. Results: Between April 2015 to July 2016, 94 patients completed the survey. They were 66% female, mean age 45 years (SD 16, range 21-82) and 34% leukemia/lymphoma, 18% breast cancer, and 12% genitourinary cancer survivors. Patients were a mean of 6.7 years (SD 7.9, range 0-42) from their cancer diagnosis at the time of clinic appointment. Nearly half (48%) were married or living with a partner and 49% were living alone (single, divorced, widowed). 70.2% reported being sexually active (alone or with a partner) in the last year: of these only half (55.3%) reported being sexually active in the last month. For those who were not sexually active the most commonly cited reasons included lack of interest (24.5%) and not having a partner (30.9%), with 12.8% reporting not being sexually active due to a physical problem. Survivors rated their sexual satisfaction in the past month as a 5.0 (SD 3.7; scale of 0-10, 0=not at all satisfying 10=extremely satisfying). An independent samples t-test revealed a statistically significant difference in sexual satisfaction between survivors under 45 years in age and ≥45 years in age (t=4.4, df=68.0, p < 0.05). Older survivors (mean=3.71, SD=3.7) reported significantly lower levels of sexual satisfaction than did younger survivors (mean=7.11, SD=2.8). The most commonly reported sexual function issues for women included vaginal dryness (23.4%) and for men included difficulty getting an erection (7.4%). Conclusions: Sexual dysfunction is a common long-term effect of cancer across diagnoses and most treatments, warranting widespread implementation of targeted interventions to manage sexual dysfunction and improve quality of life for these survivors.
Symptom burden in long-term head and neck cancer survivors.
Authors: Pocobelli Gaia , Ziebell Rebecca , Fujii Monica , McClure Jennifer , Chubak Jessica 
Published: March 2017

124 Background: The symptom burden faced by long-term head and neck cancer survivors could inform clinical decision making but it is not well understood. Methods: In 2016 we surveyed current enrollees of Group Health (an integrated health care delivery system in Washington State) who were aged ≥18 years when diagnosed with head and neck cancer in 2011 (n = 54). Symptoms experienced in the past 24 hours were assessed using the validated MD Anderson Symptom Inventory head and neck cancer module (MDASI-HN). Survivors were asked to report on a 10-point scale the severity of the problem at its worst (“not present” to “as bad as you can imagine”). Self-reported risk factor and demographic information were also collected. Results: Eighty percent of persons responded to the survey (n = 43) via web questionnaire (n = 12), mailed questionnaire (n = 26) or telephone interview (n = 5). One person who reported to have not been diagnosed with head and neck cancer was excluded, leaving 42 participants. Overall, 29% had no more than mild symptoms (all MDASI-HN symptoms rated <5 ), 43% had no more than moderate symptoms (all MDASI-HN symptoms rated <7 ), 57% had one or more symptoms rated as severe (at least one MDASI-HN symptom rated ≥7 ), and 45% had two or more symptoms rated as severe. The symptoms most commonly rated as severe were: dry mouth (38%), difficulty swallowing or chewing (17%), pain (17%), fatigue (17%), disturbed sleep (15%), feeling sad (15%), choking or coughing (15%), problems with tasting food (15%), problems with teeth or gums (15%), problems with mucus in the mouth or throat (12%), and feeling distressed (12%). Persons who rated one or more symptom as severe were more likely than those who did not to have had cancer recurrence (44% versus 6%), receipt of cancer treatment in the previous three years (36% versus 17%), age ≥65 years at diagnosis (63% versus 17%), non-white race (21% versus 6%), no more than high school education (33% versus 17%), current unemployment/disability/retirement (71% versus 44%), and annual household income <$100,000 (71% versus 56%). Conclusions: In the context of limited data on this topic, in this small study we found that it was not uncommon for five-year survivors of head and neck cancer to experience one or more symptoms which they rated as being a severe problem.
Systematic evaluation of risk factors for acquired heart disease in sarcoma survivors.
Authors: Baker Laurence H. , Murthy Venkatesh Locharla , Weinberg Richard Lawrence , Bobowski Nina Pagadala 
Published: March 2017

127 Background: Sarcoma survivors are at high risk for severe heart disease at a young age. The study objective is to evaluate risk factors for cardiac disease in sarcoma survivors receiving more than 300 mg/m2 of Doxorubicin. Left ventricular ejection fraction is a routinely used test but is not predictive. It is imperative to determine which modifiable cardiovascular risk factors increase cardiac risk. Methods: Our unique Sarcoma Survivorship Clinic was established to evaluate high risk sarcoma patients for the long-term and late effects of cancer and its treatment. Each patient regularly electronically completes NIH’s PROMIS questionnaires developed for this clinic. Family medical history is reviewed. Chemotherapy doses are abstracted from original medical records. Data collected includes: blood pressure, lipid profile, high-sensitivity C-reactive protein (hs-CRP), basic metabolic panel, chemistries, renal and pulmonary function, echocardiography. We will compare standardized cardiac risk assessments with mediastinal calcification and epicardial fat on serial chest CT scans. All patients signed an informed consent. Results: The 24 patient cohort had a cumulative dose of > 300 mg/m2 of Doxorubicin. No patient had chest radiation. All patients had normal left ejection fractions (median= 60%). Eight patients (33%) had an elevated hs-CRP (>3) and 10 patients (42%) had elevated blood pressure. Framingham risk may underestimate risk in this relatively young population and other metrics may be required. Conclusions: Our findings suggest high risk sarcoma survivors' follow-up management requires a comprehensive approach to establish the patient's overall cardiac risk profile. Symptoms may be discounted and/or attributed to other causes, leading to delayed and/or inappropriate treatment of cardiovascular disease. We must improve our knowledge of the long-term cardiac risk associated with surviving a bone or soft tissue sarcoma to effectively counsel survivors and offer effective intervention strategies to prevent or minimize the impact of adverse late effects.
Effect of chemotherapy-induced peripheral neuropathy on postural control in cancer survivors.
Authors: Herman Haley K. , Monfort Scott M. , Pan Xueliang Jeff , Chaudhari Ajit M.W. , Lustberg Maryam B. 
Published: March 2017

128 Background: Advances in screening and treatment have significantly improved the survival of cancer patients. However, chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity of curative treatment; many patients either cannot complete planned course of treatment or have long standing effects on quality of life. CIPN has been shown to lead to pain, falls, and difficulty walking. Balance changes have been reported with other neuropathies but have not been investigated in depth in cancer patients. This study aims to improve our understanding of changes in postural control associated with CIPN. We hypothesize that patients who report more significant CIPN symptoms will perform more poorly on balance testing. Methods: Eleven cancer patients were enrolled (9 female/ 2 male; 9 breast cancer/ 2 GI cancer; 1.67 ± 0.05 m; 85.8 ± 19.3 kg; 56.5 ± 14.5 yrs). These patients included cases (n = 7), tested within 6 weeks of finishing taxane or oxaliplatin chemotherapy, and controls (n = 4) who did not receive chemotherapy. Patients’ sensory symptoms were assessed by EORTC QLQ-CIPN20. Standing on a balance plate, patients were instructed to close their eyes and remain still while their center of pressure (CoP) was recorded. Medial-lateral root mean squared CoP excursion (RMS) was calculated to provide a measure of postural stability, with higher values indicating poorer control of CoP position and being predictive of falls. Results: Groups were not statistically different in terms of height, mass, or age (p > 0.1). Cases had an average of 3.8 mm (95% CI: 1.7 mm, 6.0 mm) increase in RMS over controls (p = 0.004). Furthermore, cases scored an average of 37.6 points (95% CI: 19.5 points, 55.7 points) lower on a normalized CIPN 20 scale, suggesting worse sensory symptoms (p = 0.002). Conclusions: Patients with CIPN symptoms displayed significantly poorer control of their CoP. This supports the hypothesis that CIPN symptoms associate with poorer balance. The balance deficits reported here are consistent with increased risk of falls and negative post-treatment sequelae. This further suggests a need for closer monitoring and even targeted balance-focused rehabilitation following chemotherapy.