bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in telomere length and cardiovascular risk in testicular cancer survivors.
Authors: Volders Ellen L.D. , Meijer Coby , Steeneken Lotte S. , Lubberts Sjoukje , Zwart Nynke , van Roon Arie M. , Lefrandt Joop D. , de Jong Igle Jan , Demaria Marco , Nuver Janine , Gietema Jourik A. 
Published: June 2022

12079 Background: Testicular cancer (TC) survivors cured with chemotherapy (CT) are prone to develop cardiovascular events, as part of an early aging phenotype. Telomere shortening could be a mechanism contributing to these events and their risk factors. Methods: In a prospectively followed cohort of patients with disseminated TC who received cisplatin containing CT (Lubberts et al., Eur J Cancer 2016), mean absolute leukocyte telomere length (TL) was measured using qPCR before and one year after start of cisplatin containing CT. Cardiovascular risk factors, including development of the metabolic syndrome (according to the NCEP ATP III definition) and hypogonadism (LH >10 U/L or testosterone < 10 nmol/L or use of testosterone suppletion), were assessed before and up to 5 years after CT. Shortening of TL was defined as a decrease of >33% after one year compared to baseline; short TL was defined as <5 kilobase (kb) pair (=P25). Data are presented as median (range). For comparisons, a Mann-Whitney U or Chi-Square test was applied. Results: 55 out of 73 patients of the initial cohort were evaluable for this analysis. CT regimens consisted of 3xBEP (n=41), 4x BEP (n=11), 4xEP (n=3). At baseline, patients with a BMI > 30 kg/m2 (n=12) had a shorter TL (4.9 (2.2-13.4) vs. 6.3 kb (3.1-12.9), p=.045); there was no difference in age. For the whole group, TL did not change one year after CT compared to baseline (5.7 (2.2-13.4) vs. 5.8 kb (1.6-19.2), p=.335). Patients with TL shortening after 1 year (n=7) showed a significant increase in diastolic blood pressure (p=.007) and triglycerides (p=.003), compared to those with unchanged TL (table). TL shortening after 1 year or short TL at baseline (n=7+11) are not significant predictors for newly developed metabolic syndrome (25 vs. 21%; p=.777), nor hypogonadism (38 vs. 17%; p=.120) after 5 years, compared to the others. Conclusions: A small subset of TC patients treated with cisplatin containing CT showed shortening of TL 1 year after treatment. This shortening is associated with a rise in diastolic blood pressure and triglycerides. Short or shortening of telomeres are not predictive for development of the metabolic syndrome or hypogonadism. [Table: see text]
Adverse health outcomes (AHO) in testis cancer survivors (TCS) following high-dose chemotherapy (HDCT) and autologous stem cell transplant.
Authors: Miller Meagan Elizabeth , Ashkar Ryan , Althouse Sandra K. , Hanna Nasser H. , Abonour Rafat , Travis Lois B. , Einhorn Lawrence H. , Adra Nabil , Abu Zaid Mohammad Issam 
Published: June 2022

12083 Background: Patients with relapsed/refractory germ cell tumors are often cured with tandem platinum-based HDCT followed by autologous stem cell transplant in the ≥2nd line treatment setting. A comprehensive assessment of long-term AHO (adverse health outcomes) in TCS cured with HDCT has not been previously described. Methods: Testis cancer survivors (TCS) at least 1 year after HDCT and treated at Indiana University were eligible. TCS were asked to complete a comprehensive, well validated survey regarding 19 different AHO. TCS demographics, disease characteristics, treatment received, and AHO were collected. Results: From 2/2021-1/2022, 118 eligible TCS were invited. 70 TCS completed the survey (59.3% completion rate). TCS received HDCT followed by autologous stem cell transplant in the 2nd (91.4%), 3rd (7.1%) or 4th line (1.4%) setting. At the time of survey completion, 93% of respondents were at least two years from HDCT (range 1.6-16.2 y) with a median age of 42 y (range 24.8-66.6 y). Median age at the time of original germ cell tumor diagnosis was 32 y (range 17.4-56.8 y). TCS reported a median of 3 AHO with 37% of participants reporting 5 or more AHO. 90% of participants reported tinnitus, 91% experienced hearing impairment, and 52% required the use of hearing aids. Additionally, 46% TCS noted peripheral neuropathy and 26% reported problems with balance/vertigo/dizziness. Prevalence of kidney disease was 10%, and 24% TCS experienced erectile dysfunction. In regards to physical activity, 47% of participants were not participating in vigorous physical activity (defined as > 6 mets/week). 16% TCS reported use of medications to treat anxiety and/or depression, and 19% required testosterone replacement therapy. The prevalence of hypertension, coronary artery disease, Raynaud phenomenon, hypercholesterolemia, diabetes, and thyroid disease were 13%, 1%, 17%, 12%, 4%, and 6% respectively. Conclusions: Despite the high cure rate of HDCT, TCS report a substantial burden of morbidity with the majority experiencing ototoxicity, and with half of the TCS requiring hearing aids. Special attention to these AHO and efforts to develop ototoxicity prevention approaches are urgently needed for this patient population.
Racial disparity in breast cancer survivorship: Results of a qualitative research study to identify themes from a series national healthcare provider live virtual forums.
Authors: Binkley Jill M. , Gabram Sheryl G. A. , McCullough Lauren E. , Finley Janae , Fowler Dawnovise , VanHoose Lisa 
Published: June 2022

12091 Background: Significant disparity exists in the diagnosis, treatment, and survivorship outcomes among Black breast cancer (BC) survivors. Unmet physical and emotional needs in BC survivors are well documented, but there is mounting evidence that Black BC survivors have more significant survivorship issues and a greater burden of illness than White counterparts. Barriers to rehabilitation and recovery care exist for all BC survivors; however, they are magnified in Black BC survivors due to systemic racism, healthcare provider bias and discrimination, lack of culturally relevant care models, and socio-economic barriers. There is limited literature on lived personal and professional experiences of racial disparity in BC survivorship. Methods: The purpose of this qualitative research was to document patient, clinician and researchers’ perceptions surrounding contributing factors, lived experiences, and potential solutions to racial disparity in BC survivorship against the contextual background of reported inequities. A narrative approach was utilized to identify themes from a series of four virtual healthcare provider forums that explored lived personal and professional experiences, issues and potential solutions surrounding racial disparity in BC survivorship from October 2020-September 2021. The forums included perspectives of patients, healthcare providers, researchers, and stakeholders in the BC field. The total live and online views for all four forums was 2,093. An independent thematic analysis was performed by the investigators, all of whom have emic perspectives with respect to race and/or breast cancer. Results: Three main themes were independently identified by study investigators: 1. societal and cultural contributing factors contributing to racial disparity in BC survivorship, 2. contribution of healthcare providers and systems to racial disparity in BC survivorship and 3. models of care and research considerations that would reduce racial disparity. These themes were widely echoed by forum participants throughout the series. With respect to solutions, widespread implementation of navigation models and the Prospective Model of Rehabilitation for Women with Breast Cancer that address physical and psychosocial treatment side effects would reduce disparity. The importance of the inclusion of voices of Black BC survivors in community-based participatory research aimed at reducing survivorship disparity is critical. Conclusions: The findings provide compelling documentation of lived personal and professional experiences of racial disparity in BC survivorship. These issues have been described in the literature for nearly two decades. Potential solutions exist and must be enacted immediately to ensure equitable survivorship outcomes for Black individuals following a BC diagnosis.
Associations between diet quality and chronic health conditions (CHCs) in adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study (SJLIFE).
Authors: Finch Emily R , Foley Elizabeth , Hyun Geehong , Goodenough Chelsea Goodliffe , Zhang Fang Fang , Krull Kevin R. , Bhakta Nickhill , Park Yikyung , Ehrhardt Matthew J. , Brinkman Tara M. , Lanctot Jennifer Q. , Robison Leslie L. , Hudson Melissa M. , Ness Kirsten K. 
Published: June 2022

12095 Background: Survivors of childhood cancer are at increased risk for early development of CHCs, including metabolic syndrome (MetS), low bone mineral density (LBMD), and gastrointestinal (GI) disease. Dietary modification is often recommended for prevention and/or treatment of these CHCs in non-cancer populations. However, associations between diet quality and severity of CHCs in adult survivors of childhood cancer are not well known. Methods: Adult survivors (≥10 years post-diagnosis) of childhood cancer who completed a clinical evaluation and Block Food Frequency Questionnaire were included. Diet quality was estimated using the Mediterranean diet score (aMED), with scores ranging from 0 to 9 (increased scores represent higher adherence to diet). CHCs were graded (modified CTCAE) and classified as “low” (grade ≤1 for LBMD and GI; grade ≤2 for MetS) or “high” (grade 2-4 for LBMD and GI; grade 3-4 for MetS). A multivariable linear regression model was used to estimate the mean aMED score by “low” or “high” disease category, with adjustment for age at evaluation, sex, race, education, total energy intake, adjusted BMI, physical activity, smoking, and alcohol consumption. Results: 2,822 survivors of childhood cancer (52.4% male, 83.1% non-Hispanic white) were included. The most prevalent diagnosis was acute lymphoblastic leukemia (34.1%). Time from primary diagnosis was 24.2±8.5 years and age at recruitment was 32.5±8.7 years. Lower adherence to aMED diet was associated with “high” MetS and LBMD, but not GI disease. See the Table for aMED multivariate-adjusted diet quality scores by CHC. Conclusions: In this cross-sectional analysis, MetS and LBMD were associated with poor adherence to the aMED diet. Although longitudinal investigation of associations between diet quality and CHCs in survivors of childhood cancer are needed to determine causal association between diet quality and CHCs in childhood cancer survivors, dietary interventions in early or late cancer survivors may help prevent development or progression of specific treatment related chronic conditions. [Table: see text]
Implementation of electronic patient-reported outcomes in head and neck oncology at a comprehensive cancer center.
Authors: McCleary Nadine Jackson , Sethi Rosh K , Uppaluri Ravindra , Whittaker Sarah , Cleveland Jessica , Black Brittany , Zhang Sunyi , Hassett Michael J. , Goguen Laura A. 
Published: June 2022

12115 Background: Monitoring electronic patient reported outcomes (ePROs) has demonstrated impact on quality of life and survival in oncology. Maintaining high response rates to ePRO measures is critical in routine care. We evaluate the routine care implementation of head and neck oncology (HNO)-focused ePROs and the impact of patient demographics and assignment method on response rate. Methods: Since October 2021, patients diagnosed with head and neck cancer (PHN) at Dana-Farber Cancer Institute (DFCI) have had the opportunity to respond to the EHR-integrated European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ- H&N43) at clinic visits, not to exceed every 30 days. PHN are also prompted at 7 and 14 days postoperative, regardless of clinic visit. HNO clinicians selected EORTC QLQ- H&N43 because of its actionable scores and limited overlap with cross-cutting ePRO tools at DFCI. Reviewed by Patient and Family Advisory Council members, PHN can respond to the questionnaire in English or Spanish via any internet-enabled device or tablet provided in clinic. Tablet assignment rates are sent via automated report to the HNO clinic manager. Results: Between October 2021 and January 2022, PHN responded to 64% of questionnaires for eligible clinic visits (1618/2535). Post-operatively, 65% of PHN responded to EORTC QLQ- H&N43 at least once within 28 days of surgery. Prompted at 7 and 14 days, PHN responded to 44% (133/300) of all post-operative questionnaires. Overall, PHN responded on their own device 50% of the time and on tablets in clinic 50% of the time. Response rates significantly associated with race, primary language, and age at clinic, but not post-operatively due to low sample size. PHN with a primary language other than English, older PHN, and PHN with races other than white responded less frequently, with the exception of Asian PHN in clinic who had the highest response rates. Clinician champions, EHR-integration, and a timely feedback loop to clinic managers facilitated response rates. Conclusions: Successful implementation of HNO ePROs is aided by clinical engagement and availability of real-time response rate data. ePRO response rate in HNO was found to be associated with race, primary language, age, and assignment method. Further work to focus on improving disparities within response rates and linking automatic interventions to scores is needed. [Table: see text]
Self-reported efficacy and usage of cannabis among patients with cancer within the Minnesota Cannabis Program.
Authors: Zylla Dylan M. , Parsons Helen , Ziegenfuss Jeanette Y , Lindgren Bruce , Park Susan , Blaes Anne Hudson 
Published: June 2022

12122 Background: Patients with cancer are increasingly using cannabis to alleviate symptoms of pain, nausea, insomnia, and appetite loss. Despite the increased popularity of cannabis, little is known about the patterns of use in the cancer population, efficacy in treating symptoms outside of small clinical studies, and out-of-pocket expenses. We assessed self-reported efficacy and patterns of cannabis use from patients with cancer registered with the Minnesota Cannabis Program (MCP). Methods: We conducted an anonymous survey from December 2021-January 2022 of 797 individuals with cancer-associated pain, nausea/vomiting and/or anorexia currently enrolled in the MCP who had purchased a cannabis related product in the preceding three months. The mailed survey included questions about cancer history, cannabis use, and changes in symptoms. We conducted a descriptive analysis to describe patterns of use. Results: 225 individuals responded to the survey after a single mailing for a 28% response rate. 70% reported using cannabis at least once prior to cancer diagnosis. Respondents had diverse cancer diagnoses (breast (24%), lung (14%), colorectal (10%), prostate (9%)) and were more often female (52%), married, (71%), white (95%), and retired (40%) with a median age of 62.0. Most respondents (46%) had stage IV disease with the remaining 34% stage 1-3 (20% unknown). Household income varied across respondents with 10% reporting annual income <$20,000, 39% between $50-100k, and 33% with incomes ≥100k. 88% purchased at least one product with THC:CBD (tetrahydrocannabinol/cannabidiol) composition >1. Respondents reported that oral products were preferred to vaporizers (81% vs 45%) and 75% reported at least daily use. 27% reported monthly average out of pocket expenses for cannabis of $100-200; with 31% spending ≥$200/mo. The Table outlines perceived change in symptoms amongst users. Conclusions: Patients with cancer in the MCP with recent cannabis purchases predominantly use high THC:CBD products delivered via oral or vaporizer route on daily basis. While out of pocket costs for these products can be significant, many respondents report significant improvements in cancer related symptoms.[Table: see text]
Major stressful events and risk of developing head/neck and pancreatic cancer.
Authors: Sridhar Arthi , Nguyen Chandler H. , Abushalha Kamelah , Saghir Iqra , Tahanan Amirali , Rahbar Mohammad Hossein , Jafri Syed Hasan Raza 
Published: June 2022

12128 Background: Major stressful life events have been shown to be associated with an increased risk of lung cancer, breast cancer and the development of various chronic illnesses. The stress response generated by our body results in a variety of physiological and metabolic changes which can affect the immune system, endocrine system and metabolism which has been shown to be associated with tumor progression. There is an indication that stress may need to be considered as a risk factor for malignancies. Methods: This is a matched case control study. The objective of this study was to determine if major stressful life events are associated with the incidence of head, neck, and pancreatic cancer (HNPC). Cases (CA) were HNPC patients diagnosed within the previous 12 months. Controls (CO) were patients without a prior history of malignancy and were matched with the cases by age and smoking status. Basic demographic data and medical information were collected from the patient’s medical records. Data on major stressful life events were collected using the modified Holmes-Rahe stress scale, and the following variables: death of a spouse, death of a child/immediate family member, serious personal illness, divorce/separation, loss of a job, caring for ill family member, financial difficulties, relocation, stress at work, detention/incarceration and retirement. A total sample of 300 was needed (100 cases, 200 controls) to achieve at least 80% power to detect odds ratios (OR) of 2.00 or higher at 5% level of significance. Results: From January 2018 to August 2021, 278 patients were enrolled (CA = 77, CO = 201) matched for mean age (years) (CA = 63, CO = 64), median smoking exposure (years) (CA = 36, CO = 38). About 65% of patients in CA group and 49% of CO group were male and 54% and 46% of the CA and CO groups respectively were of white race. In a multivariable logistic regression analysis after controlling for potential confounding variables (including sex, age, race, education, marital status, smoking history), there was no difference in lifetime incidence of major stressful event between the cases and controls. However, patients with HNPC were significantly more likely to report a major stressful life event within past 5 years when compared to CO [OR = 2.59 (1.24, 5.44), p = 0.012]. Conclusions: Patients with head, neck and pancreatic cancers are significantly associated with having a major stressful life event within 5 years of their diagnosis. This study highlights the potential need to recognize stressful life events as risk factors for developing malignancies and consider incorporating early rehabilitative efforts for major life stressful events.
Association between unmet needs and utilization of emergency services among cancer survivors in Canada.
Authors: Delisle Megan E , Srikanthan Amirrtha , Wang Ying , Fitch Margaret I 
Published: June 2022

12131 Background: In 2016, the Canadian Partnership Against Cancer distributed surveys to over 40,000 cancer survivors to understand their experiences transitioning from primary cancer treatment to follow-up cancer care. Previously reported results of this survey identified that cancer survivors had high rates of unmet physical, emotional and practical needs. This study describes the association between these unmet needs and emergency services (ES) utilization within the first three years after cancer treatment. Methods: 13,319 respondents returned the survey (response rate 33%). Respondents in this study have non-metastatic breast, hematologic, colorectal, melanoma or prostate cancer. The association between self-reported unmet needs and ES utilization was assessed using multivariable logistic regression. High ES utilization was defined as accessing ES more than three times per year during the first three years after active cancer treatment. Results: 8,911 participants are included in this analysis; 80.5% reported at least one unmet practical, physical, and emotional need (n=7169, Table). A total of 3.9% (n=344) reported high ES utilization. Unmet needs were a significant predictor of high ES utilization (OR 1.75 95% CI 1.14-2.68 p=0.01). Other significant predictors of high ES utilization on the multivariable analysis included: not being able to identify a healthcare provider in charge of follow-up cancer care (OR 2.73 95% CI 1.32-5.65 p=0.01), high oncologist utilization (OR 3.08 95% CI 2.28-4.15 p<0.01), high primary care provider utilization (OR 2.3 95% CI 1.76-3.0 p<0.01), having a chronic condition (OR 1.6 95% CI 1.19-2.07 p<0.01), having colorectal cancer (OR 2.12 95% CI 1.31-3.44 p<0.01), being enrolled in a clinical trial (OR 1.54 95% CI 1.11-2.16 p=0.01), and rating follow-up cancer care coordination as fair or poor (OR 1.39 95% CI 1.03-1.86 p=0.03). Conclusions: Unmet needs are associated with high ES utilization in the first three years after cancer treatment. A better understanding of the reasons for this association is required to develop approaches to reduce potentially preventable ES utilization and improve perceived care needs among cancer survivors. [Table: see text]