I am an instructor in pediatric hematology/oncology. I completed fellowship in pediatric hematology/oncology at Stanford and previously trained in internal medicine and pediatrics (med-peds) at CHOP and Penn. I am passionate about the intersection between clinical care and clinical research, and committed to understanding the long-term effects of childhood cancer therapies over the course of our patients' lifetimes. It is through this type of research that we can learn how to modify our initial treatments to ensure the best possible outcomes in the long run. Additionally, I aim to develop community-based partnerships to translate evidence-based survivorship research to real-world clinical practice settings in communities with socioeconomic disadvantages and structural barriers to long-term follow-up care by targeting social determinants of health with the goal of improving access to care and health equity for adolescent/young adult (AYA) cancer survivors.
- Pediatric Hematology-Oncology
- Pediatric oncology
- Cancer survivorship
- Targeted therapy in Ph+ leukemias
- Adolescent/Young Adult (AYA) transitions in care
- Health equity and advocacy
- Community-Based Participatory Research
Instructor, Pediatrics - Hematology & Oncology
Board Certification: American Board of Pediatrics, Pediatric Hematology-Oncology (2021)
Fellowship: Stanford University Pediatric Hematology Oncology Fellowship (2020) CA
Board Certification: American Board of Internal Medicine, Internal Medicine (2017)
Board Certification: American Board of Pediatrics, Pediatrics (2017)
Residency: University of Pennsylvania Internal Medicine and Pediatric Combine Residency (2017) PA
Medical Education: Stanford University School of Medicine (2013) CA
MPH, Yale University School of Public Health, Social/Behavioral Science (2008)
BS, Yale University, Biology (2007)
Current Research and Scholarly Interests
I am involved with clinical research related to cancer survivorship, with a particular focus on late effects of childhood cancer treatments and community partnerships to improve health equity for adolescent/young adult cancer survivors in under-resourced settings.
Areas of focus include:
Late effects of novel therapies:
This research relates to the use of BCR-ABL tyrosine kinase inhibitors for chronic myeloid leukemia (CML) and Ph+ acute lymphoblastic leukemia (ALL), as little is known about the long-term and late effects of these therapies in young people. I lead the New Agents task force for the Children's Oncology Group Long-Term Follow-Up Guidelines.
Community partnerships to improve health equity for AYA cancer survivors:
This is a new area of research for me that involves developing community partnerships to translate evidence-based survivorship research to real-world clinical practice settings in communities with socioeconomic disadvantages and structural barriers to long-term follow-up care. This research will target social determinants of health with the goal of improving access to care and health equity. I plan to utilize community-based participatory research methods to understand the key issues facing AYA cancer survivors and to collaboratively develop multi-level pragmatic interventions to improve health equity and access to survivorship care for AYA cancer survivors in communities with socioeconomic disadvantages.
Collaboration between oncology-survivorship-primary care:
In collaboration with a multidisciplinary team, I contributed to the development of an online continuing medical education cancer survivorship course for primary care physicians and other healthcare providers, which is available here: https://mededucation.stanford.edu/courses/health-after-cancer/
We are now in the process of adapting this course for cancer survivors and caregivers.
Adolescent/young adult cancer survivorship care:
As a collaboration with the Stanford Adolescent/Young Adult Cancer (SAYAC) program, I see patients in a pilot clinic for young adult survivors of childhood leukemia and bone marrow transplant, with a focus on cancer survivorship and transitioning to adult-focused care and from active cancer treatment to long-term follow-up care.
Pharmacogenomic Analysis in Pediatric Acute Lymphoblastic Leukemia
This is a retrospective biobank study evaluating the impact of novel genetic variants in a population of 6-mercaptopurine treated pediatric acute lymphoblastic leukemia patients.
Graduate and Fellowship Programs
Pediatric Hem/Onc (Fellowship Program)
International Survey of Pediatric Oncologists' Beliefs and Communication Practices Regarding Symptom Self-Monitoring by Childhood Cancer Survivors.
JCO oncology practice
Childhood cancer survivors report self-monitoring for and worrying about symptoms of disease recurrence and secondary cancers, although symptom-related worry is associated with poorer health-related quality of life. This survey captured pediatric oncologists' beliefs and communication practices regarding symptom self-monitoring for childhood cancer survivors.Using a closed-loop snowball sampling technique, pediatric oncologists completed an online survey regarding the importance of symptom self-monitoring for off-therapy patients, the degree to which symptom self-monitoring was perceived to cause stress and worry, and communication practices.196 pediatric oncologists (White [78%]; female [64%]; Mage = 47 years) from every continent except Antarctica participated. Oncologists believed it is important for off-therapy patients to self-monitor for symptoms of cancer recurrence (90%) and treatment late effects (94%), although some noted that recurrence (30%) and late effects (55%) are typically detected by routine surveillance before symptoms appear. Oncologists varied in their beliefs that off-therapy patients do (31%) or do not (31%) worry unnecessarily about symptoms of recurrence. Two thirds (62%) of oncologists reported often/always discussing with off-therapy patients which symptoms could indicate cancer recurrence, whereas fewer than half (43%) often/always discussed which symptoms were unlikely to indicate recurrence. Oncologists identified a need for education regarding how to communicate around symptom self-monitoring and the potential utility of a screening tool to identify those who worry excessively.Despite nearly universal belief that their off-therapy patients should self-monitor for symptoms of disease recurrence and late effects, a substantial proportion of pediatric oncologists do not counsel patients on symptom self-monitoring. Since nearly one-third believe that off-therapy patients worry unnecessarily about symptoms of recurrence, improving patient education regarding which symptoms are and are not medically concerning could decrease stress and improve health-related quality of life for pediatric cancer survivors.
View details for DOI 10.1200/OP.22.00630
View details for PubMedID 36800566
Understanding unmet needs of adult survivors of childhood cancer in California's Salinas Valley: A community-academic partnership to develop programs for families after cancer treatment
AMER ASSOC CANCER RESEARCH. 2023: 144-145
View details for Web of Science ID 000916472900194
Perspectives of Childhood Cancer Survivors as Young Adults: a Qualitative Study of Illness Education Resources and Unmet Information Needs.
Journal of cancer education : the official journal of the American Association for Cancer Education
This study investigates the resources used by childhood cancer survivors (CCS) to learn about their cancer histories and evaluates if CCS feel these resources prepare them to manage their health needs as young adults. Young adult participants (aged 18-30 years) were diagnosed with cancer at ≤ 10 years and recruited by word of mouth and from social media and/or non-profit organizations and completed semi-structured interviews. A descriptive thematic analysis guided by an essentialist/realist paradigm combined inductive and deductive approaches to identify key themes. Fourteen participants were interviewed, and six key themes were identified: (1) CCS are aware of general cancer history (age at diagnosis, treating hospital, cancer type), (2) CCS are unaware of treatment regimen (medications and duration), (3) CCS want to learn more about their treatment regimens and (4) potential late effects of treatment, (5) CCS use diverse resources to learn about their cancer histories and potential late effects, and (6) survivors' interests to learn about their cancer histories change over time. Limited knowledge of their cancer treatments leaves some CCS unprepared to manage their health needs as young adults or to address potential risk of late effects. CCS recognize their limited knowledge, but the resources available to them fall short of their information needs. Identifying the shortcomings of resources used by CCS provides evidence for how resources need to be improved to meet survivors' cancer education needs.
View details for DOI 10.1007/s13187-022-02240-1
View details for PubMedID 36456891
View details for PubMedCentralID 3771083
Development of clinical pathways to improve multidisciplinary care of high-risk pediatric oncology patients.
Frontiers in oncology
2022; 12: 1033993
Clinical pathways are evidence-based tools that have been integrated into many aspects of pediatric hospital medicine and have proven effective at reducing in-hospital complications from a variety of diseases. Adaptation of similar tools for specific, high-risk patient populations in pediatric oncology has been slower, in part due to patient complexities and variations in management strategies. There are few published studies of clinical pathways for pediatric oncology patients. Pediatric patients with a new diagnosis of leukemia or lymphoma often present with one or more "oncologic emergencies" that require urgent intervention and deliberate multidisciplinary care to prevent significant consequences. Here, we present two clinical pathways that have recently been developed using a multidisciplinary approach at a single institution, intended for the care of patients who present with hyperleukocytosis or an anterior mediastinal mass. These clinical care pathways have provided a critical framework for the immediate care of these patients who are often admitted to the pediatric intensive care unit for initial management. The goal of the pathways is to facilitate multidisciplinary collaborations, expedite diagnosis, and streamline timely treatment initiation. Standardizing the care of high-risk pediatric oncology patients will ultimately decrease morbidity and mortality associated with these diseases to increase the potential for excellent outcomes.
View details for DOI 10.3389/fonc.2022.1033993
View details for PubMedID 36523979
View details for PubMedCentralID PMC9744920
Standard Cytogenetic Risk Stratification Is Not Predictive of CD19 CAR Outcomes and Impact of Disease Burden Varies between Cytogenetic Risk Groups
AMER SOC HEMATOLOGY. 2022: 10386-10388
View details for DOI 10.1182/blood-2022-165951
View details for Web of Science ID 000893230303174
The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization
2022; 22 (8): 1375-1383
View details for Web of Science ID 000889963700018
Male-Specific Late Effects in Adult Hematopoietic Cell Transplantation Recipients: A Systematic Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation
TRANSPLANTATION AND CELLULAR THERAPY
2022; 28 (6)
View details for DOI 10.1016/j.jtct.2021.10.0132666-6367
View details for Web of Science ID 000834051500022
Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation.
Bone marrow transplantation
Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. We provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. The systematic review summarizes incidence, risk factors, screening, prevention and treatment of these complications and provides consensus evidence-based recommendations for clinical practice and future research.
View details for DOI 10.1038/s41409-022-01591-z
View details for PubMedID 35523848
The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization.
OBJECTIVE: The COVID-19 pandemic prompted health systems to rapidly adopt telehealth for clinical care. We examined the impact of demography, subspecialty characteristics, and broadband availability on the utilization of telehealth in pediatric populations before and after the early period of the COVID-19 pandemic.METHODS: Outpatients scheduled for subspecialty visits at sites affiliated with a single quaternary academic medical center between March - June 2019 and March - June 2020 were included. The contribution of demographic, socioeconomic, and broadband availability to visit completion and telehealth utilization were examined in multivariable regression analyses.RESULTS: Among visits scheduled in 2020 compared to 2019, in-person visits fell from 23,318 to 11,209, while telehealth visits increased from 150 to 7,675. Visits among established patients fell by 15% and new patients by 36% (p<.0001). Multivariable analysis revealed that completed visits were reduced for Hispanic patients and those with reduced broadband; high income, private non-HMO insurance, and those requesting an interpreter were more likely to complete visits. Of those with visits scheduled in 2020, established patients, those with reduced broadband, and patients older than 1 year were more likely to complete TH appointments. Cardiology, oncology, and pulmonology patients were less likely to complete scheduled TH appointments.CONCLUSIONS: Following COVID-19 onset, outpatient pediatric subspecialty visits shifted rapidly to telehealth. However, the impact of this shift on social disparities in outpatient utilization was mixed with variation among subspecialties. A growing reliance on telehealth will necessitate insights from other healthcare settings serving populations of diverse social and technological character.
View details for DOI 10.1016/j.acap.2022.03.010
View details for PubMedID 35318159
Educational innovation to integrate cancer survivorship in primary care: course evaluation and learner outcomes.
Journal of cancer survivorship : research and practice
PURPOSE: To evaluate the outcomes of an online cancer survivorship course designed to influence practice change in primary care clinicians through asynchronous education that incorporates emotionally sensitive patient stories and practical resources to prepare clinicians to care for cancer survivors.METHODS: The Health After Cancer: Cancer Survivorship for Primary Care continuing medical education (CME) course launched in April 2020. Learners who earned CME credit for the course (n=288) completed a survey that assessed satisfaction, engagement, and intent to change practice. A follow-up survey was completed by a subset of learners (n=47) and evaluated impact on clinical practice. Metrics representing learners' interaction with the course were collected automatically. Quantitative survey data and learner metrics were analyzed descriptively, and qualitative survey data were coded to generate latent themes relevant to learning outcomes.RESULTS: The course reached a global audience of learners from the USA and 40 countries. Each patient case had slight drop-offs in viewership over video play time. Learners reported high satisfaction and relevance to practice. Three latent themes were generated from the qualitative data: improve patient communication, utilize course materials, enhance collaboration with multidisciplinary team.CONCLUSIONS: The course achieved its purpose of educating learners through an asynchronous format that showcased the value of using patient-centered stories to close a knowledge gap related to cancer survivorship care. Learners self-reported changes in practice; however, further assessment needs to be conducted to measure long-term impact to clinical practice.IMPLICATIONS FOR CANCER SURVIVORS: Educational approaches that prepare generalists and specialists to care for cancer survivors are essential to optimize health outcomes for cancer survivors. Ongoing efforts are needed to increase use of these resources throughout medical training and within the primary care community.
View details for DOI 10.1007/s11764-021-01131-6
View details for PubMedID 35107793
Physician risk perceptions and surveillance practices for tyrosine kinase inhibitor long-term effects in pediatric CML.
Pediatric hematology and oncology
Chronic myeloid leukemia (CML) is effectively treated with long-term tyrosine kinase inhibitor (TKI) therapy, yet little is known about risks of prolonged TKI exposure in young patients, and long-term effect monitoring is not standardized. We surveyed North American pediatric oncologists (n=119) to evaluate perceived risk of and surveillance practices for potential toxicities associated with prolonged TKI exposure in children and adolescents/young adults (AYAs) with CML. Survey domains included general and specific risk perceptions and surveillance practices for asymptomatic patients on chronic TKI therapy. We analyzed data descriptively and explored relationships between risk perceptions and surveillance. Risk perceptions varied among oncologists but were similar across six categories (thyroid, cardiac, vascular, metabolic, fertility, psychologic), with less than one-third rating each risk as moderate or high in pediatric and AYA patients. More oncologists perceived moderate or high risk of growth abnormalities in children (62% pediatric, 14% AYA) and financial toxicity in all patients (60% pediatric, 64% AYA). A greater proportion of oncologists with moderate or high perceived risk of thyroid abnormalities reported testing thyroid function compared to those with lower perceived risk; patterns for metabolic risk/lipid tests and cardiac risk/tests were similar. In summary, we found that pediatric oncologists had variable risk perceptions and surveillance practices for potential toxicities associated with prolonged TKI exposure. Standardizing surveillance would help quantify risks and refine recommendations.Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2021.2017085 .
View details for DOI 10.1080/08880018.2021.2017085
View details for PubMedID 34918996
Comparison of the Transcriptomic Signatures in Pediatric and Adult CML.
1800; 13 (24)
Children with chronic myeloid leukemia (CML) tend to present with higher white blood counts and larger spleens than adults with CML, suggesting that the biology of pediatric and adult CML may differ. To investigate whether pediatric and adult CML have unique molecular characteristics, we studied the transcriptomic signature of pediatric and adult CML CD34+ cells and healthy pediatric and adult CD34+ control cells. Using high-throughput RNA sequencing, we found 567 genes (207 up- and 360 downregulated) differentially expressed in pediatric CML CD34+ cells compared to pediatric healthy CD34+ cells. Directly comparing pediatric and adult CML CD34+ cells, 398 genes (258 up- and 140 downregulated), including many in the Rho pathway, were differentially expressed in pediatric CML CD34+ cells. Using RT-qPCR to verify differentially expressed genes, VAV2 and ARHGAP27 were significantly upregulated in adult CML CD34+ cells compared to pediatric CML CD34+ cells. NCF1, CYBB, and S100A8 were upregulated in adult CML CD34+ cells but not in pediatric CML CD34+ cells, compared to healthy controls. In contrast, DLC1 was significantly upregulated in pediatric CML CD34+ cells but not in adult CML CD34+ cells, compared to healthy controls. These results demonstrate unique molecular characteristics of pediatric CML, such as dysregulation of the Rho pathway, which may contribute to clinical differences between pediatric and adult patients.
View details for DOI 10.3390/cancers13246263
View details for PubMedID 34944883
Gene Expression Analysis of CML Patients across the Age Spectrum
AMER SOC HEMATOLOGY. 2021
View details for DOI 10.1182/blood-2021-148701
View details for Web of Science ID 000736398805199
Psychosocial impacts of the COVID-19 pandemic on young adult cancer survivors and parents of children with cancer.
LIPPINCOTT WILLIAMS & WILKINS. 2021
View details for DOI 10.1200/JCO.2021.39.15_suppl.10050
View details for Web of Science ID 000708120605237
Implementation of a clinic to facilitate the transition from pediatric to adult cancer survivorship care.
LIPPINCOTT WILLIAMS & WILKINS. 2021
View details for DOI 10.1200/JCO.2021.39.15_suppl.e13519
View details for Web of Science ID 000708120300199
Patterns of surveillance for late effects of BCR-ABL tyrosine kinase inhibitors in survivors of pediatric Philadelphia chromosome positive leukemias.
2021; 21 (1): 474
BACKGROUND: Targeted anticancer therapies such as BCR-ABL tyrosine kinase inhibitors (TKIs) have improved outcomes for chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). However, little is known about long-term risks of TKIs in children. Exposure-based survivorship guidelines do not include TKIs, thus surveillance practices may be variable.METHODS: We retrospectively examined surveillance for cardiac and endocrine late effects in children receiving TKIs for Ph+leukemias, diagnosed at <21years between 2000 and 2018. Frequency of echocardiogram (ECHO), electrocardiogram (EKG), thyroid stimulating hormone (TSH), dual-energy x-ray absorptiometry (DXA), and bone age testing were abstracted. Descriptive statistics were stratified by leukemia type.RESULTS: 66 patients (CML n=44; Ph+ALL n=22) met inclusion criteria. Among patients with CML, ≥1 evaluation was done: ECHO (50.0%), EKG (48.8%), TSH (43.9%), DXA (2.6%), bone age (7.4%). Among patients with Ph+ALL, ≥1 evaluation was done: ECHO (86.4%), EKG (68.2%), TSH (59.1%), DXA (63.6%), bone age (44.4%). Over a median 6.3 and 5.7years of observation, respectively, 2% of patients with CML and 57% with Ph+ALL attended a survivorship clinic.CONCLUSIONS: Despite common exposure to TKIs in survivors of Ph+leukemias, patterns of surveillance for late effects differed in CML and Ph+ALL, with the latter receiving more surveillance likely due to concomitant chemotherapy exposures. Targeted therapies such as TKIs are revolutionizing cancer treatment, but surveillance for late effects and referral to survivorship clinics are variable despite the chronicity of exposure. Evidence based guidelines and longer follow-up are needed.
View details for DOI 10.1186/s12885-021-08182-z
View details for PubMedID 33926411
Chronic Myelogenous Leukemia in Childhood.
Current oncology reports
2021; 23 (4): 40
PURPOSE OF REVIEW: Chronic myelogenous leukemia (CML) is rare in children, requiring extrapolation from treatment of adults. In this review, we explore similarities and differences between adult and pediatric CML with a focus on therapeutic advances and emerging clinical questions.RECENT FINDINGS: Pediatric CML is effectively treated with long-term targeted therapy using tyrosine kinase inhibitors (TKIs). Newly diagnosed pediatric patients in chronic phase can now be treated with imatinib, dasatinib, or nilotinib without allogeneic hematopoietic stem cell transplantation. While treatment-free remission is possible in adults in chronic phase with optimal response to therapy, data are currently insufficient to support stopping TKI in pediatrics outside of a clinical trial. Knowledge gaps remain regarding long-term and late effects of TKIs in pediatric CML. Targeted therapy has markedly improved outcomes for pediatric CML, while raising a number of clinical questions, including the possibility of treatment-free remission and long-term health implications of prolonged TKI exposure at a young age.
View details for DOI 10.1007/s11912-021-01025-x
View details for PubMedID 33718985
Health After Cancer: An Innovative Continuing Medical Education Course Integrating Cancer Survivorship Into Primary Care.
Academic medicine : journal of the Association of American Medical Colleges
PROBLEM: The transition from oncology care back to primary care after cancer therapy is challenging for cancer survivors who seek services that address the effect of their cancer history on their present health. Lack of knowledge about the health needs of cancer survivors is a barrier to incorporating survivorship care into primary care practice. Formal training in cancer survivorship is rarely included in medical education and presents an opportunity for intervention.APPROACH: The authors developed (January 2019 - March 2020) an online continuing medical education (CME) course for primary care physicians (PCPs) that launched in April 2020. Course design and content were informed by critically reviewing cancer survivorship CME courses and understanding cancer survivors' clinical experiences in a primary care setting. The course aims to pique learners' interest through a concise, practical educational experience using peer-to-peer primary care-focused instruction in a case-based, multimedia-enriched format. In the course, 4 patient cases illustrate the physical and psychological effects of cancer treatment, and a primary care narrator demonstrates ways to approach these concerns during a clinic visit, providing tips for empathic communication with cancer survivors. The course development team-including a PCP, medical and pediatric oncologists, and medical educators with expertise in instructional design-used an iterative process to review and revise the content. PCPs and specialists reviewed the script and provided constructive feedback that was incorporated into revisions.OUTCOMES: The authors will evaluate course effectiveness based upon user experience and perceived effect on clinical practice and professional growth. A follow-up survey will assess barriers to course completion and durability of effect.NEXT STEPS: Future directions include dissemination of the course to a broader audience including medical trainees, evaluation of higher-level learning outcomes (e.g., effect on PCPs' clinical practice), and adaptation of the course for patients with a focus on self-management.
View details for DOI 10.1097/ACM.0000000000003935
View details for PubMedID 33496435
Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation.
Transplantation and cellular therapy
Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies, such as prostate, penile, and testicular cancer. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT.Here, we provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation.We utilized systematic review methodology to summarize incidence, risk factors, screening, prevention and treatment of these complications and provide consensus evidence-based recommendations for clinical practice and future research.Most of the evidence regarding male GvHD is still based on limited data, precluding strong therapeutic recommendations. We therefore recommend to systematically screen for male genital GvHD regularly and report it to large registries to allow for a better understanding. Future research should also address treatment since little published evidence is available to date. Male-specific endocrine consequences of HCT include hypogonadism which may also affect bone health. Since the evidence is scarce, current recommendations for hormone substitution and/or bone health treatment are based on similar principles as for the general population. Following HCT, sexual health decreases and this topic should be addressed at regular intervals. Future studies should focus on interventional strategies to address sexual dysfunction. Infertility remains prevalent in patients having undergone myeloablative conditioning, which warrants offering sperm preservation in all HCT candidates. Most studies on fertility rely on descriptive registry analysis and surveys, hence the importance of reporting post-HCT conception data to large registries. Although the quality of evidence is low, the development of cancer in male genital organs does not seem more prevalent than in the general population; however, subsequent malignancies in general seem to be more prevalent in males than females, and special attention should be given to skin and oral mucosa.Male-specific late effects, probably more under-reported than female-specific complications, should be systematically considered during the regular follow-up visits of male survivors who have undergone HCT. Care of patients with male-specific late effects warrants close collaboration between transplant physicians and specialists from other involved disciplines. Future research should be directed towards better data collection on male-specific late effects and on studies about the interrelationship between these late effects, to allow the development of evidence based effective management practices.
View details for DOI 10.1016/j.jtct.2021.10.013
View details for PubMedID 34757220
Screening practices for late effects in pediatric patients on tyrosine kinase inhibitors.
LIPPINCOTT WILLIAMS & WILKINS. 2020
View details for Web of Science ID 000560368308361
Minding the Gap for Survivors of Childhood Cancer.
View details for DOI 10.1001/jamaoncol.2019.5556
View details for PubMedID 31895404
Barriers and facilitators of risk-based health care for adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.
BACKGROUND: Optimal risk-based survivor health care includes surveillance for late effects and education targeted at reducing or preventing risky health behaviors. Understanding the reasons for a lack of risk-based follow-up care is essential.METHODS: Adult participants from the Childhood Cancer Survivor Study were surveyed about having a cancer-related visit in the past 2years and the likelihood of having a cancer-related visit in the future. Additional factors thought to be related to the primary outcomes were also assessed.RESULTS: Nine hundred seventy-five survivors completed the survey. Twenty-seven percent (95% confidence interval [CI], 24%-30%) had a cancer-related medical visit in the previous 2years, and 41% (95% CI, 38%-44%) planned to have such a visit within the next 2years. The likelihood of having had a cancer-related visit within the last 2years was higher among survivors assigning greater importance to these visits (relative risk [RR], 1.2; 95% CI, 1.1-1.3), perceiving greater susceptibility to health problems (RR, 1.2; 95% CI, 1.1-1.3), having a moderate to life-threatening chronic health problem related to their cancer (RR, 2.1; 95% CI, 1.7-2.7), seeing a primary care provider for a cancer-related problem (RR, 1.3; 95% CI, 1.0-1.6), having a cancer treatment summary (RR, 1.3; 95% CI, 1.0-1.6), and endorsing greater confidence in physicians' abilities to address questions and concerns (RR, 1.2; 95% CI, 1.0-1.3).CONCLUSIONS: Educational interventions improving awareness of treatment history and susceptibility to cancer-related late effects and corresponding risk-based care are likely to be beneficial for survivors of childhood cancers.
View details for DOI 10.1002/cncr.32568
View details for PubMedID 31626337
Creating a Culture of Wellness in Residency.
Academic medicine : journal of the Association of American Medical Colleges
Despite increased awareness and recognition of the prevalence of physician burnout and the associated risks of depression and suicide, there is a paucity of actionable guidelines for residency programs to mitigate these risks for their residents. In this Invited Commentary, the authors acknowledge that, although there are inherent barriers to resident wellness, there are numerous modifiable barriers that present opportunities for programs to enable culture change and improve resident wellbeing. The authors frame the discussion with a personal narrative written by a resident in their internal medicine program who experienced burnout, depression, and suicidality during his intern year. They aim to inspire residency programs and hospital leadership to identify and intervene upon the modifiable barriers to wellness for residents in their programs in order to shape meaningful cultural change.
View details for DOI 10.1097/ACM.0000000000002250
View details for PubMedID 29668521
Effect of Population Socioeconomic and Health System Factors on Medical Care of Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study
JOURNAL OF ADOLESCENT AND YOUNG ADULT ONCOLOGY
2017; 6 (1): 74–82
To determine the independent contribution of population socioeconomic and health system factors on childhood cancer survivors' medical care and screening.7899 childhood cancer survivors in the United States and Canada enrolled in the Childhood Cancer Survivor Study (CCSS). Population-level factors were derived from U.S. Area Health Resource File or 201 Canadian Census. Health service utilization and individual-level factors were self-reported. Multivariable logistic regression was used to calculate the effect of population factors on medical care (any care vs. no care; risk-based care vs. general care) and indicated echocardiogram or mammogram, adjusting for individual sociodemographic and health status.After adjusting for individual factors, population factors had a nominal impact on childhood cancer survivors' medical care and screening. Higher population median income was associated with risk-based survivor-focused care versus general care (odds ratio [OR] 1.05, 95% confidence interval [CI], 1.01-1.09) among all participants, but not among U.S. residents only (OR 1.03, 95% CI, 0.99-1.07). For U.S. residents, the number of CCSS centers within the geographic area was associated with greater odds of receiving risk-based survivor-focused medical care (OR 1.12, 95% CI, 1.04-1.20). Areas with higher median income had higher rates of echocardiogram screening among survivors at risk of cardiomyopathy (for every $10,000 increase in median income, there is a 12% increase in odds of echocardiogram screening; 95% CI 1.05-1.20). A positive relationship was identified between greater number of physicians and surgeons in the county of residence and recommended echocardiogram (for every additional 1000 physicians and surgeons: OR 1.12, 95% CI, 1.01-1.23). We found no association between population-level factors and mammography screening.Population socioeconomic disparities moderately affect childhood cancer survivors' risk-based medical care and screening after accounting for individual sociodemographic and health factors.
View details for DOI 10.1089/jayao.2016.0016
View details for Web of Science ID 000395765800009
View details for PubMedID 27754726
View details for PubMedCentralID PMC5346913
Exercise intensity in cancer survivors: A matter of the heart
View details for DOI 10.1186/s40959-017-0022-x
Web Exclusives. Annals Story Slam - A Long Stay.
Annals of internal medicine
2017; 167 (12): SS1
View details for DOI 10.7326/W17-0075
View details for PubMedID 29255880
Health Care Utilization, Lifestyle, and Emotional Factors and Mammography Practices in the Childhood Cancer Survivor Study
CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION
2015; 24 (11): 1699-1706
Women with a history of chest radiotherapy have an increased risk of breast cancer; however, many do not undergo annual recommended screening mammography. We sought to characterize the relationship between mammography and potentially modifiable factors, with the goal of identifying targets for intervention to improve utilization.Of 625 female participants sampled from the Childhood Cancer Survivor Study, who were treated with chest radiotherapy, 551 responded to a survey about breast cancer screening practices. We used multivariate Poisson regression to assess several lifestyle and emotional factors, health care practices, and perceived breast cancer risk, in relation to reporting a screening mammogram within the last two years.Women who had a Papanicolaou test [prevalence ratio (PR): 1.77; 95% confidence interval (CI) 1.26-2.49], and who perceived their breast cancer risk as higher than the average woman were more likely to have had a mammogram (PR, 1.26; 95% CI, 1.09-1.46). We detected an attenuated effect of echocardiogram screening [PR, 0.70; 95% CI (0.52-0.95)] on having a mammogram among older women compared with younger women. Smoking, obesity, physical activity, coping, and symptoms of depression and somatization were not associated with mammographic screening.Our findings suggest that compliance with routine and risk-based screening can be an important indicator of mammography in childhood cancer survivors. In addition, there is a need to ensure women understand their increased breast cancer risk, as a means to encouraging them to follow breast surveillance guidelines.Screening encounters could be used to promote mammography compliance in this population.
View details for DOI 10.1158/1055-9965.EPI-14-1377
View details for Web of Science ID 000365598600008
View details for PubMedID 26304504
View details for PubMedCentralID PMC4633330
Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia
PEDIATRIC BLOOD & CANCER
2013; 60 (8): 1358-1364
Adult survivors of childhood acute lymphoblastic leukemia (ALL) are at increased cardiovascular risk. Studies of factors including treatment exposures that may modify risk of low cardiorespiratory fitness in this population have been limited.To assess cardiorespiratory fitness, maximal oxygen uptake (VO2 max) was measured in 115 ALL survivors (median age, 23.5 years; range 18-37). We compared VO2 max measurements for ALL survivors to those estimated from submaximal testing in a frequency-matched (age, gender, race/ethnicity) 2003-2004 National Health and Nutritional Examination Survey (NHANES) cohort. Multivariable linear regression models were constructed to evaluate the association between therapeutic exposures and outcomes of interest.Compared to NHANES participants, ALL survivors had a substantially lower VO2 max (mean 30.7 vs. 39.9 ml/kg/min; adjusted P < 0.0001). For any given percent total body fat, ALL survivors had an 8.9 ml/kg/min lower VO2 max than NHANES participants. For key treatment exposure groups (cranial radiotherapy [CRT], anthracycline chemotherapy, or neither), ALL survivors had substantially lower VO2 max compared with NHANES participants (all comparisons, P < 0.001). Almost two-thirds (66.7%) of ALL survivors were classified as low cardiorespiratory fitness compared with 26.3% of NHANES participants (adjusted P < 0.0001). In multivariable models including only ALL survivors, treatment exposures were modestly associated with VO2 max. Among females, CRT was associated with low VO2 max (P = 0.02), but anthracycline exposure was not (P = 0.58). In contrast, among males, anthracycline exposure ≥ 100 mg/m(2) was associated with low VO2 max (P = 0.03), but CRT was not (P = 0.54).Adult survivors of childhood ALL have substantially lower levels of cardiorespiratory fitness compared with a similarly aged non-cancer population.
View details for DOI 10.1002/pbc.24492
View details for Web of Science ID 000320399800025
View details for PubMedID 23418044
View details for PubMedCentralID PMC3725590
Acute Cardiovascular Toxicity of Low-Dose Intrathecal Ziconotide.
Pain medicine (Malden, Mass.)
View details for PubMedID 23855951
A feasibility study to evaluate breast cancer patients' knowledge of their diagnosis and treatment
PATIENT EDUCATION AND COUNSELING
2012; 89 (2): 321-329
To evaluate the feasibility of an electronic survey to assess patients' knowledge of their breast cancer and treatment, and interest in receiving a medical summary.Women undergoing breast cancer treatment completed an interviewer-administered electronic survey in person or by telephone. Medical records were abstracted to evaluate knowledge accuracy.Among 38 eligible patients approached for the study, 35 (92%) participated and 33 (94%) completed the survey. Participants' perceived knowledge tended to be greater than their actual knowledge. Reporting of clinicopathologic features was most accurate for stage (91%) and lymph node status (88%), and least accurate for tumor size (61%), type (61%), and grade (33%). Accurate reporting of tumor receptor over-expression varied from 76% (estrogen receptor) to 39% (progesterone receptor). Many patients correctly recalled general treatment modalities and details of surgery; fewer recalled details of radiation and chemotherapy. Importantly, nearly all (32/33) were interested in receiving a breast cancer medical summary.An electronic survey is feasible to assess breast cancer patients' knowledge. This data suggest that patients have gaps in knowledge and would like a personalized medical summary.Larger studies are needed to validate and characterize knowledge gaps, and test interventions to improve physician-patient information sharing.
View details for DOI 10.1016/j.pec.2012.08.015
View details for Web of Science ID 000311766700016
View details for PubMedID 23031612
View details for PubMedCentralID PMC5310250
Increasing Rates of Breast Cancer and Cardiac Surveillance Among High-Risk Survivors of Childhood Hodgkin Lymphoma Following a Mailed, One-Page Survivorship Care Plan
PEDIATRIC BLOOD & CANCER
2011; 56 (5): 818-824
Hodgkin lymphoma (HL) survivors face substantially elevated risks of breast cancer and cardiovascular disease. They and their physicians are often unaware of these risks and surveillance recommendations.A prospective one-arm study was conducted among a random sample of 72 HL survivors, ages 27-55 years, participating in the Childhood Cancer Survivor Study (CCSS) who were at increased risk for breast cancer and/or cardiomyopathy and had not had a screening mammogram or echocardiogram, respectively, within the prior 2 years. A one-page survivorship care plan with recommendations for surveillance was mailed to participants. In addition, survivors' primary physicians were contacted and provided patient-specific information and a web-based Virtual Information Center was made available for both survivors and physicians. Outcomes were assessed by telephone 6 months after the intervention.The survivor participation (62/72; 86%) and 6-month retention (56/61; 92%) rates were high. Tension and anxiety, measured by the Profile of Mood States, did not increase following risk notification; 91% of survivors described their reactions to receiving the information in positive terms. At 6 months, 41% of survivors reported having completed the recommended mammogram; 20% reported having an echocardiogram (females 30%, males 10%). Only 29% of survivors visited the website. Nine physicians enrolled, and none used the study resources.A mailed, personalized survivorship care plan was effective in communicating risk and increasing compliance with recommended medical surveillance. Internet- and telephone-based strategies to communicate risk were not utilized by survivors or physicians.
View details for DOI 10.1002/pbc.22696
View details for Web of Science ID 000288132100020
View details for PubMedID 21370417
Inconsistent mammography perceptions and practices among women at risk of breast cancer following a pediatric malignancy: a report from the Childhood Cancer Survivor Study
CANCER CAUSES & CONTROL
2010; 21 (10): 1585-1595
Women treated with chest radiation for a pediatric cancer have low mammography screening rates despite their high risk for breast cancer. This study characterized the relationship between perceptions of mammography and screening practices. A cross-sectional survey was administered to 523 women in North America who were treated with chest radiation before 21 years of age. Women with inconsistent mammography perceptions and practices were identified using the Pros and Cons of Mammography for perceptions and Transtheoretical Model stages of adoption for prior and intended screening practices. Classification and regression tree (CART) analysis was used to identify barriers to and facilitators of screening among women with positive and negative perceptions. Nearly one-third of the cohort had inconsistent perceptions and practices: 37.4% had positive perceptions and were not having mammograms; 27.6% had negative/neutral perceptions and were having mammograms. Regardless of perceptions, a recent physician's recommendation for mammography, age ≥ 40, and interest in routine health care were universally associated with mammography practices. For women with positive perceptions and a physician's recommendation, barriers to screening included high acceptance coping, low active-planning coping, and high internal health locus of control. For women with negative perceptions, acknowledging the importance of asymptomatic screening was associated with mammography.
View details for DOI 10.1007/s10552-010-9587-5
View details for Web of Science ID 000281934800006
View details for PubMedID 20506037
View details for PubMedCentralID PMC2941535
Long-term Survivors of Childhood Ewing Sarcoma: Report From the Childhood Cancer Survivor Study
JOURNAL OF THE NATIONAL CANCER INSTITUTE
2010; 102 (16): 1272-1283
The survival of Ewing sarcoma (ES) patients has improved since the 1970s but is associated with considerable future health risks.The study population consisted of long-term (> or =5-year) survivors of childhood ES diagnosed before age 21 from 1970 to 1986. Cause-specific mortality was evaluated in eligible survivors (n = 568), and subsequent malignant neoplasms, chronic health conditions, infertility, and health status were evaluated in the subset participating in the Childhood Cancer Survivor Study (n = 403). Outcomes were compared with the US population and sibling control subjects (n = 3899). Logistic, Poisson, or Cox proportional hazards models, with adjustments for sex, age, race/ethnicity, and potential intrafamily correlation, were used. Statistical tests were two-sided.Cumulative mortality of ES survivors was 25.0% (95% confidence interval [CI] = 21.1 to 28.9) 25 years after diagnosis. The all-cause standardized mortality ratio was 13.3 (95% CI = 11.2 to 15.8) overall, 23.1 (95% CI = 17.6 to 29.7) for women, and 10.0 (95% CI = 7.9 to 12.5) for men. The nonrecurrence-progression non-external cause standardized mortality ratio (subsequent non-ES malignant neoplasms and cardiac and pulmonary causes potentially attributable to ES treatment) was 8.7 (95% CI = 6.2 to 12.0). Twenty-five years after ES diagnosis, cumulative incidence of subsequent malignant neoplasms, excluding nonmelanoma skin cancers, was 9.0% (95% CI = 5.8 to 12.2). Compared with siblings, survivors had an increased risk of severe, life-threatening, or disabling chronic health conditions (relative risk = 6.0, 95% CI = 4.1 to 9.0). Survivors had lower fertility rates (women: P = .005; men: P < .001) and higher rates of moderate to extreme adverse health status (P < .001).Long-term survivors of childhood ES exhibit excess mortality and morbidity.
View details for DOI 10.1093/jnci/djq278
View details for Web of Science ID 000281182500011
View details for PubMedID 20656964
View details for PubMedCentralID PMC2948841
Systematic Review: Surveillance for Breast Cancer in Women Treated With Chest Radiation for Childhood, Adolescent, or Young Adult Cancer
ANNALS OF INTERNAL MEDICINE
2010; 152 (7): 444–W154
Women treated with therapeutic chest radiation may develop breast cancer.To summarize breast cancer risk and breast cancer surveillance in women after chest radiation for pediatric or young adult cancer.Studies from MEDLINE, EMBASE, the Cochrane Library, and CINAHL (1966 to December 2008).Articles were selected to answer any of 3 questions: What is the incidence and excess risk for breast cancer in women after chest radiation for pediatric or young adult cancer? For these women, are the clinical characteristics of breast cancer and the outcomes after therapy different from those of women with sporadic breast cancer in the general population? What are the potential benefits and harms associated with breast cancer surveillance among women exposed to chest radiation?Three investigators independently extracted data and assessed study quality.Standardized incidence ratios ranged from 13.3 to 55.5; cumulative incidence of breast cancer by age 40 to 45 years ranged from 13% to 20%. Risk for breast cancer increased linearly with chest radiation dose. Available limited evidence suggests that the characteristics of breast cancer in these women and the outcomes after diagnosis are similar to those of women in the general population; mammography can detect breast cancer, although sensitivity is limited.The quality of evidence for key questions 2 and 3 is limited by substantial study heterogeneity, variation in study design, and small sample size.Women treated with chest radiation have a substantially elevated risk for breast cancer at a young age, which does not seem to plateau. In this high-risk population, there seems to be a benefit associated with early detection. Further research is required to better define the harms and benefits of lifelong surveillance.
View details for DOI 10.7326/0003-4819-152-7-201004060-00009
View details for Web of Science ID 000276386900005
View details for PubMedID 20368650
View details for PubMedCentralID PMC2857928
Knowledge of Hepatitis C Virus Screening in Long-Term Pediatric Cancer Survivors A Report From the Childhood Cancer Survivor Study
2010; 116 (4): 974-982
Pediatric cancer survivors who were treated before routine hepatitis C virus (HCV) screening of blood donors in 1992 have an elevated risk of transfusion-acquired HCV.To assess long-term pediatric cancer survivors' knowledge of HCV testing and blood transfusion history, a questionnaire was administered to 9242 participants in the Childhood Cancer Survivor Study who are at risk for transfusion-acquired HCV after cancer therapy from 1970 to 1986.More than 70% of survivors reported either no prior HCV testing (41%) or uncertainty about testing (31%), with only 29% reporting prior testing. One half recalled having a treatment-related blood transfusion; those who recalled a transfusion were more likely to report HCV testing (39%) than those who did not (18%) or were unsure (20%). In multivariate models, survivors who reported no prior HCV testing were more likely to be older (odds ratio [OR] per 5-year increase, 1.1; 95% confidence interval [CI], 1.0-1.1) and to report no care at a cancer center within the past 2 years (OR, 1.2; 95% CI, 1.0-1.4), no cancer treatment summary (OR, 1.3; 95% CI, 1.2-1.5), and no transfusions (OR, 2.6; 95% CI, 2.3-3.0) or uncertainty about transfusions (OR, 2.2; 95% CI, 1.9-2.6), and less likely to be racial/ethnic minorities (OR, 0.9; 95% CI, 0.8-1.0) or survivors of acute myeloid leukemia (OR, 0.7; 95% CI, 0.5-1.0).Many pediatric cancer survivors at risk for transfusion-acquired HCV are unaware of their transfusion history and prior testing for HCV and would benefit from programs to increase HCV knowledge and screening.
View details for DOI 10.1002/cncr.24810
View details for Web of Science ID 000274315800027
View details for PubMedID 20041485
View details for PubMedCentralID PMC2819650
Stathmin and Tubulin Expression and Survival of Ovarian Cancer Patients Receiving Platinum Treatment With and Without Paclitaxel
2009; 115 (11): 2453–63
Paclitaxel interacts with microtubules to exert therapeutic effects. Molecules that affect microtubule activity, such as betaIII-tubulin and stathmin, may interfere with the treatment. In this study, the authors analyzed betaIII-tubulin and stathmin expression in ovarian tumors and examined their associations with treatment response and patient survival.The study included 178 patients with epithelial ovarian cancer who underwent cytoreductive surgery followed by platinum-based chemotherapy; of these patients, 75 also received paclitaxel. Fresh tumor samples that were collected at surgery were analyzed for messenger RNA expression of betaIII-tubulin and stathmin using real-time polymerase chain reaction analysis. Associations of these molecules with treatment response, disease progression, and overall survival were evaluated.High stathmin expression was associated with worse disease progression-free and overall survival compared with low stathmin expression. This association was independent of patient age, disease stage, tumor grade, histology, and residual tumor size and was observed in patients who received platinum plus paclitaxel, but not in patients who received platinum without paclitaxel, suggesting that stathmin expression in tumor tissue may interfere with paclitaxel treatment. Similar effects were not observed for betaIII-tubulin, although high betaIII-tubulin expression was associated with disease progression among patients who received platinum without paclitaxel. No associations were observed between treatment response and tubulin or stathmin expression. Expression levels of betaIII-tubulin and stathmin were correlated significantly.High stathmin expression predicted an unfavorable prognosis in patients with ovarian cancer who received paclitaxel and platinum chemotherapy. This finding supports the possibility that stathmin may interfere with paclitaxel treatment, leading to a poor prognosis for patients with ovarian cancer.
View details for DOI 10.1002/cncr.24282
View details for Web of Science ID 000266300200012
View details for PubMedID 19322891
Peptide concentrations and mRNA expression of IGF-I, IGF-II and IGFBP-3 in breast cancer and their associations with disease characteristics
BREAST CANCER RESEARCH AND TREATMENT
2009; 115 (1): 151-162
To measure peptide concentrations and mRNA expression of the IGF Family in breast cancer and to examine their associations with the disease features.Fresh tumor samples were collected from 348 patients who underwent surgery for breast cancer. Tissue levels of mRNA and peptide of IGF-I, IGF-II, and IGFBP-3 were analyzed with real-time RT-PCR and ELISA, respectively. Cox proportional hazards regression model was used to examine the associations of IGF markers with patient survival.Age was inversely associated with IGF-I, IGF-II and IGFBP-3 at both mRNA and peptide levels. Small tumors, early TNM stages, or low grades were associated with high mRNA expression of IGFs and IGFBP-3. Hormone receptors were positively correlated with IGF-I and IGF-II expression. Survival analysis showed that patients with high expression of one of the IGF-I transcripts, IGF-IA, had lower risk of disease recurrence (HR = 0.47, 95%CI: 0.27-0.81) and death (HR = 0.35, 95%CI: 0.18-0.70) compared to those with low expression. High IGFBP-3 expression was also inversely associated with reduced risk of death (HR = 0.47, 95%CI: 0.23-0.95). Similar associations, however, were not observed when tissue levels of IGF-I peptide or IGFBP-3 protein were analyzed. High IGF-II peptide was related to increased risk of relapse (HR = 1.91, 95%CI: 1.12-3.27).Our findings of high mRNA expression of IGFs and IGFBP-3 being associated with less aggressive tumors and favorable prognosis were consistent with previous observations, but were not supported by the measurement of tissue levels of IGF-I peptide and IGFBP-3 protein, suggesting that IGF mRNA expression and tissue levels of IGF peptides are regulated by different mechanisms and assessing these molecules in tumor tissue may have different implications.
View details for DOI 10.1007/s10549-008-0046-x
View details for Web of Science ID 000265440400017
View details for PubMedID 18481170
Breast Cancer Surveillance Practices Among Women Previously Treated With Chest Radiation for a Childhood Cancer
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
2009; 301 (4): 404-414
Women treated with chest radiation for a pediatric malignancy have a significantly increased risk of breast cancer at a young age and are recommended to have an annual screening mammogram starting at age 25 years or 8 years after radiation, whichever occurs last.To characterize the breast cancer surveillance practices among female pediatric cancer survivors who were treated with chest radiation and identify correlates of screening.Between June 2005 and August 2006, a 114-item questionnaire was administered to a random sample of 625 women aged 25 through 50 years who had survived pediatric cancer, who had been treated with chest radiation, and who were participating in the Childhood Cancer Survivor Study (CCSS), a North American cohort of long-term survivors diagnosed from 1970-1986. Comparisons were made with similarly aged pediatric cancer survivors not treated with chest radiation (n = 639) and the CCSS siblings cohort (n = 712).Screening mammogram within the previous 2 years.Of 1976 cancer survivors and siblings who were contacted, 87.9% participated. Among the 551 women with a history of chest radiation, 55% reported a screening mammogram in the past 2 years (ages 25-39 years, 36.5%; 95% confidence interval [CI], 31.0%-42.0%; ages 40-50 years, 76.5%; 95% CI, 71.3%-81.7%). In comparison, 40.5% of survivors without chest radiation and 37.0% of CCSS siblings reported a screening mammogram in the same time interval. Notably, among women with a history of chest radiation, 47.3% (95% CI; 41.6%-53.0%) of those younger than 40 years had never had a mammogram and only 52.6% (95% CI; 46.4%-58.8%) of women aged 40 through 50 years were being regularly screened (2 mammograms within 4 years). Screening rates were higher among women who reported a physician recommendation than those who did not (ages 25-39 years, 76.0% vs 17.6%; ages 40-50 years, 87.3% vs 58.3%). In multivariate models, the association was particularly strong for younger women (ages 25-39 years, prevalence ratio [PR], 3.0; 95% CI, 2.0-4.0; ages 40-50 years, PR, 1.3; 95% CI, 1.1-1.6).In this cohort of women who had childhood cancer treated with chest radiation, 63.5% of those aged 25 through 39 years and 23.5% of those aged 40 through 50 years had not had mammography screening for breast cancer within the previous 2 years despite a guideline recommendation that survivors of childhood cancer who were treated with chest radiation should undergo annual screening mammography.
View details for Web of Science ID 000262777200020
View details for PubMedID 19176442
View details for PubMedCentralID PMC2676434
ERCC1 genotype and phenotype in epithelial ovarian cancer identify patients likely to benefit from paclitaxel treatment in addition to platinum-based therapy
JOURNAL OF CLINICAL ONCOLOGY
2007; 25 (33): 5172-5179
To investigate the effect of excision repair cross-complementation group 1 (ERCC1) on treatment response and survival of patients treated with platinum chemotherapy with or without paclitaxel.Tumor samples from epithelial ovarian cancer patients were evaluated for ERCC1 mRNA expression and a single nucleotide polymorphism at codon 118 (C>T). Of 178 patients treated with postoperative platinum-based chemotherapy, 75 were also given paclitaxel. For all of these patients, ERCC1 expression and genotype were analyzed for associations with treatment response and survival.Among the 103 patients treated with platinum without paclitaxel, the C/C genotype, compared with C/T and T/T, was associated with greater risk of disease progression and death (hazard ratio [HR], 1.95, P = .051; HR, 2.01, P = .033, respectively); high levels of ERCC1 mRNA, compared with low levels, were associated with greater risk of disease progression (HR, 2.41; P = .014). Similarly, when the ERCC1 data were combined, patients with the C/C genotype and high ERCC1 expression had greater risk for disease progression (HR, 3.73; P = .003) compared with those with low expression and non-C/C genotype. However, for the 75 patients treated with platinum plus paclitaxel, the C/C genotype and high ERCC1 expression were not associated with poor prognosis, suggesting that paclitaxel may help to alleviate ERCC1-related platinum resistance.Ovarian cancer patients with high ERCC1 expression or the C/C genotype at codon 118 may benefit from the combination of platinum and paclitaxel, while those with low ERCC1 expression or the C/T or T/T genotype may respond well to platinum without paclitaxel.
View details for DOI 10.1200/JCO.2007.11.8547
View details for Web of Science ID 000251074400008
View details for PubMedID 18024864
Genetic polymorphisms and treatment response in advanced non-small cell lung cancer
2007; 56 (2): 281-288
Genetic polymorphisms involved in DNA repair and apoptosis are suspected to influence patient response to cancer treatment. To evaluate the effect of genetic variations on chemotherapy and/or radiotherapy, we genotyped four single nucleotide polymorphisms (SNPs) in ATM (A60G), ERCC1 (Asn118Asn), APE1 (Asn148Glu), and iASPP (A67T), and examined their associations with treatment response among patients with advanced non-small cell lung cancer (NSCLC).Included in the study were 230 patients diagnosed with inoperable advanced NSCLC. Of these patients, 76 received platinum-based chemotherapy, 125 received chemotherapy plus radiation, and 29 received radiotherapy only. The SNPs were genotyped using the TaqMan methods.Among the patients who received chemotherapy only, ERCC1 (Asn118Asn) genotype was significantly associated with treatment response. Patients with either one or two T alleles (T/T+C/T) at Asn118Asn were more likely not to respond to platinum-based chemotherapy compared to those without the T allele (OR=4.10, 95% CI: 1.31-12.85). For patients who were treated with both chemotherapy and radiotherapy, treatment response seemed to differ substantially between patients with different genotypes of iASPP (A67T). Patients carrying an A allele (A/T+A/A) at A67T were more likely to respond to combined chemotherapy and radiotherapy compared to those not carrying the A allele (OR=0.25, 95% CI: 0.08-0.74). An association with treatment response was also suggested for the selected polymorphism in APE1, but no association was found for the ATM polymorphism.We found that SNPs in ERCC1 and iASPP were associated with response to chemotherapy or combined chemotherapy and radiotherapy in NSCLC patients. These findings support the notion that genetic variations related to DNA repair or apoptosis may affect the effect of chemotherapy or radiation on NSCLC.
View details for DOI 10.1016/j.lungcan.2006.12.002
View details for Web of Science ID 000246779600018
View details for PubMedID 17222938