A longitudinal mixed methods study on changes in body weight, body composition, and lifestyle in breast cancer patients during chemotherapy and in a comparison group of women without cancer: study protocol

Background

More than 60% of women diagnosed with early stage breast cancer receive (neo)adjuvant chemotherapy. Breast cancer patients receiving chemotherapy often experience symptoms such as nausea, vomiting and loss of appetite that potentially affect body weight and body composition. Changes in body weight and body composition may detrimentally affect their quality of life, and could potentially increase the risk of disease recurrence, cardiovascular disease and diabetes. To date, from existing single method (quantitative or qualitative) studies is not clear whether changes in body weight and body composition in breast cancer patients are treatment related because previous studies have not included a control group of women without breast cancer.

Methods

We therefore developed the COBRA-study (Change Of Body composition in BReast cancer: All-in Assessment-study) to assess changes in body weight, body composition and related lifestyle factors such as changes in physical activity, dietary intake and other behaviours. Important and unique features of the COBRA-study is that it used I) a “Mixed Methods Design”, in order to quantitatively assess changes in body weight, body composition and lifestyle factors and, to qualitatively assess how perceptions of women may have influenced these measured changes pre-, during and post-chemotherapy, and II) a control group of non-cancer women for comparison. Descriptive statistics on individual quantitative data were combined with results from a thematic analysis on the interviews- and focus group data to understand patients’ experiences before, during and after chemotherapy.

Discussion

The findings of our mixed methods study, on chemotherapy treated cancer patients and a comparison group, can enable healthcare researchers and professionals to develop tailored intervention schemes to help breast cancer patients prevent or handle the physical and mental changes they experience as a result of their chemotherapy. This will ultimately improve their quality of life and could potentially reduce their risk for other co-morbidity health issues such as cardiovascular disease and diabetes.

The Association of Olfactory Function with BMI, Appetite, and Prospective Weight Change in Dutch Community-Dwelling Older Adults

OBJECTIVES

The olfactory decline that often accompanies aging is thought to contribute to undernutrition in older adults. It is believed to negatively affect eating pleasure, appetite, food intake and subsequently nutritional status. We have evaluated the associations of olfactory function with BMI, appetite and prospective weight change in a cohort of Dutch community-dwelling older adults.

DESIGN

Cross-sectional cohort study.

PARTICIPANTS

Dutch community-dwelling older adults from the ongoing Longitudinal Aging Study Amsterdam (LASA). Measurements and setting: In 2012-2013, the 40-item University of Pennsylvania Smell Identification Test (UPSIT) was administered to 824 LASA participants to evaluate their olfactory function. Body weight, height, appetite, comorbidity, cognitive status and socio-demographic factors were also assessed. Follow-up weight was measured after three years.

RESULTS

673 participants (aged 55-65 years) were included in the regression analyses. Median UPSIT-score was 33. When adjusted for potential confounders, lower UPSIT-score (indicative of poorer olfactory function) was not associated with poor appetite (OR = 1.062, p = 0.137) or prospective weight change (B = -0.027, p = 0.548). It was, however, associated with lower BMI in smokers (B = 0.178, p = 0.032), but not in non-smokers (B = -0.015, p = 0.732).

CONCLUSION

Lower olfactory function scores were associated with lower BMI in community-dwelling older adults who smoke, but not with appetite or prospective weight change. Therefore, smoking older adults with olfactory impairments may pose as a vulnerable group with respect to developing undernutrition.

Perceptions of Dutch health care professionals on weight gain during chemotherapy in women with breast cancer

Purpose

Dutch Health care professionals (HCPs) provide little information concerning health risks associated with weight gain during chemotherapy for breast cancer. Women with breast cancer have specified the need for more information on nutrition and physical activity to deal with weight gain. The aims of this study were to assess the perceptions of Dutch HCPs on weight gain during chemotherapy and in addition evaluate whether and what kind of information on dietary intake and physical activity HCPs provide to prevent/treat weight gain during (neo)adjuvant chemotherapy.

Methods

A qualitative study was conducted using semi-structured interviews with 34 HCPs involved in breast cancer care: general practitioners, oncologists, specialized nurses, and dieticians.

Results

To date, little information about nutrition, physical activity, and weight gain is given during chemotherapy because it is not part of most HCPs’ training, it is not included in the guidelines and it is not the best time to bring up information in the opinion of HCPs. Weight gain was perceived as just a matter of a few kilos and not an important health issue during treatment. All HCPs felt it is better that women themselves addressed their weight gain after chemotherapy.

Conclusion

More knowledge about health risks associated with chemotherapy-induced weight gain and how to combat these issues needs to be made readily available to the HCPs and should become part of their training. Existing patient guidelines should include information on how to prevent and/or reduce weight gain through self-management of nutrition intake and physical activity during and post chemotherapy.

Predictors for achieving adequate protein and energy intake in nursing home rehabilitation patients

Background

Adequate energy and protein intake could be essential for contributing significantly to the rehabilitations process. Data on the actual nutritional intake of older nursing home rehabilitation patients have not yet been investigated.

Aims

To investigate the nutritional intake and predictors for achieving protein and energy requirements on the 14th day of admission in nursing home rehabilitation patients.

Methods

Fifty-nine patients aged 65+ years newly admitted to nursing home rehabilitation wards were included. Data on potential variables were collected on admission. On the fourteenth day nutritional intake was assessed. Intake was considered ‘adequate’ if patients had achieved ≥ 1.2 g of protein/kg bodyweight and ≥ 85% of their energy needs according to Harris and Benedict + 30%. Multiple logistic regression analyses were performed to select predictors for adequate intake.

Results

Protein and energy intake was assessed in 79 patients [67% female, mean age 82 ± (SD) 8 years, BMI 25 ± 6 kg/m²]. Mean energy intake was 1677 kcal (± 433) and mean protein intake was 68 g (± 20). Fourteen patients (18%) achieved an adequate protein and energy intake. Predictors for adequate intake were use of sip/tube feeding (OR = 7.7; 95% CI = 1.35–44.21), BMI (0.68; 0.53–0.87) and nausea (8.59; 1.42–52.01).

Conclusion

Only 18% of older nursing home rehabilitation patients had an adequate protein and energy intake at 14 days after admission. Patients with higher BMI were less likely, while those using sip/tube feeding or feeling nauseous were more likely to achieve an adequate protein and energy intake.

Development of benchmark quality criteria for assessing whole-endoscopy Barrett's esophagus biopsy cases

Background

Dysplasia in Barrett's esophagus (BE) biopsies is associated with low observer agreement among general pathologists. Therefore, expert review is advised. We are developing a web-based, national expert review panel for histological review of BE biopsies.

Objective

The aim of this study was to create benchmark quality criteria for future members.

Methods

Five expert BE pathologists, with 10–30 years of BE experience, weekly handling 5–10 cases (25% dysplastic), assessed a case set of 60 digitalized cases, enriched for dysplasia. Each case contained all slides from one endoscopy (non-dysplastic BE (NDBE), n = 21; low-grade dysplasia (LGD), n = 20; high-grade dysplasia (HGD), n = 19). All cases were randomized and assessed twice followed by group discussions to create a consensus diagnosis. Outcome measures: percentage of ‘indefinite for dysplasia’ (IND) diagnoses, intra-observer agreement, and agreement with the consensus ‘gold standard’ diagnosis.

Results

Mean percentage of IND diagnoses was 8% (3–14%) and mean intra-observer agreement was 0.84 (0.66–1.02). Mean agreement with the consensus diagnosis was 90% (95% prediction interval (PI) 82–98%).

Conclusion

Expert pathology review of BE requires the scoring of a limited number of IND cases, consistency of assessment and a high agreement with a consensus gold standard diagnosis. These benchmark quality criteria will be used to assess the performance of other pathologists joining our panel.

Associations of mindful eating domains with depressive symptoms and depression in three European countries

OBJECTIVE

To examine associations of mindful eating domains with depressive symptoms and depression in three European countries. Moderation by change in appetite-with increased appetite as marker for depression with atypical features - was also tested.

METHODS

Data were collected in Denmark (n = 1522), Spain (n = 1512) and the Netherlands (n = 1439). Multiple linear and logistic regression analyses segregated by country were used to test associations of four mindful eating domains (Mindful Eating Behaviour Scale; MEBS) with depressive symptoms (continuous score on the Center for Epidemiologic Studies Depression Scale; CES-D) and depression (score above the CES-D cut-off value, and/or use of antidepressants, and/or psychological treatment). Moderation by change in appetite was tested with bias-corrected bootstrap confidence intervals.

RESULTS

The domains Focused Eating, Eating with Awareness and Eating without Distraction were significantly negatively associated with depressive symptoms and depression in all three countries (e.g. Focused Eating Denmark: B = - 0.71, 95% CI: - 0.87, - 0.54; OR = 0.89, 95% CI: 0.86, 0.93). The domain Hunger and Satiety Cues (only measured in the Netherlands) was significantly positively associated with depressive symptoms in the adjusted models (B = 0.09, 95% CI: 0.02, 0.16), but not with depression (OR = 1.02, 95% CI: 0.98, 1.05). These associations were found for both people with and without increased appetite.

LIMITATIONS

The cross-sectional design, which makes it impossible to draw causal conclusions.

CONCLUSIONS

The present study indicates that higher scores on three mindful eating domains are consistently associated with a lower level of depressive symptoms and a lower likelihood of having depression in three European countries.

Atherothrombosis and Thromboembolism: Position Paper from the Second Maastricht Consensus Conference on Thrombosis

Atherothrombosis is a leading cause of cardiovascular mortality and long-term morbidity. Platelets and coagulation proteases, interacting with circulating cells and in different vascular beds, modify several complex pathologies including atherosclerosis. In the second Maastricht Consensus Conference on Thrombosis, this theme was addressed by diverse scientists from bench to bedside. All presentations were discussed with audience members and the results of these discussions were incorporated in the final document that presents a state-of-the-art reflection of expert opinions and consensus recommendations regarding the following five topics: 1. Risk factors, biomarkers and plaque instability: In atherothrombosis research, more focus on the contribution of specific risk factors like ectopic fat needs to be considered; definitions of atherothrombosis are important distinguishing different phases of disease, including plaque (in)stability; proteomic and metabolomics data are to be added to genetic information. 2. Circulating cells including platelets and atherothrombosis: Mechanisms of leukocyte and macrophage plasticity, migration, and transformation in murine atherosclerosis need to be considered; disease mechanism-based biomarkers need to be identified; experimental systems are needed that incorporate whole-blood flow to understand how red blood cells influence thrombus formation and stability; knowledge on platelet heterogeneity and priming conditions needs to be translated toward the in vivo situation. 3. Coagulation proteases, fibrin(ogen) and thrombus formation: The role of factor (F) XI in thrombosis including the lower margins of this factor related to safe and effective antithrombotic therapy needs to be established; FXI is a key regulator in linking platelets, thrombin generation, and inflammatory mechanisms in a renin-angiotensin dependent manner; however, the impact on thrombin-dependent PAR signaling needs further study; the fundamental mechanisms in FXIII biology and biochemistry and its impact on thrombus biophysical characteristics need to be explored; the interactions of red cells and fibrin formation and its consequences for thrombus formation and lysis need to be addressed. Platelet-fibrin interactions are pivotal determinants of clot formation and stability with potential therapeutic consequences. 4. Preventive and acute treatment of atherothrombosis and arterial embolism; novel ways and tailoring? The role of protease-activated receptor (PAR)-4 vis à vis PAR-1 as target for antithrombotic therapy merits study; ongoing trials on platelet function test-based antiplatelet therapy adjustment support development of practically feasible tests; risk scores for patients with atrial fibrillation need refinement, taking new biomarkers including coagulation into account; risk scores that consider organ system differences in bleeding may have added value; all forms of oral anticoagulant treatment require better organization, including education and emergency access; laboratory testing still needs rapidly available sensitive tests with short turnaround time. 5. Pleiotropy of coagulation proteases, thrombus resolution and ischaemia-reperfusion: Biobanks specifically for thrombus storage and analysis are needed; further studies on novel modified activated protein C-based agents are required including its cytoprotective properties; new avenues for optimizing treatment of patients with ischaemic stroke are needed, also including novel agents that modify fibrinolytic activity (aimed at plasminogen activator inhibitor-1 and thrombin activatable fibrinolysis inhibitor.

Insufficient Protein Intakes is Highly Prevalent among Physically Active Elderly

OBJECTIVES

Sufficient protein intake and habitual physical activity are key factors in the prevention and treatment of sarcopenia. In the present study, we assessed habitual dietary protein intake and the contribution of animal proteins in male versus female physically active elderly and identified determinants of protein intake.

DESIGN

a cross-sectional study.

SETTING

the study was performed within the Nijmegen Exercise Study.

PARTICIPANTS

physically active elderly ≥ 65 yrs.

MEASUREMENTS

Physical activity was assessed using the SQUASH questionnaire and expressed in Metabolic Equivalent of Task hours per week (METhr/wk). Dietary protein intake was determined using a validated food frequency questionnaire (FFQ). Multivariate linear regression analysis was used to determine whether age, sex, educational level, smoking, alcohol intake and physical activity were associated with protein intake (g/kg/d).

RESULTS

A total of 910 participants (70±4 yrs, 70% male) were included and reported a habitual physical activity level of 85.0±53.5 METhr/wk. Protein intake was 1.1±0.3 g/kg/d with 57% animal-based proteins for males, and 1.2±0.3 g/kg/d with 59% animalbased proteins for females (both P<0.05). In total, 16%, 42% and 67% of the male elderly and 10%, 34% and 56% of the female elderly did not meet the recommended protein intake of 0.8, 1.0 and 1.2 g/kg/d, respectively. Female sex (β=0.055, P=0.036) and more physical activity (β=0.001, P=0.001) were associated with a higher daily protein intake (g/kg/d).

CONCLUSION

The majority of physically active elderly and in particular males (i.e. 67%) does not reach a protein intake of 1.2 g/kg/d, which may offset the health benefits of an active lifestyle on muscle synthesis and prevention of sarcopenia. Intervention studies are warranted to assess whether protein supplementation may enhance muscle mass and strength in physically active elderly.

Digital microscopy as valid alternative to conventional microscopy for histological evaluation of Barrett's esophagus biopsies

Management of Barrett's esophagus (BE) relies heavily on histopathological assessment of biopsies, associated with significant intra- and interobserver variability. Guidelines recommend biopsy review by an expert in case of dysplasia. Conventional review of biopsies, however, is impractical and does not allow for teleconferencing or annotations. An expert digital review platform might overcome these limitations. We compared diagnostic agreement of digital and conventional microscopy for diagnosing BE ± dysplasia. Sixty BE biopsy glass slides (non-dysplastic BE (NDBE); n = 25, low-grade dysplasia (LGD); n = 20; high-grade dysplasia (HGD); n = 15) were scanned at ×20 magnification. The slides were assessed four times by five expert BE pathologists, all practicing histopathologists (range: 5-30 years), in 2 alternating rounds of digital and conventional microscopy, each in randomized order and sequence of slides. Intraobserver and pairwise interobserver agreement were calculated, using custom weighted Cohen's kappa, adjusted for the maximum possible kappa scores. Split into three categories (NDBE, IND, LGD+HGD), the mean intraobserver agreement was 0.75 and 0.84 for digital and conventional assessment, respectively (p = 0.35). Mean pairwise interobserver agreement was 0.80 for digital and 0.85 for conventional microscopy (p = 0.17). In 47/60 (78%) of digital microscopy reviews a majority vote of ≥3 pathologists was reached before consensus meeting. After group discussion, a majority vote was achieved in all cases (60/60). Diagnostic agreement of digital microscopy is comparable to that of conventional microscopy. These outcomes justify the use of digital slides in a nationwide, web-based BE revision platform in the Netherlands. This will overcome the practical issues associated with conventional histologic review by multiple pathologists.

In Silico Probe-Based Detection of Citrus Viruses in NGS Data

The conservation of plant biosecurity relies on the rapid identification of pathogenic organisms, including viruses. With next-generation sequencing (NGS), it is possible to identify multiple viruses within a metagenomic sample. In this study, we explored the use of electronic probes (e-probes) for the simultaneous detection of 11 recognized citrus viruses. E-probes were designed and screened against raw sequencing data to minimize the bioinformatic processing time required. The e-probes were able to accurately detect their cognate viruses in simulated datasets, without any false negatives or positives. The efficiency of the e-probe-based approach was validated with NGS datasets generated from different RNA preparations: double-stranded RNA (dsRNA) from 'Mexican' lime infected with different Citrus tristeza virus (CTV) genotypes, dsRNA from field samples, and small RNA and total RNA from grapefruit infected with the CTV T3 genotype. A set of probes was made available that is able to accurately detect CTV in sequence data regardless of the input dataset or the genotype that plants are infected with.

Weight change during chemotherapy in breast cancer patients: a meta-analysis

BACKGROUND

Weight gain during chemotherapy in women with breast cancer is commonly reported. However, there are important differences between studies that examined weight change during chemotherapy; e.g. type of chemotherapy, menopausal status, time between body weight measurements and sample size. The purpose of this meta-analysis was to quantify changes in body weight during chemotherapy for women with breast cancer, taking these differences into account.

METHODS

We identified relevant studies using PubMed, Scopus and Embase databases. The search was limited to human studies published in English up to and including December 2015. Only studies among women with early stage breast cancer treated with chemotherapy, with reported body weight before and after chemotherapy and type of chemotherapy were included. Random-effect models were used, and heterogeneity between studies was explored through stratified analyses and meta-regression. Sensitivity analyses were done to explore whether a specific study markedly affected the results.

RESULTS

In total 25 papers were found, including data from 2620 women. Overall, body weight increased during chemotherapy: 2.7 kg (95% CI 2.0, 7.5) with a high degree of heterogeneity (I² = 94.2%). Stratified analyses showed weight gain in all strata, but did not substantially reduce heterogeneity. Univariate meta-regression showed less weight gain in prospective studies compared to chart review studies (-2.0, 95% CI: -3.1, -0.8). Studies including cyclophosphamide, methotrexate and 5-fluorouracil (CMF) regimes showed a greater weight gain compared to those that did not (2.2, 95% CI: 1.1, 3.3); and papers published until the year 2000 showed a greater weight gain compared to those published after 2000 (1.9, 95% CI:-0.8, 3.1). In the multivariate models only studies including CMF regimes and studies published until 2000 were associated with significant weight gain of respectively 1.3 and 1.4 kg.

CONCLUSION

Despite the high heterogeneity, this meta-analysis shows significant weight gain during chemotherapy for women with breast cancer. Weight gain was more pronounced in papers published until 2000 and women receiving CMF as chemotherapy regime. Although weight gain after chemotherapy has decreased over the course of time, weight gain is still substantial and deserves clinical attention.

Long-term Survival and Clinical Benefit from Adoptive T-cell Transfer in Stage IV Melanoma Patients Is Determined by a Four-Parameter Tumor Immune Signature

The presence of tumor-infiltrating immune cells is associated with longer survival and a better response to immunotherapy in early-stage melanoma, but a comprehensive study of the in situ immune microenvironment in stage IV melanoma has not been performed. We investigated the combined influence of a series of immune factors on survival and response to adoptive cell transfer (ACT) in stage IV melanoma patients. Metastases of 73 stage IV melanoma patients, 17 of which were treated with ACT, were studied with respect to the number and functional phenotype of lymphocytes and myeloid cells as well as for expression of galectins-1, -3, and -9. Single factors associated with better survival were identified using Kaplan-Meier curves and multivariate Cox regression analyses, and those factors were used for interaction analyses. The results were validated using The Cancer Genome Atlas database. We identified four parameters that were associated with a better survival: CD8⁺ T cells, galectin-9⁺ dendritic cells (DC)/DC-like macrophages, a high M1/M2 macrophage ratio, and the expression of galectin-3 by tumor cells. The presence of at least three of these parameters formed an independent positive prognostic factor for long-term survival. Patients displaying this four-parameter signature were found exclusively among patients responding to ACT and were the ones with sustained clinical benefit. Cancer Immunol Res; 5(2); 170-9. ©2017 AACR.

Perspectives on the Causes of Undernutrition of Community-Dwelling Older Adults: A Qualitative Study

OBJECTIVES

Undernutrition is a major health concern particularly in vulnerable older adults. The present study aimed to reveal the causes of undernutrition as reported by community-dwelling older adults.

DESIGN

Twenty-five semi-structured interviews and two focus group discussions were performed and analyzed.

SETTING

Community-dwelling.

PARTICIPANTS

Older adults.

MEASUREMENTS

A questionnaire on demographics, Short Nutritional Assessment Questionnaire 65+ and interviews on the potential causes of undernutrition.

RESULTS

33 older adults agreed to participate in the interviews and focus groups. Our findings indicate that a wide variety of causes of undernutrition, both modifiable and non-modifiable, were mentioned by the older adults. Many modifiable causes of undernutrition were reported in the mental, social or food and appetite theme, such as poor food quality provided by meal services, the inability to do groceries, loneliness and mourning. Non-modifiable causes included, forgetfulness, aging, surgery and hospitalization.

CONCLUSIONS

This study provides guidance to better understand the underlying causes of undernutrition from an older adult's perspective. The modifiable causes provide specific direction towards practical implications that might decrease or prevent undernutrition. Non-modifiable causes should raise awareness of an increased risk of undernutrition by health professionals in primary and secondary care, caregivers and family members.

Abstract PR11: Neo-antigen landscape dynamics during human melanoma-T cell interactions

Recognition of the neo-antigens that are formed as a consequence of DNA damage is likely to be a major driving force behind the clinical activity of T cell checkpoint blockade and adoptive T cell therapy for treatment of non-virally induced solid cancers. Consequently, strategies to selectively enhance T cell reactivity against genetically defined neo-antigens are currently under development. In mouse models, T cell pressure has been shown to sculpt the antigenicity of tumors through selection of tumor cell variants that do not express the relevant neo-antigens. However, it is unclear whether the T cell-recognized neo-antigen repertoire is constant over time in human cancers. To address this issue, we analyzed the stability of neo-antigen specific T cell responses and the antigens they recognize in stage IV melanoma patients treated by adoptive T cell transfer. Fresh tumor tissue resected before and after treatment was used to establish autologous melanoma cell lines, to culture tumor-infiltrating lymphocytes (TIL) and to generate T-cell infusion products by autologous mixed lymphocyte tumor cell cultures using peripheral blood lymphocytes. Material from 2 patients with objective clinical responses after infusion of autologous tumor-specific CD4+ and CD8+ T cells was analyzed by whole exome and RNA sequencing. Subsequently, 31-mer peptides covering all the non-synonymous somatic mutations were used to test the reactivity of both the T-cell infusion products and TIL isolated from subsequent tumor lesions by ELISA and flow cytometry. The expression of genes encoding T cell-recognized neo-antigens was then analyzed within the tumor cell lines and within the corresponding paraffin-embedded tumor tissue, by real-time PCR analysis, a competitive allele-specific PCR assay, and by analysis of heterozygosity and next generation amplicon sequencing. Analysis of the infusion products showed that 50-80% of T cells reacted to autologous tumor cells, with only a very low percentage of these cells recognizing known shared tumor-associated epitopes. Instead, tumor reactivity was predominantly mediated by CD4+ and CD8+ T cells recognizing clonally expressed neo-antigens formed by private mutations. CD8+ T cells within the infusion products and within TIL populations generated from subsequent tumor lesions of these two patients recognized a total of 6 different neo-antigens, and analysis of these neo-antigens in both the index lesion and subsequent lesions revealed profound alterations in the T cell-recognized neo-antigen landscape. In particular, in 2 cases, the mutant allele was lost from a subsequent tumor, in one case, expression of the mutant gene was substantially reduced in a recurring lesion, and in another case expression of the mutant gene was increased approx. 40-fold in a subsequent tumor. Notably, in 4 out of 4 cases these changes in neo-antigen expression were paralleled by loss or gain of the respective neo-antigen specific T cell response. Collectively, our data demonstrate that under conditions in which a high frequency of tumor-specific T cells is present, tumor cell variants with reduced or lost neo-antigen expression can emerge, similar to what has been observed in mice. This, and the observation of concurrent acquisition of novel T cell reactivity, reveal the dynamics of T cell - neo-antigen interaction in human cancer, and indicate that immunotherapies that maximize the capacity to respond to an altering neo-antigen landscape may offer the highest chance to achieve long-term tumor control.

Citation Format: Els M.E. Verdegaal, Noel de Miranda, Marten Visser, Tom Harryvan, Marit van Buuren, Rikke Andersen, Sine Hadrup, Caroline van der Minne, Remko Schotte, Hergen Spits, John Haanen, Ellen Kapiteijn, Ton Schumacher, Sjoerd H. Van Der Burg. Neo-antigen landscape dynamics during human melanoma-T cell interactions [abstract]. In: Proceedings of the Second CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; 2016 Sept 25-28; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(11 Suppl):Abstract nr PR11.

Control of parasitic infection with ivermectin long-acting injection (IVOMEC® GOLD) and production benefit in first-season grazing cattle facing a high-level larval challenge in Germany

Gastrointestinal and pulmonary nematode infections are affecting the health and productivity of grazing cattle worldwide. To evaluate the effects of a single treatment with ivermectin long-acting injection (IVM LAI; IVOMEC® GOLD, Merial; 3.15 % ivermectin w/v) in first-grazing season cattle, two studies were conducted under continued stocking conditions for 84 or 100 days in Bavaria, Germany. Each study involved 68 naturally infected, approximately 4- to 6-month-old Brown Swiss bull calves. Animals were blocked based on pretreatment body weights. Within each block of four animals, animals were randomly assigned to treatments: one to saline (control) and three to IVM LAI. Treatments were injected at 1 mL/50 kg body weight subcutaneously in front of the shoulder. Animals in both studies were managed as one herd each grazing together. Cattle were weighed and fecal samples were collected pretreatment and at intervals thereafter for determination of weight gain and treatment efficacy, respectively. Fecal examination including composite fecal culture indicated the presence of nematodes of the genera Cooperia (dominating), Haemonchus, Nematodirus, Ostertagia, Strongyloides, Trichostrongylus, Trichuris, and Dictyocaulus, and Moniezia cestodes in the cattle. Following treatment, IVM LAI-treated cattle did not shed any Dictyocaulus larvae for 84 days while controls continued to pass larvae. Compared to the controls, IVM LAI-treated cattle had significantly (p < 0.01) lower strongylid egg counts at each occasion. Percentage reductions were ≥94 % up to 70 days after treatment and were ≥83.9 and 58.9 % at 84 and 100 days. Over the 84- or 100-day study periods, IVM LAI-treated cattle gained significantly more weight than the controls: 22.7 and 12.4 kg, respectively. The two studies demonstrated a high efficacy of IVM LAI against gastrointestinal and pulmonary nematode infections under field conditions in Germany which was associated with significant benefit as to weight gain.

Trends in risk factors for coronary heart disease in the Netherlands

BACKGROUND

Favourable trends in risk factor levels in the general population may partly explain the decline in coronary heart disease (CHD) morbidity and mortality. Our aim was to present long-term national trends in established risk factors for CHD.

METHODS

Data were obtained from five data sources including several large scale population based surveys, cohort studies and general practitioner registers between 1988 and 2012. We applied linear regression models to age-standardized time trends to test for statistical significant trends. Analyses were stratified by sex and age (younger <65 and older ≥65 years adults).

RESULTS

The results demonstrated favourable trends in smoking (except in older women) and physical activity (except in older men). Unfavourable trends were found for body mass index (BMI) and diabetes mellitus prevalence. Although systolic blood pressure (SBP) and total cholesterol trends were favourable for older persons, SBP and total cholesterol remained stable in younger persons.

CONCLUSIONS

Four out of six risk factors for CHD showed a favourable or stable trend. The rise in diabetes mellitus and BMI is worrying with respect to CHD morbidity and mortality.

Evaluation of the First AIDS Kit, the AIDS and Lifestyle Education Programme for Teenagers

The impact of the First AIDS Kit, an AIDS and lifestyle education programme, on secondary school students' behavioural intentions, their knowledge of AIDS as well as attitude towards people with AIDS, was evaluated. The programme was presented by counselling teachers in 11 schools involving 339 students in Stds 6 to 9. The programme was evaluated by means of a questionnaire before and after the programme, as well as by focus group discussions with students and interviews with the presenters of the programme. Although the programme was not presented in ideal circumstances, it had a positive effect on students' knowledge of AIDS, their attitude towards people with AIDS and although not statistically significant, some aspects of their behavioural intentions. Students evaluated the programme positively, as preparing them for life and giving them more control over their lives. Students gave suggestions to improve the programme with regard to the content, presenter, educational techniques, role of parents and how to address moral issues. It is recommended that AIDS education should form part of long-term life skills and sex education and the focus should be on behavioural change. Community education and participation are also key elements in the effectiveness of school-based AIDS education programmes.

Circumferential cryoablation in a strictured esophagus: a feasibility and dose-finding study in a porcine model after inducing stenosis by endoscopic mucosal resection

In the treatment of early esophageal Barrett's neoplasia, radiofrequency ablation may be hindered by stenosis due to prior endoscopic resection (ER). The flexible balloon-based circumferential CryoBalloon Ablation System (CBAS) may overcome this problem by the conformability of the compliant balloon which might enable circumferential cryoablation in a stenosis. The aim of the current study was to evaluate the feasibility of the CBAS as well as the dose-response effect of cryoablation in a strictured esophagus model. In six pigs, a stenosis was induced by ER (3 cm in length, 75% of circumference) in the proximal, mid, and distal esophagus. After 28 days, cryoablation with the CBAS was performed, with the length of ablation time (6, 8, or 10 seconds) randomly assigned per stricture location within the esophagus. Four days post-ablation, the esophagi were harvested for histopathological assessment of the percentage of the total circumference affected by cryoablation and the maximum depth of necrosis. At 28 days, all 18 ER areas had transformed into strictures with ±50% of its original diameter remaining. In 9 of 18 strictures, more than one attempt for cryoablation was necessary due to displacement of the balloon. Histopathological evaluation showed a wide range in circumferential uniformity (0-100%) and maximum necrosis depth (epithelium to external proper muscle layer) of cryoablation, both independent of ablation times. Deepest ablation effects were seen at the center of the resection-induced scar. This first generation CryoBalloon Focal Ablation System was not feasible for ablation within severe stenoses, since it results in inconsistent circumferential uniformity of cryoablation with subsequent differences in depth of ablation. Further research with a next generation CBAS in a more realistic stricture model is warranted.

Abstract P1-10-28: Cultural and religious differences during breast cancer treatment between Dutch and non-Western immigrant women

Background

Twelve percent of the Dutch population consists of non-Western immigrant women with an incidence of breast cancer that has risen from 2,9% in 2005 to 5% in 2015. For the second generation of these women the incidence of breast cancer is expected to meet the native Dutch population rates soon, partly due to adoption of Western style dietary habits and physical activity. Chemotherapeutic treatment (CT) for breast cancer is associated with increased body fatness and interventions to prevent this increase are currently explored. Whether perceptions on cancer and treatment differ between non-Western immigrant women than for Dutch women needs to be evaluated before these interventions can be set up. This study aimed to explore cultural and religious differences on women's perceptions of the diagnosis of breast cancer and changes in physical activity and eating habits during chemotherapy treatment.

Methods

A longitudinal qualitative multiple case study was conducted. Newly diagnosed women with breast cancer were recruited and purposively selected (n=23, non-immigrant) from six hospitals in the Netherlands. Semi structured interviews were conducted three times (in total 69): before start of CT, halfway and after CT. In addition 38 women (20 non-immigrant and 18 immigrant) were recruited and interviewed after finishing CT. All interviews (n=107, from 61 women) were audiotaped and transcribed verbatim. A thematic content analysis approach was used.

Results

All 43 non-immigrant women, mean age 51,1 yrs. and 18 immigrant women mean age 43,2 yrs., experienced known side effects from CT. Loss of hair and sometimes the breast appeared to be especially for immigrant women a shocking experience and for some even a loss of femininity. Most of the women perceived to have received incomplete and often unclear information from hospitals about weight and CT treatment. Immigrant women participating the Ramadan during treatment encountered resistance from their physicians. Weight gain during period of CT was higher among immigrant women (mean 13,1 kg, 4-28 kg) than among non-immigrant women (mean 2,5 kg, 2-9 kg). Although both groups said to be less physically active and complained about fatigue, non-immigrant women trying to maintain daily structure and were more active with their diet than most immigrants. Immigrant women expressed cancer as a taboo in their culture impeding them to talk openly about their illness, only when side effects of CT such as hair loss were visible they found it inevitable. Cancer was associated with death at time of diagnosis. For most immigrants and a few non-immigrants this was considered a religious ordeal from Allah or God, these women perceived less influence on their behavior during treatment. Most non-religious women perceived breast cancer as bad luck, stress or heredity.

Conclusion

Especially immigrant women experienced little respect for their culture and insufficient information about treatment. Non-immigrants had a need to actively contribute to their treatment while this need was less obvious for immigrants. Probably because they felt not encouraged by their religion and culture.

Citation Format: de Kruif AJ, Derks MJ, de Boer MR, Winkels R, Visser M, Kampman E, Westerman MJ. Cultural and religious differences during breast cancer treatment between Dutch and non-Western immigrant women. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-28.

Are a Healthy Diet and Physical Activity Synergistically Associated with Cognitive Functioning in Older Adults?

OBJECTIVES

Previous research has demonstrated that being both physically active and adhering a healthy diet is associated with improved cognitive functioning; however, it remains unclear whether these factors act synergistically. We investigated the synergistic association of a healthy diet and being physically active with cognitive functioning.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Data from the Longitudinal Aging Study Amsterdam (LASA) were used. We analyzed data from 2,165 community dwelling adults who were aged 55-85 years, 56% of whom were female. Cognitive functioning was assessed by the Mini-Mental State Examination (MMSE), an MMSE score of >26 indicates good cognitive functioning. Physical activity was assessed by the LASA Physical Activity Questionnaire and was considered sufficient if the person engaged in moderately intense physical activity ≥ 20 min/day. A healthy diet score was based on the intake of fruit, vegetables and fish. Each of the food groups was assigned a score that ranged from 1 (well below the Dutch guideline for a healthy diet) to 4 (well above the Dutch guideline for a healthy diet), and the scores were aggregated to determine a healthy diet (healthy ≥ 9 points). Multiple logistic and linear regression analyses were used to examine the (synergistic) association among physical activity, a healthy diet and cognitive functioning. All analyses were adjusted for potential chronic diseases and lifestyle confounders.

RESULTS

Of all of the participants, 25% were diagnosed with a cognitive impairment (MMSE ≤26), 80% were physically active and 41% had a healthy diet. Sixty three percent of the participants both adhered to a healthy diet and were physically active. Sufficient daily physical activity (OR=2.545 p<.001) and adherence to a healthy diet (OR=1.766 p=.002) were associated with good cognitive functioning. After adjusting for confounding factors, sufficient physical activity was not significantly related to cognitive functioning (p=.163); however adherence to a healthy diet remained significantly associated with good cognitive functioning (p=.017). No interaction among sufficient physical activity, healthy diet adherence and good cognitive functioning was observed (crude: p=.401, adjusted: p=.216).

CONCLUSION

The results of this cross-sectional study indicate that adherence to a healthy diet is inde-pendently related to cognitive functioning. Being physically active does not modify this association. Furthermore, these two lifestyle factors do not synergistically relate to cognitive functioning.

Effects of Lugol staining on stenosis formation induced by radiofrequency ablation of esophageal squamous epithelium: a study in a porcine model

Preliminary data show higher stricture rates after radiofrequency ablation (RFA) for early esophageal squamous neoplasia compared with Barrett's esophagus. We studied the effects of Lugol stain (LS) directly prior to RFA on stricture formation in squamous epithelium. Of 16 pigs, the distal half of the esophagus was LS, followed by circumferential RFA (single application 12 J/cm(2) ) in the unstained and stained esophagus. Pigs were euthanized at day 0 (n = 4), 3 (n = 4), or 28 (n = 8). Histology was evaluated in four areas: blank-control (no RFA, no LS), blank-RFA (no LS), LS+RFA, and LS-control (no RFA). Stenosis severity in LS+RFA and blank-RFA at 28 days was assessed by the ratio of the mucosal diameter at the RFA area to the diameter 2 cm proximal of this zone. Histology showed submucosal edema in 50% of LS+RFA versus 0% in blank-RFA. Severity and depth of inflammation (day 3) was equal in LS+RFA and blank-RFA. Severity and depth of fibrosis (day 28) appeared more severe in LS+RFA. Consequently, stenosis was present in 100% (LS+RFA) versus 12.5% (blank-RFA). The stenosis-severity ratio was 0.40 (interquartile range 0.29-0.45) in LS+RFA versus 0.73 (interquartile range 0.64-0.78) in blank-RFA (P = 0.012). Limitations of this study were the difference in uptake of LS between pigs and humans, the difference in esophageal anatomy between pigs and humans, and between the proximal and distal esophagus within pigs. In conclusion, in the porcine squamous esophagus, stenosis rate and severity after RFA increased when preceded by LS. LS may be contributing in the altered response of squamous epithelium to RFA as compared with Barrett's esophagus.

Self- Perception of Body Weight Status in Older Dutch Adults

INTRODUCTION

OBJECTIVES

The prevalence of obesity is highest in older persons and a correct self-perception of body weight status is necessary for optimal weight control. The aim of this study was to determine self-perception of, and satisfaction with, body weight status, and to compare current versus ideal body image in a large, nationally representative sample of older people. Furthermore, determinants of misperception were explored.

DESIGN

A cross-sectional study.

SETTING

The Longitudinal Aging Study Amsterdam (LASA), conducted in a population-based sample in the Netherlands.

PARTICIPANTS

1295 men and women aged 60-96 years.

MEASUREMENTS

Body weight status was assessed using measured weight and height. Self-perceived body weight status, satisfaction with body weight and current and ideal body image were also assessed. Multiple logistic regression analysis was used to investigate the association of age, educational level and objectively measured BMI with underestimation of body weight status.

RESULTS

The prevalence of obesity was 19.9% in men and 29.3% in women. The agreement between objective and self-perceived body weight status was low (Kappa < 0.2). Among overweight and obese persons, 42.1% of men and 44.1% of women were (very) dissatisfied with their body weight status and >99% of obese participants desired to be thinner (ideal body image < current image). Only 4.4% of obese men and 12.3% of obese women perceived their body weight status correctly. Higher age (women), lower educational level (men) and higher BMI (all) were associated with greater underestimation of body weight status.

CONCLUSION

Many older persons misperceive their body weight status. Future actions to improve body weight perception in older persons are necessary to increase the impact of public health campaigns focussing on a healthy body weight in old age.

Polyunsaturated fatty acids in relation to incident mobility disability and decline in gait speed; the Age, Gene/Environment Susceptibility-Reykjavik Study

BACKGROUND/OBJECTIVES

Low intake of long chain polyunsaturated fatty acids (PUFAs) are associated with physical disability; however, prospective studies of circulating PUFAs are scarce. We examined associations between plasma phospholipid n-3 and n-6 PUFAs with risk of incident mobility disability and gait speed decline.

SUBJECTS/METHODS

Data are from a subgroup of the Age, Gene/Environment Susceptibility-Reykjavik Study, a population-based study of risk factors for disease and disability in old age. In this subgroup (n = 556, mean age 75.1 ± 5.0 years, 47.5% men), plasma phospholipid PUFAs were assessed at baseline using gas chromatography. Mobility disability and usual gait speed were assessed at baseline and after 5.2 ± 0.2 years. Mobility disability was defined as the following: having much difficulty, or being unable to walk 500 m or climb up 10 steps; decline in gait speed was defined as change ⩾ 0.10 m/s. Logistic regression analyses were performed to determine associations between sex-specific s.d. increments in PUFAs with risk of incident mobility disability and gait speed decline. Odds ratios (95% confidence intervals) adjusted for demographics, follow-up time, risk factors and serum vitamin D were reported.

RESULTS

In women, but not men, every s.d. increment increase of total n-3 PUFAs and docosahexaenoic acid (DHA) was associated with lower mobility disability risk, odds ratio 0.48 (0.25; 0.93) and odds ratio 0.45 (0.24; 0.83), respectively. There was no association between n-6 PUFAs and the risk of incident mobility disability or gait speed decline.

CONCLUSIONS

Higher concentrations of n-3 PUFAs and, particularly, DHA may protect women from impaired mobility but does not appear to have such an effect in men.

Simultaneous use of endoscopic resection and radiofrequency ablation is not safe in an esophageal porcine model

Radiofrequency ablation (RFA) is safe and effective for eradication of Barrett’s esophagus after endoscopic resection (ER) of neoplasia. Widespread ER, however, is likely to induce stenosis, hampering subsequent circumferential RFA. A ‘single step’ procedure with ER and circumferential RFA in the same session may avoid this problem. Two variants are possible: circumferential RFA of Barrett’s esophagus including the lesion followed by ER of the ablated lesion (‘RFA→ER’), or ER of the lesion directly followed by circumferential RFA of remaining Barrett’s esophagus including the resection wound (‘ER→RFA’). First aim was to evaluate perforation risk of ‘ER→RFA’ using increasing RFA energies. Second aim was to compare stenosis rate after ‘ER→RFA’ versus ‘RFA→ER’. In Experiment 1, 24 areas in six pigs underwent widespread ER directly followed by circumferential RFA with increasing energies (2 x 10, 2 x 12-6 x 12 J/cm(2)) in the esophagus. In Experiment 2, eight pigs each had four treatment areas randomized: ‘ER→RFA’, RFA alone, ER alone, and ‘RFA→ER’. No acute perforations occurred when ablating ER wounds. Two delayed perforations occurred: one in experiment 1, another in experiment n2 at the ‘ER→RFA’ area. The remaining seven pigs in experiment 2 showed stenosis in all ‘ER→RFA’ and ‘RFA→ER’ areas versus 5/7 RFA alone areas, and 0/7 ER alone areas. In conclusion, the ‘single step’ variant ‘ER→RFA’ is not safe in this porcine model and seems therefore not ethical to evaluate in humans at this stage. Given the high rate of stenosis after ‘RFA→ER’ and RFA alone, one might question the validity of the porcine model for this type of experiments.