1
|
Sloss EA, McPherson JP, Beck AC, Guo JW, Scheese CH, Flake NR, Chalkidis G, Staes CJ. Patient and Caregiver Perceptions of an Interface Design to Communicate Artificial Intelligence-Based Prognosis for Patients With Advanced Solid Tumors. JCO Clin Cancer Inform 2024; 8:e2300187. [PMID: 38657194 DOI: 10.1200/cci.23.00187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE Use of artificial intelligence (AI) in cancer care is increasing. What remains unclear is how best to design patient-facing systems that communicate AI output. With oncologist input, we designed an interface that presents patient-specific, machine learning-based 6-month survival prognosis information designed to aid oncology providers in preparing for and discussing prognosis with patients with advanced solid tumors and their caregivers. The primary purpose of this study was to assess patient and caregiver perceptions and identify enhancements of the interface for communicating 6-month survival and other prognosis information when making treatment decisions concerning anticancer and supportive therapy. METHODS This qualitative study included interviews and focus groups conducted between November and December 2022. Purposive sampling was used to recruit former patients with cancer and/or former caregivers of patients with cancer who had participated in cancer treatment decisions from Utah or elsewhere in the United States. Categories and themes related to perceptions of the interface were identified. RESULTS We received feedback from 20 participants during eight individual interviews and two focus groups, including four cancer survivors, 13 caregivers, and three representing both. Overall, most participants expressed positive perceptions about the tool and identified its value for supporting decision making, feeling less alone, and supporting communication among oncologists, patients, and their caregivers. Participants identified areas for improvement and implementation considerations, particularly that oncologists should share the tool and guide discussions about prognosis with patients who want to receive the information. CONCLUSION This study revealed important patient and caregiver perceptions of and enhancements for the proposed interface. Originally designed with input from oncology providers, patient and caregiver participants identified additional interface design recommendations and implementation considerations to support communication about prognosis.
Collapse
Affiliation(s)
| | - Jordan P McPherson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- College of Pharmacy, University of Utah, Salt Lake City, UT
| | - Anna C Beck
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jia-Wen Guo
- College of Nursing, University of Utah, Salt Lake City, UT
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Carolyn H Scheese
- College of Nursing, University of Utah, Salt Lake City, UT
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Naomi R Flake
- Clinical & Translational Science Institute, University of Utah, Salt Lake City, UT
| | | | - Catherine J Staes
- College of Nursing, University of Utah, Salt Lake City, UT
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| |
Collapse
|
2
|
Tran A, Weigel RJ, Beck AC. ATA risk stratification in papillary thyroid microcarcinoma has low positive predictive value when identifying recurrence. Am J Surg 2024; 229:106-110. [PMID: 37968147 DOI: 10.1016/j.amjsurg.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/25/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Rising incidence of papillary thyroid microcarcinomas (PTMC) has raised concerns for overdiagnosis. Utility of the American Thyroid Association Risk Stratification System (ATA-RSS) 2015 in predicting risk of disease recurrence in patients with PTMC was assessed. METHODS Electronic health records of patients who underwent total thyroidectomy were queried. ATA-RSS 2015 risk stratification was performed on those with PTMC, and validity for predicting disease recurrence was calculated. RESULTS With 10-year median follow up, recurrence was higher in PTMC patients with high/intermediate vs low ATA risk (33 % vs 4 %, p = 0.002). Sensitivity of ATA-RSS for detecting recurrence was 60 %, specificity 90 %, PPV 33.3 %, NPV 96.6 %, and accuracy 88 %. When microscopic extrathyroidal extension (ETE) was excluded as an intermediate risk criterion, PPV improved to 50 % and accuracy improved to 92.5 % CONCLUSIONS: ATA-RSS 2015 predicts recurrence in PTMC with high NPV but low PPV. Exclusion of microscopic ETE improved PPV, which may help prevent overtreatment.
Collapse
Affiliation(s)
- Andy Tran
- University of Iowa Carver College of Medicine, USA
| | - Ronald J Weigel
- University of Iowa Hospitals and Clinics, Department of Surgery, USA
| | - Anna C Beck
- University of Iowa Hospitals and Clinics, Department of Surgery, USA; University of Wisconsin School of Medicine and Public Health, Department of Surgery, USA.
| |
Collapse
|
3
|
Staes CJ, Beck AC, Chalkidis G, Scheese CH, Taft T, Guo JW, Newman MG, Kawamoto K, Sloss EA, McPherson JP. Design of an interface to communicate artificial intelligence-based prognosis for patients with advanced solid tumors: a user-centered approach. J Am Med Inform Assoc 2023; 31:174-187. [PMID: 37847666 PMCID: PMC10746322 DOI: 10.1093/jamia/ocad201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES To design an interface to support communication of machine learning (ML)-based prognosis for patients with advanced solid tumors, incorporating oncologists' needs and feedback throughout design. MATERIALS AND METHODS Using an interdisciplinary user-centered design approach, we performed 5 rounds of iterative design to refine an interface, involving expert review based on usability heuristics, input from a color-blind adult, and 13 individual semi-structured interviews with oncologists. Individual interviews included patient vignettes and a series of interfaces populated with representative patient data and predicted survival for each treatment decision point when a new line of therapy (LoT) was being considered. Ongoing feedback informed design decisions, and directed qualitative content analysis of interview transcripts was used to evaluate usability and identify enhancement requirements. RESULTS Design processes resulted in an interface with 7 sections, each addressing user-focused questions, supporting oncologists to "tell a story" as they discuss prognosis during a clinical encounter. The iteratively enhanced interface both triggered and reflected design decisions relevant when attempting to communicate ML-based prognosis, and exposed misassumptions. Clinicians requested enhancements that emphasized interpretability over explainability. Qualitative findings confirmed that previously identified issues were resolved and clarified necessary enhancements (eg, use months not days) and concerns about usability and trust (eg, address LoT received elsewhere). Appropriate use should be in the context of a conversation with an oncologist. CONCLUSION User-centered design, ongoing clinical input, and a visualization to communicate ML-related outcomes are important elements for designing any decision support tool enabled by artificial intelligence, particularly when communicating prognosis risk.
Collapse
Affiliation(s)
- Catherine J Staes
- College of Nursing, University of Utah, Salt Lake City, UT 84112, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Anna C Beck
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, United States
| | - George Chalkidis
- Healthcare IT Research Department, Center for Digital Services, Hitachi Ltd., Tokyo, Japan
| | - Carolyn H Scheese
- College of Nursing, University of Utah, Salt Lake City, UT 84112, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Teresa Taft
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Jia-Wen Guo
- College of Nursing, University of Utah, Salt Lake City, UT 84112, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Michael G Newman
- Department of Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT 84112, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Elizabeth A Sloss
- College of Nursing, University of Utah, Salt Lake City, UT 84112, United States
| | - Jordan P McPherson
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84108, United States
- Department of Pharmacy, Huntsman Cancer Institute, Salt Lake City, UT 84112, United States
| |
Collapse
|
4
|
Beck AC, Bayard S, Plitas G, Sevilimedu V, Kuba MG, Garcia P, Morrow M, Tadros AB. Does Non-Classic Lobular Carcinoma In Situ at the Lumpectomy Margin Increase Local Recurrence? Ann Surg Oncol 2023; 30:6061-6069. [PMID: 37493892 DOI: 10.1245/s10434-023-13899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The clinical significance of nonclassic, lobular carcinoma in situ (NC-LCIS) at the surgical margin of excisions for invasive cancer is unknown. We sought to determine whether NC-LCIS at or near the margin in the setting of a concurrent invasive carcinoma is associated with risk of ipsilateral breast tumor recurrence (IBTR) and locoregional recurrence (LRR). METHODS Patients with stage 0-III breast cancer and NC-LCIS who underwent lumpectomy between January 2010 and January 2022 at a single institution were retrospectively identified. NC-LCIS margins were stratified as <2 mm, ≥2 mm, or within shave margin. Rates of IBTR and LRR were examined. RESULTS A total of 511 female patients (median age 60 years [interquartile range (IQR) 52-69]) with NC-LCIS and an associated ipsilateral breast cancer with a median follow-up of 3.4 years (IQR 2.0-5.9) were identified. Final margins for NC-LCIS were ≥2 mm in 348 patients (68%), <2 mm in 37 (7.2%), and within shave margin in 126 (24.6%). Crude incidence of IBTR was 3.3% (n = 17) and that of LRR was 4.9% (n = 25). There was no difference in the crude rate of IBTR by NC-LCIS margin status (IBTR rate: 3.7% ≥2 mm, 0% <2 mm, 3.2% within shave margin, p = 0.8) nor in LRR (LRR rate: 4.9% ≥2 mm, 2.7% <2 mm, 5.6% within shave margin, p = 0.9). CONCLUSIONS For completely excised invasive breast cancers associated with NC-LCIS, extent of margin width for NC-LCIS was not associated with a difference in IBTR or LRR. These data suggest that the decision to perform reexcision of margin after lumpectomy should be driven by the invasive cancer, rather than the NC-LCIS margin.
Collapse
Affiliation(s)
- Anna C Beck
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Solange Bayard
- Department of Surgery, Weill Cornell Medical Center, New York, NY, USA
| | - George Plitas
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Gabriela Kuba
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paula Garcia
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
5
|
Thomas Hebdon MC, Xu J, Beck AC, Cloyes KG, Mooney K, Reblin M, Lyn Tay D, Cleary C, Ellington L. Caregiver Burden and Workplace Productivity Among Hospice Cancer Caregivers. Oncol Nurs Forum 2023; 50:665-670. [PMID: 37677767 DOI: 10.1188/23.onf.665-670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES To examine the relationships among family caregiver burden and workplace productivity and activity impairment among home hospice family caregivers of individuals with cancer who worked while providing end-of-life caregiving. SAMPLE & SETTING Baseline data from a longitudinal study of communication between hospice providers and hospice family caregivers were used for this secondary analysis. METHODS & VARIABLES Working family caregivers with complete workplace productivity and activity impairment data were included in this analysis (N = 30). Demographic data, caregiver burden, and workplace productivity and activity impairment were examined with descriptive statistics, correlation analysis, and hierarchical linear regressions. RESULTS Hospice family caregivers were primarily White, female, married, and employed full-time. Caregiver burden levels were significantly positively associated with activity impairment, presenteeism, and work productivity loss. These relationships remained statistically significant when controlling for age. IMPLICATIONS FOR NURSING Hospice and oncology nurses can support working hospice family caregivers by assessing for burden and associated workplace challenges, as well as by providing referrals for respite and community resources.
Collapse
|
6
|
Beck AC, Morrow M. Axillary lymph node dissection: Dead or still alive? Breast 2023; 69:469-475. [PMID: 36702672 PMCID: PMC10300611 DOI: 10.1016/j.breast.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 01/24/2023] Open
Abstract
Although sentinel lymph node biopsy is now the primary method of axillary staging and is therapeutic for patients with limited nodal disease, axillary lymph node dissection (ALND) is still necessary for staging in groups where sentinel lymph node biopsy has not been proven to be accurate and to maintain local control in those with a heavy axillary tumor burden. Additionally, newer approaches to systemic therapy tailored to risk level sometimes necessitate knowledge of the number of involved axillary nodes which can only be obtained with ALND. Ongoing trials will address whether there are additional circumstances where radiotherapy can replace ALND.
Collapse
Affiliation(s)
- Anna C Beck
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
| |
Collapse
|
7
|
Fuller T, Hendrick J, Beck AC. Undue Influence versus Relational Autonomy in Clinical Decision Making #439. J Palliat Med 2022; 25:996-997. [PMID: 35647638 DOI: 10.1089/jpm.2022.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy Fuller
- Fast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin) and Associate Editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts are available at PCNOW with contact information, and how to reference Fast Facts
| | - John Hendrick
- Fast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin) and Associate Editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts are available at PCNOW with contact information, and how to reference Fast Facts
| | - Anna C Beck
- Fast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin) and Associate Editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts are available at PCNOW with contact information, and how to reference Fast Facts
| |
Collapse
|
8
|
Bleicher J, McGuire LE, Robbins RB, Johnson JE, Fischbuch S, Gupta S, Beck AC, Cohan JN. Preoperative Advance Care Planning for Older Adults Undergoing Major Abdominal Surgery. Am J Hosp Palliat Care 2022; 39:406-412. [PMID: 34047202 PMCID: PMC10512745 DOI: 10.1177/10499091211020276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) is recommended for older patients undergoing surgery. ACP consists of creating advance directives (ADs), identifying surrogate decision makers (SDMs), and documenting goals of care. We identified factors associated with documentation of preoperative ACP to identify opportunities to optimize ACP for older surgical patients. METHODS This was a retrospective study of surgical patients ≥70 years old who underwent elective, high-risk abdominal procedures between 01/2015-08/2019. Clinical data were obtained from our institution's National Surgical Quality Improvement Project database. ACP metrics were extracted from the electronic medical record. We analyzed the data to identify patient factors associated with ACP metrics. We also analyzed whether ACP was more frequent for patients who experienced postoperative complications or death. RESULTS 267/1,651 patients were included. 97 patients (36%) had an AD available on the day of surgery, 57 (21%) had an SDM identified, and 31 (12%) had a documented goals of care conversation. On multivariable analysis, older age and white race were associated with an increased likelihood of having an AD available on the day of surgery. Women were 1.7 times more likely to have an SDM (p = 0.02). No patient or surgeon factors were significantly associated with goals of care documentation. ACP was not performed more frequently in patients who experienced postoperative complications or death. CONCLUSION In this series, ACP was not routinely documented for older patients undergoing major surgery. ACP was not more frequent in patients who experienced complications or death, demonstrating the importance of universal preoperative ACP in older patients.
Collapse
Affiliation(s)
- Josh Bleicher
- University of Utah, Department of Surgery, Salt Lake City, Utah
| | | | | | | | - Sarah Fischbuch
- Huntsman Cancer Institute at the University of Utah, Department of Population Sciences, Salt Lake City, Utah
| | - Sumati Gupta
- Huntsman Cancer Institute at the University of Utah, Department of Medical Oncology, Salt Lake City, Utah
| | - Anna C. Beck
- Huntsman Cancer Institute at the University of Utah, Department of Medical Oncology, Salt Lake City, Utah
| | | |
Collapse
|
9
|
Guillen KP, Fujita M, Butterfield AJ, Scherer SD, Bailey MH, Chu Z, DeRose YS, Zhao L, Cortes-Sanchez E, Yang CH, Toner J, Wang G, Qiao Y, Huang X, Greenland JA, Vahrenkamp JM, Lum DH, Factor RE, Nelson EW, Matsen CB, Poretta JM, Rosenthal R, Beck AC, Buys SS, Vaklavas C, Ward JH, Jensen RL, Jones KB, Li Z, Oesterreich S, Dobrolecki LE, Pathi SS, Woo XY, Berrett KC, Wadsworth ME, Chuang JH, Lewis MT, Marth GT, Gertz J, Varley KE, Welm BE, Welm AL. A human breast cancer-derived xenograft and organoid platform for drug discovery and precision oncology. Nat Cancer 2022; 3:232-250. [PMID: 35221336 PMCID: PMC8882468 DOI: 10.1038/s43018-022-00337-6] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022]
Abstract
Models that recapitulate the complexity of human tumors are urgently needed to develop more effective cancer therapies. We report a bank of human patient-derived xenografts (PDXs) and matched organoid cultures from tumors that represent the greatest unmet need: endocrine-resistant, treatment-refractory and metastatic breast cancers. We leverage matched PDXs and PDX-derived organoids (PDxO) for drug screening that is feasible and cost-effective with in vivo validation. Moreover, we demonstrate the feasibility of using these models for precision oncology in real time with clinical care in a case of triple-negative breast cancer (TNBC) with early metastatic recurrence. Our results uncovered a Food and Drug Administration (FDA)-approved drug with high efficacy against the models. Treatment with this therapy resulted in a complete response for the individual and a progression-free survival (PFS) period more than three times longer than their previous therapies. This work provides valuable methods and resources for functional precision medicine and drug development for human breast cancer. Welm and colleagues present a biobank of human-derived xenografts and organoids and demonstrate its value for high-throughput drug screening and applied precision medicine.
Collapse
Affiliation(s)
- Katrin P Guillen
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Maihi Fujita
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Andrew J Butterfield
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Sandra D Scherer
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Matthew H Bailey
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Zhengtao Chu
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Yoko S DeRose
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Ling Zhao
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Emilio Cortes-Sanchez
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Chieh-Hsiang Yang
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Toner
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Guoying Wang
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Yi Qiao
- Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Xiaomeng Huang
- Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Jeffery A Greenland
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jeffery M Vahrenkamp
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - David H Lum
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Rachel E Factor
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Edward W Nelson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Cindy B Matsen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jane M Poretta
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Regina Rosenthal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Anna C Beck
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Medical Oncology, University of Utah, Salt Lake City, UT, USA
| | - Saundra S Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Medical Oncology, University of Utah, Salt Lake City, UT, USA
| | - Christos Vaklavas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Medical Oncology, University of Utah, Salt Lake City, UT, USA
| | - John H Ward
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Medical Oncology, University of Utah, Salt Lake City, UT, USA
| | - Randy L Jensen
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Kevin B Jones
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Zheqi Li
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, PA, USA
| | - Steffi Oesterreich
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, PA, USA
| | - Lacey E Dobrolecki
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
| | - Satya S Pathi
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Xing Yi Woo
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Kristofer C Berrett
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Mark E Wadsworth
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey H Chuang
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA.,Department of Genetics and Genome Sciences, UCONN-Health, Farmington, CT, USA
| | - Michael T Lewis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
| | - Gabor T Marth
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Jason Gertz
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Katherine E Varley
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Bryan E Welm
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. .,Department of Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Alana L Welm
- Department of Oncological Sciences, University of Utah, Salt Lake City, UT, USA. .,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
10
|
Tay DL, Iacob E, Reblin M, Cloyes KG, Jones M, Hebdon MCT, Mooney K, Beck AC, Ellington L. What contextual factors account for anxiety and depressed mood in hospice family caregivers? Psychooncology 2022; 31:316-325. [PMID: 34510631 PMCID: PMC8818016 DOI: 10.1002/pon.5816] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE End-of-life caregiving is associated with poorer mental health compared with other caregiving. The objective of this study was to examine the association between contextual characteristics and appraisal factors on family caregivers' mental health and well-being. METHODS Family hospice caregivers were recruited across four states using a non-probabilistic sampling approach. This study analyzed contextual (demographic, caregiving, economic) and appraisal factors (Medical Outcomes Study Social Support Survey, Zarit Burden Interview) on caregivers' anxiety and depression (Hospital Anxiety and Depression scale, and positive affect and well-being (Positive Affect and Well-being Scale). Hierarchical linear regression models were generated in SPSS version 24. RESULTS Data from 102 family caregivers were analyzed. On average, participants were 58.93 years of age (SD = 14.24), mostly female (72.55%), spouses/partners (51.96%), and non-Hispanic White (78.43%). Most (75.49%) described their financial situation as comfortable or more than adequate. Younger age (B = -0.11, 95% CI = -0.18 to -0.05) and increased caregiving burden (B = 0.18, 95% CI = 0.09 to 0.27) were associated with increased anxiety, while lower perceived financial adequacy (B = -1.19, 95% CI = -2.07 to -0.32), lower social support (B = -0.04, 95% CI = -0.06 to -0.01), and increased caregiving burden (B = 0.15, 95% CI = 0.08-0.22) were associated with worsened depression. Greater social support (B = 0.10, 95% CI = 0.05-0.14) and lower caregiving burden (B = -0.19, 95% CI = -0.32 to -0.07) were associated with greater positive affect and well-being. CONCLUSIONS Findings suggest significant impact of contextual factors on mental health and well-being, and support the need for holistic assessment of hospice caregivers' wellbeing and programs and policies providing social services and economic support to caregivers.
Collapse
Affiliation(s)
| | - Eli Iacob
- College of Nursing, University of Utah, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, USA
| | | | - Miranda Jones
- Department of Psychology, University of Michigan, USA
| | | | | | | | | |
Collapse
|
11
|
Guo JW, Reblin M, Tay D, Ellington L, Beck AC, Cloyes KG. Patterns of stress and support in social support networks of in-home hospice cancer family caregivers. J Soc Pers Relat 2021; 38:3121-3141. [PMID: 34898795 PMCID: PMC8664070 DOI: 10.1177/02654075211024743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Family caregivers of home hospice cancer patients often experience burden and distress, which can be mitigated by perceived social support. However, less attention has been paid to the non-family sources of support within social networks, or to how sources of support may also be sources of stress. We describe support and stress in social networks of hospice family caregivers and identify caregiving characteristics associated with classes identified in our data. We collected demographic and psychosocial self-report data from family caregivers providing in-home hospice care for advanced cancer patients (N = 90). Caregivers also reported perceived support and stress from specific family and non-family relationships. We identified three classes with unique patterns of stress and support within caregivers' support networks using a latent class analysis. Classes include: 1) high support, low stress across family and non-family network members ("supportive"; 53% of caregivers); 2) high support, high stress across family and non-family network ("ambivalent maximizers"; 26%); and 3) high support, high stress across family network only ("family-focused ambivalent"; 21%). Caregivers in the ambivalent maximizer class reported more burden than caregivers in the supportive class (p = .024). This is one of the first studies to systematically explore the role of non-family support, as well as how stress and support co-occur within relationships and across networks. As informal support networks of hospice family caregivers are complex and multifaceted, understanding the patterns of support and stress across various network members is essential to offer services to more effectively manage caregiver burden.
Collapse
Affiliation(s)
| | | | - Djin Tay
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Lee Ellington
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Anna C. Beck
- 1. University of Utah School of Medicine, Medical Oncology, 30 North 1900 East, Salt Lake City, UT, USA 84132; 2. University of Utah Health Huntsman Cancer Institute, Supportive Oncology and Survivorship, 1950 Circle of Hope, Salt Lake City, UT, USA 84112
| | - Kristin G Cloyes
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| |
Collapse
|
12
|
Spanheimer PM, Bashir A, Lorenzen AW, Beck AC, Liao J, Lizarraga IM, Erdahl LM, Sugg SL, Karwal MW, Weigel RJ. A Pilot Study of Preoperative Vandetanib on Markers of Proliferation and Apoptosis in Breast Cancer. Am J Clin Oncol 2021; 44:456-462. [PMID: 34190716 PMCID: PMC8387410 DOI: 10.1097/coc.0000000000000845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Preclinical data supports antitumor activity of tyrosine kinase inhibitor vandetanib with Ret as the therapeutic target in breast cancer. We investigated the effect of preoperative vandetanib on markers of proliferation and apoptosis in breast cancer. METHODS Patients with invasive breast cancer were randomly assigned vandetanib 300 mg or placebo PO daily for 2 weeks before operative resection from January 2014 to June 2017. Pretreatment and posttreatment specimens were analyzed by immunohistochemistry for Ki-67, TUNEL, and p-ERK with stratification by Ret expression by immunohistochemistry. RESULTS Ten patients were enrolled. There was no statistically significant difference in ERK activation compared with placebo (P=0.45); however, ERK activation was reduced 74% compared with pretreatment biopsy with vandetinib treatment (P=0.005) without a significant reduction in the placebo group (-29%, P=0.55). Mean change in Ki-67 after vandetanib treatment was +0.3% compared with +2.0% in placebo treated patients, P=0.72. Mean change in TUNEL was +0.48 apoptotic nuclei per HPF in the vandetanib arm compared with +1.02 in the placebo arm, P=0.32. In vandetanib treated patients, Ki-67 was reduced 0.3% in RET-positive tumors compared with increased 1.0% in RET-negative tumors, P=0.43 and TUNEL was increased 0.77 in RET-positive tumors and 0.2 in RET-negative tumors, P=0.21. CONCLUSIONS In this pilot study, no statistically significant differences on prespecified markers were seen with vandetanib compared with placebo. In accordance with the investigational hypothesis, there was a nonsignificant trend with vandetanib treatment of reduction in p-ERK and increased effects in Ret expressing tumors.
Collapse
Affiliation(s)
- Philip M. Spanheimer
- Department of Surgery and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Amani Bashir
- Department of Pathology, University of Iowa, Iowa City, IA
| | | | - Anna C. Beck
- Department of Surgery, University of Iowa, Iowa City, IA
| | - Junlin Liao
- Department of Surgery, University of Iowa, Iowa City, IA
| | | | | | - Sonia L. Sugg
- Department of Surgery, University of Iowa, Iowa City, IA
| | - Mark W. Karwal
- Department of Medicine, University of Iowa, Iowa City, IA
| | | |
Collapse
|
13
|
Beck AC, Rajan A, Landers S, Kelley S, Bellizzi AM, Lal G, Sugg SL, Howe JR, Chan CH, Weigel RJ. Expression of cancer stem cell markers in tall cell variant papillary thyroid cancer identifies a molecular profile predictive of recurrence in classic papillary thyroid cancer. Surgery 2021; 171:245-251. [PMID: 34362588 DOI: 10.1016/j.surg.2021.03.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Tall cell variant of papillary thyroid carcinoma is an aggressive subtype of papillary thyroid carcinoma. We examined expression of cancer stem cell markers in tall cell variant compared with other well-differentiated thyroid cancers. METHODS Expression of cancer stem cell markers was examined in 572 thyroid tumors from The Cancer Genome Atlas Thyroid Cancer database and tall cell variant and papillary thyroid carcinoma tumors by immunohistochemistry. RESULTS Expression of the PROM1 gene, encoding the cancer stem cell marker CD133, was elevated in tall cell variant compared to classic papillary thyroid carcinoma in a large cohort of unmatched samples from The Cancer Genome Atlas Thyroid Cancer database (P < .001). By immunohistochemistry in age and stage matched samples, CD133 protein was confirmed to be significantly increased in tall cell variant versus classic papillary thyroid carcinoma (P = .006). Analyzing all thyroid cancers, high PROM1 expression was associated with worse disease-specific survival. Optimal cutoffs were determined to define a tall cell variant-like cancer stem cell signature characterized by high PROM1, high ALDH1A3, and low CD24 expression. Classic papillary thyroid carcinoma with a tall cell variant-like gene signature had worse recurrence disease-free survival compared to classic papillary thyroid carcinoma with a non-tall cell variant signature (P = .02). CONCLUSION Tall cell variant of papillary thyroid carcinoma has increased expression of cancer stem cell markers compared to classic papillary thyroid carcinoma. The tall cell variant-like cancer stem cell gene signature identified a molecular subtype of classic papillary thyroid carcinoma that has a worse recurrence-free survival.
Collapse
Affiliation(s)
- Anna C Beck
- University of Iowa, Department of Surgery, Iowa City, IA. https://twitter.com/beck_md
| | - Anand Rajan
- University of Iowa, Department of Pathology, Iowa City, IA
| | | | - Sarah Kelley
- University of Iowa, Department of Surgery, Iowa City, IA
| | - Andrew M Bellizzi
- University of Iowa, Department of Pathology, Iowa City, IA. https://twitter.com/IHC_guy
| | - Geeta Lal
- University of Iowa, Department of Surgery, Iowa City, IA. https://twitter.com/GeetaLalMD
| | - Sonia L Sugg
- University of Iowa, Department of Surgery, Iowa City, IA. https://twitter.com/SoniaLSugg
| | - James R Howe
- University of Iowa, Department of Surgery, Iowa City, IA
| | - Carlos H Chan
- University of Iowa, Department of Surgery, Iowa City, IA. https://twitter.com/CarlosHFChan
| | | |
Collapse
|
14
|
Tay DL, Thompson C, Jones M, Gettens C, Cloyes KG, Reblin M, Thomas Hebdon MC, Beck AC, Mooney K, Ellington L. "I Feel All Alone Out Here": Analysis of Audio Diaries of Bereaved Hospice Family Caregivers During the COVID-19 Pandemic. J Hosp Palliat Nurs 2021; 23:346-353. [PMID: 33660671 PMCID: PMC8243771 DOI: 10.1097/njh.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The COVID-19 pandemic has dramatically changed social life. This secondary qualitative analysis aimed to better understand the impact of the pandemic on bereaved hospice family caregivers' experiences of social connection and isolation in a time of social distancing and general anxiety. Six caregivers in 3 states recorded audio diaries (N = 59) between March 13 and May 15, 2020. Caregivers were, on average, 56.80 years old (SD, 14.22; range, 32-67 years old) and consisted of spouses (n = 2), adult children (n = 3), and a sibling (n = 1). Using NVIVO 12, caregiver diaries were coded for (1) "social connection" (n = 23), defined as being able to access or seeking informal or formal social support networks; (2) "isolation" (n = 17), defined as being unable or reluctant to access informal or formal social support networks, or feeling alone; and (3) "bereavement processes" (n = 147), informed by the dual process model of bereavement (restoration and loss-oriented stressors). Content analysis revealed that caregivers were able to connect with others despite physical distancing expectations, expressed loneliness and grief while in isolation, and described moving on in the face of uncertainty. Findings provide insight into how caregivers experienced bereavement during the initial period of the pandemic and highlight implications for hospice bereavement services.
Collapse
|
15
|
Dans M, Kutner JS, Agarwal R, Baker JN, Bauman JR, Beck AC, Campbell TC, Carey EC, Case AA, Dalal S, Doberman DJ, Epstein AS, Fecher L, Jones J, Kapo J, Lee RT, Loggers ET, McCammon S, Mitchell W, Ogunseitan AB, Portman DG, Ramchandran K, Sutton L, Temel J, Teply ML, Terauchi SY, Thomas J, Walling AM, Zachariah F, Bergman MA, Ogba N, Campbell M. NCCN Guidelines® Insights: Palliative Care, Version 2.2021. J Natl Compr Canc Netw 2021; 19:780-788. [PMID: 34340208 DOI: 10.6004/jnccn.2021.0033] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Palliative care has evolved to be an integral part of comprehensive cancer care with the goal of early intervention to improve quality of life and patient outcomes. The NCCN Guidelines for Palliative Care provide recommendations to help the primary oncology team promote the best quality of life possible throughout the illness trajectory for each patient with cancer. The NCCN Palliative Care Panel meets annually to evaluate and update recommendations based on panel members' clinical expertise and emerging scientific data. These NCCN Guidelines Insights summarize the panel's recent discussions and highlights updates on the importance of fostering adaptive coping strategies for patients and families, and on the role of pharmacologic and nonpharmacologic interventions to optimize symptom management.
Collapse
Affiliation(s)
- Maria Dans
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Justin N Baker
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Anna C Beck
- Huntsman Cancer Institute at the University of Utah
| | | | | | - Amy A Case
- Roswell Park Comprehensive Cancer Center
| | | | | | | | | | - Joshua Jones
- Abramson Cancer Center at the University of Pennsylvania
| | | | - Richard T Lee
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Kelley S, Beck AC, Weigel RJ, Howe JR, Sugg SL, Lal G. Influence of endocrine multidisciplinary tumor board on patient management and treatment decision making. Am J Surg 2021; 223:76-80. [PMID: 34303521 DOI: 10.1016/j.amjsurg.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multidisciplinary Tumor Boards (MDT) are used to obtain input regarding cancer management. This study assessed the impact of our institutional Endocrine MDT. METHODS MDT notes on patients with thyroid cancer treated during 2012-2018 were abstracted retrospectively from the electronic medical record. Management change (MC) was prospectively collected by the MDT coordinator. Biannual evaluations reviewed the impact of the MDT as observed by attendees. RESULTS MC was recommended in 47 (15%) of 286 presentations, with additional imaging being the most frequent (43%). Presentation of recurrences were more likely to result in MC (24% vs. 13% initial, p = 0.03). Overall, 98% of attendees found the conference exceeded educational expectations. About 24% reported intending to use a more evidence/guideline-based approach after attending and this trend increased over time (p = 0.002). CONCLUSION MDT presentations led to a higher rate of MC particularly in recurrent TC patients and increased evidenced-based practice for attendees.
Collapse
Affiliation(s)
- Sarah Kelley
- University of Iowa Hospitals and Clinics, Department of Internal Medicine, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Anna C Beck
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Ronald J Weigel
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - James R Howe
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Sonia L Sugg
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Geeta Lal
- University of Iowa Hospitals and Clinics, Department of Surgery, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
| |
Collapse
|
17
|
White JR, Thompson DT, Koch KE, Kiriazov BS, Beck AC, van der Heide DM, Grimm BG, Kulak MV, Weigel RJ. AP-2α-Mediated Activation of E2F and EZH2 Drives Melanoma Metastasis. Cancer Res 2021; 81:4455-4470. [PMID: 34210752 DOI: 10.1158/0008-5472.can-21-0772] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/09/2021] [Accepted: 06/29/2021] [Indexed: 12/13/2022]
Abstract
In melanoma metastasis, the role of the AP-2α transcription factor, which is encoded by TFAP2A, is controversial as some findings have suggested tumor suppressor activity while other studies have shown high TFAP2A expression in node-positive melanoma associated with poor prognosis. Here we demonstrate that AP-2α facilitates melanoma metastasis through transcriptional activation of genes within the E2F pathway including EZH2. A BioID screen found that AP-2α interacts with members of the nucleosome remodeling and deacetylase (NuRD) complex. Loss of AP-2α removed activating chromatin marks in the promoters of EZH2 and other E2F target genes through activation of the NuRD repression complex. In melanoma cells, treatment with tazemetostat, an FDA-approved and highly specific EZH2 inhibitor, substantially reduced anchorage-independent colony formation and demonstrated heritable antimetastatic effects, which were dependent on AP-2α. Single-cell RNA sequencing analysis of a metastatic melanoma mouse model revealed hyperexpansion of Tfap2a High/E2F-activated cell populations in transformed melanoma relative to progenitor melanocyte stem cells. These findings demonstrate that melanoma metastasis is driven by the AP-2α/EZH2 pathway and suggest that AP-2α expression can be used as a biomarker to predict responsiveness to EZH2 inhibitors for the treatment of advanced melanomas. SIGNIFICANCE: AP-2α drives melanoma metastasis by upregulating E2F pathway genes including EZH2 through inhibition of the NuRD repression complex, serving as a biomarker to predict responsiveness to EZH2 inhibitors.
Collapse
Affiliation(s)
| | | | - Kelsey E Koch
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | | | - Anna C Beck
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | | | | | | | | |
Collapse
|
18
|
Mooney K, Titchener K, Haaland B, Coombs LA, O'Neil B, Nelson R, McPherson JP, Kirchhoff AC, Beck AC, Ward JH. Evaluation of Oncology Hospital at Home: Unplanned Health Care Utilization and Costs in the Huntsman at Home Real-World Trial. J Clin Oncol 2021; 39:2586-2593. [PMID: 33999660 DOI: 10.1200/jco.20.03609] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Patients with cancer experience high rates of morbidity and unplanned health care utilization and may benefit from new models of care. We evaluated an adult oncology hospital at home program's rate of unplanned hospitalizations and health care costs and secondarily, emergency department (ED) use, length of hospital stays, and intensive care unit (ICU) admissions during the 30 days after enrollment. METHODS We conducted a prospective, nonrandomized, real-world cohort comparison of 367 hospitalized patients with cancer-169 patients consecutively admitted after hospital discharge to Huntsman at Home (HH), a hospital-at-home program, compared with 198 usual care patients concurrently identified at hospital discharge. All patients met clinical criteria for HH admission, but those in usual care lived outside the HH service area. Primary outcomes were the number of unplanned hospitalizations and costs during the 30 days after enrollment. Secondary outcomes included length of hospital stays, ICU admissions, and ED visits during the 30 days after enrollment. RESULTS Groups were comparable except that more women received HH care. In propensity-weighted analyses, the odds of unplanned hospitalizations was reduced in the HH group by 55% (odds ratio, 0.45, 95% CI, 0.29 to 0.70; P < .001) and health care costs were 47% lower (mean cost ratio, 0.53; 95% CI, 0.39 to 0.72; P < .001) over the 30-day period. Secondary outcomes also favored HH. Total hospital stay days were reduced by 1.1 days (P = .004) and ED visits were reduced by 45% (odds ratio, 0.55; 95% CI, 0.33 to 0.92; P = .022). There was no evidence of a difference in ICU admissions (P = .972). CONCLUSION This oncology hospital at home program shows initial promise as a model for oncology care that may lower unplanned health care utilization and health care costs.
Collapse
Affiliation(s)
- Kathi Mooney
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Karen Titchener
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Lorinda A Coombs
- School of Nursing, University of North Carolina, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Brock O'Neil
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Richard Nelson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Anna C Beck
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - John H Ward
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| |
Collapse
|
19
|
Beck AC, Cho E, White JR, Paemka L, Li T, Gu VW, Thompson DT, Koch KE, Franke C, Gosse M, Wu VT, Landers SR, Pamatmat AJ, Kulak MV, Weigel RJ. AP-2α Regulates S-Phase and Is a Marker for Sensitivity to PI3K Inhibitor Buparlisib in Colon Cancer. Mol Cancer Res 2021; 19:1156-1167. [PMID: 33753551 DOI: 10.1158/1541-7786.mcr-20-0867] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/21/2021] [Accepted: 03/16/2021] [Indexed: 01/22/2023]
Abstract
Activating protein 2 alpha (AP-2α; encoded by TFAP2A) functions as a tumor suppressor and influences response to therapy in several cancer types. We aimed to characterize regulation of the transcriptome by AP-2α in colon cancer. CRISPR-Cas9 and short hairpin RNA were used to eliminate TFAP2A expression in HCT116 and a panel of colon cancer cell lines. AP-2α target genes were identified with RNA sequencing and chromatin immunoprecipitation sequencing. Effects on cell cycle were characterized in cells synchronized with aphidicolin and analyzed by FACS and Premo FUCCI. Effects on invasion and tumorigenesis were determined by invasion assay, growth of xenografts, and phosphorylated histone H3 (PHH3). Knockout of TFAP2A induced significant alterations in the transcriptome including repression of TGM2, identified as a primary gene target of AP-2α. Loss of AP-2α delayed progression through S-phase into G2-M and decreased phosphorylation of AKT, effects that were mediated through regulation of TGM2. Buparlisib (BKM120) repressed in vitro invasiveness of HCT116 and a panel of colon cancer cell lines; however, loss of AP-2α induced resistance to buparlisib. Similarly, buparlisib repressed PHH3 and growth of tumor xenografts and increased overall survival of tumor-bearing mice, whereas, loss of AP-2α induced resistance to the effect of PI3K inhibition. Loss of AP-2α in colon cancer leads to prolonged S-phase through altered activation of AKT leading to resistance to the PI3K inhibitor, Buparlisib. The findings demonstrate an important role for AP-2α in regulating progression through the cell cycle and indicates that AP-2α is a marker for response to PI3K inhibitors. IMPLICATIONS: AP-2α regulated cell cycle through the PI3K cascade and activation of AKT mediated through TGM2. AP-2α induced sensitivity to Buparlisib/BKM120, indicating that AP-2α is a biomarker predictive of response to PI3K inhibitors.
Collapse
Affiliation(s)
- Anna C Beck
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Edward Cho
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | | | - Lily Paemka
- Department of Surgery, University of Iowa, Iowa City, Iowa.,Department of Biochemistry, Cell and Molecular Biology, West African Center for Cell Biology of Infectious Pathogens, School of Biological Sciences, College of Basic and Applied Science University of Ghana, Accra, Ghana
| | - Tiandao Li
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Vivian W Gu
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | | | - Kelsey E Koch
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | | | - Matthew Gosse
- Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Vincent T Wu
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | | | | | | | | |
Collapse
|
20
|
Beck AC, Goffredo P, Gao X, McGonagill PW, Weigel RJ, Hassan I. Unanticipated Admission Following Outpatient Laparoscopic Cholecystectomy: Identifying Opportunities for Improvement. Am Surg 2020; 87:1080-1086. [PMID: 33316162 DOI: 10.1177/0003134820956347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unanticipated admissions are a burden to the health care system. Over 400 000 outpatient laparoscopic cholecystectomies (LCs) are performed annually in the United States. The aim of this study is to identify causes of unanticipated admissions and modifiable risk factors. METHODS Patients undergoing elective outpatient LCs were identified from the 2013-2015 American College of Surgeons National Surgical Quality Improvement Program database. RESULTS A total of 69 376 patients underwent outpatient LC or LC+ intraoperative cholangiogram (IOC); 2027 (2.9%) were admitted after a median of 5 days (interquartile range 3-8). Admission rates varied by preoperative indications: pancreatitis (4.9%), gallstones with obstruction (3.9%), cholecystitis (3.0%), and gallstones without obstruction (2.6%) (P = .003). The most frequent causes were infection, retained stones, and other GI complications. Patients admitted for infection or cardiopulmonary complications were older with higher American Society of Anesthesiologists (ASA) (P < .01), while patients with pain and retained stones were younger with lower ASA (P < .01). Patients who underwent LC+IOC had a lower admission rate due to retained stones (.17% vs. .31% LC, P = .006). CONCLUSIONS Unanticipated admissions following outpatient LC occur infrequently for diverse reasons usually within the first week after surgery. Associated factors are patient and disease related and not at all modifiable. In selected patients, increased IOC use may decrease admissions from retained stones.
Collapse
Affiliation(s)
- Anna C Beck
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Paolo Goffredo
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Xiang Gao
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Patrick W McGonagill
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ronald J Weigel
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Imran Hassan
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
21
|
Beck AC, Sugg SL, Weigel RJ, Belding-Schmitt M, Howe JR, Lal G. Racial disparities in comorbid conditions among patients undergoing thyroidectomy for Graves' disease: An ACS-NSQIP analysis. Am J Surg 2020; 221:106-110. [PMID: 32553518 DOI: 10.1016/j.amjsurg.2020.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/08/2020] [Accepted: 05/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies indicate that racial disparities exist in the presentation and outcomes of patients undergoing thyroidectomy for cancer and benign disease. We examined the relationship between race, pre-operative characteristics and outcomes in patients undergoing thyroidectomy for GD. METHODS Patients were identified from the 2013-2016 American College of Surgeons NSQIP database using ICD-9/10 codes consistent with diffuse toxic goiter. RESULTS AA patients were more likely to have an ASA classification of ≥3 (41% vs 30%, p < 0.001), a higher rate of CHF (2.1% vs 0.5%, p = 0.01), hypertension (46% vs 32%, p < 0.001) and dyspnea (10% vs 5%, p < 0.001) compared to Non-Hispanic Caucasians (NH-C) patients. Complications were higher in patients with ASA≥3 and CHF but not affected by race. CONCLUSIONS Analysis of a national database of thyroidectomy for GD revealed a higher burden of preoperative comorbidities in AA patients compared to other races, although race was not an independent predictor of outcomes.
Collapse
Affiliation(s)
- Anna C Beck
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, 200 Hawkins Drive, 1500 JCP, Iowa City, IA, 52242, USA
| | - Sonia L Sugg
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, 200 Hawkins Drive, 1500 JCP, Iowa City, IA, 52242, USA
| | - Ronald J Weigel
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, 200 Hawkins Drive, 1500 JCP, Iowa City, IA, 52242, USA
| | - Mary Belding-Schmitt
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, 200 Hawkins Drive, 1500 JCP, Iowa City, IA, 52242, USA
| | - James R Howe
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, 200 Hawkins Drive, 1500 JCP, Iowa City, IA, 52242, USA
| | - Geeta Lal
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, 200 Hawkins Drive, 1500 JCP, Iowa City, IA, 52242, USA.
| |
Collapse
|
22
|
Beck AC, Yuan H, Liao J, Imperiale P, Shipley K, Erdahl LM, Sugg SL, Weigel RJ, Lizarraga IM. Rate of BRCA mutation in patients tested under NCCN genetic testing criteria. Am J Surg 2020; 219:145-149. [PMID: 31255259 PMCID: PMC7266680 DOI: 10.1016/j.amjsurg.2019.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/17/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND BRCA genetic testing is recommended by the National Comprehensive Cancer Network (NCCN) in breast cancer patients who meet specific criteria. Limited data are available on the likelihood of detecting a mutation when these guidelines are followed. METHODS A retrospective chart review examined patients with breast cancer who underwent BRCA testing based on NCCN guidelines. RESULTS Twelve (6.0%) of the 199 patients had a deleterious BRCA mutation. Family history of BRCA mutations (50%, p = 0.019), age ≤45 at diagnosis (9.7%, p = 0.034) and meeting ≥3 NCCN criteria (13.3%, p = 0.03) yielded the highest rates of BRCA mutation. Having a family history of BRCA mutation and age ≤45 were associated with increased rate of BRCA mutation on multivariate analysis (OR 14.3, CI 1.2-166.3; OR 11.6, CI 1.2-108.6). CONCLUSION Select NCCN criteria are associated with higher rates of BRCA mutations. Waiting for genetic testing results to guide surgical management may be warranted in this subset of patients.
Collapse
Affiliation(s)
- Anna C Beck
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Haimiao Yuan
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Junlin Liao
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Pamela Imperiale
- University of Iowa Carver College of Medicine, 375 Newton Road, Iowa City, IA, 52242, USA
| | - Krysten Shipley
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Lillian M Erdahl
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Sonia L Sugg
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Ronald J Weigel
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Ingrid M Lizarraga
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| |
Collapse
|
23
|
Thomas EA, Mijangos JL, Hansen PA, White S, Walker D, Reimers C, Beck AC, Garland EL. Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial. Integr Cancer Ther 2019; 18:1534735419855138. [PMID: 31165653 PMCID: PMC6552347 DOI: 10.1177/1534735419855138] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: The primary aims of this Stage I pilot randomized controlled trial were to establish the feasibility of integrating exercise and nutrition counseling with Mindfulness-Oriented Recovery Enhancement (MORE), a novel intervention that unites training in mindfulness, reappraisal, and savoring skills to target mechanisms underpinning appetitive dysregulation a pathogenic process that contributes to obesity among cancer survivors; to identify potential therapeutic mechanisms of the MORE intervention; and to obtain effect sizes to power a subsequent Stage II trial. Methods: Female overweight and obese cancer survivors (N = 51; mean age = 57.92 ± 10.04; 88% breast cancer history; 96% white) were randomized to one of two 10-week study treatment conditions: (a) exercise and nutrition counseling or (b) exercise and nutrition counseling plus the MORE intervention. Trial feasibility was assessed via recruitment and retention metrics. Measures of therapeutic mechanisms included self-reported interoceptive awareness, maladaptive eating behaviors, and savoring, as well as natural reward responsiveness and food attentional bias, which were evaluated as psychophysiological mechanisms. Results: Feasibility was demonstrated by 82% of participants who initiated MORE receiving a full dose of the intervention. Linear mixed models revealed that the addition of MORE led to significantly greater increases in indices of interoceptive awareness, savoring, and natural reward responsiveness, and, significantly greater decreases in external eating behaviors and food attentional bias—the latter of which was significantly associated with decreases in waist-to-hip ratio. Path analysis demonstrated that the effect of MORE on reducing food attentional bias was mediated by increased zygomatic electromyographic activation during attention to natural rewards. Conclusions and Implications: MORE may target appetitive dysregulatory mechanisms implicated in obesity by promoting interoceptive awareness and restructuring reward responsiveness.
Collapse
Affiliation(s)
| | | | - Pamela A Hansen
- 2 Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Shelley White
- 2 Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Darren Walker
- 2 Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Celestial Reimers
- 2 Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anna C Beck
- 2 Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Eric L Garland
- 2 Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
24
|
Wu VT, Kiriazov B, Koch KE, Gu VW, Beck AC, Borcherding N, Li T, Addo P, Wehrspan ZJ, Zhang W, Braun TA, Brown BJ, Band V, Band H, Kulak MV, Weigel RJ. A TFAP2C Gene Signature Is Predictive of Outcome in HER2-Positive Breast Cancer. Mol Cancer Res 2019; 18:46-56. [PMID: 31619506 DOI: 10.1158/1541-7786.mcr-19-0359] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/05/2019] [Accepted: 10/11/2019] [Indexed: 11/16/2022]
Abstract
The AP-2γ transcription factor, encoded by the TFAP2C gene, regulates the expression of estrogen receptor-alpha (ERα) and other genes associated with hormone response in luminal breast cancer. Little is known about the role of AP-2γ in other breast cancer subtypes. A subset of HER2+ breast cancers with amplification of the TFAP2C gene locus becomes addicted to AP-2γ. Herein, we sought to define AP-2γ gene targets in HER2+ breast cancer and identify genes accounting for physiologic effects of growth and invasiveness regulated by AP-2γ. Comparing HER2+ cell lines that demonstrated differential response to growth and invasiveness with knockdown of TFAP2C, we identified a set of 68 differentially expressed target genes. CDH5 and CDKN1A were among the genes differentially regulated by AP-2γ and that contributed to growth and invasiveness. Pathway analysis implicated the MAPK13/p38δ and retinoic acid regulatory nodes, which were confirmed to display divergent responses in different HER2+ cancer lines. To confirm the clinical relevance of the genes identified, the AP-2γ gene signature was found to be highly predictive of outcome in patients with HER2+ breast cancer. We conclude that AP-2γ regulates a set of genes in HER2+ breast cancer that drive cancer growth and invasiveness. The AP-2γ gene signature predicts outcome of patients with HER2+ breast cancer and pathway analysis predicts that subsets of patients will respond to drugs that target the MAPK or retinoic acid pathways. IMPLICATIONS: A set of genes regulated by AP-2γ in HER2+ breast cancer that drive proliferation and invasion were identified and provided a gene signature that is predictive of outcome in HER2+ breast cancer.
Collapse
Affiliation(s)
- Vincent T Wu
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Boris Kiriazov
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Kelsey E Koch
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Vivian W Gu
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa
| | - Anna C Beck
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | | | - Tiandao Li
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Peter Addo
- Department of Surgery, University of Iowa, Iowa City, Iowa
| | | | - Weizhou Zhang
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Terry A Braun
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | - Bartley J Brown
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | - Vimla Band
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Hamid Band
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Ronald J Weigel
- Department of Surgery, University of Iowa, Iowa City, Iowa. .,Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa.,Department of Biochemistry, University of Iowa, Iowa City, Iowa
| |
Collapse
|
25
|
Goffredo P, Utria AF, Beck AC, Chun YS, Howe JR, Weigel RJ, Vauthey JN, Hassan I. The Prognostic Impact of KRAS Mutation in Patients Having Curative Resection of Synchronous Colorectal Liver Metastases. J Gastrointest Surg 2019; 23:1957-1963. [PMID: 30276588 DOI: 10.1007/s11605-018-3978-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/13/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND m-KRAS has been recently reported to be a significant prognostic factor in patients undergoing resection of colorectal liver metastases. This is due to the lack of response to monoclonal epithelial growth factor receptor antibodies, and potentially as a result of a more aggressive tumor biology. METHODS The National Cancer Database was queried to identify patients with known KRAS status presenting with colorectal cancer and liver metastases who underwent resection of the primary tumor and metastatic disease between 2010 and 2015. RESULTS A total of 2655 patients were identified of which 1116 (42%) had m-KRAS. Tumor size, lymph node involvement rates, and margin status of the primary tumor were similar between patients with m-KRAS and wild-type KRAS (wt-KRAS). In the multivariable analysis, African-American race and right-sided colon cancers were independently associated with m-KRAS (both p < 0.001). m-KRAS patients had a significantly lower overall survival (OS) than those with wt-KRAS, with a 3- and 5-year OS of 51 vs. 64% and 31 vs. 42%, respectively (p < 0.001). After adjustment for available prognostic confounders, factors independently associated with worse OS were increasing age, receipt of monoagent chemotherapy, tumor size, positive lymph node, and resection margin status of the primary tumor, right-sided cancers, and m-KRAS. CONCLUSIONS m-KRAS is associated with worse OS in patients presenting with colorectal cancer and liver metastases undergoing resection of the primary tumor and metastatic disease. Right-sided lesions and African-American race were associated with m-KRAS. However, while right-sided remained an independent prognostic factor for OS, race did not.
Collapse
Affiliation(s)
- Paolo Goffredo
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA
| | - Alan F Utria
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA
| | - Anna C Beck
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - James R Howe
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA
| | - Ronald J Weigel
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Imran Hassan
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA.
| |
Collapse
|
26
|
Goffredo P, Robinson TJ, Frakes JM, Beck AC, Kalakoti P, Hassan I. The impact of location on the prognosis of squamous cell carcinomas of the anorectal region. J Surg Res 2018; 231:173-178. [PMID: 30278926 DOI: 10.1016/j.jss.2018.05.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/17/2018] [Accepted: 05/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Because anal and rectal squamous cell carcinomas (R-SCCs and A-SCCs) share a common histology and an excellent response to chemoradiation, we hypothesized that R-SCC and A-SCC may represent a similar biological entity, and location would not affect clinical presentation and prognosis. METHODS Patients diagnosed with R-SCC (n = 2881) and A-SCC (n = 21,854) were identified in the Surveillance, Epidemiology, and End Results database (1998-2013). R-SCCs were staged based on American Joint Committee on Cancer classification for A-SCC, and impact of location was analyzed accordingly. RESULTS Compared to A-SCC, R-SCCs were more common in females (65% versus 48%, P < 0.001) and older patients (62 versus 56 yrs, P < 0.001). R-SCC presented with more advanced disease than A-SCC: mean size 4.2 versus 3.6 cm; T4 14% versus 5%; nodal involvement 20% versus 15%; and metastases 13% versus 6% (all P < 0.001). In multivariable analysis, R-SCCs and A-SCCs had similar disease-specific survival (DSS) for stages 0, I, and III; however, stage II R-SCC had significantly worse DSS than A-SCCs (P = 0.002). This was due to a greater proportion of T3 (>5 cm) R-SCC tumors (36% versus 27%, P < 0.001), which had a lower DSS than T2 (2-5 cm) tumors. Within T3 and T4 tumors, R-SCCs had lower DSS than A-SCCs. CONCLUSIONS R-SCC presented with higher stages than A-SCC, suggesting a delayed diagnosis. Larger R-SCC (T3-T4) had worse survival compared to T3-4 A-SCC, which may be due to a combination of more advanced disease within-stage as well as the use of less efficacious therapeutic regimens. Therefore, location may represent a significant prognostic factor for SCC of the anorectal region.
Collapse
Affiliation(s)
- Paolo Goffredo
- Department of Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Timothy J Robinson
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Jessica M Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Anna C Beck
- Department of Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Piyush Kalakoti
- Department of Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Imran Hassan
- Department of Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa.
| |
Collapse
|
27
|
Beck AC, Kulak MV, Kiriazov B, Weigel RJ. Preclinical Studies Show Topotecan Decreases the Cancer Stem Cell Population in Colon Cancer. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Beck AC, Goffredo P, Hassan I, Sugg SL, Lal G, Howe JR, Weigel RJ. Risk factors for 30-day readmission after adrenalectomy. Surgery 2018; 164:766-773. [PMID: 30097166 DOI: 10.1016/j.surg.2018.04.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Readmissions represent a substantial burden to the health care system. Risk factors for 30-day readmission after adrenalectomy were examined. METHODS Patients who underwent adrenalectomy were selected from the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2015. RESULTS Among 4,221 patients who underwent adrenalectomy, 216 (5.1%) were readmitted. On multivariate analysis, pre-operative predictive factors associated with readmission were American Society of Anesthesiologists classification (odds ratio [OR] 1.4, confidence interval [CI] 1.1-1.8), disseminated cancer (OR 1.6, CI 1.1-2.5), and adrenal injury (OR 10.9, CI 1.8-68.9). Elective procedures had fewer readmissions (OR 0.50, CI 0.33-0.76). and procedures with greater relative value units had greater readmission rates (OR 1.01, CI 1.004-1.02). An open adrenalectomy (21% of patients) had a higher rate of readmission than a laparoscopic approach (8.0% vs 4.3%, OR 1.5, CI 1.1-2.0). Postoperative risk factors affecting readmission included reoperations (OR 3.2, CI 1.3-8.0), wound complications (OR 6.6, CI 3.8-11.7), systemic infection (OR 6.5, CI 3.9-10.7), renal complications (OR 7.1, CI 2.6-19.2), venous thrombotic events (OR 11.3, CI 5.6-22.6), and discharge to home (OR 0.40, CI 0.22-0.73). CONCLUSION Encouraging the appropriate use of laparoscopic adrenalectomy, preventing venous thrombotic events and surgical infections, and improving early post-operative follow-up in high-risk patients may decrease readmissions.
Collapse
Affiliation(s)
- Anna C Beck
- From the Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Paolo Goffredo
- From the Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Imran Hassan
- From the Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Sonia L Sugg
- From the Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Geeta Lal
- From the Department of Surgery, University of Iowa, Iowa City, Iowa
| | - James R Howe
- From the Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Ronald J Weigel
- From the Department of Surgery, University of Iowa, Iowa City, Iowa..
| |
Collapse
|
29
|
Werner TL, Ray A, Lamb JG, VanBrocklin M, Hueftle K, Cohen AL, Beck AC, Buys SS, Dyess DL, Butler TW, Dumlao TL, Neumayer L, Khong HT. A Phase I Study of Neoadjuvant Chemotherapy With Nab-Paclitaxel, Doxorubicin, and Cyclophosphamide in Patients With Stage II to III Breast Cancer. Clin Breast Cancer 2017; 17:503-509. [DOI: 10.1016/j.clbc.2017.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 11/29/2022]
|
30
|
De Andrade JP, Lorenzen AW, Wu VT, Bogachek MV, Park JM, Gu VW, Sevenich CM, Cassady VC, Beck AC, Kulak MV, Robinson RA, Lal G, Weigel RJ. Targeting the SUMO pathway as a novel treatment for anaplastic thyroid cancer. Oncotarget 2017; 8:114801-114815. [PMID: 29383121 PMCID: PMC5777733 DOI: 10.18632/oncotarget.21954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/15/2017] [Indexed: 12/20/2022] Open
Abstract
Cancer stem cells (CSCs) are expanded in anaplastic thyroid cancer (ATC) and standard treatment approaches have failed to improve survival, suggesting a need to specifically target the CSC population. Recent studies in breast and colorectal cancer demonstrated that inhibition of the SUMO pathway repressed CD44 and cleared the CSC population, mediated through SUMO-unconjugated TFAP2A. We sought to evaluate effects of inhibiting the SUMO pathway in ATC. ATC cell lines and primary ATC tumor samples were evaluated. The SUMO pathway was inhibited by knockdown of PIAS1 and use of SUMO inhibitors anacardic acid and PYR-41. The expression of TFAP2A in primary ATC was examined by immunohistochemistry. All ATC cell lines expressed TFAP2A but only 8505C expressed SUMO-conjugated TFAP2A. In 8505C only, inhibition of the SUMO pathway by knockdown of PIAS1 or treatment with SUMO inhibitors repressed expression of CD44 with a concomitant loss of SUMO-conjugated TFAP2A. The effect of SUMO inhibition on CD44 expression was dependent upon TFAP2A. Treatment with SUMO inhibitors resulted in a statistically improved tumor-free survival in mice harboring 8505C xenografts. An examination of primary ATC tissue determined that TFAP2A was expressed in 4 of 11 tumors surveyed. We conclude that inhibition of the SUMO pathway repressed the CSC population, delaying the outgrowth of tumor xenografts in ATC. The effect of SUMO inhibition was dependent upon expression of SUMO-conjugated TFAP2A, which may serve as a molecular marker for therapeutic effects of SUMO inhibitors. The findings provide pre-clinical evidence for development of SUMO inhibitors for the treatment of ATC.
Collapse
Affiliation(s)
| | | | - Vincent T Wu
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | | | - Jung M Park
- Department of Surgery, University of Iowa, Iowa City, IA, USA.,Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA, USA
| | - Vivian W Gu
- Department of Surgery, University of Iowa, Iowa City, IA, USA.,Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, USA
| | | | | | - Anna C Beck
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Mikhail V Kulak
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | | | - Geeta Lal
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Ronald J Weigel
- Department of Surgery, University of Iowa, Iowa City, IA, USA.,Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA, USA.,Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
31
|
Dans M, Smith T, Back A, Baker JN, Bauman JR, Beck AC, Block S, Campbell T, Case AA, Dalal S, Edwards H, Fitch TR, Kapo J, Kutner JS, Kvale E, Miller C, Misra S, Mitchell W, Portman DG, Spiegel D, Sutton L, Szmuilowicz E, Temel J, Tickoo R, Urba SG, Weinstein E, Zachariah F, Bergman MA, Scavone JL. NCCN Guidelines Insights: Palliative Care, Version 2.2017. J Natl Compr Canc Netw 2017; 15:989-997. [DOI: 10.6004/jnccn.2017.0132] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
32
|
Levy M, Smith T, Alvarez-Perez A, Back A, Baker JN, Beck AC, Block S, Dalal S, Dans M, Fitch TR, Kapo J, Kutner JS, Kvale E, Misra S, Mitchell W, Portman DG, Sauer TM, Spiegel D, Sutton L, Szmuilowicz E, Taylor RM, Temel J, Tickoo R, Urba SG, Weinstein E, Zachariah F, Bergman MA, Scavone JL. Palliative Care Version 1.2016. J Natl Compr Canc Netw 2016; 14:82-113. [PMID: 26733557 DOI: 10.6004/jnccn.2016.0009] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Palliative Care provide interdisciplinary recommendations on palliative care for patients with cancer. The NCCN Guidelines are intended to provide guidance to the primary oncology team on the integration of palliative care into oncology. The NCCN Palliative Care Panel's recommendations seek to ensure that each patient experiences the best quality of life possible throughout the illness trajectory. Accordingly, the NCCN Guidelines outline best practices for screening, assessment, palliative care interventions, reassessment, and after-death care.
Collapse
|
33
|
Ellington L, Clayton MF, Reblin M, Cloyes K, Beck AC, Harrold JK, Harris P, Casarett D. Interdisciplinary Team Care and Hospice Team Provider Visit Patterns during the Last Week of Life. J Palliat Med 2016; 19:482-7. [PMID: 27104950 DOI: 10.1089/jpm.2015.0198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Hospice provides intensive end-of-life care to patients and their families delivered by an interdisciplinary team of nurses, aides, chaplains, social workers, and physicians. Significant gaps remain about how team members respond to diverse needs of patients and families, especially in the last week of life. OBJECTIVE The study objective was to describe the frequency of hospice team provider visits in the last week of life, to examine changes in frequency over time, and to identify patient characteristics that were associated with an increase in visit frequency. DESIGN This was a retrospective cohort study using electronic medical record data. SETTING/SUBJECTS From U.S. not-for-profit hospices, 92,250 records were used of patients who died at home or in a nursing home, with a length of stay of at least seven days. MEASUREMENTS Data included basic demographic variables, diagnoses, clinical markers of illness severity, patient functioning, and number of hospice team member visits in the last seven days of life. RESULTS On average the total number of hospice team member visits in the last week of life was 1.36 visits/day. Most were nurse visits, followed by aides, social workers, and chaplains. Visits increased over each day on average across the last week of life. Greater increase in visits was associated with patients who were younger, male, Caucasian, had a spouse caregiver, and shorter lengths of stay. CONCLUSIONS This study provides important information to help hospices align the interdisciplinary team configuration with the timing of team member visits, to better meet the needs of the patients and families they serve.
Collapse
Affiliation(s)
- Lee Ellington
- 1 College of Nursing, University of Utah , Salt Lake City, Utah
| | | | - Maija Reblin
- 1 College of Nursing, University of Utah , Salt Lake City, Utah
| | - Kristin Cloyes
- 1 College of Nursing, University of Utah , Salt Lake City, Utah
| | - Anna C Beck
- 2 Huntsman Cancer Institute, School of Medicine, University of Utah , Salt Lake City, Utah
| | | | - Pamela Harris
- 4 Kansas City Hospice and Palliative Care , Overland Park, Kansas
| | - David Casarett
- 5 Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| |
Collapse
|
34
|
Beck AC, Mooney K. Caring for the life you saved. Oncology (Williston Park) 2015; 29:240-248. [PMID: 25952486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
35
|
Garland EL, Beck AC, Lipschitz DL, Nakamura Y. Dispositional mindfulness predicts attenuated waking salivary cortisol levels in cancer survivors: a latent growth curve analysis. J Cancer Surviv 2014; 9:215-22. [PMID: 25287787 DOI: 10.1007/s11764-014-0402-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 09/12/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE Cancer survivors experience significant stress and diminished well-being long after treatment. Dispositional mindfulness is linked with salutary coping with stress and enhanced well-being, with potentially beneficial effects on stress-related hormones. In the present study, we evaluated dispositional mindfulness as a predictor of changes in waking salivary cortisol levels among a sample of cancer survivors. METHODS Mindfulness, well-being, and saliva samples were collected at baseline and at 4- and 12-week follow-ups. Latent growth curve analysis was conducted to examine baseline dispositional mindfulness as a predictor of changes in waking salivary cortisol over time, and regression analyses examined associations between well-being and cortisol. RESULTS Findings indicated that cancer survivors who reported lower baseline levels of dispositional mindfulness exhibited increases in waking cortisol over time, whereas those who reported higher baseline dispositional mindfulness showed comparatively stable waking cortisol over the study period. Furthermore, increases in waking cortisol were associated with decreased well-being over the study period. CONCLUSIONS This study provides preliminary evidence that cancer survivors with higher levels of dispositional mindfulness may be buffered from deleterious changes in cortisol secretion. IMPLICATIONS FOR CANCER SURVIVORS Enhanced dispositional mindfulness may promote salutary neuroendocrine function among cancer survivors and thereby improve well-being during the survivorship process.
Collapse
Affiliation(s)
- Eric L Garland
- Supportive Oncology and Survivorship Program, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | | | |
Collapse
|
36
|
Videnovic A, Semenov I, Chua-Adajar R, Baddi L, Blumenthal DT, Beck AC, Simuni T, Futterer S, Gradishar W, Tellez C, Raizer JJ. Capecitabine-induced multifocal leukoencephalopathy: A report of five cases. Neurology 2005; 65:1792-4; discussion 1685. [PMID: 16237130 DOI: 10.1212/01.wnl.0000187313.83515.7e] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Capecitabine is used to treat advanced breast and gastrointestinal malignancies. A single case of encephalopathy and three cases of peripheral neuropathy are the only neurotoxicities reported. The authors report five additional cases of capecitabine-induced multifocal leukoencephalopathy.
Collapse
Affiliation(s)
- A Videnovic
- Davee Department of Neurology and Neurological Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Impaired hematopoiesis and dysregulated cytokine expression have important implications for cancer in the elderly. In aged people, hematopoiesis is dysregulated and becomes paradoxically down-modulated under periods of increased hematopoietic demand. This down-modulation may explain, at least in part, the increased incidence of anemia in the elderly, although the cause of anemia can usually be identified in these patients and frequently reversed with targeted therapy. An age-associated decrease in the expression of interleukin-2 may contribute to impaired cellular immunity. Additionally, the increased interleukin-6 production frequently found in the elderly may participate in promoting the survival and proliferation of malignant myeloma and in inducing resistance by myeloma cells to therapies that act through apoptosis. Dysregulation of the expression of these and other cytokines may be a mechanism contributing to age-related impairment of the hematopoietic response, the genesis and therapeutic resistance of specific malignancies, and cancer cachexia.
Collapse
Affiliation(s)
- C A Baraldi-Junkins
- Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Administration Medical Center, Utah, USA
| | | | | |
Collapse
|
38
|
Beck AC, Ward JH, Hammond EH, Wray RB, Samlowski WE. Cardiomyopathy associated with high-dose interleukin-2 therapy. West J Med 1991; 155:293-6. [PMID: 1949788 PMCID: PMC1002997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A C Beck
- Department of Internal Medicine, University of Utah, Salt Lake City
| | | | | | | | | |
Collapse
|
39
|
Abstract
Nocardial cerebral abscess is an unusual neurologic manifestation of the acquired immunodeficiency syndrome. A 20-year-old woman with the acquired immunodeficiency syndrome presented with headache and fever. Nocardia asteroides was cultured from a stereotaxic brain biopsy specimen. Despite antibiotic therapy to which the pathogen was sensitive, resolution of the abscess followed only after complete surgical excision.
Collapse
|
40
|
Beck AC, Hillmar ED. The power of positive management. Pers J 1983; 62:126-31. [PMID: 10259222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
41
|
Abstract
Problems faced by Government veterinarians in the planning and implemention of the national bovine brucellosis eradication campaign are described. These problems stem from the uncertainty associated with the epidemiology of the disease and its initial status in eradication areas. They are compounded by contraints on abattoir capacity, finance and time. A computer stimulation model is discussed which is designed to assist campaign organisers to cope with these problems. Inputs related to expected test and slaughter rates, district disease prevalence and proposed campaign intensity are entered into the model. Output from the model inlcudes distributions giving predicted testing workloads, cattle slaughtered and disease status over the course of the campaign. The operation of the model is illustrated using data from the Bangalow district of New South Wales.
Collapse
|