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Badr MS, Martin JL, Sankari A, Zeineddine S, Salloum A, Henzel MK, Strohl K, Shamim-Uzzaman A, May AM, Fung CH, Pandya N, Carroll S, Mitchell MN. Intensive support does not improve positive-airway pressure use in spinal cord injury/disease: a randomized clinical trial. Sleep 2024; 47:zsae044. [PMID: 38422375 DOI: 10.1093/sleep/zsae044] [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: 09/29/2023] [Revised: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
STUDY OBJECTIVE Treatment of sleep-disordered breathing (SDB) with positive airway pressure (PAP) therapy has unique clinical challenges in individuals living with spinal cord injuries and diseases (spinal cord injury [SCI]/D). Interventions focused on increasing PAP use have not been studied in this population. We aimed to evaluate the benefits of a program to increase PAP use among Veterans with SCI/D and SDB. METHODS Randomized controlled trial comparing a behavioral Intervention (n = 32) and educational control (n = 31), both including one face-to-face and five telephone sessions over 3 months. The intervention included education about SDB and PAP, goal setting, troubleshooting, and motivational enhancement. The control arm included non-directive sleep education only. RESULTS Primary outcomes were objective PAP use (nights ≥4 hours used within 90 days) and sleep quality (Pittsburgh Sleep Quality Index [PSQI] at 3 months). These did not differ between intervention and control (main outcome timepoint; mean difference 3.5 [-9.0, 15.9] nights/week for PAP use; p = .578; -1.1 [-2.8, 0.6] points for PSQI; p = .219). Secondary outcomes included fatigue, depression, function, and quality of life. Only fatigue improved significantly more in the intervention versus the control group (p = .025). Across groups, more PAP use was associated with larger improvements in sleep quality, insomnia, sleepiness, fatigue, and depression at some time points. CONCLUSIONS PAP use in Veterans with SCI/D and SDB is low, and a 3-month supportive/behavioral program did not show significant benefit compared to education alone. Overall, more PAP use was associated with improved symptoms suggesting more intensive support, such as in-home assistance, may be required to increase PAP use in these patients. CLINICAL TRIALS INFORMATION Title: "Treatment of Sleep Disordered Breathing in Patients with SCI." Registration number: NCT02830074. Website: https://clinicaltrials.gov/study/NCT02830074?cond=Sleep%20Apnea&term=badr&rank=5.
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Affiliation(s)
- M Safwan Badr
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jennifer L Martin
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Abdulghani Sankari
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Medical Education, Ascension Providence Hospital, Southfield, MI, USA
| | - Salam Zeineddine
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Anan Salloum
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - M Kristina Henzel
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Kingman Strohl
- Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Afifa Shamim-Uzzaman
- Department of Neurology, VA Ann Arbor Healthcare System
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Anna M May
- Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Constance H Fung
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Nishtha Pandya
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Sean Carroll
- Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Di Felice C, Strumpf ZB, Edmiston EA, Cuvillier Padilla CF, Ellis-Jones LC, McKell JL, Shatat MA, Williams SD, May AM. Improving Referral Patterns for Bronchoscopic Lung Volume Reduction: A Quality Improvement Initiative. Chronic Obstr Pulm Dis 2024; 11:95-100. [PMID: 37676641 PMCID: PMC10913923 DOI: 10.15326/jcopdf.2023.0397] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 09/08/2023]
Abstract
Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment option for patients with severe emphysema and hyperinflation refractory to optimal medical care. This therapy is effective in improving functional status and quality of life, underscoring the importance of identifying potential procedure candidates. To our knowledge, scalable strategies to improve the referral of advanced lung disease patients are lacking. This quality improvement project aimed to increase identification and referral for BLVR in a large Veterans Affairs academic medical center. We show implementing case identification within a pulmonary function testing report, in conjunction with provider education, increased referral rates for BLVR. Because of the ubiquity of lung function testing, other advanced lung disease programs may consider adopting this strategy to improve patients' access to timely clinical evaluation and therapy.
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Affiliation(s)
- Christopher Di Felice
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Zachary B. Strumpf
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Elizabeth A. Edmiston
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Christian F. Cuvillier Padilla
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
- Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Leah C. Ellis-Jones
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
| | - Joanne L. McKell
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Mohammad A. Shatat
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Sherrie D. Williams
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Anna M. May
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
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May AM. Sleep-disordered Breathing and Inpatient Outcomes in Nonsurgical Patients: Analysis of the Nationwide Inpatient Cohort. Ann Am Thorac Soc 2023; 20:1784-1790. [PMID: 37748082 PMCID: PMC10704237 DOI: 10.1513/annalsats.202305-469oc] [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: 06/24/2023] [Accepted: 09/25/2023] [Indexed: 09/27/2023] Open
Abstract
Rationale: Sleep-disordered breathing (SDB) is associated with increased complications and length of stay (LOS) after surgery. SDB-related adverse consequences for nonsurgical admissions are not well defined. Objectives: Evaluate associations between SDB and subtypes and LOS, cost, and mortality in nonsurgical patients. Methods: This retrospective cohort analysis used adult nonsurgical admissions from the 2017 National Inpatient Sample of the Healthcare Costs and Utilization Project. SDB associations with LOS (primary outcome), costs, and mortality were evaluated via logistic regression. Covariates included age, sex, Elixhauser Comorbidity Index, socioeconomic status, hospital type, and insurance type. Results: The cohort included 6,046,544 hospitalizations. Compared with those without SDB, patients with SDB were older (63.6 ± 13.5 vs. 57.4 ± 20.7 yr), higher proportion male (55.8% vs. 40.9%), and more likely to be White (75.7% vs. 66.5%). SDB was associated with increased odds of increased LOS and hospitalization costs (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.16-1.17 and OR, 1.67; 95% CI, 1.66-1.67 in adjusted analyses, respectively) but lower mortality (OR, 0.79; 95% CI, 0.77-0.81). The results for obstructive sleep apnea (OSA) echoed those for SDB. Obesity hypoventilation syndrome had substantially increased LOS (OR, 3.05; 95% CI, 2.98-3.13), mortality (1.76; 95% CI, 1.66-1.86), and costs (OR, 2.67; 95% CI, 2.60-2.73) even after adjustment. Conclusions: Obesity hypoventilation syndrome is associated with higher LOS, mortality, and costs during hospitalization, whereas OSA, despite higher LOS and costs, is associated with decreased mortality. Investigation is warranted on whether paradoxically higher costs but lower mortality in OSA may be indicative of less vigilance in hospitalized patients with undiagnosed SDB.
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Affiliation(s)
- Anna M May
- Geriatrics Research, Education, and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Cleveland, Ohio; and School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [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: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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May AM, Patel SR, Yamauchi M, Verma TK, Weaver TE, Chai-Coetzer CL, Thornton JD, Ewart G, Showers T, Ayas NT, Parthasarathy S, Mehra R, Billings ME. Moving toward Equitable Care for Sleep Apnea in the United States: Positive Airway Pressure Adherence Thresholds: An Official American Thoracic Society Policy Statement. Am J Respir Crit Care Med 2023; 207:244-254. [PMID: 36722719 PMCID: PMC9896653 DOI: 10.1164/rccm.202210-1846st] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Positive airway pressure (PAP) is a highly effective treatment for obstructive sleep apnea (OSA), but adherence limits its efficacy. In addition, coverage of PAP by CMS (Centers for Medicare & Medicaid Services) and other insurers in the United States depends on adherence. This leaves many beneficiaries without PAP, disproportionally impacting non-white and low socioeconomic position patients with OSA and exacerbating sleep health disparities. Methods: An inter-professional, multidisciplinary, international committee with various stakeholders was formed. Three working groups (the historical policy origins, impact of current policy, and international PAP coverage models) met and performed literature reviews and discussions. Using surveys and an iterative discussion-based consensus process, the policy statement recommendations were created. Results: In this position paper, we advocate for policy change to CMS PAP coverage requirements to reduce inequities and align with patient-centered goals. We specifically call for eradicating repeat polysomnography, eliminating the 4-hour rule, and focusing on patient-oriented outcomes such as improved sleepiness and sleep quality. Conclusions: Modifications to the current policies for PAP insurance coverage could improve health disparities.
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Koevoets EW, Geerlings MI, Monninkhof EM, Mandl R, Witlox L, van der Wall E, Stuiver MM, Sonke GS, Velthuis MJ, Jobsen JJ, van der Palen J, Bos MEMM, Göker E, Menke-Pluijmers MBE, Sommeijer DW, May AM, de Ruiter MB, Schagen SB. Effect of physical exercise on the hippocampus and global grey matter volume in breast cancer patients: A randomized controlled trial (PAM study). Neuroimage Clin 2023; 37:103292. [PMID: 36565574 PMCID: PMC9800528 DOI: 10.1016/j.nicl.2022.103292] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Physical exercise in cancer patients is a promising intervention to improve cognition and increase brain volume, including hippocampal volume. We investigated whether a 6-month exercise intervention primarily impacts total hippocampal volume and additionally hippocampal subfield volumes, cortical thickness and grey matter volume in previously physically inactive breast cancer patients. Furthermore, we evaluated associations with verbal memory. METHODS Chemotherapy-exposed breast cancer patients (stage I-III, 2-4 years post diagnosis) with cognitive problems were included and randomized in an exercise intervention (n = 70, age = 52.5 ± 9.0 years) or control group (n = 72, age = 53.2 ± 8.6 years). The intervention consisted of 2x1 hours/week of supervised aerobic and strength training and 2x1 hours/week Nordic or power walking. At baseline and at 6-month follow-up, volumetric brain measures were derived from 3D T1-weighted 3T magnetic resonance imaging scans, including hippocampal (subfield) volume (FreeSurfer), cortical thickness (CAT12), and grey matter volume (voxel-based morphometry CAT12). Physical fitness was measured with a cardiopulmonary exercise test. Memory functioning was measured with the Hopkins Verbal Learning Test-Revised (HVLT-R total recall) and Wordlist Learning of an online cognitive test battery, the Amsterdam Cognition Scan (ACS Wordlist Learning). An explorative analysis was conducted in highly fatigued patients (score of ≥ 39 on the symptom scale 'fatigue' of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), as previous research in this dataset has shown that the intervention improved cognition only in these patients. RESULTS Multiple regression analyses and voxel-based morphometry revealed no significant intervention effects on brain volume, although at baseline increased physical fitness was significantly related to larger brain volume (e.g., total hippocampal volume: R = 0.32, B = 21.7 mm3, 95 % CI = 3.0 - 40.4). Subgroup analyses showed an intervention effect in highly fatigued patients. Unexpectedly, these patients had significant reductions in hippocampal volume, compared to the control group (e.g., total hippocampal volume: B = -52.3 mm3, 95 % CI = -100.3 - -4.4)), which was related to improved memory functioning (HVLT-R total recall: B = -0.022, 95 % CI = -0.039 - -0.005; ACS Wordlist Learning: B = -0.039, 95 % CI = -0.062 - -0.015). CONCLUSIONS No exercise intervention effects were found on hippocampal volume, hippocampal subfield volumes, cortical thickness or grey matter volume for the entire intervention group. Contrary to what we expected, in highly fatigued patients a reduction in hippocampal volume was found after the intervention, which was related to improved memory functioning. These results suggest that physical fitness may benefit cognition in specific groups and stress the importance of further research into the biological basis of this finding.
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Affiliation(s)
- E W Koevoets
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Department of General Practice, Amsterdam UMC, Amsterdam, the Netherlands
| | - E M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - R Mandl
- Department of Psychiatry, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - L Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - M M Stuiver
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences, Amsterdam, the Netherlands
| | - G S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M J Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - J J Jobsen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Research Methodology, Measurement, Universiteit Twente, Enschede, the Netherlands
| | - M E M M Bos
- Department of Medical Oncology, ErasmusMC Cancer Institute, Rotterdam, the Netherlands
| | - E Göker
- Department of Medical Oncology, Alexander Monro Hospital, Bilthoven, the Netherlands
| | | | - D W Sommeijer
- Department of Internal Medicine, Flevohospital, Almere, the Netherlands; Department of Medical Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| | - A M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - M B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - S B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Brain and Cognition Group, University of Amsterdam, Amsterdam, the Netherlands.
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May AM, Billings ME. Racial Differences in Positive Airway Pressure Adherence in the Treatment of Sleep Apnea. Sleep Med Clin 2022; 17:543-550. [PMID: 36333073 PMCID: PMC10260288 DOI: 10.1016/j.jsmc.2022.07.002] [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: 11/05/2022]
Abstract
Although data are limited, studies suggest on average lower positive airway pressure use in Black, indigenous, and people of color (BIPOC) compared with Whites in most but not all studies. Most of these observational studies are certainly limited by confounding by socioeconomic status and other unmeasured factors that likely contribute to differences. The etiology of these observed disparities is likely multifactorial, due in part to financial limitations, differences in sleep opportunity, poor sleep quality due to environmental disruptions, and so forth. These disparities in sleep health are likely related to chronic inequities, including experiences of racism, neighborhood features, structural, and contextual factors. Dedicated studies focusing on understanding adherence in BIPOC are lacking. Further research is needed to understand determinants of PAP use in BIPOC subjects and identify feasible interventions to improve sleep health and reduce sleep apnea treatment disparities.
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Affiliation(s)
- Anna M May
- Research Section and Sleep Section, VA Northeast Ohio Healthcare System, Cleveland, OH, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Martha E Billings
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Washington School of Medicine, UW Medicine Sleep Center, Harborview Medical Center, Box 359803, 325 Ninth Avenue, Seattle, WA 98104, USA
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van Vulpen JK, Hiensch AE, van Hillegersberg R, Ruurda JP, Backx FJG, Nieuwenhuijzen GAP, Kouwenhoven EA, Groenendijk RPR, van der Peet DL, Hazebroek EJ, Rosman C, Wijnhoven BPL, van Berge Henegouwen MI, van Laarhoven HWM, Siersema PD, May AM. Supervised exercise after oesophageal cancer surgery: the PERFECT multicentre randomized clinical trial. Br J Surg 2021; 108:786-796. [PMID: 33837380 PMCID: PMC10364897 DOI: 10.1093/bjs/znab078] [Citation(s) in RCA: 4] [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: 12/10/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study investigated whether a supervised exercise programme improves quality of life (QoL), fatigue and cardiorespiratory fitness in patients in the first year after oesophagectomy. METHODS The multicentre PERFECT trial randomly assigned patients to an exercise intervention (EX) or usual care (UC) group. EX patients participated in a 12-week moderate- to high-intensity aerobic and resistance exercise programme supervised by a physiotherapist. Primary (global QoL, QoL summary score) and secondary (QoL subscales, fatigue and cardiorespiratory fitness) outcomes were assessed at baseline, 12 and 24 weeks and analysed as between-group differences using either linear mixed effects models or ANCOVA. RESULTS A total of 120 patients (mean(s.d.) age 64(8) years) were included and randomized to EX (61 patients) or UC (59 patients). Patients in the EX group participated in 96 per cent (i.q.r. 92-100 per cent) of the exercise sessions and the relative exercise dose intensity was high (92 per cent). At 12 weeks, beneficial EX effects were found for QoL summary score (3.5, 95 per cent c.i. 0.2 to 6.8) and QoL role functioning (9.4, 95 per cent c.i. 1.3 to 17.5). Global QoL was not statistically significant different between groups (3.0, 95 per cent c.i. -2.2 to 8.2). Physical fatigue was lower in the EX group (-1.2, 95 per cent c.i. -2.6 to 0.1), albeit not significantly. There was statistically significant improvement in cardiorespiratory fitness following EX compared with UC (peak oxygen uptake (1.8 ml/min/kg, 95 per cent c.i. 0.6 to 3.0)). After 24 weeks, all EX effects were attenuated. CONCLUSIONS A supervised exercise programme improved cardiorespiratory fitness and aspects of QoL. TRIAL REGISTRATION Dutch Trial Register NTR 5045 (www.trialregister.nl/trial/4942).
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Affiliation(s)
- J K van Vulpen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A E Hiensch
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - F J G Backx
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - E A Kouwenhoven
- Department of Surgery, ZGT Hospital, Almelo, The Netherlands
| | - R P R Groenendijk
- Department of Surgery, IJsselland Hospital, Capelle a/d IJssel, The Netherlands
| | - D L van der Peet
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E J Hazebroek
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - C Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M I van Berge Henegouwen
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A M May
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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9
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Suijkerbuijk KPM, May AM, van Eijs MJM. Checkpoint inhibition: protecting against or predisposing for second primary tumors? Ann Oncol 2021; 32:935. [PMID: 33794292 DOI: 10.1016/j.annonc.2021.03.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - A M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M J M van Eijs
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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10
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May AM, Wang L, Kwon DH, Van Wagoner DR, Chung MK, Dalton JE, Mehra R. Sleep apnea screening instrument evaluation and novel model development and validation in the paroxysmal atrial fibrillation population. Int J Cardiol Heart Vasc 2020; 31:100624. [PMID: 33364332 PMCID: PMC7752750 DOI: 10.1016/j.ijcha.2020.100624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/11/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 12/27/2022]
Abstract
Standard sleep apnea (SA) screening instruments perform suboptimally in the atrial fibrillation (AF) population. We evaluated and optimized common OSA screening tools in the AF population. Participants of the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT, NCT02576587) age (±5 years)-, sex-, body mass index (BMI ± 5 kg/m2)-matched case control study (n = 150 each group) completed concurrent questionnaires and overnight polysomnography. Models based on STOP, STOP-BANG, Berlin, NoSAS and Epworth Sleepiness Scale and also models with STOP-BANG predictors with resting heart rate or left atrial volume were constructed. “Best subset” analysis was used to select a predictor subset for evaluation. We assessed test performance for two outcome thresholds: apnea-hypopnea index (AHI) ≥ 5 and AHI ≥ 15. Paroxysmal AF participants were: 61.3 ± 12.1 years, BMI = 31.2 ± 6.6 kg/m2 with median AHI = 11.8(IQR: 3.8, 24.5); 65 (43.3%) with AHI ≥ 15. Only STOP and STOP-BANG did not perform worse in AF relative to controls. For AHI ≥ 15, STOP-BANG (AUC 0.71, 95%CI:0.55–0.85) did not perform as well as NABS – a composite of neck circumference, age, and BMI as continuous variables and snoring (AUC 0.88, 95%CI:0.76–0.96). Optimal model for AHI ≥ 15 was NABS (sensitivity = 45%, specificity = 97%). For AHI ≥ 5, NABS was also the best performing (AUC 0.82, 95%CI:0.68–0.92, sensitivity = 78%, specificity = 67%). We identify a novel, short-item SA screening instrument for use in paroxysmal AF, i.e. NABS, with improved discriminative ability compared to commonly-used instruments. Further validation studies are needed to assess utility in other AF subtypes. Trial registration: clinicaltrials.gov NCT02576587.
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Affiliation(s)
- Anna M May
- Sleep Medicine Section, VA Northeast Ohio Healthcare System, Cleveland, OH, United States.,Research Section, VA Northeast Ohio Healthcare System, Cleveland, OH, United States.,Division of Pulmonary, Critical Care, & Sleep Medicine. University Hospitals Cleveland Medical Center, Cleveland, OH, United States.,Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Lu Wang
- Department of Quantitative Heath Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Deborah H Kwon
- Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - David R Van Wagoner
- Department of Cardiovascular & Metabolic Science, Lerner Research Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Mina K Chung
- Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States.,Department of Cardiovascular & Metabolic Science, Lerner Research Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Jarrod E Dalton
- Department of Quantitative Heath Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Reena Mehra
- Sleep Disorders Center, Neurologic Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
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11
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Abstract
Abstract
Introduction
Serious mental illness (SMI) is associated with excess morbidity and mortality irrespective of healthcare access. Adherence differences may contribute to this health disparity. In those with sleep disorders, adherence to positive airway pressure (PAP) can improve health outcomes. We hypothesized that SMI is associated with lower PAP adherence.
Methods
In this retrospective cohort study, 5047 veterans receiving a PAP machine from the VANEOHS (1/1/2010 - 6/31/2015) were evaluated for 90-day PAP adherence (% days used ≥4 hours). A composite variable of any billing diagnosis of psychotic spectrum disorder, bipolar disorder, post-traumatic stress disorder (PTSD), or major depression was examined via linear regression. Analyses were adjusted for demographics, comorbidities, and medications. We conducted sensitivity analyses of 30-day adherence as well as subset analyses of associations between each disorder and adherence.
Results
The group was 38.8 ± 11.9 years old, 3.9% female with 52.6% with major depression, 25.0% with PTSD. 58.4% of the cohort had at least one psychiatric disorder. PTSD with depression was the most common comorbidity in those with two or more psychiatric diagnoses. Unadjusted analyses showed worse adherence in those with any SMI (β = -7.5%, 95% CI: -9.8% -5.3%), which was mitigated in adjusted analyses (β = -1.6%, 95% CI: -5.1%, 1.9%). All individual SMIs were negatively associated with adherence, but only PTSD was associated with less adherence in adjusted analyses (β = -6.4%, 95%CI: -11.2%, -1.6%). Sensitivity analyses of 30-day adherence were similar to primary analyses.
Conclusion
In this large cohort of veterans, broadly defined SMI was associated with lower 30- and 90-day adherence in unadjusted but not adjusted analyses. Replication and refinement of the link between SMI, particularly PTSD, and adherence may provide opportunities for targeted interventions and improve health disparities.
Support
This work was supported in part by Career Development Award IK2CX001882 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service.
The contents of this work do not represent the views of the Department of Veterans Affairs or the United States government.
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Affiliation(s)
- A M May
- VA Northeast Ohio Healthcare System, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - K Gandotra
- VA Northeast Ohio Healthcare System, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - G E Jaskiw
- VA Northeast Ohio Healthcare System, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
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12
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May AM, May RD, Bena J, Wang L, Monahan K, Stone KL, Barrett-Connor E, Koo BB, Winkelman JW, Redline S, Mittleman MA, Mehra R. Individual periodic limb movements with arousal are temporally associated with nonsustained ventricular tachycardia: a case-crossover analysis. Sleep 2020; 42:5533205. [PMID: 31585012 DOI: 10.1093/sleep/zsz165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/30/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Both periodic limb movements during sleep (PLMS) and arousals are associated with sympathetic nervous system activation and may be arrhythmogenic. We hypothesize a temporal relationship exists between individual PLMS, particularly with arousal, and nonsustained ventricular tachycardia (NSVT) events. METHODS A bidirectional time-stratified case-crossover design was used to assess temporal associations between PLMS and NSVT during sleep in 49 Osteoporotic Fractures in Men Sleep Study participants with NSVT in a community-based cohort (n = 2,911). Sleep time was divided into approximate 30-min segments. For each NSVT (n = 141), we selected a preceding 30-s hazard period and three randomly chosen 30-s control periods from sleep within the same segment and evaluated for PLMS, respiratory events, minimum saturation, and arousals. Odds ratios and 95% confidence intervals-OR (95% CI)-were determined by conditional logistic regression; covariates included EEG arousals, minimum saturation, and respiratory events in the same hazard/control period. RESULTS Participants with NSVT were 79.5 ± 6.2 years with a PLMS index of 32.1 (IQR: 10.1, 61.4) and apnea-hypopnea index of 17.1 (IQR: 9.4, 26.1). PLMS without arousal were not significantly associated with NSVT (OR = 0.80, 95% CI: 0.41-1.59). PLMS with arousal were associated with NSVT in unadjusted analyses (OR = 2.50, 95% CI: 1.11-5.65) and after adjustment (OR = 2.31, 95% CI: 1.02-5.25). Arousals associated with PLMS were associated with NSVT in unadjusted (OR = 2.84, 95% CI: 1.23-6.56) and adjusted analyses (OR = 2.61, 95% CI: 1.13-6.05). CONCLUSIONS PLMS with (but not without) arousals are temporally associated with a greater than twofold higher odds of subsequent NSVT episodes. PLMS-related arousals may be physiologically important ventricular arrhythmia triggers. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT00070681.
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Affiliation(s)
- Anna M May
- Sleep Medicine Section, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Ryan D May
- Department of Engineering, Case Western Reserve University, Cleveland, OH
| | - James Bena
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH
| | - Lu Wang
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH
| | - Ken Monahan
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | | | - Brian B Koo
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - John W Winkelman
- Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA
| | - Susan Redline
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Department of medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Murray A Mittleman
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Reena Mehra
- Sleep Center, Neurologic Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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13
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May AM. Transferring effective interventions for cancer-related fatigue from the adjuvant to the advanced cancer session: does it work? Ann Oncol 2020; 31:9-10. [PMID: 31912802 DOI: 10.1016/j.annonc.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- A M May
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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14
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Bernard P, Savard J, Steindorf K, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, May AM, Galvao DA, Chinapaw MJ, Stuiver MM, Griffith KA, Mesters I, Knoop H, Goedendorp MM, Bohus M, Thorsen L, Schmidt ME, Ulrich CM, Sonke GS, van Harten W, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, Kersten MJ, Nollet F, Wenzel J, Wiskemann J, Verdonck-de Leeuw IM, Brug J, Buffart LM. Effects and moderators of exercise on sleep in adults with cancer: Individual patient data and aggregated meta-analyses. J Psychosom Res 2019; 124:109746. [PMID: 31443811 DOI: 10.1016/j.jpsychores.2019.109746] [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: 03/04/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the effects of exercise interventions on sleep disturbances and sleep quality in patients with mixed cancer diagnoses, and identify demographic, clinical, and intervention-related moderators of these effects. METHODS Individual patient data (IPD) and aggregated meta-analyses of randomized controlled trials (RCTs). Using data from the Predicting OptimaL cAncer RehabIlitation and Supportive care project, IPD of 2173 adults (mean age = 54.8) with cancer from 17 RCTs were analyzed. A complementary systematic search was conducted (until November 2018) to study the overall effects and test the representativeness of analyzed IPD. Effect sizes of exercise effects on self-reported sleep outcomes were calculated for all included RCTs. Linear mixed-effect models were used to evaluate the effects of exercise on post-intervention outcome values, adjusting for baseline values. Moderator effects were studied by testing interactions for demographic, clinical and intervention-related characteristics. RESULTS For all 27 eligible RCTs from the updated search, exercise interventions significantly decreased sleep disturbances in adults with cancer (g = -0.09, 95% CI [-0.16; -0.02]). No significant effect was obtained for sleep quality. RCTs included in IPD analyses constituted a representative sample of the published literature. The intervention effects on sleep disturbances were not significantly moderated by any demographic, clinical, or intervention-related factor, nor by sleep disturbances. CONCLUSIONS This meta-analysis provides some evidence that, compared to control conditions, exercise interventions may improve sleep disturbances, but not sleep quality, in cancer patients, although this effect is of a small magnitude. Among the investigated variables, none was found to significantly moderate the effect of exercise interventions on sleep disturbances.
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Affiliation(s)
- P Bernard
- Université Laval Cancer Research Center, Québec, Québec, Canada; School of Psychology, Université Laval, Québec, Québec, Canada; CHU de Québec - Université Laval Research Center, Québec, Québec, Canada; Physical Activity Sciences Department, Université du Québec à Montréal, Montréal, Quebec, Canada; Research centre, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada.
| | - J Savard
- Université Laval Cancer Research Center, Québec, Québec, Canada; School of Psychology, Université Laval, Québec, Québec, Canada; CHU de Québec - Université Laval Research Center, Québec, Québec, Canada
| | - K Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany
| | - M G Sweegers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - K S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P B Jacobsen
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - A M May
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - D A Galvao
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - M J Chinapaw
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - M M Stuiver
- Department of Physiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K A Griffith
- School of Nursing, University of Maryland, Baltimore, USA
| | - I Mesters
- Department of Epidemiology, Maastricht University, The Netherlands
| | - H Knoop
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - M M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg t University, Mannheim, Germany
| | - M Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg t University, Mannheim, Germany; Faculty of Health, University of Antwerp, Belgium
| | - L Thorsen
- National Advisory Unit on Late Effects after Cancer, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - M E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany
| | - C M Ulrich
- Huntsman Cancer Institute and University of Utah, Department of Population Health Sciences, Salt Lake City, USA
| | - G S Sonke
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - W van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Huntsman Cancer Institute and University of Utah, Department of Population Health Sciences, Salt Lake City, USA
| | | | - M J Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - D R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - W van Mechelen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - M J Kersten
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, The Netherlands
| | - F Nollet
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J Wenzel
- Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA
| | - J Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - I M Verdonck-de Leeuw
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology-Head and Neck Surgery, The Netherlands; Department of Clinical Psychology, Vrije Universiteit Amsterdam, The Netherlands
| | - J Brug
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands; National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - L M Buffart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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15
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May AM, Gandotra K, Auckley DH. A 15-Year-Old Boy with Mysterious Variability in Apnea-Hypopnea Index. Chest 2019; 153:e9-e12. [PMID: 29307436 DOI: 10.1016/j.chest.2016.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/01/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022] Open
Abstract
CASE PRESENTATION A 15-year-old boy presented as a direct referral for polysomnography for evaluation of snoring, unrefreshing sleep, and daytime sleepiness despite a self-reported average of 8 hours of sleep a night. The mother reported he snored intermittently, although there were no witnessed apneic episodes or fragmented sleep. He denied morning headaches. He reported that his sleep was generally unrefreshing and he would experience significant daytime sleepiness, especially after school or when doing his homework. However, his Epworth Sleepiness Scale score was only 3 of 24. He denied any symptoms consistent with a movement disorder, parasomnia, cataplexy, hypnogogic/hypnopompic hallucinations, sleep paralysis, circadian rhythm disorders, or insomnia. He reported a family history of sleep apnea in his grandfather.
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Affiliation(s)
- Anna M May
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH.
| | - Kamal Gandotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Dennis H Auckley
- Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
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16
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May AM, May RD, Bena J, Wang L, Monahan K, Stone KL, Barrett-Connor E, Koo BB, Winkelman JW, Redline S, Mittleman MA, Mehra R. 0670 Sleep-Related Event Physiologic Timing for Triggering Nonsustained Ventricular Tachycardia: A Case-crossover Analysis. Sleep 2019. [DOI: 10.1093/sleep/zsz067.668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- Anna M May
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Ryan D May
- Case Western Reserve University, Cleveland, OH, USA
| | - James Bena
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lu Wang
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ken Monahan
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | | | | | | | - Susan Redline
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Reena Mehra
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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17
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van de Wiel HJ, Stuiver MM, May AM, van Grinsven S, Aaronson NK, Retèl VP, Oldenburg HSA, van der Poel HG, Horenblas S, van Harten WH, Groen WG. (Cost-)effectiveness of an internet-based physical activity support program (with and without physiotherapy counselling) on physical activity levels of breast and prostate cancer survivors: design of the PABLO trial. BMC Cancer 2018; 18:1073. [PMID: 30400784 PMCID: PMC6220515 DOI: 10.1186/s12885-018-4927-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/22/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Higher levels of physical activity (PA) after treatment are associated with beneficial effects on physical and psychosocial functioning of cancer survivors. However, survivors often do not meet the recommended levels of PA. In order to promote PA, we developed a closed internet-based program. The aim of the study is to evaluate the (cost-)effectiveness of an internet-based PA-promotion program, alone or combined with physiotherapy counselling, compared to usual care, on PA-levels of breast or prostate cancer survivors. In this multicenter randomised controlled trial (RCT), breast or prostate cancer survivors who completed their primary treatment 3-12 months earlier, will be randomised to either 6-months access to a fully-automated internet-based intervention alone, an internet-based intervention plus remote support by a physiotherapist, or a control group. The intervention is based on the Transtheoretical Model and includes personalized feedback, information, video's and assignments. Additionally, in a second arm, physiotherapy counselling is provided through monthly scheduled and on-demand telephone calls. The control group will receive usual care and a leaflet with PA guidelines. METHODS At baseline, 6 and 12 months, the primary outcome (PA) will be measured during 7 consecutive days by accelerometers. Secondary outcomes are self-reported PA, fatigue, mood, health-related quality of life, and costs. The group differences for primary and secondary outcomes will be analyzed using linear mixed models. DISCUSSION If proven to be (cost)effective, this internet-based intervention, either alone or in combination with telephone support, will be a welcome addition to previous RCT's. TRIAL REGISTRATION Netherlands trial register (NTR6911), Date of trial registration: December 21, 2017.
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Affiliation(s)
- H J van de Wiel
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M M Stuiver
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,ACHIEVE Centre of Applied Research, Faculty of Health, University of Applied Sciences Amsterdam , Amsterdam, The Netherlands
| | - A M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht of University, Utrecht, The Netherlands
| | | | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - V P Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - H S A Oldenburg
- Division of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Horenblas
- Division of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W H van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. .,Rijnstate Hospital, Arnhem, The Netherlands. .,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
| | - W G Groen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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18
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May AM, Koo B, Yaffe K, Leng Y, Cawthon PM, Redline S, Stone KL, Mehra R. 1015 Frequent Periodic Limb Movements During Sleep and Risk of Incident Stroke. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1014] [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: 11/14/2022] Open
Affiliation(s)
- A M May
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - B Koo
- Yale School of Medicine, New Haven, CT
| | - K Yaffe
- University of California San Francisco, San Francisco, CA
| | - Y Leng
- University of California San Francisco, San Francisco, CA
| | - P M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA
- University of California, San Francisco, San Francisco, CA
| | - S Redline
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Brigham and Women’s Hospitals, Harvard Medical School, Boston, MA
| | - K L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - R Mehra
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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19
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May AM, Gharibeh T, Wang L, Hurley A, Walia H, Strohl KP, Mehra R. CPAP Adherence Predictors in a Randomized Trial of Moderate-to-Severe OSA Enriched With Women and Minorities. Chest 2018; 154:567-578. [PMID: 29684316 DOI: 10.1016/j.chest.2018.04.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 01/09/2018] [Revised: 03/12/2018] [Accepted: 04/11/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Suboptimal CPAP adherence in OSA clinical trials involving predominantly white men limits interpretability and generalizability. We examined predictors of CPAP adherence in a clinical trial enriched with minorities. METHODS The Sleep Apnea Stress Study-a randomized, double-blind, sham-controlled trial of patients with moderate-to-severe OSA-included participants with complete 8-week adherence data (n = 138). Overnight 14-channel polysomnography, anthropometry, socioeconomic status, mood questionnaires, and week 1 CPAP adherence were analyzed via adjusted linear models relative to CPAP adherence (average minutes per night usage). RESULTS Overall, age was 51 ± 12 years, 55% of the patients were male, 55% were white, BMI was 36.7 ± 7.7 kg/m2, and median apnea-hypopnea index was 20 (interquartile range, 13-37). In univariate analyses adherence increased with randomization to active CPAP (81 min; 95% CI, 30-132), increasing age (35 min/decade; 95% CI, 13-57), white race (78 min, 95% CI, 26-129), and per hour of week 1 adherence (41 min, 95% CI, 32-51). Active CPAP (48 min, 95% CI, 6-91), increasing age (27 min/decade, 95% CI, 10-44), and higher 1-week adherence (36 min/h, 95% CI, 27-46) were significantly associated with improved adherence in multivariable analyses. Subgroup analyses showed stronger associations of adherence with treatment arm in whites and increasing age in minorities. Increasing age and white race were more strongly associated with adherence in women. CONCLUSIONS In this trial with near-even sex distribution and high ethnic minority representation, we identified CPAP assignment, increasing age, and early adherence to be associated with improved adherence in addition to sex-specific and race-specific adherence differences. These results can inform targeted clinical trial adherence optimization strategies. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00607893; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Anna M May
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH.
| | - Tarek Gharibeh
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Ahuja Medical Center, Cleveland, OH
| | - Lu Wang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Amanda Hurley
- Indiana Wesleyan University School of Nursing, Marion, IN
| | - Harneet Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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20
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Bijlsma RM, Wouters RHP, Wessels H, May AM, Ausems MGEM, Voest EE, Bredenoord AL. Managing unsolicited findings in genomics: A qualitative interview study with cancer patients. Psychooncology 2018; 27:1327-1333. [PMID: 29471587 DOI: 10.1002/pon.4676] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/14/2017] [Revised: 02/08/2018] [Accepted: 02/10/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Next-generation sequencing (NGS) is increasingly being employed in the context of personalized cancer treatment. Anticipating unsolicited findings that may arise during a NGS procedure is a key consideration; however, little is known about cancer patients' intentions, needs, and preferences concerning the return of unsolicited findings. METHODS A qualitative design using individual semi-structured interviews with 24 cancer patients was utilized to explore patients' decisions on whether to receive unsolicited findings from NGS. These interviews were subsequently analyzed using the constant comparative method to develop codes and themes. RESULTS We identified 4 interrelated themes that emerged in the context of the return of unsolicited findings. First, we describe how cancer patients expressed a strong need to control their lives. Second, we show the importance of family dynamics. Third, the NGS procedure regarding unsolicited findings is perceived as cognitively complex, and fourth, the procedure is also considered emotionally complex. CONCLUSIONS The results of our study contribute to a better understanding of what cancer patients consider important and what may motivate and influence them when making decisions on the disclosure of unsolicited findings following NGS. We show how Joel Feinberg's classification of autonomy may help clinicians to better understand cancer patients' desire for autonomous decision making while also acknowledging the emotional and cognitive difficulties regarding the disclosure of unsolicited findings. These insights could be helpful for clinicians to guide patients through this complex process.
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Affiliation(s)
- R M Bijlsma
- Cancer Center, Department of Medical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - R H P Wouters
- Julius Center, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, Netherlands
| | - H Wessels
- Department of Corporate Communications, University Medical Center Utrecht, Utrecht, Netherlands
| | - A M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - M G E M Ausems
- Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - E E Voest
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Department of Medical Oncology, Amsterdam, Netherlands
| | - A L Bredenoord
- Julius Center, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, Netherlands
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21
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van Vulpen JK, Sweegers MG, Kalter J, Peeters PH, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Steindorf K, Stuiver MM, Hayes S, Mesters I, Knoop H, Goedendorp M, Mutrie N, Thorsen L, Schmidt M, Sonke GS, Bohus M, James EL, Oldenburg HS, Velthuis MJ, Nollet F, Wenzel J, Wiskemann J, Galvão DA, Chinapaw MJ, Irwin ML, Griffith KA, van Weert E, Daley AJ, McConnachie A, Schulz KH, Short CE, Plotnikoff RC, Potthoff K, van Beurden M, van Harten WH, Schmitz KH, Winters-Stone KM, Taaffe DR, van Mechelen W, Kersten MJ, Verdonck-de Leeuw IM, Brug J, Buffart LM, May AM. Abstract P6-12-06: Effect and moderators of exercise on fatigue in patients with breast cancer: Meta-analysis of individual patient data. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background - Fatigue is one of the most common and disabling complaints in patients with breast cancer and can effectively be reduced by physical exercise, with small to moderate effect sizes. To identify heterogeneity in responses to exercise and to further personalize exercise prescriptions, moderators of exercise effects on fatigue should be investigated. However, most randomized controlled trials (RCTs) are not adequately powered for such analyses. Therefore we conducted meta-analyses using the individual patient data of several exercise RCTs. The aim is to investigate the effect and moderators of physical exercise on cancer-related fatigue in patients with breast cancer.
Methods - Within the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium, principal investigators of 34 exercise RCTs worldwide have shared their individual patient data. Twenty-two of these RCTs included patients with breast cancer with a total sample size of 3,061. Different questionnaires to assess level of fatigue were used, which was acknowledged by using z-scores in the analysis. A one-step individual patient data meta-analysis, using a linear mixed-effect model adjusted for baseline fatigue, with a random intercept on study (to account for study clustering) was undertaken to investigate effect of exercise on fatigue. The result, a between-group difference in z-scores, corresponds to a Cohen's d effect size. An interaction term was included in the model to assess potential moderators including demographic (age, marital status, education), clinical (body mass index, presence of distant metastasis), intervention-related (intervention timing, delivery mode and duration), and exercise-related (exercise type, frequency, intensity, duration) characteristics.
Results – Exercise significantly reduced fatigue reported by women with breast cancer (β= -0.15, 95% CI -0.21;-0.09). This effect did not differ significantly between patients with different demographic and clinical characteristics (p-valuesinteraction >0.05). Also, neither timing (during or post-treatment) and duration of the intervention, nor exercise-related factors moderated intervention effects on fatigue. Supervised exercise had significantly larger effects on fatigue than unsupervised exercise (βdifference= -0.17, 95%CI -0.28;-0.05). Compared to the control group, supervised exercise significantly improved fatigue (β = -0.21, 95%CI = -0.28;-0.14), while unsupervised exercise did not (β = -0.04, 95%CI = -0.14;0.06).
Conclusion – Exercise significantly reduces fatigue in patients with breast cancer across subgroups formed on the basis of age, marital status, education level, body mass index, and presence of distant metastasis. The effect of exercise is significantly larger when performed under supervision. Hence, exercise, and preferably supervised exercise, represents a viable intervention for the prevention and treatment of fatigue among patients with breast cancer.
Citation Format: van Vulpen JK, Sweegers MG, Kalter J, Peeters PH, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Steindorf K, Stuiver MM, Hayes S, Mesters I, Knoop H, Goedendorp M, Mutrie N, Thorsen L, Schmidt M, Sonke GS, Bohus M, James EL, Oldenburg HS, Velthuis MJ, Nollet F, Wenzel J, Wiskemann J, Galvão DA, Chinapaw MJ, Irwin ML, Griffith KA, van Weert E, Daley AJ, McConnachie A, Schulz K-H, Short CE, Plotnikoff RC, Potthoff K, van Beurden M, van Harten WH, Schmitz KH, Winters-Stone KM, Taaffe DR, van Mechelen W, Kersten M-J, Verdonck-de Leeuw IM, Brug J, Buffart LM, May AM. Effect and moderators of exercise on fatigue in patients with breast cancer: Meta-analysis of individual patient data [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-06.
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Affiliation(s)
- JK van Vulpen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MG Sweegers
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Kalter
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - PH Peeters
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KS Courneya
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - RU Newton
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - NK Aaronson
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - PB Jacobsen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - K Steindorf
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MM Stuiver
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - S Hayes
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - I Mesters
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - H Knoop
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M Goedendorp
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - N Mutrie
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - L Thorsen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M Schmidt
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - GS Sonke
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M Bohus
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - EL James
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - HS Oldenburg
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MJ Velthuis
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - F Nollet
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Wenzel
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Wiskemann
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - DA Galvão
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MJ Chinapaw
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - ML Irwin
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KA Griffith
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - E van Weert
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - AJ Daley
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - A McConnachie
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - K-H Schulz
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - CE Short
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - RC Plotnikoff
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - K Potthoff
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M van Beurden
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - WH van Harten
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KH Schmitz
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KM Winters-Stone
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - DR Taaffe
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - W van Mechelen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M-J Kersten
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - IM Verdonck-de Leeuw
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Brug
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - LM Buffart
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - AM May
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
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Perfors IAA, Helsper CW, Noteboom EA, van der Wall E, de Wit NJ, May AM. Randomised controlled trial protocol (GRIP study): examining the effect of involvement of a general practitioner and home care oncology nurse after a cancer diagnosis on patient reported outcomes and healthcare utilization. BMC Cancer 2018; 18:132. [PMID: 29402234 PMCID: PMC5799905 DOI: 10.1186/s12885-018-4005-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 07/08/2016] [Accepted: 01/18/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Due to the ageing population and improving diagnostics and treatments, the number of cancer patients and cancer survivors is increasing. Policymakers, patients and professionals advocate a transfer of (part of) cancer care from the hospital environment to the primary care setting, as this could stimulate personalized and integrated care, increase cost-effectiveness and would better meet the patients' needs and expectations. The effects of structured active follow-up from primary care after cancer diagnosis have not been studied yet. Therefore the GRIP study aims to assess the effects of structured follow-up after a cancer diagnosis, by a primary care team including a general practitioner (GP) and a home care oncology nurse (HON), on satisfaction and healthcare utilization of patients treated with curative intent. METHODS We will conduct a multicentre, two-arm randomised controlled trial in The Netherlands. We plan to include 150 patients who will be treated with curative intent for either breast, lung, colorectal, gynaecologic cancer, or melanoma. Further inclusion criteria are: age 18 years and older, able to answer questionnaires in Dutch, GP agrees to participate and the possibility to include the patient before the start of treatment. All patients receive care as usual. The intervention arm will receive additional structured follow-up consisting of a GP consultation before onset of treatment to empower the patient for shared decision making with the specialist and a minimum of three contacts with the HON during and after treatment. Primary outcomes are: patient satisfaction with care at the level of specialist, GP and nurse and healthcare utilization. Secondary outcomes include: quality of life, employment status, patient empowerment, shared decision making, mental health and satisfaction with given information. Repeated questionnaires, filled in by the participants, will be assessed within the 1-year study period. DISCUSSION This randomised controlled trial will evaluate the effects of structured follow-up after a cancer diagnosis by a primary care team including a GP and HON, for patients undergoing treatment with curative intent. Results from the present study may provide the evidence needed to optimally rearrange responsibilities in cancer care delivery and consequently improve cancer care and patient related outcomes. TRIAL REGISTRATION Trial number: NTR5909 .
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Affiliation(s)
- I A A Perfors
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - C W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - E A Noteboom
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - E van der Wall
- Internal Medicine and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - N J de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - A M May
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
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May AM, May RD, Bena J, Wang L, Monahan K, Stone KL, Cawthon PM, Barrett-Connor E, Koo BB, Winkelman JW, Redline S, Mittleman MA, Mehra R. 0720 ASSOCIATION OF INDIVIDUAL PERIODIC LIMB MOVEMENTS AND NON-SUSTAINED TACHYCARDIA DURING SLEEP: A CASE-CROSSOVER ANALYSIS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.719] [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: 11/12/2022] Open
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Abstract
A surge of data has reproducibly identified strong associations of OSA with cardiac arrhythmias. As an extension of epidemiologic and clinic-based findings, experimental investigations have made strides in advancing our understanding of the putative OSA and cardiac arrhythmogenesis mechanistic underpinnings. Although most studies have focused on the links between OSA and atrial fibrillation (AF), relationships with ventricular arrhythmias have also been characterized. Key findings implicate OSA-related autonomic nervous system fluctuations typified by enhanced parasympathetic activation during respiratory events and sympathetic surges subsequent to respiratory events, which contribute to augmented arrhythmic propensity. Other more immediate pathophysiologic influences of OSA-enhancing arrhythmogenesis include intermittent hypoxia, intrathoracic pressure swings leading to atrial stretch, and hypercapnia. Intermediate pathways by which OSA may trigger arrhythmia include increased systemic inflammation, oxidative stress, enhanced prothrombotic state, and vascular dysfunction. Long-term OSA-associated sequelae such as hypertension, atrial enlargement and fibrosis, ventricular hypertrophy, and coronary artery disease also predispose to cardiac arrhythmia. These factors can lead to a reduction in atrial effective refractory period, triggered and abnormal automaticity, and promote slowed and heterogeneous conduction; all of these mechanisms increase the persistence of reentrant arrhythmias and prolong the QT interval. Cardiac electrical and structural remodeling observed in OSA animal models can progress the arrhythmogenic substrate to further enhance arrhythmia generation. Future investigations clarifying the contribution of specific OSA-related mechanistic pathways to arrhythmia generation may allow targeted preventative therapies to mitigate OSA-induced arrhythmogenicity. Furthermore, interventional studies are needed to clarify the impact of OSA pathophysiology reversal on cardiac arrhythmogenesis and related adverse outcomes.
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Affiliation(s)
- Anna M May
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
| | - David R Van Wagoner
- Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Reena Mehra
- Neurologic Institute, Respiratory Institute, Heart and Vascular Institute and Molecular Cardiology Department, Lerner Research Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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May AM, Blackwell T, Stone PH, Stone KL, Cawthon PM, Sauer WH, Varosy PD, Redline S, Mehra R. Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men. Am J Respir Crit Care Med 2016; 193:783-91. [PMID: 26595380 DOI: 10.1164/rccm.201508-1523oc] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 01/19/2023] Open
Abstract
RATIONALE Although research supports a sleep-disordered breathing and atrial fibrillation association, prospective data examining sleep-disordered breathing predicting incident atrial fibrillation are lacking. OBJECTIVES To investigate sleep-disordered breathing indices as predictors of incident atrial fibrillation. METHODS A cohort (n = 843) of ambulatory older men without prevalent atrial fibrillation was assessed for baseline sleep indices: apnea-hypopnea index, central sleep apnea (central apnea index, ≥5 vs. <5), central sleep apnea or Cheyne-Stokes respiration, obstructive apnea-hypopnea index, and percentage of sleep time with less than 90% oxygen saturation. Incident clinically symptomatic adjudicated or self-reported atrial fibrillation outcome was ascertained (mean follow-up, 6.5 ± 0.7 yr). We used logistic regression models adjusted for age, race, body mass index, cardiopulmonary disease, alcohol use, pacemaker, cholesterol, cardiac medications, and alternate apnea type for obstructive and central apnea. Age interaction terms and median age-stratified analyses were performed. MEASUREMENTS AND MAIN RESULTS Central sleep apnea (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.18-5.66) and Cheyne-Stokes respiration with central sleep apnea (OR, 2.27; 95% CI, 1.13-4.56), but not obstructive apnea or hypoxemia, predicted incident atrial fibrillation. Central apnea, Cheyne-Stokes respiration, and sleep-disordered breathing-age interaction terms were significant (P < 0.05). Unlike the case with younger participants, among participants aged 76 years or older (albeit with small atrial fibrillation counts), atrial fibrillation was related to central apnea (OR, 9.97; 95% CI, 2.72-36.50), Cheyne-Stokes respiration with central apnea (OR, 6.31; 95% CI, 1.94-20.51), and apnea-hypopnea index (OR, 1.22; 95% CI, 1.08-1.39 [per 5-unit increase]). CONCLUSIONS In older men, central apnea and Cheyne-Stokes respiration predicted increased atrial fibrillation risk, with findings being strongest in older participants in whom overall sleep-disordered breathing also increased atrial fibrillation risk.
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Affiliation(s)
- Anna M May
- 1 Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Terri Blackwell
- 2 California Pacific Medical Center Research Institute, San Francisco, California
| | - Peter H Stone
- 3 Brigham and Women's Hospital, Boston, Massachusetts
| | - Katie L Stone
- 2 California Pacific Medical Center Research Institute, San Francisco, California
| | - Peggy M Cawthon
- 2 California Pacific Medical Center Research Institute, San Francisco, California
| | | | - Paul D Varosy
- 4 University of Colorado at Denver, Denver, Colorado
| | - Susan Redline
- 3 Brigham and Women's Hospital, Boston, Massachusetts.,5 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Reena Mehra
- 6 Sleep Center, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
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Mehra R, May AM. In Reply: Sleep apnea ABCs. Cleve Clin J Med 2016; 82:556-62. [PMID: 26366949 DOI: 10.3949/ccjm.82c.090002] [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: 11/14/2022]
Affiliation(s)
- Reena Mehra
- Director, Sleep Disorders Research, Cleveland Clinic, Cleveland, OH, USA
| | - Anna M May
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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Verkooijen HM, Young Afat D, van den Bongard D, van Vulpen M, May AM, van Gils C. Abstract P5-18-02: The cohort multiple randomized controlled trial is a feasible and patient-acceptable design for pragmatic evaluation of multiple interventions, with potential for improved recruitment and generalisability: The UMBRELLA experience. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-18-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The randomized controlled trial (RCT) is the gold standard for evaluation of effectiveness of new interventions. In oncology, however, RCTs are often complicated by logistic challenges, slow recruitment, limited generalisability, and strong patient's and doctor's preferences for new interventions. At the University Medical Center Utrecht (the Netherlands), we implemented an innovative alternative to the classic RCT: the cohort multiple randomized controlled trial (cmRCT). The cmRCT serves as a multi-trial facility and has the potential to improve recruitment and generalisability.
Methods: We initiated the 'Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaluation (UMBRELLA)' at the department of radiation oncology. UMBRELLA is a large prospective cohort of breast cancer patients, for whom we capture clinical data (patient and tumor characteristics, treatment, imaging, toxicity, recurrence and survival). Patients provide Patient Reported Outcome Measures (PROMs) on quality of life, pain, fatigue, anxiety and depression, physical activity and cosmetics. For each intervention to be tested, a subcohort of eligible patients is identified within UMBRELLA. From this subcohort, a random sample of patients is selected and offered the intervention (which they can accept or refuse). Patients from the subcohort, who are not randomly selected, receive standard care, serve as controls, and are not informed about the trial. Outcomes of patients offered the intervention are compared to those of patients receiving standard care. This process can be repeated (simultaneously) for multiple experimental interventions.
Results: Since October 2013, some 1000 patients have been enrolled in UMBRELLA. In order to make the design suitable for the clinical oncology practice, we developed a tailored informed consent procedure. First, we ask patients to enroll in the cohort and to provide PROMs. In addition, patients give broad consent to be either randomly selected to receive experimental interventions or to serve as control without further notice. In a second stage, at the initiation of a trial within the cohort, informed consent to receive the experimental intervention is sought in those randomly selected to receive the intervention. After completion of the trial, aggregated results are shared with all patients. Participation in UMBRELLA is 90%, and 90% of enrolled patients give broad consent for randomization. PROMs return rates vary from 70-90%. In September 2015, the first trial will be initiated, which aims to evaluate the impact of exercise programs on quality of life of inactive survivors. Preliminary inclusion and participation rates of this trial will be presented in December.
Conclusion: High participation rates, high PROM return rates and high levels of broad informed consent for randomisation within UMBRELLA indicate that this innovative design is feasible in the oncology practice, acceptable for patients and likely to provide generalisable results. Results of trials within UMBRELLA need to confirm whether cmRCT is indeed an acceptable alternative for classic pragmatic RCTs.
Citation Format: Verkooijen HM, Young Afat D, van den Bongard D, van Vulpen M, May AM, van Gils C. The cohort multiple randomized controlled trial is a feasible and patient-acceptable design for pragmatic evaluation of multiple interventions, with potential for improved recruitment and generalisability: The UMBRELLA experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-18-02.
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Affiliation(s)
| | | | | | | | - AM May
- UMC Utrecht, Utrecht, Netherlands
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May AM, Boer JH, Velthuis M, Steins Bisschop CN, Los M, Erdkamp F, ten Bokkel Huinink D, Bloemendal HJ, Rodenhuis C, de Roos MAJ, Verhaar M, van der Wall E, Peeters PHM. Abstract P1-10-09: Are patients with breast cancer undergoing adjuvant treatment able to follow an exercise program with a moderate to high intensity? Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-10-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
PURPOSE: We recently showed in a randomized trial, the Physical Activity during Cancer Treatment (PACT) study, that an 18-week exercise program reduced complaints of fatigue and improved physical fitness in newly diagnosed breast cancer patients undergoing adjuvant treatment. The beneficial effects were probably underestimated due to high levels of physical activity in the control group that received usual care only. Another possibility for dilution of the effect might be limited participation of the intervention group in the supervised exercise program or low compliance, i.e., an adjustment of the prescribed exercise protocol. We set out to study participation and compliance and to find determinants of reduced compliance.
METHODS: 102 patients in the PACT study were randomized into the intervention group that received a supervised exercise program 2 times a week for 18 weeks (36 sessions in total). Each session had a duration of 60 minutes and included a pre-specified period of aerobic interval exercises of specific intensities as well as muscle strength exercises. Sessions were supervised by physiotherapists, intensity was based on individual fitness characteristics and results were kept in a log.
We computed attendance (percentage of total sessions attended) and compliance (adherence to the prescribed duration and intensity of the aerobic part and to the muscle strength part of each attended session). We computed for each woman the percentage of sessions the women complied with the protocol, and report median percentages for compliance with the aerobic exercises, duration and intensity, and with the muscle strength exercises separately. Determinants of low compliance that were included in linear regression models were: age, behavioral, physical and psychosocial factors.
RESULTS: For 92 patients exercise logs were available. Patients were, on average, 50.2±7.8 years of age, all patients received chemotherapy and 70% received radiotherapy. Participation was high: patients participated in 83% (interquartile range 69-91%) of the sessions offered. Overall, also compliance was high: in 88% (63-97%) and 84% (65-94%) of all attended sessions patients were able to complete the aerobic (duration) and muscle strength program, respectively, as prescribed in the protocol. Compliance to the high-intensity part of the aerobic program was lower: in 50% (22-82%) of the sessions the intensity of the aerobic exercises was adjusted. Especially patients who received radiotherapy in addition to chemotherapy and patients who were more physically fatigued at baseline had a lower compliance to the high-intensity part of the aerobic exercises (β=-5.3 (confidence interval -9.4;-1.2) and β=-0.6 (-1.0;-0.1), respectively).
CONLUSIONS: Participation in and compliance to an 18-week aerobic and muscle strength exercise program was high. Thus, patients are well capable to exercise during adjuvant treatment for breast cancer. This study shows that preferably high intensity aerobic exercises were adjusted in a significant number of participants rather than the duration or the strength exercises. This has to be taken into account when developing training programs, especially in those patients who receive both, radiotherapy and chemotherapy.
Citation Format: May AM, Boer JH, Velthuis M, Steins Bisschop CN, Los M, Erdkamp F, ten Bokkel Huinink D, Bloemendal HJ, Rodenhuis C, de Roos MAJ, Verhaar M, van der Wall E, Peeters PHM. Are patients with breast cancer undergoing adjuvant treatment able to follow an exercise program with a moderate to high intensity?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-09.
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Affiliation(s)
- AM May
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - JH Boer
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - M Velthuis
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - CN Steins Bisschop
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - M Los
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - F Erdkamp
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - D ten Bokkel Huinink
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - HJ Bloemendal
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - C Rodenhuis
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - MAJ de Roos
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - M Verhaar
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - E van der Wall
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
| | - PHM Peeters
- University Medical Center Utrecht, Utrecht, Netherlands; Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Orbis Medisch Centrum, Sittard, Netherlands; Diakonessenhuis, Utrecht, Netherlands; Meander Medical Center, Amersfoort, Netherlands; Hospital Rivierenland, Tiel, Netherlands; Hofpoort Hospital, Woerden, Netherlands
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Buckland G, Travier N, Huerta JM, Bueno-de-Mesquita HBA, Siersema PD, Skeie G, Weiderpass E, Engeset D, Ericson U, Ohlsson B, Agudo A, Romieu I, Ferrari P, Freisling H, Colorado-Yohar S, Li K, Kaaks R, Pala V, Cross AJ, Riboli E, Trichopoulou A, Lagiou P, Bamia C, Boutron-Ruault MC, Fagherazzi G, Dartois L, May AM, Peeters PH, Panico S, Johansson M, Wallner B, Palli D, Key TJ, Khaw KT, Ardanaz E, Overvad K, Tjønneland A, Dorronsoro M, Sánchez MJ, Quirós JR, Naccarati A, Tumino R, Boeing H, Gonzalez CA. Healthy lifestyle index and risk of gastric adenocarcinoma in the EPIC cohort study. Int J Cancer 2015; 137:598-606. [PMID: 25557932 DOI: 10.1002/ijc.29411] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [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: 07/08/2014] [Revised: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 12/21/2022]
Abstract
Several modifiable lifestyle factors, including smoking, alcohol, certain dietary factors and weight are independently associated with gastric cancer (GC); however, their combined impact on GC risk is unknown. We constructed a healthy lifestyle index to investigate the joint influence of these behaviors on GC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The analysis included 461,550 participants (662 first incident GC cases) with a mean follow-up of 11.4 years. A healthy lifestyle index was constructed, assigning 1 point for each healthy behavior related to smoking status, alcohol consumption and diet quality (represented by the Mediterranean diet) for assessing overall GC and also body mass index for cardia GC and 0 points otherwise. Risk of GC was calculated using Cox proportional hazards regression models while adjusting for relevant confounders. The highest versus lowest score in the healthy lifestyle index was associated with a significant lower risk of GC, by 51% overall (HR 0.49 95% CI 0.35, 0.70), by 77% for cardia GC (HR 0.23 95% CI 0.08, 0.68) and by 47% for noncardia GC (HR 0.53 (95% CI 0.32, 0.87), p-trends<0.001. Population attributable risk calculations showed that 18.8% of all GC and 62.4% of cardia GC cases could have been prevented if participants in this population had followed the healthy lifestyle behaviors of this index. Adopting several healthy lifestyle behaviors including not smoking, limiting alcohol consumption, eating a healthy diet and maintaining a normal weight is associated with a large decreased risk of GC.
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Affiliation(s)
- G Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - N Travier
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
| | - H B As Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- The School of Public Health, Imperial College London, London, United Kingdom
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Samfundet Folkhälsan, Helsinki, Finland
| | - D Engeset
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
| | - U Ericson
- Diabetes and Cardiovascular Disease, Genetic Epidemiology Department of Clinical Sciences, Malmö Lund University, Clinical Research Center 60:13, Malmö, Sweden
| | - B Ohlsson
- Department of Clinical Sciences, Skåne University Hospital, Malmö, Sweden
- Division of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - A Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - I Romieu
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
| | - P Ferrari
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
| | - H Freisling
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
| | - S Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
| | - K Li
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - R Kaaks
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - V Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - A J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - P Lagiou
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece
| | - M C Boutron-Ruault
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University of Paris-Sud, Villejuif, France
- IGR, Villejuif, France
| | - G Fagherazzi
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University of Paris-Sud, Villejuif, France
- IGR, Villejuif, France
| | - L Dartois
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University of Paris-Sud, Villejuif, France
- IGR, Villejuif, France
| | - A M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - S Panico
- Dipartijmento Di Medicina Clinica E Di Chiruigia, Federico II University, Naples, Itlay
| | - M Johansson
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
- Department for Biobank Research, Umeå University, Umeå, Sweden
| | - B Wallner
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - K T Khaw
- University of Cambridge CB2 2QQ and Nick Wareham, Professor and Director of MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - E Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - K Overvad
- Aarhus University, Department of Public Health, Section for Epidemiology, Aarhus, Denmark
| | - A Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - M Dorronsoro
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
- Public Health Direction and Biodonostia - Ciberesp, Basque Regional Health Department, San Sebatian, Spain
| | - M J Sánchez
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
- Escuela Andaluza De Salud Pública, Instituto De Investigación Biosanitaria De Granada (Granada.Ibs), Granada, Spain
| | - J R Quirós
- Public Health Directorate, Oviedo, Spain
| | - A Naccarati
- HuGeF-Human Genetics Foundation, Molecular and Genetic Epidemiology Unit, Torino, Italy
| | - R Tumino
- The Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy
| | - H Boeing
- The German Institute of Human Nutrition, Potsdam-Rehbücke, Germany
| | - C A Gonzalez
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
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Naegele M, Leppla L, Kiote-Schmidt C, Ihorst G, Rebafka A, Koller A, May AM, Hasemann M, Duyster J, Wäsch R, Engelhardt M. Trained clinical nurse specialists proficiently obtain bone marrow aspirates and trephine biopsies in a nearly painless procedure--a prospective evaluation study. Ann Hematol 2015; 94:1577-84. [PMID: 26027858 DOI: 10.1007/s00277-015-2405-0] [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] [Received: 01/08/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
Patients often experience bone marrow examinations (BMEs) as frightening and painful. Varying operators and uncertainty about who will perform the BME worsen their anxiety. In our study, clinical nurse specialists (CNSs) were trained to perform BMEs to ensure continuity and to test the feasibility, patient satisfaction, and biopsy quality. This exploratory evaluation assessed 574 BMEs at our tertiary center between January 2012 and February 2013, 398 BMEs performed by CNS and 176 by physicians. Our aims were to determine whether BMEs by CNS yield results similar to those of physicians, analyzing (1) patient satisfaction with the BME (a) consent and (b) performance, (2) induced pain, and (3) quality of aspirates and length of trephine biopsies. When performed by CNS, 100 % of the patients were satisfied with the consent procedure and 99 % with the BME performance (physicians 99 and 91 %, respectively). The median pain score was low when both CNS and physicians performed the BME, with no or only mild pain in 92 and 76 % of patients, respectively. Bone marrow (BM) aspirates by CNS and physicians were assessed as technically evaluable in ~70 %; moreover, the median length of trephine biopsies was similar when performed by CNS or physicians with 12 and 13 mm, respectively. In conclusion, BMEs conducted by motivated CNS and within a structured training program are feasible and yield equal outcomes compared to physicians. The use of adequate pain management during BMEs by trained and experienced operators results in an extremely rare use of sedatives, low pain scores, and high patient satisfaction.
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Affiliation(s)
- M Naegele
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
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Abstract
Obstructive sleep apnea results in intermittent hypoxia via repetitive upper airway obstruction leading to partial or complete upper airway closure, apneas and hypopneas, respectively. Intermittent hypoxia leads to sympathetic nervous system activation and oxidative stress with a resultant systemic inflammatory cascade. The putative mechanism by which obstructive sleep apnea has been linked to numerous pathologic conditions including stoke, cardiovascular disease, hypertension, and metabolic derangements is through these systemic effects. Treatment of obstructive sleep apnea appears to reduce systemic markers of inflammation and ameliorates the adverse sequelae of this disease.
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Affiliation(s)
- Anna M May
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Reena Mehra
- Neurologic Institute, Respiratory Institute, Heart and Vascular Institute and Lerner Research Institute, Cleveland Clinic Lerner College of Medicine of Case Western Research University, Cleveland Clinic Foundation, Cleveland, Ohio
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van der Meulen IC, May AM, de Leeuw JRJ, Koole R, Oosterom M, Hordijk GJ, Ros WJG. Long-term effect of a nurse-led psychosocial intervention on health-related quality of life in patients with head and neck cancer: a randomised controlled trial. Br J Cancer 2014; 110:593-601. [PMID: 24280999 PMCID: PMC3915114 DOI: 10.1038/bjc.2013.733] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/24/2013] [Accepted: 10/30/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Head and neck cancer (HNC) patients are prone to have a poor health-related quality of life after cancer treatment. This study investigated the effect of the nurse counselling and after intervention (NUCAI) on the health-related quality of life and depressive symptoms of HNC patients between 12 and 24 months after cancer treatment. METHODS Two hundred and five HNC patients were randomly allocated to NUCAI (N=103) or usual care (N=102). The 12-month nurse-led NUCAI is problem-focused and patient-driven and aims to help HNC patients manage with the physical, psychological and social consequences of their disease and its treatment. Health-related quality of life was evaluated with the EORTC QLQ-C30 and QLQ H&N35. Depressive symptoms were evaluated with the CES-D. RESULTS At 12 months the intervention group showed a significant (P<0.05) improvement in emotional and physical functioning, pain, swallowing, social contact, mouth opening and depressive symptoms. At 18 months, global quality of life, role and emotional functioning, pain, swallowing, mouth opening and depressive symptoms were significantly better in the intervention group than in the control group, and at 24 months emotional functioning and fatigue were significantly better in the intervention group. CONCLUSION The NUCAI effectively improved several domains of health-related quality of life and depressive symptoms in HNC patients and would seem a promising intervention for implementation in daily clinical practice.
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Affiliation(s)
- I C van der Meulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
- Departments of Oral Maxillofacial Surgery and Otorhinolaryngology, University Medical Center Utrecht, G05. 129, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - A M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - J R J de Leeuw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - R Koole
- Departments of Oral Maxillofacial Surgery and Otorhinolaryngology, University Medical Center Utrecht, G05. 129, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - M Oosterom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - G-J Hordijk
- Departments of Oral Maxillofacial Surgery and Otorhinolaryngology, University Medical Center Utrecht, G05. 129, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - W J G Ros
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
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Rinaldi S, Kaaks R, Friedenreich CM, Key TJ, Travis R, Biessy C, Slimani N, Overvad K, Østergaard JN, Tjønneland A, Olsen A, Mesrine S, Fournier A, Dossus L, Lukanova A, Johnson T, Boeing H, Vigl M, Trichopoulou A, Benetou V, Trichopoulos D, Masala G, Krogh V, Tumino R, Ricceri F, Panico S, Bueno-de-Mesquita HB, Monninkhof EM, May AM, Weiderpass E, Quirós JR, Travier N, Molina-Montes E, Amiano P, Huerta JM, Ardanaz E, Sund M, Johansson M, Khaw KT, Wareham N, Scalbert A, Gunter MJ, Riboli E, Romieu I. Physical activity, sex steroid, and growth factor concentrations in pre- and post-menopausal women: a cross-sectional study within the EPIC cohort. Cancer Causes Control 2014; 25:111-24. [PMID: 24173534 DOI: 10.1007/s10552-013-0314-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 07/03/2013] [Accepted: 10/14/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE Increased physical activity (PA) is associated with a reduced risk of several cancers. PA may reduce cancer risk by changing endogenous hormones levels, but relatively little research has focused on this topic. The purpose of this study was to elucidate the relation between PA and endogenous hormone concentrations. METHODS A cross-sectional analysis of 798 pre- and 1,360 post-menopausal women included as controls in case-control studies on endogenous hormones (steroids, progesterone, sex-hormone-binding globulin (SHBG), and growth factors) levels, and cancer risk nested within European Prospective Investigation into Cancer and Nutrition cohort was performed. Multivariate regression analyses were performed to compare geometric mean levels of hormones and SHBG by categories of PA. RESULTS In pre-menopausal women, active women had 19 % significantly lower concentrations of androstenedione, 14 % lower testosterone, and 20 % lower free testosterone than inactive women, while no differences were observed for estrogens, progesterone, SHBG, and growth factors. In post-menopausal women, active women had 18 % significantly lower estradiol and 20 % lower free estradiol concentrations than inactive women, while no differences were observed for the other hormones and SHBG. More vigorous forms of physical activity were associated with higher insulin-like growth factor-I concentrations. Adjustment for body mass index did not alter the associations. Overall, the percentage of variance in hormone concentrations explained by PA levels was <2 %. CONCLUSIONS Our results support the hypothesis of an influence, although small in magnitude, of PA on sex hormone levels in blood, independent of body size.
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Affiliation(s)
- S Rinaldi
- International Agency for Research on Cancer (IARC), Lyon, France,
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Aumann K, Frey AV, May AM, Hauschke D, Kreutz C, Marx JP, Timmer J, Werner M, Pahl HL. [Differential diagnosis of myeloproliferative neoplasms. Quantitative NF-E2 immunohistochemistry for differentiating between essential thrombocythemia and primary myelofibrosis]. Pathologe 2013; 34 Suppl 2:201-9. [PMID: 24196613 DOI: 10.1007/s00292-013-1824-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Besides essential thrombocythemia (ET), polycythemia vera (PV) and primary myelofibrosis (PMF) the myeloproliferative neoplasms (MPN) defined by the World Health Organization (WHO) comprise the entity of unclassifiable MPNs (MPN, U). The exact differential diagnosis of the specific MPN entities can be challenging particularly at early stages of the diseases. So far, pathologists have had to rely only on histomorphological evaluation of bone marrow biopsies in combination with laboratory data because helpful ancillary tests are not yet available. Even molecular tests, such as JAK2 mutation analysis are not helpful particularly in the differential diagnosis of ET and PMF because both entities are associated with the V617F mutation in 50 % of the cases. Recently overexpression of the transcription factor NF-E2 in MPN was described. MATERIALS AND METHODS A collective of samples consisting of 163 bone marrow biopsies including 139 MPN cases was stained immunohistochemically for NF-E2 and analyzed regarding the subcellular localization of NF-E2 in erythroid progenitor cells. The results were compared between the MPN entities as well as the controls and statistical analyses were conducted. RESULTS AND DISCUSSION This study showed that NF-E2 immunohistochemistry and analysis of the proportion of nuclear positive erythroblasts of all erythroid precursor cells can help to distinguish between ET and PMF even in early stages of the diseases. An MPN, U case showing a proportion of more than 20 % nuclear positive erythroblasts can be classified as a PMF with 92 % accuracy.
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Affiliation(s)
- K Aumann
- Institut für Pathologie, Universitätsklinikum Freiburg, Breisacher Str. 115a, 79106, Freiburg, Deutschland,
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Stricker MD, Onland-Moret NC, Boer JMA, van der Schouw YT, Verschuren WMM, May AM, Peeters PHM, Beulens JWJ. Dietary patterns derived from principal component- and k-means cluster analysis: long-term association with coronary heart disease and stroke. Nutr Metab Cardiovasc Dis 2013; 23:250-256. [PMID: 22647416 DOI: 10.1016/j.numecd.2012.02.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 02/14/2012] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Studies comparing dietary patterns derived from different a posteriori methods in view of predicting disease risk are scarce. We aimed to explore differences between dietary patterns derived from principal component- (PCA) and k-means cluster analysis (KCA) in relation to their food group composition and ability to predict CHD and stroke risk. METHODS AND RESULTS The study was conducted in the EPIC-NL cohort that consists of 40,011 men and women. Baseline dietary intake was measured using a validated food-frequency questionnaire. Food items were consolidated into 31 food groups. Occurrence of CHD and stroke was assessed through linkage with registries. After 13 years of follow-up, 1,843 CHD and 588 stroke cases were documented. Both PCA and KCA extracted a prudent pattern (high intakes of fish, high-fiber products, raw vegetables, wine) and a western pattern (high consumption of French fries, fast food, low-fiber products, other alcoholic drinks, soft drinks with sugar) with small variation between components and clusters. The prudent component was associated with a reduced risk of CHD (HR for extreme quartiles: 0.87; 95%-CI: 0.75-1.00) and stroke (0.68; 0.53-0.88). The western component was not related to any outcome. The prudent cluster was related with a lower risk of CHD (0.91; 0.82-1.00) and stroke (0.79; 0.67-0.94) compared to the western cluster. CONCLUSION PCA and KCA found similar underlying patterns with comparable associations with CHD and stroke risk. A prudent pattern reduced the risk of CHD and stroke.
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Affiliation(s)
- M D Stricker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Bamia C, Halkjaer J, Lagiou P, Trichopoulos D, Tjønneland A, Berentzen TL, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Rohrmann S, Linseisen J, Steffen A, Boeing H, May AM, Peeters PH, Bas Bueno-de-Mesquita H, van den Berg SW, Dorronsoro M, Barricarte A, Rodriguez Suarez L, Navarro C, González CA, Boffetta P, Pala V, Hallmans G, Trichopoulou A. Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition-Elderly Network on Ageing and Health study. J Intern Med 2010; 268:133-44. [PMID: 20210842 DOI: 10.1111/j.1365-2796.2010.02219.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Later life weight change and mortality amongst elders. DESIGN Nested case-control study. SETTING Six countries from the European Investigation into Cancer and nutrition-Elderly, Network on Ageing and Health. SUBJECTS A total of 1712 deceased (cases) and 4942 alive (controls) were selected from 34,239 participants, > or = 60 years at enrolment (1992-2000) who were followed-up until March 2007. Annual weight change was estimated as the weight difference from recruitment to the most distant from-date-of-death re-assessment, divided by the respective time. OUTCOME MEASURES Mortality in relation to weight change was examined using conditional logistic regression. RESULTS Weight loss > 1 kg year(-1) was associated with statistically significant increased death risk (OR = 1.65; 95% CI: 1.41-1.92) compared to minimal weight change (+/-1 kg year(-1)). Weight gain > 1 kg year(-1) was also associated with increased risk of death (OR = 1.15; 95% CI: 0.98-1.37), but this was evident and statistically significant only amongst overweight/obese (OR = 1.55; 95% CI: 1.17-2.05). In analyses by time interval since weight re-assessment, the association of mortality with weight loss was stronger for the interval proximal (< 1 year) to death (OR = 3.10; 95% CI: 2.03-4.72). The association of mortality with weight gain was stronger at the interval of more than 3 years and statistically significant only amongst overweight/obese (OR = 1.58; 95% CI: 1.07-2.33). Similar patterns were observed regarding death from circulatory diseases and cancer. CONCLUSIONS In elderly, stable body weight is a predictor of lower subsequent mortality. Weight loss is associated with increased mortality, particularly short-term, probably reflecting underlying nosology. Weight gain, especially amongst overweight/obese elders, is also associated with increased mortality, particularly longer term.
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Affiliation(s)
- C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
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Hanson AD, May AM, Grumet R, Bode J, Jamieson GC, Rhodes D. Betaine synthesis in chenopods: Localization in chloroplasts. Proc Natl Acad Sci U S A 2010; 82:3678-82. [PMID: 16593569 PMCID: PMC397850 DOI: 10.1073/pnas.82.11.3678] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PLANTS FROM SEVERAL FAMILIES (CHENOPODIACEAE, GRAMINEAE, COMPOSITAE) ACCUMULATE BETAINE (GLYCINE BETAINE) IN RESPONSE TO SALT OR WATER STRESS VIA THE PATHWAY: choline --> betainal (betaine aldehyde) --> betaine. Betaine accumulation is probably a metabolic adaptation to stress. Intact protoplasts from leaves of spinach (Spinacia oleracea) oxidized [(14)C]choline to betainal and betaine, as did protoplast lysates. Upon differential centrifugation, the [(14)C]choline-oxidizing activity of lysates sedimented with chloroplasts. Chloroplasts purified from protoplast lysates by a Percoll cushion procedure retained strong [(14)C]choline-oxidizing activity (1-3 nmol/mg of chlorophyll per hr), although the proportion of the intermediate, [(14)C]betainal, in the reaction products was usually higher than for protoplasts. Isolated chloroplasts also readily oxidized [(14)C]betainal to betaine (20-100 nmol/mg of chlorophyll per hr). Light increased the oxidation of both [(14)C]choline and [(14)C]betainal by isolated chloroplasts approximately 3-fold; this light-stimulation was abolished by 3-(3,4-dichlorophenyl)-1,1-dimethylurea (DCMU). Similar results were obtained with another chenopod (Beta vulgaris) but not with pea (Pisum sativum), a species that accumulates no betaine. The chloroplast site for betaine synthesis in chenopods contrasts with the mitochondrial site in mammals.
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Affiliation(s)
- A D Hanson
- MSU-DOE Plant Research Laboratory, Michigan State University, East Lansing, MI 48824
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Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K, van der Schouw YT, Spencer E, Moons KGM, Tjønneland A, Halkjaer J, Jensen MK, Stegger J, Clavel-Chapelon F, Boutron-Ruault MC, Chajes V, Linseisen J, Kaaks R, Trichopoulou A, Trichopoulos D, Bamia C, Sieri S, Palli D, Tumino R, Vineis P, Panico S, Peeters PHM, May AM, Bueno-de-Mesquita HB, van Duijnhoven FJB, Hallmans G, Weinehall L, Manjer J, Hedblad B, Lund E, Agudo A, Arriola L, Barricarte A, Navarro C, Martinez C, Quirós JR, Key T, Bingham S, Khaw KT, Boffetta P, Jenab M, Ferrari P, Riboli E. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359:2105-20. [PMID: 19005195 DOI: 10.1056/nejmoa0801891] [Citation(s) in RCA: 1407] [Impact Index Per Article: 87.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have relied predominantly on the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) to assess the association of adiposity with the risk of death, but few have examined whether the distribution of body fat contributes to the prediction of death. METHODS We examined the association of BMI, waist circumference, and waist-to-hip ratio with the risk of death among 359,387 participants from nine countries in the European Prospective Investigation into Cancer and Nutrition (EPIC). We used a Cox regression analysis, with age as the time variable, and stratified the models according to study center and age at recruitment, with further adjustment for educational level, smoking status, alcohol consumption, physical activity, and height. RESULTS During a mean follow-up of 9.7 years, 14,723 participants died. The lowest risks of death related to BMI were observed at a BMI of 25.3 for men and 24.3 for women. After adjustment for BMI, waist circumference and waist-to-hip ratio were strongly associated with the risk of death. Relative risks among men and women in the highest quintile of waist circumference were 2.05 (95% confidence interval [CI], 1.80 to 2.33) and 1.78 (95% CI, 1.56 to 2.04), respectively, and in the highest quintile of waist-to-hip ratio, the relative risks were 1.68 (95% CI, 1.53 to 1.84) and 1.51 (95% CI, 1.37 to 1.66), respectively. BMI remained significantly associated with the risk of death in models that included waist circumference or waist-to-hip ratio (P<0.001). CONCLUSIONS These data suggest that both general adiposity and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-to-hip ratio in addition to BMI in assessing the risk of death.
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Affiliation(s)
- T Pischon
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.
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De Ruiter CJ, May AM, van Engelen BGM, Wevers RA, Steenbergen-Spanjers GC, de Haan A. Muscle function during repetitive moderate-intensity muscle contractions in myoadenylate deaminase-deficient Dutch subjects. Clin Sci (Lond) 2002; 102:531-9. [PMID: 11980572 DOI: 10.1042/cs20010190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/17/2022]
Abstract
We investigated whether the capacity for repetitive submaximal muscle contraction was reduced in a group of subjects (n=8) with a primary deficiency of myoadenylate deaminase (MAD). Quadriceps femoris muscle fatigue was evaluated using voluntary and electrically stimulated contractions during 20 min of repetitive voluntary isometric contractions at 40% of maximal force-generating capacity (MFGC). After 5 min of exercise, MFGC had declined significantly to 70.6+/-4.1% (mean+/-S.E.M.) and 87.2+/-1.6% of baseline values in MAD-deficient and sedentary control subjects (n=8) respectively (P=0.002 between groups). After 5 min of exercise, the half-relaxation time had increased significantly to 113.4+/-6.1% of baseline in MAD-deficient muscle, but had decreased significantly to 94.1+/-1.3% in control subjects (P=0.003 between groups). All control subjects completed the 20-min exercise test. Five of the MAD-deficient subjects had to stop exercising due to early muscle fatigue; however, three of the MAD-deficient subjects were able to complete the 20-min exercise test. In conclusion, although the capacity for repetitive submaximal isometric muscle contractions for the group of MAD-deficient subjects was significantly decreased, it remains uncertain whether MAD deficiency is the sole cause of pronounced muscle fatigue.
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Affiliation(s)
- C J De Ruiter
- Institute for Fundamental and Clinical Human Movement Sciences, Vrije Universiteit, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands.
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May AM. The place of coronary surgery in the treatment of arteriosclerotic heart disease (ASHD). Am Heart J 1979; 97:671-3. [PMID: 433740 DOI: 10.1016/0002-8703(79)90196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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May AM. Letter: Gateway insurance. Vasc Surg 1976; 10:44-5. [PMID: 961034 DOI: 10.1177/153857447601000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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May AM. Editorial: Trip on "line". Vasc Surg 1975; 9:265-7. [PMID: 1202809 DOI: 10.1177/153857447500900412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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May AM. Letter: Abdominal angina. Vasc Surg 1975; 9:185-6. [PMID: 1199429 DOI: 10.1177/153857447500900311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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May AM, Neville WE, Rumel WR, Davis MV. Surgery for coronary heart disease, 1969-1971. Report of the Subcommittee, Committee on Cardiovascular Surgery, American College of Chest Physicians. Chest 1973; 63:615-7. [PMID: 4695362 DOI: 10.1378/chest.63.4.615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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May AM, Bailey CP, Beall A, Varco R. Operations for coronary disease. Report of the Committee on Cardiovascular surgery. American College of Chest Physicians. Calif Med 1969; 55:332-5. [PMID: 4887215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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May AM. The pathogenesis of coronary occlusive phenomena and its surgical implications. Vasc Dis 1966; 3:287-94. [PMID: 5922203] [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: 01/17/2023]
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May AM, Torre E. Fecal Impaction: Report of Unusual Case. Cal West Med 1943; 59:224. [PMID: 18746624 PMCID: PMC1780479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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