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Piro B, Garland S, Jean-Pierre P, Gonzalez B, Seixas A, Muench A, Killgore WD, Wills CC, Grandner MA. 1053 Sleep Duration And Timing Associated With History Of Breast Prostate And Skin Cancer: Data From A Nationally-representative Sample. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1049] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Sleep disturbances are a common problem among cancer survivors. Also, cancer patients can have altered circadian rhythms and these changes can continue to affect the patient long after the conclusion of their treatment. This analysis aims to investigate how the sleep and wake times of cancer survivors differ from the rest of the population, depending on the type of cancer.
Methods
Data from the 2015-2016 National Health and Nutrition Examination Survey were used. Population-weighted data on N=5,581 individuals provided complete data. History of breast, prostate, and skin cancer (melanoma or other) was self-reported. Sleep duration was self-reported in half-hour increments, and typical bedtime and waketime was self-reported. Covariates included age, sex, and race/ethnicity. Weighted linear regressions with sleep duration, bedtime and waketime were examined, with each cancer type as predictor.
Results
Prevalence was 1.7% for prostate cancer, 1.5% for breast cancer, 2.3% for non-melanoma skin cancer, and 0.8% for melanoma. In adjusted analyses, prostate cancer was associated with an additional 26.5 minutes of average total sleep (95%CI 2.2,50.9, p=0.03), a 23.1 bedtime minutes earlier (95%CI -40.4,-5.8, p=0.009), and no difference in waketime. Breast cancer was associated with a bedtime that was 41.1 minutes later (95%CI 10.3,72.0, p=0.009) and a waketime that was 48.7 minutes later (95%CI 12.5,84.9, p=0.008), but no difference in sleep duration. No statistically significant effects were seen for either type of skin cancer, melanoma or non-melanoma.
Conclusion
Prostate cancer was associated with an earlier bedtime and associated increased sleep time. Breast cancer, on the other hand, was associated with a phase delay of the sleep period but no change in sleep duration. Skin cancer was not associated with differences in sleep duration or timing. These findings may have implications for not only treatment of sleep problems in different types of cancer, but also possible circadian mechanisms.
Support
Dr. Grandner is supported by R01MD011600
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Affiliation(s)
- B Piro
- University of Arizona, Tucson, AZ
| | - S Garland
- Memorial University of Newfoundland, St. John’s, NL, CANADA
| | | | | | - A Seixas
- New York University, New York, NY
| | - A Muench
- University of Pennsylvania, Philadelphia, PA
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Ajamian L, Melnychuk L, Jean-Pierre P, Zaharatos GJ. DNA Vaccine-Encoded Flagellin Can Be Used as an Adjuvant Scaffold to Augment HIV-1 gp41 Membrane Proximal External Region Immunogenicity. Viruses 2018; 10:E100. [PMID: 29495537 PMCID: PMC5869493 DOI: 10.3390/v10030100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 02/07/2023] Open
Abstract
Flagellin's potential as a vaccine adjuvant has been increasingly explored over the last three decades. Monomeric flagellin proteins are the only known agonists of Toll-like receptor 5 (TLR5). This interaction evokes a pro-inflammatory state that impacts upon both innate and adaptive immunity. While pathogen associated molecular patterns (PAMPs) like flagellin have been used as stand-alone adjuvants that are co-delivered with antigen, some investigators have demonstrated a distinct advantage to incorporating antigen epitopes within the structure of flagellin itself. This approach has been particularly effective in enhancing humoral immune responses. We sought to use flagellin as both scaffold and adjuvant for HIV gp41 with the aim of eliciting antibodies to the membrane proximal external region (MPER). Accordingly, we devised a straightforward step-wise approach to select flagellin-antigen fusion proteins for gene-based vaccine development. Using plasmid DNA vector-based expression in mammalian cells, we demonstrate robust expression of codon-optimized full length and hypervariable region-deleted constructs of Salmonella enterica subsp. enterica serovar Typhi flagellin (FliC). An HIV gp41 derived sequence including the MPER (gp41607-683) was incorporated into various positions of these constructs and the expressed fusion proteins were screened for effective secretion, TLR5 agonist activity and adequate MPER antigenicity. We show that incorporation of gp41607-683 into a FliC-based scaffold significantly augments gp41607-683 immunogenicity in a TLR5 dependent manner and elicits modest MPER-specific humoral responses in a mouse model.
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Affiliation(s)
- Lara Ajamian
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC H3T 1E2, Canada.
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC H4A 3J1, Canada.
| | - Luca Melnychuk
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC H3T 1E2, Canada.
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC H4A 3J1, Canada.
| | - Patrick Jean-Pierre
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC H3T 1E2, Canada.
| | - Gerasimos J Zaharatos
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC H3T 1E2, Canada.
- Division of Infectious Disease, Department of Medicine & Division of Medical Microbiology, Department of Clinical Laboratory Medicine, Jewish General Hospital, Montréal, QC H3T 1E2, Canada.
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Melnychuk L, Ajamian L, Jean-Pierre P, Liang J, Gheorghe R, Wainberg MA, Zaharatos GJ. Development of a DNA vaccine expressing a secreted HIV-1 gp41 ectodomain that includes the membrane-proximal external region. Vaccine 2017; 35:2736-2744. [PMID: 28392143 DOI: 10.1016/j.vaccine.2017.03.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 02/15/2017] [Accepted: 03/11/2017] [Indexed: 12/17/2022]
Abstract
A limited number of sites on the HIV-1 Envelope protein are vulnerable to broadly neutralizing antibodies (bnAbs). One of these sites, the membrane proximal external region (MPER), is located at the C-terminus of the gp41 ectodomain (gp41ecto). This highly conserved sequence is bound by several well-characterized bnAbs. Efforts to produce a gp41 immunogen are in part hampered by the MPER's hydrophobicity and propensity to induce aggregation. We sought to produce a DNA vaccine expressing a gp41ecto that is both secreted from mammalian cells and maintains binding by bnAbs to the MPER. Through in silico analysis, we predicted regions of gp41ecto that could induce aggregation and possibly hinder secretion. We generated deletion mutants of gp41ecto and tested their ability to be secreted by mammalian cells. Upon deletion of regions in either the fusion peptide (FP) or MPER, secretion of the gp41ecto increased. In an effort to both augment secretion and maintain binding by bnAbs, we developed constructs with the FP deletion and introduced point mutations in the MPER. Two constructs (gp41 ΔFP and gp41 ΔFP+I682E) maintained binding by gp41 MPER-specific bnAbs (4E10, Z13e1 and 10E8). These were evaluated as DNA vaccines in a mouse model. Both vaccines proved to be immunogenic and appeared to elicit some MPER-specific antibodies that bound gp41 ectodomain-derived proteins but not short peptides spanning the MPER. No neutralizing capacity was detected against a clade C virus containing a homologous MPER.
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Affiliation(s)
- Luca Melnychuk
- Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Lara Ajamian
- Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Jiaming Liang
- Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Romina Gheorghe
- Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada
| | - Mark A Wainberg
- Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Gerasimos J Zaharatos
- Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada; Division of Infectious Diseases, Department of Medicine, Jewish General Hospital, Montréal, Québec, Canada.
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Jean-Pierre P, McDonald B. Neuroepidemiology of cancer and treatment-related neurocognitive dysfunction in adult-onset cancer patients and survivors. Neuroepidemiology 2016; 138:297-309. [DOI: 10.1016/b978-0-12-802973-2.00017-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Jean-Pierre P, Winters P, Ahles T, Antoni M, Armstrong D, Penedo F, Lipshultz SE, Miller TL, Fiscella K. Cancer-related memory problems, demographic, and socioeconomic backgrounds: A cross-sectional study of the United States population. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9084] [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: 11/20/2022] Open
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Jean-Pierre P, Winters P, Ahles T, Antoni M, Armstrong D, Penedo F, Lipshultz SE, Miller TL, Morrow GR, Fiscella K. Prevalence of memory problems that limit daily functioning in adult cancer patients: A national representative sample of the U.S. population. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Figueroa-Moseley CD, Morrow GR, Jean-Pierre P, Purnell J. Ethnic minority participation in Community Clinical Oncology Program (CCOP) research studies. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1550] [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: 11/20/2022] Open
Abstract
1550 Background: Low minority participation in clinical research is concerning for both research and for the public health. Objective: The aim of this project was to investigate barriers and successes in minority participation in cancer medical research and cancer clinical trials. More specifically to: (1) determine major environmental, cultural, and economic barriers confronted by minority patients with cancer; and (2) determine the components of an environment that supports greater recruitment and retention of minorities to Clinical Community Oncology Practice (CCOP) cancer studies. Methods: Six focus groups consisting of 8 to 12 current or former minority cancer patients and 18 health care practitioners, from geographically diverse areas, were recruited to participate in this qualitative study. Focus group participants were asked questions about their attitudes and beliefs concerning their cancer and medical research. Health care practitioners were questioned on site recruitment and retention practices. Results: Two major thematic areas emerged for providers: barriers minority recommendation to trials and reasons for why minorities are underrepresented in trials. The three thematic areas for focus group participants were perceptions of medical research, reasons for participation or nonparticipation, and effects of Tuskegee Syphilis Study on participation. Conclusions: The Tuskegee Syphilis Study may have been a major impetus for why many Blacks and other minorities in this sample do not participate in medical research. Providers seem to state what was obviously important in connecting with the community, however, their actions in the community varied. This qualitative study gives voice to communities which mistrust the medical community in general and medical research in particular, and highlights the need for interventions bridging the community and research. No significant financial relationships to disclose.
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Affiliation(s)
| | - G. R. Morrow
- University of Rochester Medical Center, Rochester, NY
| | | | - J. Purnell
- University of Rochester Medical Center, Rochester, NY
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Jean-Pierre P, Mohile S, Morrow G, Figueroa-Moseley C, Berenberg J, Atkins J, Weiss M. Neuroprotective effect of SSRI among 781 cancer patients receiving chemotherapy: A URCC CCOP Study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9512 Background: Cancer and its treatment impact important areas of cognitive function such as attention and memory, which are essential to patients effective psychosocial functioning and quality of life. Previous studies reported that 17% to 75% of cancer patients reported cognitive dysfunction during and after treatment. Few studies, however, have examined the effectiveness of pharmacological interventions to control cancer-related cognitive dysfunction (CRCD). The present study examines the effect of paroxetine hydrochloride (Paxil, P) on CRCD. Methods: The sample included 574 female and 207 male cancer patients between 22 and 87 years. Memory Problems was assessed using a Self-Reported Memory Problem (SRMP) measures derived from the Fatigue Symptom Checklist that relate to memory dysfunction. Cronbach coefficient alpha (α) and a principal components analysis (PCA) were conducted to determine reliability and appropriateness of the SRMP for this sample. A repeated measure ANOVA (r-ANOVA) and t-tests were used to assess changes in mean scores on the SRMP and the effect of P versus placebo. Depression was assessed using the CESD. Results: Scale reliability assessment showed α = .90, supporting the reliability of the SRMP. The PCA revealed a one-component structure that explained 72% of the variance. The r-ANOVA showed a significant difference between scores on the SRMP at baseline (after first chemotherapy cycle, and before P) and follow-up (after four cycles of chemotherapy, after P) (Wilks' Lambda = .99, F (1, 583) = 5.52, p = 0.02). The t-tests also showed a significant effect of P on CRMP (p < 0.05). P had a significant effect after controlling for depression (p < 0.001) Conclusions: CRCD is a serious problem for patients that can be alleviated by P. Future studies should examine the usefulness of other psychotropic agents and combined behavioral and pharmacologic interventions to control CRCD. Supported by NCI Grants U10CA37420, R25CA102618, and 3U01CA116924–04S1. No significant financial relationships to disclose.
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Affiliation(s)
- P. Jean-Pierre
- University of Rochester Medical Center, Rochester, NY; Hawaii MBCCOP, Hawaii, HI; SCCC CCOP, SC; Marshfield CCOP, Marshfield CCOP, WI
| | - S. Mohile
- University of Rochester Medical Center, Rochester, NY; Hawaii MBCCOP, Hawaii, HI; SCCC CCOP, SC; Marshfield CCOP, Marshfield CCOP, WI
| | - G. Morrow
- University of Rochester Medical Center, Rochester, NY; Hawaii MBCCOP, Hawaii, HI; SCCC CCOP, SC; Marshfield CCOP, Marshfield CCOP, WI
| | - C. Figueroa-Moseley
- University of Rochester Medical Center, Rochester, NY; Hawaii MBCCOP, Hawaii, HI; SCCC CCOP, SC; Marshfield CCOP, Marshfield CCOP, WI
| | - J. Berenberg
- University of Rochester Medical Center, Rochester, NY; Hawaii MBCCOP, Hawaii, HI; SCCC CCOP, SC; Marshfield CCOP, Marshfield CCOP, WI
| | - J. Atkins
- University of Rochester Medical Center, Rochester, NY; Hawaii MBCCOP, Hawaii, HI; SCCC CCOP, SC; Marshfield CCOP, Marshfield CCOP, WI
| | - M. Weiss
- University of Rochester Medical Center, Rochester, NY; Hawaii MBCCOP, Hawaii, HI; SCCC CCOP, SC; Marshfield CCOP, Marshfield CCOP, WI
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Carroll J, Humiston SG, Salamone CM, Jean-Pierre P, Epstein RM, Fiscella K. Patients’ experiences with navigation for cancer care. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e17520] [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: 11/20/2022] Open
Abstract
e17520 Background: Patient navigation is a promising strategy for improving cancer care. We examined (1) how navigation influences patients’ perspectives on their cancer care and (2) the most effective (i.e., meaningful or valuable) aspects of navigation from the patient's viewpoint. Methods: We conducted post-study patient interviews from a randomized controlled trial (usual care vs. patient navigation services) from cancer diagnosis through treatment completion. Patients were recruited from 11 primary care, hospital and community oncology practices in Monroe County, NY. We interviewed patients about their specific experiences with cancer care including their expectations and experience of patient navigation or, for non-navigated patients, other sources of assistance. Results: Thirty-five patients (32 female, 3 male) newly diagnosed with breast (n = 28) or colorectal (n = 7) cancer who completed the study and were interviewed from May 2007 through March 2008. Patients who received navigation were very positive about their experience. Valued aspects of navigation included emotional support, assistance with information needs and problem-solving (such as with insurance or financial stressors), and logistical coordination of cancer care. Unmet cancer care needs expressed by patients randomized to usual care consisted of lack of assistance or support with childcare, household responsibilities, coordination of care, and emotional support. Conclusions: Cancer patients value navigation. Instrumental benefits were the most important expectations for navigation from navigated and non-navigated patients. However, when describing their actual experience of navigation, navigated patients frequently mentioned receiving emotional support as well as assistance with information needs, problem-solving, and logistical aspects of cancer care coordination. No significant financial relationships to disclose.
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Affiliation(s)
- J. Carroll
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | - R. M. Epstein
- University of Rochester Medical Center, Rochester, NY
| | - K. Fiscella
- University of Rochester Medical Center, Rochester, NY
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Abstract
e20571 Background: The development of cognitive difficulties, including memory loss, confusion, and difficulty concentrating following cancer treatment is a significant concern in patients receiving chemotherapy. Methods: This secondary analysis of a study assessing the effects of a RCT of paroxetine on fatigue in cancer patients investigated changes in self-report cognitive functioning over four cycles of chemotherapy and then approximately two years later. Approximately half of the patients were chemotherapy naïve. Questions on 5 point scales anchored by 1 = “absence of” and 5 = “a great deal” evaluating whether patients experienced heavy headedness, muddled thoughts, difficulty thinking, trouble concentrating, and forgetfulness. Each was answered seven days after each treatment and scores from each cycle were summed. Results: Fifty-eight of 84 patients completed questionnaires for all four cycles and are included herein. Paired t-tests showed cognitive difficulties were highest following the 1st on-study chemotherapy cycle (mean=7.9) and were significantly improved at the 3rd (mean=6.9) and 4th (mean=6.6) on-study cycles (both, p<0.005). Independent sample t-tests revealed that paroxetine had no effect on cognitive functioning when compared to placebo at all 4 cycles (all, p>0.54). Fifteen participants were reassessed two years after completing treatement. There was an increase in reported cognitive difficulties from the last cycle (mean=5.9) to the follow-up time-point (mean=7.8) that was not significant (p=0.18). Patients with ≥2 point change in score from the last on-study cycle to follow-up were categorized as “better” or “worse”. Those with <2 point change in score were classified as “no change”. Four (27 %) patients got worse (mean change=9.0), 2 (13 %) got better (mean change=-3.5), and 9 (60%) did not change. Conclusions: These data suggest that self-report cognitive difficulties related to cancer treatment are most pronounced following initial cycles of chemotherapy treatment and improve during the treatment course. Further studies need to include objective neuropsychological examinations and biological correlates of cognitive functioning to understand the extent of cognitive decline due to chemotherapy. Funding: DOD DA17–96-C-6106, NCI R25CA10618. No significant financial relationships to disclose.
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Affiliation(s)
| | - J. A. Roscoe
- University of Rochester Medical Center, Rochester, NY
| | | | - G. R. Morrow
- University of Rochester Medical Center, Rochester, NY
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Purnell J, Morrow GR, Roscoe JA, Jean-Pierre P, Atkins JN, Moore DF, Kasper LM. Disruptions in activities of daily living for African American prostate cancer patients compared to Whites. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5163] [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: 11/20/2022] Open
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Kohli S, Fisher SG, Heckler CE, Jean-Pierre P, Mohile SG, Wade III JL, Khanna R, Banerjee T, Morrow GR. Subjective assessment of cognitive function in the aging cancer patient: A URCC CCOP longitudinal study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9631] [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: 11/20/2022] Open
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Morrow GR, Jean-Pierre P, Roscoe JA, Heckler CE, Schwartzenberger PO, Giguere JK, Dakhil SR. A phase III randomized, placebo-controlled, double-blind trial of a eugeroic agent in 642 cancer patients reporting fatigue during chemotherapy: A URCC CCOP Study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Carroll J, Epstein R, Fiscella K, Jean-Pierre P, Figueroa-Moseley C, Morrow G. Communication about physical activity in an underserved patient population. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17012] [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: 11/20/2022] Open
Abstract
17012 Background: Promoting physical activity may help reduce the incidence of several cancers. The 5A model, used to promote other patient behavior changes in clinical practice, may be applicable to physical activity. Our goal was to determine clinicians’ use of the 5A (Ask, Advise, Agree, Assist, Arrange) guidelines when communicating about physical activity and cancer risk with an underserved patient population. Methods: Analysis of 50 audiotaped transcribed office visits with adult patients and their clinicians in two community health centers in Rochester, NY. We conducted post-visit interviews to assess patient recall of communication about physical activity.We used descriptive statistics to assess patient demographics and the frequency of each of the 5As occurring in the audiotaped visits. Analysis of the transcripts of the visits explored other contextual factors related to use of the 5As for communication about physical activity and cancer risk. Results: Patients were predominantly female (70%) and were African American (50%), Caucasian (35%) and other/mixed ethnicity (15%). In the 50 office visits, there were twelve (24%) Ask, twelve (24%) Advise, three (6%) Agree, two (4%) Assist, and one (2%) Arrange statement. Physical activity communication was mostly (92%) clinician-initiated; the only discussion which included all 5As was patient-initiated. No discussion linked physical activity to cancer risk or cancer prevention. Patients recalling the most communication about physical activity with their clinician reported that it was contextualized to their specific health needs, included support and encouragement, and consisted of clear, simple advice. Conclusions: Communication about physical activity incorporating the Agree and Arrange steps of the 5As was infrequent. Cancer prevention interventions should target these steps and prompt the patient to initiate communication to improve physical activity in underserved populations. This project was supported by a grant from the National Cancer Institute, R25- CA102618. No significant financial relationships to disclose.
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Affiliation(s)
- J. Carroll
- Univ of Rochester Cancer Ctr, Rochester, NY; University of Rochester, Rochester, NY
| | - R. Epstein
- Univ of Rochester Cancer Ctr, Rochester, NY; University of Rochester, Rochester, NY
| | - K. Fiscella
- Univ of Rochester Cancer Ctr, Rochester, NY; University of Rochester, Rochester, NY
| | - P. Jean-Pierre
- Univ of Rochester Cancer Ctr, Rochester, NY; University of Rochester, Rochester, NY
| | - C. Figueroa-Moseley
- Univ of Rochester Cancer Ctr, Rochester, NY; University of Rochester, Rochester, NY
| | - G. Morrow
- Univ of Rochester Cancer Ctr, Rochester, NY; University of Rochester, Rochester, NY
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Jean-Pierre P, Morrow GR, Fiscella K, Parrella M, Kohli S, Khanna R, Jacobs AD, Issell B. A brief measure of patients self-reported chemotherapy-related memory problem: Psychometric studies. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19655] [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: 11/20/2022] Open
Abstract
19655 Background: Memory is a central component of individuals’ functional systems of behavior, (i.e., cognition, emotionality, and executive functioning) that can be deleteriously affected by cancer treatment. It is important to identify and understand the effects of cancer treatment on memory in order to develop effective interventions to ameliorate these problems. This study involves structural and reliability analyses of a brief measure of chemotherapy-related memory problem to facilitate prompt and reliable preliminary assessments in oncology research and practice. Methods: Patients (N = 821) included in this analysis were part of a larger randomized clinical trial on cancer-related fatigue. These patients completed the Fatigue Symptom Checklist (FSCL) at four time points. Five items from the FSCL that assess memory problems were aggregated into a brief self-report memory problem measure (SRMP). Results: Reliability assessment of the SRMP revealed a Cronbach coefficient alpha of 0.90. The data was found suitable for latent structure analysis using various criteria: Kaiser-Myer-Olkin, Bartlett’s Test of sphericity, Kaiser’s (1959) simplest criterion test of γ >1, and the presence of item-correlation coefficients of r = .30. Principal components analysis showed one component with eigenvalue (γ) exceeding 1, that explained 72% of the variance. Subsequent reliability assessments of the SRMP revealed Cronbach coefficients alpha of 0.90 and above, all with a single component explaining 71.36% to 73.36% of the variances. Conclusions: The results supported the use of the SRMP as a reliable one- dimensional measure of cancer treatment-related memory problem. The SMRP could be used for preliminary assessment of possible underlying memory problems that might need further examinations. Studies to establish the construct validity of the SRMP are under way. Supported by NCI grant R25CA102618. No significant financial relationships to disclose.
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Affiliation(s)
- P. Jean-Pierre
- University of Rochester Cancer Center, Rochester, NY; Mt. Sinai School of Medicine/Pilgrim Psych Ctr., New York, NY; University of Rochester Medical Center, Rochester, NY; Columbus CCOP, Columbus, OH; Virginia Mason CCOP, Virginia, VA; Hawaii MBCCOP, Hawaii, HI
| | - G. R. Morrow
- University of Rochester Cancer Center, Rochester, NY; Mt. Sinai School of Medicine/Pilgrim Psych Ctr., New York, NY; University of Rochester Medical Center, Rochester, NY; Columbus CCOP, Columbus, OH; Virginia Mason CCOP, Virginia, VA; Hawaii MBCCOP, Hawaii, HI
| | - K. Fiscella
- University of Rochester Cancer Center, Rochester, NY; Mt. Sinai School of Medicine/Pilgrim Psych Ctr., New York, NY; University of Rochester Medical Center, Rochester, NY; Columbus CCOP, Columbus, OH; Virginia Mason CCOP, Virginia, VA; Hawaii MBCCOP, Hawaii, HI
| | - M. Parrella
- University of Rochester Cancer Center, Rochester, NY; Mt. Sinai School of Medicine/Pilgrim Psych Ctr., New York, NY; University of Rochester Medical Center, Rochester, NY; Columbus CCOP, Columbus, OH; Virginia Mason CCOP, Virginia, VA; Hawaii MBCCOP, Hawaii, HI
| | - S. Kohli
- University of Rochester Cancer Center, Rochester, NY; Mt. Sinai School of Medicine/Pilgrim Psych Ctr., New York, NY; University of Rochester Medical Center, Rochester, NY; Columbus CCOP, Columbus, OH; Virginia Mason CCOP, Virginia, VA; Hawaii MBCCOP, Hawaii, HI
| | - R. Khanna
- University of Rochester Cancer Center, Rochester, NY; Mt. Sinai School of Medicine/Pilgrim Psych Ctr., New York, NY; University of Rochester Medical Center, Rochester, NY; Columbus CCOP, Columbus, OH; Virginia Mason CCOP, Virginia, VA; Hawaii MBCCOP, Hawaii, HI
| | - A. D. Jacobs
- University of Rochester Cancer Center, Rochester, NY; Mt. Sinai School of Medicine/Pilgrim Psych Ctr., New York, NY; University of Rochester Medical Center, Rochester, NY; Columbus CCOP, Columbus, OH; Virginia Mason CCOP, Virginia, VA; Hawaii MBCCOP, Hawaii, HI
| | - B. Issell
- University of Rochester Cancer Center, Rochester, NY; Mt. Sinai School of Medicine/Pilgrim Psych Ctr., New York, NY; University of Rochester Medical Center, Rochester, NY; Columbus CCOP, Columbus, OH; Virginia Mason CCOP, Virginia, VA; Hawaii MBCCOP, Hawaii, HI
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Mehandru S, Poles MA, Tenner-Racz K, Jean-Pierre P, Manuelli V, Lopez P, Shet A, Low A, Mohri H, Boden D, Racz P, Markowitz M. Lack of mucosal immune reconstitution during prolonged treatment of acute and early HIV-1 infection. PLoS Med 2006; 3:e484. [PMID: 17147468 PMCID: PMC1762085 DOI: 10.1371/journal.pmed.0030484] [Citation(s) in RCA: 224] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 09/22/2006] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND During acute and early HIV-1 infection (AEI), up to 60% of CD4(+) T cells in the lamina propria of the lower gastrointestinal (GI) tract are lost as early as 2-4 wk after infection. Reconstitution in the peripheral blood during therapy with highly active antiretroviral therapy (HAART) is well established. However, the extent of immune reconstitution in the GI tract is unknown. METHODS AND FINDINGS Fifty-four AEI patients and 18 uninfected control participants underwent colonic biopsy. Forty of the 54 AEI patients were followed after initiation of antiretroviral therapy (18 were studied longitudinally with sequential biopsies over a 3-y period after beginning HAART, and 22 were studied cross sectionally after 1-7 y of uninterrupted therapy). Lymphocyte subsets, markers of immune activation and memory in the peripheral blood and GI tract were determined by flow cytometry and immunohistochemistry. In situ hybridization was performed in order to identify persistent HIV-1 RNA expression. Of the patients studied, 70% maintained, on average, a 50%-60% depletion of lamina propria lymphocytes despite 1-7 y of HAART. Lymphocytes expressing CCR5 and both CCR5 and CXCR4 were persistently and preferentially depleted. Levels of immune activation in the memory cell population, CD45RO+ HLA-DR+, returned to levels seen in the uninfected control participants in the peripheral blood, but were elevated in the GI tract of patients with persistent CD4+ T cell depletion despite therapy. Rare HIV-1 RNA-expressing cells were detected by in situ hybridization. CONCLUSIONS Apparently suppressive treatment with HAART during acute and early infection does not lead to complete immune reconstitution in the GI mucosa in the majority of patients studied, despite immune reconstitution in the peripheral blood. Though the mechanism remains obscure, the data suggest that there is either viral or immune-mediated accelerated T cell destruction or, possibly, alterations in T cell homing to the GI tract. Although clinically silent over the short term, the long-term consequences of the persistence of this lesion may emerge as the HIV-1-infected population survives longer owing to the benefits of HAART.
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Affiliation(s)
- Saurabh Mehandru
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, New York, United States of America
| | - Michael A Poles
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, New York, United States of America
- Department of Medicine, Division of Gastroenterology, New York University School of Medicine, New York, New York, United States of America
| | | | - Patrick Jean-Pierre
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, New York, United States of America
| | - Victoria Manuelli
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, New York, United States of America
| | - Peter Lopez
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, New York, United States of America
| | - Anita Shet
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, New York, United States of America
| | - Andrea Low
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, New York, United States of America
| | - Hiroshi Mohri
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, New York, United States of America
| | - Daniel Boden
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, New York, United States of America
| | - Paul Racz
- Bernhard-Nocht Institut Fur Tropenmedizin, Hamburg, Germany
| | - Martin Markowitz
- Aaron Diamond AIDS Research Center, Rockefeller University, New York, New York, United States of America
- * To whom correspondence should be addressed. E-mail:
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Mehandru S, Poles MA, Tenner-Racz K, Manuelli V, Jean-Pierre P, Lopez P, Shet A, Low A, Mohri H, Boden D, Racz P, Markowitz M. Mechanisms of gastrointestinal CD4+ T-cell depletion during acute and early human immunodeficiency virus type 1 infection. J Virol 2006; 81:599-612. [PMID: 17065209 PMCID: PMC1797467 DOI: 10.1128/jvi.01739-06] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
During acute and early human immunodeficiency virus type 1 (HIV-1) infection (AEI) more than 50% of CD4+ T cells are preferentially depleted from the gastrointestinal (GI) lamina propria. To better understand the underlying mechanisms, we studied virological and immunological events within the peripheral blood (PB) and GI tract during AEI. A total of 32 AEI subjects and 18 uninfected controls underwent colonic biopsy. HIV-1 viral DNA and RNA levels were quantified in CD4+ T cells derived from the GI tract and PB by using real-time PCR. The phenotype of infected cells was characterized by using combinations of immunohistochemistry and in situ hybridization. Markers of immunological memory, activation, and proliferation were examined by flow cytometry and immunohistochemistry, and the host-derived cytotoxic cellular response was examined by using immunohistochemistry. GI CD4+ T cells harbored, on average, 13-fold higher HIV-1 viral DNA levels and 10-fold higher HIV-1 RNA levels than PB CD4+ T cells during AEI. HIV-1 RNA was detected in both "activated" and "nonactivated" mucosal CD4+ T cells. A significantly higher number of activated and proliferating T cells were detected in the GI tract compared to the PB, and a robust cytotoxic response (HIV-1 specificity not determined) was detected in the GI tract as early as 18 days postinfection. Mucosal CD4+ T-cell depletion is multifactorial. Direct viral infection likely accounts for the earliest loss of CD4+ T cells. Subsequently, ongoing infection of susceptible CD4+ T cells, along with activation-induced cellular death and host cytotoxic cellular response, are responsible for the persistence of the lesion.
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Affiliation(s)
- Saurabh Mehandru
- Aaron Diamond AIDS Research Center, Rockefeller University, 455 First Ave., 7th Fl., New York, NY 10016, USA
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Kohli S, Griggs JJ, Jean-Pierre P, Mustian KM, Roscoe JA, Wade JL, Kuebler J, Fishkin E, Morrow GR. Self-reported cognitive impairment in cancer patients: A URCC CCOP longitudinal study of 595 patients. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8502] [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: 11/20/2022] Open
Abstract
8502 Background: Patients undergoing cancer treatment often report cognitive impairment, manifested as problems with concentration and memory. Such cognitive problems may be noticed only by the patient. The purpose of this multicenter longitudinal study was to investigate the frequency and severity of self-reported problems with memory and concentration over time. Methods: Patients undergoing treatment for solid tumors self-rated problems with memory and concentration using an 11-point Likert Scale (0 = Not present to 10 = “As bad as you can imagine”) at baseline before treatment began (T1), at their worst during treatment (T2), and at 6 months following treatment (T3). Any symptom level ≥ 7 was classified as “severe.” T-tests, paired or independent as appropriate, were used to examine differences in symptoms over time and between patients treated with and without chemotherapy. Results: Of 595 participants, 356 (60%) received chemotherapy, with or without radiation and 239 (40%) radiation alone. Concentration problems were reported by 48% of all participants at T1 (5% severe), 67% at T2 (18% severe) and 58% (8% severe) at T3 (p < .001). Memory loss was reported by 53% at T1 (4% severe), 67% (18% severe) at T2 and 68% (11% severe) at T3 (p < .001). The average frequency and severity of both symptoms in patients receiving chemotherapy increased significantly between T1 and T2 (p<.001). Both symptoms were less severe in patients receiving radiation alone at all three measurements (all ps<.001). Symptoms at T3 were significantly higher than T1 for both groups (p<.001). Conclusion: Self-reported problems with memory and concentration are experienced by the majority of cancer patients who receive chemotherapy and radiation. The cognitive problems get worse during treatment and persist at least 6 months following. Controlled studies of interventions for problems of memory loss and concentration are warranted. Supported in part by a supplement from the Division of Cancer Control and Population Sciences, NCI, to Public Health Service grant U10 CA37420 and by NCI grant 1R25CA102618. No significant financial relationships to disclose.
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Affiliation(s)
- S. Kohli
- University of Rochester, Rochester, NY; Central Illinois CCOP, Decatur, IL; Columbus CCOP, Columbus, OH; Northern New Jersey CCOP, Hackensack, NJ
| | - J. J. Griggs
- University of Rochester, Rochester, NY; Central Illinois CCOP, Decatur, IL; Columbus CCOP, Columbus, OH; Northern New Jersey CCOP, Hackensack, NJ
| | - P. Jean-Pierre
- University of Rochester, Rochester, NY; Central Illinois CCOP, Decatur, IL; Columbus CCOP, Columbus, OH; Northern New Jersey CCOP, Hackensack, NJ
| | - K. M. Mustian
- University of Rochester, Rochester, NY; Central Illinois CCOP, Decatur, IL; Columbus CCOP, Columbus, OH; Northern New Jersey CCOP, Hackensack, NJ
| | - J. A. Roscoe
- University of Rochester, Rochester, NY; Central Illinois CCOP, Decatur, IL; Columbus CCOP, Columbus, OH; Northern New Jersey CCOP, Hackensack, NJ
| | - J. L. Wade
- University of Rochester, Rochester, NY; Central Illinois CCOP, Decatur, IL; Columbus CCOP, Columbus, OH; Northern New Jersey CCOP, Hackensack, NJ
| | - J. Kuebler
- University of Rochester, Rochester, NY; Central Illinois CCOP, Decatur, IL; Columbus CCOP, Columbus, OH; Northern New Jersey CCOP, Hackensack, NJ
| | - E. Fishkin
- University of Rochester, Rochester, NY; Central Illinois CCOP, Decatur, IL; Columbus CCOP, Columbus, OH; Northern New Jersey CCOP, Hackensack, NJ
| | - G. R. Morrow
- University of Rochester, Rochester, NY; Central Illinois CCOP, Decatur, IL; Columbus CCOP, Columbus, OH; Northern New Jersey CCOP, Hackensack, NJ
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Figueroa-Moseley CD, Williams GC, Morrow GR, Jean-Pierre P, Carroll J, Ryan J. Empowered to stop smoking: The impact of a SDT smoking cessation intervention on economically disadvantaged whites and blacks. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.1012] [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: 11/20/2022] Open
Abstract
1012 Background: Few studies have examined the potential influence of an empowering Self Determination Theory (SDT) intervention on reducing smoking behaviors and outcomes for Whites and Blacks. Objectives: To determine if empowerment to stop smoking is associated with smoking outcomes in Whites and Blacks, and to examine if empowerment to stop smoking improved under the SDT Intervention vs. Usual Care conditions. Methods: A longitudinal randomized trial study was conducted to examine the effect of a SDT and health behavior change intervention for tobacco cessation among adult smokers. Participants were randomized into the SDT Intervention or the Usual Care condition. The present study includes data from a sample of 821 Whites and 177 Blacks who completed anonymous surveys at 1, 6, and 18-months intervals on empowerment to stop smoking (Perceived Competence Scale, Treatment Self-Regulation Questionnaire), demographics, and smoking behaviors. Results: Stepwise logistic regressions showed that empowerment to stop smoking was associated with quitting smoking at 1, 6, and 18 month follow-up for both treatment conditions. At one month, participants in the SDT Intervention with the highest levels of empowerment were 6.3 times more likely to quit smoking as compared with those in the usual care condition who were only 3.15 times as likely to quit smoking. Similar findings were found at 6 months and at 18 months (6- month SDT Intervention Empowerment High: (OR = 8.66, 95% C.I. 4.6, 16.3); 6 month Usual Care Empowerment High: (OR = 3.10, 95% C.I. 1.4, 7.0); 18- month SDT Intervention Empowerment High: (OR = 4.10, 95% C.I. 2.2, 7.5); 18 month Usual Care Empowerment High: (OR = 3.11, 95% C.I. 1.3, 7.7). In the SDT Intervention at 6 months being Black increased successful quitting by 2.4 times. Conclusions: Findings indicate that at each time-point the SDT Intervention empowered more participants to stop smoking than usual care alone. Findings also suggest that Blacks may increase their ability to stop smoking in the SDT Intervention condition. These preliminary findings highlight the need to further investigate the possible roles of empowerment interventions in smoking cessation among Whites and Blacks, especially cancer patients. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - G. R. Morrow
- University of Rochester Medical Center, Rochester, NY
| | | | - J. Carroll
- University of Rochester Medical Center, Rochester, NY
| | - J. Ryan
- University of Rochester Medical Center, Rochester, NY
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Carroll JK, Epstein R, Fiscella K, Volpe E, Jean-Pierre P, Morrow G. Health promotion and cancer screening services for African refugee women. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6101] [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: 11/20/2022] Open
Abstract
6101 Background: Previous work has shown that refugee women do not receive adequate preventive healthcare services, especially cancer screening. To identify factors that could affect the provision of cancer screening services to African Somali refugee women living in Rochester, NY, we assessed beliefs these women have about health promotion, access to care and use of preventive healthcare services. Methods: Individual in-depth interviews were conducted on a community-based sample of 34 resettled Somali-born women who were older than 18 years. Interviews were audiotaped and transcribed verbatim. A professional interpreter listened to all audiotaped interviews to check accuracy of transcription and translation. Content was analyzed by a multidisciplinary team using a grounded theory approach. Results: Median age of the women was 27 years. Length of residence in US was two months to nine years. For these women, health maintenance for acute survival took precedence over long-term prevention of disease. All women were familiar with basic health promotion practices, immunizations and routine medical examinations, and participants used both US-based and traditional techniques to prevent illness. Most women (71%, n=24), recognized the importance of maintaining good hygiene (59%, n=20) understood the need to have an adequate source of safe food and water, (74%, n=25) saw the need for access to a regular source of healthcare and (65%, n=22) acknowledged the need to function well at home. Few women understood cancer prevention services. Only three (9%) women recognized that the purpose of the Papanicalaou test was to screen for cervical cancer. Only six women (18%) recognized mammography (either the term or the procedure) and all of them were English-speaking, had lived in the US five years or longer, and had worked in the healthcare field. Conclusions: While traditional beliefs about health promotion did not appear to impede delivery of most preventive services, and participants understood prevention of infectious disease, their familiarity with cancer and cancer screening services was poor. Future health promotion programs need to increase refugee women’s knowledge about these services while building on other positive health-promoting beliefs. Supported by AHRQ 5R03HS014105 and NCI 1R25CA102618 No significant financial relationships to disclose.
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Affiliation(s)
- J. K. Carroll
- University of Rochester Cancer Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY; University of Rochester, Rochester, NY
| | - R. Epstein
- University of Rochester Cancer Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY; University of Rochester, Rochester, NY
| | - K. Fiscella
- University of Rochester Cancer Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY; University of Rochester, Rochester, NY
| | - E. Volpe
- University of Rochester Cancer Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY; University of Rochester, Rochester, NY
| | - P. Jean-Pierre
- University of Rochester Cancer Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY; University of Rochester, Rochester, NY
| | - G. Morrow
- University of Rochester Cancer Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY; University of Rochester, Rochester, NY
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Jean-Pierre P, Roscoe JA, Morrow GR, Hofman M, Fiscella K, Griggs J, Carroll J, Figueroa-Moseley C, Mattar BI, Wade JL. Cancer patients’ reported illness and treatment related concerns, perception of availability and use of available information: The influence of socio-demographics. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6077] [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: 11/20/2022] Open
Abstract
6077 Backgrounds: Studies that examine the roles of socio-demographics in illness perception and healthcare communication among cancer patients are relatively absent. Methods: This sample included 973 (904 whites, 69 non-whites) patients undergoing treatment for cancer at 20 geographically separate sites. Concerns over understanding the diagnosis and treatment plan were assessed on a 5-point-scale (“1=no concern” to “5=a great deal of concern”). Patients were also asked if: a) whether or not information was available to them, b) if yes, did they used it or not, and c) would more information have been helpful. χ2-analyses and ANCOVAs, were conducted to examine group differences in education, occupation, and concern over understanding the diagnosis and treatment plan. Logistic regressions were conducted to assess the independent association of race to patients’ beliefs that additional information would have been helpful. Results: χ2 analyses showed no significant difference between whites and non-whites in education and occupation (Ps > .05). Subsequent ANCOVAs showed significant group differences in concerns over understanding the diagnosis (F(1, 967) = 9.13, p = 0.003) and treatment plan (F(1, 967) = 7.95, p = 0.01), after adjusting for education, occupation, age, and gender. Additionally, χ2 showed significant group differences in beliefs that more information would have been helpful (p < .05). More non-whites (70.3%) than whites (53.1%) indicated that additional information would have been helpful to understanding the diagnosis. Similarly, more non-whites (69.4%) than whites (53.4%) indicated that additional information would have been helpful to understanding the treatment plan. Subsequent logistic regressions confirmed that race independently predicted patients’ indications that more information would have been helpful to understanding the diagnosis (OR = 1.96, 95%CI = 1.12, 3.42) and treatment plan (OR = 1.84, 95%CI = 1.05, 3.22). Conclusion: The findings underscore the need for oncology professionals to consider and integrate information about socio-demographics in their intervention and communication with racial/ethnic minority patients. Supported by NHI PHS-grant U10-CA37420 No significant financial relationships to disclose.
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Affiliation(s)
- P. Jean-Pierre
- University of Rochester Medical Center, Rochester, NY; Wichita CCOP, Wichita, KS; Central Illinois CCOP, Decatur, IL
| | - J. A. Roscoe
- University of Rochester Medical Center, Rochester, NY; Wichita CCOP, Wichita, KS; Central Illinois CCOP, Decatur, IL
| | - G. R. Morrow
- University of Rochester Medical Center, Rochester, NY; Wichita CCOP, Wichita, KS; Central Illinois CCOP, Decatur, IL
| | - M. Hofman
- University of Rochester Medical Center, Rochester, NY; Wichita CCOP, Wichita, KS; Central Illinois CCOP, Decatur, IL
| | - K. Fiscella
- University of Rochester Medical Center, Rochester, NY; Wichita CCOP, Wichita, KS; Central Illinois CCOP, Decatur, IL
| | - J. Griggs
- University of Rochester Medical Center, Rochester, NY; Wichita CCOP, Wichita, KS; Central Illinois CCOP, Decatur, IL
| | - J. Carroll
- University of Rochester Medical Center, Rochester, NY; Wichita CCOP, Wichita, KS; Central Illinois CCOP, Decatur, IL
| | - C. Figueroa-Moseley
- University of Rochester Medical Center, Rochester, NY; Wichita CCOP, Wichita, KS; Central Illinois CCOP, Decatur, IL
| | - B. I. Mattar
- University of Rochester Medical Center, Rochester, NY; Wichita CCOP, Wichita, KS; Central Illinois CCOP, Decatur, IL
| | - J. L. Wade
- University of Rochester Medical Center, Rochester, NY; Wichita CCOP, Wichita, KS; Central Illinois CCOP, Decatur, IL
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Hofman M, Morrow GR, Ranson SL, Jean-Pierre P, Dakhil SR, Moore T, Atkins J. Chemotherapy-naïve cancer patients’ expectations of developing treatment-related side effects: A URCC CCOP study of 670 patients from community practices. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8509] [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: 11/20/2022] Open
Abstract
8509 Background: Adequate management of cancer related side effects is important for patients yet challenging for clinical staff. Cancer treatment side effects have been characterized reasonably well in the literature; however, less is known about the relationships among response expectancies, personal characteristics, and side effects development of chemotherapy-naïve patients undergoing doxorubicin treatments. Methods: The present sample included 701 cancer patients from 14 CCOP institutions affiliated with the URCC CCOP research base. Of the total sample, 670 patients provided evaluable data to an item that assessed expectations that they will develop side effects such as nausea, vomiting, fatigue, and hair loss. Patients indicated their expectations on a 5-point scale (from 1 = “I am certain I will NOT have this” to 5 = “I am certain I WILL have this”). Results: The median number of symptoms expected (any value other than 1) was 4. Hair loss was most expected (98%) and vomiting the least (87%). Older patients (> 53-years, N = 316, ) were less confident they would get nausea (Mold = 2.96, SE = 0.064; Myoung = 3.23, SE = 0.057, p < 0.01) and hair loss (Mold = 4.22, SD = 0.063; Myoung = 4.39, SE = 0.051, p < 0.05). Females (n = 633) were more confident they would get hair loss than males (Mfemale = 4.34, SE = 0.041; Mmale = 3.89, SE = 0.172, p < 0.05). Patients who had some college (n = 397) thought it was more likely they would get hair loss than patients with less education (Mcollege = 4.38, SE = 0.048; Mnocollege = 4.21, SE = 0.069, p < 0.05). Conclusions: Chemotherapy-naïve patients scheduled to take doxorubicin clearly exhibit expectations about treatment side effects, which are influenced by age, gender and education. The findings show that knowledge of patients’ response expectancies and personal characteristics should be considered and integrated into interventions to control treatment side effects. Supported, in part, by a supplement from the Division of Cancer Control and Population Sciences, NCI, to Public Health Service grant U10 CA37420 and by grant RSG-01-071-PBP from the ACS [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. Hofman
- University of Rochester, Rochester, NY; CCOP, Wichita, KS; CCOP, Columbus, OH; SCCC, Winston-Salem, NC
| | - G. R. Morrow
- University of Rochester, Rochester, NY; CCOP, Wichita, KS; CCOP, Columbus, OH; SCCC, Winston-Salem, NC
| | - S. L. Ranson
- University of Rochester, Rochester, NY; CCOP, Wichita, KS; CCOP, Columbus, OH; SCCC, Winston-Salem, NC
| | - P. Jean-Pierre
- University of Rochester, Rochester, NY; CCOP, Wichita, KS; CCOP, Columbus, OH; SCCC, Winston-Salem, NC
| | - S. R. Dakhil
- University of Rochester, Rochester, NY; CCOP, Wichita, KS; CCOP, Columbus, OH; SCCC, Winston-Salem, NC
| | - T. Moore
- University of Rochester, Rochester, NY; CCOP, Wichita, KS; CCOP, Columbus, OH; SCCC, Winston-Salem, NC
| | - J. Atkins
- University of Rochester, Rochester, NY; CCOP, Wichita, KS; CCOP, Columbus, OH; SCCC, Winston-Salem, NC
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Shet A, Berry L, Mohri H, Mehandru S, Chung C, Kim A, Jean-Pierre P, Hogan C, Simon V, Boden D, Markowitz M. Tracking the prevalence of transmitted antiretroviral drug-resistant HIV-1: a decade of experience. J Acquir Immune Defic Syndr 2006; 41:439-46. [PMID: 16652051 DOI: 10.1097/01.qai.0000219290.49152.6a] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [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] [Indexed: 11/26/2022]
Abstract
Transmitted resistance to antiretroviral drugs in acute and early HIV-1 infection has been well documented, although overall trends vary depending on geography and cohort characteristics. To describe the changing pattern of transmitted drug-resistant HIV-1 in a well-defined cohort in New York City, a total of 361 patients with acute or recent HIV-1 infection were prospectively studied over a decade (1995-2004) with respect to HIV-1 genotypes and longitudinal T-cell subsets and HIV-1 RNA levels. The prevalence of overall transmitted resistance changed from 13.2% to 24.1% (P = 0.11) during the periods 1995 to 1998 and 2003 to 2004. Nonnucleoside reverse transcriptase inhibitor resistance prevalence increased significantly from 2.6% to 13.4% (P = 0.007) during the same periods, whereas prevalence of multidrug-resistant virus shifted from 2.6% to 9.8% (P = 0.07) but did not achieve statistical significance. A comparable immunologic and virologic response of appropriately treated individuals was observed regardless of viral drug susceptibility status, suggesting that initial combination therapy guided by baseline resistance testing in the case of acute and early infection may result in a favorable treatment response even in the case of a drug-resistant virus. These data have important implications for selection of empiric first-line regimens for treatment of acutely infected antiretroviral-naive individuals and reinforce the need for baseline resistance testing in acute and early HIV-1 infection.
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Affiliation(s)
- Anita Shet
- Aaron Diamond AIDS Research Center (an affiliate of the Rockefeller University), New York, NY 10016, USA
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Markowitz M, Mohri H, Mehandru S, Shet A, Berry L, Kalyanaraman R, Kim A, Chung C, Jean-Pierre P, Horowitz A, La Mar M, Wrin T, Parkin N, Poles M, Petropoulos C, Mullen M, Boden D, Ho DD. Infection with multidrug resistant, dual-tropic HIV-1 and rapid progression to AIDS: a case report. Lancet 2005; 365:1031-8. [PMID: 15781098 DOI: 10.1016/s0140-6736(05)71139-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [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: 11/26/2022]
Abstract
BACKGROUND Rapid progression to AIDS after acute HIV-1 infection, though uncommon, has been noted, as has the transmission of multidrug resistant viruses. Here, we describe a patient in whom these two factors arose concomitantly and assess the effects. METHODS We did a case study of a patient with HIV-1 seroconversion. We genotyped the virus and host genetic markers by PCR and nucleotide sequencing. To ascertain the drug susceptibility of our patient's HIV-1 we did phenotypic studies with the PhenoSense assay. We assessed viral coreceptor use via syncytium formation in vitro and with a modified PhenoSense assay. FINDINGS Our patient seems to have been recently infected by a viral variant of HIV-1 resistant to multiple classes of antiretroviral drugs. Furthermore, his virus population is dual tropic for cells that express CCR5 or CXCR4 coreceptor. The infection has resulted in progression to symptomatic AIDS in 4-20 months. INTERPRETATION The intersection of multidrug resistance and rapid development of AIDS in this patient is of concern, especially in view of his case history, which includes high-risk sexual contacts and use of metamfetamine. The public health ramifications of such a case are great.
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Affiliation(s)
- Martin Markowitz
- Aaron Diamond AIDS Research Center, Rockefeller University, 455 First Avenue, 7th Floor, New York, NY 10016, USA.
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