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Johnson BJ, Barcus RA, Olson JD, Lipford ME, Andrews RN, Dugan GO, Tooze JA, Kim J, Deycmar S, Whitlow CT, Cline JM. Total-Body Irradiation Alters White Matter Volume and Microstructural Integrity in Rhesus Macaques. Int J Radiat Oncol Biol Phys 2024; 119:208-218. [PMID: 37972714 DOI: 10.1016/j.ijrobp.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Long-term survivors of brain irradiation can experience irreversible injury and cognitive impairment. T1-weighted and diffusion tensor magnetic resonance imaging (MRI) are used to evaluate brain volume and white matter (WM) microstructure in neurodevelopmental and neurodegenerative conditions. The goal of this study was to evaluate the long-term effects of single-dose total-body irradiation (TBI) or TBI with 5% partial-body sparing on brain volumetrics and WM integrity in macaques. METHODS AND MATERIALS We used MRI scans from a cohort of male rhesus macaques (age range, 3.6-22.8 years) to compare global and regional brain volumes and WM diffusion in survivors of TBI (T1-weighted, n = 137; diffusion tensor imaging, n = 121; dose range, 3.5-10 Gy) with unirradiated controls (T1-weighted, n = 48; diffusion tensor imaging, n = 38). RESULTS In all regions of interest, radiation affected age-related changes in fractional anisotropy, which tended to increase across age in both groups but to a lesser extent in the irradiated group (interaction P < .01). Depending on the region of interest, mean diffusivity decreased or remained the same across age in unirradiated animals, whereas it increased or did not change in irradiated animals. The increases in mean diffusivity were driven by changes in radial diffusivity, which followed similar trends across age. Axial diffusivity did not differ by irradiation status. Age-related changes in relative volumes in controls reflected normal trends in humans, with increasing WM and decreasing gray matter until middle age. Cerebrospinal fluid (CSF) volume did not differ across age in controls. WM volume was lower and CSF volume was higher in young irradiated macaques. WM volume was similar between groups, and CSF volume lower in older irradiated macaques. Gray matter volume was unaffected by radiation. CONCLUSIONS TBI results in delayed WM expansion and long-term disruption of WM integrity. Diffusion changes suggest that myelin injury in WM is a hallmark of late-delayed radiation-induced brain injury.
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Affiliation(s)
- Brendan J Johnson
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Richard A Barcus
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John D Olson
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Megan E Lipford
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rachel N Andrews
- Department of Radiation Oncology, Section on Radiation Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Greg O Dugan
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jeongchul Kim
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Simon Deycmar
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christopher T Whitlow
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina; Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - J Mark Cline
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Prentice RL, Aragaki AK, Zheng C, Manson JE, Tinker LF, Ravelli MN, Mossavar-Rahmani Y, Wallace RB, Tooze JA, Johnson KC, Lampe JW, Neuhouser ML, Schoeller DA. Biomarker-assessed total energy intake and its cohort study association with all-cause mortality in postmenopausal females. Am J Clin Nutr 2024; 119:1329-1337. [PMID: 38428741 DOI: 10.1016/j.ajcnut.2024.02.020] [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: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The association of total energy intake (EI) with all-cause mortality is uncertain as are the dependencies of this association on age and weight change history. OBJECTIVES To identify an EI biomarker suitable for use in epidemiologic association studies and to study EI associations with total mortality in a Women's Health Initiative (WHI) cohort of postmenopausal United States females (1993-present). METHODS EI biomarkers were developed based on doubly labeled water (DLW) total energy expenditure (TEE) and weight variation during the 2-wk DLW protocol period using the energy balance method in an embedded feeding study (n = 153). This along with 2 earlier WHI nutrition biomarker studies having TEE assessments (n = 1131 total), with 14.6 y (median) follow-up, constituted a prospective cohort for the study of EI and all-cause mortality. RESULTS An empirical biomarker for log(EI) was developed that had a correlation of 0.73 with log(feeding study-consumed EI). The overall association between EI and mortality was nonsignificant. The association, however, depended on age (P = 0.009), with lower EI associated with lower mortality at younger ages, and also on preceding weight change history (P = 0.03). Among participants with stable or increasing weight, mortality hazard ratios (95% confidence intervals [CIs]) for a 12% lower EI were 0.66 (95% CI: 0.51, 0.87) at age 60, 0.84 (95% CI: 0.72, 0.98) at age 70, and 1.06 (95% CI: 0.87, 1.29) at age 80. Corresponding values for participants having preceding weight loss were 0.83 (95% CI: 0.61, 1.12) at age 60, 1.05 (95% CI: 0.87, 1.26) at age 70, and 1.33 (95% CI: 1.08, 1.63) at age 80. A previously considered EI biomarker, using a theoretical model for variation in body fat and fat-free mass components over time, gave similar results following rescaling. CONCLUSIONS Lower EI is associated with lower all-cause mortality among younger postmenopausal females with stable or increasing weight and with higher mortality among older females with weight loss. This study was registered with clinicaltrials.gov as NCT00000611.
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Affiliation(s)
- Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States.
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Cheng Zheng
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Michele N Ravelli
- Biotech Center and Neurology, University of Wisconsin, Madison, WI, United States
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Robert B Wallace
- College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Center, Memphis TN, United States
| | - Johanna W Lampe
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States
| | - Dale A Schoeller
- Biotech Center and Nutritional Sciences, University of Wisconsin, Madison WI, United States
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3
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Bitting RL, Tooze JA, Goodman M, Vile DC, Brown JM, Thomas CY, Neve M, Kooshki M, Addo S, Triozzi PL, Dubey P. Low-dose Paclitaxel with Pembrolizumab Enhances Clinical and Immunologic Responses in Platinum-refractory Urothelial Carcinoma. Cancer Res Commun 2024; 4:530-539. [PMID: 38345536 PMCID: PMC10896069 DOI: 10.1158/2767-9764.crc-23-0436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/09/2023] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Single-agent checkpoint inhibition is effective in a minority of patients with platinum-refractory urothelial carcinoma; therefore, the efficacy of combining low-dose paclitaxel with pembrolizumab was tested. MATERIALS AND METHODS This was a prospective, single-arm phase II trial with key inclusion criteria of imaging progression within 12 months of platinum therapy and Eastern Cooperative Oncology Group ≤1. Treatment was pembrolizumab 200 mg day 1 and paclitaxel 80 mg/m2 days 1 and 8 of a 21-day cycle for up to eight cycles unless progression or unacceptable adverse events (AE). The primary endpoint was overall response rate (ORR) with overall survival (OS), 6-month progression-free survival (PFS), and safety as key secondary endpoints. Change in circulating immune cell populations, plasma, and urinary miRs were evaluated. RESULTS Twenty-seven patients were treated between April 2016 and June 2020, with median follow-up of 12.4 months. Baseline median age was 68 years, with 81% men and 78% non-Hispanic White. ORR was 33% by intention to treat and 36% in imaging-evaluable patients with three complete responses. Six-month PFS rate was 48.1% [95% confidence interval (CI): 28.7-65.2] and median OS 12.4 months (95% CI: 8.7 months to not reached). Common ≥ grade 2 possibly-related AEs were anemia, lymphopenia, hyperglycemia, and fatigue; grade 3/4 AEs occurred in 56%, including two immune-mediated AEs (pneumonitis and nephritis). Responding patients had a higher percentage of circulating CD4+IFNγ+ T cells. Levels of some miRs, including plasma miR 181 and miR 223, varied in responders compared with nonresponders. CONCLUSIONS The addition of low-dose paclitaxel to pembrolizumab is active and safe in platinum-refractory urothelial carcinoma. SIGNIFICANCE We found that combining pembrolizumab with low-dose paclitaxel may be effective in patients with urothelial carcinoma progressing on platinum chemotherapy, with favorable safety profiles.
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Affiliation(s)
- Rhonda L Bitting
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Janet A Tooze
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael Goodman
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Donald C Vile
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jessica M Brown
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio
| | - Christopher Y Thomas
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Morgan Neve
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mitra Kooshki
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Safoa Addo
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Pierre L Triozzi
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Purnima Dubey
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio
- Pelotonia Institute of Immunooncology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
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4
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Reynolds LM, Houston DK, Skiba MB, Whitsel EA, Stewart JD, Li Y, Zannas AS, Assimes TL, Horvath S, Bhatti P, Baccarelli AA, Tooze JA, Vitolins MZ. Diet Quality and Epigenetic Aging in the Women's Health Initiative. J Acad Nutr Diet 2024:S2212-2672(24)00002-9. [PMID: 38215906 DOI: 10.1016/j.jand.2024.01.002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Higher diet quality scores are associated with a lower risk for many chronic diseases and all-cause mortality; however, it is unclear if diet quality is associated with aging biology. OBJECTIVE This study aimed to examine the association between diet quality and a measure of biological aging known as epigenetic aging. DESIGN A cross-sectional data analysis was used to examine the association between three diet quality scores based on self-reported food frequency questionnaire data and five measures of epigenetic aging based on DNA methylation (DNAm) data from peripheral blood. PARTICIPANTS/SETTING This study included 4,500 postmenopausal women recruited from multiple sites across the United States (1993-98), aged 50 to 79 years, with food frequency questionnaire and DNAm data available from the Women's Health Initiative baseline visit. MAIN OUTCOME MEASURES Five established epigenetic aging measures were generated from HumanMethylation450 Beadchip DNAm data, including AgeAccelHannum, AgeAccelHorvath, AgeAccelPheno, AgeAccelGrim, and DunedinPACE. STATISTICAL ANALYSES PERFORMED Linear mixed models were used to test for associations between three diet quality scores (Healthy Eating Index, Dietary Approaches to Stop Hypertension, and alternate Mediterranean diet scores) and epigenetic aging measures, adjusted for age, race and ethnicity, education, tobacco smoking, physical activity, Women's Health Initiative substudy from which DNAm data were obtained, and DNAm-based estimates of leukocyte proportions. RESULTS Healthy Eating Index, Dietary Approaches to Stop Hypertension, and alternate Mediterranean diet scores were all inversely associated with AgeAccelPheno, AgeAccelGrim, and DunedinPACE (P < 0.05), with the largest effects with DunedinPACE. A one standard deviation increment in diet quality scores was associated with a decrement (β ± SE) in DunedinPACE z score of -0.097 ± 0.014 (P = 9.70 x 10-13) for Healthy Eating Index, -0.107 ± 0.014 (P = 1.53 x 10-14) for Dietary Approaches to Stop Hypertension, and -0.068 ± 0.013 (P = 2.31 x 10-07) for the alternate Mediterranean diet. CONCLUSIONS In postmenopausal women, diet quality scores were inversely associated with DNAm-based measures of biological aging, particularly DunedinPACE.
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Affiliation(s)
- Lindsay M Reynolds
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
| | - Denise K Houston
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Meghan B Skiba
- Division of Biobehavioral Health Science, University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Yun Li
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Anthony S Zannas
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Themistocles L Assimes
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Steve Horvath
- Department of Human Genetics, University of California Los Angeles, Los Angeles, California; Altos Labs, San Diego, California
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mara Z Vitolins
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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5
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Danhauer SC, Brenes GA, Tooze JA, Abubaker T, Thomas A, Howard DS, Puccinelli-Ortega N, Jimenez K, Graves KD. Cultural and linguistic adaptation of a telephone-based cognitive-behavioral therapy (CBT) intervention to treat depression and anxiety in Hispanic cancer survivors. J Psychosoc Oncol 2023:1-15. [PMID: 38127055 DOI: 10.1080/07347332.2023.2296045] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE/OBJECTIVES The purpose of this study was to transcreate a manualized cognitive-behavioral therapy (CBT) intervention to address depression and anxiety among Hispanic cancer survivors. DESIGN/RESEARCH APPROACH Stakeholders reviewed the CBT workbook for language, content, and cultural relevance. We designed semi-structured interview guides to elicit intervention feedback. SAMPLE/PARTICIPANTS Stakeholder participants were Hispanic cancer survivors (n = 4), bilingual mental health providers (n = 2), and oncology professionals (n = 4). METHODS Transcreation was conducted by initial translation of the workbook followed by incorporation of stakeholder feedback. A bilingual (Spanish and English) interviewer conducted stakeholder interviews. The study team discussed themes/suggestions before refining the workbook. FINDINGS Stakeholders reported enthusiasm for the intervention. We gathered significant feedback regarding wording, images, and resources for the workbook. CONCLUSION Development of culturally appropriate mental health resources for Hispanic cancer survivors is critical. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY By broadening research on psychosocial care to the Hispanic population, we increase the reach of evidence-based psychological care. Future research should fully evaluate the adapted CBT intervention among Hispanic survivors.
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Affiliation(s)
- Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Gretchen A Brenes
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Tebianne Abubaker
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alexandra Thomas
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Dianna S Howard
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nicole Puccinelli-Ortega
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Karolina Jimenez
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Falk DS, Tooze JA, Winkfield KM, Bell RA, Birken SA, Morris BB, Strom C, Copus E, Shore K, Weaver KE. Factors Associated with Delaying and Forgoing Care Due to Cost among Long-term, Appalachian Cancer Survivors in Rural North Carolina. Cancer Surviv Res Care 2023; 1:2270401. [PMID: 38178811 PMCID: PMC10766413 DOI: 10.1080/28352610.2023.2270401] [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] [Received: 05/03/2023] [Accepted: 10/09/2023] [Indexed: 01/06/2024]
Abstract
Background Little research exists on delayed and forgone health and mental health care due to cost among rural cancer survivors. Methods We surveyed survivors in 7 primarily rural, Appalachian counties February to May 2020. Univariable analyses examined the distribution and prevalence of delayed/forgone care due to cost in the past year by independent variables. Chi-square or Fisher's tests examined bivariable differences. Logistic regressions assessed the odds of delayed/forgone care due to cost. Results Respondents (n=428), aged 68.6 years on average (SD: 12.0), were 96.3% non-Hispanic white and 49.8% female; 25.0% reported delayed/forgone care due to cost. The response rate was 18.5%. The proportion of delayed/forgone care for those aged 18-64 years was 46.7% and 15.0% for those aged 65+ years (P<0.0001). Females aged 65+ years (OR: 2.00; CI: 1.02-3.93) had double the odds of delayed/forgone care due to cost compared to males aged 65+ years. Conclusion About one in four rural cancer survivors reported delayed/forgone care due to cost, with rates approaching 50% in survivors aged <65 years. Impact Clinical implications indicate the need to: 1) ask about the impact of care costs, and 2) provide supportive services to mitigate effects of treatment costs, particularly for younger and female survivors.
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Affiliation(s)
- Derek S Falk
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157 (Sponsor)
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, Ohio, USA 44106 (Present)
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, USA 37208
- Department of Radiation Oncology, Vanderbilt University Medical Center, Preston Research Building, Rm B-1003, 2220 Pierce Ave, Nashville, TN, USA 37232
| | - Ronny A Bell
- Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA 27599
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA 27599
| | - Sarah A Birken
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157
- Department of Implementation Science, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157
| | - Bonny B Morris
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157 (Sponsor)
| | - Carla Strom
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157
| | - Emily Copus
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157
| | - Kelsey Shore
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157
| | - Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157 (Sponsor)
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157
- Department of Implementation Science, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157
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7
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Brickey WJ, Caudell DL, Macintyre AN, Olson JD, Dai Y, Li S, Dugan GO, Bourland JD, O’Donnell LM, Tooze JA, Huang G, Yang S, Guo H, French MN, Schorzman AN, Zamboni WC, Sempowski GD, Li Z, Owzar K, Chao NJ, Cline JM, Ting JPY. The TLR2/TLR6 ligand FSL-1 mitigates radiation-induced hematopoietic injury in mice and nonhuman primates. Proc Natl Acad Sci U S A 2023; 120:e2122178120. [PMID: 38051771 PMCID: PMC10723152 DOI: 10.1073/pnas.2122178120] [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: 12/09/2021] [Accepted: 10/23/2023] [Indexed: 12/07/2023] Open
Abstract
Thrombocytopenia, hemorrhage, anemia, and infection are life-threatening issues following accidental or intentional radiation exposure. Since few therapeutics are available, safe and efficacious small molecules to mitigate radiation-induced injury need to be developed. Our previous study showed the synthetic TLR2/TLR6 ligand fibroblast stimulating lipopeptide (FSL-1) prolonged survival and provided MyD88-dependent mitigation of hematopoietic acute radiation syndrome (H-ARS) in mice. Although mice and humans differ in TLR number, expression, and function, nonhuman primate (NHP) TLRs are like those of humans; therefore, studying both animal models is critical for drug development. The objectives of this study were to determine the efficacy of FSL-1 on hematopoietic recovery in small and large animal models subjected to sublethal total body irradiation and investigate its mechanism of action. In mice, we demonstrate a lack of adverse effects, an easy route of delivery (subcutaneous) and efficacy in promoting hematopoietic progenitor cell proliferation by FSL-1. NHP given radiation, followed a day later with a single subcutaneous administration of FSL-1, displayed no adversity but showed elevated hematopoietic cells. Our analyses revealed that FSL-1 promoted red blood cell development and induced soluble effectors following radiation exposure. Cytologic analysis of bone marrow aspirates revealed a striking enhancement of mononuclear progenitor cells in FSL-1-treated NHP. Combining the efficacy of FSL-1 in promoting hematopoietic cell recovery with the lack of adverse effects induced by a single administration supports the application of FSL-1 as a viable countermeasure against H-ARS.
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Affiliation(s)
- W. June Brickey
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
- Lineberger Comprehensive Cancer Center, Center of Translational Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
| | - David L. Caudell
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Winston Salem, NC27157
| | - Andrew N. Macintyre
- Duke Human Vaccine Institute, Department of Medicine, Duke University School of Medicine, Durham, NC27710
| | - John D. Olson
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Winston Salem, NC27157
| | - Yanwan Dai
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC27705
| | - Sirui Li
- Lineberger Comprehensive Cancer Center, Center of Translational Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
| | - Gregory O. Dugan
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Winston Salem, NC27157
| | - J. Daniel Bourland
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC27157
| | - Lisa M. O’Donnell
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Winston Salem, NC27157
| | - Janet A. Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC27157
| | - Guannan Huang
- Lineberger Comprehensive Cancer Center, Center of Translational Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
| | - Shuangshuang Yang
- Lineberger Comprehensive Cancer Center, Center of Translational Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
| | - Hao Guo
- Lineberger Comprehensive Cancer Center, Center of Translational Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
| | - Matthew N. French
- Duke Human Vaccine Institute, Department of Medicine, Duke University School of Medicine, Durham, NC27710
| | - Allison N. Schorzman
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
| | - William C. Zamboni
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
| | - Gregory D. Sempowski
- Duke Human Vaccine Institute, Department of Medicine, Duke University School of Medicine, Durham, NC27710
| | - Zhiguo Li
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC27705
- Duke Cancer Institute, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC27705
| | - Kouros Owzar
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC27705
- Duke Cancer Institute, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC27705
| | - Nelson J. Chao
- Department of Medicine, Duke University School of Medicine, Durham, NC27705
| | - J. Mark Cline
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Winston Salem, NC27157
| | - Jenny P. Y. Ting
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
- Lineberger Comprehensive Cancer Center, Center of Translational Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
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Salsman JM, McLouth LE, Tooze JA, Little-Greene D, Cohn M, Kehoe MS, Moskowitz JT. An eHealth, Positive Emotion Skills Intervention for Enhancing Psychological Well-Being in Young Adult Cancer Survivors: Results from a Multi-Site, Pilot Feasibility Trial. Int J Behav Med 2023; 30:639-650. [PMID: 36890329 PMCID: PMC10485177 DOI: 10.1007/s12529-023-10162-5] [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] [Accepted: 02/01/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Young adult (YA) cancer survivors experience clinically significant distress and have limited access to psychosocial support. Given growing evidence for unique adaptive benefits of positive emotion in the context of health-related and other life stress, we developed an eHealth positive emotion skills intervention for post-treatment survivors called EMPOWER (Enhancing Management of Psychological Outcomes With Emotion Regulation) and evaluated feasibility and proof of concept for reducing distress and enhancing well-being. METHOD In this single-arm pilot feasibility trial, post-treatment YA cancer survivors (ages 18-39) participated in the EMPOWER intervention which included 8 skills (e.g., gratitude, mindfulness, acts of kindness). Participants completed surveys at baseline (pre-intervention), 8 weeks (post-intervention), and 12 weeks (1-month follow-up). Primary outcomes included feasibility (assessed by participation percentage) and acceptability (would recommend EMPOWER skills to a friend). Secondary outcomes included psychological well-being (mental health, positive affect, life satisfaction, meaning/purpose, general self-efficacy) and distress (depression, anxiety, anger). RESULTS We assessed 220 YAs for eligibility; 77% declined. Of those screened, 44 (88%) were eligible and consented, 33 began the intervention, and 26 (79%) completed the intervention. Overall retention was 61% at 12 weeks. Average acceptability ratings were high (8.8/10). Participants (M = 30.8 years, SD = 6.6) were 77% women, 18% racial/ethnic minorities, and 34% breast cancer survivors. At 12 weeks, EMPOWER was associated with improved mental health, positive affect, life satisfaction, meaning/purpose, and general self-efficacy (ps < .05, ds = .45 to .63) and decreased anger (p < .05, d = - 0.41). CONCLUSION EMPOWER demonstrated evidence of feasibility and acceptability as well as proof of concept for enhancing well-being and reducing distress. Self-guided, eHealth interventions show promise for addressing YA cancer survivors' needs and warrant additional research to optimize survivorship care. TRIAL REGISTRATION ClinicalTrials .gov NCT02832154, https://clinicaltrials.gov/ct2/show/NCT02832154.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine & Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Laurie E McLouth
- Department of Behavioral Science and Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine & Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Denisha Little-Greene
- Health Care Education, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Mia Sorkin Kehoe
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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9
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Cheng JJ, Tooze JA, Callahan KE, Pajewski NM, Pardee TS, Reed DR, Klepin HD. Assessment of an embedded primary care-derived electronic health record (EHR) frailty index (eFI) in older adults with acute myeloid leukemia. J Geriatr Oncol 2023; 14:101509. [PMID: 37454532 PMCID: PMC10977044 DOI: 10.1016/j.jgo.2023.101509] [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: 02/28/2023] [Revised: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Assessing frailty is integral to treatment decision-making for older adults with acute myeloid leukemia (AML). Prior electronic frailty indices (eFI) derive from an accumulated-deficit model and are associated with mortality in older primary care populations. We evaluated use of an embedded eFI in AML by describing baseline eFI categories by treatment type and exploring associations between eFI categories, survival, and treatment received. MATERIALS AND METHODS This was a retrospective study of subjects ≥60 years old with new AML treated at an academic medical center from 1/2018-10/2020. The eFI requires ≥2 ambulatory visits over two years and uses demographics, vitals, ICD-10 codes, outpatient labs, and available functional information from Medicare Annual Wellness Visits. Frailty was defined as fit (eFI ≤ 0.10), pre-frail (0.10 < eFI ≤ 0.21), and frail (eFI > 0.21). Chemotherapy was intensive (anthracycline-based) or less-intensive (hypomethylating agent, low dose cytarabine +/- venetoclax). Therapy type, pre-treatment characteristics, and chemotherapy cycles were compared by eFI category using chi-square and Fisher's exact tests and ANOVA. Median survival was compared by eFI category using log-rank tests stratified by therapy type. RESULTS Among 166 older adults treated for AML (mean age 74 years, 61% male, 85% Caucasian), only 79 (48%) had a calculable eFI score before treatment. Of these, baseline eFI category was associated with treatment received (fit (n = 31): 68% intensive, 32% less intensive; pre-frail (n = 38): 37% intensive, 63% less intensive; frail (n = 10): 0% intensive, 100% less intensive; not calculable (n = 87): 48% intensive, 52% less-intensive; p < 0.01). The prevalence of congestive heart failure and secondary AML differed by frailty status (p < 0.01). Median survival did not differ between eFI categories for intensively (p = 0.48) or less-intensively (p = 0.09) treated patients. For those with less-intensive therapy who lived ≥6 months, eFI category was not associated with the number of chemotherapy cycles received (p = 0.97). The main reason for an incalculable eFI was a lack of outpatient visits in our health system prior to AML diagnosis. DISCUSSION A primary care-derived eFI was incalculable for half of older adults with AML at an academic medical center. Frailty was associated with chemotherapy intensity but not survival or treatment duration. Next steps include testing adaptations of the eFI to the AML setting.
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Affiliation(s)
- Justin J Cheng
- Wake Forest University School of Medicine, Department of Medicine, United States of America.
| | - Janet A Tooze
- Wake Forest University School of Medicine, Division of Public Health Sciences, Department of Biostatistics and Data Science, United States of America
| | - Kathryn E Callahan
- Wake Forest University School of Medicine, Department of Medicine, Section of Gerontology and Geriatric Medicine, United States of America
| | - Nicholas M Pajewski
- Wake Forest University School of Medicine, Division of Public Health Sciences, Department of Biostatistics and Data Science, United States of America
| | - Timothy S Pardee
- Wake Forest University School of Medicine, Department of Medicine, Section of Hematology and Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Daniel R Reed
- Wake Forest University School of Medicine, Department of Medicine, Section of Hematology and Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Heidi D Klepin
- Wake Forest University School of Medicine, Department of Medicine, Section of Hematology and Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC 27157, United States of America
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10
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Bailey RL, Jun S, Cowan AE, Eicher-Miller HA, Gahche JJ, Dwyer JT, Hartman TJ, Mitchell DC, Seguin-Fowler RA, Carroll RJ, Tooze JA. Major Gaps in Understanding Dietary Supplement Use in Health and Disease. Annu Rev Nutr 2023; 43:179-197. [PMID: 37196365 PMCID: PMC11078263 DOI: 10.1146/annurev-nutr-011923-020327] [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: 05/19/2023]
Abstract
Precise dietary assessment is critical for accurate exposure classification in nutritional research, typically aimed at understanding how diet relates to health. Dietary supplement (DS) use is widespread and represents a considerable source of nutrients. However, few studies have compared the best methods to measure DSs. Our literature review on the relative validity and reproducibility of DS instruments in the United States [e.g., product inventories, questionnaires, and 24-h dietary recalls (24HR)] identified five studies that examined validity (n = 5) and/or reproducibility (n = 4). No gold standard reference method exists for validating DS use; thus, each study's investigators chose the reference instrument used to measure validity. Self-administered questionnaires agreed well with 24HR and inventory methods when comparing the prevalence of commonly used DSs. The inventory method captured nutrient amounts more accurately than the other methods. Reproducibility (over 3 months to 2.4 years) of prevalence of use estimates on the questionnaires was acceptable for common DSs. Given the limited body of research on measurement error in DS assessment, only tentative conclusions on these DS instruments can be drawn at present. Further research is critical to advancing knowledge in DS assessment for research and monitoring purposes.
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Affiliation(s)
- Regan L Bailey
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | - Shinyoung Jun
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang-si, Republic of Korea
| | - Alexandra E Cowan
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | | | - Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland, USA
| | - Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland, USA
- Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Terryl J Hartman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Diane C Mitchell
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | - Rebecca A Seguin-Fowler
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | - Raymond J Carroll
- Department of Statistics, Texas A&M University, College Station, Texas, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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11
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Houston DK, Marsh AP, Neiberg RH, Demons JL, Campos CL, Kritchevsky SB, Delbono O, Tooze JA. Corrigendum to 'Vitamin D Supplementation and Muscle Power, Strength and Physical Performance in Older Adults: A Randomized Controlled Trial' [The American Journal of Clinical Nutrition, Volume 117, Issue 6, June 2023, Pages 1086-1095]. Am J Clin Nutr 2023; 118:486. [PMID: 37331702 PMCID: PMC10493470 DOI: 10.1016/j.ajcnut.2023.06.004] [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: 06/20/2023] Open
Affiliation(s)
- Denise K Houston
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, USA
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Jamehl L Demons
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Claudia L Campos
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Osvaldo Delbono
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC, USA
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12
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Sohl SJ, Strahley AE, Tooze JA, Levine B, Kelly MG, Wheeler A, Evans S, Danhauer SC. Qualitative results from a randomized pilot study of eHealth Mindful Movement and Breathing to improve gynecologic cancer surgery outcomes. J Psychosoc Oncol 2023; 42:223-241. [PMID: 37462260 PMCID: PMC10794552 DOI: 10.1080/07347332.2023.2236083] [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: 01/19/2024]
Abstract
PURPOSE Improved management of pain and co-morbid symptoms (sleep disturbances, psychological distress) among women undergoing surgery for suspected gynecologic malignancies may reach a population vulnerable to chronic pain. PARTICIPANTS Women undergoing surgery for a suspected gynecologic malignancy. METHOD We conducted a pilot randomized controlled trial of eHealth Mindful Movement and Breathing (eMMB) compared to an empathic attention control (AC). Semi-structured interviews were conducted by telephone (n = 23), recorded, transcribed, coded, and analyzed using thematic analysis. FINDINGS Participants reported overall high acceptability such that all would recommend the study to others. Positive impacts of practicing eMMB included that it relieved tension, facilitated falling asleep, and decreased pain. Participants also reported high adherence to self-directed eMMB and AC writing practices and described facilitators and barriers to practicing. CONCLUSIONS This qualitative feedback will inform future research to assess the efficacy of eMMB for reducing pain and use of remotely-delivered interventions more broadly. CLINICAL TRIAL REGISTRATION NUMBER NCT03681405.
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Affiliation(s)
- Stephanie J. Sohl
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA
| | - Ashley E. Strahley
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA
| | - Janet A. Tooze
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Beverly Levine
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA
| | - Michael G. Kelly
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Amy Wheeler
- Kinesiology Department, California State University, San Bernardino, 5500 University Pkwy, San Bernardino, CA 92407
| | - Sue Evans
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA
| | - Suzanne C. Danhauer
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA
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13
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Houston DK, Marsh AP, Neiberg RH, Demons JL, Campos CL, Kritchevsky SB, Delbono O, Tooze JA. Vitamin D Supplementation and Muscle Power, Strength and Physical Performance in Older Adults: A Randomized Controlled Trial. Am J Clin Nutr 2023; 117:1086-1095. [PMID: 37084814 PMCID: PMC10447505 DOI: 10.1016/j.ajcnut.2023.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/03/2022] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Low 25-hydroxyvitamin D (25[OH]D) concentrations (<30 ng/mL [<50 nmol/L]) have been associated with muscle weakness and impaired physical performance in observational studies. However, the effect of vitamin D supplementation on changes in muscle strength and physical performance in randomized controlled trials has been mixed. OBJECTIVES To determine the effect of daily vitamin D supplementation on leg power, strength, and physical performance in low-functioning older adults with 25(OH)D concentrations of 18 to <30 ng/mL. METHODS In this double-blind, randomized controlled trial, 136 low-functioning [Short Physical Performance Battery (SPPB) scores ≤10] adults aged 65-89 y with 25(OH)D concentrations of 18 to <30 ng/mL were randomly assigned to 2000 IU/d vitamin D3 or placebo for 12 mo. Lower-extremity leg power (primary outcome), leg and grip strength, SPPB, timed up and go (TUG), postural sway, and gait velocity and spatiotemporal parameters (secondary outcomes) were assessed at baseline, 4 and 12 mo. A subset (n = 37) also underwent a muscle biopsy at baseline and 4 mo and muscle fiber composition and contractile properties were assessed. RESULTS Participants' mean ± SD age and SPPB scores at baseline were 73.4 ± 6.3 y and 7.8 ± 1.8, respectively. Mean ± SD 25(OH)D concentrations at baseline and 12 mo were 19.4 ± 4.2 ng/mL and 28.6 ± 6.7 ng/mL in the vitamin D group and 19.9 ± 4.9 ng/mL and 20.2 ± 5.0 ng/mL in the placebo group for a mean ± SE difference of 9.1 ± 1.1 ng/mL (P < 0.0001). However, there were no differences in change in leg power, leg or grip strength, SPPB score, TUG, postural sway, or gait velocity and spatiotemporal parameters by intervention group over 12 mo or muscle fiber composition and contractile properties over 4 mo. CONCLUSIONS In low-functioning older adults with 25(OH)D concentrations of 18 to <30 ng/mL, randomization to 2000 IU/d vitamin D3 did not result in improvements in leg power, strength, or physical performance or muscle fiber composition and contractile properties. This trial was registered at clinicaltrials.gov as NCT02015611.
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Affiliation(s)
- Denise K Houston
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, USA
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Jamehl L Demons
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Claudia L Campos
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Osvaldo Delbono
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC, USA
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14
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Klepin HD, Tooze JA, Bitting RL, Davis B, Pleasant K, Melo AC, Cook K, Soto-Pantoja DR, Tallant EA, Gallagher PE. Study design and methods for the pilot study of muscadine grape extract supplement to improve fatigue among older adult cancer survivors (FOCUS) trial. J Geriatr Oncol 2023; 14:101478. [PMID: 36990930 PMCID: PMC10164712 DOI: 10.1016/j.jgo.2023.101478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Fatigue is a prevalent symptom among both cancer survivors and older adults. Negative consequences of fatigue include increased sedentary behavior, decreased physical activity and function, and lower quality of life. Few pharmacologic interventions improve fatigue. Our preclinical and clinical data show promising effects of a muscadine grape extract supplement (MGES) on oxidative stress, mitochondrial bioenergetics, the microbiome, and the symptom of fatigue. This pilot study seeks to translate these observations to cancer survivorship by testing the preliminary effect of MGE supplementation on older adult cancer survivors with self-reported fatigue. MATERIALS AND METHODS We designed a double-blinded placebo-controlled pilot study to evaluate preliminary efficacy of MGE supplementation versus placebo on fatigue among older adult cancer survivors (aged ≥65 years) who report baseline fatigue. Sixty-four participants will be enrolled and randomized 1:1 to twice daily MGES (four tablets twice daily) versus placebo for 12 weeks. The primary outcome is change in Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue score from baseline to 12 weeks. Secondary outcomes are change in self-reported physical function, physical fitness (6-min walk test), self-reported physical activity, global quality of life (QOL), and the Fried frailty index. Correlative biomarker assays will assess changes in 8-hydroxy-2 deoxyguanosine, peripheral blood mitochondrial function, inflammatory markers, and the gut microbiome. DISCUSSION This pilot study builds on preclinical and clinical observations to estimate effects of MGE supplementation on fatigue, physical function, QOL, and biologic correlates in older adult cancer survivors. Trial registration #: CT.govNCT04495751; IND 152908.
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Affiliation(s)
- Heidi D Klepin
- Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston Salem, NC, United States of America.
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Rhonda L Bitting
- Division of Medical Oncology, Duke University, Durham, NC, United States of America
| | - Brittany Davis
- Department of Surgery/Hypertension, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Katherine Pleasant
- Department of Surgery/Hypertension, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Ana Clara Melo
- Department of Surgery/Hypertension, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Katherine Cook
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, NC, United States of America
| | - David R Soto-Pantoja
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, NC, United States of America
| | - E Ann Tallant
- Department of Surgery/Hypertension, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Patricia E Gallagher
- Department of Surgery/Hypertension, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
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15
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Sohl SJ, Befus D, Tooze JA, Levine B, Golden SL, Puccinelli-Ortega N, Pasche BC, Weaver KE, Lich KH. Feasibility of Systems Support Mapping to guide patient-driven health self-management in colorectal cancer survivors. Psychol Health 2023; 38:602-622. [PMID: 34570677 PMCID: PMC8957632 DOI: 10.1080/08870446.2021.1979549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/30/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate feasibility of System Support Mapping (MAP), a systems thinking activity that involves creating a diagram of existing self-management activities (e.g. symptom management, health behaviors) to facilitate autonomous engagement in optimal self-management. DESIGN One-arm pilot study of MAP in colorectal cancer survivors (NCT03520283). MAIN OUTCOME MEASURES Feasibility of recruitment and retention (primary outcome), acceptability, and outcome variability over time. RESULTS We enrolled 24 of 66 cancer survivors approached (36%) and 20 completed follow-up (83%). Key reasons for declining participation included: not interested (n = 18), did not perceive a need (n = 9), and emotional distress/overwhelmed (n = 7). Most participants reported that MAP was acceptable (e.g. 80% liked MAP quite a bit/very much). Exploratory analyses revealed a -4.68 point reduction in fatigue from before to 2 weeks after MAP exceeding a minimally important difference (d = -0.68). There were also improvements in patient autonomy (d = 0.63), self-efficacy (for managing symptoms: d = 0.56, for managing chronic disease: d = 0.44), psychological stress (d = -0.45), anxiety (d = -0.34), sleep disturbance (d = -0.29) and pain (d = -0.32). Qualitative feedback enhanced interpretation of results. CONCLUSIONS MAP feasibility in colorectal cancer survivors was mixed, predominantly because many patients did not perceive a need for this approach. MAP was acceptable among participants and showed promise for improving health outcomes.
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Affiliation(s)
- Stephanie J Sohl
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Deanna Befus
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, ON, Canada
| | - Janet A Tooze
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Beverly Levine
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Shannon L Golden
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | | | - Boris C Pasche
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Kathryn E Weaver
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Prentice RL, Aragaki AK, Manson JE, Schoeller DA, Tinker LF, Mossavar-Rahmani Y, Wallace RB, LaMonte MJ, Tooze JA, Johnson KC, Lampe JW, Neuhouser ML. Total energy expenditure as assessed by doubly labeled water and all-cause mortality in a cohort of postmenopausal women. Am J Clin Nutr 2023; 117:955-963. [PMID: 36889672 PMCID: PMC10273089 DOI: 10.1016/j.ajcnut.2023.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/12/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The association of TEE with all-cause mortality is uncertain, as is the dependence of this association on age. OBJECTIVES To examine the association between TEE and all-cause mortality, and its age interaction, in a Women's Health Initiative (WHI) cohort of postmenopausal United States women (1992-present). METHODS A cohort of 1131 WHI participants having DLW TEE assessment of ∼10.0 y (median) following WHI enrollment with ∼13.7 y (median) of subsequent follow-up, was used to study the EE associations with all-cause mortality. To enhance the comparability of TEE and total EI, key analyses excluded participants having >5% weight change between WHI enrollment and DLW assessment. The influence of participant age on mortality associations was examined, as was the ability of concurrent and earlier weight and height measurements to explain the results. RESULTS There were 308 deaths following the TEE assessment through 2021. TEE was unrelated to overall mortality (P = 0.83) in this cohort of generally healthy, older (mean 71 y at TEE assessment) United States women. However, this potential association varied with age (P = 0.003). Higher TEE was associated with a higher mortality rate at the age of 60 y and a lower mortality rate at the age of 80 y. Within the weight-stable subset (532 participants, 129 deaths), TEE was weakly positively related to overall mortality (P = 0.08). This association also varied with age (P = 0.03), with mortality HRs (95% CIs) for a 20% increment in TEE of 2.33 (1.24, 4.36) at the age of 60 y, 1.49 (1.10, 2.02) at 70 y of age, and 0.96 (0.66, 1.38) at 80 y of age. This pattern remained, although was somewhat attenuated, following control for baseline weight and weight changes between WHI enrollment and TEE assessment. CONCLUSIONS Higher EE is associated with higher all-cause mortality among younger postmenopausal women, only partially explained by weight and weight change. This study is registered with clinicaltrials.gov identifier: NCT00000611.
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Affiliation(s)
- Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States.
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Dale A Schoeller
- Biotech Center and Nutritional Sciences, University of Wisconsin, Madison, WI, United States
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Robert B Wallace
- College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Michael J LaMonte
- Department of Epidemiology and Public Health, University at Buffalo-SUNY, Buffalo, NY, United States
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Center, Memphis, TN, United States
| | - Johanna W Lampe
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States
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17
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Hsieh KL, Speiser JL, Neiberg RH, Marsh AP, Tooze JA, Houston DK. Factors associated with falls in older adults: A secondary analysis of a 12-month randomized controlled trial. Arch Gerontol Geriatr 2023; 108:104940. [PMID: 36709562 PMCID: PMC10068618 DOI: 10.1016/j.archger.2023.104940] [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: 10/26/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE While identifying older adults at risk for falls is important, fall prediction models have had limited success, in part because of a poor understanding of which physical function measures to include. The purpose of this secondary analysis was to determine physical function measures that are associated with future falls in older adults. METHODS In a 12-month trial comparing Vitamin D3 supplementation versus placebo on neuromuscular function, 124 older adults completed physical function measures at baseline, including the Short Physical Performance Battery (SPPB), Timed Up and Go, tests of leg strength and power, standing balance on a force plate with firm and foam surfaces, and walking over an instrumented walkway. Falls were recorded with monthly diaries over 12 months and categorized as no falls vs. one or more falls. Univariate and multivariable logistic regression adjusting for demographics, treatment assignment, depression, and prescription medications were conducted to examine the association between each physical function measure and future falls. Models were additionally adjusted for fall history. RESULTS 61 participants sustained one or more falls. In univariate analysis, white race, depression, fall history, SPPB, and postural stability on foam were significantly associated with future falls. In multivariable analysis, fall history (OR (95% CI): 3.20 (1.42-7.43)), SPPB (0.80 (0.62-1.01)), and postural stability on foam (3.01 (1.18, 8.45)) were each significantly associated with future falls. After adjusting for fall history, only postural stability on foam was significantly associated with falls. CONCLUSIONS When developing fall prediction models, fall history, the SPPB, and postural stability when standing on foam should be considered.
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Affiliation(s)
- Katherine L Hsieh
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine; Department of Physical Therapy, Georgia State University.
| | - Jaime L Speiser
- Department of Biostatistics and Data Science, Division of Public Health Services, Wake Forest University School of Medicine
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Division of Public Health Services, Wake Forest University School of Medicine
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Division of Public Health Services, Wake Forest University School of Medicine
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
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18
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Olson JD, Tooze JA, Bourland DJ, Cline JM, Faria EB, Cohen EP. Measurement of renal cortical fibrosis by CT scan. Res Diagn Interv Imaging 2023; 5:100024. [PMID: 37155521 PMCID: PMC10124964 DOI: 10.1016/j.redii.2023.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Rationale and objectives The accurate, non-invasive, and rapid measurement of renal cortical fibrosis is needed for well-defined benchmarks of permanent injury and for use of anti-fibrotic agents. It is also needed for non-invasive and rapid assessment of the chronicity of human renal diseases. Materials and methods We have used a non-human primate model of radiation nephropathy to develop a novel method of size-corrected CT imaging to quantify renal cortical fibrosis. Results Our method has an area under the receiver operating curve of 0.96, which is superior to any other non-invasive method of measuring renal fibrosis. Conclusion Our method is suitable for immediate translation to human clinical renal diseases.
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Affiliation(s)
- John D Olson
- Department of Comparative Medicine, Wake Forest University, Winston-Salem, NC, 27101, USA
| | - Janet A Tooze
- Department of Comparative Medicine, Wake Forest University, Winston-Salem, NC, 27101, USA
| | - Daniel J Bourland
- Department of Comparative Medicine, Wake Forest University, Winston-Salem, NC, 27101, USA
| | - J Mark Cline
- Department of Comparative Medicine, Wake Forest University, Winston-Salem, NC, 27101, USA
| | - Eduardo B Faria
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Eric P Cohen
- Nephrology Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Corresponding author. (E.P. Cohen)
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19
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Addington EL, Schlundt D, Bonnet K, Birdee G, Avis NE, Wagner LI, Rothman RL, Ridner S, Tooze JA, Wheeler A, Schnur JB, Sohl SJ. Qualitative similarities and distinctions between participants' experiences with a yoga intervention and an attention control. Support Care Cancer 2023; 31:172. [PMID: 36795229 PMCID: PMC10211359 DOI: 10.1007/s00520-023-07639-0] [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: 09/12/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE This manuscript aims to compare and contrast acceptability and perceived benefits of yoga-skills training (YST) and an empathic listening attention control (AC) in the Pro-You study, a randomized pilot trial of YST vs. AC for adults receiving chemotherapy infusions for gastrointestinal cancer. METHODS Participants were invited for a one-on-one interview at week 14 follow-up, after completing all intervention procedures and quantitative assessments. Staff used a semi-structured guide to elicit participants' views on study processes, the intervention they received, and its effects. Qualitative data analysis followed an inductive/deductive approach, inductively identifying themes and deductively guided by social cognitive theory. RESULTS Some barriers (e.g., competing demands, symptoms), facilitators (e.g., interventionist support, the convenience of clinic-based delivery), and benefits (e.g., decreased distress and rumination) were common across groups. YST participants uniquely described the importance of privacy, social support, and self-efficacy for increasing engagement in yoga. Benefits specific to YST included positive emotions and greater improvement in fatigue and other physical symptoms. Both groups described some self-regulatory processes, but through different mechanisms: self-monitoring in AC and the mind-body connection in YST. CONCLUSIONS This qualitative analysis demonstrates that participant experiences in a yoga-based intervention or an AC condition reflect social cognitive and mind-body frameworks of self-regulation. Findings can be used to develop yoga interventions that maximize acceptability and effectiveness and to design future research that elucidates the mechanisms by which yoga is efficacious.
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Affiliation(s)
- Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - David Schlundt
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | | | - Gurjeet Birdee
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nancy E Avis
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Sheila Ridner
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Janet A Tooze
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Amy Wheeler
- California State University, San Bernardino, CA, USA
| | - Julie B Schnur
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephanie J Sohl
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
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20
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Qin Y, Rivera RL, Zhang Y, Wang Q, Tooze JA, Abbott AR, Maulding MK, Craig BA, Bailey RL, Eicher-Miller HA. A Randomized Intervention of Supplemental Nutrition Assistance Program-Education Did Not Improve Dietary Outcomes Except for Vitamin D Among Lower-Income Women in Indiana. J Acad Nutr Diet 2023; 123:284-298.e2. [PMID: 35781080 DOI: 10.1016/j.jand.2022.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The goal of US Department of Agriculture Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is to improve the likelihood that those eligible for SNAP will make healthy choices aligned with the Dietary Guidelines for Americans, 2020-2025. OBJECTIVE The objective of the study was to evaluate the long-term effects of a direct SNAP-Ed intervention in which participants actively engage in learning with educator instruction about dietary quality and usual intake of key nutrient and food groups among Indiana SNAP-Ed-eligible women participants as an example sample in the context of no similar existing evaluation. DESIGN The study design was a parallel-arm, randomized controlled, nutrition education intervention, with follow-up at 1 year. PARTICIPANTS/SETTING Participants (18 years and older; n = 97 women) eligible for SNAP-Ed and interested in receiving nutrition education lessons were recruited from 31 Indiana counties from August 2015 to May 2016 and randomized to an intervention (n = 53) or control (n = 44) group. INTERVENTION The intervention comprised core lessons of Indiana SNAP-Ed delivered between 4 and 10 weeks after baseline assessment. Each participant completed a baseline and 1-year follow-up assessment. Dietary intake was assessed using repeated 24-hour dietary recalls (up to 2). MAIN OUTCOME MEASURES Mean usual nutrient, food group intake, diet quality (ie, Healthy Eating Index-2010 scores), and proportion of intervention and control groups meeting Dietary Guidelines for Americans, 2020-2025 recommendations and Dietary Reference Intake indicators of requirement or adequacy, were determined using the National Cancer Institute method and the simple Healthy Eating Index-2010 scoring algorithm method. Dietary changes between intervention and control groups were examined over time using mixed linear models. STATISTICAL ANALYSES PERFORMED Bonferroni-corrected significance levels were applied to the results of the mixed linear models for comparisons of usual intake of nutrients and foods. RESULTS No differences in diet quality, intake of food group components, food group intake, or nutrients were observed at 1-year follow-up, except that vitamin D intake was higher among those who received SNAP-Ed compared with the control group. CONCLUSIONS A direct SNAP-Ed intervention did not improve diet quality, food group intake, or key nutrient intake, except for vitamin D, among Indiana SNAP-Ed-eligible women up to 1 year after the nutrition education.
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Affiliation(s)
- Yue Qin
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Rebecca L Rivera
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Yumin Zhang
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Qi Wang
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Janet A Tooze
- School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Angela R Abbott
- Health and Human Sciences Extension, Purdue University, West Lafayette, IN
| | - Melissa K Maulding
- Department of Nutrition and Dietetics, Eastern Illinois University, Charleston
| | - Bruce A Craig
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN
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21
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Lucas AR, Pan JH, Ip EH, Hall DL, Tooze JA, Levine B, Mohr DC, Penedo FJ, Cella D, Wagner LI. Validation of the Lee-Jones theoretical model of fear of cancer recurrence among breast cancer survivors using a structural equation modeling approach. Psychooncology 2023; 32:256-265. [PMID: 36468339 PMCID: PMC10107857 DOI: 10.1002/pon.6076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The Lee-Jones model posits that antecedent individual and interpersonal factors predicate the development of fear of cancer recurrence (FCR) through cognitive and emotional processing, which further to behavioral, emotional, and/or physiological responses. We analyzed data from FoRtitude, a FCR intervention grounded in the Lee-Jones FCR model, to evaluate associations between FCR antecedents, resources (e.g., breast cancer self-efficacy, BCSE) and psychological and behavioral consequences. METHODS Women with breast cancer who completed treatment and reported clinically elevated levels of FCR were randomized into a 4-week online psychosocial intervention or contact control group. We assessed BCSE, FCR, and physical activity, anxiety and depression, or symptoms at baseline, 4 and 8 weeks. Separate structural equation models were constructed with both baseline data and change scores (baseline-8 weeks) to examine the pathways linking BCSE, FCR and: (1) physical activity; (2) anxiety and depression; and (3) symptoms (fatigue, sleep disturbance, cognitive concerns). RESULTS At baseline, higher levels of BCSE were associated with lower levels of FCR. Higher FCR was associated with worse psychological effects and symptoms but not behavioral response. Change models revealed that an increase in BCSE was associated with a decrease in FCR at 8-week assessment, which was associated with reductions in psychological effects. A change in BCSE was also directly associated with reductions in psychological effects. CONCLUSIONS Results support the Lee-Jones model as a foundation for FCR interventions among breast cancer survivors. Replicability among varied populations is needed to examine effects on behavioral outcomes of FCR such as health care utilization. CLINICAL TRIALS REGISTRATION NCT03384992.
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Affiliation(s)
- Alexander R Lucas
- Department of Health Behavior and Policy, Internal Medicine - Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jun-Hao Pan
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
| | - Edward H Ip
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Daniel L Hall
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet A Tooze
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Beverly Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David C Mohr
- Department of Preventive Medicine and Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Frank J Penedo
- Departments of Medicine and Psychology, University of Miami, Miami, Florida, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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22
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Falk D, Tooze JA, Winkfield KM, Bell RA, Morris B, Strom C, Copus E, Shore K, Weaver KE. A comparison of survey incentive methods to recruit rural cancer survivors into cancer care delivery research studies. Cancer Causes Control 2022; 33:1381-1386. [PMID: 35986825 PMCID: PMC10112050 DOI: 10.1007/s10552-022-01621-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
Unconditional (upfront) incentives are proposed to improve acceptance of cancer research among underrepresented, racial/ethnic minority populations, but few studies have tested incentive strategies among rural cancer survivors. Descriptive statistics summarized demographic characteristics of survey respondents, and response rates by arm were compared using Chi-square tests. We compared upfront ($2) and response-based ($10 conditional) incentives in a mailed survey of adult post-treatment rural survivors. Individuals meeting eligibility criteria from the electronic medical record (n = 2,830) were randomized into two incentive arms (n = 1,414 for the upfront arm and n = 1,416 for the contingent arm). Of the total delivered, presumed eligible participants (n = 1,304 upfront arm; n = 1,317 contingent arm), 67.8% were aged 65y+, 49.8% were female, and 95.1% were non-Hispanic white. The response rate for all participants was 18.5%. We received eligible surveys from 281 rural survivors in the first arm (response rate: 21.5%); and 205 surveys in the second arm (response rate: 15.6%). Participants who received the upfront incentive had a higher response rate than those receiving a response-based incentive, X2 (1, 2,621) = 15.53, p < 0.0001. Incentivizing survey completion with an upfront $2 bill encouraged a higher survey response rate; other supplemental strategies are needed to achieve a higher response rate for this population.
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Affiliation(s)
- Derek Falk
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA
- Department of Radiation Oncology, Vanderbilt University Medical Center, Preston Research Building, Rm B-1003, 2220 Pierce Ave, Nashville, TN, 37232-5671, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Bonny Morris
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Carla Strom
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Emily Copus
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Kelsey Shore
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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23
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Hall DL, Levine BJ, Jeter E, Chandler A, Tooze JA, Duffecy J, Victorson D, Gradishar W, Leach J, Saphner T, Smith ML, Penedo F, Mohr DC, Cella D, Wagner LI. A spotlight on avoidance coping to manage fear of recurrence among breast cancer survivors in an eHealth intervention. J Behav Med 2022; 45:771-781. [PMID: 35930212 PMCID: PMC9362703 DOI: 10.1007/s10865-022-00349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
Background Fear of recurrence (FoR) is prevalent among breast cancer survivors (BCS) and may be exacerbated by avoidance coping. This study examined BCS with avoidance coping and their engagement in a FoR eHealth intervention (FoRtitude). Methods BCS (N = 196) with elevated FoR participated in FoRtitude. Patient-reported measures assessed avoidance coping with FoR and baseline emotional and behavioral health. Intervention engagement was measured quantitatively (e.g., website logins, telecoaching attendance) and qualitatively (i.e., telecoaching notes). Results 38 BCS (19%) endorsed avoidance coping, which was associated with more severe post-traumatic anxiety-related symptoms and worse global mental health (ps < .05), but not anxiety (p = .19), depression (p = .11), physical health (p = .12), alcohol consumption (p = .85), or physical activity (p = .39). Avoidance coping was not associated with engagement levels (ps > .05) but did characterize engagement-related motivators and barriers. Conclusions Avoidance coping was not a barrier to FoRtitude engagement. eHealth delivery is a promising modality for engaging survivors with avoidance coping in FoR interventions.
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Affiliation(s)
- Daniel L Hall
- Harvard Medical School, Massachusetts General Hospital, 100 Cambridge St., 16th floor, Boston, MA, 02114, USA.
| | - Beverly J Levine
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Elizabeth Jeter
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Allison Chandler
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Janet A Tooze
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | | | | | | | | | | | | | | | | | | | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston Salem, NC, USA
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24
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Cowan AE, Tooze JA, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Potischman N, Bhadra A, Carroll RJ, Bailey RL. Trends in Overall and Micronutrient-Containing Dietary Supplement Use in US Adults and Children, NHANES 2007-2018. J Nutr 2022; 152:2789-2801. [PMID: 35918260 PMCID: PMC9839985 DOI: 10.1093/jn/nxac168] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dietary supplement (DS) use is widespread in the United States and contributes large amounts of micronutrients to users. Most studies have relied on data from 1 assessment method to characterize the prevalence of DS use. Combining multiple methods enhances the ability to capture nutrient exposures from DSs and examine trends over time. OBJECTIVES The objective of this study was to characterize DS use and examine trends in any DS as well as micronutrient-containing (MN) DS use in a nationally representative sample of the US population (≥1 y) from the 2007-2018 NHANES using a combined approach. METHODS NHANES obtains an in-home inventory with a frequency-based dietary supplement and prescription medicine questionnaire (DSMQ), and two 24-h dietary recalls (24HRs). Trends in the prevalence of use and selected types of products used were estimated for the population and by sex, age, race/Hispanic origin, family income [poverty-to-income ratio (PIR)], and household food security (food-secure vs. food-insecure) using the DSMQ or ≥ 1 24HR. Linear trends were tested using orthogonal polynomials (significance set at P < 0.05). RESULTS DS use increased from 50% in 2007 to 56% in 2018 (P = 0.001); use of MN products increased from 46% to 49% (P = 0.03), and single-nutrient DS (e.g., magnesium, vitamins B-12 and D) use also increased (all P < 0.001). In contrast, multivitamin-mineral use decreased (70% to 56%; P < 0.001). In adults (≥19 y), any (54% to 61%) and MN (49% to 54%) DS use increased, especially in men, non-Hispanic blacks and Hispanics, and low-income adults (PIR ≤130%). In children (1-18 y), any DS use remained stable (∼38%), as did MN use, except for food-insecure children, whose use increased from 24% to 31% over the decade (P = 0.03). CONCLUSIONS The prevalence of any and MN DS use increased over time in the United States. This may be partially attributed to increased use of single-nutrient products. Population subgroups differed in their DS use.
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Affiliation(s)
- Alexandra E Cowan
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, TX, USA
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T Dwyer
- NIH Office of Dietary Supplements, Bethesda, MD, USA,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Raymond J Carroll
- Department of Statistics, Texas A&M University, College Station, TX, USA
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Sohl S, Tooze JA, Levine BJ, Zeidan F, Wheeler A, Kelly M, Shalowitz D, Danhauer S. A randomized pilot of eHealth mindful movement and breathing to improve gynecologic surgery outcomes. J Psychosoc Oncol 2022; 41:251-266. [PMID: 35900116 PMCID: PMC9883595 DOI: 10.1080/07347332.2022.2101908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To conduct a pilot randomized controlled trial of eHealth Mindful Movement and Breathing (eMMB) compared to an empathic attention control (AC). PARTICIPANTS Women undergoing surgery for a suspected gynecologic malignancy. METHODS eMMB is a brief yoga intervention delivered remotely during the perioperative timeframe. We assessed feasibility and participants completed assessments (baseline, weeks 2 and 4 postoperatively). We summarized feasibility, participant characteristics, and outcomes by intervention group and time. FINDINGS Forty-three percent of eligible patients approached participated (n = 31). Adherence to the interventions was 77%. Percent of participants to complete outcomes was 81% at Week 2 and 84% at Week 4 (>70%; retention was the primary feasibility indicator). Average reductions in the primary outcome of pain intensity were larger in the eMMB group than AC group (Week 2 d = -0.38; Week 4 d = -0.46). IMPLICATIONS This pilot study of eMMB supported feasibility and improvements in pain intensity that warrant a future efficacy study.
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Affiliation(s)
- Stephanie Sohl
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine
| | - Janet A. Tooze
- Department of Biostatistical & Data Sciences, Wake Forest School of Medicine
| | - Beverly J. Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine
| | - Fadel Zeidan
- Department of Anesthesiology, University of California, San Diego
| | - Amy Wheeler
- Kinesiology Department, California State University, San Bernardino
| | - Michael Kelly
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine
| | - David Shalowitz
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine
| | - Suzanne Danhauer
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine
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Greene KA, Tooze JA, Lenchik L, Weaver AA. Change in Lumbar Muscle Size and Composition on MRI with Long-Duration Spaceflight. Ann Biomed Eng 2022; 50:816-824. [PMID: 35459964 PMCID: PMC9167780 DOI: 10.1007/s10439-022-02968-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
Prolonged microgravity results in muscle atrophy, especially among the anti-gravity spinal muscles. How individual paravertebral muscle groups change in size and composition with spaceflight needs further exploration. This study investigates lumbar spine musculature changes among six crewmembers on long-duration space missions using non-invasive measurement of muscle changes with magnetic resonance imaging (MRI). Pre- and post-flight lumbar images were analyzed for changes in cross-sectional area, volume, and fat infiltration of the psoas (PS), quadratus lumborum (QL), and paraspinal [erector spinae and multifidus (ES + MF)] muscles using mixed models. Crewmembers used onboard exercise equipment, including a cycle ergometer (CEVIS), treadmill (T2/COLBERT), and the advanced resistive exercise device (ARED). Correlations were used to assess muscle changes related to exercise modality. There was substantial variability in muscle changes across crewmembers but collectively a significant decrease in paraspinal area (- 9.0 ± 4.8%, p = 0.04) and a significant increase in QL fat infiltration (7.3 ± 4.1%, p = 0.05). More CEVIS time may have protected against PS volume loss (p = 0.05) and PS fat infiltration (p < 0.01), and more ARED usage may have protected against ES + MF volume loss (p = 0.05). Crewmembers using modern onboard exercise equipment may be less susceptible to muscle changes. However, variability between crewmembers and muscle size and quality losses suggest additional research is needed to ensure in-flight countermeasures preserve muscle health.
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Affiliation(s)
- Katelyn A Greene
- Department of Biomedical Engineering, Center for Injury Biomechanics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ashley A Weaver
- Department of Biomedical Engineering, Center for Injury Biomechanics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA.
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Klepin HD, Isom S, Callahan KE, Pajewski N, Topaloglu U, Wagner LI, Gabbard J, Justice JN, Parala-Metz A, Tooze JA. Association between an electronic health record (EHR)–embedded frailty index and survival among older adults receiving cancer chemotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12009] [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
12009 Background: Innovative strategies to facilitate rapid frailty screening are critically needed to enhance personalized oncology care among vulnerable older patients. An electronic frailty index (eFI) holds promise as a passive measure of frailty. The eFI was initially designed for primary care. The objective of this study was to establish feasibility, estimate prevalence of frailty, and evaluate the predictive value of the eFI for overall survival (OS) among older adults with cancer planned to receive chemotherapy. Methods: Consecutive patients (N = 509) aged 65+ with newly diagnosed lung, colorectal or breast cancer treated with chemotherapy were identified from our cancer registry between 2017 and 2020. Calculation of the eFI requires at least two ambulatory visits over a 2-year period and utilizes demographic information, vital signs, smoking status, ICD-10 diagnosis codes, select outpatient laboratory measurements, and functional information (if available from Medicare Annual Wellness Visits) during the 2 years prior to diagnosis. Frailty status is categorized as fit (eFI ≤0.10), pre-frail (0.10 < eFI≤0.21), and frail (eFI > 0.21) based on the proportion of deficits present over the total number evaluated (score range 0-1). Non-calculable scores indicate insufficient historical primary care data within two years prior to cancer diagnosis. OS was estimated by eFI category using Kaplan Meier curves and compared using log rank testing. Cox proportional hazards models evaluated the adjusted association between eFI categories and mortality. Results: The cohort included 509 adults (median age 72.2 yrs, 55% female, 83.5% white, 13.4% black, 45.8% stage 4) with lung (N = 312), colorectal (N = 111) and breast (N = 86) cancer. Distribution of eFI categories at diagnosis were fit (25.9%), pre-frail (41.1%), frail (17.3 %) and not calculable (15.7%). The proportion of patients categorized as “fit” differed by disease type (19.9% lung, 30.6% colorectal, 41.9% breast, p < 0.0001). In univariate analyses, eFI frailty category was associated with OS (median OS for fit, pre-frail, frail and not calculable were > 54, 25, 19 and 10 months respectively, p < 0.0001.). Adjusting for age, gender, race, stage, and cancer type, the hazard of death was higher for pre-frail (Hazard Ratio, [HR] 1.7, 95% Confidence Interval [CI] 1.2-2.4), frail (HR 2.3, 95% CI 1.5-3.4) and not calculable eFI categories (HR 2.8, 95% CI 1.8-4.2) compared to fit patients. Conclusions: Calculating an EHR embedded eFI at the time of diagnosis among older adults treated with chemotherapy was feasible and identified nearly one-fifth of patients as frail. eFI-defined frailty status was associated with survival, with poorer survival among the most frail supporting eFI validity. The eFI is a promising scalable tool to efficiently conduct frailty screening in oncology clinical practice.
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Affiliation(s)
- Heidi D. Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC
| | - Scott Isom
- Comprehensive Cancer Center Wake Forest University, Winston-Salem, NC
| | | | | | | | | | | | | | | | - Janet A. Tooze
- Wake Forest University School of Medicine, Winston-Salem, NC
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Klepin HD, Tooze JA, Rejeski J, Mihalko S, Pardee TS, Demark-Wahnefried W, Powell BL, Geiger AM, Kritchevsky S. Tailoring a physical activity intervention to older adults receiving intensive chemotherapy for acute myeloid leukemia (AML): One size does not fit all. J Geriatr Oncol 2022; 13:511-515. [PMID: 35487616 PMCID: PMC9060358 DOI: 10.1016/j.jgo.2021.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/01/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Heidi D Klepin
- Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Shannon Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Timothy S Pardee
- Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Bayard L Powell
- Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ann M Geiger
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Stephen Kritchevsky
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Abstract
Laboratory animal research is an important contributor to both human and animal medicine. Currently, there is extensive use of cynomolgus monkeys (Macaca fascicularis) in pathology and toxicology research. The purpose of this study was to define reference values for absolute and percentage organ weights in M fascicularis of different ages and sex. Organ weights were obtained from necropsies of 1022 cynomolgus monkeys at the Wake Forest School of Medicine from 1997 to 2018. Distributions of absolute and percentage weights for each organ were described; sex and age groups were compared using analysis of variance. Age effects on percentage of body weights for each organ were analyzed within each sex. Diet effects were also analyzed. This evaluation showed that male body weights and absolute organ weights were greater for all age groups; however, female organ to body weight percentages were greater for most organs. Percentage of organ weight to body weight declined for the adrenals, brain, lung, thyroid and thymus during maturation, whereas percentage weight of pancreas, prostate, testes, and uterus increased. Animals consuming a high-fat, Western-type diet had a lower body weight than animals consuming a carbohydrate-rich chow diet. This information will be useful for further toxicology and pathology studies concerning cynomolgus monkeys.
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Affiliation(s)
| | - Jean F Gardin
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - J Mark Cline
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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30
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Eicher-Miller HA, Wright BN, Tooze JA, Craig BA, Liu Y, Bailey RL, McCormack LA, Stluka S, Franzen-Castle L, Henne B, Mehrle D, Remley D. Evaluating a food pantry-based intervention to improve food security, dietary intake and quality in Midwestern food pantries. J Acad Nutr Diet 2022; 122:2060-2071. [DOI: 10.1016/j.jand.2022.02.016] [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] [Received: 04/26/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 10/31/2022]
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Nightingale C, Sterba KR, Levine B, Tooze JA, Greven K, Frizzell B, Hughes RT, Snavely A, Lesser GJ, Norona S, Pleasant K, Weaver KE. Feasibility and Acceptability of a Multi-Modality Self-Management Intervention for Head and Neck Cancer Caregivers: A Pilot Randomized Trial. Integr Cancer Ther 2022; 21:15347354221098984. [PMID: 35575280 PMCID: PMC9121462 DOI: 10.1177/15347354221098984] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/28/2022] [Revised: 03/29/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Head and neck cancer (HNC) patients undergoing radiation therapy (RT) experience significant side effects, presenting challenging care tasks for their informal (unpaid) caregivers. HNC caregivers report low caregiving self-efficacy, high distress, and interest in supportive care interventions. OBJECTIVE This randomized pilot trial assessed the feasibility and acceptability of a 6 to 7 week supported self-management intervention (Prepare to Care) offering psychoeducation and stress management skills building for caregivers of patients receiving RT for HNC. METHODS Caregivers were randomized to Prepare to Care or standard of care. Primary feasibility measures included participation and retention percentages. Assessments were completed before the intervention, at intervention completion, and 6-weeks later after intervention completion. RESULTS Caregivers (N = 38) were predominantly female (88.6%), an average age of 56 years old, and a spouse/partner to the patient (71.4%). Participation percent was 42.2%; retention at intervention conclusion was 80% and 77% at the 6-week follow-up. Quantitative and qualitative results support acceptability, with 64% to 88% reporting each intervention module was helpful (quite a bit or very). Intervention caregivers reported a significantly greater improvement in self-efficacy for progressive muscle relaxation (PMR). CONCLUSIONS Prepare to Care and the randomized pilot trial methods are feasible and acceptable for HNC caregivers of patients receiving RT. A significant treatment effect was observed for self-efficacy for PMR, and findings were in the expected direction regarding improved caregiving self-efficacy. Further research is necessary to determine the efficacy of this intervention with a focus on increased engagement strategies and longer-term outcomes. TRIAL REGISTRATION NCT03032250.
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Affiliation(s)
| | | | | | | | | | - Bart Frizzell
- Wake Forest School of Medicine,
Winston-Salem, NC, USA
| | | | - Anna Snavely
- Wake Forest School of Medicine,
Winston-Salem, NC, USA
| | | | - Sandra Norona
- Wake Forest School of Medicine,
Winston-Salem, NC, USA
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32
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Hammon DE, Pearsall K, Smith NM, McBride AS, Bass AL, Tooze JA, McLean TW. Eutectic Mixture of Lidocaine and Prilocaine Decreases Movement and Propofol Requirements for Pediatric Lumbar Puncture During Deep Sedation: A Randomized, Placebo-Controlled, Double Blind Trial. J Pediatr Hematol Oncol 2022; 44:e213-e216. [PMID: 33885035 PMCID: PMC8528901 DOI: 10.1097/mph.0000000000002169] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/24/2021] [Indexed: 01/03/2023]
Abstract
Deep sedation/general anesthesia is commonly used in pediatric oncology patients undergoing lumbar puncture (LP). Propofol is often used for sedation, with or without a narcotic. We hypothesized that eutectic mixture of lidocaine and prilocaine (EMLA) would allow for lower cumulative doses of propofol and less movement. We performed a prospective, randomized, double blind, placebo-controlled trial in children undergoing sedation for LP. Standard initial weight-based doses of propofol and fentanyl were administered, with either EMLA cream or a placebo cream applied topically. The primary outcome was the total dose of propofol administered to each patient. We also tracked patient movement and complications. Twenty-seven patients underwent 152 LPs. Patients randomized to EMLA cream (n=75) were significantly more likely to receive a lower dose of propofol (2.94 mg/kg, SE=0.25, vs. 3.22 mg/kg, SE=0.19; P=0.036) and to not require additional propofol doses (probability 0.49, SE=0.08 vs. 0.69, SE=0.06; P=0.001) compared with patients randomized to placebo cream (n=77). In addition, patients with EMLA cream were significantly less likely to demonstrate minor or major movement. EMLA cream results in less movement and less propofol administration in pediatric oncology patients undergoing sedation for LP.
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Affiliation(s)
- Dudley E. Hammon
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katharine Pearsall
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nancy M. Smith
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Allison S. McBride
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Andora L. Bass
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Janet A. Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas W. McLean
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Sohl SJ, Tooze JA, Johnson EN, Ridner SH, Rothman RL, Lima CR, Ansley KC, Wheeler A, Nicklas B, Avis NE, Wagner LI. A Randomized Controlled Pilot Study of Yoga Skills Training Versus an Attention Control Delivered During Chemotherapy Administration. J Pain Symptom Manage 2022; 63:23-32. [PMID: 34343620 PMCID: PMC8766874 DOI: 10.1016/j.jpainsymman.2021.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT It is important to address fatigue and co-occurring symptoms during chemotherapy to preserve quality of life in patients with gastrointestinal (GI) cancer. OBJECTIVE To conduct a randomized controlled pilot study of a Yoga Skills Training (YST) intervention compared to an attention control (AC) among adults diagnosed with GI cancer. METHODS YST consisted of four 30-minute sessions delivered individually during chemotherapy plus home practice. AC provided empathic attention plus home diaries. Patient-reported (PROMIS T-score) assessments of fatigue, depressive symptoms, sleep disturbances, and psychological stress (Perceived Stress Scale) were collected at chemotherapy visits: baseline, Week 8, Week 10 and Week 14, and analyzed using a mixed effects model. Inflammatory cytokines were assessed at baseline and Week 10. RESULTS Forty-four of 77 adults approached agreed to participate (57%; YST n = 23; AC n = 21). Participants' mean age was 58 years and 48% were men. Participants randomized to YST reported a larger decline in fatigue (-2.4 difference, d = 0.30) and depressive symptoms (-2.5 difference, d = 0.30) than AC participants from baseline to Week 10 and sleep disturbances at Week 8 (-3.9 difference, d = 0.50). Differences in magnitude of change in symptoms were consistent with or exceeded a minimally important difference. Psychological stress decreased more in the AC at Week 10 (d = 0.30). Reductions in inflammatory cytokines (IL-6, sTNF R1) were larger in the YST group than AC. CONCLUSION YST showed promise for improving fatigue, depressive symptoms, sleep disturbances, and inflammation. YST is also feasible and reaches patients underrepresented in yoga research (i.e., GI cancer, men), thus warranting further examination.
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Affiliation(s)
- Stephanie J Sohl
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA.
| | - Janet A Tooze
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Emily Nance Johnson
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Sheila H Ridner
- Vanderbilt University School of Nursing (S.H.R.), Nashville, Tennessee, USA
| | - Russell L Rothman
- Vanderbilt University School of Medicine (R.L.R.), Nashville, Tennessee, USA
| | - Caio Rocha Lima
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Katherine C Ansley
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Amy Wheeler
- California State University (A.W.), San Bernardino, California, USA
| | - Barbara Nicklas
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Nancy E Avis
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
| | - Lynne I Wagner
- Wake Forest School of Medicine (S.J.S., J.A.T., E.N.J., C.R.L., K.C.A., B.N., N.E.A, L.I.W.), Winston-Salem, North Carolina, USA
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Cowan AE, Bailey RL, Jun S, Dodd KW, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Potischman N, Bhadra A, Carroll RJ, Tooze JA. The Total Nutrient Index is a Useful Measure for Assessing Total Micronutrient Exposures Among US Adults. J Nutr 2021; 152:863-871. [PMID: 34928350 PMCID: PMC8891182 DOI: 10.1093/jn/nxab428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most dietary indices reflect foods and beverages and do not include exposures from dietary supplements (DS) that provide substantial amounts of micronutrients. A nutrient-based approach that captures total intake inclusive of DS can strengthen exposure assessment. OBJECTIVES We examined the construct and criterion validity of the Total Nutrient Index (TNI) among US adults (≥19 years; nonpregnant or lactating). METHODS The TNI includes 8 underconsumed micronutrients identified by the Dietary Guidelines for Americans: calcium; magnesium; potassium; choline; and vitamins A, C, D, and E. The TNI is expressed as a percentage of the RDA or Adequate Intake to compute micronutrient component scores; the mean of the component scores yields the TNI score, ranging from 0-100. Data from exemplary menus and the 2003-2006 (≥19 years; n = 8861) and 2011-2014 NHANES (≥19 years; n = 9954) were employed. Exemplary menus were used to determine whether the TNI yielded high scores from dietary sources (women, 31-50 years; men ≥ 70 years). TNI scores were correlated with Healthy Eating Index (HEI) 2015 overall and component scores for dairy, fruits, and vegetables; TNI component scores for vitamins A, C, D, and E were correlated with respective biomarker data. TNI scores were compared between groups with known differences in nutrient intake based on the literature. RESULTS The TNI yielded high scores on exemplary menus (84.8-93.3/100) and was moderately correlated (r = 0.48) with the HEI-2015. Mean TNI scores were significantly different for DS users (83.5) compared with nonusers (67.1); nonsmokers (76.8) compared with smokers (70.3); and those living with food security (76.6) compared with food insecurity (69.1). Correlations of TNI vitamin component scores with available biomarkers ranged from 0.12 (α-tocopherol) to 0.36 (serum 25-hydroxyvitamin D), and were significantly higher than correlations obtained from the diet alone. CONCLUSIONS The evaluation of validity supports that the TNI is a useful construct to assess total micronutrient exposures of underconsumed micronutrients among US adults.
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Affiliation(s)
- Alexandra E Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | | | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Kevin W Dodd
- NIH National Cancer Institute, Bethesda, MD, USA
| | | | | | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T Dwyer
- NIH Office of Dietary Supplements, Bethesda, MD, USA,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Raymond J Carroll
- Department of Statistics, Texas A&M University, College Station, TX, USA
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Weaver AA, Tooze JA, Cauley JA, Bauer DC, Tylavsky FA, Kritchevsky SB, Houston DK. Effect of Dietary Protein Intake on Bone Mineral Density and Fracture Incidence in Older Adults in the Health, Aging, and Body Composition Study. J Gerontol A Biol Sci Med Sci 2021; 76:2213-2222. [PMID: 33677533 PMCID: PMC8599066 DOI: 10.1093/gerona/glab068] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dietary recommendations may underestimate the protein older adults need for optimal bone health. This study sought to determine associations of protein intake with bone mineral density (BMD) and fracture among community-dwelling White and Black older adults. METHOD Protein as a percentage of total energy intake (TEI) was assessed with a Food Frequency Questionnaire in 2160 older adults (73.5 ± 2.8 years; 51.5% women; 35.8% Black) in the Health, Aging, and Body Composition prospective cohort. Hip, femoral neck, and whole body BMD was assessed by dual-energy x-ray absorptiometry at baseline and 4 years, and lumbar trabecular, cortical, and integral BMD was assessed by computed tomography at baseline and 5 years. Fragility fractures over 5 years were adjudicated from self-report data collected every 6 months. Associations with tertiles of protein intake were assessed using analysis of covariance for BMD and multivariate Cox regression for fracture, adjusting for confounders. RESULTS Participants in the upper protein tertile (≥15% TEI) had 1.8%-6.0% higher mean hip and lumbar spine BMD compared to the lower protein tertile (<13% TEI; p < .05). Protein intake did not affect change in BMD at any site over the follow-up period. Participants in the upper protein tertile had a reduced risk of clinical vertebral fracture over 5 years of follow-up (hazard ratio: 0.36 [95% confidence interval: 0.14, 0.97] vs lower protein tertile, p = .04). CONCLUSIONS Older adults with higher protein intake (≥15% TEI) had higher BMD at the hip, whole body, and lumbar spine, and a lower risk of vertebral fracture.
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Affiliation(s)
- Ashley A Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pennsylvania, USA
| | - Douglas C Bauer
- Department of Epidemiology and Biostatistics, University of California San Francisco, USA
| | - Frances A Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Speiser JL, Callahan KE, Ip EH, Miller ME, Tooze JA, Kritchevsky SB, Houston DK. Predicting Future Mobility Limitation in Older Adults: A Machine Learning Analysis of Health ABC Study Data. J Gerontol A Biol Sci Med Sci 2021; 77:1072-1078. [PMID: 34529794 DOI: 10.1093/gerona/glab269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mobility limitation in older adults is common and associated with poor health outcomes and loss of independence. Identification of at-risk individuals remains challenging because of time-consuming clinical assessments and limitations of statistical models for dynamic outcomes over time. Therefore, we aimed to develop machine learning models for predicting future mobility limitation in older adults using repeated measures data. METHODS We used annual assessments over nine years of follow-up from the Health, Aging, and Body Composition study to model mobility limitation, defined as self-report of any difficulty walking a quarter mile or climbing 10 steps. We considered 46 predictors, including demographics, lifestyle, chronic conditions and physical function. With a split sample approach, we developed mixed models (generalized linear and Binary Mixed Model forest) using: 1) all 46 predictors, 2) a variable selection algorithm, and 3) the top five most important predictors. Age was included in all models. Performance was evaluated using area under the receiver operating curve (AUC) in two internal validation datasets. RESULTS AUC ranged from 0.80-0.84 for the models. The most important predictors of mobility limitation were ease of getting up from a chair, gait speed, self-reported health status, body mass index and depression. CONCLUSIONS Machine learning models using repeated measures had good performance for identifying older adults at-risk of developing mobility limitation. Future studies should evaluate the utility and efficiency of the prediction models as a tool in clinical settings for identifying at-risk older adults who may benefit from interventions aimed to prevent or delay mobility limitation.
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Affiliation(s)
- Jaime Lynn Speiser
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kathryn E Callahan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Edward H Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael E Miller
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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Cowan AE, Jun S, Tooze JA, Dodd KW, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Potischman N, Bhadra A, Carroll RJ, Bailey RL. A narrative review of nutrient based indexes to assess diet quality and the proposed total nutrient index that reflects total dietary exposures. Crit Rev Food Sci Nutr 2021; 63:1722-1732. [PMID: 34470512 PMCID: PMC8888777 DOI: 10.1080/10408398.2021.1967872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A priori dietary indices provide a standardized, reproducible way to evaluate adherence to dietary recommendations across different populations. Existing nutrient-based indices were developed to reflect food/beverage intake; however, given the high prevalence of dietary supplement (DS) use and its potentially large contribution to nutrient intakes for those that use them, exposure classification without accounting for DS is incomplete. The purpose of this article is to review existing nutrient-based indices and describe the development of the Total Nutrient Index (TNI), an index developed to capture usual intakes from all sources of under-consumed micronutrients among the U.S. population. The TNI assesses U.S. adults' total nutrient intakes relative to recommended nutrient standards for eight under-consumed micronutrients identified by the Dietary Guidelines for Americans: calcium, magnesium, potassium, choline, and vitamins A, C, D, E. The TNI is scored from 0 to 100 (truncated at 100). The mean TNI score of U.S. adults (≥19 y; n = 9,954) based on dietary data from NHANES 2011-2014, was 75.4; the mean score for the index ignoring DS contributions was only 69.0 (t-test; p < 0.001). The TNI extends existing measures of diet quality by including nutrient intakes from all sources and was developed for research, monitoring, and policy purposes.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.1967872.
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Affiliation(s)
- Alexandra E. Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | | | | | | | | | - Patricia M. Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T. Dwyer
- NIH Office of Dietary Supplements, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Raymond J. Carroll
- Department of Statistics, Texas A&M University, 447 Blocker Building, College Station, TX, USA
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
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Jun S, Cowan AE, Dodd KW, Tooze JA, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Potischman N, Bhadra A, Forman MR, Bailey RL. Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016. Am J Clin Nutr 2021; 114:1059-1069. [PMID: 33964856 PMCID: PMC8408856 DOI: 10.1093/ajcn/nqab113] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/29/2020] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Food insecurity is associated with poorer nutrient intakes from food sources and lower dietary supplement use. However, its association with total usual nutrient intakes, inclusive of dietary supplements, and biomarkers of nutritional status among US children remains unknown. OBJECTIVE The objective was to assess total usual nutrient intakes, Healthy Eating Index-2015 (HEI-2015) scores, and nutritional biomarkers by food security status, sex, and age among US children. METHODS Cross-sectional data from 9147 children aged 1-18 y from the 2011-2016 NHANES were analyzed. Usual energy and total nutrient intakes and HEI-2015 scores were estimated using the National Cancer Institute method from 24-h dietary recalls. RESULTS Overall diet quality was poor, and intakes of sodium, added sugars, and saturated fat were higher than recommended limits, regardless of food security status. Food-insecure girls and boys were at higher risk of inadequate intakes for vitamin D and magnesium, and girls also had higher risk for inadequate calcium intakes compared with their food-secure counterparts, when total intakes were examined. Choline intakes of food-insecure children were less likely to meet the adequate intake than those of their food-secure peers. No differences by food security status were noted for folate, vitamin C, iron, zinc, potassium, and sodium intakes. Food-insecure adolescent girls aged 14-18 y were at higher risk of micronutrient inadequacies than any other subgroup, with 92.8% (SE: 3.6%) at risk of inadequate intakes for vitamin D. No differences in biomarkers for vitamin D, folate, iron, and zinc were observed by food security status. The prevalence of iron deficiency was 12.7% in food-secure and 12.0% in food-insecure adolescent girls. CONCLUSIONS Food insecurity was associated with compromised intake of some micronutrients, especially among adolescent girls. These results highlight a need for targeted interventions to improve children's overall diet quality, including the reduction of specific nutrient inadequacies, especially among food-insecure children. This study was registered at clinicaltrials.gov as NCT03400436.
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Affiliation(s)
- Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Alexandra E Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Kevin W Dodd
- National Cancer Institute, NIH, Bethesda, MD, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T Dwyer
- Office of Dietary Supplements, NIH, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Michele R Forman
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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Mongraw-Chaffin M, Hairston KG, Hanley AJG, Tooze JA, Norris JM, Palmer ND, Bowden DW, Lorenzo C, Chen YDI, Wagenknecht LE. Association of Visceral Adipose Tissue and Insulin Resistance with Incident Metabolic Syndrome Independent of Obesity Status: The IRAS Family Study. Obesity (Silver Spring) 2021; 29:1195-1202. [PMID: 33998167 PMCID: PMC9022784 DOI: 10.1002/oby.23177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/12/2021] [Accepted: 03/08/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Although increasing evidence suggests that visceral adipose tissue (VAT) is a major underlying cause of metabolic syndrome (MetS), few studies have measured VAT at multiple time points in diverse populations. VAT and insulin resistance were hypothesized to differ by MetS status within BMI category in the Insulin Resistance Atherosclerosis Study (IRAS) Family Study and, further, that baseline VAT and insulin resistance and increases over time are associated with incident MetS. METHODS Generalized estimating equations were used for differences in body fat distribution and insulin resistance by MetS status. Mixed effects logistic regression was used for the association of baseline and change in adiposity and insulin resistance with incident MetS across 5 years, adjusted for age, sex, race/ethnicity, and family correlation. RESULTS VAT and insulin sensitivity differed significantly by MetS status and BMI category at baseline. VAT and homeostatic model assessment of insulin resistance (HOMA-IR) at baseline (VAT odds ratio [OR] = 1.16 [95% CI: 1.12-2.31]; HOMA-IR OR = 1.85 [95% CI: 1.32-2.58]) and increases over time (VAT OR = 1.55 [95% CI: 1.22-1.98]; HOMA-IR OR = 3.23 [95% CI: 2.20-4.73]) were associated with incident MetS independent of BMI category. CONCLUSIONS Differing levels of VAT may be driving metabolic heterogeneity within BMI categories. Both overall and abdominal obesity (VAT) may play a role in the development of MetS. Increased VAT over time contributed additional risk.
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Affiliation(s)
| | - Kristen G Hairston
- Department of Endocrinology and Metabolism, Wake Forest School of Medicine, Winston-Salem, NC
| | - Anthony JG Hanley
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nicolette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
| | - Donald W Bowden
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
| | - Carlos Lorenzo
- Department of Medicine, University of Texas at San Antonio Health Sciences Center, San Antonio TX
| | - Yii-Der Ida Chen
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lynne E Wagenknecht
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC
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Bitting RL, Tooze JA, Isom S, Petty WJ, Grant SC, Desnoyers RJ, Thomas A, Thomas CY, Alistar AT, Golden SL, Pleasant K, Chappell MC, Tallant EA, Gallagher PE, Klepin HD. Phase I Study of Muscadine Grape Extract for Patients With Advanced Cancer. Am J Clin Oncol 2021; 44:239-246. [PMID: 33867481 PMCID: PMC8141001 DOI: 10.1097/coc.0000000000000814] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Preclinical studies with muscadine grape extract (MGE) show antitumor activity and decreased systemic inflammation. This phase I study (NCT02583269) assessed safety and tolerability of a proprietary MGE preparation in patients with advanced solid tumors. METHODS Patients with metastatic or unresectable cancers who were progressing on standard therapies were assigned to MGE in a standard 3+3 design. Five dose levels were tested (320 to 1600 mg total phenolics/d). Safety and maximum-tolerated dose were assessed after 4 weeks. Patients were evaluated for response at 8 weeks and continued on MGE if clinically stable. Secondary outcomes were response, survival, adherence, fatigue, and quality of life (QOL). RESULTS In total, 23 patients (lung, n=7; gastrointestinal, n=7; genitourinary, n=6; other, n=3) received MGE capsules by mouth twice daily. The cohort [median age 72 years, 48% Eastern Cooperative Oncology Group (ECOG) 2] was heavily pretreated. After 4 weeks on MGE, possibly attributable adverse events grade 2 or higher were fatigue (n=1), decreased lymphocyte count (n=1), and constipation (n=2), including 1 dose-limiting toxicity for grade 3 constipation. Maximum-tolerated dose was not reached. No partial responses were observed. Median time on therapy was 8 weeks, with 29% of patients treated beyond 16 weeks and a median overall survival of 7.2 months. QOL and fatigue levels were stable from baseline to 8 weeks. Higher MGE dose was correlated with improvement in self-reported physical well-being QOL at 8 weeks (r=0.6; P=0.04). CONCLUSIONS MGE is safe and well-tolerated in heavily pretreated and older cancer patients. The potential anticancer properties and the effects of MGE on physical well-being and QOL metrics will be evaluated in future studies.
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Affiliation(s)
- Rhonda L. Bitting
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Departments of Internal Medicine, Wake Forest University, Winston-Salem NC
| | - Janet A. Tooze
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Biostatistics and Data Science, Wake Forest University, Winston-Salem NC
| | - Scott Isom
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Biostatistics and Data Science, Wake Forest University, Winston-Salem NC
| | - W. Jeffrey Petty
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Departments of Internal Medicine, Wake Forest University, Winston-Salem NC
| | - Stefan C. Grant
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Departments of Internal Medicine, Wake Forest University, Winston-Salem NC
| | - Rodwige J. Desnoyers
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Departments of Internal Medicine, Wake Forest University, Winston-Salem NC
| | - Alexandra Thomas
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Departments of Internal Medicine, Wake Forest University, Winston-Salem NC
| | - Christopher Y. Thomas
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Departments of Internal Medicine, Wake Forest University, Winston-Salem NC
| | - Angela T. Alistar
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Departments of Internal Medicine, Wake Forest University, Winston-Salem NC
| | | | | | | | - E. Ann Tallant
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Surgery/Hypertension, Wake Forest University, Winston-Salem NC
| | - Patricia E. Gallagher
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Surgery/Hypertension, Wake Forest University, Winston-Salem NC
| | - Heidi D. Klepin
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem NC
- Departments of Internal Medicine, Wake Forest University, Winston-Salem NC
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Wagner LI, Tooze JA, Hall DL, Levine BJ, Beaumont J, Duffecy J, Victorson D, Gradishar W, Leach J, Saphner T, Sturtz K, Smith ML, Penedo F, Mohr DC, Cella D. Targeted eHealth Intervention to Reduce Breast Cancer Survivors' Fear of Recurrence: Results from the FoRtitude Randomized Trial. J Natl Cancer Inst 2021; 113:1495-1505. [PMID: 34057469 PMCID: PMC8244801 DOI: 10.1093/jnci/djab100] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/04/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Fear of recurrence (FoR) is a prevalent concern among breast cancer survivors (BCS), yet few accessible interventions exist. This study evaluated a targeted eHealth intervention, “FoRtitude,” to reduce FoR using cognitive behavioral skills training and telecoaching. Methods BCS (N = 196) were recruited from an academic medical center and 3 National Cancer Institute Community Oncology Research Program community sites, had stage 0-III breast cancer, were 1-10 years postprimary treatment, with moderate to high FoR and familiarity with the internet. Using the Multiphase Optimization Strategy, participants were independently randomly assigned to 3 cognitive behavioral skills (relaxation, cognitive restructuring, worry practice) vs an attention control condition (health management content [HMC]) and to telecoaching (motivational interviewing) vs no telecoaching. Website content was released across 4 weeks and included didactic lessons, interactive tools, and a text-messaging feature. BCS completed the Fear of Cancer Recurrence Inventory at baseline and at 4 and 8 weeks. Fear of Cancer Recurrence Inventory scores over time were compared using mixed-effects models. All statistical tests were 2-sided. Results FCRI scores [SD] decreased statistically significantly from baseline to postintervention (T0 = 53.1 [17.4], T2 = 41.9 [16.2], P < .001). The magnitude of reduction in FCRI scores was comparable across cognitive behavior therapy (CBT) and attention control HMC conditions and was predicted by increased self-efficacy. Telecoaching was associated with lower attrition and greater website use (mean adherence score [SD] = 26.6 [7.2] vs 21.0 [10.5], P < .001). Conclusions BCS experienced statistically significant reductions in FoR postintervention, but improvements were comparable between CBT and attention controls. Telecoaching improved adherence and retention. Future research is needed on optimal integration of CBT and HMC, dose, and features of eHealth delivery that contributed to reducing FoR. In the COVID-19 era, remote delivery has become even more essential for reaching survivors struggling with FoR.
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Affiliation(s)
- Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC
| | - Daniel L Hall
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Beverly J Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | | | - Jenna Duffecy
- Department of Psychiatry, University of Illinois, Chicago, IL
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - William Gradishar
- Department of Medicine/Division of Hematology & Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - Frank Penedo
- Departments of Medicine and Psychology, University of Miami, Coral Gables, FL
| | - David C Mohr
- Department of Preventive Medicine and Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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Klepin HD, Tooze JA, Geiger AM, Pardee TS, Ellis LR, Howard D, Demark-Wahnefried W, Mihalko S, Rejeski J, Powell BL, Kritchevsky S. A symptom-adapted physical activity intervention during induction chemotherapy for older adults with acute myeloid leukemia (AML) to maintain physical function. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12009 Background: Older adults are at risk for physical function decline during therapy for AML. Impaired physical function after induction therapy is associated with shorter survival Interventions designed to maintain function may improve treatment outcomes. We piloted a physical activity (PA) intervention among older adults receiving intensive chemotherapy for AML designed to prevent functional decline. Methods: Single institution randomized pilot study of PA vs. usual care. Eligibility included age ≥60 years, newly-diagnosed AML, ambulatory, planned intensive induction chemotherapy. Intervention participants were offered a PA session five days/week tailored daily to symptoms and conditions during the induction hospitalization. Session options were: 1) Standard (ward-based), walking + balance trahining + resistance exercises; 2) Intermediate (room-based), upper-body ergometer + balance training + resistance exercises; 3) Low-intensity (bed-based), upper-body ergometer + resistance exercises. Behavioral counseling sessions to establish PA goals and overcome barriers were conducted weekly during hospitalization and continued monthly by phone for 6 months. Assessment of physical function occurred at baseline, weekly during hospitalization (approximately 4-6 weeks), 3 months, and 6 months. The primary functional outcome of interest was the Short Physical Performance Battery (SPPB; 5 repeat chair stands, gait speed, balance tests; score 0-12 higher indicates better function). Clinically significant change in physical function was defined as ≥1.0 on the SPPB. Proportions of those that declined, remained stable, or improved on the SPPB were compared by group using an exact test for trend. Results: Among 96 eligible patients 70 enrolled (recruitment rate 73%, average participation 3 sessions/week). The mean age was 72.1±6.3 years, 70% were male. Mean baseline SPPB score was 7.0±3.8. In the surviving intention to treat population (N = 66), more intervention participants, compared to controls, maintained or improved their SPPB score (38% vs. 25%) during induction hospitalization (p = 0.278). Among those who achieved remission (N = 42), function was maintained or improved in a greater proportion of intervention participants (55%) compared to controls (23%), p = 0.047. Maintenance or improvement in SPPB from baseline to last follow-up (3 or 6 months post enrollment) was 62% vs 54% for intervention versus control among the intention to treat cohort (N = 50) and 67% vs. 55% among those who achieved remission (N = 40). Conclusions: A symptom adapted PA intervention with behavioral counseling during induction chemotherapy shows promise in preventing clinically meaningful decline in physical function among older adults with AML who achieve remission. Continued maintenance intervention may sustain benefits. Clinical trial information: NCT01519596.
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Affiliation(s)
- Heidi D. Klepin
- Comprehensive Cancer Center, Wake Forest Baptist Health, Winston Salem, NC
| | - Janet A. Tooze
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | - Leslie R. Ellis
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Dianna Howard
- Wake Forest University School of Medicine, Winston-Salem, NC
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Newman TM, Shively CA, Register TC, Appt SE, Yadav H, Colwell RR, Fanelli B, Dadlani M, Graubics K, Nguyen UT, Ramamoorthy S, Uberseder B, Clear KYJ, Wilson AS, Reeves KD, Chappell MC, Tooze JA, Cook KL. Diet, obesity, and the gut microbiome as determinants modulating metabolic outcomes in a non-human primate model. Microbiome 2021; 9:100. [PMID: 33952353 PMCID: PMC8101030 DOI: 10.1186/s40168-021-01069-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/01/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND The objective of this study was to increase understanding of the complex interactions between diet, obesity, and the gut microbiome of adult female non-human primates (NHPs). Subjects consumed either a Western (n=15) or Mediterranean (n=14) diet designed to represent human dietary patterns for 31 months. Body composition was determined using CT, fecal samples were collected, and shotgun metagenomic sequencing was performed. Gut microbiome results were grouped by diet and adiposity. RESULTS Diet was the main contributor to gut microbiome bacterial diversity. Adiposity within each diet was associated with subtle shifts in the proportional abundance of several taxa. Mediterranean diet-fed NHPs with lower body fat had a greater proportion of Lactobacillus animalis than their higher body fat counterparts. Higher body fat Western diet-fed NHPs had more Ruminococcus champaneliensis and less Bacteroides uniformis than their low body fat counterparts. Western diet-fed NHPs had significantly higher levels of Prevotella copri than Mediterranean diet NHPs. Western diet-fed subjects were stratified by P. copri abundance (P. copriHIGH versus P. copriLOW), which was not associated with adiposity. Overall, Western diet-fed animals in the P. copriHIGH group showed greater proportional abundance of B. ovatus, B. faecis, P. stercorea, P. brevis, and Faecalibacterium prausnitzii than those in the Western P. copriLOW group. Western diet P. copriLOW subjects had a greater proportion of Eubacterium siraeum. E. siraeum negatively correlated with P. copri proportional abundance regardless of dietary consumption. In the Western diet group, Shannon diversity was significantly higher in P. copriLOW when compared to P. copriHIGH subjects. Furthermore, gut E. siraeum abundance positively correlated with HDL plasma cholesterol indicating that those in the P. copriLOW population may represent a more metabolically healthy population. Untargeted metabolomics on urine and plasma from Western diet-fed P. copriHIGH and P. copriLOW subjects suggest early kidney dysfunction in Western diet-fed P. copriHIGH subjects. CONCLUSIONS In summary, the data indicate diet to be the major influencer of gut bacterial diversity. However, diet and adiposity must be considered together when analyzing changes in abundance of specific bacterial taxa. Interestingly, P. copri appears to mediate metabolic dysfunction in Western diet-fed NHPs. Video abstract.
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Affiliation(s)
- Tiffany M Newman
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Carol A Shively
- Department of Pathology, Section of Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Thomas C Register
- Department of Pathology, Section of Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Susan E Appt
- Department of Pathology, Section of Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Hariom Yadav
- Department of Neurosurgery and Brain Repair, USF Center for Microbiome Research University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | | | | | | | | | | | | | - Beth Uberseder
- Department of Pathology, Section of Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Kenysha Y J Clear
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Adam S Wilson
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Kimberly D Reeves
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Mark C Chappell
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Janet A Tooze
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Katherine L Cook
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
- Wake Forest School of Medicine, 575 N. Patterson Ave, Suite 340, Winston-Salem, NC, 27101, USA.
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Bitting RL, Vile DC, Tooze JA, Thomas CY, Neve M, Kooshki M, Brown J, Dubey P, Triozzi P, Goodman MM. Single-arm phase II study of low-dose paclitaxel and pembrolizumab in platinum-refractory metastatic urothelial carcinoma (UC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.433] [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
433 Background: Single agent checkpoint inhibition is effective in a small proportion of platinum-refractory UC patients but improvements are needed. UC is highly inflammatory, and low-dose chemotherapy may enhance the response to immunotherapy. We evaluated whether combination therapy with low-dose paclitaxel and pembrolizumab is more efficacious than single-agent pembrolizumab which had an objective response rate (ORR) of 21% in a similar patient population in the KEYNOTE-045 study. We also incorporated multiple novel biomarker studies to explore immune regulatory mechanisms in UC. Methods: This is a prospective, single-arm phase II trial (NCT02581982) of pembrolizumab combined with low-dose paclitaxel in patients with platinum-refractory metastatic UC. Key inclusion criteria included measurable progression of disease within 12 months of platinum therapy and ECOG ≤1. Patients received pembrolizumab 200mg day 1 and paclitaxel 80 mg/m2 days 1 and 8 of a 21 day cycle for up to 8 cycles unless clinical or radiographic disease progression or unacceptable adverse events (AEs) were observed. Responding patients could remain on pembrolizumab maintenance for up to 2 years. The primary endpoint was ORR; key secondary endpoints included overall survival (OS), 6-month progression free survival (PFS), and safety. Results: Twenty-seven patients were treated between 4/2016 - 6/2020, with a median follow up of 9.9 months. At baseline, the median age was 68 years (range 49-80), with 81% men and 78% non-Hispanic white. The majority (59%) were ECOG 1. Twenty-one of 27 (78%) received prior definitive therapy: chemoradiation in 24% and surgery in 76%. The majority (78%) of patients received prior cisplatin. 70% progressed on a cisplatin-based regimen while 30% progressed on carboplatin-based regimen within 12 months of study entry. The ORR by intention to treat was 9 of 27 patients (33%) and in patients evaluable for response by imaging was 9 of 25 (36%), including 3 with complete response. Disease control rate in evaluable patients was 72%. Six-month PFS was 46.8% (95% CI: 27.2%, 64.2%) and median OS was 11.7 months (95% CI: 8.7 mo, NR). Common ≥ grade 2 AEs were anemia (44%), lymphopenia (37%), hyperglycemia (33%), and fatigue (33%). Possible treatment-related at least grade 3 or 4 AEs occurred in 56% of subjects, including 2 immune-mediated AEs (pneumonitis and nephritis) resulting in therapy cessation but a durable partial response. There were no grade 5 events. Conclusions: This study illustrates that the addition of low-dose paclitaxel to pembrolizumab improves outcomes in patients with platinum-refractory UC, relative to single-agent pembrolizumab. No unanticipated safety signals emerged. Exploratory analyses including PDL1 status, tumor mutational burden, and change in circulating microRNAs and in immune cell populations are ongoing. Clinical trial information: NCT02581982.
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Affiliation(s)
- Rhonda L. Bitting
- Comprehensive Cancer Center of Wake Forest Baptist Health, Winston Salem, NC
| | | | - Janet A. Tooze
- Wake Forest University School of Medicine, Winston Salem, NC
| | | | - Morgan Neve
- Comprehensive Cancer Center of Wake Forest Baptist Health, Winston Salem, NC
| | - Mitra Kooshki
- Comprehensive Cancer Center of Wake Forest Baptist Health, Winston Salem, NC
| | - Jessica Brown
- Pelotonia Institute of Immunooncology, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Purnima Dubey
- Pelotonia Institute of Immunooncology, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Pierre Triozzi
- Comprehensive Cancer Center of Wake Forest Baptist Health, Winston Salem, NC
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Agarwal S, Tooze JA, Bauer DC, Cauley JA, Harris TB, Koster A, Womack CR, Kritchevsky SB, Houston DK. Association between 25-Hydroxyvitamin D and Metabolic Syndrome in Older Adults: The Health, Aging and Body Composition Study. Int J Endocrinol 2021; 2021:6671823. [PMID: 33777141 PMCID: PMC7981173 DOI: 10.1155/2021/6671823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/13/2021] [Accepted: 03/04/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Low 25-hydroxyvitamin D (25[OH]D) levels and metabolic syndrome (MetS) are prevalent among older adults; however, longitudinal studies examining 25(OH)D status and MetS are lacking. We explore the association of 25(OH)D levels with prevalent and incident MetS in white and black older adults. Research Design and Methods. A total of 1620 white and 1016 black participants aged 70-79 years from the Health ABC cohort with measured 25(OH)D levels and data on MetS and covariates of interest were examined. The association between 25(OH)D levels and prevalent MetS at baseline and incident MetS at 6-year follow-up was examined in whites and blacks separately using logistic regression adjusting for demographics, lifestyle factors, and renal function. RESULTS At baseline, 635 (39%) white and 363 (36%) black participants had prevalent MetS. In whites, low 25(OH)D levels were associated with prevalent MetS (adjusted OR (95% CI), 1.85 (1.47, 2.34)) and 1.96 (1.46, 2.63) for 25(OH)D of 20-<30 and <20 vs. ≥30 ng/ml, respectively). The association was attenuated after adjustment for BMI but remained significant. No association was found between 25(OH)D levels and prevalent MetS in blacks. Among those without MetS at baseline (765 whites, 427 blacks), 150 (20%) whites and 87 (20%) blacks had developed MetS at 6-year follow-up. However, 25(OH)D levels were not associated with incident MetS in whites or blacks. CONCLUSION In older adults, low 25(OH)D levels were associated with increased odds of prevalent MetS in whites but not in blacks. No association was observed between 25(OH)D levels and incident MetS in either whites or blacks.
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Affiliation(s)
- Subhashish Agarwal
- Department of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Janet A. Tooze
- Division of Public Health Sciences and Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Douglas C. Bauer
- General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jane A. Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tamara B. Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD, USA
| | - Annemarie Koster
- Department of Social Medicine, University of Maastricht, Maastricht, Netherlands
| | - Catherine R. Womack
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Denise K. Houston
- For the Health ABC Study, Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Falk DS, Winkfield KE, Tooze JA, Shore K, Strom C, Weaver KE. Abstract PO-078: Delaying and forgoing care due to cost among rural cancer survivors. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-078] [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] Open
Abstract
Abstract
Purpose: Financial hardship, including delaying/forgoing services because of cost, is reported by approximately 30% of an estimated 16.9 million cancer survivors. However, hardship is poorly assessed and interventions sporadically implemented for survivors. The objective of this study is to assess factors associated with delaying and forgoing care services due to cost to inform a patient navigation program for rural cancer survivors. Methods: Adults with a cancer diagnosis who were 6 months or more post-definitive treatment or were receiving on-going maintenance therapy were identified for a cross-sectional mailed survey through the electronic medical record. Participants were predominately residents of one of eight priority rural counties in Northwest North Carolina (all resided in a zip-code defined by a Rural- Urban Commuting Area [RUCA] code of 4-10). Items from the 2019 National Health Information Survey (NHIS) assessed delayed/foregone medical care. Univariate statistics described the sample distribution and prevalence of delaying/forgoing care. Participants were randomized into two incentive groups ($2 bill with the survey mailing vs a $10 gift card upon completion). Chi-square tests examined the factors associated with delaying/forgoing services by demographic and cancer characteristics. Results: The survey response rate was 22.0%; 451 complete surveys were included in the present analyses. Enrolled survivors (49.7% female) were predominately non-Hispanic white (96.2%), with a mean age of 69 years, and 69.0% were 5 years or more post diagnosis. The most common cancer sites were prostate (21.5%), breast (19.7%), and colorectal (7.3%). Delayed medical care was reported by 16.2% of the sample. The prevalence of forgoing care due to cost was 6.4% for medical care, 12.3% for medications, 6.4% for mental health, and 7.0% for medical tests. Chi-square tests found significant differences by age, gender, and radiation treatment status (yes/no), with higher prevalence of delaying care among survivors aged 41-64 vs younger and older survivors (34.1% vs 27.2% and 8.8%, P<0.001), females vs males (22.4% vs 10.4%, P<0.001), and those treated with radiation therapy compared to those who were not (21.0% vs 13.2%, P=0.03). Survivors aged 18-40 compared to older survivors (18.8% vs 13.4% [aged 41-64] and 3.2% [aged 65+], P<0.001), and females vs male survivors (10.7% vs 3.2%, P=0.006) were also more likely to report forgoing care due to cost. Discussion: A minority of post- treatment rural cancer survivors report delaying and forgoing medical care because of cost. Patient navigation programs should prioritize ongoing screening efforts for financial hardship among younger and female rural survivors after initial treatment completion.
Citation Format: Derek S. Falk, Karen E. Winkfield, Janet A. Tooze, Kelsey Shore, Carla Strom, Kathryn E. Weaver. Delaying and forgoing care due to cost among rural cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-078.
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Affiliation(s)
| | | | | | - Kelsey Shore
- 2Wake Forest Baptist Health Comprehensive Cancer Center, Winston-Salem, NC
| | - Carla Strom
- 2Wake Forest Baptist Health Comprehensive Cancer Center, Winston-Salem, NC
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Jun S, Cowan AE, Bhadra A, Dodd KW, Dwyer JT, Eicher-Miller HA, Gahche J, Guenther PM, Potischman N, Tooze JA, Bailey RL. Older adults with obesity have higher risks of some micronutrient inadequacies and lower overall dietary quality compared to peers with a healthy weight, National Health and Nutrition Examination Surveys (NHANES), 2011-2014. Public Health Nutr 2020; 23:2268-2279. [PMID: 32466808 PMCID: PMC7429309 DOI: 10.1017/s1368980020000257] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/04/2023]
Abstract
OBJECTIVE To evaluate total usual intakes and biomarkers of micronutrients, overall dietary quality and related health characteristics of US older adults who were overweight or obese compared with a healthy weight. DESIGN Cross-sectional study. SETTING Two 24-h dietary recalls, nutritional biomarkers and objective and subjective health characteristic data were analysed from the National Health and Nutrition Examination Survey 2011-2014. We used the National Cancer Institute method to estimate distributions of total usual intakes from foods and dietary supplements for eleven micronutrients of potential concern and the Healthy Eating Index (HEI)-2015 score. PARTICIPANTS Older adults aged ≥60 years (n 2969) were categorised by sex and body weight status, using standard BMI categories. Underweight individuals (n 47) were excluded due to small sample size. RESULTS A greater percentage of obese older adults compared with their healthy-weight counterparts was at risk of inadequate Mg (both sexes), Ca, vitamin B6 and vitamin D (women only) intakes. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/l was higher in obese (12 %) than in healthy-weight older women (6 %). Mean overall HEI-2015 scores were 8·6 (men) and 7·1 (women) points lower in obese than in healthy-weight older adults. In addition, compared with healthy-weight counterparts, obese older adults were more likely to self-report fair/poor health, use ≥ 5 medications and have limitations in activities of daily living and cardio-metabolic risk factors; and obese older women were more likely to be food-insecure and have depression. CONCLUSIONS Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.
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Affiliation(s)
- Shinyoung Jun
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN, 47907, USA
| | - Alexandra E. Cowan
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN, 47907, USA
| | - Anindya Bhadra
- Department of Statistics, Purdue University, 250 N. University St., West Lafayette, IN 47907, USA
| | - Kevin W. Dodd
- National Cancer Institute, National Institutes of Health, Medical Center Drive, Rockville, MD 20850, USA
| | - Johanna T. Dwyer
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD 20892-7517, USA
| | - Heather A. Eicher-Miller
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN, 47907, USA
| | - Jaime Gahche
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD 20892-7517, USA
| | - Patricia M. Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, 250 South 850 East, Salt Lake City, UT 84112. USA
| | - Nancy Potischman
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD 20892-7517, USA
| | - Janet A. Tooze
- School of Medicine, Wake Forest University, Winston-Salem, NC, 27101, USA
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN, 47907, USA
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Wright BN, Tooze JA, Bailey RL, Liu Y, Rivera RL, McCormack L, Stluka S, Franzen-Castle L, Henne B, Mehrle D, Remley D, Eicher-Miller HA. Dietary Quality and Usual Intake of Underconsumed Nutrients and Related Food Groups Differ by Food Security Status for Rural, Midwestern Food Pantry Clients. J Acad Nutr Diet 2020; 120:1457-1468. [DOI: 10.1016/j.jand.2020.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/06/2020] [Indexed: 11/27/2022]
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Palmer NR, Avis NE, Fino NF, Tooze JA, Weaver KE. Rural cancer survivors' health information needs post-treatment. Patient Educ Couns 2020; 103:1606-1614. [PMID: 32147307 PMCID: PMC7311274 DOI: 10.1016/j.pec.2020.02.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study describes the most common cancer-related health information needs among rural cancer survivors and characteristics associated with reporting more information needs. METHODS Rural breast, prostate, and colorectal cancer survivors, two to five years post-diagnosis, identified from an institutional cancer registry, completed a mailed/telephone-administered survey. Respondents were asked about 23 health information needs in eight domains (tests and treatment, side effects and symptoms, health promotion, fertility, interpersonal, occupational, emotional, and insurance). Poisson regression models were used to assess relationships between number of health information needs and demographic and cancer characteristics. RESULTS Participants (n = 170) reported an average of four health information needs, with the most common domains being: side effects and symptoms (58 %), health promotion (54 %), and tests and treatment (41 %). Participants who were younger (compared to 5-year increase, rate ratio [RR] = 1.11, 95 % CI = 1.02-1.21), ethnic minority (RR = 1.89, 95 % CI = 1.17-3.06), less educated (RR = 1.49, 95 % CI = 1.00-2.23), and financially stressed (RR = 1.87, 95 % CI = 1.25-2.81) had a greater number of information needs. CONCLUSIONS Younger, ethnic minority, less educated, and financially strained rural survivors have the greatest need for informational support. PRACTICE IMPLICATIONS The provision of health information for rural cancer survivors should consider type of cancer, treatments received, and sociocultural differences to tailor information provided.
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Affiliation(s)
- Nynikka R Palmer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nora F Fino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Shaw PA, Gustafson P, Carroll RJ, Deffner V, Dodd KW, Keogh RH, Kipnis V, Tooze JA, Wallace MP, Küchenhoff H, Freedman LS. STRATOS guidance document on measurement error and misclassification of variables in observational epidemiology: Part 2-More complex methods of adjustment and advanced topics. Stat Med 2020; 39:2232-2263. [PMID: 32246531 PMCID: PMC7272296 DOI: 10.1002/sim.8531] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 12/09/2018] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/24/2022]
Abstract
We continue our review of issues related to measurement error and misclassification in epidemiology. We further describe methods of adjusting for biased estimation caused by measurement error in continuous covariates, covering likelihood methods, Bayesian methods, moment reconstruction, moment-adjusted imputation, and multiple imputation. We then describe which methods can also be used with misclassification of categorical covariates. Methods of adjusting estimation of distributions of continuous variables for measurement error are then reviewed. Illustrative examples are provided throughout these sections. We provide lists of available software for implementing these methods and also provide the code for implementing our examples in the Supporting Information. Next, we present several advanced topics, including data subject to both classical and Berkson error, modeling continuous exposures with measurement error, and categorical exposures with misclassification in the same model, variable selection when some of the variables are measured with error, adjusting analyses or design for error in an outcome variable, and categorizing continuous variables measured with error. Finally, we provide some advice for the often met situations where variables are known to be measured with substantial error, but there is only an external reference standard or partial (or no) information about the type or magnitude of the error.
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Affiliation(s)
- Pamela A Shaw
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond J Carroll
- Department of Statistics, Texas A&M University, College Station, Texas, USA
- School of Mathematical and Physical Sciences, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Veronika Deffner
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians-Universität, Munich, Germany
| | - Kevin W Dodd
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Victor Kipnis
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael P Wallace
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Helmut Küchenhoff
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians-Universität, Munich, Germany
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Information Management Services Inc., Rockville, Maryland, USA
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