1
|
Grogan M, Davis MK, Crespo-Leiro MG, Sultan MB, Gundapaneni B, Stedile Angeli F, Hanna M. Effect of long-term tafamidis treatment on health-related quality of life in patients with transthyretin amyloid cardiomyopathy. Eur J Heart Fail 2024. [PMID: 38439606 DOI: 10.1002/ejhf.3190] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
AIMS To evaluate the effect of long-term tafamidis treatment on health-related quality of life (HRQoL) in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) enrolled in the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) and long-term extension (LTE) study. METHODS AND RESULTS We examined change from baseline in Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS) and clinical summary (KCCQ-CS) scores in patients who received tafamidis meglumine 80 mg for 30 months in ATTR-ACT and tafamidis (meglumine 80 mg or bioequivalent free acid 61 mg) for 30 months in the LTE study, and in patients who received placebo for 30 months in ATTR-ACT and tafamidis for 30 months in the LTE study. In ATTR-ACT, 176 and 177 patients were randomized to tafamidis 80 mg and placebo, respectively. Patients who continuously received tafamidis had a 6- to 7-point reduction in least squares (LS) mean (standard error) KCCQ-OS and KCCQ-CS scores at month 30 (-6.25 [1.53] and -7.48 [1.39]), with little or no further decline over the next 30 months (-5.92 [1.77] and -9.21 [1.88] at month 60). Patients who received placebo in ATTR-ACT had a 20-point reduction in LS mean KCCQ-OS and KCCQ-CS scores at month 30 (-19.60 [1.94] and -19.90 [2.01]), but the decline slowed after initiating tafamidis (-24.70 [3.04] and -25.30 [3.36] at month 60). CONCLUSION Tafamidis reduced HRQoL decline in patients with ATTR-CM. Patients continuously treated with tafamidis for 60 months demonstrated stabilized HRQoL. In patients who initially received placebo in ATTR-ACT, tafamidis reduced the decline in HRQoL during the LTE study.
Collapse
Affiliation(s)
- Martha Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Maria G Crespo-Leiro
- Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC): CIBERCV, Universidade da Coruña (UDC), Instituto de Investigacion Biomedicas A Coruña (INIBIC), A Coruña, Spain
| | | | | | | | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
2
|
Cheng R, Kittleson MM, Wechalekar AD, Alvarez-Cardona J, Mitchell JD, Scarlatelli Macedo AV, Dutra JPP, Campbell CM, Liu JE, Landau HJ, Davis MK, Morrissey S, Casselli S, Lousada I, Seabra-Garcez JD, Szor RS, Ganatra S, Trachtenberg B, Maurer MS, Stockerl-Goldstein K, Lenihan D. Moving towards establishing centres of excellence in cardiac amyloidosis: an International Cardio-Oncology Society statement. Heart 2024:heartjnl-2023-323502. [PMID: 38267197 DOI: 10.1136/heartjnl-2023-323502] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
The prevalence of amyloidosis has been increasing, driven by a combination of improved awareness, evolution of diagnostic pathways, and effective treatment options for both transthyretin and light chain amyloidosis. Due to the complexity of amyloidosis, centralised expert providers with experience in delineating the nuances of confirmatory diagnosis and management may be beneficial. There are many potential benefits of a centre of excellence designation for the treatment of amyloidosis including recognition of institutions that have been leading the way for the optimal treatment of this condition, establishing the expectations for any centre who is engaging in the treatment of amyloidosis and developing cooperative groups to allow more effective research in this disease space. Standardising the expectations and criteria for these centres is essential for ensuring the highest quality of clinical care and community education. In order to define what components are necessary for an effective centre of excellence for the treatment of amyloidosis, we prepared a survey in cooperation with a multidisciplinary panel of amyloidosis experts representing an international consortium. The purpose of this position statement is to identify the essential elements necessary for highly effective clinical care and to develop a general standard with which practices or institutions could be recognised as a centre of excellence.
Collapse
Affiliation(s)
- Richard Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | | | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Jose Alvarez-Cardona
- Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Joshua D Mitchell
- Cardiology/IM, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Joao Pedro Passos Dutra
- Center for Oncological Research (CEPON) and SOS Cardio Hospital in Florianópolis, Santa Catarina, Brazil
| | - Courtney M Campbell
- Baylor Scott and White Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas, USA
| | - Jennifer E Liu
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Heather J Landau
- Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Margot K Davis
- Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Sarju Ganatra
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | | | - Mathew S Maurer
- Center for Advanced Cardiac Care, Columbia University Medical Center, New York, New York, USA
| | | | - Daniel Lenihan
- Cardiology, International Cardio-Oncology Society and St Frances Healthcare, Cape Girardeau, Missouri, USA
| |
Collapse
|
3
|
Masoudkabir F, Mohammadifard N, Mani A, Ignaszewski A, Davis MK, Vaseghi G, Mansourian M, Franco C, Gotay C, Sarrafzadegan N. Shared Lifestyle-Related Risk Factors of Cardiovascular Disease and Cancer: Evidence for Joint Prevention. ScientificWorldJournal 2023; 2023:2404806. [PMID: 37520844 PMCID: PMC10386903 DOI: 10.1155/2023/2404806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 02/25/2023] [Accepted: 06/09/2023] [Indexed: 08/01/2023] Open
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of mortality and morbidity worldwide and are the major focus of the World Health Organization's joint prevention programs. While, diverse diseases, CVD and cancer, have many similarities. These include common lifestyle-related risk factors and shared environmental, metabolic, cellular, inflammatory, and genetic pathways. In this review, we will discuss the shared lifestyle-related and environmental risk factors central to both diseases and how the strategies commonly used to prevent atherosclerotic vascular disease can be applied to cancer prevention.
Collapse
Affiliation(s)
- Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Mohammadifard
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arya Mani
- Yale Cardiovascular Genetics Program, Yale Cardiovascular Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew Ignaszewski
- Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot K. Davis
- Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Golnaz Vaseghi
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Epidemiology and Biostatistics Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Christopher Franco
- Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carolyn Gotay
- School of Population & Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
4
|
Jimenez-Zepeda V, Bril V, Lemieux-Blanchard E, Royal V, McCurdy A, Schwartz D, Davis MK. A Comprehensive Multidisciplinary Diagnostic Algorithm for the Early and Efficient Detection of Amyloidosis. Clin Lymphoma Myeloma Leuk 2023; 23:194-202. [PMID: 36653205 DOI: 10.1016/j.clml.2022.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
Amyloidosis is a rare protein misfolding disease caused by the accumulation of amyloid fibrils in various tissues and organs. There are different subtypes of amyloidosis, with light chain (AL) amyloidosis being the most common. Amyloidosis is notoriously difficult to diagnose because it is clinically heterogeneous, no single test is diagnostic for the disease, and diagnosis typically involves multiple specialists. Here, we propose an integrated, multidisciplinary algorithm for efficiently diagnosing amyloidosis. Drawing on research from several medical disciplines, we have combined clinical decisions and best practices into a comprehensive algorithm to facilitate the early detection of amyloidosis. Currently, many patients are diagnosed more than 6 months after symptom onset, yet early diagnosis is the major predictor of survival. Our algorithm aims to shorten the time to diagnosis with efficient sequencing of tests and minimizing uninformative investigations. We also recommend typing and staging of confirmed amyloidosis to guide treatment. By reducing time to diagnosis, our algorithm could lead to earlier and more targeted treatment, ultimately improving prognosis and survival.
Collapse
Affiliation(s)
- Victor Jimenez-Zepeda
- Department of Hematology, University of Calgary and Arnie Charbonneau Cancer Institute, Calgary, Alberta, Canada.
| | - Vera Bril
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toranto, Ontario, Canada
| | - Emilie Lemieux-Blanchard
- Department of Hematology, Service d'hématologie-oncologie du Centre hospitalier de l'Université de Montréal and Centre de recherche du CHUM, Montreal, Quebec, Canada
| | - Virginie Royal
- Department of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montreal, Montreal, Quebec, Canada
| | - Arleigh McCurdy
- Division of Hematology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Schwartz
- Faculty of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot K Davis
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Klimis H, Pinthus JH, Aghel N, Duceppe E, Fradet V, Brown I, Siemens DR, Shayegan B, Klotz L, Luke PP, Niazi T, Lavallee LT, Mousavi N, Hamilton RJ, Chin JL, Gopaul D, Violette PD, Davis MK, Hanna N, Sabbagh R, Ben Zadok OI, Hajjar LA, Kann AG, Mian R, Rangarajan S, Huei Ng KK, Iakobishvili Z, Selvanayagam JB, Avezum A, Leong DP. The Burden of Uncontrolled Cardiovascular Risk Factors in Men With Prostate Cancer: A RADICAL-PC Analysis. JACC CardioOncol 2023; 5:70-81. [PMID: 36875906 PMCID: PMC9982287 DOI: 10.1016/j.jaccao.2022.09.008] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 01/18/2023] Open
Abstract
Background Cardiovascular disease (CVD) incidence is higher in men with prostate cancer (PC) than without. Objectives We describe the rate and correlates of poor cardiovascular risk factor control among men with PC. Methods We prospectively characterized 2,811 consecutive men (mean age 68 ± 8 years) with PC from 24 sites in Canada, Israel, Brazil, and Australia. We defined poor overall risk factor control as ≥3 of the following: suboptimal low-density lipoprotein cholesterol (>2 mmol/L if Framingham Risk Score [FRS] ≥15 and ≥3.5 mmol/L if FRS <15), current smoker, physical inactivity (<600 MET min/wk), suboptimal blood pressure (BP) (≥140/90 mm Hg if no other risk factors, systolic BP ≥120 mm Hg if known CVD or FRS ≥15, and ≥130/80 mm Hg if diabetic), and waist:hip ratio >0.9. Results Among participants (9% with metastatic PC and 23% with pre-existing CVD), 99% had ≥1 uncontrolled cardiovascular risk factor, and 51% had poor overall risk factor control. Not taking a statin (odds ratio [OR]: 2.55; 95% CI: 2.00-3.26), physical frailty (OR: 2.37; 95% CI: 1.51-3.71), need for BP drugs (OR: 2.36; 95% CI: 1.84-3.03), and age (OR per 10-year increase: 1.34; 95% CI: 1.14-1.59) were associated with poor overall risk factor control after adjustment for education, PC characteristics, androgen deprivation therapy, depression, and Eastern Cooperative Oncology Group functional status. Conclusions Poor control of modifiable cardiovascular risk factors is common in men with PC, highlighting the large gap in care and the need for improved interventions to optimize cardiovascular risk management in this population.
Collapse
Key Words
- ADT, androgen deprivation therapy
- BP, blood pressure
- CVD, cardiovascular disease
- ECOG, Eastern Cooperative Oncology Group
- GnRH, gonadotropin-releasing hormone
- HDL, high-density lipoprotein
- HbA1c, glycosylated hemoglobin
- LDL, low-density lipoprotein
- PC, prostate cancer
- PHQ-9, Patient Health Questionnaire-9
- PSA, prostate-specific antigen
- androgen deprivation therapy
- cardiovascular disease prevention
- cardiovascular risk
- prospective
- prostate cancer
Collapse
Affiliation(s)
- Harry Klimis
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Nazanin Aghel
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Emmanuelle Duceppe
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Vincent Fradet
- Department of Surgery, Université Laval, Quebec, Canada.,Research Center of CHU de Québec, Université Laval, Oncology Axis, Quebec, Canada.,CHU de Québec, Site L'Hôtel-Dieu de Québec, Quebec, Canada
| | - Ian Brown
- Division of Urology, Niagara Health System, Saint Catharines, Ontario, Canada
| | - D Robert Siemens
- Queen's Cancer Research Institute, Kingston, Ontario, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Urology, Queen's University, Kingston, Ontario, Canada
| | - Bobby Shayegan
- Department of Surgery, Division of Urology, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Laurence Klotz
- Department of Surgery, Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patrick P Luke
- Department of Surgery, Division of Urology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Tamim Niazi
- Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Luke T Lavallee
- Division of Urology, Department of Surgery, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada
| | - Negareh Mousavi
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Robert J Hamilton
- Department of Surgery, Division of Urology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Joseph L Chin
- Department of Urology, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Darin Gopaul
- Department of Medicine, Division of Radiation Oncology, Grand River Regional Cancer Centre, Kitchener, Ontario, Canada
| | - Philippe D Violette
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Woodstock Hospital, Woodstock, Ontario, Canada
| | - Margot K Davis
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nawar Hanna
- Department of Surgery, Division of Urology, CIUSSS de l'Est-de-l'Île-de-Montréal, Installation Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Robert Sabbagh
- Department of Surgery, Division of Urology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Ludhmila Abrahão Hajjar
- Department of Cardiology, Instituto do Coração, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rajibul Mian
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Kelvin Kuan Huei Ng
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Zaza Iakobishvili
- Department of Community Cardiology, Tel Aviv Jaffa District, Clalit Health Fund and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph B Selvanayagam
- Department of Medicine, School of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Darryl P Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| |
Collapse
|
6
|
Huang H, Christidi E, Shafaattalab S, Davis MK, Tibbits GF, Brunham LR. RARG S427L attenuates the DNA repair response to doxorubicin in induced pluripotent stem cell-derived cardiomyocytes. Stem Cell Reports 2022; 17:756-765. [PMID: 35364012 PMCID: PMC9023798 DOI: 10.1016/j.stemcr.2022.03.002] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
Abstract
Doxorubicin is a commonly used chemotherapeutic drug, but its use is limited by doxorubicin-induced cardiotoxicity (DIC), which can lead to irreversible heart failure and death. A missense variant rs2229774 (p.S427L) in the retinoic acid receptor gamma (RARG) gene is associated with increased susceptibility to DIC, but the precise mechanism underlying this association is incompletely understood. We performed molecular dynamic simulations to determine the effect of this variant on RARG structure and then validated these predictions using CRISPR-Cas9-genome-edited, induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs). We found that this variant leads to reduced activation of its target genes in response to doxorubicin, including gene pathways involved in DNA repair and consequently an inability to mediate DNA repair after exposure to doxorubicin. Our findings establish a role of RARG p.S427L in attenuating DNA repair in DIC and provide insight into the pathogenesis of this cardiotoxic effect. RARG p.S427L is predicted to alter the stability of the C terminus of the protein The RARG p.S427L variant has impaired ability to activate its target genes This variant attenuates the DNA repair response to doxorubicin
Collapse
Affiliation(s)
- Haojun Huang
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Effimia Christidi
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Sanam Shafaattalab
- Molecular Cardiac Physiology Group, Departments of Biomedical Physiology and Kinesiology and Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Margot K Davis
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Glen F Tibbits
- Molecular Cardiac Physiology Group, Departments of Biomedical Physiology and Kinesiology and Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; Cellular and Regenerative Medicine Centre, British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Liam R Brunham
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada.
| |
Collapse
|
7
|
Affiliation(s)
- Margot K. Davis
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Howard Lim
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - Agnes Y.Y. Lee
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| |
Collapse
|
8
|
Yao RJR, Gibson J, Simmons C, Davis MK. Management strategies and clinical outcomes in breast cancer patients who develop left ventricular dysfunction during trastuzumab therapy. Cardiooncology 2021; 7:12. [PMID: 33766148 PMCID: PMC7995775 DOI: 10.1186/s40959-021-00099-7] [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] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/09/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Trastuzumab reduces risk of breast cancer recurrence but carries risk of cardiotoxicity that may be reversible upon treatment cessation and institution of left ventricular (LV) enhancement therapies (LVETx). We assessed management patterns of trastuzumab-induced cardiotoxicity (TIC) in a contemporary real-world setting. METHODS We reviewed charts of all breast cancer patients who received adjuvant trastuzumab in British Columbia between January 2010 and December 2013, spanning the opening of a cardio-oncology clinic. LV dysfunction (LVD) was classified as minimal (LVEF nadir 45-49%), mild (40-44%) or moderate-severe (< 40%). Charts were reviewed for baseline characteristics, management strategies, and outcomes. Multivariable analysis was performed to identify patient characteristics associated with trastuzumab completion and cardiology referral. RESULTS Of 967 patients receiving trastuzumab, 171 (17.7%) developed LVD, including 114 patients (11.8%) with LVEF declines of ≥10 to < 50%. Proportions of patients receiving cardiology referrals and LVETx increased and wait times to consultation decreased after a dedicated cardio-oncology clinic opened. LVETx was used more frequently in patients with moderate-severe LVD compared to minimal or mild LVD. Factors associated with completion of trastuzumab included mastectomy (OR 5.1, 95% CI 1.1-23.0) and proximity to quaternary care centre (OR 7.7, 95% CI 2.2-26.2). Moderate-severe LVD was associated with a lower probability of completing trastuzumab (OR 0.07 vs. minimal LVD, 95% CI 0.01-0.74). Factors associated with cardiology referral included heart failure symptoms (OR 8.0, 95% CI 1.5-42.9), proximity to quaternary care centre (OR 6.8, 95% CI 1.3-34.2), later year of cancer diagnosis (OR 2.4 per year, 95% CI 1.4-4.3), node-positive disease (OR 0.18, 95% CI 0.06-0.56), mastectomy (OR 0.05, 95% CI 0.01-0.52), and minimal LVD (OR 0.14, 95% CI 0.05-0.46). LVEF recovered to > 50% in 90.7% of patients. CONCLUSIONS Management strategies in patients with TIC are associated with cancer characteristics and severity of cardiotoxicity. Access to dedicated cardio-oncology clinics may facilitate optimal care of this complex patient population.
Collapse
Affiliation(s)
- Ren Jie Robert Yao
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jordan Gibson
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christine Simmons
- Division of Medical Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - Margot K Davis
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada.
- Gordon & Leslie Diamond Health Care Centre, 2775 Laurel St., 9th Floor, Vancouver, BC, V5Z 1 M9, Canada.
| |
Collapse
|
9
|
Davis MK, Fine NM, Small GR, Connolly K, Bosley D, Zieroth S, Virani SA. Establishing a Cardiac Amyloidosis Clinic: A Practical Primer for Cardiologists. Can J Cardiol 2021; 37:674-678. [PMID: 33485855 DOI: 10.1016/j.cjca.2021.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 12/01/2022] Open
Abstract
Cardiac amyloidosis is an emerging and important cause of heart failure, arrhythmia, and other cardiovascular disease in Canada. In this context, many centres have expressed interest in the development of effective care pathways for screening, evaluating, and treating this rapidly growing patient population. In October 2019, a group of Canadian stakeholders met, including specialists in cardiac amyloidosis, experts in heart failure and chronic disease management, and academic and community-based cardiologists at various stages of cardiac amyloidosis clinic development. Objectives of the meetings included discussion of existing care pathways, consideration of barriers to program development, and achieving a consensus on essential and desirable components of a best-practice cardiac amyloidosis program. Topics discussed included optimal settings for cardiac amyloidosis clinics and integration with other specialty clinics, funding limitations that act as barriers to program development and potential solutions to these barriers, the roles of the multidisciplinary team and specialist physicians in amyloidosis care, and diagnostic pathways and strategies for the identification of patients with cardiac amyloidosis. In this report, we summarize the discussion points and key recommendations for the development of a cardiac amyloidosis clinic that emerged from this meeting, focused on program integration and care coordination, human resource elements, access to care, and quality improvement and outcome measures in cardiac amyloidosis.
Collapse
Affiliation(s)
- Margot K Davis
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Nowell M Fine
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gary R Small
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Debra Bosley
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shelley Zieroth
- Division of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sean A Virani
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Fervaha G, Izard JP, Tripp DA, Aghel N, Shayegan B, Klotz L, Niazi T, Fradet V, Taussky D, Lavallée LT, Hamilton RJ, Brown I, Chin J, Gopaul D, Violette PD, Davis MK, Karampatos S, Pinthus JH, Leong DP, Siemens DR. Psychological morbidity associated with prostate cancer: Rates and predictors of depression in the RADICAL PC study. Can Urol Assoc J 2020; 15:181-186. [PMID: 33212008 DOI: 10.5489/cuaj.6912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Across all cancer sites and stages, prostate cancer has one of the greatest median five-year survival rates, highlighting the important focus on survivorship issues following diagnosis and treatment. In the current study, we sought to evaluate the prevalence and predictors of depression in a large, multicenter, contemporary, prospectively collected sample of men with prostate cancer. METHODS Data from the current study were drawn from the baseline visit of men enrolled in the RADICAL PC study. Men with a new diagnosis of prostate cancer or patients initiating androgen deprivation therapy for prostate cancer for the first time were recruited. Depressive symptoms were evaluated using the nine-item version of the Patient Health Questionnaire (PHQ-9). To evaluate factors associated with depression, a multivariable logistic regression model was constructed, including biological, psychological, and social predictor variables. RESULTS Data from 2445 patients were analyzed. Of these, 201 (8.2%) endorsed clinically significant depression. Younger age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.16-1.60 per 10-year decrease), being a current smoker (OR 2.77, 95% CI 1.66-4.58), former alcohol use (OR 2.63, 95% CI 1.33-5.20), poorer performance status (OR 5.01, 95% CI 3.49-7.20), having a pre-existing clinical diagnosis of depression or anxiety (OR 3.64, 95% CI 2.42-5.48), and having high-risk prostate cancer (OR 1.49, 95% CI 1.05-2.12) all conferred independent risk for depression. CONCLUSIONS Clinically significant depression is common in men with prostate cancer. Depression risk is associated with a host of biopsychosocial variables. Clinicians should be vigilant to screen for depression in those patients with poor social determinants of health, concomitant disability, and advanced disease.
Collapse
Affiliation(s)
- Gagan Fervaha
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jason P Izard
- Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Oncology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Dean A Tripp
- Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Psychology, Faculty of Arts and Sciences, Queen's University, Kingston, ON, Canada.,Department of Anesthesia, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Nazanin Aghel
- Division of Cardiology, Cardio-Oncology Program, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Laurence Klotz
- Sunnybrook Health Sciences Centre, and Department of Surgery (Urology), University of Toronto, Toronto, ON, Canada
| | - Tamim Niazi
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Vincent Fradet
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada, and Centre de recherche du CHU de Québec-Université Laval, axe Oncologie, Quebec City, QC, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal-CHUM, Montreal, QC, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert J Hamilton
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, and Department of Surgery (Urology), University of Toronto, Toronto, ON, Canada
| | | | | | - Darin Gopaul
- Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | - Philippe D Violette
- Department of Surgery and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Margot K Davis
- Department of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Karampatos
- The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jehonathan H Pinthus
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Darryl P Leong
- The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - D Robert Siemens
- Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Oncology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | |
Collapse
|
11
|
Fine NM, Davis MK, Anderson K, Delgado DH, Giraldeau G, Kitchlu A, Massie R, Narayan J, Swiggum E, Venner CP, Ducharme A, Galant NJ, Hahn C, Howlett JG, Mielniczuk L, Parent MC, Reece D, Royal V, Toma M, Virani SA, Zieroth S. Canadian Cardiovascular Society/Canadian Heart Failure Society Joint Position Statement on the Evaluation and Management of Patients With Cardiac Amyloidosis. Can J Cardiol 2020; 36:322-334. [PMID: 32145862 DOI: 10.1016/j.cjca.2019.12.034] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 01/29/2023] Open
Abstract
Cardiac amyloidosis is an under-recognized and potentially fatal cause of heart failure and other cardiovascular manifestations. It is caused by deposition of misfolded precursor proteins as fibrillary amyloid deposits in cardiac tissues. The two primary subtypes of systemic amyloidosis causing cardiac involvement are immunoglobulin light chain (AL), a plasma cell dyscrasia, and transthyretin (ATTR), itself subdivided into a hereditary subtype caused by a gene mutation of the ATTR protein, and an age-related wild type, which occurs in the absence of a gene mutation. Clinical recognition requires a high index of suspicion, inclusive of the extracardiac manifestations of both subtypes. Diagnostic workup includes screening for serum and/or urine monoclonal protein suggestive of immunoglobulin light chains, along with serum cardiac biomarker measurement and performance of cardiac imaging for findings consistent with amyloid infiltration. Modern cardiac imaging techniques, including the use of nuclear scintigraphy with bone-seeking radiotracer to noninvasively diagnose ATTR cardiac amyloidosis, have reduced reliance on the gold standard endomyocardial biopsy. Disease-modifying therapeutic approaches have evolved significantly, particularly for ATTR, and pharmacologic therapies that slow or halt disease progression are becoming available. This Canadian Cardiovascular Society/Canadian Heart Failure Society joint position statement provides evidence-based recommendations that support the early recognition and optimal diagnostic approach and management strategies for patients with cardiac amyloidosis. This includes recommendations for the symptomatic management of heart failure and other cardiovascular complications such as arrhythmia, risk stratification, follow-up surveillance, use of ATTR disease-modifying therapies, and optimal clinical care settings for patients with this complex multisystem disease.
Collapse
Affiliation(s)
| | - Margot K Davis
- University of British Columbia, Vancouver, British Columbia, Canada.
| | - Kim Anderson
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | - Jane Narayan
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | - Donna Reece
- University of Toronto, Toronto, Ontario, Canada
| | | | - Mustafa Toma
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean A Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | | |
Collapse
|
12
|
Christidi E, Huang H, Shafaattalab S, Maillet A, Lin E, Huang K, Laksman Z, Davis MK, Tibbits GF, Brunham LR. Variation in RARG increases susceptibility to doxorubicin-induced cardiotoxicity in patient specific induced pluripotent stem cell-derived cardiomyocytes. Sci Rep 2020; 10:10363. [PMID: 32587261 PMCID: PMC7316788 DOI: 10.1038/s41598-020-65979-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/11/2020] [Indexed: 01/04/2023] Open
Abstract
Doxorubicin is a potent anticancer drug used to treat a variety of cancer types. However, its use is limited by doxorubicin-induced cardiotoxicity (DIC). A missense variant in the RARG gene (S427L; rs2229774) has been implicated in susceptibility to DIC in a genome wide association study. The goal of this study was to investigate the functional role of this RARG variant in DIC. We used induced pluripotent stem cell derived cardiomyocytes (iPSC-CMs) from patients treated with doxorubicin. iPSC-CMs from individuals who experienced DIC (cases) showed significantly greater sensitivity to doxorubicin compared to iPSC-CMs from doxorubicin-treated individuals who did not develop DIC (controls) in cell viability and optical mapping experiments. Using CRISPR/Cas9, we generated isogenic cell lines that differed only at the RARG locus. Genetic correction of RARG-S427L to wild type resulted in reduced doxorubicin-induced double stranded DNA breaks, reactive oxygen species production, and cell death. Conversely, introduction of RARG-S427L increased susceptibility to doxorubicin. Finally, genetic disruption of the RARG gene resulted in protection from cell death due to doxorubicin treatment. Our findings suggest that the presence of RARG-S427L increases sensitivity to DIC, establishing a direct, causal role for this variant in DIC.
Collapse
Affiliation(s)
- Effimia Christidi
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Haojun Huang
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Sanam Shafaattalab
- Molecular Cardiac Physiology Group, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
- Department of Cardiovascular Science, British Columbia Children's Hospital, Vancouver, Canada
| | | | - Eric Lin
- Molecular Cardiac Physiology Group, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Kate Huang
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Zachary Laksman
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot K Davis
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glen F Tibbits
- Molecular Cardiac Physiology Group, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
- Department of Cardiovascular Science, British Columbia Children's Hospital, Vancouver, Canada
| | - Liam R Brunham
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, Canada.
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
13
|
Kenk M, Grégoire JC, Coté MA, Connelly KA, Davis MK, Dresser G, Ghosh N, Goodman S, Johnson C, Fleshner N. Optimizing screening and management of cardiovascular health in prostate cancer: A review. Can Urol Assoc J 2020; 14:E458-E464. [PMID: 32569573 DOI: 10.5489/cuaj.6685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In clinical practice, cancer management does not consistently encompass screening and identification of cardiovascular (CV) risk. The use of androgen deprivation therapy (ADT) in prostate cancer has been associated with increased CV risk and development of metabolic syndrome, necessitating identification of patients at risk in this population (e.g., those with pre-existing CV disease). A multidisciplinary team of Canadian physicians was assembled to develop a series of recommendations intended to identify patients who may benefit from optimal management of their CV disease and/or modification of cardiac risk factors. A key goal was the development of a simple screening tool for identification of patients with pre-existing CV disease. This simple and inclusive set of recommendations are intended for use within urology clinics to facilitate holistic approaches and simplify the management of patients.
Collapse
Affiliation(s)
- Miran Kenk
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Marc-Andre Coté
- Centre hospitalier universitaire de Quebec, Québec City, QC, Canada
| | - Kim A Connelly
- St. Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Margot K Davis
- University of British Columbia Diamond Health Care Center, Vancouver, BC, Canada
| | - George Dresser
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, ON, Canada
| | - Nina Ghosh
- Queensway Carleton Hospital, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shaun Goodman
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Neil Fleshner
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
14
|
Abstract
OPINION STATEMENT Cardiovascular diseases are a common cause of morbidity and mortality in cancer survivors. Furthermore, some cancer therapies are now being increasingly recognized to have negative cardiovascular effects, or cardiotoxicity. Exercise therapy has been found to improve cardiorespiratory fitness in patients with cancer as well as attenuate the cardiotoxic effects of cancer therapy. It is the centerpiece for cardiac and pulmonary rehabilitation programs. It is also an important component in cardio-oncology rehabilitation. Exercise is generally safe, and its benefit is observed when started as soon as the diagnosis of cancer and throughout cancer survivorship.
Collapse
Affiliation(s)
- Calvin K W Tong
- Division of Cardiology, University of British Columbia, 2775 Laurel St., 9th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Benny Lau
- Division of Cardiology, University of British Columbia, 2775 Laurel St., 9th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Margot K Davis
- Division of Cardiology, University of British Columbia, 2775 Laurel St., 9th Floor, Vancouver, BC, V5Z 1M9, Canada.
| |
Collapse
|
15
|
Davis MK, Villa D, Tsang TS, Starovoytov A, Gelmon K, Virani SA. Effect of Eplerenone on Diastolic Function in Women Receiving Anthracycline-Based Chemotherapy for Breast Cancer. JACC CardioOncol 2019; 1:295-298. [PMID: 34396193 PMCID: PMC8352029 DOI: 10.1016/j.jaccao.2019.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Margot K. Davis
- Gordon & Leslie Diamond Health Care Centre, 2775 Laurel Street, 9th Floor-Cardiology, Vancouver, British Columbia V5Z 1M9, Canada @DktrV
| | | | | | | | | | | |
Collapse
|
16
|
Davis MK, Fine NM. An Urgent Need for Data to Drive Decision Making: Rationale for the Canadian Registry for Amyloidosis Research. Can J Cardiol 2019; 36:447-449. [PMID: 32044152 DOI: 10.1016/j.cjca.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022] Open
Abstract
Recent developments in cardiac amyloidosis have raised awareness of the disease and have advanced diagnostic and treatment strategies. Novel therapies may vastly improve the prognosis of the disease but will be associated with significant costs. Data are needed to inform clinical decisions and to drive resource allocation within the health care system. Many aspects of disease management are unlikely to be addressed by clinical trials and are better suited to nonrandomized cohort studies, but the limited numbers of patients in any single centre present barriers to high-quality observational research. Disease registries offer opportunities to assemble large numbers of patients from multiple institutions for adequately powered observational studies, to recruit patients for randomized clinical trials; to provide real-world effectiveness and safety data, to study cost-effectiveness of novel therapies, and to engage patients in the collection of patient-reported outcome data. Existing amyloidosis registries have limitations. Canada is an ideal setting for a national amyloidosis registry, with ethnic diversity, relatively few academic centres, access to advanced diagnostic and therapeutic options, and a track record of collaboration among institutions. The Canadian Registry for Amyloidosis Research aims to capitalize on this opportunity and provide high-quality data to inform clinical practice and health care policy in Canada and beyond.
Collapse
Affiliation(s)
- Margot K Davis
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Nowell M Fine
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
17
|
Bland KA, Kirkham AA, Bovard J, Shenkier T, Zucker D, McKenzie DC, Davis MK, Gelmon KA, Campbell KL. Effect of Exercise on Taxane Chemotherapy-Induced Peripheral Neuropathy in Women With Breast Cancer: A Randomized Controlled Trial. Clin Breast Cancer 2019; 19:411-422. [PMID: 31601479 DOI: 10.1016/j.clbc.2019.05.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/10/2019] [Accepted: 05/24/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse effect of taxanes. We sought to evaluate the effect of exercise on taxane CIPN in women with breast cancer. PATIENTS AND METHODS Women (n = 27) were randomized to immediate exercise (IE, during taxane chemotherapy) or delayed exercise (DE, after chemotherapy). Supervised aerobic, resistance, and balance training was offered 3 days a week for 8-12 weeks. CIPN symptoms and quality of life were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 and CIPN20 (scored from 0 to 100). The percentage of participants reporting moderate to severe sensory symptoms ('3/4' or '4/4' for CIPN20 sensory items) was also evaluated, along with clinical sensory testing at the lower limb (vibration sense and pinprick). Taxane treatment adherence, including relative dose intensity, was extracted from patient medical records. Assessments occurred at: baseline (before taxane chemotherapy), pre-cycle 4 (before the final taxane cycle), the end of chemotherapy, and follow-up (10-15 weeks after chemotherapy). RESULTS No differences in the EORTC QLQ CIPN20 symptom scores were detected between groups at any time point. At pre-cycle 4, there was a significant difference between groups in patient-reported moderate to severe numbness in the toes or feet (IE: n = 1, 9%, DE: n = 7, 50%, P = .04) and impaired vibration sense in the feet (IE: n = 2, 18%, DE: n = 10, 83%, P < .01). Overall global health status/quality of life was higher in IE compared to DE at the end of chemotherapy (P = .05), yet both groups had worse CIPN20 sensory (Δ24.3 ± 4.6, P < .01) and motor symptom scores (Δ10.5 ± 1.9, P < .01) relative to baseline. By the end of chemotherapy, no differences between groups were found for moderate to severe numbness in the toes or feet (P = 1.0) or impaired vibration sense in the feet (P = .71). More IE participants received ≥ 85% relative dose intensity (IE: n = 12, 100%, DE: n = 10, 67%, P < .05). CONCLUSION Exercise may attenuate CIPN over the course of taxane chemotherapy and possibly improve taxane adherence in women with breast cancer. These findings, as well as whether exercise can attenuate CIPN by the end of taxane chemotherapy, should be confirmed in larger trials.
Collapse
Affiliation(s)
- Kelcey A Bland
- Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Amy A Kirkham
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Joshua Bovard
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | | | - David Zucker
- Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
| | - Donald C McKenzie
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Margot K Davis
- Division of Cardiology, Gordon & Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, Canada
| | | | - Kristin L Campbell
- Rehabilitation Sciences, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
18
|
Zadravec K, Bland KA, Kirkham AA, Bovard J, Shenkier T, Zucker D, Davis MK, McKenzie DC, Gelmon KA, Campbell KL. Adherence And Attendance During Versus After Chemotherapy In Exercise Influence On Taxane Side Effects. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563450.54362.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Bland KA, Kirkham AA, Bovard JM, McKenzie DC, Davis MK, Shenkier T, Gelmon KA, Zucker D, Campbell KL. Effect of Exercise During Versus After Chemotherapy for Breast Cancer on Fatigue and Quality Of Life. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000560503.59726.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
20
|
Abstract
Cardiovascular (CV) disease is a common comorbidity in acute leukemia (AL) patients and can be worsened by the use of anthracyclines. Interruptions and underutilization of CV medications during AL treatments may negatively impact the CV health of these patients. A 30-question electronic survey was distributed to Canadian hematologists who treat adults with AL to determine the frequency, timing and rationale for interruptions in statins, antiplatelets and angiotensin antagonists in patients undergoing intensive chemotherapy. Strategies for mitigating anthracycline cardiotoxicity, methods of establishing baseline CV risk and utilization of clinical pharmacists were also assessed. Results indicate that it is common for AL patients undergoing intensive chemotherapy to require CV medication interruptions. This highlights the need for collaboration between hematology and cardiology healthcare teams and utilization of multidisciplinary healthcare professionals to improve CV care during AL.
Collapse
Affiliation(s)
| | - Katie Lacaria
- Lower Mainland Pharmacy Services, British Columbia, Canada
| | | | - Margot K Davis
- Vancouver General Hospital Cardio-Oncology Program, British Columbia, Canada
| | - David Sanford
- The Leukemia/Bone Marrow Transplant Program of BC, British Columbia, Canada
| |
Collapse
|
21
|
Bertic M, Chue CD, Virani S, Davis MK, Ignaszewski A, Sedlak T. Coronary Vasospasm Following Heart Transplantation: Rapid Progression to Aggressive Cardiac Allograft Vasculopathy. Can J Cardiol 2018; 34:1687.e9-1687.e11. [PMID: 30527163 DOI: 10.1016/j.cjca.2018.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022] Open
Abstract
Coronary artery vasospasm (CVS) has been described in orthotopic heart transplant patients but is rare in the post-transplanted, denervated heart. Severe CVS has been associated with accelerated cardiac allograft vasculopathy (CAV) and allograft rejection. Allograft vasculopathy is the leading cause of decreased long-term survival in orthotopic heart transplant. The prognostic significance and relationship of the presence and severity of CVS with CAV are not well understood. We present a case of severe symptomatic CVS with rapid development of severe CAV. Our case emphasizes the need for close angiographic surveillance and intracoronary imaging for early detection of CAV in the presence of vasospasm.
Collapse
Affiliation(s)
- Mia Bertic
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colin Dominic Chue
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Virani
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot K Davis
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Ignaszewski
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Sedlak
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
22
|
Bland KA, Kirkham AA, Bovard J, Shenkier T, Zucker D, Davis MK, McKenzie DC, Gelmon KA, Campbell KL. Effect of Exercise on Chemotherapy-Induced Peripheral Neuropathy Symptoms in Women with Breast Cancer. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536350.37199.5c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
23
|
Masoudkabir F, Sarrafzadegan N, Gotay C, Ignaszewski A, Krahn AD, Davis MK, Franco C, Mani A. Cardiovascular disease and cancer: Evidence for shared disease pathways and pharmacologic prevention. Atherosclerosis 2017; 263:343-351. [PMID: 28624099 PMCID: PMC6207942 DOI: 10.1016/j.atherosclerosis.2017.06.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/08/2017] [Accepted: 06/01/2017] [Indexed: 12/21/2022]
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of mortality and morbidity worldwide. Strategies to improve their treatment and prevention are global priorities and major focus of World Health Organization's joint prevention programs. Emerging evidence suggests that modifiable risk factors including diet, sedentary lifestyle, obesity and tobacco use are central to the pathogenesis of both diseases and are reflected in common genetic, cellular, and signaling mechanisms. Understanding this important biological overlap is critical and may help identify novel therapeutic and preventative strategies for both disorders. In this review, we will discuss the shared genetic and molecular factors central to CVD and cancer and how the strategies commonly used for the prevention of atherosclerotic vascular disease can be applied to cancer prevention.
Collapse
Affiliation(s)
- Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Cancer Control Research Program, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Andrew Ignaszewski
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot K Davis
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Franco
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arya Mani
- Yale Cardiovascular Genetics Program, Yale Cardiovascular Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
24
|
Yeung DF, Toma M, Davis MK, Ignaszewski A. Ranolazine for Refractory Angina in a Heart Transplant Recipient With Cardiac Allograft Vasculopathy. Am J Transplant 2017; 17:1427-1428. [PMID: 28035732 DOI: 10.1111/ajt.14190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- D F Yeung
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Toma
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - M K Davis
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Ignaszewski
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
25
|
Johnson CB, Davis MK, Law A, Sulpher J. Shared Risk Factors for Cardiovascular Disease and Cancer: Implications for Preventive Health and Clinical Care in Oncology Patients. Can J Cardiol 2016; 32:900-7. [DOI: 10.1016/j.cjca.2016.04.008] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 12/16/2022] Open
|
26
|
Virani SA, Dent S, Brezden-Masley C, Clarke B, Davis MK, Jassal DS, Johnson C, Lemieux J, Paterson I, Sebag IA, Simmons C, Sulpher J, Thain K, Thavendiranathan P, Wentzell JR, Wurtele N, Côté MA, Fine NM, Haddad H, Hayley BD, Hopkins S, Joy AA, Rayson D, Stadnick E, Straatman L. Canadian Cardiovascular Society Guidelines for Evaluation and Management of Cardiovascular Complications of Cancer Therapy. Can J Cardiol 2016; 32:831-41. [DOI: 10.1016/j.cjca.2016.02.078] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 12/30/2022] Open
|
27
|
Davis MK, Virani SA. Routine Prophylactic Cardioprotective Therapy Should Not Be Given to All Recipients of Potentially Cardiotoxic Cancer Chemotherapy. Can J Cardiol 2016; 32:926-30. [PMID: 27245087 DOI: 10.1016/j.cjca.2016.02.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/16/2015] [Revised: 02/15/2016] [Accepted: 02/20/2016] [Indexed: 11/19/2022] Open
Abstract
With growing recognition of the associations between cancer therapy and cardiotoxicity, attention has increasingly focused on the prevention of cancer therapy-related cardiovascular disease. Various strategies for cardioprotection have been proposed, including routine administration of therapies such as inhibitors of the renin-angiotensin-aldosterone system and β-blockers. We argue this approach is unsupported by the evidence and will be associated with a high likelihood of adverse effects. We highlight alternate strategies for managing this emerging issue, which focus on a targeted approach to primary prevention driven by early identification of cardiotoxicity and selective prophylaxis of patients at increased risk for developing cardiotoxicity.
Collapse
Affiliation(s)
- Margot K Davis
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean A Virani
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
28
|
Davis MK, Kale P, Liedtke M, Schrier S, Arai S, Wheeler M, Lafayette R, Coakley T, Witteles RM. Outcomes after heart transplantation for amyloid cardiomyopathy in the modern era. Am J Transplant 2015; 15:650-8. [PMID: 25648766 DOI: 10.1111/ajt.13025] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [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: 07/15/2014] [Revised: 09/10/2014] [Accepted: 09/12/2014] [Indexed: 01/25/2023]
Abstract
We conducted a review of patients undergoing heart transplantation (HT) at our institution for amyloid cardiomyopathy (ACM) between 2008 and 2013. Complete follow-up was available for all patients. Nineteen patients with ACM underwent HT during the study period, accounting for 9.4% of all HT performed at our institution during this period. Amyloid subtype was light chain (AL) in 9 patients and transthyretin (ATTR) in 10 (2 wild-type, 7 familial, 1 unknown). Eight of nine patients with AL amyloidosis began chemotherapy prior to HT, six have resumed chemotherapy since HT, and five have undergone autologous stem cell transplantation. Most recent free light chain levels in AL patients decreased by a median of 85% from peak values. Only one patient developed recurrent graft amyloidosis, occurring at 3.5 years post-HT and asymptomatic. After a median follow-up of 380 days, 17 (89.5%) patients are alive. To our knowledge, this is the largest single-center series reported of ACM patients undergoing HT in the modern era. Our results suggest that acceptable outcomes following HT can be achieved in the short-to-intermediate term and that this is a feasible option for end-stage ACM with careful patient selection and aggressive control of amyloidogenic light chains in AL patients.
Collapse
Affiliation(s)
- M K Davis
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Davis MK, Li D, Wai E, Tyldesley S, Simmons C, Baliski C, McBride ML. Hospital-Related Cardiac Morbidity among Survivors of Breast Cancer: Long-Term Risks and Predictors. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
31
|
Cheung AW, White CW, Davis MK, Freed DH. Short-term mechanical circulatory support for recovery from acute right ventricular failure: clinical outcomes. J Heart Lung Transplant 2014; 33:794-9. [PMID: 24726682 DOI: 10.1016/j.healun.2014.02.028] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [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: 10/25/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Acute right ventricular failure (ARVF) refractory to optimal medical management may require rescue therapy with mechanical circulatory support (MCS). The RV exhibits a greater capacity for rapid recovery than the left ventricle, making devices designed specifically for temporary RV MCS attractive. We report our experience with the Impella Right Direct (RD) and Right Peripheral (RP) temporary ventricular assist devices (Abiomed, Danvers, MA) in patients with ARVF. METHODS We conducted a retrospective cohort study examining the clinical outcomes of consecutive patients supported with the Impella RD or RP at 2 institutions during a 6-year period. RESULTS During the study period, 18 patients (67% men; mean age 57 ± 10 years) received MCS, 15 with the Impella RD and 3 with the Impella RP. Before RV MCS, all patients required intravenous inotropes, 7 (39%) required inhaled nitric oxide, 7 (39%) required intra-aortic balloon counterpulsation, and 2 (11%) had experienced a cardiac arrest. Device implantation resulted in an improvement in cardiac index (2.1 ± 0.1 liters/min/m(2) pre-implant vs 2.6 ± 0.2 liters/min/m(2) post-implant, p = 0.04) and reduced central venous pressure (22 ± 5 vs 15 ± 4 mm Hg, p < 0.01). Fourteen (78%) patients recovered sufficient RV function to facilitate device explanation after 7 days (range, 2-19 days) of support, and 4 (22%) patients died on support after 6 days (range 1-11 days). Survival to 30 days was 72% and to 1 year was 50%. At 1-year follow-up, the mean New York Heart Association functional classification was 1.3 ± 0.5, and only 1 patient demonstrated severe RV dysfunction on echocardiography. CONCLUSIONS Most patients with ARVF rapidly recover sufficient RV function to facilitate device explantation, highlighting an expanding role for minimally invasive temporary RV assist devices optimized for the treatment of recoverable ARVF.
Collapse
Affiliation(s)
- Anson W Cheung
- Division of Cardiac Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher W White
- Division of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Margot K Davis
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren H Freed
- Division of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
32
|
Davis MK, Higgins J, Kaan A, Ignaszewski A, Cheung A. Outcomes of Patients With Acute Right Ventricular Failure in the Era of Mechanical Circulatory Support. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.06.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Abstract
The cardiorenal syndrome (CRS) is a complex clinical syndrome in which dysfunction of either the heart or the kidneys affects the functioning of the other organ system. Many therapies used in heart failure have further detrimental effects on renal function. Cardiac resynchronization therapy (CRT) is a relatively new form of device therapy that reduces morbidity and mortality in patients with heart failure. This review will discuss the effects of CRT on renal function in patients with CRS, the impact of baseline renal function on response to CRT, and potential risks associated with CRT in this unique population.
Collapse
Affiliation(s)
- Margot K. Davis
- Division of Cardiology, Gordon and Leslie Diamond Health Care Centre, The University of British Columbia, Vancouver, BC, Canada V5Z 1M9
| | - Sean A. Virani
- Division of Cardiology, Gordon and Leslie Diamond Health Care Centre, The University of British Columbia, Vancouver, BC, Canada V5Z 1M9
| |
Collapse
|
34
|
Davis MK, Rufo PA, Polyak SF, Weinstein DA. Adalimumab for the treatment of Crohn-like colitis and enteritis in glycogen storage disease type Ib. J Inherit Metab Dis 2008; 31 Suppl 3:505-9. [PMID: 18172743 DOI: 10.1007/s10545-007-0774-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 11/05/2007] [Accepted: 11/12/2007] [Indexed: 12/29/2022]
Abstract
Glycogen storage disease (GSD) type Ib is a congenital disorder of glycogen metabolism that is associated with neutropenia, neutrophil dysfunction, and an inflammatory bowel disease that mimics a Crohn phenotype. Gastrointestinal inflammation in GSD Ib has been successfully treated with 5-aminosalicylic acid and granulocyte colony-stimulating factor (G-CSF). However, therapeutic options for patients not responding to traditional therapies have been limited owing to untoward effects of glucocorticoids and immunomodulators in this metabolic disorder. Adalimumab is a monoclonal antibody targeting tumour necrosis factor-α that has shown promise for the treatment of patients with Crohn disease. Due to the limited options for treating GSD-associated inflammatory bowel disease, use of adalimumab was attempted in a case unresponsive to aminosalicylate, G-CSF, and antibiotic therapy. Significant clinical and histological improvement was observed in our patient, and the medication was well tolerated.
Collapse
Affiliation(s)
- M K Davis
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | | | | |
Collapse
|
35
|
Mulrooney JE, Davis MK, Wagner TL, Ingram RL. Persistence and efficacy of termiticides used in preconstruction treatments to soil in Mississippi. J Econ Entomol 2006; 99:469-75. [PMID: 16686149 DOI: 10.1603/0022-0493-99.2.469] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Laboratory and field studies were conducted to determine the persistence and efficacy of termiticides used as preconstruction treatments against subterranean termites. Bifenthrin (0.067%), chlorpyrifos (0.75%), and imidacloprid (0.05%) ([AI]; wt:wt) were applied to soil beneath a monolithic concrete slab at their minimum labeled rates. Soil samples were taken from three depths (0-2.5, 2.6-7.6, and 7.7-15.2 cm) at six sampling times (0, 3, 6, 9, 12 and 48 mo) from sites in Harrison and Oktibbeha counties in Mississippi. Residue analyses were conducted on the 0-2.5- and 2.6-7.5-cm depths, and bioassays were conducted using all three depths. In field studies, significant termiticide degradation occurred between sampling times 0 and 48 mo for all termiticides. At all sampling times, the top 2.5 cm of soil contained more termiticide than the other depths. Time to 50% dissipation of termiticide in the 0-2.5-cm depth was 9, 6, and 2 mo for bifenthrin, chlorpyrifos, and imidacloprid, respectively. Termite mortalities in contact bioassays remained high for bifenthrin and chlorpyrifos throughout the 48-mo sampling period; however, mortality of termites exposed to imidacloprid-treated soil dropped after the initial sampling. Termites readily penetrated all termiticide-treated soil in bioassays of 52-mm soil cores at 48 mo. Percentage of mortality in these bioassays was 15, 43, and 13 for bifenthrin, chlorpyrifos, and imidacloprid respectively.
Collapse
Affiliation(s)
- J E Mulrooney
- Food Products Insect Research Unit, US Forest Service, 201 Lincoln Green, Starkville, MS 39759, USA
| | | | | | | |
Collapse
|
36
|
de Carmejane O, Morris MD, Davis MK, Stixrude L, Tecklenburg M, Rajachar RM, Kohan DH. Bone chemical structure response to mechanical stress studied by high pressure Raman spectroscopy. Calcif Tissue Int 2005; 76:207-13. [PMID: 15742234 DOI: 10.1007/s00223-004-0168-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2004] [Accepted: 10/07/2004] [Indexed: 11/29/2022]
Abstract
While the biomechanical properties of bone are reasonably well understood at many levels of structural hierarchy, surprisingly little is known about the response of bone to loading at the ultrastructural and crystal lattice levels. In this study, our aim was to examine the response (i.e., rate of change of the vibrational frequency of mineral and matrix bands as a function of applied pressure) of murine cortical bone subjected to hydrostatic compression. We determined the relative response during loading and unloading of mineral vs. matrix, and within the mineral, phosphate vs. carbonate, as well as proteinated vs. deproteinated bone. For all mineral species, shifts to higher wave numbers were observed as pressure increased. However, the change in vibrational frequency with pressure for the more rigid carbonate was less than for phosphate, and caused primarily by movement of ions within the unit cell. Deformation of phosphate on the other hand, results from both ionic movement as well as distortion. Changes in vibrational frequencies of organic species with pressure are greater than for mineral species, and are consistent with changes in protein secondary structures such as alterations in interfibril cross-links and helix pitch. Changes in vibrational frequency with pressure are similar between loading and unloading, implying reversibility, as a result of the inability to permanently move water out of the lattice. The use of high pressure Raman microspectroscopy enables a deeper understanding of the response of tissue to mechanical stress and demonstrates that individual mineral and matrix constituents respond differently to pressure.
Collapse
Affiliation(s)
- O de Carmejane
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Douglas GP, Killam WP, Hochgesang MS, Deula RA, Limbe W, Davis MK. Improving completeness, accuracy & timeliness of HIV voluntary counseling & testing client data in Malawi using touchscreen computers. AMIA Annu Symp Proc 2005; 2005:942. [PMID: 16779229 PMCID: PMC1560701] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A real-time data collection system can mitigate problems of data completeness, accuracy and timeliness often experienced using paper-based data collection and subsequent data entry. The Client Management Information System developed for the Malawi AIDS Counseling and Resource Organization employs touchscreen computers to collect client information during voluntary counseling and testing sessions. A user-friendly interface allows counselors with low levels of computer literacy to electronically capture client data in real-time without compromising the quality of counseling.
Collapse
Affiliation(s)
- G P Douglas
- Center for Biomedical Informatics - University of Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
As part of a smoke alarm giveaway and installation program (The Get-Alarmed Campaign), a total of 454 households were surveyed in two counties in Georgia, one metropolitan and one nonmetropolitan. The targeted communities in these counties had a high prevalence of low-income and minority populations and thus were at high risk of house fire-related morbidity and mortality. The objectives of the program were to determine the prevalence of and predictors for installed, functioning smoke alarms, and to install at least one smoke alarm and/or smoke alarm batteries in 100% of participating homes in need. Characteristics associated with smoke alarm ownership included home ownership, having a higher income, and having a central heating source, factors which should be considered in targeting future intervention strategies. At onset, 159/454 households (35.0%) had no smoke alarms installed and 56/275 households with existing smoke alarms (20.4%) had none that were functional. Regardless of ownership status, a free smoke alarm was installed in the household of 93.8% of participants and new batteries were installed in existing smoke alarms for 31.7% of participants. This project illustrates the usefulness of a door-to-door campaign in increasing smoke alarm ownership in both a rural and a suburban community with a high concentration of residents at high risk of house fire-related morbidity and mortality.
Collapse
Affiliation(s)
- A R Jones
- Clinical Research Center, Morehouse School of Medicine, Atlanta, Georgia 30310-1495, USA
| | | | | |
Collapse
|
39
|
Abstract
PURPOSE To examine how specific health plan practices contribute to physicians' willingness to recommend a health plan to a patient, and whether the relative importance of plan practices is viewed differently when patients are seriously ill. METHODS The Physician's Evaluation of Health Plans Project has surveyed 1,757 generalist physicians in 16 health plans in 5 areas nationwide. Each physician reported on one plan. Three multi-item scales assessed physicians' perceptions of health plan activities that facilitated or impeded high-quality care in the plans and the clinical capabilities of plan physicians. Regression analyses were used to explore relations between facilitators, barriers, and clinical capabilities, and two global physician judgments (the physician's willingness to recommend a plan and their judgment that a plan provided lower quality for sicker patients). RESULTS A physician's willingness to recommend a health plan is more highly related to what plans do to facilitate care than to the barriers created by plans in managing care. However, barriers to care were substantially more important when evaluating health plan quality for sicker patients. CONCLUSIONS From the physician's perspective, the relative importance of plan strategies to manage care is different for typical patients and patients who are more seriously ill. Efforts to collect information on health plan quality should separately evaluate care for sicker patients, in addition to evaluating the overall performance of the health plan.
Collapse
Affiliation(s)
- M A Smith
- Department of Preventive Medicine, University of Wisconsin-Madison Medical School, USA.
| | | | | | | |
Collapse
|
40
|
Abstract
Physicians provide one source of information about the quality of care in health plans, but concerns exist that physicians cannot distinguish quality from financial considerations or other underlying attitudes. We examined whether physicians can (a) distinguish different domains of health plan quality and (b) distinguish health plan quality from their underlying attitudes. We analyzed data on 419 generalist physicians from four health plans. Three scales assessed physicians' perceptions of facilitators and barriers to high-quality care in the plans and the clinical capabilities of plan physicians. Structural equation modeling indicated that physicians could distinguish domains of health plan quality. Physicians could also distinguish plan quality from their attitudes toward the plan, but plan quality was more highly correlated with general managed care attitudes than expected. These data suggest that physicians can provide information about health plan quality, but it will be important to validate these measures against patient outcomes.
Collapse
Affiliation(s)
- M A Smith
- University of Wisconsin-Madison Medical School, USA
| | | | | | | | | | | |
Collapse
|
41
|
Jones AR, Oster RA, Pederson LL, Davis MK, Blumenthal DS. Influence of a rural primary care clerkship on medical students' intentions to practice in a rural community. J Rural Health 2001; 16:155-61. [PMID: 10981367 DOI: 10.1111/j.1748-0361.2000.tb00449.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to examine the relationship of a rural clerkship to medical students' interest in establishing careers in rural communities. The Association of American Medical Colleges Medical School Graduation Questionnaire (GQ) for years 1988 through 1997 was examined to compare the career plans of students graduating from Morehouse School of Medicine (MSM) with those of all students graduating from United States medical schools before the period 1988 through 1992 and after the period 1993 through 1997, after the inception of the rural clerkship at MSM. Select GQ data items examined include student demographics, medical school experiences, and career plans. Statistical analyses were used to compare pre- and post-clerkship responses for MSM students and to compare their responses with the national trends. Results indicate that, following a transition period, MSM students showed an increased preference for a future career in a rural community. A smaller upward trend in the national data was observed. There appears to be an association between the rural clerkship experience at MSM and the stated preferred career choices of the students.
Collapse
Affiliation(s)
- A R Jones
- Morehouse School of Medicine, Atlanta, Ga., USA
| | | | | | | | | |
Collapse
|
42
|
Abstract
A growing body of research suggests that infant feeding practices influence the risk for several chronic diseases of childhood and adolescence. Increased risks for type 1 diabetes, celiac disease, some childhood cancers, and inflammatory bowel disease have been associated with artificial infant feeding and short-term breastfeeding. As genetic susceptibility is understood more completely and gene-environment interactions are elucidated, evidence to either confirm or refute these findings will be forthcoming.
Collapse
Affiliation(s)
- M K Davis
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
43
|
Lipchik GL, Holroyd KA, O'Donnell FJ, Cordingley GE, Waller S, Labus J, Davis MK, French DJ. Exteroceptive suppression periods and pericranial muscle tenderness in chronic tension-type headache: effects of psychopathology, chronicity and disability. Cephalalgia 2000; 20:638-46. [PMID: 11128821 DOI: 10.1111/j.1468-2982.2000.00105.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We examined pericranial muscle tenderness and abnormalities in the second exteroceptive suppression period (ES2) of the temporalis muscle in chronic tension-type headache (CTTH; n = 245) utilizing a blind design and methods to standardize the elicitation and scoring of these variables. No ES2 variable differed significantly between CTTH sufferers and controls (all tests, P>0.05). We found no evidence that CTTH sufferers with daily or near daily headaches, a mood or an anxiety disorder, or high levels of disability exhibit abnormal ES2 responses (all tests, P>0.05). CTTH sufferers were significantly more likely than controls to exhibit pervasive tenderness in pericranial muscles examined with standardized (500 g force) manual palpation (P<0.005). Female CTTH sufferers exhibited higher levels of pericranial muscle tenderness than male CTTH sufferers at the same level of headache activity (P<0.0001). Elevated pericranial muscle tenderness was associated with a comorbid anxiety disorder. These findings provide further evidence of pericranial hyperalgesia in CTTH and suggest this phenomenon deserves further study. Basic research that better elucidates the biological significance of the ES2 response and the factors that influence ES2 assessments appears necessary before this measure can be of use in clinical research.
Collapse
Affiliation(s)
- G L Lipchik
- Ohio University & Headache Treatment & Research, Athens, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Lipchik GL, Holroyd KA, O'donnell FJ, Cordingley GE, Waller S, Labus J, Davis MK, French DJ. Exteroceptive suppression periods and pericranial muscle tenderness in chronic tension-type headache: effects of psychopathology, chronicity and disability. Cephalalgia 2000. [DOI: 10.1046/j.1468-2982.2000.00105.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
45
|
Abstract
To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of outcome measure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study.
Collapse
Affiliation(s)
- D J Martin
- Department of Psychology, Ohio University, USA.
| | | | | |
Collapse
|
46
|
Abstract
Conducted a meta-analytic evaluation of the effectiveness of school-based child abuse prevention programs. Literature searches identified 27 studies meeting inclusion criteria for use in this meta-analysis. The average effect size for all programs studied was 1.07, indicating that children who participated in prevention programs performed 1.07 SD higher than control group children on the outcome measures used in the studies. Analysis of moderator variables revealed significant effects for age, number of sessions, participant involvement, type of outcome measure, and use of behavioral skills training. Most important, programs presented over 4 or more sessions that allowed children to become physically involved produced the highest effect sizes. Although most often used only with younger children, findings suggest that active, long-term programs may be more effective for children of all ages.
Collapse
Affiliation(s)
- M K Davis
- Department of Psychology, Ohio University, Athens 45701, USA
| | | |
Collapse
|
47
|
Unwin BK, Davis MK, De Leeuw JB. Pathologic gambling. Am Fam Physician 2000; 61:741-9. [PMID: 10695586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Pathologic gambling and problem gambling affect approximately 5 to 15 million Americans and are common in young people. The community-minded family physician is in a good position to identify and assist patients who have gambling-related problems and thereby prevent or treat the resultant personal, family and social disruptions. Provider and community education about the depth and breadth of this condition is crucial for the identification and treatment of a growing problem. As with many psychologic conditions, identification of the disorder and treatment of the patient by the family physician comprise the primary treatment. Screening tools, treatment programs and self-help groups provide additional resources for the family physician. An illustrative case report demonstrates the importance of heightened awareness of and screening for this common condition.
Collapse
Affiliation(s)
- B K Unwin
- Department of Family and Community Medicine, Darnall Army Community Hospital, Fort Hood, Texas 76544, USA
| | | | | |
Collapse
|
48
|
Davis MK. Review of the evidence for an association between infant feeding and childhood cancer. Int J Cancer Suppl 1999; 11:29-33. [PMID: 9876474] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
To assess the association between infant feeding and childhood cancer, a qualitative review of 9 published case-control studies was undertaken. The results of this synthesis suggest that children who are never breast-fed or are breast-fed short-term have a higher risk than those breast-fed for > or = 6 months of developing Hodgkin's disease (HD), but not non-Hodgkin's lymphoma or acute lymphoblastic leukemia. HD has features of a complex cellular immune disorder and of chronic infection. Human milk contains an extensive array of anti-microbial activity and appears to stimulate early development of the infant immune system. Artificially fed infants negotiate exposure to infectious agents without the benefits of this immunologic armament and do not do as well as breast-fed infants in resisting infection. Thus, human milk may make the breast-fed infant better able to negotiate future carcinogenic insults by modulating the interaction between infectious agents and the developing infant immune system or by directly affecting the long-term development of the infant immune system. Further research should attempt to confirm the association between infant feeding and HD in large, population-based, case-control studies. Improved measurement of infant feeding must be addressed if future studies are to advance our understanding of this association. In addition, studies of specific measures of immunity, particularly of cellular immune responses, should be conducted in populations of breast-fed and non-breast-fed young children.
Collapse
Affiliation(s)
- M K Davis
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| |
Collapse
|
49
|
Borowsky SJ, Davis MK, Goertz C, Lurie N. Are all health plans created equal? The physician's view. JAMA 1997; 278:917-21. [PMID: 9302244] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT The health care market is demanding increasing amounts of information regarding quality of care in health plans. Physicians are a potentially important but infrequently used source of such information. OBJECTIVE To assess physicians' views on health plan practices that promote or impede delivery of high-quality care in health plans and to compare ratings between plans. SETTING Minneapolis-St Paul, Minn. PARTICIPANTS One hundred physicians in each of 3 health plans. Each physician rated 1 health plan. MAIN OUTCOME MEASURES Likert-type items that assessed health plan practices that promote or impede delivery of high-quality care. RESULTS A total of 249 physicians (84%) completed the survey. Fewer than 20% of all physicians gave plans the highest rating (excellent or strongly agree) for health plan practices that promote delivery of high-quality care (such as providing continuing medical education for physicians, identifying patients needing preventive care, and providing physicians feedback about practice patterns). Barriers to delivering high-quality care related to sufficiency of time to spend with patients, covered benefits and copayment structure, and utilization management practices. Ratings differed across health plans. For example, the percentage of physicians indicating that they would recommend the plan they rated to their own family was 64% for plan 1, 92% for plan 2, and 24% for plan 3 (P<.001 for all comparisons). CONCLUSIONS Physician surveys can highlight strengths and weaknesses in health plans, and their ratings differ across plans. Physician ratings of health plan practices that promote or impede delivery of high-quality care may be useful to consumers and purchasers of health care as a tool to evaluate health plans and promote quality improvement.
Collapse
Affiliation(s)
- S J Borowsky
- Department of Medicine, Minneapolis Veterans Affairs Medical Center, MN 55417, USA
| | | | | | | |
Collapse
|
50
|
Davis MK. A comprehensive weight-loss program for soldiers. Mil Med 1996; 161:84-8. [PMID: 8857219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A weight-loss treatment program for active duty military personnel is discussed and evaluated. The Fat Loss and Exercise Program at U.S. Army Hospital, Bremerhaven, Germany, consisted of a 3-week inpatient treatment program and 6 months of weekly outpatient follow-up. The program combined a multidisciplinary team approach to the treatment of obesity--psychology, internal medicine, nursing, nutrition care, and physical therapy. Patients showed a significant weight and body fat loss [F(2,90) = 52.91 and 65.85, p < 0.001, respectively] from the initiation of treatment (mean = 205.9 pounds, 28.91%) to the end of the inpatient program (mean = 192.8 pounds, 25.97%) with maintenance over 6 months (mean = 190.4 pounds, 25.03%). Changes in cholesterol levels by treatment phase are also discussed. Results demonstrate positive increases in high-density lipoprotein at each phase. These results support a comprehensive, multidisciplinary inpatient treatment of obesity within the military.
Collapse
Affiliation(s)
- M K Davis
- U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD 21010-5422, USA
| |
Collapse
|