Advancing the care of individuals with cancer through innovation & technology: Proceedings from the cardiology oncology innovation summit 2020 and 2021

As cancer therapies increase in effectiveness and patients' life expectancies improve, balancing oncologic efficacy while reducing acute and long-term cardiovascular toxicities has become of paramount importance. To address this pressing need, the Cardiology Oncology Innovation Network (COIN) was formed to bring together domain experts with the overarching goal of collaboratively investigating, applying, and educating widely on various forms of innovation to improve the quality of life and cardiovascular healthcare of patients undergoing and surviving cancer therapies. The COIN mission pillars of innovation, collaboration, and education have been implemented with cross-collaboration among academic institutions, private and public establishments, and industry and technology companies. In this report, we summarize proceedings from the first two annual COIN summits (inaugural in 2020 and subsequent in 2021) including educational sessions on technological innovations for establishing best practices and aligning resources. Herein, we highlight emerging areas for innovation and defining unmet needs to further improve the outcome for cancer patients and survivors of all ages. Additionally, we provide actionable suggestions for advancing innovation, collaboration, and education in cardio-oncology in the digital era.

Factors associated with human papillomavirus and meningococcal vaccination among adolescents living in rural and urban areas

Background

Studies have shown that adolescent vaccination rates with human papillomavirus (HPV) and quadrivalent meningococcal conjugate (MenACWY) vaccines are lower in rural areas of the U.S. than in urban areas. We sought to determine factors associated with vaccine acceptance in these two settings.

Methods

We conducted a cross-sectional survey of 536 parents or guardians of teens age 13 through 15 years in select rural and urban counties of Minnesota and Wisconsin. We collected information on demographic variables, receipt of adolescent vaccines, and attitudes toward HPV vaccine in particular. Multivariable logistic regression models were used to assess associations between covariates and outcomes of interest (HPV vaccine receipt and MenACWY receipt).

Results

Of the 536 respondents, 267 (50%) resided in a rural county. Most respondents were female (78%) and non-Hispanic White (88%). About half (52%) of teens of the surveyed parents received the three vaccines recommended specifically for adolescents: 90% received tetanus-diphtheria-acellular pertussis (Tdap), 84% received MenACWY, and 60% received one or more doses of HPV vaccine. Rural and urban parents surveyed differed on several covariates relating to teen's health services, parent's demographics, and household characteristics. Parent's perception of the importance that their healthcare providers placed on vaccination with HPV and MenACWY were independently associated with receipt of each of those vaccines (odds ratio [OR] 6.37, 95% confidence interval [CI] 2.90-13.96 and OR 2.15, 95% CI 1.07-4.31, respectively). Parents of vaccinated teens were less likely to report concerns about potential harm from the HPV vaccine or having heard stories about health problems caused by the HPV vaccine.

Conclusion

Teen receipt of HPV vaccine and MenACWY appears to be influenced by parents' perception of vaccine importance, provider recommendations, and concerns regarding potential harm from the HPV vaccine. Continued education of providers and parents of the importance of adolescent vaccinations is warranted.

Prevalence and Risk Factors for Sexually Transmitted Infections in Gay and Bisexual Prostate Cancer Survivors: Results From the Restore-2 Study

Background

Equitable cancer survivorship care for gay and bisexual male (GBM) prostate cancer survivors should be responsive to their sexual health needs. Rates of sexually transmitted infections (STIs) are higher among GBM compared to heterosexual men across the lifespan. In addition, evidence suggests that GBM will use a variety of strategies to cope with sexual dysfunction that may increase risk for STIs. The purpose of this study was to determine the prevalence of STIs following prostate cancer treatment among GBM and identify risk factors.

Methods

In 2019, 401 GBM previously treated for prostate cancer were recruited into the Restore-2 Study. They completed a baseline online questionnaire with items assessing STIs diagnosed since being treated for prostate cancer. Any STI diagnoses was regressed on demographic, clinical, and relationship related variables using binary logistic regression.

Results

Forty-five participants (11.4%) were diagnosed with an STI during or following their prostate cancer treatment. The mostly commonly diagnosed STI was syphilis (4.3%), followed by gonorrhoea (2.8%), and chlamydia (2.5%). Four participants were infected with HIV following their prostate cancer treatment. Independent risk factors for STI diagnosis included time since prostate cancer diagnosis (aOR = 1.18; 95% CI: 1.10-1.26), nonmonogamous sexual relationship (aOR = 11.23; 95% CI: 2.11-59.73), better sexual function (aOR = 1.02; 95% CI: 1.01-1.04), penile injection treatment (aOR = 3.28; 95% CI: 1.48-7.29), and multiple sex partners (aOR = 5.57; 95% CI: 1.64-18.96).

Conclusions

GBM prostate cancer survivors are at risk for STIs. Culturally responsive STI prevention should be incorporated into cancer survivorship plans, particularly as men are treated for and regain sexual function over time.

Comorbidity Prevalence and Impact on Quality of Life in Gay and Bisexual Men Following Prostate Cancer Treatment

Introduction

Studies have demonstrated worse health related quality of life (HRQOL) outcomes in gay and bisexual men (GBM) following prostate cancer treatment compared to heterosexual men potentially due to differences in comorbidity burden.

Aim

To establish the prevalence of comorbidities and their association with HRQOL metrics in GBM following prostate cancer treatment.

Methods

We evaluated HRQOL and prevalence of comorbidities in 193 GBM from the United States and Canada in a cross-sectional, online survey: the Masked for Review. HRQOL was measured with the Expanded Prostate Cancer Index Composite (EPIC) and the 12-Item Short Form Health Survey (SF-12).

Main Outcome Measures

Our outcomes included comorbidity prevalence, mean differences for HRQOL scores by comorbidity status, and mean differences for HRQOL by comorbidity count.

Results

GBM were found to have a higher prevalence of blood vessel disease and mental health disorders but lower prevalence of obesity and type 2 diabetes when compared to published data in general prostate cancer populations. Statistically significant reductions in HRQOL metrics were associated with mental health diagnoses, diabetes, and obesity. Increased number of comorbidities was also associated with reductions in HRQOL metrics in nearly all categories.

Conclusion

These results suggest that the worse QOL outcomes in GBM following prostate cancer treatment may be due to differences in comorbidity burden. This study is the first to evaluate the relationship between comorbidities and HRQOL outcomes in GBM. Limitations of this study include a small sample size and cross-sectional study design. If confirmed in larger, longitudinal, clinically confirmed studies, these findings indicate a need to intervene on and consider comorbidities in GBM diagnosed with prostate cancer.

Haggart R, Polter E, Ross M, et al. Comorbidity Prevalence and Impact on Quality of Life in Gay and Bisexual Men Following Prostate Cancer Treatment. Sex Med 2021;9:100439.

The Challenge of Coming Out to Providers by Gay and Bisexual Men With Prostate Cancer: Qualitative Results from the Restore Study

This study investigates the experience of communicating sexual orientation by gay, bisexual and men who have sex with men (GBM) to physicians involved in their prostate cancer care. Methodology consisted of qualitative analysis conducted on 30 in-depth interviews of GBM recruited from a national online cancer support site. Results revealed four key strategies around sexual disclosure. These ranged from explicitly outing themselves to selective or non-disclosure. Disclosures had unpredictable multiple outcomes ranging from increased trust in the patient-physician relationship to seeking alternate treatment. We concluded competent care is achieved when physicians know their patient's sexual orientation, and are trained in them.

The Reliability of Self-Reported Gleason Scores in Studies of Sexual Minority Prostate Cancer Survivors

In two studies, gay, bisexual, and other men who have sex with men prostate cancer survivors report lower Gleason scores than heterosexual prostate cancer survivors, leading some to speculate that men who have sex with men may have more intensive screening than other men. In the largest study of men who have sex with men prostate cancer survivors to date, 23 of 193 (11.9%) men who have sex with men prostate cancer survivors reported low Gleason scores (2-5). We contacted 14 of them, a 61 percent response rate. At second interview, most men clarified that they reported only a partial score rather than the sum score. We conclude the average lower score is not a result of differences in screening but likely measurement error. A revised Gleason item question is provided to overcome this research artifact.

LOWER URINARY TRACT AND BOWEL SYMPTOMS PREDICT QUALITY OF LIFE IN GAY AND BISEXUAL PROSTATE CANCER SURVIVORS

Little is known about disparities in prostate cancer survivorship experienced by gay and bisexual men (GBM). However, early evidence suggests GBM may experience worse urinary and bowel symptoms than heterosexual men. This cross-sectional Internet-based survey describes the prevalence of lower urinary tract (LUTS) and bowel symptoms and their associations with physical and mental health related quality of life (QOL) in GBM treated for prostate cancer. This study enrolled 193 men who identified as gay or bisexual and had received prostate cancer treatment. The Expanded Prostate Cancer Index Composite instrument measured LUTS and bowel symptoms. The MOS SF-12 measured physical and mental QOL. Participants had a mean age of 63.4 years, were 5.6 years past treatment, and were treated with prostatectomy (52%), radiation (19%), or combined or systemic treatment (29%). The most common symptoms were nocturia (77%), urinary frequency (67%), urinary leakage (59%), bowel urgency (45%), bowel frequency (35%), and watery bowel movements (34%). Mean scores were 81.4±19.2 for urinary function, 74.5±20.7 for urinary bother, 88.9±12.1 for bowel function, 84.5±16.3 for bowel bother, 52.5±8.8 for physical QOL, and 46.0±11.4 for mental QOL. In multivariable models adjusted for age, race, treatment type, and time since diagnosis, urinary bother was associated with worse physical QOL (Adjusted Mean Difference (AMD): 0.11, 95%CI: 0.02-0.21), and bowel bother was associated with worse mental QOL (AMD: 0.23, 95%CI: 0.05-0.42). LUTS and bowel symptoms were common. Symptom bother rather than function predicted QOL. Understanding these disparities will help tailor treatments for this underserved population.

Abstract 5309: Dietary magnesium is inversely associated with colorectal cancer risk in the Atherosclerosis Risk in Communities study

Background: Magnesium is a key nutritional mineral required for the regulation of numerous biochemical reactions throughout the body. Main food sources of magnesium include whole grains, nuts, and green vegetables, but more than 50% of Americans do not currently meet their daily recommended magnesium intake. Prior research has shown that those deficient in magnesium have increased susceptibility to oxidative stress and chronic inflammation, leading to endothelial dysfunction and potentially stimulating cancer cell proliferation and invasiveness. Previous epidemiological studies suggested a link between a diet high in magnesium and reduced CRC, especially among women. The American Cancer Society underscores the importance of clarifying the role of dietary magnesium in CRC development overall and by gender. Thus, we prospectively examined the associations between dietary magnesium intake and CRC risk in the ARIC study, overall, and separately in men and women.

Methods: The ARIC study followed 15,792 men and women (45-64 years old at baseline) for cancer occurrence from 1987-2006. Participants received medical examinations and completed questionnaires at 4 visits; food frequency data were collected at Visit I (1987-89) and magnesium intake estimated. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95%CI for CRC associated with dietary magnesium intake in quartiles using two models: Model 1 adjusted for baseline age, race, center, sex, energy intake, BMI, and physical activity. Model 2 included Model 1 covariates as well as intake of alcohol, dietary calcium, dietary fiber, aspirin, CRP levels, and cigarette smoking.

Results: The analytic cohort (n=14,160, 54.5% women, 27.3% black and 72.7% white, 45-64 years at baseline) was followed for a median of 15.4 years; 315 CRC cases were identified. Since only the highest quartile of dietary magnesium intake met US recommendations (>300 mg/day), we examined the highest quartile versus the 3 lowest quartiles combined (reference category). In Model 1, the highest quartile of dietary magnesium was associated with lower CRC risk: HR (95%CI) =0.68 (0.47-0.99). The inverse association between magnesium and CRC persisted in Model 2 (HR=0.70; 95% CI 0.48, 1.02). The association followed a similar trend after stratification by colon and rectal cancer cases (HR(95% CI) =0.72 (0.48-1.08) and HR(95% CI)=0.49 (0.23-1.06), respectively) and by men and women (HR(95% CI)=0.75 (0.42-1.21) and HR(95% CI)=0.63 (0.36-1.12) respectively). There was no interaction of dietary magnesium intake with dietary calcium intake, alcohol consumption use or dietary fiber.

Conclusion: Our findings corroborate an inverse association between higher dietary magnesium intake and CRC risk, with similar associations observed in men and women. Support: NHLBI, NCI, NPCR

Citation Format: Guillaume C. Onyeaghala, Elizabeth Polter, Pamela L. Lutsey, Aaron R. Folsom, Corrine E. Joshu, Elizabeth A. Platz, Anna E. Prizment. Dietary magnesium is inversely associated with colorectal cancer risk in the Atherosclerosis Risk in Communities study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5309. doi:10.1158/1538-7445.AM2017-5309