1
|
Sheshadri A, Elia JR, Garcia G, Abrams G, Adey DB, Lai JC, Sudore RL. Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners. Kidney Med 2024; 6:100779. [PMID: 38419789 PMCID: PMC10900112 DOI: 10.1016/j.xkme.2023.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Rationale & Objective Despite guidelines calling to improve physical activity in older adults, and evidence suggesting that prekidney transplant physical function is highly associated with posttransplant outcomes, only a small percentage of older patients treated with dialysis are engaged in structured exercise. We sought to elucidate barriers and facilitators of exercise among older adults treated with dialysis awaiting transplant and their care partners. Study Design Individual, in-depth, cognitive interviews were conducted separately for patients and care partners through secure web-conferencing. Setting & Participants Twenty-three patients (≥50 years of age, treated with dialysis from the University of San Francisco kidney transplantation clinic, with a short physical performance battery of ≤10) and their care partners. Analytical Approach All audio interviews were transcribed verbatim. Three investigators independently coded data and performed qualitative thematic content. The interview guide was updated iteratively based on the Capability Opportunity Motivation Behavior model. Results Patients' median age was 60 years (57 ± 63.5) and care partners' median ages was 57 years (49.5 ± 65.5). Thirty-nine percent of patients and 78% of care partners were female, 39% of patients and 30% of care partners self-identified as African American, and 47% of dyads were spouse or partner relationships. Major themes for barriers to pretransplant exercise included lack of understanding of an appropriate regimen, physical impairments, dialysis schedules, and safety concerns. Major facilitators included having individualized or structured exercise programs, increasing social support for patients and care partners, and motivation to regain independence or functionality or to promote successful transplantation. Limitations Participants geographically limited to Northern California. Conclusions Although patients and care partners report numerous barriers to pretransplant exercise and activity, they also reported many facilitators. An individualized, structured, home-based exercise program could circumvent many of the reported barriers and allow older patients to improve pretransplant physical function.
Collapse
Affiliation(s)
- Anoop Sheshadri
- Division of Nephrology, Department of Medicine, University of California, San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Jessica R. Elia
- Division of Nephrology, Department of Medicine, University of California, San Francisco
| | - Gabriel Garcia
- Division of Nephrology, Department of Medicine, University of California, San Francisco
| | - Gary Abrams
- University of California Weill Institute for Neurosciences, San Francisco, California
| | - Deborah B. Adey
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Jennifer C. Lai
- Division of Gastroenterology/Hepatology, Department of Medicine, University of California, San Francisco
| | - Rebecca L. Sudore
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California
| |
Collapse
|
2
|
Lee PSY, Freedman RL, Abrams G, Lin X, Bahl RS. Surgically Induced Scleritis Associated With Suture Hypersensitivity Following Strabismus Surgery. J Pediatr Ophthalmol Strabismus 2024; 61:e4-e6. [PMID: 38306237 DOI: 10.3928/01913913-20231214-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
A 67-year-old woman with history of mild suture hyper-sensitivity presented with localized scleritis after strabismus surgery. After infection was ruled out, the patient was prescribed topical and systemic non-steroidal anti-inflammatory drugs and systemic steroids, which led to full clinical resolution. [J Pediatr Ophthalmol Strabismus. 2024;61(1):e4-e6.].
Collapse
|
3
|
Cheung S, Henderson-Sabes J, Mastick J, Abrams G, Snowberg K, Alfaro E, Quinn M, Paul S, Cooper B, Wallhagen M, Conley Y, Levine J, Miaskowski C. Cancer survivors and neurotoxic chemotherapy: hearing loss and tinnitus. BMJ Support Palliat Care 2023; 13:345-353. [PMID: 35896321 PMCID: PMC9880249 DOI: 10.1136/spcare-2022-003684] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/13/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Little is known about hearing loss and tinnitus associated with neurotoxic chemotherapy. Study evaluated for differences in occurrence rates and effects of hearing loss and tinnitus in survivors who received a platinum alone, a taxane alone or a platinum and taxane containing regimen. METHODS Total of 273 survivors with breast, gastrointestinal, gynaecological or lung cancer completed self-report measures of hearing loss and tinnitus and had an audiometric assessment that obtained pure tone air conduction thresholds bilaterally at frequencies of between 0.25 kHz to 16.0 kHz. To adjust for age-related and gender-related changes in hearing, each survivor's audiogram was evaluated using the National Health and Nutrition Examination Survey-modified Occupational Safety and Health Administration standards. Survivor was classified as having hearing loss if at any frequency they scored poorer than the 50th percentile for their age and gender. Survivors were categorised as having tinnitus if they reported that for >10% of their time awake, they were consciously aware of their tinnitus. Differences among the chemotherapy groups were evaluated using parametric and non-parametric tests. RESULTS For most of the demographic and clinical characteristics, no differences were found among the three chemotherapy groups. Occurrence rates for audiogram-confirmed hearing loss ranged from 52.3% to 71.4%. Occurrence rates for tinnitus ranged from 37.1% to 40.0%. No differences were found among the three chemotherapy groups in the occurrence rates or effects of hearing loss and tinnitus. CONCLUSION These findings suggest that regardless of the chemotherapy regimen common mechanistic pathway(s) may underlie these two neurotoxicities.
Collapse
Affiliation(s)
- Steven Cheung
- School of Medicine, UCSF, San Francisco, California, USA
| | | | | | - Gary Abrams
- School of Medicine, UCSF, San Francisco, California, USA
| | | | - Emely Alfaro
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - Marisa Quinn
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - Steven Paul
- School of Nursing, UCSF, San Francisco, California, USA
| | - Bruce Cooper
- School of Nursing, UCSF, San Francisco, California, USA
| | | | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon Levine
- School of Medicine, UCSF, San Francisco, California, USA
| | | |
Collapse
|
4
|
Kryza-Lacombe M, Santiago R, Hwang A, Raptentsetsang S, Maruyama BA, Chen J, Cassar M, Abrams G, Novakovic-Agopian T, Mukherjee P. Resting-State Connectivity Changes After Goal-Oriented Attentional Self-Regulation Training in Veterans With Mild Traumatic Brain Injury: Preliminary Findings from a Randomized Controlled Trial. Neurotrauma Rep 2023; 4:420-432. [PMID: 37405257 PMCID: PMC10316036 DOI: 10.1089/neur.2022.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Mild traumatic brain injury (mTBI) can have lasting consequences on cognitive functioning and well-being. Goal-Oriented Attentional Self-Regulation (GOALS) training has been shown to improve attention and executive functioning, as well as emotional functioning, in veterans with chronic TBI. An ongoing clinical trial (NCT02920788) is further evaluating GOALS training, including underlying neural mechanisms of change. The present study aimed to examine training-induced neuroplasticity by resting-state functional connectivity (rsFC) changes in GOALS versus active control. Veterans with a history of mTBI ≥6 months post-injury (N = 33) were randomly assigned to GOALS (n = 19) or an intensity-matched active control group (Brain Health Education [BHE] training; n = 14). GOALS consists of attention regulation and problem solving applied to individually defined, relevant goals through a combination of group, individual, and home practice sessions. Participants underwent multi-band resting-state functional magnetic resonance imaging at baseline and post-intervention. Exploratory 2 × 2 mixed analyses of variance identified pre-to-post changes in seed-based connectivity for GOALS versus BHE in five significant clusters. GOALS versus BHE demonstrated a significant increase in right lateral pre-frontal cortex connectivity with the right frontal pole and right middle temporal gyrus, as well as increased posterior cingulate connectivity with the pre-central gyrus. Rostral pre-frontal cortex connectivity with the right precuneus and the right frontal pole decreased in GOALS versus BHE. These GOALS-related changes in rsFC point to potential neural mechanisms underlying the intervention. This training-induced neuroplasticity may play a role in improved cognitive and emotional functioning post-GOALS.
Collapse
Affiliation(s)
- Maria Kryza-Lacombe
- Mental Illness Research Education and Clinical Centers, Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Rachel Santiago
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
| | - Anna Hwang
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Sky Raptentsetsang
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Brian A. Maruyama
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
| | - Jerry Chen
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
| | | | - Gary Abrams
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Tatjana Novakovic-Agopian
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Pratik Mukherjee
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
5
|
Khanna P, Oppenheim T, Tu-Chan A, Abrams G, Ganguly K. Measuring Arm and Hand Joint Kinematics to Estimate Impairment During a Functional Reach and Grasp Task after Stroke. Neurorehabil Neural Repair 2023; 37:409-417. [PMID: 37300318 PMCID: PMC10330436 DOI: 10.1177/15459683231179173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Current approaches to characterizing deficits in upper limb movements after stroke typically focus either on changes in a functional measure, for example, how well a patient can complete a task, or changes in impairment, for example, isolated measurements of joint range of motion. However, there can be notable dissociations between static measures of impairment versus those of function. OBJECTIVE We develop a method to measure upper limb joint angles during performance of a functional task and use measurements to characterize joint impairment in the context of a functional task. METHODS We developed a sensorized glove that can precisely measure select finger, hand, and arm joints while participants complete a functional reach-to-grasp task involving manipulation of a sensorized object. RESULTS We first characterized the accuracy and precision of the glove's joint angle measurements. We then measured joint angles in neurologically intact participants (n = 4 participants, 8 limbs) to define the expected distribution of joint angle variation during task execution. These distributions were used to normalize finger, hand, and arm joint angles in stroke participants (n = 6) as they performed the task. We present a participant-specific visualization of functional joint angle variance which illustrated that stroke participants with nearly identical clinical scores exhibited unique patterns of joint angle variation. CONCLUSIONS Overall, measuring individual joint angles in the context of a functional task may inform whether changes in functional scores over recovery or rehabilitation are driven by changes in impairment or the development of compensatory strategies, and provide a quantified path toward personalized rehabilitative therapy.
Collapse
Affiliation(s)
- Preeya Khanna
- Department of Neurology, University of California, San Francisco, USA
| | - Tomas Oppenheim
- Department of Mechanical Engineering, California Maritime Academy, Vallejo, California, USA
| | - Adelyn Tu-Chan
- Department of Neurology, University of California, San Francisco, USA
- Neurology & Rehabilitation Service, San Francisco VA Medical Center, 1700 Owens Street, San Francisco, California, 94158, USA
| | - Gary Abrams
- Department of Neurology, University of California, San Francisco, USA
- Neurology & Rehabilitation Service, San Francisco VA Medical Center, 1700 Owens Street, San Francisco, California, 94158, USA
| | - Karunesh Ganguly
- Department of Neurology, University of California, San Francisco, USA
- Neurology & Rehabilitation Service, San Francisco VA Medical Center, 1700 Owens Street, San Francisco, California, 94158, USA
| |
Collapse
|
6
|
Kornblith E, Schweizer S, Abrams G, Gardner R, Barnes D, Yaffe K, Novakovic-Agopian T. Telehealth delivery of group-format cognitive rehabilitation to older veterans with TBI: a mixed-methods pilot study. Appl Neuropsychol Adult 2023:1-13. [PMID: 37044120 DOI: 10.1080/23279095.2023.2199160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Traumatic brain injury (TBI) is common among Veterans and may interact with aging, increasing risk for negative cognitive, emotional, and functional outcomes. However, no accessible (i.e., in-home) group interventions for TBI targeted to older adults exist. Goal Oriented Attentional Self-Regulation (GOALS) is a manualized, group cognitive rehabilitation training that improves executive function and emotional regulation among Veterans with TBI and healthy older adults. Our objectives were to adapt GOALS for delivery to older Veterans via in-home video telehealth (IVT) and evaluate feasibility and participant-rated acceptability of the telehealth GOALS intervention (TeleGOALS). Six Veterans 69+, with multiple TBIs completed the 10-session intervention in groups of 2. One participant withdrew, and another completed the remaining sessions alone (total n enrolled = 8). Required adaptations were noted; questionnaire responses were quantified; and feedback was analyzed and coded to identify themes. Quantitative and qualitative methods were used to examine feasibility (i.e., recruitment and retention) and participant-rated acceptability. Minimal adaptations were required for IVT delivery. Key themes emerged: (a) the importance of telehealth logistics, (b) facilitators' roles in prioritizing interpersonal connection, and (c) telehealth's capability to create opportunities for community reintegration. Thematic saturation (the point at which feedback from respondents is consistent and no further adaptations are required) was achieved. Participants stated they would likely recommend TeleGOALS to other Veterans. Although further study with a larger, more diverse sample is required, the adapted TeleGOALS intervention appears highly feasible and acceptable for older Veterans with TBI able and willing to participate in a group-format IVT intervention.
Collapse
Affiliation(s)
- Erica Kornblith
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Sara Schweizer
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Gary Abrams
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Raquel Gardner
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Deborah Barnes
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Kristine Yaffe
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Tatjana Novakovic-Agopian
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
| |
Collapse
|
7
|
Mohamed MA, Abrams G, Massa-Buck B, DiBlassio S, El-Dib M, Aly H. Sterile water moisturizer of the skin of extremely low birth weight infants. J Neonatal Perinatal Med 2023; 16:403-409. [PMID: 37718868 DOI: 10.3233/npm-230083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To assess the feasibility of sterile water application to the skin of the extremely low birth weight (ELBW) newborns in the first week of life and examine its effects on their skin integrity and outcomes. DESIGN Pilot randomized controlled trial. SETTING Open-bay, 18 bed Level III NICU in the Eastern United States. PARTICIPANTS Twenty-eight ELBW neonates. Two newborns expired, sixteen newborns remained in the intervention group and twelve newborns in the control group. METHODS ELBW neonates were either assigned to receive frequent sterile water wash to skin or not during care for the first week of life. Using the Neonatal Skin Condition Scale (NSCS), assessments were performed twice a day during the first week. Fluid intake, serum electrolytes, culture proven sepsis and other morbidities, and length of stay (LOS) were compared while controlling for confounding variables using multiple regression analysis. RESULTS There was no difference in the demographic or clinical characteristics between both groups. Sterile water wash application to skin was not associated with differences in skin health indices or fluid intake. However, it was associated with higher median sodium level and with early regression of bilirubin level when compared to controls. CONCLUSION Frequent skin washes with sterile water are feasible and safe. However, they may not be associated with improved skin integrity or fluid intake.
Collapse
Affiliation(s)
- M A Mohamed
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - G Abrams
- Newborn Services, George Washington University Hospital, Children's National Health System, Washington DC, USA
| | - B Massa-Buck
- Newborn Services, George Washington University Hospital, Children's National Health System, Washington DC, USA
| | - S DiBlassio
- Department of Neonatology, Washington Hospital Center, Washington DC, USA
| | - M El-Dib
- Neonatal Neurocritical Care Program, Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - H Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| |
Collapse
|
8
|
Haas ND, Viele C, Paul SM, Abrams G, Smoot B, Melisko M, Levine JD, Miaskowski C, Kober KM. Polymorphisms in Cytokine Receptor and Regulator Genes are Associated with Levels of Exercise in Women Prior to Breast Cancer Surgery. Biol Res Nurs 2023; 25:76-87. [PMID: 36036249 DOI: 10.1177/10998004221120091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Little is known about the genetic characteristics associated with exercise in women undergoing breast cancer surgery. Purpose: In a sample of women who were evaluated prior to breast cancer surgery (n = 310), we evaluated for differences in demographic and clinical characteristics between patients who did and did not exercise on a regular basis and evaluated for associations between polymorphisms in genes for pro- and anti-inflammatory cytokines, their receptors, and their transcriptional regulators. Methods: Patients completed an investigator-developed exercise questionnaire. Based on the recommended level of exercise (≥150 minutes/week), survivors were classified into no exercise (NoEx), less exercise (LessEx), or recommended exercise (RecEx) groups. Candidate gene analyses were done to identify relationships between polymorphisms and exercise group membership (i.e., NoEx vs. RecEx). Only 23.5% of the total sample met the recommendations for regular exercise. Results: Compared to the RecEx group (n = 78), patients in the NoEx group (n = 120) had less education; were less likely to report being White or Asia/Pacific Islander; more likely to report a lower household income; had a higher body mass index (BMI), had a poorer functional status; had a higher comorbidity burden; were more likely to self-report high blood pressure; and were more likely to have received neoadjuvant chemotherapy. Polymorphisms in IFNGR1 and NFKB1 were associated with membership in the NoEx group. Conclusions: While they warrant replication, our findings suggest that variations in cytokine-related genes may play a role in exercise behavior, and that clinicians need to assess for barriers to regular exercise and educate patients on its benefits.
Collapse
Affiliation(s)
- Nadia D Haas
- School of Nursing, 8785University of California, San Francisco, CA, USA
| | - Carol Viele
- School of Nursing, 8785University of California, San Francisco, CA, USA
| | - Steve M Paul
- School of Nursing, 8785University of California, San Francisco, CA, USA
| | - Gary Abrams
- School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Betty Smoot
- School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Michelle Melisko
- School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, 8785University of California, San Francisco, CA, USA.,School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Kord M Kober
- School of Nursing, 8785University of California, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| |
Collapse
|
9
|
Miaskowski C, Mastick J, Paul S, Wallhagen M, Abrams G, Levine JD. Associations among hearing loss, multiple co-occurring symptoms, and quality of life outcomes in cancer survivors. J Cancer Surviv 2023; 17:59-68. [PMID: 36454519 PMCID: PMC9714406 DOI: 10.1007/s11764-022-01301-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Evaluate for differences in demographic and clinical characteristics, occurrence of common symptoms, symptom severity scores, and quality of life (QOL) outcomes in survivors with (n = 155) and without (n = 118) audiometrically confirmed hearing loss. METHODS Survivors, who were recruited from throughout the San Francisco Bay area, completed the self-report questionnaires to obtain the information of demographic and clinical characteristics; the occurrence and severity of depression, anxiety, fatigue, decrements in energy, sleep disturbance, pain, and cognitive impairment; and the general and cancer-specific QOL outcomes. Parametric and non-parametric tests were used to evaluate for differences between the two survivor groups. RESULTS Survivors with audiometrically confirmed hearing loss were older, more likely to be male, were more likely to be unemployed, report a lower annual household income, and had a higher comorbidity burden. Except for the severity of worst pain, no between-group differences were found in the occurrence rates for or severity of any of the symptoms. Survivors with hearing loss reported worse physical function and general health scores. CONCLUSIONS While no between-group differences in symptom occurrence rates and severity scores were found, across the total sample, a relatively high percentage of survivors who were over 6 years from their cancer diagnosis reported clinically meaningful levels of depression (25%), anxiety (50%), fatigue (40%), decrements in energy (70%), sleep disturbance (58%), cognitive impairment (57%), and pain (60%). IMPLICATIONS FOR CANCER SURVIVORS Clinicians need to perform routine assessments of hearing loss, as well as common co-occurring symptoms and initiate individualized symptom management interventions.
Collapse
Affiliation(s)
- Christine Miaskowski
- School of Medicine, University of California, San Francisco, CA, USA.
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA.
| | - Judy Mastick
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Steven Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Margaret Wallhagen
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
10
|
Miaskowski C, Levine JD, Paul SM, Cooper B, Abrams G, Topp K, Cheung S, Henderson-Sabes J, Conley YP, Snowberg K, Alfaro E, Quinn M, Kober KM. Similarities in the Neuropathy Phenotype of Cancer Survivors Who Received Different Classes of Chemotherapy Drugs. J Pain 2022; 23:1604-1615. [PMID: 35533976 DOI: 10.1016/j.jpain.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
With the advent of platinum and taxane compounds used as single agents or in combination regimens, survival rates for some of the most common cancers have improved substantially. However, information on differences in the chemotherapy-induced peripheral neuropathy (CIPN) phenotype among single and combination regimens is limited. Study's purposes were to evaluate for differences in demographic and clinical characteristics; subjective and objective measures of CIPN; as well as the severity of common symptoms and quality of life among survivors who received platinum- (n = 95), taxane- (n = 200), or platinum and taxane-containing (n = 131) regimens. Patients completed self-report questionnaires (ie, duration of CIPN, pain intensity, pain qualities, pain interference) and underwent a physical examination that evaluated light touch, pain, and cold sensations and balance. For most of the subjective and objective measures of CIPN, as well as symptom severity and quality of life scores, no differences were found among the 3 chemotherapy groups. In all 3 chemotherapy treatment groups, CIPN was a painful, small fiber, and length dependent neuropathy. These findings support the hypothesis that CIPN induced by different classes of chemotherapy, as single agents or in combination, produce a similar CIPN phenotype which raises the possibility that CIPN induced by diverse chemotherapy protocols has the same underlying mechanism. PERSPECTIVE: In this study, that compared patients who received only platinum, only taxane, or both platinum and taxane containing regimens, no differences were found among the 3 groups in the CIPN phenotype. Findings raise the possibility that CIPN induced by diverse chemotherapy protocols has the same underlying mechanism.
Collapse
Affiliation(s)
- Christine Miaskowski
- School of Medicine, University of California, San Francisco, California; School of Nursing, University of California, San Francisco, California.
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, California
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California
| | - Kimberly Topp
- School of Medicine, University of California, San Francisco, California
| | - Steven Cheung
- School of Medicine, University of California, San Francisco, California
| | | | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karin Snowberg
- School of Nursing, University of California, San Francisco, California
| | - Emely Alfaro
- Adult Infusion Services, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Marisa Quinn
- Adult Infusion Services, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California
| |
Collapse
|
11
|
Smoot BJ, Mastick J, Shepherd J, Paul SM, Kober KM, Cooper BA, Conley YP, Dixit N, Hammer MJ, Fu MR, Abrams G, Miaskowski C. Use of Dual-Energy X-Ray Absorptiometry to Assess Soft Tissue Composition in Breast Cancer Survivors With and Without Lymphedema. Lymphat Res Biol 2022; 20:391-397. [PMID: 34793255 PMCID: PMC9422781 DOI: 10.1089/lrb.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In patients with lymphedema (LE), in addition to hand dominance, between-group comparisons of interlimb soft tissue differences need to account for differences in whole-body adiposity, measured directly by dual energy X-ray absorptiometry (DXA) or indirectly by body mass index. No study has evaluated the effects of hand dominance and whole-body adiposity on limb composition in patients with LE. This study's purpose was to compare soft tissue composition of affected and unaffected limbs of women with breast cancer, who did and did not have LE, controlling for dominance and percent body fat. Methods and Results: Whole-body DXA scans were acquired and included measures of percent body fat, upper limb total mass, upper limb fat mass, and upper limb fat-free mass. Participants were classified into one of three groups: women without LE; women with only subjective LE; and women with objective signs of LE at the time of assessment. Differences among the LE groups were evaluated using analysis of variance (ANOVA) and Chi-square analyses. Analysis of covariance (ANCOVA) was used to control for percent body fat and for the affected limb dominance. Compared to women without LE, women with objective signs of LE have greater total limb mass, fat mass, and fat-free mass in their affected limbs, independent of affected side dominance and percent body fat. In addition, the interlimb differences in total mass, fat mass, and fat-free mass were greater for the women with objective signs of LE, compared to the other two groups. Conclusions: DXA is useful in identifying soft tissue changes in patients with LE. Given that limb circumferences measure only changes in limb volume and that bioimpedance provides estimates of extracellular fluid, DXA has the advantage of being able to estimate the volumes of specific tissues in the limb.
Collapse
Affiliation(s)
- Betty J. Smoot
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - John Shepherd
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Steven M. Paul
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Kord M. Kober
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce A. Cooper
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Niharika Dixit
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Mei R. Fu
- School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Gary Abrams
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Medicine, University of California San Francisco, San Francisco, California, USA
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
12
|
Guest JM, Malbin B, Abrams G, Parendo A, Das S, Okeagu C, Ross BX, Kumar A, Lin X. Accuracy of intravitreal injection volume for aflibercept pre-filled syringe and BD Luer-Lok one-milliliter syringe. Int J Retina Vitreous 2022; 8:27. [PMID: 35382900 PMCID: PMC8981608 DOI: 10.1186/s40942-022-00375-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the accuracy of intravitreal injection volume of the pre-filled syringe (PFS) in which aflibercept is packaged compared to the BD Luer-Lok 1-mL syringe. Methods Ophthalmologists injected their typical intravitreal volume for aflibercept using either the PFS or BD Luer-Lok 1-mL syringe for 5 times each. The injected fluid was weighed using a micro-scale and converted to volume. The volume of fluid injected was also evaluated when the 0.05 mL line on the PFS was lined up to the tip or base of the dome-shaped plunger. Results Injection volume was measured for 12 physicians. The average injected fluid volume was 74.22 ± 15.87 µL for PFS and 53.42 ± 4.61 µL for the BD Luer-Lok 1-mL syringe (p < 0.0001). The average deviation in volume injected for the PFS was higher compared to the BD Luer-Lok 1-mL syringe (11.36 µL vs. 3.35 µL, p < 0.0001). When the PFS was lined up with the tip of the dome-shaped plunger at the 0.05-mL line, the average injected volume was 71.03% higher. Conclusions The intravitreal injection volume and variability using the new PFS were significantly higher than the volume injected using the BD Luer-Lok 1-mL syringe previously used, potentially leading to higher rates of visually significant elevation of intraocular pressures.
Collapse
|
13
|
Chan RJ, Cooper B, Koczwara B, Chan A, Tan CJ, Gordon L, Paul SM, Dunn LB, Conley YP, Kober KM, Abrams G, Levine JD, Miaskowski C. Characteristics associated with inter-individual variability in financial distress in patients with breast cancer prior to and for 12 months following surgery. Support Care Cancer 2021; 30:1293-1302. [PMID: 34477973 DOI: 10.1007/s00520-021-06524-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate for inter-individual differences in financial distress and identify demographic, clinical, and symptom characteristics associated with higher levels of financial distress. METHODS Patients (n = 387) were enrolled prior to breast cancer surgery and followed for 12 months. Financial distress was measured using a 0 (no problem) to 10 (severe problem) numeric rating scale. Hierarchical linear modeling was used to evaluate for inter-individual differences in trajectories of financial distress and characteristics associated with financial distress at enrollment and over 12 months. RESULTS Patients' mean age was 55.0 (± 11.7) years and the majority underwent breast conservation surgery (80.6%). Mean financial distress score prior to surgery was 3.3 (± 3.4; range 0 to 10). Unconditional model for financial distress demonstrated no significant changes over time (-0.006/month). Younger age, lower income, receipt of an axillary lymph node dissection and adjuvant chemotherapy, and lower attentional function were associated with higher preoperative levels of financial distress. CONCLUSION Risk factors identified in this study can be used to inform clinicians regarding the need to initiate financial discussions and social work referrals for some patients. Additional clinical or system level interventions should be considered for vulnerable groups with these risk factors.
Collapse
Affiliation(s)
- Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA5042, Australia.
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia.
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, QLD, Australia.
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Flinders University, Bedford Park, Australia
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, USA
| | - Chia Jie Tan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
- Department of Pharmacy, National Cancer Centre, Singapore, Singapore
| | - Louisa Gordon
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
14
|
Maruyama BA, Abrams G, Kornblith E, Posecion LF, McQuaid JR, Neylan TC, Groberio J, Chen AJW, Novakovic-Agopian T. Improvement in executive functioning after Goal-Oriented Attentional Self-Regulation training is associated with reduction in PTSD hyperarousal symptoms among veterans with comorbid PTSD and mild TBI. Appl Neuropsychol Adult 2021:1-9. [PMID: 34410839 DOI: 10.1080/23279095.2021.1960531] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Goal-Oriented Attentional Self-Regulation (GOALS) is a cognitive rehabilitation training program that combines mindfulness-based attention regulation with individualized goal management strategies to improve functioning in daily life after traumatic brain injury (TBI). While not a specific target of GOALS training, previous research has indicated improvements in emotional functioning following GOALS training, specifically symptoms related to depression and posttraumatic stress disorder (PTSD). The current study is based on the hypothesis that improvements in cognitive control processes related to executive functioning and attention after GOALS training generalize to improvements in emotional functioning, thereby resulting in reductions in emotional distress. The current study analyzed archival data from 33 Veteran participants with a confirmed diagnosis of PTSD and a history of mild TBI who received either GOALS training or a psychoeducational intervention matched for time, therapist attention, and participation format. Regression analysis was used to assess the strength of the relationship between improvements in Overall Attention/Executive Functioning and decreases in hyperarousal symptoms associated with PTSD. Results from the regression analysis revealed that improvements in Overall Attention/Executive Functioning after GOALS was significantly associated with reductions in hyperarousal symptoms associated with PTSD (R2 = 0.26, F(1,15) = 5.01, β = -.51, p < .05). The current findings suggest that cognitive improvements after GOALS training may lead to changes in emotional functioning, resulting in decreased emotional distress. This is important, particularly in VA settings, because the results potentially highlight additional areas of research and focus on the treatment of comorbid mild TBI and PTSD among Veterans.
Collapse
Affiliation(s)
- Brian A Maruyama
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Gary Abrams
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Erica Kornblith
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Lainie F Posecion
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA
| | - John R McQuaid
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Thomas C Neylan
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Jessica Groberio
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Anthony J-W Chen
- University of California, San Francisco, CA, USA.,Department of Veterans Affairs, VA Northern California Health Care System, Martinez, CA, USA
| | - Tatjana Novakovic-Agopian
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| |
Collapse
|
15
|
Patel V, Syeda S, Zeiter J, Nassiri N, Kim C, Truhan A, Chapman C, Adam C, Parendo A, Savage M, Abrams G. Randomized, Comparative Study of Full- and Half-Dose Fluorescein Angiography. Journal of VitreoRetinal Diseases 2021; 5:337-344. [PMID: 37007600 PMCID: PMC9976241 DOI: 10.1177/2474126420975310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This study determines whether fluorescein angiography (FA) with a 250-mg dose of fluorescein (half dose) is equal in quality to the standard 500-mg dose of fluorescein (full dose) when using digital ultra-widefield (UWF) technology. Methods: In a randomized, prospective study using a UWF imaging system, FAs performed with half dose were compared with angiograms performed with full dose. Imaging studies were reviewed by 4 reviewers based on 6 characteristics: dye transit, macrovasculature, macula detail, microvasculature, leakage, and overall quality. The scores for macrovasculature, macula detail, microvasculature, and overall quality were converted to a fuzzy rating score to confirm results. Results: Seventy-nine FAs from 67 patients were reviewed for this study, including 12 patients who had both half-dose and full-dose FAs. Of all the factors studied, only microvasculature received a significantly different score between full dose and half dose that was confirmed by the fuzzy rating scale (3.79 vs 3.53; P = .04). Among those eyes that received both full and half dose, there was no significant difference in any of the 6 factors. Conclusions: In a UWF imaging system, aside from looking at fine microvascular abnormalities, the 250-mg dose of fluorescein provided similar results to a 500-mg dose. The images were not significantly different in overall quality.
Collapse
Affiliation(s)
- Vaama Patel
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Sarah Syeda
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - John Zeiter
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nariman Nassiri
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Chaesik Kim
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Alan Truhan
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christopher Chapman
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christopher Adam
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Anthony Parendo
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mack Savage
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gary Abrams
- Department of Ophthalmology, Visual and Anatomic Sciences and the Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
16
|
Abstract
PURPOSE To investigate the choroidal thickness (CT) and choroidal area (CA) in patients with unilateral commotio retinae of the macula using spectral domain optical coherence tomography with enhanced-depth imaging. METHODS This is a retrospective review of 16 eyes of 8 consecutive patients with unilateral macular commotio retinae within 7 days of blunt ocular trauma that underwent optical coherence tomography with enhanced-depth imaging seen at our institution. The contralateral, nontraumatized eye served as the control group. All patients underwent spectral domain optical coherence tomography imaging with enhanced-depth imaging protocol. Using the electronic caliper within the Zeiss optical coherence tomography review software, CT was measured from the outer portion of the retinal pigment epithelium band to the inner surface of the sclera. The central horizontal and vertical rasters were averaged to calculate the final CT measurement of each eye. The final CA reading of each eye was obtained by averaging the central 1,500 μm2 of subfoveal CA using the same rasters. The researchers compared the CT, CA, and best-corrected visual acuity in traumatized eyes with macular commotio with their fellow nontraumatized control eyes. RESULTS Traumatized eyes with macular commotio retinae had greater subfoveal CT and CA (P = 0.0027, P = 0.0279) compared with the normal fellow eye. An increase in CT and CA in the subfoveal area in the presence of commotio retinae was associated with worse visual acuity (P = 0.0180). CONCLUSION Subfoveal CT and CA were greater in eyes with commotio retinae when compared with normal fellow eyes. Increased CT and CA in macular commotio retinae were associated with decreased visual acuity.
Collapse
Affiliation(s)
- Marie Burke
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
| | - Philip Lieu
- W. K. Kellogg Eye Center, Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan; and
| | - Gary Abrams
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
| | - Joseph Boss
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
- Cleveland Clinic Foundation, Cole Eye Institute, Department of Ophthalmology, Cleveland, Ohio
| |
Collapse
|
17
|
Barnes DE, Lee JA, Chesney MA, Yaffe K, Abrams G, Nicosia FM, Martinez S, Ordonez C, Woo M, Boscardin WJ, Mehling W. Preventing loss of independence through exercise (PLIÉ) for persons with dementia: A randomized, controlled trial. Alzheimers Dement 2020. [DOI: 10.1002/alz.042345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Deborah E Barnes
- University of California, San Francisco San Francisco CA USA
- San Francisco VA Health Care System San Francisco CA USA
| | - Jennifer Ann Lee
- University of California, San Francisco San Francisco CA USA
- San Francisco VA Health Care System San Francisco CA USA
| | - Margaret A Chesney
- University of California, San Francisco San Francisco CA USA
- San Francisco VA Health Care System San Francisco CA USA
| | - Kristine Yaffe
- University of California, San Francisco San Francisco CA USA
- San Francisco VA Health Care System San Francisco CA USA
| | - Gary Abrams
- University of California, San Francisco San Francisco CA USA
- San Francisco VA Health Care System San Francisco CA USA
| | - Francesca M Nicosia
- University of California, San Francisco San Francisco CA USA
- San Francisco VA Health Care System San Francisco CA USA
| | - Steven Martinez
- University of California, San Francisco San Francisco CA USA
- San Francisco VA Health Care System San Francisco CA USA
| | | | | | - W John Boscardin
- University of California, San Francisco San Francisco CA USA
- San Francisco VA Health Care System San Francisco CA USA
| | - Wolf Mehling
- University of California, San Francisco San Francisco CA USA
- San Francisco VA Health Care System San Francisco CA USA
| |
Collapse
|
18
|
Novakovic-Agopian T, Posecion L, Kornblith E, Abrams G, McQuaid JR, Neylan TC, Burciaga J, Joseph J, Carlin G, Groberio J, Maruyama B, Chen AJW. Goal-Oriented Attention Self-Regulation Training Improves Executive Functioning in Veterans with Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury. J Neurotrauma 2020; 38:582-592. [PMID: 33019861 DOI: 10.1089/neu.2019.6806] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Difficulties in executive-control functions are common sequelae of both traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The goal of this study was to assess whether a cognitive rehabilitation training that was applied successfully in civilian and military TBI would be effective for military Veterans with comorbid PTSD and mild TBI (mTBI). In the previous study, Veterans with a history of mild to severe TBI improved significantly after goal-oriented attentional self-regulation (GOALS) training on measures of attention/executive function, functional task performance, and emotional regulation. The objective of this study was to assess effects of GOALS training in Veterans with comorbid PTSD and mTBI. Forty Veterans with a current PTSD diagnosis and history of mTBI (6+ months post) were randomized to either five weeks of GOALS or Brain-Health Education (BHE) training matched in time and intensity. Evaluator-blinded assessments at baseline and post-training included neuropsychological and complex functional task performance, and self-report measures of emotional functioning/regulation. After GOALS but not BHE training, participants significantly improved from baseline on primary outcome measures of: overall complex attention/executive function neuropsychological performance composite (F = 12.35, p = 0.001; Cohen d = 0.48), and overall mood disturbance -POMS emotional regulation self-report (F = 4.29, p = 0.05, Cohen d = 0.41). In addition, GOALS but not BHE participants indicated a significant decrease in PTSD symptoms (PCL-M Total Score) (F = 4.80, p = 0.05, Cohen d = 0.60), and demonstrated improvement on complex functional task performance-GPS Learning and Memory (F = 5.06, p = 0.05, Cohen d = 0.56]. Training in attentional self-regulation applied to participant-defined goals may improve cognitive functioning in Veterans with comorbid PTSD and mTBI. Improving cognitive control functioning may also improve functioning in other domains such as emotional regulation and functional performance, potentially making it particularly relevant for Veterans with a history of mTBI and comorbid psychiatric symptoms.
Collapse
Affiliation(s)
- Tatjana Novakovic-Agopian
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA.,VA Northern California Health Care System, Martinez, California, USA
| | - Lainie Posecion
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Erica Kornblith
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - Gary Abrams
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - John R McQuaid
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - Thomas C Neylan
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - Joaquin Burciaga
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Jeremy Joseph
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - Gerald Carlin
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Jessica Groberio
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Brian Maruyama
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Anthony J W Chen
- University of California, San Francisco, San Francisco, California, USA.,VA Northern California Health Care System, Martinez, California, USA
| |
Collapse
|
19
|
Wilcoxon A, Kober KM, Viele C, Topp K, Smoot B, Abrams G, Chesney M, Paul SM, Conley YP, Levine JD, Miaskowski C. Association Between Physical Activity Levels and Chemotherapy-Induced Peripheral Neuropathy Severity in Cancer Survivors. Oncol Nurs Forum 2020; 47:703-719. [PMID: 33063789 DOI: 10.1188/20.onf.703-719] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate for differences in demographic and clinical characteristics, as well as subjective and objective measures of chemotherapy-induced peripheral neuropathy (CIPN), among different exercise groups. SAMPLE & SETTING Cancer survivors (N = 290) were recruited from throughout the San Francisco Bay Area. METHODS & VARIABLES Based on the recommended 150 minutes or more of exercise per week, survivors were classified into the no exercise (NoEx), less exercise (LessEx), or recommended exercise (RecEx) group. Survivors completed self-report questionnaires and underwent sensory and balance testing. RESULTS Compared to the RecEx group, survivors in the NoEx group had less education, were less likely to be married/partnered, had a lower household income, had a higher level of comorbidity, and had poorer functional status. No differences were found among the groups in CIPN duration; pain intensity scores; or changes in light touch, cold, and pain sensations. IMPLICATIONS FOR NURSING Clinicians can recommend walking as a therapeutic option for survivors with CIPN and refer them to physical therapy.
Collapse
|
20
|
Pennington DL, Bielenberg J, Lasher B, Herbst E, Abrams G, Novakovic-Agopian T, Batki SL. A randomized pilot trial of topiramate for alcohol use disorder in veterans with traumatic brain injury: Effects on alcohol use, cognition, and post-concussive symptoms. Drug Alcohol Depend 2020; 214:108149. [PMID: 32712569 PMCID: PMC8370467 DOI: 10.1016/j.drugalcdep.2020.108149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/09/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Topiramate is an effective treatment for alcohol use disorder (AUD) and has also been used in the care of mild traumatic brain injury (mTBI). This pilot study aimed to obtain a preliminary assessment of topiramate's efficacy in reducing alcohol use and post-concussive symptoms, and its potential negative impact on cognitive function in 32 Veterans with co-occurring AUD and mTBI. METHODS This was a prospective 12-week, randomized, double-blind, placebo-controlled pilot study of flexible-dose topiramate or placebo. Primary outcome was reduction of drinking days per week within the topiramate arm. Secondary outcomes included between group comparisons of alcohol use and craving, post-concussive symptoms, and cognitive function. RESULTS Drinking days per week significantly decreased within both the topiramate and placebo arm. There were no significant treatment-by-week interactions on alcohol use/craving, or post-concussive symptoms in intent-to-treat analyses. In per-protocol analyses, topiramate significantly reduced number of drinks per week compared with placebo. Topiramate transiently impaired verbal fluency and working memory. Processing speed, cognitive inhibition, and mental flexibility significantly improved between weeks 1 and 12, regardless of treatment arm. CONCLUSIONS Significant improvement occurred in both the topiramate and placebo groups over 12 weeks of treatment in alcohol use and post-concussive symptoms. Among treatment completers there was greater reduction of alcohol use in the topiramate arm. Topiramate was also associated with negative but transient effects on cognitive function. Results suggest both a possible benefit for topiramate treatment in reducing alcohol use and some potential for negative cognitive effects in Veterans with AUD and mTBI.
Collapse
Affiliation(s)
- David L Pennington
- University of California, San Francisco, Department of Psychiatry, 4150 Clement St., San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System (SFVAHCS), 4150 Clement St., San Francisco, CA, USA; Northern California Institute for Research and Education (NCIRE), 4150 Clement St., San Francisco, CA, USA.
| | - Jennifer Bielenberg
- San Francisco Veterans Affairs Health Care System (SFVAHCS), 4150 Clement St., San Francisco, CA, USA; Northern California Institute for Research and Education (NCIRE), 4150 Clement St., San Francisco, CA, USA
| | - Brooke Lasher
- San Francisco Veterans Affairs Health Care System (SFVAHCS), 4150 Clement St., San Francisco, CA, USA; Northern California Institute for Research and Education (NCIRE), 4150 Clement St., San Francisco, CA, USA
| | - Ellen Herbst
- University of California, San Francisco, Department of Psychiatry, 4150 Clement St., San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System (SFVAHCS), 4150 Clement St., San Francisco, CA, USA; Northern California Institute for Research and Education (NCIRE), 4150 Clement St., San Francisco, CA, USA
| | - Gary Abrams
- San Francisco Veterans Affairs Health Care System (SFVAHCS), 4150 Clement St., San Francisco, CA, USA
| | - Tatjana Novakovic-Agopian
- University of California, San Francisco, Department of Psychiatry, 4150 Clement St., San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System (SFVAHCS), 4150 Clement St., San Francisco, CA, USA; Northern California Institute for Research and Education (NCIRE), 4150 Clement St., San Francisco, CA, USA
| | - Steven L Batki
- University of California, San Francisco, Department of Psychiatry, 4150 Clement St., San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System (SFVAHCS), 4150 Clement St., San Francisco, CA, USA; Northern California Institute for Research and Education (NCIRE), 4150 Clement St., San Francisco, CA, USA
| |
Collapse
|
21
|
Eton EA, Abrams G, Khan NW, Fahim AT. Autoimmune retinopathy associated with monoclonal gammopathy of undetermined significance: a case report. BMC Ophthalmol 2020; 20:153. [PMID: 32299429 PMCID: PMC7160953 DOI: 10.1186/s12886-020-01423-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 04/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background Monoclonal gammopathy of undetermined significance (MGUS) is a plasma cell dyscrasia and precursor to multiple myeloma. It has known ocular manifestations, but has not previously been shown to have an association with autoimmune retinopathy. Case presentation A 57 year-old female presented with 1 year of progressive, bilateral, peripheral vision loss, photopsias, and nyctalopia. Her fundus examination and extensive ancillary testing were concerning for hereditary versus autoimmune retinopathy. The patient was found to have anti-retinal antibodies against carbonic anhydrase II and enolase proteins with a negative genetic retinal dystrophy panel. Malignancy work-up was negative, but the patient was diagnosed with MGUS, a premalignant condition. The patient was treated with immunosuppressive therapies, with rituximab demonstrating the most robust therapeutic response with respect to patient symptoms and ophthalmic testing. Conclusions MGUS should be considered as a potential etiology of autoimmune retinopathy in patients without other autoimmune or malignant disease processes. Immunosuppressive therapy may be helpful in limiting disease progression, with rituximab showing efficacy in retinopathy refractory to other agents.
Collapse
Affiliation(s)
- Emily A Eton
- Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA.
| | - Gary Abrams
- Kresge Eye Institute, Wayne State University, 4717 St. Antoine, Detroit, MI, 48201, USA
| | - Naheed W Khan
- Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Abigail T Fahim
- Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| |
Collapse
|
22
|
Kober KM, Lee MC, Olshen A, Conley YP, Sirota M, Keiser M, Hammer MJ, Abrams G, Schumacher M, Levine JD, Miaskowski C. Differential methylation and expression of genes in the hypoxia-inducible factor 1 signaling pathway are associated with paclitaxel-induced peripheral neuropathy in breast cancer survivors and with preclinical models of chemotherapy-induced neuropathic pain. Mol Pain 2020; 16:1744806920936502. [PMID: 32586194 PMCID: PMC7322824 DOI: 10.1177/1744806920936502] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Paclitaxel is an important chemotherapeutic agent for the treatment of breast cancer. Paclitaxel-induced peripheral neuropathy (PIPN) is a major dose-limiting toxicity that can persist into survivorship. While not all survivors develop PIPN, for those who do, it has a substantial negative impact on their functional status and quality of life. No interventions are available to treat PIPN. In our previous studies, we identified that the HIF-1 signaling pathway (H1SP) was perturbed between breast cancer survivors with and without PIPN. Preclinical studies suggest that the H1SP is involved in the development of bortezomib-induced and diabetic peripheral neuropathy, and sciatic nerve injury. The purpose of this study was to identify H1SP genes that have both differential methylation and differential gene expression between breast cancer survivors with and without PIPN. METHODS A multi-staged integrated analysis was performed. In peripheral blood, methylation was assayed using microarray and gene expression was assayed using RNA-seq. Candidate genes in the H1SP having both differentially methylation and differential expression were identified between survivors who received paclitaxel and did (n = 25) and did not (n = 25) develop PIPN. Then, candidate genes were evaluated for differential methylation and differential expression in public data sets of preclinical models of PIPN and sciatic nerve injury. RESULTS Eight candidate genes were identified as both differential methylation and differential expression in survivors. Of the eight homologs identified, one was found to be differential expression in both PIPN and "normal" mice dorsal root ganglia; three were differential methylation in sciatic nerve injury versus sham rats in both pre-frontal cortex and T-cells; and two were differential methylation in sciatic nerve injury versus sham rats in the pre-frontal cortex. CONCLUSIONS This study is the first to evaluate for methylation in cancer survivors with chronic PIPN. The findings provide evidence that the expression of H1SP genes associated with chronic PIPN in cancer survivors may be regulated by epigenetic mechanisms and suggests genes for validation as potential therapeutic targets.
Collapse
Affiliation(s)
- Kord M Kober
- School of Nursing, University of
California, San Francisco, CA, USA
- Helen Diller Family Comprehensive
Cancer Center, University of California, San Francisco, CA, USA
- Bakar Computational Health Sciences
Institute, University of California, San Francisco, CA, USA
| | - Man-Cheung Lee
- School of Medicine, University of
California, San Francisco, CA, USA
| | - Adam Olshen
- Helen Diller Family Comprehensive
Cancer Center, University of California, San Francisco, CA, USA
- Department of Epidemiology and
Biostatistics, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing,
University
of Pittsburgh, Pittsburgh, PA, USA
| | - Marina Sirota
- Bakar Computational Health Sciences
Institute, University of California, San Francisco, CA, USA
- School of Medicine, University of
California, San Francisco, CA, USA
| | - Michael Keiser
- Bakar Computational Health Sciences
Institute, University of California, San Francisco, CA, USA
- School of Medicine, University of
California, San Francisco, CA, USA
- Institute for Neurodegenerative
Diseases, University of California, San Francisco, CA, USA
| | - Marilyn J Hammer
- Phyllis F. Cantor Center,
Dana-Farber Cancer Institute, Boston, MA, USA
| | - Gary Abrams
- School of Medicine, University of
California, San Francisco, CA, USA
| | - Mark Schumacher
- School of Medicine, University of
California, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of
California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of
California, San Francisco, CA, USA
- Helen Diller Family Comprehensive
Cancer Center, University of California, San Francisco, CA, USA
| |
Collapse
|
23
|
Novakovic-Agopian T, Abrams G, Kornblith E, Posecion L. Long Term Outcomes of Executive Function Training in Veterans with PTSD and mild TBI. Arch Phys Med Rehabil 2019. [DOI: 10.1016/j.apmr.2019.08.050] [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: 11/24/2022]
|
24
|
Kornblith E, Posecion L, Abrams G, Chen AJW, Burciaga J, D'Esposito M, Novakovic-Agopian T. Long-Term Effect of Cognitive Rehabilitation Regardless of Prerehabilitation Cognitive Status for Veterans with TBI. Appl Neuropsychol Adult 2019; 28:436-448. [PMID: 31456428 DOI: 10.1080/23279095.2019.1652174] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Persisting difficulties in executive functioning (EF) are common after traumatic brain injury (TBI). Cognitive rehabilitation can be effective, but the impact of pretreatment neurocognitive functioning on long term effects of rehabilitation is unknown. Because this information can impact treatment planning, we examined the relationship between prerehabilitation neurocognitive status and long-term effects of EF training. Archival data were drawn from a trial of Goal-Oriented Attentional Self-Regulation group-format EF training for Veterans with TBI [mild-severe; 11 years postinjury; 96% male, 32% nonwhite, 14.21 years education (SD 1.72), 41.13 years old (SD 11.39)]. Using prerehabilitation neurocognitive performance, participants were clustered into cognitive difficulty (CD) and cognitively normal (CN) groups. Six-plus months after EF rehabilitation training, participants completed a structured telephone interview and/or in-person cognitive/functional/emotional assessment using standardized measures of cognitive, daily, and emotional functioning frequently employed in TBI research. At 6+ months post-EF training compared to prerehabilitation, CD and CN improved in multiple cognitive (Overall Attention/EF: F(1,18) = 26.17, partial η2 = .59; Total Memory: F(1,18) = 6.82, partial η2 = .28) and functional domains (Goal Processing Scale [GPS] total score: F(1,15) = 6.71, partial η2 = .31). CD improved more than CN on Learning and Memory functional domain [F(1,15) = 6.10, partial η2 = .29]. Results of our small archival analysis raise the possibility that Veterans with chronic TBI may demonstrate long-term effects of EF training.
Collapse
Affiliation(s)
- Erica Kornblith
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Lainie Posecion
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Gary Abrams
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Anthony J-W Chen
- University of California, San Francisco, CA, USA.,Rehabilitation, Veterans Affairs Northern California Health Care System, Martinez, CA, USA.,University of California, Berkeley: Berkeley, CA
| | - Joaquin Burciaga
- University of California, Berkeley: Berkeley, CA.,Children's Health Council, Palo Alto, CA, USA
| | - Mark D'Esposito
- Children's Health Council, Palo Alto, CA, USA.,Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - Tatjana Novakovic-Agopian
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| |
Collapse
|
25
|
Novakovic-Agopian T, Kornblith E, Abrams G, McQuaid JR, Posecion L, Burciaga J, D'Esposito M, Chen AJW. Long-term effects of executive function training among veterans with chronic TBI. Brain Inj 2019; 33:1513-1521. [PMID: 31423838 DOI: 10.1080/02699052.2019.1645357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: To investigate long-term effects of GOALS executive function training in Veterans with chronic TBI. In a recently completed study Veterans with chronic TBI showed improvement immediately post-GOALS but not control training on measures of executive function, functional task performance, and emotion regulation. We now examine the long-term maintenance of post-GOALS training changes in the same sample. Setting: San Francisco VA Health Care System (SFVAHCS), and VA Northern California Health-Care System (VANCHS) in Martinez. Participants and Design: 24 Veterans with chronic TBI were assessed at baseline, post-GOALS training, and long-term follow-up 6+ months following completion of training with a structured telephone interview, neuropsychological and complex functional performance measures, and self-report measures of daily and emotional functioning. Results: Participants reported an increased likelihood of involvement in competitive employment/volunteering at follow-up (61%) compared to baseline (26%; χ2 = 5.66, p < .01, ѱ = .35). Repeated measures MANOVAS indicated improvement on attention/executive function (F = 13.85, p < .01, partial η2 = .42), complex functional task performance (GPS Total: F = 9.12, p < .01, partial η2 = .38) and daily functioning (MPAI Total: F = 3.23, p < .05, partial η2 = .21), and reduction in overall mood disturbance (POMS Total: F = 3.42, p < .05, partial η2 = .22) at follow-up relative to baseline. Discussion: Training in attention regulation applied to participant-defined goals is associated with meaningful long-term improvement in cognitive skills, emotion regulation, and daily functioning in Veterans with chronic TBI.
Collapse
Affiliation(s)
- Tatjana Novakovic-Agopian
- Mental Health Service, San Francisco VA Health Care System , San Francisco , California , USA.,Department of Psychiatry, University of California , San Francisco , California , USA.,Neurology Service, Veteran's Administration Northern California Health Care System , Martinez , California , USA
| | - Erica Kornblith
- Mental Health Service, San Francisco VA Health Care System , San Francisco , California , USA
| | - Gary Abrams
- Neurology Service, San Francisco VA Health Care System , San Francisco , California , USA.,Department of Neurology, University of California , San Francisco , California , USA
| | - John R McQuaid
- Mental Health Service, San Francisco VA Health Care System , San Francisco , California , USA.,Department of Psychiatry, University of California , San Francisco , California , USA
| | - Lainie Posecion
- Mental Health Service, San Francisco VA Health Care System , San Francisco , California , USA
| | - Joaquin Burciaga
- Mental Health Service, San Francisco VA Health Care System , San Francisco , California , USA
| | - Mark D'Esposito
- Neurology Service, Veteran's Administration Northern California Health Care System , Martinez , California , USA.,Helen Wills Neuroscience Institute, University of California , Berkeley , USA
| | - Anthony J W Chen
- Neurology Service, Veteran's Administration Northern California Health Care System , Martinez , California , USA.,Neurology Service, San Francisco VA Health Care System , San Francisco , California , USA.,Helen Wills Neuroscience Institute, University of California , Berkeley , USA
| |
Collapse
|
26
|
Petrovchich I, Kober KM, Wagner L, Paul SM, Abrams G, Chesney MA, Topp K, Smoot B, Schumacher M, Conley YP, Hammer M, Levine JD, Miaskowski C. Deleterious Effects of Higher Body Mass Index on Subjective and Objective Measures of Chemotherapy-Induced Peripheral Neuropathy in Cancer Survivors. J Pain Symptom Manage 2019; 58:252-263. [PMID: 31047960 PMCID: PMC6679783 DOI: 10.1016/j.jpainsymman.2019.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/28/2022]
Abstract
CONTEXT Recent, albeit, limited evidence suggests that body mass index (BMI) may be a modifiable risk factor to reduce the deleterious effects of chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors. OBJECTIVES To evaluate for differences in demographic, clinical, pain, sensation, and balance characteristics among three BMI groups. We hypothesized that as BMI increased, survivors would report higher pain intensity scores and have significant decrements in measures of sensation and balance. METHODS A total of 416 survivors with CIPN were evaluated using subjective and objective measures of CIPN. Survivors were divided into three BMI groups (i.e., normal weight, overweight, and obese). Differences among the BMI groups were evaluated using parametric and nonparametric statistics. RESULTS Of the 416 survivors, 45.4% were normal weight, 32.5% were overweight, and 22.1% were obese. Compared with the normal-weight group, survivors in the other two groups had lower functional status scores, a higher comorbidity burden, higher pain intensity scores, and higher interference scores. In addition, compared with the normal-weight group, survivors in the other two BMI groups had significantly worse balance scores. CONCLUSION Our findings support the hypothesis that as BMI increased, pain sensation and balance characteristics worsened. Our findings suggest that nutritional counseling as well as exercise and weight management programs in survivors with CIPN may improve these clinically important problems.
Collapse
Affiliation(s)
- Iva Petrovchich
- School of Nursing, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Laura Wagner
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California, USA
| | - Margaret A Chesney
- School of Medicine, University of California, San Francisco, California, USA
| | - Kimberly Topp
- School of Medicine, University of California, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, California, USA
| | - Mark Schumacher
- School of Medicine, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | | |
Collapse
|
27
|
Wong ML, Cooper BA, Paul SM, Abrams G, Topp K, Kober KM, Chesney MA, Mazor M, Schumacher MA, Conley YP, Levine JD, Miaskowski C. Age-related differences in patient-reported and objective measures of chemotherapy-induced peripheral neuropathy among cancer survivors. Support Care Cancer 2019; 27:3905-3912. [PMID: 30770977 DOI: 10.1007/s00520-019-04695-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/07/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE While older adults with cancer are more likely to develop chemotherapy-induced peripheral neuropathy (CIPN), the study aimed to determine if patient-reported and objective measures of CIPN differ by age among cancer survivors. METHODS Cancer survivors with persistent CIPN after completion of platinum and/or taxane chemotherapy completed CIPN questionnaires (severity, interference with activities, sensory, and motor symptoms) and objective testing (light touch, vibration, pain, cold sensation). CIPN measures were compared by age group (< 65 n = 260 versus ≥ 65 n = 165) using parametric and nonparametric tests. RESULTS Among 425 cancer survivors with CIPN, mean age was 60.9 (SD 10.5). CIPN location did not differ by age (overall 68% hands and feet, 27% only feet, 5% only hands). For patient-reported measures, older survivors reported less severe pain in the hands and feet than younger survivors. In addition, older survivors reported lower interference with general activity, routine activities, normal work, enjoyment of life, sleep, mood, relations with other people, and sexual activity. No age differences in sensory and motor symptom scores were found. In contrast, for objective measures, older survivors had worse light touch and cold sensations in their feet and worse vibration detection in their hands and feet. CONCLUSIONS Despite having worse light touch, cold, and vibration sensations, older cancer survivors with CIPN reported less severe pain and interference with activities. This discordance highlights the importance of including both patient-reported and objective measures to assess CIPN in cancer survivors to better evaluate this clinical condition.
Collapse
Affiliation(s)
- Melisa L Wong
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA, 94115, USA.
| | - Bruce A Cooper
- School of Nursing Office of Research, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Steven M Paul
- School of Nursing Office of Research, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Gary Abrams
- Department of Neurology, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Kimberly Topp
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Kord M Kober
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Margaret A Chesney
- Osher Center for Integrative Medicine, University of California, San Francisco, 1545 Divisadero Street, San Francisco, CA, 94143, USA
| | - Melissa Mazor
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Mark A Schumacher
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Jon D Levine
- Department of Oral and Maxillofacial Surgery, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| |
Collapse
|
28
|
Baria AM, Pangarkar S, Abrams G, Miaskowski C. Adaption of the Biopsychosocial Model of Chronic Noncancer Pain in Veterans. Pain Med 2019; 20:14-27. [PMID: 29727005 DOI: 10.1093/pm/pny058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Population Veterans with chronic noncancer pain (CNCP) are a vulnerable population whose care remains a challenge for clinicians, policy-makers, and researchers. As a result of military experience, veterans are exposed to high rates of musculoskeletal injuries, trauma, psychological stressors (e.g., post-traumatic stress disorder, depression, anxiety, substance abuse), and social factors (e.g., homelessness, social isolation, disability, decreased access to medical care) that contribute to the magnitude and impact of CNCP. In the veteran population, sound theoretical models are needed to understand the specific physiological, psychological, and social factors that influence this unique experience. Objective This paper describes an adaption of Gatchel and colleagues' biopsychosocial model of CNCP to veterans and summarizes research findings that support each component of the revised model. The paper concludes with a discussion of important implications for the use of this revised model in clinical practice and future directions for research. Conclusions The adaption of the biopsychosocial model of CNCP for veterans provides a useful and relevant conceptual framework that can be used to guide future research and improve clinical care in this vulnerable population.
Collapse
Affiliation(s)
- Ariel M Baria
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,School of Nursing
| | - Sanjog Pangarkar
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, San Francisco, California
| | | |
Collapse
|
29
|
Kober KM, Mazor M, Abrams G, Olshen A, Conley YP, Hammer M, Schumacher M, Chesney M, Smoot B, Mastick J, Paul SM, Levine JD, Miaskowski C. Phenotypic Characterization of Paclitaxel-Induced Peripheral Neuropathy in Cancer Survivors. J Pain Symptom Manage 2018; 56:908-919.e3. [PMID: 30172061 PMCID: PMC6289693 DOI: 10.1016/j.jpainsymman.2018.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
Abstract
CONTEXT Although paclitaxel is one of the most commonly used drugs to treat breast, ovarian, and lung cancers, little is known about the impact of paclitaxel-induced peripheral neuropathy (PIPN) on cancer survivors. OBJECTIVES The purposes of this study were to evaluate for differences in demographic and clinical characteristics as well as measures of sensation, balance, upper extremity function, perceived stress, symptom burden, and quality of life (QOL) between survivors who received paclitaxel and did (n = 153) and did not (n = 58) develop PIPN. METHODS Pain characteristics associated with PIPN are described in detail. Both subjective and objective measures were used to evaluate the impact of PIPN. RESULTS Survivors with PIPN were significantly older, had a higher body mass index, and a worse comorbidity profile. The duration of PIPN was almost four years, and pain scores were in the moderate range. Compared with survivors without PIPN, survivors with PIPN had a higher number of upper and lower extremity sites that had lost light touch, cold, and pain sensations. Survivors with PIPN had worse upper extremity function, more problems with balance, a higher symptom burden, and higher levels of perceived stress. In addition, survivors with PIPN had worse QOL scores particularly in the domain of physical functioning. CONCLUSION The findings from this large descriptive study are the first to document the impact of PIPN on survivors' symptom burden, functional status, and QOL.
Collapse
Affiliation(s)
- Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA.
| | - Melissa Mazor
- School of Nursing, University of California, San Francisco, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California, USA
| | - Adam Olshen
- School of Medicine, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Mark Schumacher
- School of Medicine, University of California, San Francisco, California, USA
| | - Margaret Chesney
- School of Medicine, University of California, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | | |
Collapse
|
30
|
Barnes D, Chesney M, Duffy J, Yaffe K, Abrams G, Whitmer R, Mehling W. PREVENTING LOSS OF INDEPENDENCE THROUGH EXERCISE (PLIÉ) AND PAIRED PLIÉ: RESULTS TO DATE. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Barnes
- University of California, San Francisco, and San Francisco VA Health Care System
| | - M Chesney
- University of California, San Francisco
| | - J Duffy
- Kaiser Permanente Northern California
| | - K Yaffe
- University of California, San Francisco
| | - G Abrams
- University of California, San Francisco, and San Francisco VA Health Care System
| | | | - W Mehling
- University of California, San Francisco
| |
Collapse
|
31
|
Kornblith E, Abrams G, Burciaga J, Posecion L, Novakovic-Agopian T. Baseline Neurocognitive Status And Long Term Effects Of Executive Function Training Among Veterans With TBI. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.08.088] [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: 11/27/2022]
|
32
|
Kornblith E, Abrams G, Chen AJW, Burciaga J, D’Esposito M, Novakovic-Agopian T. Impact of baseline neurocognitive functioning on outcomes following rehabilitation of executive function training for veterans with history of traumatic brain injury. Applied Neuropsychology: Adult 2018; 27:108-120. [DOI: 10.1080/23279095.2018.1490738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Gary Abrams
- Neurology Service, SFVA Medical Center, University of California, San Francisco, California, USA
| | - Anthony J.-W. Chen
- VA Northern California Health Care System, University of California, San Francisco, CA, USA
| | | | - Mark D’Esposito
- University of California Berkeley, Helen Wills Neuroscience Institute, Berkeley CA, USA
| | | |
Collapse
|
33
|
Novakovic-Agopian T, Kornblith E, Abrams G, Burciaga-Rosales J, Loya F, D'Esposito M, Chen AJW. Training in Goal-Oriented Attention Self-Regulation Improves Executive Functioning in Veterans with Chronic Traumatic Brain Injury. J Neurotrauma 2018; 35:2784-2795. [PMID: 29717652 DOI: 10.1089/neu.2017.5529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Deficits in executive control functions are some of the most common and disabling consequences of both military and civilian brain injury. However, effective interventions are scant. The goal of this study was to assess whether cognitive rehabilitation training that was successfully applied in chronic civilian brain injury would be effective for military veterans with traumatic brain injury (TBI). In a prior study, participants with chronic acquired brain injury significantly improved after training in Goal-Oriented Attentional Self-Regulation (GOALS) on measures of attention/executive function, functional task performance, and goal-directed control over neural processing on functional magnetic resonance imaging. The objective of this study was to assess effects of GOALS training in veterans with chronic TBI. A total of 33 veterans with chronic TBI and executive difficulties in their daily life completed either 5 weeks of manualized GOALS training or Brain-Health Education (BHE) matched by time and intensity. Evaluator-blinded assessments at baseline and post-training included neuropsychological and complex functional task performance and self-report measures of emotional regulation. After GOALS, but not BHE training, participants significantly improved from baseline on primary outcome measures of Overall Complex Attention/Executive Function composite neuropsychological performance score (F = 7.10, p = 0.01; partial η2 = 0.19), and on overall complex functional task performance (Goal Processing Scale Overall Performance; F = 6.92, p = 0.01, partial η2 = 0.20). Additionally, post-GOALS participants indicated significant improvement on emotional regulation self-report measures (Profile of Mood States Confusion Score; F = 6.05, p = 0.02, partialη2 = 0.20). Training in attentional self-regulation applied to participant-defined goals may improve cognitive functioning in veterans with chronic TBI. Attention regulation training may not only impact executive control functioning in real-world complex tasks, but also may improve emotional regulation and functioning. Implications for treatment of veterans with TBI are discussed.
Collapse
Affiliation(s)
- Tatjana Novakovic-Agopian
- 1 Veterans Administration Medical Center , San Francisco, California.,2 University of California , San Francisco, California.,3 Veterans Administration Northern California Health Care System , Martinez, California
| | - Erica Kornblith
- 1 Veterans Administration Medical Center , San Francisco, California
| | - Gary Abrams
- 1 Veterans Administration Medical Center , San Francisco, California.,2 University of California , San Francisco, California
| | | | - Fred Loya
- 3 Veterans Administration Northern California Health Care System , Martinez, California
| | - Mark D'Esposito
- 3 Veterans Administration Northern California Health Care System , Martinez, California.,4 University of California , Berkeley, California
| | - Anthony J W Chen
- 2 University of California , San Francisco, California.,3 Veterans Administration Northern California Health Care System , Martinez, California.,4 University of California , Berkeley, California
| |
Collapse
|
34
|
Barnes DE, Chesney MA, Whitmer RA, Yaffe K, Duffy JD, Abrams G, Mehling W. O3‐07‐04: PREVENTING LOSS OF INDEPENDENCE THROUGH EXERCISE (PLIÉ) AND PAIRED PLIÉ: INTEGRATIVE GROUP MOVEMENT PROGRAMS FOR PERSONS WITH DEMENTIA AND CAREGIVERS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Deborah E. Barnes
- San Francisco VA Health Care SystemSan FranciscoCAUSA
- University of California, San FranciscoSan FranciscoCAUSA
| | - Margaret A. Chesney
- San Francisco VA Health Care SystemSan FranciscoCAUSA
- University of California, San FranciscoSan FranciscoCAUSA
| | - Rachel A. Whitmer
- University of California, San FranciscoSan FranciscoCAUSA
- Kaiser Permanente Division of ResearchOaklandCAUSA
| | - Kristine Yaffe
- San Francisco VA Health Care SystemSan FranciscoCAUSA
- University of California, San FranciscoSan FranciscoCAUSA
| | | | - Gary Abrams
- San Francisco VA Health Care SystemSan FranciscoCAUSA
- University of California, San FranciscoSan FranciscoCAUSA
| | - Wolf Mehling
- San Francisco VA Health Care SystemSan FranciscoCAUSA
- University of California, San FranciscoSan FranciscoCAUSA
| |
Collapse
|
35
|
Miaskowski C, Paul SM, Mastick J, Abrams G, Topp K, Smoot B, Kober KM, Chesney M, Mazor M, Mausisa G, Schumacher M, Conley YP, Sabes JH, Cheung S, Wallhagen M, Levine JD. Associations Between Perceived Stress and Chemotherapy-Induced Peripheral Neuropathy and Otoxicity in Adult Cancer Survivors. J Pain Symptom Manage 2018; 56. [PMID: 29524582 PMCID: PMC6015523 DOI: 10.1016/j.jpainsymman.2018.02.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
CONTEXT The most common adverse effects from neurotoxic chemotherapy are chemotherapy-induced neuropathy (CIPN), hearing loss, and tinnitus. Although associations between perceived stress and persistent pain, hearing loss, and tinnitus are documented, no studies have examined these associations in cancer survivors who received neurotoxic chemotherapy. OBJECTIVES In this cross-sectional study, we evaluated for associations between perceived stress and the occurrence of CIPN, hearing loss, and tinnitus, in 623 adult cancer survivors who received platinum and/or taxane compounds. METHODS Survivors completed self-report measures of hearing loss, tinnitus, and perceived stress (i.e., Impact of Events Scale-Revised [IES-R]). Separate logistic regression analyses were done for each neurotoxicity to evaluate whether each of the IES-R subscale (i.e., intrusion, avoidance, hyperarousal) and total scores made a significant independent contribution to neurotoxicity group membership. RESULTS Of the 623 survivors in this study, 68.4% had CIPN, 34.5% reported hearing loss, and 31.0% reported tinnitus. Older age, higher body mass index, poorer functional status, being born prematurely, cancer diagnosis, and higher intrusion (P = 0.013), hyperarousal (P = 0.014), and total (P = 0.047) IES-R scores were associated with CIPN. Older age, being male, poorer functional status, a worse comorbidity profile, and a higher IES-R hyperarousal (P = 0.007) score were associated with hearing loss. Being male, having less education, a worse comorbidity profile, and a higher IES-R hyperarousal (P = 0.029) score were associated with tinnitus. CONCLUSION These findings suggest that increased levels of perceived stress are associated with the most common chemotherapy-induced neurotoxicities.
Collapse
Affiliation(s)
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California, USA
| | - Kimberly Topp
- School of Medicine, University of California, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Margaret Chesney
- School of Medicine, University of California, San Francisco, California, USA
| | - Melissa Mazor
- School of Nursing, University of California, San Francisco, California, USA
| | - Grace Mausisa
- School of Nursing, University of California, San Francisco, California, USA
| | - Mark Schumacher
- School of Medicine, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Steven Cheung
- School of Medicine, University of California, San Francisco, California, USA
| | - Margaret Wallhagen
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA; School of Dentistry, University of California, San Francisco, California, USA
| |
Collapse
|
36
|
Miaskowski C, Mastick J, Paul SM, Abrams G, Cheung S, Sabes JH, Kober KM, Schumacher M, Conley YP, Topp K, Smoot B, Mausisa G, Mazor M, Wallhagen M, Levine JD. Impact of chemotherapy-induced neurotoxicities on adult cancer survivors' symptom burden and quality of life. J Cancer Surviv 2017; 12:234-245. [PMID: 29159795 DOI: 10.1007/s11764-017-0662-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/24/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE Limited information is available on the impact of chemotherapy (CTX)-induced neurotoxicity on adult survivors' symptom experience and quality of life (QOL). Purposes were to describe occurrence of hearing loss and tinnitus and evaluate for differences in phenotypic characteristics and measures of sensation, balance, perceived stress, symptom burden, and QOL between survivors who received neurotoxic CTX and did (i.e., neurotoxicity group) and did not (i.e., no neurotoxicity group) develop neurotoxicity. Neurotoxicity was defined as the presence of chemotherapy-induced neuropathy (CIN), hearing loss, and tinnitus. Survivors in the no neurotoxicity group had none of these conditions. METHODS Survivors (n = 609) completed questionnaires that evaluated hearing loss, tinnitus, stress, symptoms, and QOL. Objective measures of sensation and balance were evaluated. RESULTS Of the 609 survivors evaluated, 68.6% did and 31.4% did not have CIN. Of the survivors without CIN, 42.4% reported either hearing loss and/or tinnitus and 48.1% of the survivors with CIN reported some form of ototoxicity. Compared to the no neurotoxicity group (n = 110), survivors in the neurotoxicity group (n = 85) were older, were less likely to be employed, had a higher comorbidity burden, and a higher symptom burden, higher levels of perceived stress, and poorer QOL (all p < .05). CONCLUSIONS Findings suggest that CIN, hearing loss, and tinnitus are relatively common conditions in survivors who received neurotoxic CTX. IMPLICATIONS FOR CANCER SURVIVORS Survivors need to be evaluated for these neurotoxicities and receive appropriate interventions. Referrals to audiologists and physical therapists are warranted to improve survivors' hearing ability, functional status, and QOL.
Collapse
Affiliation(s)
- Christine Miaskowski
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA.
| | - Judy Mastick
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Steven M Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Gary Abrams
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Steven Cheung
- Schools of Medicine, University of California, San Francisco, CA, USA
| | | | - Kord M Kober
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Mark Schumacher
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kimberly Topp
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Betty Smoot
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Grace Mausisa
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Melissa Mazor
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Margaret Wallhagen
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Jon D Levine
- Schools of Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
37
|
Tu-Chan AP, Natraj N, Godlove J, Abrams G, Ganguly K. Effects of somatosensory electrical stimulation on motor function and cortical oscillations. J Neuroeng Rehabil 2017; 14:113. [PMID: 29132379 PMCID: PMC5683582 DOI: 10.1186/s12984-017-0323-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/30/2017] [Indexed: 01/11/2023] Open
Abstract
Background Few patients recover full hand dexterity after an acquired brain injury such as stroke. Repetitive somatosensory electrical stimulation (SES) is a promising method to promote recovery of hand function. However, studies using SES have largely focused on gross motor function; it remains unclear if it can modulate distal hand functions such as finger individuation. Objective The specific goal of this study was to monitor the effects of SES on individuation as well as on cortical oscillations measured using EEG, with the additional goal of identifying neurophysiological biomarkers. Methods Eight participants with a history of acquired brain injury and distal upper limb motor impairments received a single two-hour session of SES using transcutaneous electrical nerve stimulation. Pre- and post-intervention assessments consisted of the Action Research Arm Test (ARAT), finger fractionation, pinch force, and the modified Ashworth scale (MAS), along with resting-state EEG monitoring. Results SES was associated with significant improvements in ARAT, MAS and finger fractionation. Moreover, SES was associated with a decrease in low frequency (0.9-4 Hz delta) ipsilesional parietomotor EEG power. Interestingly, changes in ipsilesional motor theta (4.8–7.9 Hz) and alpha (8.8–11.7 Hz) power were significantly correlated with finger fractionation improvements when using a multivariate model. Conclusions We show the positive effects of SES on finger individuation and identify cortical oscillations that may be important electrophysiological biomarkers of individual responsiveness to SES. These biomarkers can be potential targets when customizing SES parameters to individuals with hand dexterity deficits. Trial registration: NCT03176550; retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12984-017-0323-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Adelyn P Tu-Chan
- Department of Neurology, University of California, San Francisco, USA. .,Neurology & Rehabilitation Service, San Francisco VA Medical Center, 1700 Owens Street, San Francisco, California, 94158, USA.
| | - Nikhilesh Natraj
- Department of Neurology, University of California, San Francisco, USA.,Neurology & Rehabilitation Service, San Francisco VA Medical Center, 1700 Owens Street, San Francisco, California, 94158, USA
| | - Jason Godlove
- Department of Neurology, University of California, San Francisco, USA.,Neurology & Rehabilitation Service, San Francisco VA Medical Center, 1700 Owens Street, San Francisco, California, 94158, USA
| | - Gary Abrams
- Department of Neurology, University of California, San Francisco, USA.,Neurology & Rehabilitation Service, San Francisco VA Medical Center, 1700 Owens Street, San Francisco, California, 94158, USA
| | - Karunesh Ganguly
- Department of Neurology, University of California, San Francisco, USA. .,Neurology & Rehabilitation Service, San Francisco VA Medical Center, 1700 Owens Street, San Francisco, California, 94158, USA.
| |
Collapse
|
38
|
Miaskowski C, Paul SM, Mastick J, Schumacher M, Conley YP, Smoot B, Abrams G, Kober KM, Cheung S, Henderson-Sabes J, Chesney M, Mazor M, Wallhagen M, Levine JD. Hearing loss and tinnitus in survivors with chemotherapy-induced neuropathy. Eur J Oncol Nurs 2017; 32:1-11. [PMID: 29353626 DOI: 10.1016/j.ejon.2017.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 07/02/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate for differences in demographic, clinical, and pain characteristics, as well as measures of sensation, balance, perceived stress, symptom burden, and quality of life (QOL) among survivors who received neurotoxic chemotherapy (CTX) and who reported only chemotherapy-induced neuropathy (CIN, n = 217), CIN and hearing loss (CIN/HL, n = 69), or CIN, hearing loss, and tinnitus (CIN/HL/TIN, n = 85). We hypothesized that as the number of neurotoxicities increased, survivors would have worse outcomes. METHODS Survivors were recruited from throughout the San Francisco Bay area. Survivors completed self-report questionnaires for pain and other symptoms, stress and QOL. Objective measures were assessed at an in person visit. RESULTS Compared to survivors with only CIN, survivors with all three neurotoxicities were less likely to be female and less likely to report child care responsibilities. In addition, survivors with all three neurtoxicities had higher worst pain scores, greater loss of protective sensation, and worse timed get up and go scores. These survivors reported higher state anxiety and depression and poorer QOL. For some outcomes (e.g., longer duration of CIN, self-reported balance problems), significantly worse outcomes were found for the survivors with CIN/HL and CIN/HL/TIN compared to those with only CIN. CONCLUSIONS Our findings suggest that compared to survivors with only CIN, survivors with CIN/HL/TIN are at increased risk for the most severe symptom burden, significant problems associated with sensory loss and changes in balance, as well as significant decrements in all aspects of QOL.
Collapse
Affiliation(s)
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, CA, USA
| | - Mark Schumacher
- School of Medicine, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, CA, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Steven Cheung
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Margaret Chesney
- School of Medicine, University of California, San Francisco, CA, USA
| | - Melissa Mazor
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
39
|
Miaskowski C, Mastick J, Paul SM, Topp K, Smoot B, Abrams G, Chen LM, Kober KM, Conley YP, Chesney M, Bolla K, Mausisa G, Mazor M, Wong M, Schumacher M, Levine JD. Chemotherapy-Induced Neuropathy in Cancer Survivors. J Pain Symptom Manage 2017; 54:204-218.e2. [PMID: 28063866 PMCID: PMC5496793 DOI: 10.1016/j.jpainsymman.2016.12.342] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/11/2016] [Accepted: 12/27/2016] [Indexed: 12/21/2022]
Abstract
CONTEXT Evidence suggests that chemotherapy-induced neuropathy (CIN) is a significant problem for cancer survivors. However, a detailed phenotypic characterization of CIN in cancer survivors is not available. OBJECTIVES To evaluate between-group differences in demographic and clinical characteristics, as well as in measures of sensation, function, and postural control, in a sample of cancer survivors who received a platinum and/or a taxane-based CTX regimen and did (n = 426) and did not (n = 197) develop CIN. METHODS Survivors completed self-report questionnaires and underwent objective testing (i.e., light touch, pain sensation, cold sensation, vibration, muscle strength, grip strength, Purdue Pegboard test, Timed Get Up and Go test, Fullerton Advanced Balance test). Parametric and nonparametric statistics were used to compare between-group differences in study outcomes. RESULTS Of the 426 survivors with CIN, 4.9% had CIN only in their upper extremities, 27.0% only in their lower extremities, and 68.1% in both their upper and lower extremities. Demographic and clinical characteristics associated with CIN included the following: older age, lower annual income, higher body mass index, a higher level of comorbidity, being born prematurely, receipt of a higher cumulative dose of chemotherapy, and a poorer functional status. Survivors with CIN had worse outcomes for all of the following objective measures: light touch, pain, temperature, vibration, upper and lower extremity function, and balance. CONCLUSIONS This study is the first to provide a detailed phenotypic characterization of CIN in cancer survivors who received a platinum and/or a taxane compound. These data can serve as a benchmark for future studies of CIN in cancer survivors.
Collapse
Affiliation(s)
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Kimberly Topp
- School of Medicine, University of California, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California, USA
| | - Lee-May Chen
- School of Medicine, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Margaret Chesney
- School of Medicine, University of California, San Francisco, California, USA
| | - Kay Bolla
- School of Nursing, University of California, San Francisco, California, USA
| | - Grace Mausisa
- School of Nursing, University of California, San Francisco, California, USA
| | - Melissa Mazor
- School of Nursing, University of California, San Francisco, California, USA
| | - Melisa Wong
- School of Medicine, University of California, San Francisco, California, USA
| | - Mark Schumacher
- School of Medicine, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| |
Collapse
|
40
|
Stephens KE, Levine JD, Aouizerat BE, Paul SM, Abrams G, Conley YP, Miaskowski C. Associations between genetic and epigenetic variations in cytokine genes and mild persistent breast pain in women following breast cancer surgery. Cytokine 2017; 99:203-213. [PMID: 28764974 DOI: 10.1016/j.cyto.2017.07.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 04/05/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 02/08/2023]
Abstract
Persistent pain following breast cancer surgery is a significant problem. Both inherited and acquired mechanisms of inflammation appear to play a role in the development and maintenance of persistent pain. In this longitudinal study, growth mixture modeling was used to identify persistent breast pain phenotypes based on pain assessments obtained prior to and monthly for 6months following breast cancer surgery. Associations between the "no pain" and "mild pain" phenotypes and single nucleotide polymorphisms (SNPs) spanning 15 cytokine genes were evaluated. The methylation status of the CpG sites found in the promoters of genes associated with pain group membership was determined using bisulfite sequencing. In the multivariate analysis, three SNPs (i.e., interleukin 6 (IL6) rs2069840, C-X-C motif chemokine ligand 8 (CXCL8) rs4073, tumor necrosis factor (TNF) rs1800610) and two TNF CpG sites (i.e., c.-350C, c.-344C) were associated with pain group membership. These findings suggest that variations in IL6, CXCL8, and TNF are associated with the development and maintenance of mild persistent breast pain. CpG methylation within the TNF promoter may provide an additional mechanism through which TNF alters the risk for mild persistent breast pain after breast cancer surgery. These genetic and epigenetic variations may help to identify individuals who are predisposed to the development of mild levels of persistent breast pain following breast cancer surgery.
Collapse
Affiliation(s)
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, United States
| | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, United States
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, CA, United States
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | | |
Collapse
|
41
|
Barnes D, Lee J, Chesney M, Yaffe K, Abrams G, Mehling W. PREVENTING LOSS OF INDEPENDENCE THROUGH EXERCISE IN PERSONS WITH DEMENTIA IN THE VA (PLIÉ-VA). Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D.E. Barnes
- San Francisco VA Medical Center, San Francisco, California
- Psychiatry and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California,
| | - J. Lee
- San Francisco VA Medical Center, San Francisco, California
- Psychiatry and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California,
| | - M.A. Chesney
- San Francisco VA Medical Center, San Francisco, California
- Psychiatry and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California,
| | - K. Yaffe
- San Francisco VA Medical Center, San Francisco, California
- Psychiatry and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California,
| | - G. Abrams
- San Francisco VA Medical Center, San Francisco, California
- Psychiatry and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California,
| | - W. Mehling
- San Francisco VA Medical Center, San Francisco, California
- Psychiatry and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California,
| |
Collapse
|
42
|
Barnes DE, Chesney MA, Yaffe K, Abrams G, Mehling W. [P1–537]: PREVENTING LOSS OF INDEPENDENCE THROUGH EXERCISE IN PERSONS WITH DEMENTIA IN THE VA (PLIÉ‐VA). Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Deborah E. Barnes
- University of California San Francisco / San Francisco VA Medical CenterSan FranciscoCAUSA
| | - Margaret A. Chesney
- University of California San Francisco / San Francisco VA Medical CenterSan FranciscoCAUSA
| | - Kristine Yaffe
- University of California San Francisco / San Francisco VA Medical CenterSan FranciscoCAUSA
| | - Gary Abrams
- University of California San Francisco / San Francisco VA Medical CenterSan FranciscoCAUSA
| | - Wolf Mehling
- University of California San Francisco / San Francisco VA Medical CenterSan FranciscoCAUSA
| |
Collapse
|
43
|
Mausisa G, Mastick J, Mazor M, Paul SM, Cooper BA, Smoot B, Topp K, Abrams G, Chen LM, Chesney M, Kober K, Conley Y, Levine J, Miaskowski C. Subgroups of survivors with distinct aggravating factors associated with chemotherapy-induced neuropathy (CIN) in the hands. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.5_suppl.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
157 Background: CIN is the most prevalent neurologic complication of cancer treatment. Inter-individual variability exists in survivors’ reports of the factors that aggravate CIN in their hands. The purpose of this study was to identify groups of survivors with CIN in their hands based on distinct aggravating factors and evaluate for differences in demographic, clinical, symptom characteristics and quality of life (QOL) based on group membership. Methods: Cancer survivors (n = 307) who received a platinum and/or a taxane and rated their altered sensation/pain in their hands at > 3 on 0-10 scale were enrolled and completed study questionnaires, including a list of 22 factors that could make pain worse. Medical records were reviewed and sensory and motor tests were done. Latent class analysis was used to identify groups of survivors based on the occurrence rates for aggravating factors. Differences among the groups were evaluated using parametric and nonparametric statistics. Results: Three groups were identified based on occurrence rates for aggravating factors in the hands (i.e., Activity and Temperature (41.0%), Activity (8.7%), Few Factors (52.2%)). No differences were found among the groups in demographic characteristics, or sensory (light touch, temperature, pain, vibration) and motor (grip strength, pegboard) tests. Compared to the Few Factors group, the Activity and Temperature group had more comorbidities, poorer sleep, greater fatigue, and more anxious and depressive symptoms. Survivors who received a platinum compound were more likely to be in the Activity and Temperature group. Those who received a taxane compound were more likely to be in the Few Factors or Activity groups. Conclusions: Survivors who reported a higher occurrence of aggravating factors had a higher symptom burden and poorer QOL. Most differences were found between the Few Factors group and the Activity and Temperature group which may be due to the small sample size of the Activity group. Objective measures did not differ among the groups. Findings suggest that subgroups of survivors can be identified based on their reports of CIN aggravating factors.
Collapse
Affiliation(s)
- Grace Mausisa
- University of California, San Francisco, San Francisco, CA
| | - Judy Mastick
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | | | - Steven M. Paul
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | - Bruce A. Cooper
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | - Betty Smoot
- University of California San Francisco, San Francisco, CA
| | - Kimberly Topp
- University of California, San Francisco, San Francisco, CA
| | - Gary Abrams
- University of California, San Francisco, San Francisco, CA
| | | | | | - Kord Kober
- University of California, San Francisco, San Francisco, CA
| | | | - Jon Levine
- University of California, San Francisco, San Francisco, CA
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| |
Collapse
|
44
|
Mastick J, Mausisa G, Mazor M, Paul SM, Cooper BA, Smoot B, Topp K, Abrams G, Chen LM, Chesney M, Kober K, Conley Y, Levine J, Miaskowski C. Subgroups of survivors with distinct aggravating factors associated with chemotherapy-induced neuropathy (CIN) in the feet. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.5_suppl.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
151 Background: CIN is the most prevalent neurologic complication of cancer treatment. Inter-individual variability exists in survivors’ reports of the factors that aggravate CIN in their feet. The purpose of this study was to identify groups of survivors with CIN in their feet based on distinct aggravating factors and evaluate for differences in demographic, clinical, symptom characteristics and quality of life (QOL) based on group membership. Methods: Cancer survivors (n = 403) who received a platinum and/or a taxane and rated their altered sensation/pain in their feet at > 3 on 0-10 scale were enrolled and completed study questionnaires, including a list of 22 factors that could make pain worse. Medical records were reviewed and sensory and motor tests were done. Latent class analysis was used to identify groups of survivors based on the occurrence rates for aggravating factors. Differences among the groups were evaluated using parametric and nonparametric statistics. Results: Three groups were identified based on occurrence rates for aggravating factors in the feet (i.e., Activity and Temperature (40.2%), Activity (25.8%), Few Factors (34.0%)). No differences were found among the groups in demographic characteristics, or sensory (light touch, temperature, pain, vibration) and motor (Timed Up and Go, Fullerton Assessment of Balance) tests. Compared to the Few Factors group, the other two groups had higher BMI, worse foot pain, poorer functional status and sleep, more depressive symptoms, and lower QOL. Survivors who received a platinum compound were more likely to be in the Activity and Temperature group. Those that received a taxane compound were more likely to be in the Few Factors or Activity groups. Conclusions: Survivors who reported a higher occurrence of aggravating factors had a higher symptom burden and poorer QOL. Objective measures did not differ among the groups. Aggravating factors associated with the CTX received supports previous work in that the survivors who received platinum drugs noted cold temperatures aggravated their CIN. Findings suggest that subgroups of survivors can be identified based on their reports of CIN aggravating factors.
Collapse
Affiliation(s)
- Judy Mastick
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | - Grace Mausisa
- University of California, San Francisco, San Francisco, CA
| | | | - Steven M. Paul
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | - Bruce A. Cooper
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | - Betty Smoot
- University of California San Francisco, San Francisco, CA
| | - Kimberly Topp
- University of California, San Francisco, San Francisco, CA
| | - Gary Abrams
- University of California, San Francisco, San Francisco, CA
| | | | | | - Kord Kober
- University of California, San Francisco, San Francisco, CA
| | | | - Jon Levine
- University of California, San Francisco, San Francisco, CA
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| |
Collapse
|
45
|
Fortune BE, Garcia-Tsao G, Ciarleglio M, Deng Y, Fallon MB, Sigal S, Chalasani NP, Lim JK, Reuben A, Vargas HE, Abrams G, Lewis MD, Hassanein T, Trotter JF, Sanyal AJ, Beavers KL, Ganger D, Thuluvath PJ, Grace ND, Groszmann RJ. Child-Turcotte-Pugh Class is Best at Stratifying Risk in Variceal Hemorrhage: Analysis of a US Multicenter Prospective Study. J Clin Gastroenterol 2017; 51:446-453. [PMID: 27779613 PMCID: PMC5403609 DOI: 10.1097/mcg.0000000000000733] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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] [Indexed: 02/06/2023]
Abstract
GOALS/BACKGROUND Data on acute variceal hemorrhage (AVH) in the United States is limited and the best method to stratify risk is not clear. Taking advantage of a prospective US cohort study, we aimed to (1) describe clinical outcomes of AVH and their predictors; (2) compare predictors of 6-week mortality. STUDY Prospective 15-center US cohort of patients with cirrhosis presenting with endoscopically proven AVH, all of whom received antibiotics, vapreotide (a somatostain analog) infusion and endoscopic band ligation. Patients were enrolled between August 2006 and April 2008. Primary outcome was 6-week mortality. Secondary outcome was 5-day treatment failure. The prognostic value of Child-Turcotte-Pugh (CTP) class, Model for End-stage Liver Disease (MELD) score and a recent recalibrated MELD were compared. RESULTS Seventy eligible patient were enrolled; 18 (26%) patients died within 6-weeks of index bleed. Demographic, clinical, and laboratory data were compared between survivors and nonsurvivors. Multivariate models showed that admission CTP or the MELD score (separately) were independent predictors of survival. The discriminative values of CTP (area under receiver operating characteristic: 0.75) and MELD (area under receiver operating characteristic: 0.79) were good and not significantly different (P=0.27). However, calibration (correlation between observed and predicted mortality) test was significantly better for CTP than for MELD, with the recently described recalibrated MELD model having the worst agreement. Predicted mortality for CTP-A was <10%, CTP-B 10% to 30%; and CTP-C >33%. CONCLUSIONS AVH mortality of 26% in the United States is in the upper range limit compared with recent series but may be due to inclusion of patients with more advanced cirrhosis. CTP score has the best overall performance in the prediction of 6-week mortality and is best at stratifying risk.
Collapse
Affiliation(s)
- Brett E Fortune
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Yanhong Deng
- School of Public Health, Yale University, New Haven, CT, USA
| | | | | | | | - Joseph K Lim
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Adrian Reuben
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Gary Abrams
- Alabama Liver and Digestive, Montgomery, AL, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Jamal H, Abrams G. A corny cause of cerebrospinal fluid ascites: A case report and review of literature. SAGE Open Med Case Rep 2016; 4:2050313X16661961. [PMID: 27489721 PMCID: PMC4968107 DOI: 10.1177/2050313x16661961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/06/2016] [Accepted: 06/14/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To report a rare cause of cerebrospinal fluid ascites. METHODS A 37-year-old female with history of intracranial hypertension and a ventriculo-peritoneal shunt was referred to liver clinic for evaluation of newly developed ascites. RESULTS Initially, the cause of ascites was thought to be secondary to a liver etiology. However, this was excluded after a comprehensive evaluation including portal pressure measurements. We determined the ascites to be infected cerebrospinal fluid secondary to a rare commensal organism, Corynebacterium non-Jeikeium, which resolved after removing ventriculo-peritoneal shunt, appropriate antibiotics and conversion to a ventriculo-atrial shunt. CONCLUSION Cerebrospinal fluid ascites is a rare complication of VP shunts and since 1976 only 8 cases of Corynebacterium non jk VP shunt infections have been reported in the literature but none associated with ascites. Also this report highlights the beneficial role of transjugular portal pressure measurements in the evaluation of ascites.
Collapse
Affiliation(s)
- Hira Jamal
- GHS Gastroenterology & Liver Center, Greenville, SC, USA
| | - Gary Abrams
- GHS Gastroenterology & Liver Center, Greenville, SC, USA
| |
Collapse
|
47
|
Barnes DE, Lee J, Leyva Y, Chesney MA, Yaffe K, Abrams G, Mehling W. P4‐242: Preventing Loss of Independence Through Exercise in Persons With Dementia in the VA (PLIÉ‐VA). Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Deborah E. Barnes
- University of California San Francisco/San Francisco VA Medical CenterSan FranciscoCA USA
| | - Jennifer Lee
- San Francisco VA Medical CenterSan FranciscoCA USA
| | - Yani Leyva
- San Francisco VA Medical CenterSan FranciscoCA USA
| | - Margaret A. Chesney
- University of California San Francisco/San Francisco VA Medical CenterSan FranciscoCA USA
| | - Kristine Yaffe
- University of California San Francisco/San Francisco VA Medical CenterSan FranciscoCA USA
| | - Gary Abrams
- University of California San Francisco/San Francisco VA Medical CenterSan FranciscoCA USA
| | - Wolf Mehling
- University of California San Francisco/San Francisco VA Medical CenterSan FranciscoCA USA
| |
Collapse
|
48
|
Cui S, Lu Q, Ganjawala T, Abrams G, Pan ZH. 98. Evaluation of Proteasome Inhibitors on AAV-Mediated Transduction Efficiency in Retinal Bipolar Cells. Mol Ther 2016. [DOI: 10.1016/s1525-0016(16)32907-0] [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: 11/24/2022] Open
|
49
|
Langford DJ, Paul SM, West C, Levine JD, Hamolsky D, Elboim C, Schmidt BL, Cooper BA, Abrams G, Aouizerat BE, Miaskowski C. Persistent breast pain following breast cancer surgery is associated with persistent sensory changes, pain interference, and functional impairments. J Pain 2015; 15:1227-37. [PMID: 25439318 DOI: 10.1016/j.jpain.2014.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/16/2014] [Accepted: 08/19/2014] [Indexed: 11/16/2022]
Abstract
UNLABELLED Interindividual variability exists in persistent breast pain following breast cancer surgery. Recently, we used growth mixture modeling to identify 3 subgroups of women (N = 398) with distinct persistent breast pain trajectories (ie, mild, moderate, severe) over 6 months following surgery. The purposes of this study were to identify demographic and clinical characteristics that differed among the breast pain classes and, using linear mixed effects modeling, to examine how changes over time and in sensitivity in the breast scar area, pain qualities, pain interference, and hand and arm function differed among these classes. Several demographic and clinical characteristics differentiated the breast pain classes. Of note, 60 to 80% of breast scar sites tested were much less sensitive than the unaffected breast. Significant group effects were observed for pain qualities and interference scores, such that, on average, women in the severe pain class reported higher scores than women in the moderate pain class. In addition, women in the moderate pain class reported higher scores than women in the mild pain class. Compared to women in the mild pain class, women in the severe pain class had significantly impaired grip strength, and women in the moderate and severe pain classes had impaired flexion and abduction. PERSPECTIVE Subgroups of women with persistent postsurgical breast pain differed primarily with respect to the severity rather than the nature or underlying mechanisms of breast pain. Pervasive sensory loss and the association between persistent breast pain and sustained interference with function suggest the need for long-term clinical follow-up.
Collapse
Affiliation(s)
- Dale J Langford
- School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California
| | - Claudia West
- School of Nursing, University of California, San Francisco, California
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California
| | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, California
| | | | - Brian L Schmidt
- College of Dentistry, New York University, New York, New York
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California
| | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, California; Institute for Human Genetics, University of California, San Francisco, California
| | | |
Collapse
|
50
|
Langford DJ, Paul SM, West C, Abrams G, Elboim C, Levine JD, Hamolsky D, Luce JA, Kober KM, Neuhaus JM, Cooper BA, Aouizerat BE, Miaskowski C. Persistent arm pain is distinct from persistent breast pain following breast cancer surgery. J Pain 2015; 15:1238-47. [PMID: 25439319 DOI: 10.1016/j.jpain.2014.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/13/2014] [Accepted: 08/19/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED Persistent pain following breast cancer surgery is well documented. However, it is not well characterized in terms of the anatomic site affected (ie, breast, arm). In 2 separate growth mixture modeling analyses, we identified subgroups of women (N = 398) with distinct breast pain and arm pain trajectories. The fact that these latent classes differed by anatomic site, types of tissue affected, and neural innervation patterns suggests the need for separate evaluations of these distinct persistent pain conditions. The purposes of this companion study were to identify demographic and clinical characteristics that differed between the 2 arm pain classes and determine if differences existed over time in sensitivity in the upper inner arm and axillary lymph node dissection sites, pain qualities, pain interference, and hand and arm function, as well as to compare findings with persistent breast pain. Higher occurrence rates for depression and lymphedema were found in the moderate arm pain class. Regardless of pain group membership, sensory loss was observed in the upper inner arm and axillary lymph node dissection site. Arm pain was described similarly to neuropathic pain and interfered with daily functioning. Persistent arm pain was associated with sustained impairments in shoulder mobility. PERSPECTIVE For persistent breast and arm pain, changes in sensation following breast cancer surgery were notable. Persistent arm pain was associated with sustained interference with daily functioning and upper body mobility impairments. Long-term management of persistent pain following breast cancer surgery is warranted to improve the quality of survivorship for these women.
Collapse
Affiliation(s)
- Dale J Langford
- School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California
| | - Claudia West
- School of Nursing, University of California, San Francisco, California
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, California
| | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, California
| | - Judith A Luce
- School of Medicine, University of California, San Francisco, California
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California
| | - John M Neuhaus
- School of Medicine, University of California, San Francisco, California
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California
| | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, California; Institute for Human Genetics, University of California, San Francisco, California
| | | |
Collapse
|