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Ganz PA, Bandos H, Španić T, Friedman S, Müller V, Kuemmel S, Delaloge S, Brain E, Toi M, Yamauchi H, de Dueñas EM, Armstrong A, Im SA, Song CG, Zheng H, Sarosiek T, Sharma P, Geng C, Fu P, Rhiem K, Frauchiger-Heuer H, Wimberger P, t'Kint de Roodenbeke D, Liao N, Goodwin A, Chakiba-Brugère C, Friedlander M, Lee KS, Giacchetti S, Takano T, Henao-Carrasco F, Virani S, Valdes-Albini F, Domchek SM, Bane C, McCarron EC, Mita M, Rossi G, Rastogi P, Fielding A, Gelber RD, Scheepers ED, Cameron D, Garber J, Geyer CE, Tutt ANJ. Patient-Reported Outcomes in OlympiA: A Phase III, Randomized, Placebo-Controlled Trial of Adjuvant Olaparib in g BRCA1/2 Mutations and High-Risk Human Epidermal Growth Factor Receptor 2-Negative Early Breast Cancer. J Clin Oncol 2024; 42:1288-1300. [PMID: 38301187 DOI: 10.1200/jco.23.01214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/03/2023] [Accepted: 11/15/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE The OlympiA randomized phase III trial compared 1 year of olaparib (OL) or placebo (PL) as adjuvant therapy in patients with germline BRCA1/2, high-risk human epidermal growth factor receptor 2-negative early breast cancer after completing (neo)adjuvant chemotherapy ([N]ACT), surgery, and radiotherapy. The patient-reported outcome primary hypothesis was that OL-treated patients may experience greater fatigue during treatment. METHODS Data were collected before random assignment, and at 6, 12, 18, and 24 months. The primary end point was fatigue, measured with the Functional Assessment of Chronic Illness Therapy-Fatigue scale. Secondary end points, assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core 30 item, included nausea and vomiting (NV), diarrhea, and multiple functional domains. Scores were compared between treatment groups using mixed model for repeated measures. Two-sided P values <.05 were statistically significant for the primary end point. All secondary end points were descriptive. RESULTS One thousand five hundred and thirty-eight patients (NACT: 746, ACT: 792) contributed to the analysis. Fatigue severity was statistically significantly greater for OL versus PL, but not clinically meaningfully different by prespecified criteria (≥3 points) at 6 months (diff OL v PL: NACT: -1.3 [95% CI, -2.4 to -0.2]; P = .022; ACT: -1.3 [95% CI, -2.3 to -0.2]; P = .017) and 12 months (NACT: -1.6 [95% CI, -2.8 to -0.3]; P = .017; ACT: -1.3 [95% CI, -2.4 to -0.2]; P = .025). There were no significant differences in fatigue severity between treatment groups at 18 and 24 months. NV severity was worse in patients treated with OL compared with PL at 6 months (NACT: 6.0 [95% CI, 4.1 to 8.0]; ACT: 5.3 [95% CI, 3.4 to 7.2]) and 12 months (NACT: 6.4 [95% CI, 4.4 to 8.3]; ACT: 4.5 [95% CI, 2.8 to 6.1]). During treatment, there were some clinically meaningful differences between groups for other symptoms but not for function subscales or global health status. CONCLUSION Treatment-emergent symptoms from OL were limited, generally resolving after treatment ended. OL- and PL-treated patients had similar functional scores, slowly improving during the 24 months after (N)ACT and there was no clinically meaningful persistence of fatigue severity in OL-treated patients.
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Affiliation(s)
- Patricia A Ganz
- University of California, Los Angeles, Los Angeles, CA
- Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Hanna Bandos
- NRG Oncology SDMC, The University of Pittsburgh, Pittsburgh, PA
| | - Tanja Španić
- Europa Donna-The European Breast Cancer Coalition, Milan, Italy
- Europa Donna Slovenia, Ljubljana, Slovenia
| | | | - Volkmar Müller
- Depatment of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Masakazu Toi
- Kyoto University Hospital, Kyoto, Japan
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | | | - Eduardo-M de Dueñas
- Consorcio Hospitalario Provincial de Castellón, Castellón, Spain
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Anne Armstrong
- Department of Medical Oncology, Division of Cancer Sciences, The University of Manchester, The Christie Hospital, Manchester, United Kingdom
| | - Seock-Ah Im
- Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chuan-Gui Song
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Zheng
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Cuizhi Geng
- The Fourth Hospital of Hebei Medical University, Shiijazhuang, China
| | - Peifen Fu
- Breast Surgery Department, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Cologne, Germany
| | | | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | | | - Ning Liao
- Guangdong People's Hospital, Guangzhou, China
| | - Annabel Goodwin
- Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia
| | | | - Michael Friedlander
- Prince of Wales Clinical School, University of NSW and Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sylvie Giacchetti
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, Paris, France
| | - Toshimi Takano
- Breast Medical Oncology Department, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | | | | | | | - Susan M Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, PA
| | | | - Edward C McCarron
- MedStar Franklin Square Medical Center-Harry and Jeanette Weinberg Cancer Institute, Baltimore, MD
| | - Monica Mita
- Cedars Sinai Medical Center, SOCCI, Los Angeles, CA
| | | | - Priya Rastogi
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Magee Women's Hospital, Pittsburgh, PA
| | | | - Richard D Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA
- Frontier Science Foundation, Boston, MA
| | | | | | - Judy Garber
- Dana-Farber/Harvard Cancer Center, Boston, MA
| | - Charles E Geyer
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Andrew N J Tutt
- The Institute of Cancer Research London, London, United Kingdom
- Kings College London, London, United Kingdom
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Bedrosian I, Somerfield MR, Achatz MI, Boughey JC, Curigliano G, Friedman S, Kohlmann WK, Kurian AW, Laronga C, Lynce F, Norquist BS, Plichta JK, Rodriguez P, Shah PD, Tischkowitz M, Wood M, Yadav S, Yao K, Robson ME. Germline Testing in Patients With Breast Cancer: ASCO-Society of Surgical Oncology Guideline. J Clin Oncol 2024; 42:584-604. [PMID: 38175972 DOI: 10.1200/jco.23.02225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE To develop recommendations for germline mutation testing for patients with breast cancer. METHODS An ASCO-Society of Surgical Oncology (SSO) panel convened to develop recommendations based on a systematic review and formal consensus process. RESULTS Forty-seven articles met eligibility criteria for the germline mutation testing recommendations; 18 for the genetic counseling recommendations. RECOMMENDATIONS BRCA1/2 mutation testing should be offered to all newly diagnosed patients with breast cancer ≤65 years and select patients >65 years based on personal history, family history, ancestry, or eligibility for poly(ADP-ribose) polymerase (PARP) inhibitor therapy. All patients with recurrent breast cancer who are candidates for PARP inhibitor therapy should be offered BRCA1/2 testing, regardless of family history. BRCA1/2 testing should be offered to women who develop a second primary cancer in the ipsilateral or contralateral breast. For patients with prior history of breast cancer and without active disease, testing should be offered to patients diagnosed ≤65 years and selectively in patients diagnosed after 65 years, if it will inform personal and family risk. Testing for high-penetrance cancer susceptibility genes beyond BRCA1/2 should be offered to those with supportive family histories; testing for moderate-penetrance genes may be offered if necessary to inform personal and family cancer risk. Patients should be provided enough pretest information for informed consent; those with pathogenic variants should receive individualized post-test counseling. Variants of uncertain significance should not impact management, and patients with such variants should be followed for reclassification. Referral to providers experienced in clinical cancer genetics may help facilitate patient selection and interpretation of expanded testing, and provide counseling of individuals without pathogenic germline variants but with significant family history.Additional information is available at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
| | | | | | | | - Giuseppe Curigliano
- University of Milan, Italy
- European Institute of Oncology, IRCCS, Milano, Italy
| | - Sue Friedman
- FORCE (Facing Our Risk of Cancer Empowered), Tampa, FL
| | - Wendy K Kohlmann
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | | | | | | | - Patricia Rodriguez
- Hereditary Cancer Risk Assessment Program, Virginia Cancer Specialists, Arlington, VA
| | - Payal D Shah
- Basser Center for BRCA & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Katherine Yao
- Division of Surgical Oncology at NorthShore University Health System, Evanston, IL
| | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, NY
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Chan LN, Chen LM, Goldman M, Mak JS, Bauer DC, Boscardin J, Schembri M, Bae-Jump V, Friedman S, Jacoby VL. Changes in Bone Density in Carriers of BRCA1 and BRCA2 Pathogenic Variants After Salpingo-Oophorectomy. Obstet Gynecol 2023; Publish Ahead of Print:00006250-990000000-00775. [PMID: 37290104 DOI: 10.1097/aog.0000000000005236] [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] [Received: 01/04/2023] [Accepted: 03/23/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the effect of risk-reducing salpingo-oophorectomy (RRSO) on change in bone mineral density (BMD) in women aged 34-50 years with pathogenic variants in BRCA1 or BRCA2 (BRCA1/2). METHODS The PROSper (Prospective Research of Outcomes after Salpingo-oophorectomy) study is a prospective cohort of women aged 34-50 years with BRCA1 or two germline pathogenic variants that compares health outcomes after RRSO to a non-RRSO control group with ovarian conservation. Women aged 34-50 years, who were planning either RRSO or ovarian conservation, were enrolled for 3 years of follow-up. Spine and total hip BMD were measured by dual-energy X-ray absorptiometry (DXA) scans obtained at baseline before RRSO or at the time of enrollment for the non-RRSO group, and then at 1 and 3 years of study follow-up. Differences in BMD between the RRSO and non-RRSO groups, as well as the association between hormone use and BMD, were determined by using mixed effects multivariable linear regression models. RESULTS Of 100 PROSper participants, 91 obtained DXA scans (RRSO group: 40; non-RRSO group: 51). Overall, total spine, and hip BMD decreased significantly from baseline to 12 months after RRSO (estimated percent change -3.78%, 95% CI -6.13% to -1.43% for total spine; -2.96%, 95% CI -4.79% to -1.14% for total hip) and at 36 months (estimated percent change -5.71%, 95% CI -8.64% to -2.77% for total spine; -5.19%, 95% CI -7.50% to -2.87% for total hip. In contrast, total spine and hip BMD were not significantly different from baseline for the non-RRSO group. The differences in mean percent change in BMD from baseline between the RRSO and non-RRSO groups were statistically significant at both 12 and 36 months for spine BMD (12-month difference -4.49%, 95% CI -7.67% to -1.31%; 36-month difference -7.06%, 95% CI -11.01% to -3.11%) and at 36 months for total hip BMD (12-month difference -1.83%, 95% CI -4.23% to 0.56%; 36-month difference -5.14%, 95% CI -8.11% to -2.16%). Across the study periods, hormone use was associated with significantly less bone loss at both the spine and hip within the RRSO group compared with no hormone use (P<.001 at both 12 months and 36 months) but did not completely prevent bone loss (estimated percent change from baseline at 36 months -2.79%, 95% CI -5.08% to -0.51% for total spine BMD; -3.93%, 95% CI -7.27% to -0.59% for total hip BMD). CONCLUSION Women with pathogenic variants in BRCA1/2 who undergo RRSO before the age of 50 years have greater bone loss after surgery that is clinically significant when compared with those who retain their ovaries. Hormone use mitigates, but does not eliminate, bone loss after RRSO. These results suggest that women who undergo RRSO may benefit from routine screening for BMD changes to identify opportunities for prevention and treatment of bone loss. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01948609.
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Affiliation(s)
- Leslie N Chan
- School of Medicine, the Department of Obstetrics, Gynecology and Reproductive Sciences, the Helen Diller Family Comprehensive Cancer Center, the Department of Medicine, and the Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, San Francisco, California; the Division of Gynecology Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Facing Our Risk of Cancer Empowered, Tampa, Florida
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Burack JA, Friedman S, Lessage M, Brodeur D. Re-visiting the 'mysterious myth of attention deficit': A systematic review of the recent evidence. J Intellect Disabil Res 2023; 67:271-288. [PMID: 36437709 DOI: 10.1111/jir.12994] [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: 07/15/2021] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Based on the inclusive and methodologically rigorous framework provided by Ed Zigler's developmental approach, we previously challenged what we called, 'the mysterious myth of attention deficit', the fallacy of attention as a universal deficit among persons with intellectual disability (ID). In this latest update, we conducted a systematic review of studies of essential components of attention among persons with ID published in the interim since the last iteration of the mysterious myth narrative was submitted for publication approximately a decade ago. We searched the databases PubMed and PsycINFO for English-language peer-reviewed studies published from 1 January 2011 through 5 February 2021. In keeping with the developmental approach, the two essential methodological criteria were that the groups of persons with ID were aetiologically homogeneous and that the comparisons with persons with average IQs (or with available norms) were based on an appropriate index of developmental level, or mental age. Stringent use of these criteria for inclusion served to control for bias in article selection. Articles were then categorised based on aetiological group studied and component of visual attention. Based on these criteria, 18 articles were selected for inclusion out of the 2837 that were identified. The included studies involved 547 participants: 201 participants with Down syndrome, 214 participants with Williams syndrome and 132 participants with fragile X syndrome. The findings from these articles call attention to the complexities and nuances in understanding attentional functioning across homogeneous aetiological groups and highlight that functioning must be considered in relation to aetiology; factors associated with the individual, such as developmental level, motivation, styles and biases; and factors associated with both the task, such as context, focus, social and emotional implications, and levels of environmental complexity.
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Affiliation(s)
- J A Burack
- Department of Educational & Counseling Psychology, McGill University, Montreal, Canada
| | - S Friedman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - M Lessage
- Department of Psychology, University of Toronto, Toronto, Canada
| | - D Brodeur
- Department of Psychology, Acadia University, Wolfville, Canada
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Green S, Hartzfeld D, Terry AB, Fissell K, Friedman S, Paolino N, Principe K, Sandbach J, Trzupek K, Winheld S, Malinowski J. An evidence-based practice guideline of the National Society of Genetic Counselors for telehealth genetic counseling. J Genet Couns 2023; 32:4-17. [PMID: 36054686 DOI: 10.1002/jgc4.1627] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022]
Abstract
There are currently no practice guidelines available for genetic counseling using telehealth modalities. This evidence-based practice guideline was developed in response to increasing use of alternative service delivery models for genetic counseling, specifically telephone and video-based genetic counseling (telehealth genetic counseling or THGC). A recent systematic evidence review (SER) compared outcomes of THGC with in-person genetic counseling and found that for the majority of studied outcomes, THGC was a non-inferior and comparable service delivery model. The SER results were used to develop this guideline. The current and anticipated future use of THGC, including the influence of the COVID-19 pandemic, provides the context for this guideline. Recommendation: The Telehealth Practice Guideline author workgroup conditionally recommends telehealth genetic counseling, either via telephone or video, as a delivery method for genetic counseling. Depending on factors unique to individual healthcare systems and provider and patient populations, THGC may be the only service delivery model available or may be utilized in addition to other service delivery models including in-person genetic counseling. The evidence shows large desirable effects, minor undesirable effects, and increased equity for patients when THGC is available. THGC may reduce or remove existing barriers to patient access to genetic counseling, such as medical conditions and/or disabilities that may affect a patient's ability to travel, inflexible work or school schedules, and lack of reliable transportation, finances, or dependent care. THGC is likely acceptable to key groups impacted by its use and is feasible to implement. Certain patient populations may require additional resources or encounter more barriers in using telemedicine services in general. For these populations, THGC can still be a valuable option if solutions are available.
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Affiliation(s)
- Sarah Green
- Institute for Digital Health and Innovation, High Risk Pregnancy Program, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deborah Hartzfeld
- Department of Veterans Affairs, Genomic Medicine Service, Salt Lake City, Utah, USA
| | - Alissa Bovee Terry
- New York Mid-Atlantic-Caribbean Regional Genetics Network, Binghamton, New York, USA
| | | | - Sue Friedman
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, Florida, USA
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Geyer C, Garber J, Gelber R, Yothers G, Taboada M, Ross L, Rastogi P, Cui K, Arahmani A, Aktan G, Armstrong A, Arnedos M, Balmaña J, Bergh J, Bliss J, Delaloge S, Domchek S, Eisen A, Elsafy F, Fein L, Fielding A, Ford J, Friedman S, Gelmon K, Gianni L, Gnant M, Hollingsworth S, Im SA, Jager A, Jóhannsson Ó, Lakhani S, Janni W, Linderholm B, Liu TW, Loman N, Korde L, Loibl S, Lucas P, Marmé F, Martinez de Dueñas E, McConnell R, Phillips KA, Piccart M, Rossi G, Schmutzler R, Senkus E, Shao Z, Sharma P, Singer C, Španić T, Stickeler E, Toi M, Traina T, Viale G, Zoppoli G, Park Y, Yerushalmi R, Yang H, Pang D, Jung K, Mailliez A, Fan Z, Tennevet I, Zhang J, Nagy T, Sonke G, Sun Q, Parton M, Colleoni M, Schmidt M, Brufsky A, Razaq W, Kaufman B, Cameron D, Campbell C, Tutt A. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high risk, early breast cancer. Ann Oncol 2022; 33:1250-1268. [PMID: 36228963 DOI: 10.1016/j.annonc.2022.09.159] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety. PATIENTS AND METHODS One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015. RESULTS With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome. CONCLUSION With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.
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Costenbader K, Cook N, Lee IM, Hahn J, Walter J, Bubes V, Kotler G, Yang N, Friedman S, Alexander E, Manson J. OP0038 VITAMIN D AND MARINE n-3 FATTY ACID SUPPLEMENTATION FOR PREVENTION OF AUTOIMMUNE DISEASE IN THE VITAL RANDOMIZED CONTROLLED TRIAL: OUTCOMES OVER 7 YEARS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundStrong biologic rationale supports both vitamin D and marine omega-3 (n-3) fatty acids for prevention of autoimmune disease (AD). Within the randomized, double-blind, placebo-controlled VITamin D and OmegA-3 TriaL (VITAL), we tested the effects of these supplements on AD incidence. We previously reported results after 5.3 years of randomized follow-up showing overall protective effects for vitamin D on AD incidence (HR 0.78, 95% CI 0.61-0.99) and suggestive results for n-3 fatty acids (HR 0.85, 95%CI 0.67-1.08)1.ObjectivesWe aimed to test effects of these supplements with two more years of post-intervention follow-up in VITAL.MethodsVITAL enrolled and randomized men and women (age ≥50 and ≥55 years, respectively) in a 2-by-2 factorial design to vitamin D3 (2000 IU/d) and/or n-3 fatty acids (1000 mg/d) or placebo and followed for median 5.3 years. Here, we followed participants for another 2 years of observation to assess for sustained effects. Incident AD diagnoses were reported by participants annually and confirmed by medical record review by expert physicians using existing classification criteria. The primary endpoint was total incident AD, including rheumatoid arthritis (RA), polymyalgia rheumatica (PMR), autoimmune thyroid disease (AITD), psoriasis, and all others. Pre-specified secondary endpoints included individual common AD; and probable AD. Cox models calcuated hazard ratios (HR) for incident ADs.ResultsOf 25,871 participants randomized, 71% self-reported non-Hispanic Whites, 20% Black, 9% other racial/ethnic groups, 51% women, mean age was 67.1 years. During 7.5 years median follow-up, confirmed AD was diagnosed in 156 participants in vitamin D arm vs 198 in vitamin D placebo arm, HR 0.79 (0.64-0.97). Incident AD was confirmed in 167 participants in n-3 fatty acid arm and 187 in n-3 fatty acid placebo arm, HR 0.89 (0.72-1.10). For vitamin D, HRs trended toward reduction for RA 0.67 (0.37- 1.21), PMR 0.69 (0.46-1.03) and psoriasis 0.57 (0.33-0.99). For n-3 fatty acids, HRs trended toward reduction for RA 0.55 (0.30-1.10) and AITD 0.61 (0.33-1.12). Vitamin D’s effect on AD incidence was stronger in those with body mass index (BMI) < 25 (HR 0.65, 0.44-0.96) than ≥ 25 kg/m2 (p interaction 0.01).ConclusionSupplementation for 5.3 years with 2000 IU/day vitamin D (compared to placebo), followed by 2 years of observational follow-up, significantly reduced overall incident AD by 21% in older adults. HRs for RA, PMR and psoriasis trended toward reduction with vitamin D, with stronger effect in those with normal BMI. Supplementation with 1000 mg/day n-3 fatty acids did not significantly reduce total AD.References[1]Hahn J et al, BMJ, 2022 Jan 26;376: e066452.Table 1.Hazard Ratios for Primary and Secondary Endpoints, by Randomized Assignment to Vitamin D/Placebo (Left), N-3 Fatty Acids/Placebo (Right)aEndpointVitamin D3(N=12,927)Placebo (N=12,944)Hazard Ratio (95% CI)pN-3 Fatty Acids (N=12,933)Placebo (N=12,938)Hazard Ratio (95% CI)pPrimary: Confirmed AD1561980.79 (0.64-0.97)0.031671870.89 (0.72-1.10)0.27Secondary:Confirmed + probable AD2653210.83 (0.70-0.97)0.022713150.86 (0.73-1.01)0.06Excluding subjects with any pre-randomization AD Confirmed AD1271620. 79 (0.62-0.99)0.041411480.95 (0.75-1.20)0.66 Confirmed + probable AD2112700. 78 (0.65-0.94)0.0072322490.93 (0.78-1.11)0.41Excluding first 2 years follow-up Confirmed AD861300.66 (0.50-0.87)0.0031041120.92 (0.71-1.21)0.56 Confirmed + probable AD1472050.72 (0.58-0.89)0.0021721800.95 (0.77-1.17)0.63Individual ADb RA18270.67 (0.37-1.21)0.1816290.55 (0.30-1.01)0.06 PMR39570.69 (0.46-1.03)0.0746500.92 (0.61-1.37)0.67 AITD27181.50 (0.82-2.71)0.1917280.61 (0.33-1.12)0.11 Psoriasis20350.57 (0.33-0.99)0.0534211.62 (0.94-2.79)0.08aAnalyses from Cox regression models controlled for age, sex, race, and other (n-3 fatty acid or vitamin D) randomization group bConfirmed AD.Figure 1.Disclosure of InterestsKaren Costenbader Consultant of: Astra Zeneca, Glaxo Smith Kline, Neutrolis, Grant/research support from: Merck, Exagen, Gilead, Nancy Cook: None declared, I-min Lee: None declared, Jill Hahn: None declared, Joseph Walter: None declared, Vadim Bubes: None declared, Gregory Kotler: None declared, Nicole Yang: None declared, Sonia Friedman: None declared, Erik Alexander: None declared, JoAnn Manson: None declared.
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Ganz PA, Bandos H, Spanic T, Friedman S, Müller V, Kümmel S, Delaloge S, Brain E, Toi M, Yamauchi H, de Dueñas EM, Armstrong A, Im SA, Song C, Zheng H, Sarosiek T, Sharma P, Rossi G, Rastogi P, Fielding A, Gelber RD, Campbell C, Garber JE, Geyer CE, Tutt ANJ. Abstract GS4-09: Quality of life results from OlympiA: A phase III, multicenter, randomized, placebo-controlled trial of adjuvant olaparib after (neo)-adjuvant chemotherapy in patients with germline BRCA1/2 mutations and high-risk HER-2 negative early breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs4-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Background: The primary results from the OlympiA trial were recently reported (NEJM, 2021) after an interim analysis demonstrated statistically significant invasive disease-free survival (DFS) benefit from 1 year of olaparib (OL) vs. placebo (PL) after 2.5 yrs median follow-up. Although there were fewer deaths with OL than PL, overall survival (OS) did not reach the statistical significance threshold prespecified for interim analysis. The initial publication also reported on the adverse event profile, which was similar to that previously reported, as well as Global Health Status/Quality of Life (GHQ), a secondary endpoint for the Patient-Reported Outcome (PRO) sub-study. The full protocol-specified PRO analyses are presented here. Methods: The OlympiA randomized phase III trial (NCT02032823, BIG 6-13, NSABP B-55) tested the role of 1 year of adjuvant OL after completion of (neo)adjuvant chemotherapy and definitive local therapy on invasive DFS, distant DFS and OS, and sought to collect PRO data from all eligible patients (pts) prior to randomization, on treatment (trt) (6 and 12 months [mos]), and after trt (18 and 24 mos) using validated questionnaires available in multiple languages. Fatigue, the primary PRO endpoint, was measured with the FACIT-Fatigue Scale in which a clinically meaningful (CM) difference is ≥3 points. Secondary PRO endpoints included gastrointestinal (GI) symptoms (nausea and vomiting [NV], diarrhea) and multiple quality of life (QOL) domains assessed with the EORTC QLQ-C-30 questionnaire (CM differences: small 5-10 points, moderate 10-20 points [Osoba, 1998]). The primary protocol-specified PRO hypothesis was that during trt pts treated with OL may experience greater fatigue severity at 6 and 12 mos. Secondary PRO hypotheses included: a) pts receiving OL may experience greater severity of GI symptoms at 6 and 12 mos with no difference by 24 mos; b) no difference in fatigue severity post-trt at 18 and 24 mos; and c) no difference in QOL over duration of the PRO sub-study between OL and PL as measured by the GHQ score and other EORTC QLQ-C30 subscales. A mixed model for repeated measures analysis compared the primary and secondary endpoints scores. Separate analyses were performed for neoadjuvant (NAC) and adjuvant (AC) chemotherapy subgroups due to differences in interval from NAC and AC to randomization. Two-sided p-values <0.05 were considered statistically significant. Results: Of 1,836 randomized pts, 1,751 (NAC: 875 [OL:440, PL: 435], AC: 876 [OL:436, PL:440]) were included in the PRO sub-study. Baseline QOL and symptom scores did not differ between OL and PL. Fatigue severity was statistically significantly greater in pts treated with OL than with PL at 6 mos (diff OL vs. PL: NAC -1.3 [95%CI -2.4, -0.2], p=0.024; AC -1.3 [-2.3,-0.2], p=0.017) and 12 mos (NAC -1.5 [-2.8,-0.2] p=0.025; AC -1.3 [-2.4,-0.1] p=0.027); however, the differences did not meet the pre-specified criterion for CM with the FACIT-Fatigue Scale. There were no meaningful differences in fatigue severity at 18 and 24 mos. NV symptom severity was worse in pts treated with OL than with PL with small differences at 6 mos (NAC: 6.0 [4.0, 8.0], p<0.001, AC: 5.3 [3.4,7.2], p<0.001) and 12 mos (NAC: 6.3 [4.4, 8.2], p<0.001, AC: 4.5 [2.8,6.2], p<0.001), and no differences at 18 and 24 mos. In general, there were no CM differences between OL and PL in terms of other symptoms and QOL subscales with improvements in functioning over time. Conclusions: Increased trt-emergent symptoms with OL were small and resolved after trt. QOL scores were similar and slowly improved during the 24 mos after (neo) adjuvant chemotherapy. Support: U10CA180868, -180822, UG1CA189867, AstraZeneca, Merck and Co, Inc. NCT02032823
Citation Format: Patricia A Ganz, Hanna Bandos, Tanja Spanic, Sue Friedman, Volkmar Müller, Sherko Kümmel, Suzette Delaloge, Etienne Brain, Masakazu Toi, Hideko Yamauchi, Eduardo-Martínez de Dueñas, Anne Armstrong, Seock-Ah Im, Chuangui Song, Hong Zheng, Tomasz Sarosiek, Priyanka Sharma, Giovanna Rossi, Priya Rastogi, Anitra Fielding, Richard D Gelber, Christine Campbell, Judy E Garber, Charles E Geyer, Jr, Andrew NJ Tutt, On behalf of the OlympiA Trial Steering Committeeand Investigators. Quality of life results from OlympiA: A phase III, multicenter, randomized, placebo-controlled trial of adjuvant olaparib after (neo)-adjuvant chemotherapy in patients with germline BRCA1/2 mutations and high-risk HER-2 negative early breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS4-09.
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Affiliation(s)
- Patricia A Ganz
- NSABP/NRG Oncology, and UCLA Jonsson Comprehensive Cancer Center, and UCLA Fielding School of Public Health, Los Angeles, PA
| | - Hanna Bandos
- NSABP/NRG Oncology, and The University of Pittsburgh, Pgh, PA
| | - Tanja Spanic
- Europa Donna, The European Breast Cancer Coalition, Milan, Italy
| | - Sue Friedman
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL
| | - Volkmar Müller
- University Medical Cener Hamburg-Eppendorf, Hamburg, Germany
| | - Sherko Kümmel
- Charité – Universitätsmedizin Berlin, Department of Gynecology with Breast Center Breast Unit, Kliniken Essen-Mitte, Berlin, Germany
| | - Suzette Delaloge
- UNICANCER Breast Group (UCBG), Institut Gustave Roussy, Villejuif, France
| | | | - Masakazu Toi
- Japan Breast Research Group (JBCRG), and Kyoto University Hospital, Kyoto, Japan
| | - Hideko Yamauchi
- Japan Breast Research Group (JBCRG), and St. Luke's International Hospital, Tokyo, Japan
| | - Eduardo-Martínez de Dueñas
- GEICAM Spanish Breast Cancer Group, and The Consorcio Hospitalario Provincial de Castellón, Castellón, Spain
| | - Anne Armstrong
- National Cancer Research Institute - Breast Cancer Clinical Studies Group (NCRI-BCSG), The Christie NHS Foundation Trust, and the University of Manchester, Manchester, United Kingdom
| | - Seock-Ah Im
- Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - Chuangui Song
- Fujian Medical University Union Hospital, Fujian, China
| | - Hong Zheng
- Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | - Priya Rastogi
- NSABP/NRG Oncology, and UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, and Magee-Womens Hospital, Pittsburgh, PA
| | | | - Richard D Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, MA
| | | | - Judy E Garber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, and Alliance for Clinical Trials in Oncology, Boston, MA
| | - Charles E Geyer
- NRG Oncology, and Houston Methodist Cancer Center, Houston, TX
| | - Andrew NJ Tutt
- Breast International Group (BIG), and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer and The Breast Cancer Now Unit, Guy’s Hospital Cancer Centre, King's College London, London, United Kingdom
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Ratziu V, de Guevara L, Safadi R, Poordad F, Fuster F, Flores-Figueroa J, Arrese M, Fracanzani AL, Ben Bashat D, Lackner K, Gorfine T, Kadosh S, Oren R, Halperin M, Hayardeny L, Loomba R, Friedman S, Sanyal AJ. Aramchol in patients with nonalcoholic steatohepatitis: a randomized, double-blind, placebo-controlled phase 2b trial. Nat Med 2021; 27:1825-1835. [PMID: 34621052 DOI: 10.1038/s41591-021-01495-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 08/09/2021] [Indexed: 02/08/2023]
Abstract
Nonalcoholic steatohepatitis (NASH), a chronic liver disease without an approved therapy, is associated with lipotoxicity and insulin resistance and is a major cause of cirrhosis and hepatocellular carcinoma. Aramchol, a partial inhibitor of hepatic stearoyl-CoA desaturase (SCD1) improved steatohepatitis and fibrosis in rodents and reduced steatosis in an early clinical trial. ARREST, a 52-week, double-blind, placebo-controlled, phase 2b trial randomized 247 patients with NASH (n = 101, n = 98 and n = 48 in the Aramchol 400 mg, 600 mg and placebo arms, respectively; NCT02279524 ). The primary end point was a decrease in hepatic triglycerides by magnetic resonance spectroscopy at 52 weeks with a dose of 600 mg of Aramchol. Key secondary end points included liver histology and alanine aminotransferase (ALT). Aramchol 600 mg produced a placebo-corrected decrease in liver triglycerides without meeting the prespecified significance (-3.1, 95% confidence interval (CI) -6.4 to 0.2, P = 0.066), precluding further formal statistical analysis. NASH resolution without worsening fibrosis was achieved in 16.7% (13 out of 78) of Aramchol 600 mg versus 5% (2 out of 40) of the placebo arm (odds ratio (OR) = 4.74, 95% CI = 0.99 to 22.7) and fibrosis improvement by ≥1 stage without worsening NASH in 29.5% versus 17.5% (OR = 1.88, 95% CI = 0.7 to 5.0), respectively. The placebo-corrected decrease in ALT for 600 mg was -29.1 IU l-1 (95% CI = -41.6 to -16.5). Early termination due to adverse events (AEs) was <5%, and Aramchol 600 and 400 mg were safe, well tolerated and without imbalance in serious or severe AEs between arms. Although the primary end point of a reduction in liver fat did not meet the prespecified significance level with Aramchol 600 mg, the observed safety and changes in liver histology and enzymes provide a rationale for SCD1 modulation as a promising therapy for NASH and fibrosis and are being evaluated in an ongoing phase 3 program.
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Affiliation(s)
- V Ratziu
- Sorbonne Université, Institute for Cardiometabolism and Nutrition and Hôpital Pitié- Salpêtrière, INSERM UMRS 1138 CRC, Paris, France.
| | - L de Guevara
- Hospital Ángeles Clínica Londres, Mexico City, Mexico
| | - R Safadi
- Hadassah Medical Organization, Hadassah Hebrew University Medical Center, Jerusalem. The Holy Family Hospital, Nazareth, Israel
| | - F Poordad
- Texas Liver Institute/UT Health San Antonio San Antonio, San Antonio, TX, USA
| | - F Fuster
- Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile
| | | | - M Arrese
- Departamento de Gastroenterología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile and Centro de Envejecimiento y Regeneración, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Anna L Fracanzani
- Department of Internal Medicine, Ca' Granda IRCCS Foundation, Policlinico Maggiore Hospital, University of Milan, Milan, Italy
| | - D Ben Bashat
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine & Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - K Lackner
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - T Gorfine
- Galmed Pharmaceuticals Ltd, Tel-Aviv, Israel
| | - S Kadosh
- Statexcellence Ltd, Tel-Aviv, Israel
| | - R Oren
- Galmed Pharmaceuticals Ltd, Tel-Aviv, Israel
| | - M Halperin
- Galmed Pharmaceuticals Ltd, Tel-Aviv, Israel
| | - L Hayardeny
- Galmed Pharmaceuticals Ltd, Tel-Aviv, Israel
| | - R Loomba
- NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA
| | - S Friedman
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Arun J Sanyal
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA
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Armstrong J, Lynch K, Virgo KS, Schwartz MD, Friedman S, Dean M, Andrews JE, Bourquardez Clark E, Clasen J, Conaty J, Parrillo O, Sutphen R. Utilization, Timing, and Outcomes of BRCA Genetic Testing Among Women With Newly Diagnosed Breast Cancer From a National Commercially Insured Population: The ABOARD Study. JCO Oncol Pract 2021; 17:e226-e235. [PMID: 33567243 PMCID: PMC8202055 DOI: 10.1200/op.20.00571] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To evaluate timing and outcomes of BRCA testing and definitive surgical treatment among patients with newly diagnosed breast cancer. METHODS Patient-reported (n = 1,381) and deidentified health-plan (n = 2,369) data were analyzed from a consecutive national series of 3,750 women whose healthcare providers ordered BRCA testing between March 2014 and June 2015, within 1 year following breast cancer diagnosis. RESULTS Among 1,209 respondents, 54.4% received the genetic test results presurgery, 23.2% tested presurgery but received the results postsurgery, and 22.3% tested postsurgery. Patients aware of mutation-positive results presurgery were more likely to choose bilateral mastectomy (BLM) (n = 32/37) compared with patients who learned of positive results postsurgery (n = 14/32), (odds ratio [OR] = 8.23, 95% CI = 2.55 to 26.59, P < .001). When compared with women tested postsurgery, only women unaware of negative results presurgery had higher BLM rates (adjusted OR = 1.70, 95% CI = 1.07 to 2.69, P = .02). Among women > 50 tested presurgery, those unaware of negative results presurgery were more likely to choose BLM (n = 28/81) compared with those aware of negative results (n = 32/168) (OR = 2.25, 95% CI = 1.23 to 4.08, negative results awareness × age interaction, and P = .007). CONCLUSION Nearly half of participants did not receive BRCA results presurgery, which limited their ability to make fully informed surgical treatment decisions. This may represent suboptimal care for unaware mutation-positive patients compared with those who were aware presurgery. Women > 50 who test negative are significantly less likely to choose BLM, a costly surgery that does not confer survival advantage, if they are aware of negative results presurgery. These results have important implications for quality of care and costs in the US health system.
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Affiliation(s)
| | - Kristian Lynch
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Sue Friedman
- Facing Our Risk of Cancer Empowered, Inc (FORCE), Tampa, FL
| | - Marleah Dean
- Communication Department, College of Arts and Sciences, University of South Florida, Tampa, FL
| | - James E Andrews
- School of Information, University of South Florida, Tampa, FL
| | | | - Joanna Clasen
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Jessica Conaty
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Olivia Parrillo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Rebecca Sutphen
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
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Sackrison A, Brandon C, Friedman S, Brucker B. 08 The influence of race on pelvic organ prolapse surgery repair and complications. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2021.04.009] [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: 11/26/2022]
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Nye LE, Cruz K, Friedman S, Rose D, Befort C, Sullivan DK, Hamilton-Reeves JM, Harlan-Williams LM, Behbod F, Wick J, Irwin M, Klemp J. Abstract PS7-44: Energetics and lifestyle in inherited syndromes (ELLIE'S study). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps7-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: US women have a 1 in 8 lifetime chance of developing breast cancer (BC), with an estimated 10% resulting from a hereditary BC gene mutation. Individuals with mutations in genes such as BRCA1 and BRCA2 have an increased risk of breast and ovarian cancer, as well as other types of cancers. At present, there are more than a dozen other hereditary cancer related genetic mutations that have an associated moderate to high risk of developing cancer. Along with an ability to identify and characterize risk in individuals with a hereditary cancer mutation, there is a need to study modifiable factors such as dietary intake and physical activity in relation to an individual’s risk for cancer.
Obesity and poor physical fitness are independently associated with an increased risk of BC and recurrence. There is a paucity of data on the impact of BMI, obesity, and physical activity on primary and recurrent BC in genetic mutation carriers. Women with a moderate penetrance gene mutation are at a high risk for BC and yet are likely to have an impact from modifiable risk factors. The impact of obesity, diet, and physical activity on BC risk and outcomes needs to be further characterized in genetic mutation carriers.
Methods: A short REDCap electronic survey was disseminated on social media and through our advocate partner Facing our Risk of Cancer Empowered (FORCE). Eligible participants include males or females, ≥18 years with a hereditary cancer genetic mutation. The survey includes questions regarding personal health, weight, height, metabolic risk factors, reproductive history as well as personal and/or family history of cancer and gene mutation status. In addition, includes a standardized assessment for diet (14-Item Mediterranean Diet Tool) and physical activity (IPAQ and modifiable PAQ). The first 1000 participants are compensated for their time with a $10 e-card. The survey is available in English and Spanish. The Spanish version was developed in collaboration with JUNTOS Kansas City.
Objectives: To establish a cohort and describe obesity rates, physical activity, metabolic factors, and nutrition in a cohort of individuals that have an increased risk of cancer due to a hereditary cancer genetic mutation.
Results: A total of N = 1,117 surveys have been completed as of June 30, 2020. Of them, 61.2% were removed from final analysis due to incomplete surveys, internet bots, and multiple single-user entries. A total N = 443 surveys have been verified and included in this analysis. Demographics: 98.6% female (n= 437), 94.4% white (n = 418) and median age 46 (range 19 – 77 yrs). Mutations represented in the cohort include: BRCA2 (39.0%), BRCA1 (29.1%), CHEK2 (13.1%), and ATM (5.9%) and < 5%: PALB2, RAD51D, and TP53. Median BMI 24.9 ± 6.06 stdv. BMI 25 to < 30: 26.4% (n = 117). BMI 30 or > 30: 23.47% (n = 104). 61.3% responders are currently trying to lose weight. Attempts at weight loss: No attempts: n = 60 (13.5%), at least 1: n = 55 (12.4%), 2-5: n = 211 (47.6%), 6 or more: n = 117 (26.4%). Limitations to exercise include motivation (26.9%), time (23.5%), not liking exercise (15.6%), and lack of gym memberships (12.4%). 74.9% (n = 332) responded that they are interested in participating in future studies. The Spanish survey was made available 3/3/2020, no responses to date.
Conclusion: Individuals harboring a hereditary cancer genetic mutation are interested and willing to participate in research focused on lifestyle modifications and association with cancer risk. Rates of being overweight or obese are high and many have made multiple attempts at weight loss and find common barriers to exercise. Social media is a feasible platform to recruit to a lifestyle research project in a rare population. Additional steps to limit internet trolls, bots, and repetitive responses are necessary but did not impede recruitment. Further effort and collaboration are needed to expand the survey to underrepresented minorities.
Citation Format: Lauren E Nye, Kendra Cruz, Sue Friedman, Diane Rose, Christie Befort, Debra K Sullivan, Jill M Hamilton-Reeves, Lisa M Harlan-Williams, Fariba Behbod, Jo Wick, Melinda Irwin, Jennifer Klemp. Energetics and lifestyle in inherited syndromes (ELLIE'S study) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-44.
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Affiliation(s)
| | | | - Sue Friedman
- 2FORCE: Facing Our Risk of Cancer Empowered, Tampa, FL
| | - Diane Rose
- 2FORCE: Facing Our Risk of Cancer Empowered, Tampa, FL
| | | | | | | | | | | | - Jo Wick
- 3University of Kansas, Kansas City, KS
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Mansfield CA, Metcalfe KA, Snyder C, Lindeman GJ, Posner J, Friedman S, Lynch HT, Narod SA, Evans DG, Liede A. Preferences for breast cancer prevention among women with a BRCA1 or BRCA2 mutation. Hered Cancer Clin Pract 2020; 18:20. [PMID: 33014209 PMCID: PMC7526374 DOI: 10.1186/s13053-020-00152-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/12/2020] [Accepted: 09/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background Women with a BRCA1 or BRCA2 mutation have high lifetime risks of developing breast and ovarian cancer. The decision to embark on risk reduction strategies is a difficult and personal one. We surveyed an international group of women with BRCA mutations and measured choices and sequence of breast cancer risk reduction strategies. Methods Women with a BRCA1/2 mutation and no previous cancer diagnosis were recruited from the US, Canada, the UK, Australia, and from a national advocacy group. Using an online survey, we asked about cancer-risk reduction preferences including for one of two hypothetical medicines, randomly assigned, and women’s recommendations for a hypothetical woman (Susan, either a 25- or 36-year-old). Sunburst diagrams were generated to illustrate hierarchy of choices. Results Among 598 respondents, mean age was 40.9 years (range 25–55 years). Timing of the survey was 4.8 years (mean) after learning their positive test result and 33% had risk-reducing bilateral salpingo-oophorectomy (RRBSO) and bilateral mastectomy (RRBM), while 19% had RRBSO only and 16% had RRBM only. Although 30% said they would take a hypothetical medicine, 6% reported taking a medicine resembling tamoxifen. Respondents were 1.5 times more likely to select a hypothetical medicine for risk reduction when Susan was 25 than when Susan was 36. Women assigned to 36-year-old Susan were more likely to choose a medicine if they had a family member diagnosed with breast cancer and personal experience taking tamoxifen. Conclusions Women revealed a willingness to undergo surgeries to achieve largest reduction in breast cancer risk, although this would not be recommended for a younger woman in her 20s. The goal of achieving the highest degree of cancer risk reduction is the primary driver for women with BRCA1 or BRCA2 mutations in selecting an intervention and a sequence of interventions, regardless of whether it is non-surgical or surgical.
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Affiliation(s)
- Carol A Mansfield
- RTI Health Solutions, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, Durham, NC 27709-12194 USA
| | - Kelly A Metcalfe
- Women's College Hospital, University of Toronto, Toronto, Canada
| | - Carrie Snyder
- Creighton University, Omaha, NE USA.,CHI Health Creighton University Medical Center, Omaha, NE USA
| | - Geoffrey J Lindeman
- The Royal Melbourne Hospital, Parkville, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC Australia.,The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC Australia.,The University of Melbourne, Parkville, VIC Australia
| | - Joshua Posner
- RTI Health Solutions, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, Durham, NC 27709-12194 USA
| | - Sue Friedman
- Facing Our Risk of Cancer Empowered (FORCE) Advocacy Organization, Tampa, Florida USA
| | | | | | - Steven A Narod
- Women's College Hospital, University of Toronto, Toronto, Canada
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, MAHSC, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
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14
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Lynce F, Schlam I, Geng X, Peshkin BN, Friedman S, Dutil J, Nahleh Z, Campos C, Ricker C, Rodriguez P, Denduluri N, Ahn J, Isaacs C, Graves KD. BRCA1/2 mutations and risk-reducing bilateral salpingo-oophorectomy among Latinas: The UPTAKE study. J Genet Couns 2020; 30:383-393. [PMID: 33010199 PMCID: PMC10064975 DOI: 10.1002/jgc4.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 11/08/2022]
Abstract
Bilateral salpingo-oophorectomy (BSO) is a risk management approach with strong evidence of mortality reduction for women with germline mutations in the tumor suppressor genes BRCA1 and BRCA2 (BRCA1/2). Few studies to date have evaluated uptake of BSO in women from diverse racial and ethnic backgrounds who carry BRCA1/2 mutations. The objective of the UPTAKE study was to explore rates and predictors of risk-reducing BSO among Latinas affected and unaffected with breast cancer who had a deleterious BRCA1/2 mutation. We recruited 100 Latina women with deleterious BRCA1/2 mutations from community hospitals, academic health systems, community, and advocacy organizations. Women completed interviews in Spanish or English. We obtained copies of genetic test reports for participants who provided signed medical release. After performing threefold cross-validation LASSO for variable selection, we used multiple logistic regression to identify demographic and clinical predictors of BSO. Among 100 participants, 68 had undergone BSO at the time of interview. Of these 68, 35 were US-born (61% of all US-born participants) and 33 were not (77% of the non-US-born participants). Among Latinas with BRCA1/2 mutations, older age (p = 0.004), personal history of breast cancer (p = 0.003), higher income (p = 0.002), and not having a full-time job (p = 0.027) were identified as variables significantly associated with uptake of BSO. Results suggest a high rate of uptake of risk-reducing BSO among a sample of Latinas with BRCA1/2 mutations living in the US. We document factors associated with BSO uptake in a diverse sample of women. Relevant to genetic counseling, our findings identify possible targets for supporting Latinas' decision-making about BSO following receipt of a positive BRCA1/2 test.
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Affiliation(s)
- Filipa Lynce
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ilana Schlam
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Xue Geng
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Sue Friedman
- Force - Facing Our Risk of Cancer Empowered, Tampa, FL, USA
| | - Julie Dutil
- Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | | | | | - Charité Ricker
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Patricia Rodriguez
- Virginia Cancer Specialists, Arlington, VA, USA.,US Oncology Network, Virginia, VA, USA
| | - Neelima Denduluri
- Virginia Cancer Specialists, Arlington, VA, USA.,US Oncology Network, Virginia, VA, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Kristi D Graves
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
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15
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Shaw D, Faino A, Statland J, Eichinger K, Tapscott S, Tawil R, Friedman S, Wang L. FSHD / OPMD / MYOTONIC DYSTROPHY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Thomas K, Friedman S, Jorgensen T, Smith A, Lavi M. Enhancing Community Health Workers’ Nutritional Expertise via The ECHO Model. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.217] [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: 10/23/2022]
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17
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Friedman S, Moser RS, Schatz P. A-20 Do Children With LD and/or ADHD Differ at Baseline on a Pediatric Measure Used to Assess Concussion? Arch Clin Neuropsychol 2020. [DOI: 10.1093/arclin/acaa036.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To examine differences at baseline between children with ADHD and/or LD vs. children with neither ADHD/LD on 1) neurocognitive scores and 2) child- and parent-reported concussion symptoms.
Method
Retrospective data was obtained for 1856 children ages 5–11 who were assessed at baseline using ImPACT Pediatric. Groups were determined based on parent-reported diagnosis of their child at baseline (ADHD and/or LD vs. neither ADHD/LD), and groups were compared on the four factor scores: Sequential Memory, Word Memory, Visual Memory, and Rapid Processing and on child- and parent-reported concussion symptoms using a series of ANOVAs.
Results
ANOVAs revealed that children with ADHD and/or LD performed significantly worse than children without ADHD/LD on Sequential Memory (F(1,1845) = 69.86, p < .001)) and Word Memory (F(1,1853) = 10.36, p = .001)). In contrast, children with ADHD and/or LD performed significantly better on the neurocognitive measures of Visual Memory [(F(1,1845) = 4.94, p = .026)] and Rapid Processing [(F(1,1853) = 20.35, p < .001). Symptom reporting was significantly greater in the ADHD and/or LD group for both child (F(1,1853) = 30.21, p < .001) and parent (F(1,1853) = 34.64, p < .001) reported symptoms.
Conclusions
The current study demonstrated differences at baseline in children on neurocognitive performance and concussion symptom reporting based on diagnostic group. Analysis of symptom reporting suggested that children with pre-existing diagnoses of ADHD and/or LD and their parents may report concussion-like symptoms at baseline, prior to ever experiencing a concussion. This finding has clinical implications for interpretation of post-concussion symptoms without a baseline comparison in children with pre-existing diagnoses such as ADHD and/or LD.
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18
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Scott D, Friedman S, Telli ML, Kurian AW. Decision Making About Genetic Testing Among Women With a Personal and Family History of Breast Cancer. JCO Oncol Pract 2019; 16:e37-e55. [PMID: 31613719 DOI: 10.1200/jop.19.00221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To understand genetic testing use and decision making among patients with high genetic risk. MATERIALS AND METHODS A survey of breast cancer survivors was administered online by a hereditary cancer nonprofit organization, Facing Our Risk of Cancer Empowered, from October 2017 to March 2018. RESULTS Of 1,322 respondents, 46% had breast cancer at age < 45 years, 61% had a first-degree relative with cancer, and 84% underwent genetic testing, of whom 56% had a risk-associated pathogenic variant. Most (86%; 95% CI, 84% to 88%) tested respondents were very satisfied with their testing decision, versus 34% (95% CI, 27% to 41%) of untested respondents. Factors that encouraged testing included relatives' cancer risk (75%; 95% CI, 73% to 78%), clinicians' recommendations (68%; 95% CI, 66% to 71%), and potential treatment implications (67%; 95% CI, 64% to 69%). Factors that discouraged testing included insurance concerns (14%; 95% CI, 12% to 16%), cost (14%; 95% CI, 12% to 16%), and discrimination (9%; 95% CI, 7% to 11%). Thirty-nine percent (95% CI, 36% to 41%) recalled hearing from a clinician that genetic discrimination is illegal. Respondents often recalled clinicians informing them about inheritance patterns (65%; 95% CI, 62% to 67%), surgical implications (65%; 95% CI, 63% to 68%), and other cancer risks (66%; 95% CI, 63% to 68%) but less often that results could have potential implications for clinical trial eligibility (38%; 95% CI, 36% to 42%) or targeted therapies (14%; 95% CI, 12% to 16%). Patients who had genetic counseling were twice as likely to recall clinicians informing them about all queried topics. Results did not vary by diagnosis year. CONCLUSION Among patients with high genetic risk, clinicians' recommendations, potential treatment implications, and protections against discrimination were motivating factors to undergo genetic testing, but fewer than half recalled clinicians providing all this information, and this did not improve over time. Clinicians influence testing decisions and should inform patients about legal protections and treatment implications.
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Affiliation(s)
- Danika Scott
- Stanford University School of Medicine, Stanford, CA
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19
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Marashdeh MQ, Friedman S, Lévesque C, Finer Y. Esterases affect the physical properties of materials used to seal the endodontic space. Dent Mater 2019; 35:1065-1072. [PMID: 31104923 PMCID: PMC6626680 DOI: 10.1016/j.dental.2019.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 01/08/2023]
Abstract
Materials used to seal the endodontic space are subjected to enzymatic degradative activities of body fluids and bacteria. OBJECTIVES To assess effects of simulated human salivary, blood and bacterial esterases (SHSE) on physical properties of typical restorative material and root canal sealers. METHODS Specimens of set methacrylate-based resin composite (BisfilTM2B; RC), calcium-silicate sealer (EndoSequence®; BC) or epoxy-resin sealer (AH-Plus®; ER) were tested after up to 28Days exposure to phosphate buffered saline (PBS) or SHSE, using ANSI/ADA-57:2000 and ISO-6876:2012. RESULTS Regardless of media, microhardness increased with time for BC remained unchanged for ER and decreased for RC (p < 0.05). SHSE moderated the increase for BC compared to PBS (28.0 ± 4.8 vs. 38.1 ± 7.9 KHN) at 7Days, and enhanced the decrease for RC at 7Days (55.6 ± 7.1 vs. 66.3 ± 6.5 KHN) and 28Days (52.3 ± 9.2 vs. 62.6 ± 8.5 KHN). Compressive strength was enhanced only for BC by either media. BC expanded with time for both incubation conditions; SHSE moderated the expansion compared to PBS at 7Days (0.026 ± 0.01% vs. 0.049 ± 0.007%). Shrinkage of ER was similar for both incubation media and was lower than that for RC (p < 0.05). Shrinkage of RC was enhanced by SHSE compared to PBS at 7Days (0.5 ± 0.07% vs. 0.38 ± 0.08%). Weight loss was lowest for ER and highest for BC (p < 0.05). It was enhanced by SHSE compared to PBS for BC at 28Days (2.40 ± 0.2 vs. 2.96 ± 0.19 W L%), and for RC at 7Days (0.54 ± 0.09 vs. 0.80 ± 0.1 W L%). SIGNIFICANCE Simulated body fluids and bacterial esterases affected the physical properties of test materials, suggesting potential impacts on sealing ability and resistance to bacterial ingress, and tooth strength ultimately affecting their clinical performance.
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Affiliation(s)
- M Q Marashdeh
- Faculty of Dentistry, University of Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Ontario, Canada
| | - S Friedman
- Faculty of Dentistry, University of Toronto, Ontario, Canada
| | - C Lévesque
- Faculty of Dentistry, University of Toronto, Ontario, Canada
| | - Y Finer
- Faculty of Dentistry, University of Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Ontario, Canada.
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20
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O'Neill SC, Evans C, Hamilton RJ, Peshkin BN, Isaacs C, Friedman S, Tercyak KP. Information and support needs of young women regarding breast cancer risk and genetic testing: adapting effective interventions for a novel population. Fam Cancer 2019; 17:351-360. [PMID: 29124494 DOI: 10.1007/s10689-017-0059-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/10/2023]
Abstract
Young women from hereditary breast and ovarian cancer (HBOC) families face a unique set of challenges in managing their HBOC risk, where obtaining essential information to inform decision making is key. Previous work suggests that this need for specific health information also comes at a time of heightened distress and greater individuation from family. In this report, we describe our adaptation of a previously-studied behavioral intervention for this population, utilizing a systematic approach outlined by the Centers for Disease Control and Prevention. First, we assessed the information needs and levels of distress in this population and correlates of this distress. These data then were used to inform the adaptation and piloting of a three-session telephone-based peer coaching intervention. One hundred young women (M age = 25 years) who were first or second degree relatives of BRCA1/2 mutation carriers participated. Sixty-three percent of the sample endorsed unmet HBOC information needs and they, on average, reported moderate levels of cancer-related distress (M = 21.9, SD = 14.6). Greater familial disruption was associated with greater cancer-related distress in multivariable models (p < .05). Ten women who participated in the survey completed the intervention pilot. They reported lower distress from pre- to post- (15.8 vs. 12.0), as well as significantly lower decisional conflict (p < .05) and greater endorsement of an array of healthy coping strategies (i.e., active coping, instrumental coping, positive reframing, planning, p's < .05). Our survey results suggest that young adult women from HBOC families have unmet cancer genetic information and support needs. Our pilot intervention was able to reduce levels of decisional conflict and promote the use of effective coping strategies. This approach needs to be further tested in a larger randomized trial.
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Affiliation(s)
- Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Chalanda Evans
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Rebekah J Hamilton
- Armour Academic Center, College of Nursing, Rush University, 600 S. Paulina Street, Suite 1080, Chicago, IL, 60612, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Road, NW, Washington, DC, 20007, USA
| | - Sue Friedman
- FORCE, Inc., 16057 Tampa Palms Blvd. W, PMB #373, Tampa, FL, 33647, USA
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
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21
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Chauhan A, Lalor T, Watson S, Adams D, Farrah TE, Anand A, Kimmitt R, Mills NL, Webb DJ, Dhaun N, Kalla R, Adams A, Vatn S, Bonfliglio F, Nimmo E, Kennedy N, Ventham N, Vatn M, Ricanek P, Halfvarson J, Soderhollm J, Pierik M, Torkvist L, Gomollon F, Gut I, Jahnsen J, Satsangi J, Body R, Almashali M, McDowell G, Taylor P, Lacey A, Rees A, Dayan C, Lazarus J, Nelson S, Okosieme O, Corcoran D, Young R, Ciadella P, McCartney P, Bajrangee A, Hennigan B, Collison D, Carrick D, Shaukat A, Good R, Watkins S, McEntegart M, Watt J, Welsh P, Sattar N, McConnachie A, Oldroyd K, Berry C, Parks T, Auckland K, Mentzer AJ, Kado J, Mirabel MM, Kauwe JK, Robson KJ, Mittal B, Steer AC, Hill AVS, Akbar M, Forrester M, Virlan AT, Gilmour A, Wallace C, Paterson C, Reid D, Siebert S, Porter D, Liversidge J, McInnes I, Goodyear C, Athwal V, Pritchett J, Zaitoun A, Irving W, Guha IN, Hanley NA, Hanley KP, Briggs T, Reynolds J, Rice G, Bondet V, Bruce E, Crow Y, Duffy D, Parker B, Bruce I, Martin K, Pritchett J, Aoibheann Mullan M, Llewellyn J, Athwal V, Zeef L, Farrow S, Streuli C, Henderson N, Friedman S, Hanley N, Hanley KP. Scientific Business Abstracts of the 112th Annual Meeting of the Association of Physicians of Great Britain and Ireland. QJM 2018; 111:920-924. [PMID: 31222346 DOI: 10.1093/qjmed/hcy193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - T Lalor
- From the University of Birmingham
| | - S Watson
- From the University of Birmingham
| | - D Adams
- From the University of Birmingham
| | - T E Farrah
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - A Anand
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - R Kimmitt
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - N L Mills
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - D J Webb
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - N Dhaun
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - R Kalla
- From the University of Edinburgh
| | - A Adams
- From the University of Edinburgh
| | - S Vatn
- Akerhshus University Hospital
| | | | - E Nimmo
- From the University of Edinburgh
| | | | | | | | | | | | | | - M Pierik
- Maastricht University Medical Centre
| | | | | | | | | | | | - R Body
- From the University of Manchester
| | - M Almashali
- Manchester University Hospitals Foundation NHS Trust
| | | | | | | | - A Rees
- From the Cardiff University
| | | | | | | | | | - D Corcoran
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - R Young
- Robertson Centre for Biostatistics, University of Glasgow
| | - P Ciadella
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - P McCartney
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - A Bajrangee
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - B Hennigan
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - D Collison
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - D Carrick
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - A Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - R Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - S Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - M McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - J Watt
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - P Welsh
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - N Sattar
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - A McConnachie
- Robertson Centre for Biostatistics, University of Glasgow
| | - K Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - C Berry
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - T Parks
- From the London School of Hygiene and Tropical Medicine
- University of Oxford
| | | | | | - J Kado
- Fiji Islands Ministry of Health and Medical Services
| | - M M Mirabel
- French National Institute of Health and Medical Research
| | | | | | - B Mittal
- Babasaheb Bhimrao Ambedkar University
| | - A C Steer
- Murdoch Children's Research Institute
| | | | - M Akbar
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - M Forrester
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - A T Virlan
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - A Gilmour
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - C Wallace
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - C Paterson
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - D Reid
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - S Siebert
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - D Porter
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - J Liversidge
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - I McInnes
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - C Goodyear
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - V Athwal
- From the Manchester University Foundation NHS Trust
- University of Manchester
| | | | | | | | | | - N A Hanley
- From the Manchester University Foundation NHS Trust
- University of Manchester
| | | | - T Briggs
- From the Manchester Centre of Genomic Medicine, University of Manchester
| | - J Reynolds
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - G Rice
- From the Manchester Centre of Genomic Medicine, University of Manchester
| | - V Bondet
- Immunobiology of Dendritic Cells, Institut Pasteur
| | - E Bruce
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - Y Crow
- Laboratory of Neurogenetics and Neuroinflammation, INSERM UMR1163, Institut Imagine
| | - D Duffy
- Immunobiology of Dendritic Cells, Institut Pasteur
| | - B Parker
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - I Bruce
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - K Martin
- From the University of Manchester
| | | | | | | | - V Athwal
- From the University of Manchester
| | - L Zeef
- From the University of Manchester
| | - S Farrow
- From the University of Manchester
- Respiratory Therapy Area, GlaxoSmithKline
| | | | | | | | - N Hanley
- From the University of Manchester
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Sekhon L, Herlihy N, Lee J, Friedman S, Stein D, Copperman A, Lederman M. Knowledge, attitudes, and concerns of individuals with cancer-predisposing mutations regarding fertility preservation and preimplantation genetic testing. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.419] [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: 11/26/2022]
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23
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Friedman S, Magnussen B, OʼToole A, Fedder J, Larsen MD, Nørgård BM. Increased Use of Medications for Erectile Dysfunction in Men With Ulcerative Colitis and Crohn's Disease Compared to Men Without Inflammatory Bowel Disease: A Nationwide Cohort Study. Am J Gastroenterol 2018; 113:1355. [PMID: 29988041 DOI: 10.1038/s41395-018-0177-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/22/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Men with inflammatory bowel disease (IBD) may have decreased sexual function due to factors related to the underlying disease, medication, and/or surgery. We aimed to examine the use of erectile dysfunction (ED) medications in men with IBD. METHODS This is a nationwide cohort study based on the Danish registries, comprising all men >18 years old with IBD during 1 January 1995 through December 2016. The cohorts included 31,498 men with IBD and 314,980 age-matched men without IBD. Our main outcome was a first prescription of an ED medication. Cox regression analyses were used to estimate the hazard rate (HR) for use of ED medications, controlled for multiple time-varying covariates. RESULTS Overall, 21,966 (69.7%) men had ulcerative colitis (UC) while 9532 (30.3%) had Crohn's disease (CD). Men with a first ED prescription numbered 3749 (11.9%) (men with IBD) and 30,635 (9.7%) (men without IBD). Adjusting for central nervous system and intestinal anti-inflammatory medications, systemic corticosteroids and co-morbidities, the HR was 1.19 (95% CI: 1.13-1.26) (IBD and no prior IBD operation), and 1.31 (95% CI: 1.20-1.43) (IBD and prior IBD operation). The adjusted HR for UC was 1.17 (95% CI: 1.10-1.24) (no operation) and 1.43 (95% CI: 1.27-1.61) (prior operation), and for CD 1.26 (95% CI: 1.15-1.38) (no operation) and 1.20 (95% CI: 1.06-1.35) (prior operation). DISCUSSION Men with IBD are more likely to fill an ED prescription than men without IBD. This result is significant regardless of a history of IBD surgery.
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Affiliation(s)
- S Friedman
- Center for Crohn's and Colitis, Brigham and Women's Hospital, Chestnut Hill, MA, USA. Harvard Medical School, Boston, MA, USA. 3Center for Clinical Epidemiology, Odense University hospital, and Research Unit of Clinical Epidemiology, institute of Clinical Research, University of southern Denmark, Odense, Denmark. Department of Gastroenterology, Beaumont hospital and Royal College of surgeons of ireland, Dublin, ireland. Centre of Andrology and Fertility Clinic, Department D, Odense University hospital, and Research Unit of human Reproduction, institute of Clinical Research, University of southern Denmark, Odense, Denmark.,Center for Crohn's and Colitis, Brigham and Women's Hospital, Chestnut Hill, MA, USA. Harvard Medical School, Boston, MA, USA. 3Center for Clinical Epidemiology, Odense University hospital, and Research Unit of Clinical Epidemiology, institute of Clinical Research, University of southern Denmark, Odense, Denmark. Department of Gastroenterology, Beaumont hospital and Royal College of surgeons of ireland, Dublin, ireland. Centre of Andrology and Fertility Clinic, Department D, Odense University hospital, and Research Unit of human Reproduction, institute of Clinical Research, University of southern Denmark, Odense, Denmark
| | | | - A OʼToole
- Center for Crohn's and Colitis, Brigham and Women's Hospital, Chestnut Hill, MA, USA. Harvard Medical School, Boston, MA, USA. 3Center for Clinical Epidemiology, Odense University hospital, and Research Unit of Clinical Epidemiology, institute of Clinical Research, University of southern Denmark, Odense, Denmark. Department of Gastroenterology, Beaumont hospital and Royal College of surgeons of ireland, Dublin, ireland. Centre of Andrology and Fertility Clinic, Department D, Odense University hospital, and Research Unit of human Reproduction, institute of Clinical Research, University of southern Denmark, Odense, Denmark
| | - J Fedder
- Center for Crohn's and Colitis, Brigham and Women's Hospital, Chestnut Hill, MA, USA. Harvard Medical School, Boston, MA, USA. 3Center for Clinical Epidemiology, Odense University hospital, and Research Unit of Clinical Epidemiology, institute of Clinical Research, University of southern Denmark, Odense, Denmark. Department of Gastroenterology, Beaumont hospital and Royal College of surgeons of ireland, Dublin, ireland. Centre of Andrology and Fertility Clinic, Department D, Odense University hospital, and Research Unit of human Reproduction, institute of Clinical Research, University of southern Denmark, Odense, Denmark
| | | | - B M Nørgård
- Center for Crohn's and Colitis, Brigham and Women's Hospital, Chestnut Hill, MA, USA. Harvard Medical School, Boston, MA, USA. 3Center for Clinical Epidemiology, Odense University hospital, and Research Unit of Clinical Epidemiology, institute of Clinical Research, University of southern Denmark, Odense, Denmark. Department of Gastroenterology, Beaumont hospital and Royal College of surgeons of ireland, Dublin, ireland. Centre of Andrology and Fertility Clinic, Department D, Odense University hospital, and Research Unit of human Reproduction, institute of Clinical Research, University of southern Denmark, Odense, Denmark.,Center for Crohn's and Colitis, Brigham and Women's Hospital, Chestnut Hill, MA, USA. Harvard Medical School, Boston, MA, USA. 3Center for Clinical Epidemiology, Odense University hospital, and Research Unit of Clinical Epidemiology, institute of Clinical Research, University of southern Denmark, Odense, Denmark. Department of Gastroenterology, Beaumont hospital and Royal College of surgeons of ireland, Dublin, ireland. Centre of Andrology and Fertility Clinic, Department D, Odense University hospital, and Research Unit of human Reproduction, institute of Clinical Research, University of southern Denmark, Odense, Denmark
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Berg G, Barchuk M, Zago V, Cevey A, Goren N, Friedman S, Morales C, Schreier L, Miksztowicz V. Is endothelial lipase a supporting actor of lipoprotein lipase in obesity? Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.473] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lynce F, Serrano A, Friedman S, Nahleh Z, Dutil J, Campos C, Ricker C, Rodriguez P, Duron Y, Isaacs C, Graves K. Abstract P6-10-05: UPTAKE study - Uptake of preventive surgeries among Latinas with BRCA1/2 mutations. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-10-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Germline testing for BRCA1/2 genes provides an opportunity to reduce mortality and morbidity by adopting appropriate risk reduction and screening options, in particular with risk-reducing bilateral salpingo-oophorectomy (BSO).There is a paucity of data on Latinas and prophylactic measures among BRCA1/2 carriers.Existing studies are limited either by the small number of Latinas, or limited to a specific geographic location.Factors related to decision making have also not been evaluated.
Methods: The UPTAKE study is an observational study of Latinas with germline BRCA1/2 mutations.Subjects were recruited nationally and, by telephone interviews, reported uptake of prophylactic surgeries (BSO, bilateral mastectomy in unaffected women, and contralateral mastectomy in carriers with breast cancer (BC)). Women with ovarian cancer were ineligible. All women had to have been informed that they carried a deleterious BRCA1/2 mutation at least 1 year prior to completing the interview. The objectives of this study are: 1)to examine the rate of uptake of prophylactic surgeries; 2)identify acculturation and attitudinal factors related to decisions made and 3)examine relationships between primary language, receipt of genetic counseling (GC) and in which language it was provided and uptake of prophylactic surgeries. We plan to enroll 100 participants.
Results: As of 6/11/2017, 86 telephone interviews have been conducted. We anticipate that all 100 interviews will be completed by July 2017. 51.2% (44/86) of participants completed the interview in Spanish. Our population was diverse in terms of country of origin: 50.0% (43/86) were born in the US, 22.1% (19/86) in Mexico, 11.6% (10/86) in Puerto Rico, 4.6% (4/86) in El Salvador, 3.5% (3/86) in Ecuador and 8.1% (7/86) in other countries of Latin America. 30% (26/86) of the participants reported an annual household income inferior to $50.000. Only 26.7% (23/86) of women reported having a graduate degree. Approximately one quarter of participants were unemployed at the time of study participation (26.7%, 23/86). 34.9% (30/86) were unaffected and 62.8% (54/86) were affected with BC. 73.3% (63/86) of participants reported having received formal GC, of which only 28.6% (18/63) was conducted in Spanish. 66.3% (57/86) of women opted to undergo BSO and 58.1% (50/86) underwent prophylactic mastectomy. Being born outside the US and currently working were associated with higher uptake of BSO. Multivariate analysis will be performed once all interviews have been completed.
Conclusions: To our knowledge this is the largest study that evaluates uptake of prophylactic measures in Latinas known to be BRCA1/2 carriers. Our study included a heterogeneous group of participants in terms of country of origin, income and level of education including English knowledge. It was conducted across various academic and community centers in the country. The uptake of prophylactic surgeries among Latinas with germline BRCA mutations seems to be slightly lower than what has been reported in non-Hispanic whites (71-74%) but higher than in African Americans (32-50%). Results and factors associated with decision making will be updated once the total number of participants is enrolled.
Citation Format: Lynce F, Serrano A, Friedman S, Nahleh Z, Dutil J, Campos C, Ricker C, Rodriguez P, Duron Y, Isaacs C, Graves K. UPTAKE study - Uptake of preventive surgeries among Latinas with BRCA1/2 mutations [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-05.
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Affiliation(s)
- F Lynce
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
| | - A Serrano
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
| | - S Friedman
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
| | - Z Nahleh
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
| | - J Dutil
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
| | - C Campos
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
| | - C Ricker
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
| | - P Rodriguez
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
| | - Y Duron
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
| | - C Isaacs
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
| | - K Graves
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Facing Our Risk of Cancer Empowered, Tampa, FL; Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL; Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico; Nueva Vida, Alexandria, VA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; US Oncology, Arlington, VA; Latinas Contra Cancer, San Jose, CA
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Nørgård BM, Magnussen B, Larsen MD, Friedman S. Reassuring results on birth outcomes in children fathered by men treated with azathioprine/6-mercaptopurine within 3 months before conception: a nationwide cohort study. Gut 2017; 66:1761-1766. [PMID: 27456154 DOI: 10.1136/gutjnl-2016-312123] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/09/2016] [Accepted: 07/02/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Information on the safety of paternal use of azathioprine (AZA) and 6-mercaptopurine (6-MP) prior to conception is limited. Based on nationwide data from the Danish health registries, we examined the association between paternal use of AZA/6-MP within 3 months before conception and adverse birth outcomes. DESIGN This nationwide cohort study is based on data from all singletons born in Denmark from 1 January 1997 through 2013. Children fathered by men who used AZA/6-MP within 3 months before conception constituted the exposed cohort (N=699), and children fathered by men who did not use AZA/6-MP 3 months prior to conception constituted the unexposed cohort (N=1 012 624). The outcomes were congenital abnormalities (CAs), preterm birth and small for gestational age (SGA). We adjusted for multiple covariates and performed a restricted analysis of men with IBD. RESULTS There were no significantly increased risks of CAs, preterm birth or SGA in exposed versus unexposed cohorts of children. The adjusted ORs were 0.82 (95% CI 0.53 to 1.28) for CAs, 1.17 (95% CI 0.72 to 1.92) for preterm birth and 1.38 (95% CI 0.76 to 2.51) for SGA. Restricting our analysis to fathers with IBD showed similar results with no significantly increased risk of adverse birth outcomes. CONCLUSIONS This nationwide study is the largest to date, examining the effect of preconceptual paternal use of AZA/6-MP on birth outcomes in live born singletons. The results of no significantly increased risks of adverse birth outcomes are reassuring and support the continuation of paternal AZA/6-MP treatment during conception.
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Affiliation(s)
- B M Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark.,Center for Crohn's and Colitis, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - B Magnussen
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - M D Larsen
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - S Friedman
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark.,Center for Crohn's and Colitis, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Friedman S, Larsen M, Magnussen B, Jølving L, de Silva P, Nørgård B. Paternal use of azathioprine/6-mercaptopurine or methotrexate within 3 months before conception and long-term health outcomes in the offspring—A nationwide cohort study. Reprod Toxicol 2017; 73:196-200. [DOI: 10.1016/j.reprotox.2017.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/13/2017] [Accepted: 08/18/2017] [Indexed: 01/02/2023]
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Liede A, Mansfield CA, Metcalfe KA, Price MA, Snyder C, Lynch HT, Friedman S, Amelio J, Posner J, Narod SA, Lindeman GJ, Evans DG. Preferences for breast cancer risk reduction among BRCA1/BRCA2 mutation carriers: a discrete-choice experiment. Breast Cancer Res Treat 2017. [PMID: 28624978 PMCID: PMC5543193 DOI: 10.1007/s10549-017-4332-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose Unaffected women who carry BRCA1 or BRCA2 mutations face difficult choices about reducing their breast cancer risk. Understanding their treatment preferences could help us improve patient counseling and inform drug trials. The objective was to explore preferences for various risk-reducing options among women with germline BRCA1/2 mutations using a discrete-choice experiment survey and to compare expressed preferences with actual behaviors. Methods A discrete-choice experiment survey was designed wherein women choose between hypothetical treatments to reduce breast cancer risk. The hypothetical treatments were characterized by the extent of breast cancer risk reduction, treatment duration, impact on fertility, hormone levels, risk of uterine cancer, and ease and mode of administration. Data were analyzed using a random-parameters logit model. Women were also asked to express their preference between surgical and chemoprevention options and to report on their actual risk-reduction actions. Women aged 25–55 years with germline BRCA1/2 mutations who were unaffected with breast or ovarian cancer were recruited through research registries at five clinics and a patient advocacy group. Results Between January 2015 and March 2016, 622 women completed the survey. Breast cancer risk reduction was the most important consideration expressed, followed by maintaining fertility. Among the subset of women who wished to have children in future, the ability to maintain fertility was the most important factor, followed by the extent of risk reduction. Many more women said they would take a chemoprevention drug than had actually taken chemoprevention. Conclusions Women with BRCA1/2 mutations indicated strong preferences for breast cancer risk reduction and maintaining fertility. The expressed desire to have a safe chemoprevention drug available to them was not met by current chemoprevention options. Electronic supplementary material The online version of this article (doi:10.1007/s10549-017-4332-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Carol A Mansfield
- RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC, 27709, USA.
| | - Kelly A Metcalfe
- Women's College Hospital, University of Toronto, Toronto, Canada
| | - Melanie A Price
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, Australia
| | | | | | | | - Sue Friedman
- Facing Our Risk of Cancer Empowered (FORCE) Advocacy Organization, Tampa, FL, USA
| | | | - Joshua Posner
- RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC, 27709, USA
| | - Steven A Narod
- Women's College Hospital, University of Toronto, Toronto, Canada
| | - Geoffrey J Lindeman
- The Royal Melbourne Hospital, Parkville, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia.,The Walter & Eliza Hall Institute of Medical Research, Parkville, Australia
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, University of Manchester, Manchester, UK
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Holman L, Chen A, Zhao D, Dockery L, Rezende L, Friedman S. Decision-making surrounding genetic testing among women with ovarian carcinoma. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pirani C, Friedman S, Gatto MR, Iacono F, Tinarelli V, Gandolfi MG, Prati C. Survival and periapical health after root canal treatment with carrier-based root fillings: five-year retrospective assessment. Int Endod J 2017; 51 Suppl 3:e178-e188. [DOI: 10.1111/iej.12757] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- C. Pirani
- Endodontic Clinical Section; Department of Biomedical and Neuromotor Sciences (DIBINEM); School of Dentistry; Alma Mater Studiorum University of Bologna; Bologna Italy
| | - S. Friedman
- Faculty of Dentistry; University of Toronto; Toronto Ontario Canada
| | - M. R. Gatto
- Endodontic Clinical Section; Department of Biomedical and Neuromotor Sciences (DIBINEM); School of Dentistry; Alma Mater Studiorum University of Bologna; Bologna Italy
| | - F. Iacono
- Endodontic Clinical Section; Department of Biomedical and Neuromotor Sciences (DIBINEM); School of Dentistry; Alma Mater Studiorum University of Bologna; Bologna Italy
| | - V. Tinarelli
- Endodontic Clinical Section; Department of Biomedical and Neuromotor Sciences (DIBINEM); School of Dentistry; Alma Mater Studiorum University of Bologna; Bologna Italy
| | - M. G. Gandolfi
- Endodontic Clinical Section; Department of Biomedical and Neuromotor Sciences (DIBINEM); School of Dentistry; Alma Mater Studiorum University of Bologna; Bologna Italy
| | - C. Prati
- Endodontic Clinical Section; Department of Biomedical and Neuromotor Sciences (DIBINEM); School of Dentistry; Alma Mater Studiorum University of Bologna; Bologna Italy
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Friedman S, Larsen PV, Fedder J, Nørgård BM. The reduced chance of a live birth in women with IBD receiving assisted reproduction is due to a failure to achieve a clinical pregnancy. Gut 2017; 66:556-558. [PMID: 27196568 DOI: 10.1136/gutjnl-2016-311805] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 12/08/2022]
Affiliation(s)
- S Friedman
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Boston, Massachusetts, USA
| | - P V Larsen
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Fedder
- Department D, Centre of Andrology and Fertility Clinic, Odense University Hospital, and Research Unit of Human Reproduction, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - B M Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Boston, Massachusetts, USA
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Liede A, Evans G, Metcalfe KA, Price M, Snyder C, Lynch HT, Friedman S, Amelio J, Posner J, Lindeman G, Mansfield CA. Abstract P3-08-08: Preferences for breast cancer risk reduction among BRCA1 and BRCA2 mutation carriers: A discrete choice experiment. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-08-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- A Liede
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - G Evans
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - KA Metcalfe
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - M Price
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - C Snyder
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - HT Lynch
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - S Friedman
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - J Amelio
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - J Posner
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - G Lindeman
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - CA Mansfield
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
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Lucero D, Olano C, Bursztyn M, Morales C, Stranges A, Friedman S, Macri EV, Schreier L, Zago V. Supplementation with n-3, n-6, n-9 fatty acids in an insulin-resistance animal model: does it improve VLDL quality? Food Funct 2017; 8:2053-2061. [DOI: 10.1039/c7fo00252a] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Could supplementation with n-3, n-6 and n-9 fatty acids prevent atherogenic alterations of VLDL produced in insulin-resistance?
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Affiliation(s)
- D. Lucero
- Universidad de Buenos Aires
- Facultad de Farmacia y Bioquímica
- Departamento de Bioquímica Clínica
- Laboratorio de Lípidos y Aterosclerosis
- Buenos Aires
| | - C. Olano
- Universidad de Buenos Aires
- Facultad de Farmacia y Bioquímica
- Departamento de Bioquímica Clínica
- Laboratorio de Lípidos y Aterosclerosis
- Buenos Aires
| | - M. Bursztyn
- Universidad de Buenos Aires
- Facultad de Farmacia y Bioquímica
- Departamento de Bioquímica Clínica
- Laboratorio de Lípidos y Aterosclerosis
- Buenos Aires
| | - C. Morales
- Universidad de Buenos Aires
- Facultad de Medicina
- Instituto de Fisiopatología Cardiovascular (INFICA)
- Buenos Aires
- Argentina
| | - A. Stranges
- Universidad de Buenos Aires
- Facultad de Odontología
- Cátedra de Bioquímica General y Bucal
- Buenos Aires
- Argentina
| | - S. Friedman
- Universidad de Buenos Aires
- Facultad de Odontología
- Cátedra de Bioquímica General y Bucal
- Buenos Aires
- Argentina
| | - E. V. Macri
- Universidad de Buenos Aires
- Facultad de Odontología
- Cátedra de Bioquímica General y Bucal
- Buenos Aires
- Argentina
| | - L. Schreier
- Universidad de Buenos Aires
- Facultad de Farmacia y Bioquímica
- Departamento de Bioquímica Clínica
- Laboratorio de Lípidos y Aterosclerosis
- Buenos Aires
| | - V. Zago
- Universidad de Buenos Aires
- Facultad de Farmacia y Bioquímica
- Departamento de Bioquímica Clínica
- Laboratorio de Lípidos y Aterosclerosis
- Buenos Aires
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Betancourt F, Friedman S, Perlee S, Lachance H, McKay SD. P2014 Examining conserved DNA methylation in the bovine 5’ AMPK gene family. J Anim Sci 2016. [DOI: 10.2527/jas2016.94supplement444a] [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: 11/13/2022] Open
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Sherman ME, Drapkin RI, Horowitz NS, Crum CP, Friedman S, Kwon JS, Levine DA, Shih IM, Shoupe D, Swisher EM, Walker J, Trabert B, Greene MH, Samimi G, Temkin SM, Minasian LM. Rationale for Developing a Specimen Bank to Study the Pathogenesis of High-Grade Serous Carcinoma: A Review of the Evidence. Cancer Prev Res (Phila) 2016; 9:713-20. [PMID: 27221539 PMCID: PMC5010984 DOI: 10.1158/1940-6207.capr-15-0384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/08/2016] [Indexed: 01/10/2023]
Abstract
Women with clinically detected high-grade serous carcinomas (HGSC) generally present with advanced-stage disease, which portends a poor prognosis, despite extensive surgery and intensive chemotherapy. Historically, HGSCs were presumed to arise from the ovarian surface epithelium (OSE), but the inability to identify early-stage HGSCs and their putative precursors in the ovary dimmed prospects for advancing our knowledge of the pathogenesis of these tumors and translating these findings into effective prevention strategies. Over the last decade, increased BRCA1/2 mutation testing coupled with performance of risk-reducing surgeries has enabled studies that have provided strong evidence that many, but probably not all, HGSCs among BRCA1/2 mutation carriers appear to arise from the fallopian tubes, rather than from the ovaries. This shift in our understanding of the pathogenesis of HGSCs provides an important opportunity to achieve practice changing advances; however, the scarcity of clinically annotated tissues containing early lesions, particularly among women at average risk, poses challenges to progress. Accordingly, we review studies that have kindled our evolving understanding of the pathogenesis of HGSC and present the rationale for developing an epidemiologically annotated national specimen resource to support this research. Cancer Prev Res; 9(9); 713-20. ©2016 AACR.
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Affiliation(s)
- Mark E Sherman
- Division of Cancer Prevention, National Cancer Institute Bethesda, Maryland.
| | - Ronny I Drapkin
- The Penn Ovarian Cancer Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil S Horowitz
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christopher P Crum
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sue Friedman
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, Florida
| | - Janice S Kwon
- Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver, BC, Canada
| | - Douglas A Levine
- Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY
| | - Ie-Ming Shih
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Donna Shoupe
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elizabeth M Swisher
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Joan Walker
- Department of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Peggy and Charles Stephenson Cancer Center, Oklahoma City, Oklahoma
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Mark H Greene
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Goli Samimi
- Division of Cancer Prevention, National Cancer Institute Bethesda, Maryland
| | - Sarah M Temkin
- Division of Cancer Prevention, National Cancer Institute Bethesda, Maryland. Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute Bethesda, Maryland
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Roesch EE, Peshkin BN, Johnson A, Murphy S, Hamilton R, Friedman S, Isaacs C, Tercyak K, O'Neill SC. Factors associated with BRCA 1/2 testing among young women from hereditary breast and ovarian cancer families. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e13122] [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: 11/20/2022] Open
Affiliation(s)
| | - Beth N. Peshkin
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| | - Andrea Johnson
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| | - Sarah Murphy
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| | | | - Sue Friedman
- FORCE-Facing our Risk of Cancer Empowered, Tampa, FL
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Kenneth Tercyak
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| | - Suzanne C. O'Neill
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
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Nørgård BM, Larsen PV, Fedder J, de Silva PS, Larsen MD, Friedman S. Live birth and adverse birth outcomes in women with ulcerative colitis and Crohn's disease receiving assisted reproduction: a 20-year nationwide cohort study. Gut 2016; 65:767-76. [PMID: 26921349 DOI: 10.1136/gutjnl-2015-311246] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/08/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the chance of live births and adverse birth outcomes in women with ulcerative colitis (UC) and Crohn's disease (CD) compared with women without inflammatory bowel disease (IBD) who have undergone assisted reproductive technology (ART) treatments. METHODS This was a nationwide cohort study based on Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 2013. The cohorts comprised 1360 ART treatments in 432 women with UC, 554 ART treatments in 182 women with CD and 148,540 treatments in 52,489 women without IBD. Our primary outcome was live births per ART treatment cycle. We controlled for multiple covariates in the analyses. Our secondary outcomes were adverse birth outcomes. RESULTS The chance of a live birth for each embryo transfer was significantly reduced in ART treatments in women with UC (OR=0.73, 95% CI 0.58 to 0.92), but not significantly reduced in the full model of ART treatments in women with CD (OR=0.77, 95% CI 0.52 to 1.14). Surgery for CD before ART treatment significantly reduced the chance of live birth for each embryo transfer (OR=0.51, 95% CI 0.29 to 0.91). In children conceived through ART treatment by women with UC, the OR of preterm birth was 5.29 (95% CI 2.41 to 11.63) in analyses including singletons and multiple births; restricted to singletons the OR was 1.80, 95% CI 0.49 to 6.62. CONCLUSIONS Our results suggest that women with UC and CD receiving ART treatments cannot expect the same success for each embryo transfer as other infertile women. Women with CD may seek to initiate ART treatment before needing CD surgery. Increased prenatal observation in UC pregnancies after ART should be considered.
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Affiliation(s)
- B M Nørgård
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - P V Larsen
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Fedder
- Department D, Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark Research Unit of Human Reproduction, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - P S de Silva
- Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - M D Larsen
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S Friedman
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Armstrong J, Toscano M, Kotchko N, Friedman S, Schwartz MD, Virgo KS, Lynch K, Andrews JE, Aguado Loi CX, Bauer JE, Casares C, Bourquardez Clark E, Kondoff MR, Molina AD, Abdollahian M, Walker G, Sutphen R. Utilization and Outcomes of BRCA Genetic Testing and Counseling in a National Commercially Insured Population: The ABOUT Study. JAMA Oncol 2016; 1:1251-60. [PMID: 26426480 DOI: 10.1001/jamaoncol.2015.3048] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE BRCA genetic testing has substantial public health impact, yet little is known of the real-world experiences of the more than 100 000 Americans undergoing testing annually. OBJECTIVE To identify factors associated with use of BRCA testing, assess whether delivery of genetic counseling and testing services adheres to professional guidelines, and measure the impact on patient-reported outcomes. DESIGN, SETTING, AND PARTICIPANTS The American BRCA Outcomes and Utilization of Testing (ABOUT) Study analyzed data from a consecutive national series of 11 159 women whose clinicians ordered BRCA testing between December 2011 and December 2012. Aetna mailed recruitment information across the United States to commercial health plan members whose clinicians had ordered BRCA testing. A total of 3874 women (34.7%) completed questionnaires. Deidentified clinician-reported data from all respondents and a random sample of 2613 nonrespondents were also analyzed. MAIN OUTCOMES AND MEASURES The proportion of eligible participants who met testing criteria and respondents' report of receiving genetic counseling by a genetics clinician and its association with BRCA knowledge, understanding, and satisfaction were assessed. RESULTS Among 3628 women respondents whose clinicians ordered comprehensive BRCA testing, most were white non-Hispanic (2502 [69.0%]), college educated (2953 [81.4%]), married (2751 [75.8%]), and had higher incomes (2011 [55.4%]). Approximately 16.4% (596) did not meet testing criteria. Mutations were identified in 161 (5.3%) of these women who received comprehensive testing. Only 1334 (36.8%) reported receiving genetic counseling from a genetics clinician prior to testing; the lowest rates (130 [12.3%]) were among patients of obstetrician/gynecologists. The most commonly reported reason for not receiving this clinical service was lack of clinician recommendation. Those who received it demonstrated greater knowledge about BRCA (mean score difference adjusted for demographics and clinician specialty, β = 0.99 [95% CI, 0.83-1.14]; P < .001) and expressed greater understanding (β = 0.47 [95% CI, 0.41-0.54]; P < .001) and satisfaction (β = 2.21 [95% CI, 1.60-2.81]; P < .001). CONCLUSIONS AND RELEVANCE Despite improved patient knowledge, understanding, and satisfaction among patients who receive genetic counseling provided by a genetics clinician, as well as multiple guidelines emphasizing the importance of genetic counseling, most US women undergoing BRCA genetic testing do not receive this clinical service. Lack of physician recommendation is the most commonly reported reason. These findings demonstrate important gaps in clinical genetics services. Recently mandated coverage of genetic counseling services as a preventive service without patient cost sharing should contribute to improving clinical genetics services and associated outcomes in the future.
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Affiliation(s)
| | | | | | - Sue Friedman
- Facing Our Risk of Cancer Empowered, Inc (FORCE), Tampa, Florida
| | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | | | - Kristian Lynch
- Morsani College of Medicine, University of South Florida, Tampa
| | | | | | | | | | | | | | - Ashley D Molina
- Morsani College of Medicine, University of South Florida, Tampa
| | - Mehrnaz Abdollahian
- Department of Industrial and Management Systems Engineering, University of South Florida, Tampa
| | | | - Rebecca Sutphen
- Morsani College of Medicine, University of South Florida, Tampa
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Rezende LF, Huynh J, Kramer K, Cranmer M, Schlager L, Pugh-Yi R, Friedman S. Abstract P5-10-03: XRAYS (eXamining Relevance of Articles to Young Survivors) program survey of information needs and media use by young breast cancer survivors and young women at high risk for breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-10-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Women age 45 or under with breast cancer, or who are at high risk for breast cancer, have distinct health risks and needs when compared to their older counterparts. Young women with breast cancer or at high risk for breast cancer need evidence-based, high-quality information to help them make informed decisions about their specific health needs. Interpreting media reports on research findings, including determining the study implications for younger women is often challenging. To help women better understand media coverage of new research, Facing Our Risk of Cancer Empowered (FORCE) developed the CDC-funded XRAYS (eXamining Relevance of Articles to Young Survivors) program. To assure that the XRAYS program is responsive to the community's needs, FORCE launched a survey to assess where young women turn for information about breast cancer and to identify their information needs. The survey examines: how frequently women visit various media sources and health- or cancer-related websites for information on breast cancer screening, treatment, surgery, prevention, genetics, or survivorship; how much the women trust these information sources; whether they have ever tried to share media articles with their health care team and how the team received the information; and at what point(s) during the process of screening, diagnosis, treatment, survivorship and/or risk management respondents actively seek out information from the media. FORCE launched the survey nationally through its network of 50 outreach groups, partner organizations that serve young breast cancer survivors, and via a social media campaign targeting women age 45 and under with, or at high risk for breast cancer. The survey was open March 15 - June 30, 2015. We will report results from over 800 women, age 45 or younger, including those with breast cancer, who have previously had breast cancer, or who are at high risk for breast cancer. Analysis will determine response frequencies and whether information needs and utilization correlate with key demographic variables such as race/ethnicity, education, and income level. We will use correlation and multiple regression analysis to assess patterns in the types of information needed and channels where information is sought. These results will ensure XRAYS materials and dissemination efforts are efficient and responsive to the young breast cancer population's needs, and will inform the broader medical, media and patient advocacy communities about the distinct information needs of this group.
Citation Format: Rezende LF, Huynh J, Kramer K, Cranmer M, Schlager L, Pugh-Yi R, Friedman S. XRAYS (eXamining Relevance of Articles to Young Survivors) program survey of information needs and media use by young breast cancer survivors and young women at high risk for breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-10-03.
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Affiliation(s)
- LF Rezende
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - J Huynh
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - K Kramer
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - M Cranmer
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - L Schlager
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - R Pugh-Yi
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
| | - S Friedman
- FORCE: Facing Our Risk of Cancer Empowered, Tampa, Fl; Akeso Consulting, LLC, Vienna, VA
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Liede A, Fairchild A, Friedman S, Amelio J, Hallett DC, Mansfield CA, Metcalfe KA. Abstract P2-09-09: Risk-reducing surgery and cancer-related distress among female BRCA1 and BRCA2 mutation carriers. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-09-09] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Distress levels among female BRCA1 and BRCA2 mutation carriers can be similar to levels reported among breast cancer patients. However, there is a lack of data on long-term psychosocial functioning, and it is not known if uptake of risk-reducing surgery influences long-term cancer related distress in women with a BRCA mutation who are unaffected with cancer. The objective of this study was to evaluate long-term cancer-related distress in women with a BRCA mutation, and to evaluate predictors of distress, including uptake of cancer risk reducing surgery.
Methods: Female BRCA1 or BRCA2 mutation carriers, ages 25-55, and without cancer were eligible to complete the survey online. A validated instrument, Impact of Events Scale (IES)-Revised (Horowitz 1979, Weis & Marmar 1995; 0-80 overall scale), was used to assess current levels of cancer risk-related psychological distress. Respondents were recruited through the Facing Our Risk of Cancer Empowered (FORCE) advocacy organization, which includes women at high risk of breast cancer. This interim analysis is part of a larger multi-center patient preference study of BRCA mutation carriers designed to assess women's willingness to adopt hypothetical treatments to prevent breast cancer. Linear regression was used to evaluate predictors of IES distress levels.
Results: Between January and April 2015, 259 women completed the survey. The mean age of the participants was 41 years, and the mean time since receipt of genetic test results was 3.5 years (range 0-16; median 2 years). One hundred thirty-six (52%) women elected for prophylactic bilateral mastectomy (PBM), 139 (54%) elected for bilateral salpingo oophorectomy (BSO) (93 [36%] women had both surgeries), and 77 (30%) had not undergone risk-reducing surgery. The mean total IES score was 15.1 (range 0-72; median 11). Overall, 54 (21%) women reported moderate or severe cancer-related distress, and those who had undergone risk-reducing surgery reported lower perceived risk of developing breast cancer. Results to date indicate that shorter time since notification of mutation status, not having PBM (with or without BSO) (table), and not completing post-secondary education were independent predictors of higher IES distress scores.
IES severityNo prophylactic surgeryPBM onlyBSO onlyPBM and BSOn (%)77434693Subclinical27 (35)23 (54)16 (35)44 (47)Mild26 (34)13 (30)21 (46)35 (38)Moderate18 (23)5 (12)6 (13)11 (12)Severe6 (8)2 (5)3 (6)3 (3)
Conclusions: This study measured cancer-related distress in a large population of women with BRCA mutations who participate in the FORCE online support community. Higher levels of distress were associated with not having PBM and more recent genetic test disclosure. These findings are specific to a more informed community of women with high levels of understanding of cancer risk than may be seen in the clinical setting.
Citation Format: Liede A, Fairchild A, Friedman S, Amelio J, Hallett DC, Mansfield CA, Metcalfe KA. Risk-reducing surgery and cancer-related distress among female BRCA1 and BRCA2 mutation carriers. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-09.
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Affiliation(s)
- A Liede
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - A Fairchild
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - S Friedman
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - J Amelio
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - DC Hallett
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - CA Mansfield
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - KA Metcalfe
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
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Brooks SE, Muller CY, Robinson W, Walker EM, Yeager K, Cook ED, Friedman S, Somkin CP, Brown CL, McCaskill-Stevens W. Increasing Minority Enrollment Onto Clinical Trials: Practical Strategies and Challenges Emerge From the NRG Oncology Accrual Workshop. J Oncol Pract 2015; 11:486-90. [PMID: 26464496 DOI: 10.1200/jop.2015.005934] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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
Racial and ethnic diversity has historically been difficult to achieve in National Cancer Institute-sponsored clinical trials, even while as many as 80% of those trials have faced difficulty in meeting overall recruitment targets. In an attempt to address these issues, NRG Oncology recently convened a comprehensive workshop titled "Clinical Trials Enrollment: Challenges and Opportunities." Discussants at the workshop included representatives of the three legacy groups of the NRG (ie, Gynecologic Oncology Group, National Surgical Adjuvant Breast and Bowel Program, and Radiation Therapy Oncology Group), a minority-based community clinical oncology program, a large integrated health care system, the leadership of the National Cancer Institute, and a large patient advocacy group. This article summarizes the concepts discussed at the workshop, which included: needs assessments, infrastructural support, training of investigators and research staff, specific clinical trial recruitment strategies (both system and community based), and development and mentoring of young investigators. Many new, more specific tactics, including use of diverse cancer care settings, direct-to-consumer communication, and the need for centralized information technology such as the use of software to match trials to special populations, are presented. It was concluded that new, innovative trial designs and the realities of limited funding would require the adoption of effective and efficient recruiting strategies, specialized training, and stakeholder engagement. US clinical research programs must generate and embrace new ideas and pilot test novel recruitment strategies if they are to maintain their historic role as world leaders in cancer care innovation and delivery.
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Affiliation(s)
- Sandra E Brooks
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Carolyn Y Muller
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - William Robinson
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Eleanor M Walker
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Kate Yeager
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Elise D Cook
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Sue Friedman
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Carol P Somkin
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Carol Leslie Brown
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Worta McCaskill-Stevens
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
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Armstrong J, Toscano M, Kotchko N, Friedman S, Schwartz MD, Virgo KS, Lynch K, Andrews JE, Aguado Loi CX, Bauer JE, Casares C, Teten RT, Kondoff MR, Molina AD, Abdollahian M, Brand L, Walker GS, Sutphen R. American BRCA Outcomes and Utilization of Testing (ABOUT) study: a pragmatic research model that incorporates personalized medicine/patient-centered outcomes in a real world setting. J Genet Couns 2014; 24:18-28. [PMID: 25209347 DOI: 10.1007/s10897-014-9750-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/24/2014] [Indexed: 12/19/2022]
Abstract
Research to date regarding identification and management of hereditary breast and ovarian cancer syndrome (HBOC) in the U.S. has been confined primarily to academic center-based studies with limited patient engagement. To begin to understand and address the current gaps and disparities in delivery of services for the appropriate identification and optimal risk management of individuals with HBOC, we designed and have initiated the American BRCA Outcomes and Utilization of Testing (ABOUT) Study. ABOUT relies on a collaborative patient advocacy, academic and industry partnership to recruit and engage U.S. individuals who are at increased risk for HBOC and investigate their experiences, decisions and outcomes. It utilizes an extensive research infrastructure, including an interactive web-based data system and electronic interfaces for secure online participation and automated data exchange. We describe the novel recruitment approach that was designed for collaboration with a national commercial health plan partner to identify all individuals for whom a healthcare provider orders a BRCA test and mail to each individual an invitation to participate and study packet. The study packet contains detailed information about the study, a baseline questionnaire and informed consent for participation in the study, for release of relevant medical and health plan records and for ongoing research engagement. This approach employs patient-reported, laboratory-reported and health plan-reported outcomes and facilitates longitudinal engagement. We believe that the type of innovative methodology and collaborative framework we have developed for ABOUT is an ideal foundation for a patient-powered research network. This approach can make substantial contributions to identifying current and best practices in HBOC, leading to improved strategies for clinical care and optimal health outcomes among individuals with high inherited risk for cancer.
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Pal T, Vadaparampil S, Kim J, Xu Y, Friedman S, Narod SA, Metcalfe K. Interest of individuals from BRCA families to participate in research studies focused on male BRCA carriers. Fam Cancer 2014; 12:615-9. [PMID: 23504063 DOI: 10.1007/s10689-013-9624-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Although men and women are equally likely to carry a mutation in the BRCA1 and BRCA2 (BRCA) genes, the clinical significance of mutations in men remains incompletely defined. We sought evaluate interest of individuals from BRCA families to participate in a research study focused on men from BRCA families. Through an anonymous survey posted on the website of the BRCA patient advocacy organization, facing our risk of cancer empowered (FORCE), data was collected over a 21 month period (August 2010-June 2012) from members of BRCA families. The survey was completed by 405 individuals with known BRCA mutations, including 150 males and 232 females. The median age of survey respondents was 49 years (50 years for males and 48 years for females). Overall, 84% of survey respondents indicated prior BRCA mutation testing (95.2% females, 67.3% males). For the overall group of survey respondents, 84% (86% females, 84% males) indicated they would tell their male relatives about a research study focused on high risk men from BRCA families, and 53% (39% females, 74% males) thought that their male relatives would be interested in participating in such a study. Despite limited studies focused on men from BRCA mutation positive families, our survey suggests that both male and female family members are highly interested in focused on male BRCA mutation carriers. The importance of further studying this topic is underscored by emerging literature that suggest cancer surveillance and treatment decisions may improve outcomes in men with BRCA mutations.
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Affiliation(s)
- Tuya Pal
- H. Lee Moffitt Cancer Center, Tampa, FL, USA,
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Domchek SM, Li J, Digiovanni L, Voong C, Mueller R, Johnson L, Epperson CN, Friedman S, Gracia C. Quality of life in BRCA1 and BRCA2 mutation carriers (B1/2) following risk-reducing salpingo-oophorectomy (RRSO). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.1508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jiaqi Li
- University of Pennsylvania, Philadelphia, PA
| | | | - Chan Voong
- University of Pennsylvania, Philadelphia, PA
| | - Rebecca Mueller
- Basser Research Center for BRCA, University of Pennsylvania,, Philadelphia, PA
| | | | | | | | - Clarisa Gracia
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA
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O'Toole A, Winter D, Friedman S. Review article: the psychosexual impact of inflammatory bowel disease in male patients. Aliment Pharmacol Ther 2014; 39:1085-94. [PMID: 24654697 DOI: 10.1111/apt.12720] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/11/2014] [Accepted: 03/03/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Knowledge of the extent and the impact of sexual dysfunction and interpersonal relationships in men with inflammatory bowel disease is scarce. AIMS The aim of this review article was to summarise the current literature on sexual function in male patients with IBD and to provide a critical review of the IBD-related medical, surgical and psychological complications that can result in impaired quality of sexual health. METHODS To collect relevant articles, PubMed/Medline and Embase searches were performed using Boolean search phrases. RESULTS Reported rates of sexual dysfunction in male IBD patients range from 10% to 50%. Thirty-three to fifty per cent of patients report that sexual desire and satisfaction deteriorated after IBD diagnosis. Of those patients who were sexually inactive, half of these attributed lack of intercourse to underlying IBD. A striking finding reproduced in numerous studies is that disease activity relates strongly to impaired psychological function, and the most consistently reported risk factor for sexual problems in IBD patients is co-existing mood disorders. Hypogonadism is a complication of IBD and its therapies, the role of testosterone deficiency should be further explored as a potentially treatable and reversible factor in sexual dysfunction. CONCLUSIONS By understanding what factors contribute to poor sexual functioning in our patients, we can strive to minimise adverse psychosocial events. Further insight into this complex relationship requires an IBD-specific measure of sexual function in male patients. We recommend screening for and treating co-morbid depression, testosterone deficiency and striving for clinical remission to prevent psychosexual dysfunction in male patients with inflammatory bowel disease.
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Affiliation(s)
- A O'Toole
- Department of Medicine, Harvard Medical School, Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, MA, USA
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Miksztowicz V, Morales C, Zago V, Friedman S, Schreier L, Berg G. Effect of insulin-resistance on circulating and adipose tissue MMP-2 and MMP-9 activity in rats fed a sucrose-rich diet. Nutr Metab Cardiovasc Dis 2014; 24:294-300. [PMID: 24418386 DOI: 10.1016/j.numecd.2013.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 07/05/2013] [Accepted: 08/03/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Adipose tissue produces different metalloproteinases (MMPs), involved in adipogenesis and angiogenesis. Different studies have shown that in obesity the behavior of different MMPs may be altered. However there are scarce data about the effect of insulin-resistance (IR) on MMP-2 and MMP-9 activity in adipose tissue. Our aim was to determine whether sucrose induced IR modifies MMP-2 and MMP-9 behavior in expanded visceral adipose tissue and the contribution of this tissue to circulating activity of these gelatinases. METHODS AND RESULTS Male Wistar rats were fed with standard diet (Control) or standard diet plus 30% sucrose in the drinking water throughout 12 weeks (SRD). In epididymal adipose tissue vascular density, size and adipocyte density, PPARγ expression and MMP-2 and -9 were measured. Adipose tissue from SRD presented higher adipocyte size (6.32 ± 8.71 vs 4.33 ± 2.17 × 10(3) μm(2), p = 0.001) lower adipocyte density (164 (130-173) vs 190 (170-225) number/mm(2), p = 0.046) and lower vascular density (16.2 (12.8-23.5) vs 28.1 (22.3-46.5) blood vessels/mm(2), p = 0.002) than Control. MMP-2 and MMP-9 activity was decreased in SRD (1.93 ± 0.7 vs 3.92 ± 0.9 relative units, p = 0.048 and 1.80 ± 0.8 vs 5.13 ± 1.7 relative units, p = 0.004 respectively) in accordance with lower protein expression (0.35 ± 0.20 vs 2.71 ± 0.48 relative units, p = 0.004 and 1.12 ± 0.21 vs 1.52 ± 0.05 relative units, p = 0.036 respectively). There were no differences in PPARγ expression between groups. CONCLUSION Insulin resistance induced by SRD decreases MMP-2 and MMP-9 activity in adipose tissue which would not represent an important source for circulating MMP-2 and -9. In this state of IR, PPARγ would not be involved in the negative regulation of adipose tissue gelatinases.
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Affiliation(s)
- V Miksztowicz
- Laboratory of Lipids and Lipoproteins, Department of Clinical Biochemistry, Faculty of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, Buenos Aires, Argentina
| | - C Morales
- Institute of Cardiovascular Physiopathology and Department of Pathology, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - V Zago
- Laboratory of Lipids and Lipoproteins, Department of Clinical Biochemistry, Faculty of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, Buenos Aires, Argentina
| | - S Friedman
- Oral and General Biochemistry Department, Faculty of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - L Schreier
- Laboratory of Lipids and Lipoproteins, Department of Clinical Biochemistry, Faculty of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, Buenos Aires, Argentina
| | - G Berg
- Laboratory of Lipids and Lipoproteins, Department of Clinical Biochemistry, Faculty of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, Buenos Aires, Argentina.
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Holman LL, Friedman S, Daniels MS, Sun CC, Lu KH. Acceptability of prophylactic salpingectomy with delayed oophorectomy as risk-reducing surgery among BRCA mutation carriers. Gynecol Oncol 2014; 133:283-6. [PMID: 24582866 DOI: 10.1016/j.ygyno.2014.02.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/16/2014] [Accepted: 02/20/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Given the emerging evidence for the fimbria as the site of origin for many serous carcinomas in BRCA mutation carriers, consideration is being given in studying prophylactic salpingectomy with delayed oophorectomy (PSDO) as a risk-reducing surgery. We aimed to determine the interest in a study of PSDO among these women. METHODS We evaluated the results of an online survey conducted by Facing Our Risk of Cancer Empowered (FORCE), a patient advocacy group, from October 2010 to August 2012. Premenopausal BRCA mutation carriers with no history of ovarian cancer or prior bilateral salpingo-oophorectomy (BSO) were included. RESULTS Of the 204 women meeting inclusion criteria, median age was 35 years, 92.5% were white, 25.7% were Jewish, and 16.7% had a history of breast cancer. Overall, 34.3% reported interest in a study of salpingectomy, 35.3% were unsure, and 30.4% were not interested in the study. Women noted the possibility of lowering ovarian cancer risk without menopause as a compelling reason to participate (83.8%). Reasons for not participating in a salpingectomy study included surgical complications (46.6%), potential ovarian damage (42.2%), planning BSO soon (32.4%), and surgical costs (32.8%). Acceptable study risks included the need for two surgeries (77.2%), possibility of not lowering ovarian cancer risk (68%), and disruption of ovarian blood supply (66.5%). CONCLUSIONS One-third of BRCA mutation carriers indicated definite interest in a PSDO study. Potential study risks were acceptable to most women. These findings suggest that patient accrual for a clinical trial of prophylactic salpingectomy with delayed oophorectomy is possible.
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Affiliation(s)
- Laura L Holman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Sue Friedman
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL, USA
| | - Molly S Daniels
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charlotte C Sun
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Holman L, Friedman S, Daniels M, Sun C, Lu K. Acceptability of salpingectomy alone as risk-reducing surgery for BRCA mutation carriers. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Frank S, Flusberg M, Friedman S, Swinburne N, Sternschein M, Wolf E, Stein M. CT appearance of common cosmetic and reconstructive surgical procedures and their complications. Clin Radiol 2013; 68:e72-8. [DOI: 10.1016/j.crad.2012.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/10/2012] [Accepted: 10/09/2012] [Indexed: 11/29/2022]
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Friedman L, Goldstein B, Rafiuddin A, Roblejo P, Friedman S. Lack of resveratrol neuroprotection in developing rats treated with kainic acid. Neuroscience 2013; 230:39-49. [DOI: 10.1016/j.neuroscience.2012.10.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 09/13/2012] [Accepted: 10/02/2012] [Indexed: 01/06/2023]
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