1
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King AL, Roche KN, Leeper HE, Vera E, Mendoza T, Mentges K, Acquaye-Mallory AA, Adegbesan KA, Boris L, Burton E, Choi A, Grajkowska E, Kunst T, Levine J, Lollo N, Miller H, Panzer M, Penas-Prado M, Pillai V, Polskin L, Reyes J, Sahebjam S, Stockdill ML, Theeler BJ, Wu J, Gilbert MR, Armstrong TS. Feasibility of a virtual reality intervention targeting distress and anxiety symptoms in patients with primary brain tumors: Interim analysis of a phase 2 clinical trial. J Neurooncol 2023; 162:137-145. [PMID: 36884201 PMCID: PMC9993385 DOI: 10.1007/s11060-023-04271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Cancer patients experience distress and anxiety when undergoing imaging studies to monitor disease status, yet these symptoms are not always appropriately identified or well-managed. This interim analysis of a phase 2 clinical trial explored feasibility and acceptability of a virtual reality relaxation (VR) intervention for primary brain tumor (PBT) patients at the time of clinical evaluation. METHODS English speaking, adult PBT patients with previous reports of distress and upcoming neuroimaging were recruited between March of 2021 and March 2022. A brief VR session was done within 2 weeks prior to neuroimaging with patient-reported outcomes (PROs) collected before and immediately post-intervention. Self-directed VR use over the next 1 month was encouraged with additional PROs assessments at 1 and 4 weeks. Feasibility metrics included enrollment, eligibility, attrition, and device-related adverse effects with satisfaction measured with qualitative phone interviews. RESULTS Fifty-five patients were approached via email, 40 (73%) responded and 20 (50%) enrolled (9 declines, 11 screen fails). 65% of participants were ≤ 50 years, 50% were male, 90% were White/non-Hispanic, 85% had good KPS (≥ 90), and most were on active treatment. All patients completed the VR intervention, PROs questionnaires, weekly check-ins, and qualitative interview. Most (90%) reported frequent VR use and high satisfaction and only 7 mild AEs were recorded (headache, dizziness, nausea, neck pain). CONCLUSION This interim analysis supports feasibility and acceptability of a novel VR intervention to target psychological symptoms for PBT patients. Trial enrollment will continue to assess for intervention efficacy. TRIAL REGISTRATION NCT04301089 registered on 3/9/2020.
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Affiliation(s)
- Amanda L King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA. .,Office of Patient-Centered Outcomes Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Road, Bethesda, MD, 20892, USA.
| | - Kayla N Roche
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Heather E Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA.,Office of Patient-Centered Outcomes Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Road, Bethesda, MD, 20892, USA
| | - Tito Mendoza
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA.,Office of Patient-Centered Outcomes Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Road, Bethesda, MD, 20892, USA
| | - Kelly Mentges
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, USA
| | | | - Kendra A Adegbesan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Lisa Boris
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Ewa Grajkowska
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, USA
| | - Tricia Kunst
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Jason Levine
- Center for Cancer Research Office of Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Hope Miller
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Marissa Panzer
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Valentina Pillai
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, USA
| | - Lily Polskin
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Solmaz Sahebjam
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Macy L Stockdill
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Brett J Theeler
- Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
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Leeper HE, Vera E, Christ A, Acquaye A, Briceno N, Choi A, Grajkowska E, Jammula V, Levine J, Lindsley M, Reyes J, Roche KN, Rogers JL, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Polskin L, Theeler BJ, Wu J, Gilbert MR, Armstrong TS. Association of Employment Status With Symptom Burden and Health-Related Quality of Life in People Living With Primary CNS Tumors. Neurology 2023; 100:e1723-e1736. [PMID: 36754634 PMCID: PMC10115506 DOI: 10.1212/wnl.0000000000207082] [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: 06/22/2022] [Accepted: 01/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Financial toxicity significantly impacts many patients, especially cancer survivors. We evaluated the association of unemployment as a major contributor to financial toxicity with patient-reported outcomes (PROs) assessing multiple illness experience domains in a primary CNS tumor (PCNST) cohort. METHODS Patient and disease characteristics and PROs measuring symptom burden, interference, psychologic distress, functional impairment, and health-related quality of life (HRQOL) from participants enrolled an IRB-approved observational study at the US National Institutes of Health's Neuro-Oncology Branch were collected between 9/2016-12/2019. Descriptive statistics, tests of association, and comparison of group means were used to describe and evaluate PROs. RESULTS Of the 277 participants diagnosed with a PCNST, 57% were male and 43% were female. Participants reported their race as White, non-Hispanic (78%); White, Hispanic/Latino (9%); Asian (7%); Black (4%); Native Hawaiian/Pacific Islander (1%); other (2%) with 8% missing. The median age of the overall cohort was 45 years (range 18-74). Hispanic participants in the overall sample were 2.3 times more likely, and in the brain tumor group 3.2 times more likely, to report unemployment (p=.043, OR=2.3, 95% CI [1.0, 5.4] and p=.008, OR=3.2, 95% CI [1.3, 7.9], respectively). The 77 (28%) individuals unemployed due to tumor reported more functional impairment with walking, washing, dressing, performing usual activities, and reduced HRQOL (p<.001). More unemployed participants in the total sample reported moderate-to-severe depressive symptoms (25%) than those employed (8%) (X2(1)=13.9, p<.001, OR=3.7, 95% CI [1.8, 7.8]) and more moderate-to-severe anxiety symptoms (30%) than those employed (15%) (X2(1)=7.8, p=.005, OR=2.4, 95% CI [1.3, 4.5]). Unemployed brain tumor participants reported on average 3 more symptoms as moderate-to-severe compared to those employed (t(83)=-4.0, 95% CI [Formula: see text]difference [-5, -2], p<.001, Hedge's g=.70). DISCUSSION Being unemployed due to a PCNST strongly correlated with high symptom burden, functional impairment, psychological distress and reduced HRQOL which may be impediments to returning to work that warrant intervention. Lack of employer-based health insurance and reduced earnings are financial sequelae of unemployment superimposed on the physical, social, and cognitive effects of living with a PCNST. Innovations to screen for and address financial toxicity and its contributing factors are needed.
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Affiliation(s)
- Heather E Leeper
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexa Christ
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna Choi
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Varna Jammula
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jason Levine
- Office of Information Technology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kayla N Roche
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Timmer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa Boris
- Leidos Biomedical Research, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicole Lollo
- Concentric Methods, LLC, Manassas, Virginia, USA; 5. Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Marissa Panzer
- Leidos Biomedical Research, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Valentina Pillai
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lily Polskin
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Brett J Theeler
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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King AL, Roche KN, Leeper HE, Vera E, Mendoza T, Mentges K, Acquaye AA, Adegbesan K, Boris L, Burton E, Choi A, Grajkowska E, Kunst T, Levine J, Lollo N, Miller H, Panzer M, Penas-Prado M, Pillai V, Polskin L, Reyes J, Sahebjam S, Stockdill M, Theeler BJ, Wu J, Gilbert MR, Armstrong TS. Feasibility of a virtual reality intervention targeting distress and anxiety symptoms in patients with primary brain tumors: Interim analysis of a phase 2 clinical trial. Res Sq 2023:rs.3.rs-2522094. [PMID: 36789426 PMCID: PMC9928043 DOI: 10.21203/rs.3.rs-2522094/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: Cancer patients experience distress and anxiety when undergoing imaging studies to monitor disease status, yet these symptoms are not always appropriately identified or well-managed. This interim analysis of a phase 2 clinical trial explored feasibility and acceptability of a virtual reality relaxation (VR) intervention for primary brain tumor (PBT) patients at the time of clinical evaluation. Methods: English speaking, adult PBT patients with previous reports of distress and upcoming neuroimaging were recruited between March of 2021 and March 2022. A brief VR session was done within 2 weeks prior to neuroimaging with patient-reported outcomes (PROs) collected before and immediately post-intervention. Self-directed VR use over the next 1 month was encouraged with additional PROs assessments at 1 and 4 weeks. Feasibility metrics included enrollment, eligibility, attrition, and device-related adverse effects with satisfaction measured with qualitative phone interviews. Results: 55 patients were approached via email, 40 (73%) responded and 20 (50%) enrolled (9 declines, 11 screen fails). 65% of participants were ≤ 50 years, 50% were male, 90% were White/non-Hispanic, 85% had good KPS (≥ 90), and most were on active treatment. All patients completed the VR intervention, PROs questionnaires, weekly check-ins, and qualitative interview. Most (90%) reported frequent VR use and high satisfaction and only 7 mild AEs were recorded (headache, dizziness, nausea, neck pain). Conclusion: This interim analysis confirmed feasibility and acceptability of a novel VR intervention to target psychological symptoms for PBT patients. Trial enrollment will continue to assess for intervention efficacy. Trial Registration: NCT04301089 registered on 3/9/2020.
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Affiliation(s)
- Amanda L King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Kayla N Roche
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Heather E Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Tito Mendoza
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Kelly Mentges
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc
| | - Alvina A Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Kendra Adegbesan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Lisa Boris
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Ewa Grajkowska
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc
| | - Tricia Kunst
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc
| | - Jason Levine
- Center for Cancer Research Office of Information Technology, National Cancer Institute, National Institutes of Health
| | - Nicole Lollo
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc
| | - Hope Miller
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Marissa Panzer
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Valentina Pillai
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc
| | - Lily Polskin
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Solmaz Sahebjam
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Macy Stockdill
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | | | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health
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4
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Wollet A, Leeper H, Vera E, Mentges K, King A, Rogers J, Sass D(D, Acquaye A, Adegbesan K, Boris L, Burton E, Celiku O, Chambers C, Choi A, Christ A, De Le Minyety JC, Evans K, Grajkowska E, Komlodi-Pasztor E, Levine J, Lindsley M, Lollo N, Mendoza T, Miller H, Panzer M, Penas-Prado M, Pillai V, Polskin L, Reyes J, Roche K, Sahebjam S, Stockdill M, Theeler B, Wall K, Wu J, Gilbert M, Armstrong T, Shuboni-Mulligan D. INNV-25. ASSESSING SLEEP AND CIRCADIAN RHYTHMS IN PRIMARY BRAIN TUMORS PATIENTS: AN OBSERVATIONAL STUDY. Neuro Oncol 2022. [PMCID: PMC9660808 DOI: 10.1093/neuonc/noac209.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Sleep-wake disturbances are among the most common and severe symptoms in primary brain tumor (PBT) patients. Currently, no studies have quantified their physiological sleep measurements or compared these assessments to established patient reported outcome measures (PROs). Smart wearable devices, such as Fitbits, continuously monitor patient behaviors at home and provide detailed physiological measurements of sleep, activity, and heart rate. We hypothesized that smart wearable devices can accurately determine physiological sleep disturbances and circadian disruptions and will complement established PROs in a PBT patient population. This observational, cross-sectional trial monitors sleep and circadian rhythm variables using Fitbit smart wearable devices worn for 1 month. Additionally, participants will answer PROs questionnaires (PROMIS Sleep Disturbance and Sleep Related Impairment-Short Forms, Sleep Hygiene Index, Morningness-Eveningness questionnaire, and Consensus Sleep Diary) at study entry and during the last week on-study. The present study is a planned interim analysis of 54 patients to assess feasibility, including evaluation of enrollment, attrition, study parameter completion and data missingness. 73 PBT patients were screened and approached. Of these patients, 54 (74%) were enrolled on study and 19 (26%) declined participation (8 lacked interest, 3 discomfort wearing watches, 3 lacked smart phone, 2 unable to wear device at work, 2 unable to attend consent calls, 1 pregnancy and 1 cognitive complication). The accrued patients were 56% male, 56%³ 50 years of age, and 81% had a KPS³ 90. Patients represented different stages of treatment: 6% of patients were newly diagnosed, 24% on active treatment (11% 1st recurrence, 13% 2nd recurrence), and 70% were on imaging surveillance. Feasibility was confirmed as there were no deviations reported and 100% of PROs and study timepoints completed. Quantified Fitbit data including percent time worn and physiologic sleep parameters will be reported. Study enrollment for efficacy measures continues.
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Affiliation(s)
- Alex Wollet
- National Cancer Institute , youngstown, OH , USA
| | - Heather Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kelly Mentges
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Amanda King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - James Rogers
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Dilorom (Delia) Sass
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kendra Adegbesan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lisa Boris
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Orieta Celiku
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Claudia Chambers
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | | | - Karen Evans
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health , Bethesda , USA
| | - Edina Komlodi-Pasztor
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health , Bethesda , USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Tito Mendoza
- National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Hope Miller
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marissa Panzer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Valentina Pillai
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lily Polskin
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kayla Roche
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Solmaz Sahebjam
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Macy Stockdill
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Brett Theeler
- National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kathleen Wall
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Mark Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Terri Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Dorela Shuboni-Mulligan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
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5
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King A, Roche K, Leeper H, Vera E, Mendoza T, Mentges K, Acquaye A, Adegbesan K, Boris L, Burton E, Chambers C, Choi A, Christ A, Evans K, Grajkowska E, Levine J, Lindsley M, Lollo N, Komlodi-Pasztor E, Miller H, Panzer M, Penas-Prado M, Pillai V, Polskin L, Reyes J, Rogers J, Sahebjam S, Sass D(D, Shuboni-Mulligan D, Stockdill M, Theeler B, Wall K, Wollet A, Wu J, Gilbert M, Armstrong T. INNV-21. FEASIBILITY OF A VIRTUAL REALITY (VR) INTERVENTION TARGETING DISTRESS AND ANXIETY IN PRIMARY BRAIN TUMOR (PBT) PATIENTS AT THE TIME OF NEUROIMAGING: INTERIM ANALYSIS OF A PHASE 2 CLINICAL TRIAL. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
PBT patients experience high levels of distress and anxiety symptoms at the time of neuroimaging, yet few non-pharmacological interventions are available. This phase 2 clinical trial interim analysis explored feasibility of a VR relaxation intervention for a PBT population.
METHODS
PBT patients seen at NIH were recruited to participate in this single arm trial conducted via telehealth. English-speaking, adult patients with upcoming neuroimaging who can self-report symptoms and have reported distress on previous MD Anderson Symptom Inventory-Brain Tumor assessments were eligible. Exclusion criteria include recent surgery or seizures, anxiety disorders, nausea, or visual deficits. The primary intervention consisted of a brief VR session done within 2 weeks prior to neuroimaging with patient-reported outcomes (PROs) collected before and immediately post-intervention, as well as 1 week and 4 weeks later, with self-directed VR use over 1 month. A qualitative phone interview was also completed to assess patient satisfaction.
RESULTS
Fifty-five patients were screened and approached with 40 (73%) responding to initial reach-out and 20 ultimately enrolling (9 declines, 11 screen fails). Decline reasons included: no distress/anxiety (30%), treatment-related toxicities (11%), and unknown (59%). Seven (64%) failed screening due to exclusionary anxiety disorders (36% GAD, 18% PTSD, 9% claustrophobia). Of those enrolled, 65% were ≤ 50 years, 50% were male, 90% were White/non-Hispanic, 85% had good KPS ( > 80), 65% had high-grade tumors, and most were on active treatment. All enrolled patients completed the VR intervention and participation period, PROs questionnaires, weekly check-ins, and qualitative interview. Most patients (90%) reported frequent VR use with 7 mild adverse effects reported (headache, dizziness, nausea, neck pain).
CONCLUSION
These findings suggest that this intervention is feasible for this population with high enrollment and study completion, though incidence of anxiety disorders was higher than anticipated and a comprehensive evaluation of this cohort is planned.
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Affiliation(s)
- Amanda King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kayla Roche
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Heather Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Tito Mendoza
- National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kelly Mentges
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kendra Adegbesan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lisa Boris
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Claudia Chambers
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Karen Evans
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Edina Komlodi-Pasztor
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Hope Miller
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marissa Panzer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Valentina Pillai
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lily Polskin
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - James Rogers
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Solmaz Sahebjam
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Dilorom (Delia) Sass
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Dorela Shuboni-Mulligan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Macy Stockdill
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Brett Theeler
- National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kathleen Wall
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Alex Wollet
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Mark Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Terri Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
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6
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Bergsneider B, Vera E, Gal O, Christ A, King A, Acquaye A, Choi A, Leeper H, Mendoza T, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Polskin L, Wu J, Gilbert M, Armstrong T, Celiku O. NCOG-39. DISCOVERY OF CLINICAL AND DEMOGRAPHIC DETERMINANTS OF SYMPTOM BURDEN IN PRIMARY BRAIN TUMOR PATIENTS USING NETWORK ANALYSIS AND UNSUPERVISED CLUSTERING. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Precision health approaches to managing symptom burden in primary brain tumor (PBT) patients are imperative to improving patient outcomes and quality of life. Network Analysis (NA) identifies complex symptom co-severity patterns across large patient cohorts. Unsupervised clustering unbiasedly stratifies patients into clinically relevant subgroups based on symptom patterns. This is the first study to use NA and unsupervised clustering to explore PBT patients’ clinical and demographic determinants of symptom burden.
METHODS
Symptom severity data reported using the MDASI-BT from a two-institutional cohort of 1,128 PBT patients was analyzed. Gaussian Graphical Model networks were constructed for the entire cohort and for subgroups identified by unsupervised clustering. Network characteristics were analyzed and compared using permutation-based statistical tests.
RESULTS
NA on the entire cohort revealed that the majority of PBT patients experience symptoms on four core dimensions that drive overall symptom burden: cognitive, physical, focal neurologic, and affective. These dimensions substantially overlap with factor groupings defined during initial construct validation of the MDASI-BT. Fatigue/drowsiness scored the highest in all network centrality measures, indicating a pivotal role in the symptom experience. Unsupervised clustering identified four patient subgroups: PC1 (n = 683), PC2 (n = 244), PC3 (n = 92), and PC4 (n = 109). Moderately accurate networks could be constructed for PC1 and PC2, but not for PC3 and PC4 due to their small size. The PC1 network closely resembles the all-patient network, and these patients have the highest interference scores among the subgroups with fatigue/drowsiness as the primary driver. PC2 represents an older subgroup in which cognitive symptoms drive symptom burden.
CONCLUSIONS
This novel study identified clinically relevant subgroups of patients with unique symptom burdens. With further validation, our approach may inform more personalized and effective symptom management by identifying symptoms to prioritize for targeting in individual patients.
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Affiliation(s)
- Brandon Bergsneider
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Ophir Gal
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Amanda King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Heather Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Tito Mendoza
- University of Texas M.D. Anderson Cancer Center , Houston, TX , USA
| | - Lisa Boris
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marissa Panzer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Valentina Pillai
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lily Polskin
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Mark Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Terri Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Orieta Celiku
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
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7
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Briceno N, Abdullaev Z, Vera E, Komlodi-Pasztor E, Choi A, Christ A, Grajkowska E, Leeper H, Levine J, Lindsley M, Reyes J, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Theeler B, Kunst T, Evans K, Mentges K, Wu J, Polskin L, Papanicolau-Sengos A, Quezado M, Aldape K, Gilbert M, Armstrong T. BIOM-46. EXPLORING CLINICAL AND PATHOLOGIC CHARACTERISTICS IN GLIOBLASTOMA LONG -TERM SURVIVORS (LTS) VERSUS SHORT-TERM SURVIVORS (STS). Neuro Oncol 2022. [PMCID: PMC9660881 DOI: 10.1093/neuonc/noac209.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Glioblastoma (GBM) has a median survival of less than 18 months with infrequent long-term survival (LTS). Reports on LTS to date have not identified distinct molecular or clinical/imaging characteristic in long ( >3 years) versus short (< 3 year) survivors. We identified IDH wildtype GBM patients living ≥ 3 years post diagnosis (LTS, Nf25) and a control cohort (STS, Nf76) from our Natural History Study. Available tissue was analyzed with targeted panel sequencing (Nf25) and methylation analysis (Nf21) for classification, MGMT promoter (MGMTp) status and copy number changes. Median survival and age for LTS and STS was 54mo and 48yrs, and 16mo and 56yrs, respectively. LTS were more likely to be female (2.8x) or have a GTR (2.9x) but 83% less likely to be white. MGMTp was 10x more likely to be methylated in LTS tumors (95% CI [2.6, 39.6]), yet was unmethylated in 17%. LTS were 63% and 90% less likely to have TERTp or EGFR amplification (95% CI [0.14, 0.97] and [0.04, 0.29]). Core pathway review showed 21% of LTS had at least one alteration in p53, RB and RTK/PI3K with RTK/PI3K the most common (46%) . Methylation classifier identified 74% as GBM (STS=96%) with most the RTK II subtype (53%; STS=41%) and despite classic histologic features, indicated a non-GBM diagnosis in three cases (14%).Although uncommon, there are LTS with molecularly confirmed GBM. Remarkably, not all had MGMTp methylation, were young or had extensive tumor resection. Clinical estimates of outcome in GBM patients should consider the possibility of long-term survival even with established poor prognostic factors. Imaging characteristics in a subset of these cases are reported in a separate abstract. Additional interrogation of tumor from LTS may uncover additional determinants of response and outcomes.
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Affiliation(s)
- Nicole Briceno
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | | | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Edina Komlodi-Pasztor
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health , Bethesda , USA
| | - Heather Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | | | - Matthew Lindsley
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lisa Boris
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marissa Panzer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Valentina Pillai
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | | | | | | | - Kelly Mentges
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lily Polskin
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | | | | | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health , Bethesda , USA
| | - Mark Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Terri Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
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8
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Komlodi-Pasztor E, Briceno N, Vera E, Choi A, Christ A, Grajkowska E, Leeper H, Lindsley M, Wall K, Evans K, Kunst T, Mentges K, Reyes J, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Theeler B, Wu J, Polskin L, Armstrong T, Gilbert M, Smirniotopoulos J. NIMG-101. COMPARISON OF PRE-SURGICAL MRI FINDINGS FROM LONG-TERM (≥ 3 YRS) VERSUS SHORT-TERM (< 3 YRS) GLIOBLASTOMA SURVIVORS: A BLINDED, CASE-CONTROL REVIEW. Neuro Oncol 2022. [PMCID: PMC9661057 DOI: 10.1093/neuonc/noac209.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
The median overall survival of patients with glioblastoma (GBM) is 10-12 months and the five-year survival ranges from 5-10%. Favorable clinical and molecular prognostic markers have been described in the literature, although an individual patient’s prognosis cannot easily be predetermined on these features as shown in the NOB-LTS project by Briceno et al. (SNO 2021). Until now, no radiologic characteristics have been correlated with better patient outcomes. We reviewed eighteen MRI features to determine if these could aid the identification of long-term survivors (LTS).
METHODS
From the NOB-LTS cohort of our Natural History Study, 16 long-term survivals (LTS; ≥ 3 years survival post-diagnosis) were matched based on sex, age, and extent of resection to 32 control (STS, < 3 years survival post-diagnosis) patients with NGS-confirmed IDH-wt glioblastoma. Pre-surgical MRIs (T1, T1 post-contrast, T2, T2/FLAIR, DWI, ADC) were reviewed by three blinded reviewers and analyzed based on pre-set criteria.
RESULTS
T1 hypointensity occurred commonly in the LTS (71%) vs STS (29%) while central heterogeneous signal occurred commonly in the STS (73%) vs LTS (50%) patients. Restricted diffusion was seen in 82% of STS and 70% of LTS cases. No difference was seen in irregular enhancement, peripheral and grey matter enhancement on T1 post-contrast images. Evaluation of T2/FLAIR images showed no difference in the number of lobes involved, presence of mass effect, heterogeneity of the signal or the perilesional signal abnormality or involvement of grey matter.
CONCLUSION
Our results suggest that pre-surgical MRI might be a useful prognostic tool as T1 hypointensity more frequently, and T1 central heterogeneity less commonly seen in the LTS group. These imaging findings may provide additional insights regarding the differences in tumor biology between LTS and STS. Further validation and correlation with histological/molecular characteristics are planned to better predict patient outcomes with newly diagnosed glioblastoma.
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Affiliation(s)
| | - Nicole Briceno
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health , Bethesda , USA
| | - Heather Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kathleen Wall
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Karen Evans
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | | | - Kelly Mentges
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | | | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marissa Panzer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | | | - Valentina Pillai
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Brett Theeler
- National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | | | | | - Terri Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Mark Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
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9
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Miller H, Christ A, Grajkowska E, Acquaye A, Adegbesan K, Boris L, Burton E, Chambers C, Choi A, Evans K, King A, Komlodi-Pasztor E, Leeper H, Levine J, Lindsley M, Lollo N, Mentges K, Panzer M, Penas-Prado M, Pillai V, Polskin L, Reyes J, Roche K, Rogers J, Sahebjam S, Sass D(D, Shuboni-Mulligan D, Stockdill M, Theeler B, Wall K, Wollet A, Wu J, Diarte J, Gilbert M, Avila E, Armstrong T, Vera E. NCOG-40. UTILITY OF THE SEIZURE CONTROL COMPOSITE INDEX (RANO-SCCI) IN EVALUATING SEIZURES IN CNS TUMOR PATIENTS. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Seizures are a common symptom in patients with CNS tumors. The RANO-Seizure Control Composite Index (RANO-SCCI) was developed to monitor seizures over time by patients and clinicians. We describe the use of the RANO-SCCI as part of the NCI NOB-Natural History Study.
METHODS
Patients completed a RANO-SCCI prior to their clinic appointment with results shared with clinicians who then completed a RANO-SCCI as part of the same appointment. Seizure reports were tallied by respondent type and further by tumor type and grade. Concordance between patient and clinician report was also investigated.
RESULTS
One hundred fifty-seven patients underwent 250 clinical evaluations. Participants were primarily white (82%) males (57%) with median age 47 years (range: 19 – 78). Most had high grade (60%) primary brain (86%) tumors, were in surveillance (76%), with no prior recurrence (57%) and KPS ≥ 90 (76%). Half of patients and 62% of clinicians reported the patient ever having a seizure. The 12% discordance were all where the patient did not report a seizure, but clinicians did. There was good agreement on seizure reporting since last visit (74% patients, 78% clinicians), and anti-seizure medication use (51% patients, 57% clinicians). Seizures were reported more frequently in patients with high-grade tumors (WHO Grade 3 or 4) (60% patients, 76% clinicians) versus low-grade (WHO Grade 1 or 2) (51% patients, 59% clinicians), and among patients with oligodendrogliomas (71% patients, 85% clinicians) versus non-oligodendroglioma tumors (54% patients, 68% clinicians).
CONCLUSIONS
The RANO-SCCI was used for self-report and clinician report of seizure activity. A higher frequency was reported among oligodendroglioma and high-grade tumors. Disparities between patient and clinician responses may reveal a limitation in the patient’s ability to recognize and assess their seizure symptoms. Further work will investigate reporting congruence and associations with clinical and demographic characteristics.
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Affiliation(s)
- Hope Miller
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health , Bethesda , USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kendra Adegbesan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lisa Boris
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Claudia Chambers
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Karen Evans
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Amanda King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Edina Komlodi-Pasztor
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Heather Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health , Bethesda , USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kelly Mentges
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marissa Panzer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Valentina Pillai
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lily Polskin
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kayla Roche
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - James Rogers
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Solmaz Sahebjam
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Dilorom (Delia) Sass
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Dorela Shuboni-Mulligan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Macy Stockdill
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Brett Theeler
- National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kathleen Wall
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Alex Wollet
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Jose Diarte
- Memorial Sloan Kettering Cancer Center , New York, NY , USA
| | - Mark Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Edward Avila
- Memorial Sloan Kettering Cancer Center , New York, NY , USA
| | - Terri Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
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10
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Kim Y, Rogers J, Jammula V, Vera E, Christ A, Leeper H, Acquaye A, Boris L, Briceno N, Burton E, Choi A, Grajkowska E, Komlodi-Pasztor E, Levine J, Lindsley M, Lollo N, Panzer M, Penas-Prado M, Pillai V, Polskin L, Reyes J, Roche K, Smith-Cohn M, Theeler B, Wu J, Gilbert M, Armstrong T. INNV-32. COMPARING THE MONTREAL COGNITIVE ASSESSMENT (MOCA) FULL AND 5-MINUTE PROTOCOLS IN MILD COGNITIVE IMPAIRMENT SCREENING OF ADULT CNS TUMOR PATIENTS. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Mild cognitive impairment (MCI) commonly occurs in primary CNS tumor patients (PCTP). Our group and others have reported on the Montreal Cognitive Assessment (MoCA) as an MCI screening tool. Several abbreviated MoCA protocols have been developed for telehealth administration in other neurological diseases, with varied literature on scoring and clinical utility. We compared MoCA Full and 5-minute scores to assess utility in neuro-oncology.
METHODS
71 PCTP completed the MoCA Full (abnormal: < 26/30) assessing: visuospatial/executive functioning, naming, memory, attention, language, abstraction, delayed recall, and orientation. Full scores were retrospectively recoded to the Pendlebury MoCA 5-minute protocol (abnormal: < 10/12) assessing: memory, delayed recall, and orientation. Correlation was assessed using Pearson’s coefficient. Disagreements between tests were examined using t-test and chi-square test.
RESULTS
Patients were primarily White (83%), college-educated (71%) males (54%) diagnosed with glioblastoma (20%), with average age of 43 years (range: 19-75), KPS > 80 (57%), prior radiation treatment (78%), and imaging surveillance at time of testing (79%). MoCA Full and 5-minute mean scores were 25.3 (SD: 4.8) and 9.9 (SD: 2.3), respectively. MCI was indicated in 32% (n= 23) of patients using MoCA Full and 27% (n= 19) using MoCA 5-minute. Where the protocols disagreed, MCI was detected only by MoCA Full in 6 patients (8%), and MoCA 5-minute in 2 patients (3%). Visuospatial/executive (p= 0.025) and abstraction (p< 0.001) subdomain scores, unique to MoCA Full, were significantly associated with MCI detected only by the MoCA Full; other subdomains, patient characteristics, and total score were not significant. The MoCA versions were highly correlated (r= 0.90).
CONCLUSION
High correlation and agreement between MoCA Full and 5-minute scores in this neuro-oncology patient population highlight potential telehealth utility of the MoCA 5-minute. Future prospective assessment of the MoCA 5-minute is warranted to describe optimal scoring threshold and utility in neuro-oncology.
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Affiliation(s)
| | - James Rogers
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Varna Jammula
- National Cancer Institute, National Institutes of Health , Bethesda , USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Heather Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lisa Boris
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Nicole Briceno
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health , Bethesda , USA
| | - Edina Komlodi-Pasztor
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health , Bethesda , USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marissa Panzer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Valentina Pillai
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Lily Polskin
- National Institutes of Health, National Cancer Institute (NCI), Center for Cancer Research (CCR), Neuro-Oncology Branch (NOB) , Bethesda, MD , USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Kayla Roche
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Matthew Smith-Cohn
- The Ben & Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Neuroscience Institute , Seattle, WA , USA
| | - Brett Theeler
- National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Mark Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Terri Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
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11
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Sass D, Vera E, Choi A, Acquaye A, Briceno N, Christ A, Grajkowska E, Jammula V, Levine J, Lindsley M, Reyes J, Roche K, Rogers JL, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Polskin L, Theeler BJ, Wu J, Gilbert MR, Armstrong TS, Leeper H. Evaluation of the key geriatric assessment constructs in primary brain tumor population - a descriptive study. J Geriatr Oncol 2022; 13:1194-1202. [PMID: 36041994 DOI: 10.1016/j.jgo.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/04/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Despite an increasing aging population, older adults (≥ 65 years) with primary brain tumors (PBTs) are not routinely assessed for geriatric vulnerabilities. Recent reports of geriatric assessment (GA) in patients with glioblastomas demonstrated that GA may serve as a sensitive prognosticator of overall survival. Yet, current practice does not include routine evaluation of geriatric vulnerabilities and the relevance of GA has not been previously evaluated in broader cohorts of PBT patients. The objective of this descriptive study was to assess key GA constructs in adults with PBT dichotomized into older versus younger groups. MATERIALS AND METHODS A cross-sectional analysis of data collected from 579 participants with PBT recruited between 2016 and 2020, dichotomized into older (≥ 65 years, n = 92) and younger (≤ 64 years, n = 487) from an ongoing observational trial. GA constructs were evaluated using socio-demographic characteristics, Charlson Comorbidity Index (CCI), polypharmacy (>5 daily medications), Karnofsky Performance Status (KPS), Neurologic Function Score (NFS), and patient-reported outcome assessments including general health, functional status, symptom burden and interference, and mood. Descriptive statistics, t-tests, chi-square tests, and Pearson correlations were used to evaluate differences between age groups. RESULTS Older participants were more likely to have problems with mobility (58% vs. 44%), usual activities (64% vs 50%) and self-care (38% vs 26%) compared to the younger participants (odds ratios [ORs] = 1.3-1.4, ps < 0.05), while older participants were less likely to report feeling distressed (OR = 0.4, p < 0.05). Older participants also had higher CCI and were more likely to have polypharmacy (OR = 1.7, ps < 0.05). Increasing age strongly correlated with worse KPS score (r = -0.232, OR = 1.4, p < 0.001) and worse NFS (r = 0.210, OR = 1.5, p < 0.001). No differences were observed in overall symptom burden, symptom interference, and anxiety/depression scores. DISCUSSION While commonly used GA tools were not available, the study employed patient- and clinician-reported outcomes to identify potential future research directions for the use of GA in the broader neuro-oncology population. Findings illustrate missed opportunities in neuro-oncology practice and underscore the need for incorporation of GA into routine care of this population. Future studies are warranted to further evaluate the prognostic utility of GA and to better understand functional aging outcomes in this patient population.
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Affiliation(s)
- Dilorom Sass
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Varna Jammula
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, MD, USA
| | - Brett J Theeler
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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12
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Jammula V, Rogers JL, Vera E, Christ A, Leeper HE, Acquaye A, Briceno N, Choi A, Grajkowska E, Levine J, Lindsley M, Reyes J, Roche K, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Smith-Cohn MA, Penas-Prado M, Pillai V, Theeler BJ, Wu J, Gilbert MR, Armstrong TS. The Montreal Cognitive Assessment (MoCA) in Neuro-Oncology: A Pilot Study of Feasibility and Utility in Telehealth and In-Person Clinical Assessments. Neurooncol Pract 2022; 9:429-440. [PMID: 36124322 PMCID: PMC9384084 DOI: 10.1093/nop/npac038] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cognitive impairments are a common burden for patients with primary CNS tumors. Neuropsychological assessment batteries can be too lengthy, which limits their use as an objective measure of cognition during routine care. The purpose of this study was to evaluate the feasibility and utility of the brief Montreal Cognitive Assessment (MoCA) in routine in-person and telehealth visits (as a result of the global COVID-19 pandemic) with neuro-oncology patients.
Methods
71 adults with primary CNS tumors completed MoCA testing in-person (n=47) and via telehealth (n=24). Patient-reported outcomes (PROs), including symptom burden and interference, perceived cognition, general health status, and anxiety and depression, were and correlation analysis were included in this study. Feasibility was assessed through a provider satisfaction questionnaire.
Results
Patients were primarily White (83%), college-educated (71%) males (54%) with high grade tumors (66%). The average total score on the MoCA administered in-person was 25 (range: 6-30), with 34% classified as abnormal, and the average total score via telehealth was 26 (range: 12-30), with 29% classified as abnormal. Providers reported satisfaction in using the MoCA during routine clinical care, both in-person and via telehealth. Lower MoCA scores correlated with worse symptom severity, KPS, age, education, and previous treatment.
Conclusions
The MoCA was feasible in clinical and telehealth settings, and its relationship to clinical characteristics and PROs highlight the need for both objective and patient-reported measures of cognition to understand the overall cognitive profile of a patient with a CNS tumor.
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Affiliation(s)
- Varna Jammula
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James L Rogers
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather E Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew A Smith-Cohn
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett J Theeler
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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13
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Panzer M, Vera E, Acquaye A, Briceno N, Choi A, Christ A, Grajkowska E, Jammula V, Leeper H, Levine J, Lindsley M, Reyes J, Roche K, Rogers J, Timmer M, Boris L, Burton E, Lollo N, Polskin L, Penas-Prado M, Pillai V, Theeler B, Wu J, Gilbert M, Armstrong T. NCOG-47. CONGRUENCE BETWEEN PROVIDER REPORTED PERFORMANCE STATUS AND BOTH OBJECTIVE AND PERCEIVED COGNITION IN A GLIOMA POPULATION. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.636] [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: 11/12/2022] Open
Abstract
Abstract
Karnofsky performance status (KPS) scale, a clinician-reported measure, is used to assess patients’ functional ability and as a metric for trial eligibility. Glioma patients often have a degree of neurologic deficit which can invariably affect performance status. There is little research comparing KPS, patient-reported cognitive outcomes, and objective cognitive outcomes. 273 primary brain tumor patients enrolled in the NOB Natural History Study were included in this report. We evaluated Pearson correlations between KPS (range 40-100), dichotomized as Good KPS (KPS ≥ 90) and Poor KPS (KPS ≤ 80), and MDASI-BT cognitive symptom factor, NeuroQoL Cognitive Function t-score, EQ-5D-3L index score, and objective MoCA test. The majority of patients were white (81%), male (58%) with a median 50 years of age (range 24-79). Most had high grade gliomas (74%), 22% were on active treatment, and 55% had prior tumor recurrences. Providers reported a poor KPS in 37% of patients. KPS correlated with the MDASI-BT cognitive symptoms (r = -0.32), NeuroQoL (r = 0.39), and EQ-5D-3L index score (r = 0.55) (all p < 0.01). Patients with poor KPS reported moderate-severe cognitive symptoms on the Neuro-QoL Cognitive Function (40%), moderate-severe difficulty remembering on the MDASI-BT (37%), and difficulty with usual activities on the EQ-5D-3L (83%). In a subset of 27 patients, MoCA scores were assessed but no significant correlation was found with KPS (r = 0.19, p = 0.352). Patient-reported and objective cognitive dysfunction was seen in up to 36% of those with good KPS. These data demonstrate that perceived cognitive testing is associated with poor KPS but may also occur in those with good performance status. The results underscore the need for alternative measures of cognitive functioning to further explore the impact in those with good KPS and the use of the MoCA in a larger sample.
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Affiliation(s)
- Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- National Institutes of Health, Uniformed Services University, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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14
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Pillai V, Polskin L, Vera E, Acquaye A, Briceno N, Choi A, Christ A, Grajkowska E, Jammula V, Leeper H, Levine J, Lindsley M, Reyes J, Roche K, Rogers J, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Theeler B, Wu J, Gilbert M, Armstrong T, King A. NCOG-23. PATIENT-REPORTED SYMPTOM BURDEN AND INTERFERENCE: A COMPARISON BETWEEN COVID-19 PANDEMIC YEAR AND NORMATIVE DATA IN PATIENTS WITH CENTRAL NERVOUS SYSTEM (CNS) TUMORS. Neuro Oncol 2021. [PMCID: PMC8598790 DOI: 10.1093/neuonc/noab196.614] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
CNS tumor patients are highly symptomatic causing interference with activity and worse quality of life. Social distancing due to the COVID-19 pandemic increased demands on the patient, caregivers, clinicians, and the health care system. The NCI’s Neuro-Oncology Branch Natural History Study (NHS) systematically collected patient-reported outcomes (PROs) provide insight into how these challenges influenced symptom burden and interference during the COVID year. METHODS: Patient and disease characteristic as well as patient-reported symptoms and interference (MDASI-BT/-SP) and general health status (EQ-5D-3L) from 3/2020-2/2021) were compared to NHS normative sample collected prior to 3/2020. RESULTS: The sample (n = 178) was primarily White (82%), male (55%), median age of 45 (range 18 – 79) and KPS ³ 90 (51%). The majority had high-grade (70%) brain (83%) tumors (BT) with ≥ 1 prior recurrence (60%) and 25% were on active treatment. Clinical visits were primarily conducted via telehealth (64%) and 20% of all patients were diagnosed with progression at the time of assessment. Most commonly reported moderate-severe symptoms among BT patients were fatigue (30%), difficulty remembering (28%), feeling drowsy (22%). Among spinal cord tumor patients, fatigue (39%), pain (35%) and numbness/tingling in arms/legs/trunk (35%) were most frequently reported. These symptoms were reported in similar frequencies by the normative sample. Nearly half of the COVID year sample (48%) reported moderate-severe activity-related interference. Reported problems with mobility (38%), self-care (19%), pain/discomfort (40%), and usual activities (50%) were similar in both groups except for increased mood disturbance (53%) was reported during the COVID year. CONCLUSION: These findings support CNS tumor patients remained highly symptomatic with significant impact on health-related quality of life during the COVID year. Clinicians should develop timely individual care plans to help BT patients navigate their disease course. Evaluation of risk associated with more severe symptoms and functional limitations are ongoing.
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Affiliation(s)
- Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amanda King
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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15
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Leeper H, Vera E, Acquaye A, Briceno N, Choi A, Christ A, Grajkowska E, Jammula V, Levine J, Lindsley M, Reyes J, Roche K, Rogers J, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Polskin L, Theeler B, Wu J, Gilbert M, Armstrong T. QOLP-19. FINANCIAL TOXICITY AND DISTRESS DURING THE COVID-19 PANDEMIC IN PEOPLE LIVING WITH PRIMARY BRAIN TUMORS. Neuro Oncol 2021. [PMCID: PMC8598654 DOI: 10.1093/neuonc/noab196.740] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary brain tumor (PBT) patients experience high symptom burden and functional limitations, which may be impacted by the economic strain and mood disturbance during the COVID-19 pandemic. We assessed financial toxicity and associated patient reported outcomes (PROs) after one year of lockdown in a cohort of PBT patients. Patient and disease characteristics and PROs including FACIT-COST, MDASI-Brain Tumor, PROMIS-Anxiety/Depression short forms, and EQ-5D-3L were collected from 7/2020 to 5/2021 from participants in our Natural History Study. Descriptive statistics, Pearson correlations, and independent samples t-tests evaluated PRO relationships. The cohort included 112 PBT patients: 57% male, 87% white, mean age = 47 (range 25 – 80). Majority were married (65%), completed ≥ 4-year college degree (73%), earned annual family income ≥ $50,000 (68%) and living with a high-grade glioma (72%) complicated by recurrence (51%). Using FACIT-COST, 56% reported some financial hardship due to illness with a mean FACIT-COST of 28.3 (SD = 11.3, range: 0 - 44). Half of patients reported feeling moderately to extremely anxious or depressed. Non-Whites and Hispanics as well as those not currently working reported worse financial toxicity compared to White non-Hispanics and individuals currently working (21.4 vs 29.8 and 25.7 vs 30.4, respectively). Worse financial toxicity scores strongly correlated with worse overall symptom burden (r = -0.55) and interference (r = -0.42), worse anxiety (r = -0.39) and depression scores (r = -0.44), and worse overall HRQOL scores (r = –0.33)[all p< .01]. This is the first report of FACIT-COST in PBT patients to our knowledge and demonstrates that non-White individuals living with high grade glioma who are not currently working due to their tumor reported worse financial toxicity which was strongly correlated with higher symptom burden and interference with lower HRQOL. Future studies to assess financial toxicity longitudinally and post-pandemic using the FACIT-COST are needed.
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Affiliation(s)
- Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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16
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Penas-Prado M, Yuan Y, Wall K, Vera E, Ikiddeh-Barnes U, Blackburn K, Chambers C, Ratnam N, Frederico S, Acquaye A, Aldape K, Briceno N, Choi A, Christ A, Jammula V, Leeper H, Levine J, Lindsley M, Reyes J, Roche K, Rogers J, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Polskin L, Pillai V, Quezado M, Theeler B, Wu J, Armstrong T, Gilbert M. CTIM-32. IMMUNE CHECKPOINT INHIBITOR NIVOLUMAB IN PEOPLE WITH RECURRENT SELECT RARE CNS CANCERS: RESULTS OF INTERIM ANALYSIS IN A HEAVILY PRETREATED COHORT. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.224] [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: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Standard and experimental therapies for patients with rare CNS tumors are scarce. Nivolumab (PD-1 inhibitor) is approved for several non-CNS cancers. This ongoing Phase II trial (NCT03173950) will determine the efficacy of nivolumab in adults with recurrence/progression of one of 11 selected rare primary CNS tumors. Efficacy is measured by Disease Control Rate (DCR; confirmed CR/PR or durable SD for ≥ 6 months) in 2 cohorts: heavily and non-heavily pretreated patients (heavily pretreated: ≥ 3 prior therapies; non-heavily pretreated: ≤ 2). We report efficacy and safety results of a preplanned interim analysis in the heavily pretreated cohort.
METHODS
Eligibility includes recurrence/progression of an eligible tumor; age ≥ 18 years; tumor tissue available for histopathology, molecular and immune profiling; KPS ≥ 70; and no steroids at study entry. A total of 150 evaluable patients will be enrolled (75 to each cohort). Prior therapies include radiation and/or standard or investigational drugs. Nivolumab treatment is 240 mg IV every 2 weeks (4 doses); then 480 mg every 4 weeks (14 additional doses). Interim analysis was planned when sample size reached 32 in each cohort.
RESULTS
As of March 10, 2021, DCR exceeded the minimum required for interim analysis in the heavily pretreated cohort. Among 30 patients, 4 achieved SD > 6 months (medulloblastoma, anaplastic ependymoma, myxopapillary ependymoma, metastatic atypical meningioma). Safety profile (related AEs): grade 3 = 7; grade 4 = 1. Most frequent grade 3-5 AEs regardless of attribution: tumor progression (6); anemia, hydrocephalus, lymphopenia (3 each); cerebral edema, headache (2 each).
CONCLUSION
DCR exceeded the “go” boundary (i.e., > 2) in the heavily pretreated cohort. Nivolumab showed safety profile consistent with other studies. This cohort will continue to stage 2 and complete total accrual of 75 patients. The trial is currently being expanded to 10 additional sites across the BTTC/NCI-CONNECT consortium.
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Affiliation(s)
- Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ying Yuan
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathleen Wall
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Claudia Chambers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nivi Ratnam
- National Institutes of Health, Bethesda, MD, USA
| | | | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martha Quezado
- Laboratory of Pathology, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- National Institutes of Health, Uniformed Services University, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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17
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Briceno N, Abdullaev Z, Vera E, Choi A, Christ A, Grajkowska E, Leeper H, Levine J, Lindsley M, Reyes J, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Theeler B, Wu J, Polskin L, Papanicolau-Sengos A, Quezado M, Aldape K, Gilbert M, Armstrong T. PATH-08. PROGNOSTIC IMPLICATIONS FROM LONG-TERM SURVIVORS (LTS) OF GLIOBLASTOMA. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.460] [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: 11/14/2022] Open
Abstract
Abstract
Glioblastoma (GBM) is the most aggressive primary brain malignancy with < 45% living a year beyond diagnosis which drops to 7% at five years. However, there have been reports of long-term survivors (LTS) living three to ten years beyond diagnosis. Few studies have reported on molecular factors in tumors from LTS cohorts. We identified GBM (IDH1/2 wildtype) patients living at least 3 years post diagnosis (N=25), including 16 with pre-treatment tumor tissue, from our Natural History Study. Available pre- or post-treatment tumors were analyzed with targeted panel sequencing and methylation analysis for classification, MGMT promoter status and copy number changes. Classical clinical prognostic features such as limited resection or older age did not preclude long-term survival as patients with tumor biopsy (n=1) or subtotal resection (n= 5) and patients > 60 were included in the LTS cohort. Furthermore, tumors with molecular features typically associated with poor prognosis were also in this GBM LTS group. MGMT promoter was unmethylated in 17% of tumors; EGFRvIII mutation in 13%, EGFR amplification in 33%, CDKN2A homozygous loss in 30% and complete chromosome 7 gain with 10 loss in 55%. Additionally, the methylation classifier found a higher-than-expected incidence of mesenchymal tumors (29%) and RTK II (57%). Tumors had a higher percent of TP53 mutations (44%) but lower pTERT (76%) compared to TCGA. These data suggest an individual patient’s prognosis cannot easily be predetermined based on classical clinical and molecular data. This underscores the need for further analyses to discover additional factors leading to their unexpected, prolonged survival and elucidate the role of factors typically associated with poor prognosis. Future work will include RNA-sequencing and germline whole genome sequencing to determine tumor specific gene expression and identify any possible genomic alterations that confer improved survival.
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Affiliation(s)
- Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Zied Abdullaev
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- National Institutes of Health, Uniformed Services University, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Martha Quezado
- Laboratory of Pathology, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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18
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Lindsley M, Vera E, Acquaye A, Briceno N, Choi A, Christ A, Grajkowska E, Jammula V, Leeper H, Levine J, Reyes J, Roche K, Rogers J, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Polskin L, Penas-Prado M, Pillai V, Theeler B, Wu J, Gilbert M, Armstrong T. NCOG-42. SYMPTOM ONSET TO TIME OF DIAGNOSIS IN PRIMARY CENTRAL NERVOUS SYSTEM TUMOR PATIENTS: A REVIEW OF FINDINGS FROM THE NOB-NHS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.632] [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: 11/13/2022] Open
Abstract
Abstract
Prior reports suggest the low prevalence of primary central nervous system (PCNS) tumors and the healthcare setting where patients seek care can contribute to diagnostic delays, potentially affecting prognosis. This descriptive report highlights findings from patient-reported data at presentation collected from a sample of 623 PCNS tumor patients. Participants were White (88%), males (56%), median age at diagnosis 41 (2-79) with high grade (HG) (66%) brain tumors (BT) (89%). Among BT patients, 30% reported ≥ 3 concurrent symptoms at presentation including headaches (40%), seizures (30%), and memory problems or difficulty with balance/walking (20% each). Over half (57%) had symptoms for < 6 months before diagnosis and 60% presented to the Emergency Room. Sixty-five percent of HG BT patients had symptoms for < 6 months prior to diagnosis compared to low grade (LG) tumors (40%) and had surgery in < 1 month from presentation (68% vs 51%, p < 0.01). More HG BT patients presented with weakness in the arms/legs than LG BT (14% vs 8%). Among spine tumor (ST) patients, 45% reported ≥ 3 concurrent symptoms at presentation including back pain (65%), sensory changes (45%), and weakness (40%). Almost half (46%) were symptomatic for > 1 year before diagnosis, presented in an outpatient clinic (64%) with 41% having surgery < 1 month from presentation. Younger (40% vs 16%) and HG ST patients (56% vs 21%) more often reported symptoms for < 6 months before diagnosis. HG ST patients more often presented to Emergency Rooms (67% vs 25%) and had surgery < 1 month from presentation (60% vs 36%). Further analysis of symptom presentation and clinical course is ongoing. Tumor location, grade, patient age and healthcare setting were associated with the time from clinical presentation to diagnosis. Development of aids providing guidance on diagnostic evaluation/treatment to front-line healthcare providers is warranted.
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Affiliation(s)
- Matthew Lindsley
- Neuro-Oncology Branch/ National Cancer Institute, Bethesda, MD, USA
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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19
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King A, Minyety JDLC, Acquaye A, Briceno N, Choi A, Christ A, Grajkowska E, Jammula V, Leeper H, Levine J, Lindsley M, Reyes J, Roche K, Rogers J, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Polskin L, Penas-Prado M, Pillai V, Theeler B, Wu J, Gilbert M, Armstrong T, Vera E. NCOG-39. EXPLORING PATIENT REPORTED OUTCOMES (PROS) ACROSS ETHNORACIAL GROUPS IN PRIMARY BRAIN TUMOR (PBT) PATIENTS: DIFFERENCES IN THE ILLNESS EXPERIENCE. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.629] [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: 11/12/2022] Open
Abstract
Abstract
SIGNIFICANCE AND AIMS
Past research in PBT patients has demonstrated that minorities may have a survival advantage compared to Whites for high-grade tumors, though little is known about their illness experience given their underrepresentation in clinical trials. This study explored differences in PROs across race-ethnicity within a large PBT cohort describing associated burden and risk for minority populations where data is scarce.
METHODS
Demographic, clinical characteristics, MDASI-Brain Tumor, PROMIS Depression and Anxiety Short-Forms, and Neuro-QoL Cognitive Function were collected from the most recent timepoint for PBT patients enrolled on the Natural History Study. Descriptive statistics, one-way ANOVA, and linear regression were used to report results.
RESULTS
The sample included 562 PBT patients (58% male, median age = 50 [18-85]) comprised of 79% White, 6% African American (AA), 10% Hispanic, and 5% Asian patients per self-report. Most patients had a high-grade glioma (60%), with 28% on active treatment and 44% with good KPS (90-100). Among the most commonly reported moderate-severe symptoms were fatigue ( > 40% in all groups), difficulty remembering (30-40% of Asians, AAs, and Whites), and disturbed sleep (44% in Asians, 29% in Hispanics), while hemiparesis was common only for AA patients (37%). There were no differences between groups with respect to symptom burden and interference, mood disturbance, or cognitive function. Race/ethnicity group was not predictive of overall symptom burden or interference, but for all groups, higher KPS predicted lower symptom and interference scores (p < .001 and p = .004, respectively).
CONCLUSION
While some symptoms were common across ethnoracial groups, there were differences in symptom patterns, suggesting there may be other factors driving their illness experience. Future exploration of socioeconomic and cultural factors that might contribute to the symptom burden of minorities is warranted, which may allow development of targeted interventions to improve clinical outcomes in these groups.
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Affiliation(s)
- Amanda King
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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20
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Vera E, Mendoza T, Acquaye A, Briceno N, Choi A, Christ A, Grajkowska E, Jammula V, Leeper H, Levine J, Lindsley M, Reyes J, Roche K, Rogers J, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Polskin L, Penas-Prado M, Pillai V, Theeler B, Wu J, Gilbert M, Armstrong T. NCOG-18. RELATIONSHIP BETWEEN RANO-PRO WORKING GROUP STANDARDIZED PRIORITY CONSTRUCTS AND DISEASE PROGRESSION AMONG MALIGNANT GLIOMA PATIENTS AS MEASURED THROUGH CLINICAL OUTCOMES ASSESSMENTS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.609] [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: 11/12/2022] Open
Abstract
Abstract
Recognizing the importance of clinical outcomes assessments (COA), the RANO-PRO Working Group recommends inclusion of core symptoms/functions in clinical care/research for malignant glioma patients. This study evaluated the association between the recommended symptoms (pain, perceived cognition, seizures, aphasia, treatment-specific symptoms) and functions (physical: weakness, walking; and role/social: work, usual activities) and disease progression in these patients. MDASI-Brain Tumor and EQ-5D-3L scores, Karnofsky Performance Status (KPS), and Neurologic Function Score (NFS) were evaluated in relation to disease progression by chi-square tests, independent- and paired-samples t-tests, adjusted for multiple comparisons. Our sample included 336 patients with malignant glioma; 82% white, 64% male, median age=52 (21-79). Imaging study revealed disease progression for 46% of patients. All symptoms except seizures and difficulty concentrating were worse in the group whose imaging showed disease progression versus stable disease, as well as the functions of walking, work, activity, and self-care (0.8 < difference < 1.8). Patients with disease progression were 4 times more likely to have a poor KPS (≤ 80) and worse NFS. Among patients with disease progression (n=112), all symptoms, except seizures, worsened from first assessment to time of progression. Up to 22% of patients reported worsening mobility, self-care, and usual activity; 46% and 35% had worsened KPS and NFS, respectively. Seven symptoms and functions were each individually reported by at least 10% of patients as having worsened the most. Worsening of symptoms and functions was not observed among patients with stable disease, except in difficulty understanding. Identified core symptoms/functions worsen at the time of progression demonstrating the relationship between priority constructs and a traditional tumor response measure while highlighting the importance of longitudinal collection of COA. The pattern of worsening was observed via both patient- and clinician-reported outcomes, emphasizing the utility of COA in clinical care and clinical trials.
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Affiliation(s)
- Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- ASRC Federal/National Cancer Institute, Bethesda, MD, USA
| | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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21
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Polskin L, Pillai V, Vera E, Acquaye A, Briceno N, Choi A, Christ A, Grajkowska E, Jammula V, Leeper H, Levine J, Lindsley M, Reyes J, Roche K, Rogers J, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Theeler B, Wu J, Gilbert M, Armstrong T, King A. QOLP-37. MOOD DISTURBANCE IN PATIENTS WITH CENTRAL NERVOUS SYSTEM (CNS) TUMORS DURING THE COVID-19 PANDEMIC. Neuro Oncol 2021. [PMCID: PMC8598910 DOI: 10.1093/neuonc/noab196.757] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Primary CNS tumors are associated with uncertainty likely contributing to mood disturbance that is common throughout the disease trajectory. The intersection of the COVID-19 pandemic with a CNS tumor diagnosis may further impact the anxiety/depression experienced in this population. This study assessed key anxiety/depression symptoms in patients with CNS tumors prior to and during the COVID year. METHODS Patient reported outcomes (PROs), including the PROMIS Anxiety and Depression Short Forms and EQ-5D-3L, were collected at the time of clinical or telehealth evaluation from the COVID year (March 2020-February 2021) and were compared to assessments through February 2020 (a NOB-normative sample), reflecting what we would typically see in our regular clinic evaluations. RESULTS The COVID sample (N = 178) was primarily White (82%), male (55%), median age of 45 (range 18–79), and KPS ³ 90 (50%). The majority had high grade (70%) brain (83%) tumors with ³ 1 prior recurrence (60%) and 25% were on active treatment. Visits were primarily conducted via telehealth (64%) and 20% had progression at assessment. Compared to the NOB-normative sample, patients reported significantly higher depression scores (moderate-severe, 17% vs. 12%, p < 0.05), but not anxiety (18% vs. 16%). Eleven percent reported both moderate-severe anxiety and depressive symptoms (8% pre-COVID). Overall health assessed by the EQ-5D-3L was similar to the normative sample in all dimensions, apart from impact of moderate/extreme mood disturbance, which was more prevalent in the COVID year (53% vs. 43%, p < 0.05%). CONCLUSION Patients with CNS tumors are at risk for significant symptoms of depression and anxiety; this risk was heightened during the COVID year. Further evaluation of clinical factors associated with risk are underway. These findings highlight the need for assessments and interventions that can be administered via telehealth to address the mental health needs of this vulnerable population. Radiobiology
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Affiliation(s)
- Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- National Institutes of Health, Uniformed Services University, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amanda King
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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22
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Christ A, Vera E, Acquaye A, Briceno N, Choi A, Grajkowska E, Jammula V, Levine J, Lindsley M, Reyes J, Roche K, Rogers J, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Polskin L, Theeler B, Wu J, Gilbert M, Armstrong T, Leeper H. QOLP-33. EVIDENCE OF FINANCIAL TOXICITY IN PRIMARY CENTRAL NERVOUS SYSTEM TUMOR PATIENTS: CORRELATIONS BETWEEN EMPLOYMENT STATUS, SYMPTOM BURDEN AND HEALTH-RELATED QUALITY OF LIFE. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.753] [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: 11/13/2022] Open
Abstract
Abstract
SIGNIFICANCE AND AIMS
Financial toxicity (FT) after a cancer diagnosis is the consequence of decreased earnings and increased spending. In patients with primary central nervous system (PCNS) tumors, the correlation between FT and factors such as symptom burden, psychological distress, and health-related quality of life has not been extensively studied. We assessed employment status and several patient illness factors in a PCNS tumor cohort.
METHODS
Patient and disease characteristics and patient-reported outcomes (PROs) were collected from adults diagnosed with PCNS tumors between 9/2016-12/2019. Descriptive statistics and regression analyses were used to describe PROs.
RESULTS
Of 277 patients, 77 (28%) reported being unemployed due to tumor diagnosis. They reported difficulty walking (64%) and performing usual activities (64%). This group had lower general health status (p< 0.001) and higher tumor-related symptom severity (p=0.004) than employed patients. Unemployed patients reported high symptom burden with an average of 6 moderate-severe symptoms for those with brain tumors and 10 for those with spine tumors. Both brain and spine tumor patients who were unemployed reported increased mood-related interference (p=0.020), as well as moderate-severe anxiety (30%) and depression (25%) compared to employed patients (15% vs 8%, respectively). Unemployed brain tumor patients reported worse scores in cognitive and neurologic symptom subscales (p< 0.001).
CONCLUSIONS AND IMPLICATIONS
These data provide indirect evidence that financial toxicity that correlates with high symptom burden across several domains and lower health-related quality of life. Future research work will include the COST questionnaire to further evaluate the implications of FT in the PCNS tumor patient population.
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Affiliation(s)
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- National Institutes of Health, Uniformed Services University, Bethesda, MD, USA
| | | | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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23
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Leeper H, Choi A, Vera E, Acquaye A, Briceno N, Christ A, Grajkowska E, Jammula V, Levine J, Lindsley M, Reyes J, Roche K, Rogers J, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Penas-Prado M, Pillai V, Polskin L, Theeler B, Wu J, Gilbert M, Armstrong T. NCOG-16. RELEVANCE OF GERIATRIC ASSESSMENT FOR PRIMARY BRAIN TUMOR PATIENTS: IMPLICATIONS FOR RESEARCH AND CARE. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.607] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The utility of geriatric assessment (GA) has been evaluated in older adults diagnosed with solid tumors other than primary brain tumors (PBT). We assessed several key GA domains in adults with PBT receiving tumor-directed treatment.
METHODS
Patient and disease characteristics and key GA domains within patient-reported outcomes (PROs) including symptom burden (MDASI-BT), Anxiety/ Depression (PROMIS-short forms) and general health status (EQ-5D-3L) were systematically and prospectively collected between 9/2016–8/2019 from adults diagnosed with PBT. Descriptive statistics and regression analyses were used to assess PROs.
RESULTS
Of 581 participants, 92 were 65 – 85 years old (median age = 70 years; “older”) and 489 were ≤ 64 years (median age = 46 years; “younger”). Tumor grade distribution in the older group was 74% WHO grade III/IV, 26% WHO grade I/II; tumor types included gliomas and meningiomas with no tissue diagnosis in 3 patients. Older patients were 49% less likely to receive chemotherapy and twice as likely to have KPS ≤ 80 (p=0.003, OR=0.51, OR=1.98). More older patients reported problems with mobility (57% vs 44%), self-care (38% vs 26%), and usual activities (64% vs 51%) than younger patients. Charlson Comorbidity Index mean scores were significantly higher in older patients (3.5 vs 0.6, p< 0.001). The top 3 most frequently reported moderate-to-severe symptoms were similar in older vs younger groups: fatigue (44% vs 41%), feeling drowsy (29% vs 30%) and difficulty remembering (28% vs 29%). Feeling distressed was the only symptom whose frequency differed between the age groups (11% older vs 27% younger, p=0.001).
CONCLUSION
Older PBT patients had lower performance status, more co-morbidities and increased functional impairments, affirming that GA is relevant. Symptom burden was similarly high in both age groups. These findings support conducting GA concurrently in future symptom intervention and therapeutic clinical trials for adults with PBT receiving tumor-directed treatment.
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Affiliation(s)
- Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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24
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Boris L, Vera E, Acquaye A, Briceno N, Choi A, Christ A, Grajkowska E, Jammula V, Leeper H, Levine J, Lindsley M, Reyes J, Roche K, Rogers J, Timmer M, Burton E, Lollo N, Panzer M, Polskin L, Penas-Prado M, Pillai V, Theeler B, Wu J, Abdullaev Z, Aldape K, Quezado M, Gilbert M, Armstrong T. NCOG-34. A DESCRIPTIVE ANALYSIS OF GLIOMATOSIS CEREBRI CASES, COMPARED ACCORDING TO IDH STATUS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.624] [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: 11/13/2022] Open
Abstract
Abstract
Gliomatosis cerebri (GC) is a controversial entity no longer recognized as a histopathologic-defined diagnosis, characterized by diffuse, commonly bilateral infiltration of cerebral hemispheres. The purpose of this report is to describe clinical, imaging, patient-reported outcomes (PRO’s) and pathologic characteristics of clinically-defined cases from a large natural history study cohort (N=769). Of 19 patients, 10 male, 16 white, mean age at diagnosis 43 (19-70), seventeen presented as primary GC, while 2 developed GC after treatment. Ten patients were IDH-WT, 7 IDH-M, and 2 IDH undetermined. The majority (7/10) IDH-WT patients presented acutely (5 with seizures), whereas, 3 had a protracted presentation of 2 weeks-3months with 6/10 having enhancing tumors and 8/10 undergoing biopsy only. On histopathologic review, 4 were anaplastic astrocytoma (AA), 3 GBMs, 2 grade II astrocytoma, and 1 histone-mutated glioma. Nearly all (9/10) IDH-WT patients received radiation with concurrent and adjuvant temozolomide. 7/10 IDH-WT patients had a survival of only 1.5yrs or less from diagnosis. Of the 7 IDH-M patients, 4 had protracted presentations of 1 month-5 years. 6/7 had non-enhancing tumors at presentation. 4 had biopsy only and 3 underwent partial resection. 3 were AA, 2 grade II astrocytoma, 1 grade II oligodendroglioma, and 1 grade IV astrocytoma. 3/7 received radiation with concurrent and adjuvant temozolomide, 3/7 chemotherapy alone, and 1 RT alone. All 7 IDH-M patients survived 3+ years from diagnosis (range 3-10+ yrs). Both patients who developed GC later, were IDH-M, with prolonged survival (3.5yrs and the other still alive 10+yrs). PRO's at time of last clinical assessment revealed GC patients to be highly symptomatic with mean overall symptom burden, depression, and anxiety higher than our overall glioma population. GC patients have a varied clinical course mandating further investigation to enable better prognostic definition to refine treatments based on the varying clinical and molecular characteristics.
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Affiliation(s)
- Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Varna Jammula
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lily Polskin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- National Institutes of Health, Uniformed Services University, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Zied Abdullaev
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martha Quezado
- Laboratory of Pathology, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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25
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Jammula V, Vera E, Rogers J, Christ A, Leeper H, Acquaye A, Briceno N, Choi A, Grajkowska E, Levine J, Lindsley M, Reyes J, Roche K, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Smith-Cohn M, Penas-Prado M, Pillai V, Theeler B, Wu J, Gilbert M, Armstrong T. NCOG-44. FEASIBILITY AND UTILITY OF THE MONTREAL COGNITIVE ASSESSMENT IN ROUTINE CLINICAL EXAMS AND TELEHEALTH VISITS IN NEURO-ONCOLOGY. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.634] [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: 11/13/2022] Open
Abstract
Abstract
Cognitive dysfunction (CD) is common among primary brain tumor (PBT) patients and adds to the overall symptom burden. Standardized assessments able to be incorporated into routine clinical in-person and telehealth care are needed. Here, we report the feasibility, utility, and satisfaction with use of the Montreal Cognitive Assessment (MoCA) in telehealth and clinical settings by trained clinical providers. Feasibility and provider satisfaction were assessed through survey responses, and patient performance on the MoCA, after a reliability check, was reported through descriptive statistics. Seventy-nine MoCAs on 71 patients were completed in clinic (n=55) or telehealth (n=24). Majority of patients were white (83%) males (54%) with high grade PBTs (66%), and half of patients had completed at least a college education. In clinic, providers (n=9) reported the MoCA took 5-20 minutes to complete, was easy to incorporate into routine practice (78%), believed it was accurate in assessing cognition (67%), and was useful in determining treatment (88%). The average in-person MoCA score was 25 (range: 6 to 30), with 31% of scores classified as abnormal (≤26). In telehealth, providers (n=11) found the administration of the MoCA prior to attending participation in the telehealth visit helpful (75%), discussed the results with their clinical team (75%) and patient (63%), and believed the MoCA was accurate in assessing cognition remotely (63%). On average, patients took 13 minutes (9-22) to complete testing, with three tests discordant on reliability scoring and one patient unable to complete testing. The average telehealth MoCA score was 26 (12-30), with 29% of scores classified as abnormal. Overall, testing was feasible in both clinical and telehealth settings, and providers reported satisfaction with its use. Future studies should evaluate validity in a larger sample and include analysis of relevant cut-off scores, impact of disease, tumor treatment, and genomic predispositions.
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Affiliation(s)
| | - Elizabeth Vera
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James Rogers
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Leeper
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Marta Penas-Prado
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jing Wu
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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26
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Park J, Schwardt NH, Jo JH, Zhang Z, Pillai V, Phang S, Brady SM, Portillo JA, MacGibeny MA, Liang H, Pensler M, Soldin SJ, Yanovski JA, Segre JA, Kong HH. Shifts in the Skin Bacterial and Fungal Communities of Healthy Children Transitioning through Puberty. J Invest Dermatol 2021; 142:212-219. [PMID: 34252398 DOI: 10.1016/j.jid.2021.04.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 12/26/2022]
Abstract
Previous cross-sectional studies have shown that skin microbiomes in adults are distinct from those in children. However, the human skin microbiome in individuals as they sexually mature has not been studied as extensively. We performed a prospective, longitudinal study to investigate the puberty-associated shifts in skin microbiota. A total of 12 healthy children were evaluated every 6-18 months for up to 6 years. Using 16S ribosomal RNA (V1-V3) and internal transcribed spacer 1 amplicon sequencing analyzed with Divisive Amplicon Denoising Algorithm 2, we characterized the bacterial and fungal communities of five different skin and nares sites. We identified significant alterations in the composition of skin microbial communities, transitioning toward a more adult microbiome, during puberty. The microbial shifts were associated with Tanner stages (classification method for the degree of sexual maturation) and showed noticeable sex-specific differences. Over time, female children demonstrated a predominance of Cutibacterium with decreasing diversity. Among fungi, Malassezia predominated at most skin sites in more sexually mature subjects, which was more pronounced in female children. The higher relative abundances of these lipophilic taxa-C. acnes and M. restricta-were strongly associated with serum sex hormone concentrations with known influence on sebaceous gland activity. Taken together, our results support the relationship between sexual maturation, skin physiology, and the skin microbiome.
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Affiliation(s)
- Jin Park
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA; Department of Dermatology, Jeonbuk National University Medical School, Jeonju, Korea; Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Nicole H Schwardt
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jay-Hyun Jo
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Zhiwei Zhang
- Biostatistics Branch, Division of Cancer Treatment and Diagnostics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Valentina Pillai
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sheila Phang
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sheila M Brady
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Jessica A Portillo
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Margaret A MacGibeny
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA; Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Hai Liang
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Meridith Pensler
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven J Soldin
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Julia A Segre
- Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heidi H Kong
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.
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27
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Philip S, David A, Kumar KS, Renny RJ, Pillai V, Manda SR. An epidemic of sub acute intestinal obstruction during Covid-19 pandemic related lockdown - ‘the lockdown belly’. Br J Surg 2020; 107:e366. [PMID: 32687636 PMCID: PMC7405177 DOI: 10.1002/bjs.11803] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- S Philip
- Believers Regional Institute of Gastroenterology Hepatology and Transplantation (BRIGHT), Thiruvalla, Kerala, India
| | - A David
- Epidemiology and Biostatistics, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - K S Kumar
- Believers Regional Institute of Gastroenterology Hepatology and Transplantation (BRIGHT), Thiruvalla, Kerala, India
| | - R J Renny
- Believers Regional Institute of Gastroenterology Hepatology and Transplantation (BRIGHT), Thiruvalla, Kerala, India
| | - V Pillai
- Believers Regional Institute of Gastroenterology Hepatology and Transplantation (BRIGHT), Thiruvalla, Kerala, India
| | - S R Manda
- Believers Regional Institute of Gastroenterology Hepatology and Transplantation (BRIGHT), Thiruvalla, Kerala, India
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28
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Sreedharan SE, Unnikrishnan K, Pillai V. Can stop-bang questionnaire predict obstructive sleep apnea in less symptomatic cardiovascular patients? Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.286] [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: 10/25/2022]
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29
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Shah A, Juhasz C, Pillai V, Varun C, Yarraguntla K, Seraji-Bozorgzad N. Structural and functional neuroimaging as biomarkers of sudden unexpected death in epilepsy (SUDEP). J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.455] [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: 11/29/2022]
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Gupta R, Pillai V. PHYSICIANS’ PERSPECTIVE: END-OF-LIFE CARE TREATMENT FOR OLDER ADULTS IN ALLAHABAD, INDIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R. Gupta
- San Francisco State University, San Francisco, California,
| | - V. Pillai
- University of Texas at Arlington, Arlington, Texas
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Pillai V, Kekatpure V, Hedne N, Kuriakose M. Adipofascial anterolateral thigh flaps for reconstruction of maxillary defects with infratemporal fossa extension. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.1142] [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: 11/15/2022]
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Pillai V. Investigating the neck in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.150] [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: 10/19/2022]
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Pillai V. Contemporary management of advanced gingivobuccal and tongue carcinomas: perspective from the subcontinent. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.149] [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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Pillai V, Kekatpure V, Hedne N, Kuriakose M. Functional and oncologic outcomes in patients undergoing total glossectomy. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.458] [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: 11/25/2022]
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Donners A, Cheng P, Verster J, Roth T, Drake C, Pillai V, Ciesla J. Nocturnal rumination as a mediator between sleep disturbance and negative affect. Sleep Med 2015. [DOI: 10.1016/j.sleep.2015.02.1531] [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: 11/25/2022]
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Paul C, Ladra A, Pillai V, Böttiger BW, Spöhr F, Keller K, Zarghooni K. [Severe airway distress following cervical spine operation: retrospective breakdown of the chain of errors]. Anaesthesist 2011; 60:845-9. [PMID: 21728049 DOI: 10.1007/s00101-011-1914-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/11/2011] [Accepted: 05/19/2011] [Indexed: 02/05/2023]
Abstract
A 71-year-old female patient received a prothesis due to a cervical disc prolapsed and bleeding into the collar soft tissues occurred postoperatively. Following a computed tomography examination severe peracute respiratory decompensation occurred while administering topical anesthesia to the pharynx in order to perform fiber optic intubation. Endotracheal intubation using conventional laryngoscopy was unsuccessful and the patient required immediate cricothyroidotomy. As an on-site cricothyrotomy set to establish a secure airway was not available the decision was taken to perform surgical cricothyroidotomy. As a conclusion to this life-threatening event in the case of symptoms, such as dyspnea, dysphonia and dysphagia after operations of the cervical spine the airway has to be secured early and according to the local algorithm.
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Affiliation(s)
- C Paul
- Institut für Notfallmedizin, Berufsfeuerwehr Stadt Köln, Deutschland.
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Abstract
Congenital double-lumen aortic arch resulting from persistence of the fifth aortic arterial arch (PFAA) is a rare congenital anomaly. It appears as a vascular structure running inferior and parallel to the "real" aortic arch from the innominate artery to the left subclavian artery. We report a case of persistent fifth aortic arch (systemic-to-systemic arterial connection) with pentalogy of Fallot in a patient who underwent successful intracardiac repair with a transannular patch with very proximal aortic cannulation for cardiopulmonary bypass (CPB).
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Affiliation(s)
- A D Furtado
- Department of Cardiac Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
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Maurya RC, Pillai V, Rajput S. Synthesis and Structural Investigation of Some Mixed‐Ligand Cyanonitrosyl {Mo(NO)}4 Complexes of Molybdenum(II) Containing Potentially Mono‐ and Bidentate Biologically Active Organic Ligands. ACTA ACUST UNITED AC 2007. [DOI: 10.1081/sim-120020333] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- R. C. Maurya
- a Coordination Chemistry Laboratory , Department of P. G. Studies and Research in Chemistry , R. D. University , Jabalpur, 482‐001, India
| | - V. Pillai
- a Coordination Chemistry Laboratory , Department of P. G. Studies and Research in Chemistry , R. D. University , Jabalpur, 482‐001, India
| | - S. Rajput
- a Coordination Chemistry Laboratory , Department of P. G. Studies and Research in Chemistry , R. D. University , Jabalpur, 482‐001, India
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Bhuvan RR, Pillai V, Misra M, Jayakumar K. Mid term results of coronary endarterectomy. Indian J Thorac Cardiovasc Surg 2006. [DOI: 10.1007/s12055-006-0642-5] [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: 10/22/2022] Open
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Pillai V, Kumar P, Hou M, Ayyub P, Shah D. Preparation of nanoparticles of silver halides, superconductors and magnetic materials using water-in-oil microemulsions as nano-reactors. Adv Colloid Interface Sci 1995. [DOI: 10.1016/0001-8686(94)00227-4] [Citation(s) in RCA: 207] [Impact Index Per Article: 7.1] [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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Abstract
Immunoassays are used for the specific measurement of type II collagen, a major cartilage protein, which is lost in osteoarthritic joints. Poor immunogenicity and species dependent immune response to type II collagen make it difficult to obtain specific antibodies required for immunoassay development. In addition, type II collagen antibodies exhibit reactivity to structurally dissimilar antigens such as actin, myoglobin, thyroglobulin and ssDNA, complicating the isolation of specific antibodies. It is therefore necessary to characterize the antibody reactivity against both noncollagenous antigens and different collagen types. In this study, immune response to type II collagen was improved by conjugation to carrier proteins, KLH and BSA. Hybridomas were generated by fusions of lymphocytes derived from lymph nodes or spleens with X63-653-Ag8 myeloma cells. Compared to spleens, the utilization of lymph nodes as a source of lymphocytes resulted in a 23% higher number of hybridomas secreting type II collagen antibodies. Hybridomas secreting polyreactive antibodies were identified based on their reactivity to thyroglobulin and eliminated. Extensive testing of the remaining monoclonal antibodies with other structurally dissimilar antigens and various types of collagen for reactivity, allowed us to isolate specific monoclonal antibodies to type II collagen. We emphasize the importance of characterization of the reactivity of type II collagen monoclonal antibodies before employing them for immunoassays.
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Affiliation(s)
- G R Srinivas
- Department of Pharmacology, University of Rhode Island, Kingston 02881
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Pillai V, Davey MR, Power JB. Plant regeneration from mesophyll protoplasts of Centaurea cyanus, Senecio x hybridus and Callistephus chinensis. Plant Cell Rep 1990; 9:402-405. [PMID: 24227065 DOI: 10.1007/bf00232409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/1990] [Revised: 08/14/1990] [Indexed: 06/02/2023]
Abstract
Protoplasts were isolated from leaves of glasshouse-grown plants of Centaurea cyanus and axenic shoot cultures of Senecio x hybridus. Upon culture, using modified MS-based media, protoplasts of both systems entered division to produce callus, followed by plant regeneration. Leaf protoplasts of Callistephus chinensis entered sustained division only following the preconditioning for 24h of peeled leaf tissues on agar-solidified MS-based medium. Protoplasts were also isolated from cell suspensions of C. chinensis and divided in MS-based or KM media. However, only leaf mesophyll protoplasts of Callistephus produced callus, which developed shoots.The establishment of protoplast-to-plant protocols for these ornamental species has provided a basis for broadening their gene pools through somatic hybridisation.
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Affiliation(s)
- V Pillai
- Plant Genetic Manipulation Group, Department of Botany, University of Nottingham, NG7 2RD, Nottingham, UK
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Pillai V, Collins A, Morgan R. Family Walk-In Centre--Eaton Socon: evaluation of a project on preventive intervention based in the community. Child Abuse Negl 1982; 6:71-79. [PMID: 6892287 DOI: 10.1016/0145-2134(82)90052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The Family Walk-In Centre opened November 1978 as a pilot project at Eaton Socon in Cambridgeshire with the aims: to encourage parents to visit the centre on "their terms," including parents who have abused or who fear they will abuse or neglect their child who may be difficult or handicapped, or because of chronic or acute family problems; further to mobilize "Self Help" groups and offer professional support. "Help" offered to the families included informal and formal group work, family casework and education in social and physical skills. Volunteer and professional support was given at the Centre and at home. Close liaison with specialist agencies was maintained to enable families to receive appropriate help. Periodic reviews and visits were made to maintain contact. An analysis of 50 families who attended the Centre between October 1979 and May 1980 was made to assess: the attendance and reattendance rate which indicated their acceptance of help offered and their motivation to use the Centre; the types of problems presented to the Centre, the types of action taken, the progress made when reviewed after three months and the degree of involvement by the volunteers. A final analysis will comprise 100 families. A preliminary summary found: significant reduction in the registration of new cases of child abuse; self-referrals exceeded significantly other modes of referral; loneliness and parenting difficulties formed the major proportion of families seeking help; 48% of families continued to attend for 3 months or more; work done centered upon discussion of parenting problems in 30% of the cases and involvement in activities with other families in 28%; 18% were assessed as showing improved child care after 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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Abstract
Since Janssen's (1959) introduction of haloperidol, numerous clinical trials have been published showing its usefulness in the treatment of mania and hypomanic states. Davies (1962) found it an effective drug in the treatment of adult patients showing aggressive behaviour resulting from various causes, and in the management of mania. Gerle (1963), in his review, showed the effectiveness of this drug in the control of disturbed behaviour in mentally sub-normal patients. He also showed (1962) that patients taking this drug are remarkably free from toxic reactions such as jaundice, agranulocytosis and allergic dermatitis. Haloperidol has been used in our unit (Rogers, 1955, 1965a) over the past three years. The impression has been gained that it controls aggressive, overactive and destructive behaviour in severely disturbed children, without impairing their ability to participate normally in the therapeutic activities of the unit (Rogers, 1965b).
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