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Schlam I, Debnath D, Gallagher C, Dilawari AA, Tiwari SR, Aschalew M, Guebre-Xabiher H, Malloy S, Graves K, Barac A, Chitalia A. Abstract P6-05-09: Cardiovascular Risk Evaluation for Breast Cancer Survivors: A Pilot Study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-05-09] [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: 03/06/2023]
Abstract
Abstract
Introduction: Breast cancer (BC) is the most common cancer in women in the United States (US). With advances in screening and treatment, there are increasing numbers of BC survivors. Preexisting or emerging cardiovascular (CV) risk factors and some cancer therapies put BC survivors at risk for long-term CV disease (CVD). ASCO clinical practice guidelines for prevention and monitoring of cardiac dysfunction recommend treatment of CV risk factors in cancer survivors, however, the application of these guidelines in clinical practice presents several challenges. In this pilot study, we describe the feasibility of performing CVD risk assessment in a cohort of BC survivors in a single institution in an urban area that serves mostly Black/African American (AA) populations.
Methods: We identified patients with early-stage BC treated between 2015 and 2022. Patients underwent CVD risk assessment including vital signs, hemoglobin A1c, lipid panel, transthoracic echocardiogram (TTE), 6-minute walk test (6MWT), troponin T, and B-type natriuretic peptide (NT-ProBNP). The primary objective of the study was to describe the feasibility of performing a CVD risk assessment.
Results: Out of 69 eligible patients who were approached for the study, 50 were enrolled and completed the CVD risk assessment (72%). Among 19 patients who did not enroll or complete the risk assessment, time constraints to complete the work up was the predominant factor. The median age was 60.5 years (SD = 13.65; range 34-86), 76% self-identified as Black/AA, 14% as White, and 95% as Non-Hispanic. Half of the patients had hormone-receptor-positive BC, 34% human epidermal growth factor receptor 2 (HER2) positive disease (and received HER2-targeted therapies), and 28% triple-negative breast cancer (TNBC). In terms of treatment, 34% received anthracycline-containing regimens. CVD risk assessment results are shown in Table 1. Twenty-four (48%) of the patients had metabolic syndrome defined as the presence of 3 out of 5 CV risk factors (waist circumference, hypertension, low HDL, high triglycerides, insulin resistance). Although all patients had an ejection fraction (EF) above 55%, 7 patients (14%) had an abnormal global longitudinal strain (GLS). The median number of meters in the 6MWT was 369 (SD 94.46, range 67-531); 74% of patients walked a shorter distance than predicted by age and body mass index, indicating significant physical impairment. All patients had a troponin T value below the 99th percentile. The most frequent modifiable CVD-risk factors included obesity and hypertension.
Conclusion: Performing a low-cost CVD risk assessment in a population of mostly Black/AA BC survivors was feasible in this pilot study. We identified a high prevalence of CVD risk factors, with 48% of patients meeting metabolic syndrome criteria and the majority of patients demonstrated a very high level of functional impairment measured by 6MWT. Our findings underscore the importance of survivorship care focused on CVD risk in BC survivors. Limitations include the small sample size, single-institution study, and lack of CV and BC-related outcomes. The higher incidence of TNBC could be explained by a selection bias of patients receiving cytotoxic chemotherapy and the higher incidence of TNBC in the Black/AA population. Future research will focus on implementing this assessment in the survivorship clinic and establishing interventions to decrease CVD risk in cancer survivors.
Table 1. Clinical Measurements & Outcomes (n=50).
Citation Format: Ilana Schlam, Dipanjan Debnath, Christopher Gallagher, Asma A. Dilawari, Shruti R. Tiwari, Malate Aschalew, Hiwot Guebre-Xabiher, Stacy Malloy, Kristi Graves, Ana Barac, Ami Chitalia. Cardiovascular Risk Evaluation for Breast Cancer Survivors: A Pilot Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-09.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ana Barac
- 10MedStar Washington Hospital Center
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Van Dyk K, Ahn J, Zhou X, Zhai W, Ahles TA, Bethea TN, Carroll JE, Cohen HJ, Dilawari AA, Graham D, Jacobsen PB, Jim H, McDonald BC, Nakamura ZM, Patel SK, Rentscher KE, Saykin AJ, Small BJ, Mandelblatt JS, Root JC. Associating persistent self-reported cognitive decline with neurocognitive decline in older breast cancer survivors using machine learning: The Thinking and Living with Cancer study. J Geriatr Oncol 2022; 13:1132-1140. [PMID: 36030173 PMCID: PMC10016202 DOI: 10.1016/j.jgo.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/16/2022] [Accepted: 08/10/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Many cancer survivors report cognitive problems following diagnosis and treatment. However, the clinical significance of patient-reported cognitive symptoms early in survivorship can be unclear. We used a machine learning approach to determine the association of persistent self-reported cognitive symptoms two years after diagnosis and neurocognitive test performance in a prospective cohort of older breast cancer survivors. MATERIALS AND METHODS We enrolled breast cancer survivors with non-metastatic disease (n = 435) and age- and education-matched non-cancer controls (n = 441) between August 2010 and December 2017 and followed until January 2020; we excluded women with neurological disease and all women passed a cognitive screen at enrollment. Women completed the FACT-Cog Perceived Cognitive Impairment (PCI) scale and neurocognitive tests of attention, processing speed, executive function, learning, memory and visuospatial ability, and timed activities of daily living assessments at enrollment (pre-systemic treatment) and annually to 24 months, for a total of 59 individual neurocognitive measures. We defined persistent self-reported cognitive decline as clinically meaningful decline (3.7+ points) on the PCI scale from enrollment to twelve months with persistence to 24 months. Analysis used four machine learning models based on data for change scores (baseline to twelve months) on the 59 neurocognitive measures and measures of depression, anxiety, and fatigue to determine a set of variables that distinguished the 24-month persistent cognitive decline group from non-cancer controls or from survivors without decline. RESULTS The sample of survivors and controls ranged in age from were ages 60-89. Thirty-three percent of survivors had self-reported cognitive decline at twelve months and two-thirds continued to have persistent decline to 24 months (n = 60). Least Absolute Shrinkage and Selection Operator (LASSO) models distinguished survivors with persistent self-reported declines from controls (AUC = 0.736) and survivors without decline (n = 147; AUC = 0.744). The variables that separated groups were predominantly neurocognitive test performance change scores, including declines in list learning, verbal fluency, and attention measures. DISCUSSION Machine learning may be useful to further our understanding of cancer-related cognitive decline. Our results suggest that persistent self-reported cognitive problems among older women with breast cancer are associated with a constellation of mild neurocognitive changes warranting clinical attention.
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Affiliation(s)
- Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, United States of America; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, United States of America.
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, United States of America
| | - Xingtao Zhou
- Georgetown Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC, United States of America
| | - Wanting Zhai
- Georgetown Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC, United States of America
| | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Traci N Bethea
- Georgetown Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC, United States of America
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, United States of America; Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, United States of America
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, United States of America
| | - Asma A Dilawari
- Georgetown Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC, United States of America
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States of America
| | - Paul B Jacobsen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America
| | - Heather Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States of America
| | - Brenna C McDonald
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Sunita K Patel
- City of Hope National Medical Center, Los Angeles, CA, United States of America
| | - Kelly E Rentscher
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, United States of America; Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, United States of America
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Brent J Small
- University of South Florida, Health Outcome and Behavior Program and Biostatistics Resource Core, H. Lee Moffitt Cancer Center, Research Institute at the University of South Florida, Tampa, FL, United States of America
| | - Jeanne S Mandelblatt
- Georgetown Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC, United States of America
| | - James C Root
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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Bethea TN, Zhai W, Zhou X, Ahles TA, Ahn J, Cohen HJ, Dilawari AA, Graham DMA, Jim HSL, McDonald BC, Nakamura ZM, Patel SK, Rentscher KE, Root J, Saykin AJ, Small BJ, Van Dyk KM, Mandelblatt JS, Carroll JE. Associations between longitudinal changes in sleep disturbance and depressive and anxiety symptoms during the COVID-19 virus pandemic among older women with and without breast cancer in the thinking and living with breast cancer study. Cancer Med 2022; 11:3352-3363. [PMID: 35315588 PMCID: PMC9110906 DOI: 10.1002/cam4.4682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Several studies have reported sleep disturbances during the COVID-19 virus pandemic. Little data exist about the impact of the pandemic on sleep and mental health among older women with breast cancer. We sought to examine whether women with and without breast cancer who experienced new sleep problems during the pandemic had worsening depression and anxiety. METHODS Breast cancer survivors aged ≥60 years with a history of nonmetastatic breast cancer (n = 242) and frequency-matched noncancer controls (n = 158) active in a longitudinal cohort study completed a COVID-19 virus pandemic survey from May to September 2020 (response rate 83%). Incident sleep disturbance was measured using the restless sleep item from the Center for Epidemiological Studies-Depression Scale (CES-D). CES-D score (minus the sleep item) captured depressive symptoms; the State-Anxiety subscale of the State Trait Anxiety Inventory measured anxiety symptoms. Multivariable linear regression models examined how the development of sleep disturbance affected changes in depressive or anxiety symptoms from the most recent prepandemic survey to the pandemic survey, controlling for covariates. RESULTS The prevalence of sleep disturbance during the pandemic was 22.3%, with incident sleep disturbance in 10% and 13.5% of survivors and controls, respectively. Depressive and anxiety symptoms significantly increased during the pandemic among women with incident sleep disturbance (vs. no disturbance) (β = 8.16, p < 0.01 and β = 6.14, p < 0.01, respectively), but there were no survivor-control differences in the effect. CONCLUSION Development of sleep disturbances during the COVID-19 virus pandemic may negatively affect older women's mental health, but breast cancer survivors diagnosed with the nonmetastatic disease had similar experiences as women without cancer.
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Affiliation(s)
- Traci N. Bethea
- Office of Minority Health and Health Disparities ResearchGeorgetown Lombardi Comprehensive Cancer CenterWashingtonDistrict of ColumbiaUSA
- Cancer Prevention and Control ProgramGeorgetown Lombardi Comprehensive Cancer CenterWashingtonDistrict of ColumbiaUSA
| | - Wanting Zhai
- Cancer Prevention and Control ProgramGeorgetown Lombardi Comprehensive Cancer CenterWashingtonDistrict of ColumbiaUSA
| | - Xingtao Zhou
- Cancer Prevention and Control ProgramGeorgetown Lombardi Comprehensive Cancer CenterWashingtonDistrict of ColumbiaUSA
| | - Tim A. Ahles
- Department of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkNew York CityUSA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and BiomathematicsGeorgetown UniversityWashingtonDistrict of ColumbiaUSA
| | - Harvey J. Cohen
- Center for the Study of Aging and Human DevelopmentDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Asma A. Dilawari
- Cancer Prevention and Control ProgramGeorgetown Lombardi Comprehensive Cancer CenterWashingtonDistrict of ColumbiaUSA
- Medstar Washington Hospital CenterWashingtonDistrict of ColumbiaUSA
| | - Deena M. A. Graham
- John Theurer Cancer CenterHackensack University Medical CenterHackensackNew JerseyUSA
| | | | - Brenna C. McDonald
- Department of Radiology and Imaging SciencesIndiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolisIndianaUSA
| | - Zev M. Nakamura
- Department of PsychiatryUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Sunita K. Patel
- City of Hope National Medical CenterLos AngelesCaliforniaUSA
| | - Kelly E. Rentscher
- Cousins Center for PsychoneuroimmunologyUniversity of California, Los AngelesLos AngelesCaliforniaUSA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral SciencesUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - James Root
- Department of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkNew York CityUSA
| | - Andrew J. Saykin
- Department of Radiology and Imaging SciencesIndiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolisIndianaUSA
| | - Brent J. Small
- College of Behavioral and Community Sciences, School of Aging StudiesUniversity of South FloridaTampaFloridaUSA
| | - Kathleen M. Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral SciencesUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - Jeanne S. Mandelblatt
- Cancer Prevention and Control ProgramGeorgetown Lombardi Comprehensive Cancer CenterWashingtonDistrict of ColumbiaUSA
| | - Judith E. Carroll
- Cousins Center for PsychoneuroimmunologyUniversity of California, Los AngelesLos AngelesCaliforniaUSA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral SciencesUniversity of California, Los AngelesLos AngelesCaliforniaUSA
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Lynce F, Mainor C, Geng X, Jones G, Schlam I, Wang H, Feger U, Donahue R, Toney N, Jochems C, Schlom J, Gallagher C, Nanda R, Graham D, Stringer-Reasor EM, Denduluri N, Collins J, Dilawari AA, Chitalia A, Tiwari S, Nunes R, Kaltman R, Khoury K, Gatti-Mays M, Swain SM, Parsons HA, Pohlmann P, Isaacs C. Abstract PD9-02: Peripheral immune subsets and circulating tumor DNA (ctDNA) in patients (pts) with residual triple negative breast cancer (TNBC) treated with adjuvant immunotherapy and/or chemotherapy (chemo): The OXEL study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd9-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Poor clinical outcomes are noted in pts with TNBC who do not achieve a pathologic complete response (pCR). We characterized peripheral immune subsets and the role of minimal residual disease (MRD) detection via ctDNA in pts who participated in the OXEL study. Methods: OXEL (Opdivo® -XELoda ®) is a recently completed phase II open-label 3-arm randomized study of nivolumab (nivo), capecitabine (cape) or the combination as adjuvant therapy (tx) for pts with residual TNBC after appropriate neoadjuvant chemo. Residual disease was defined as ≥ 1.0 cm of primary tumor and/or nodal involvement. Eligible pts had completed definitive local tx. Pts were randomly assigned to nivo 360 mg iv q3wks x 6 (arm A); cape 1250mg/m2 po bid D1-D14 q3 wks x 6 (arm B); nivo 360mg iv q3wks + cape 1250mg/m2 po bid D1-D14 q3 wks x 6 (arm C). Peripheral blood mononuclear cells (PBMCs) and ctDNA were assessed at baseline (D1 of cycle 1), 6, and 12 wks and at time of recurrence, if applicable. PBMCs were stained with 30 markers and analyzed by flow cytometry to identify changes in 158 immune cell subsets at 6 wks, as a percent of total PBMCs. RaDaRTM, a deep sequencing based, tumor-informed personalized assay was utilized to detect the presence of ctDNA in plasma. Distant disease-free survival (DDFS) and overall survival (OS) were analyzed by the Kaplan-Meier method and Log-Rank test was used to compare DDFS and OS according to baseline MRD results. All pts will be followed for distant recurrence and survival for 3 yrs. Here we report the translational endpoints of the OXEL study. Clinical endpoints according to treatment received will be reported in a future analysis. Results: 45 pts were enrolled between 8/2018 and 6/2021. 29 (64%) were Caucasian and 14 (31%) were African American. Mean age at enrollment was 51 [+/- 12]. 93% of pts received a taxane-anthracycline containing neoadjuvant tx. 15 pts were randomized to each arm. DDFS probability at 1-yr and 2-yrs was 0.71 (+/- 0.07) and 0.66 (+/- 0.08) respectively. At 12 mos of median follow up, 13/45 pts (29%) experienced distant recurrence, none had local recurrence. 43 pts were evaluated for PBMC subsets. Changes in PBMC subsets at 6 wks were different amongst the arms; in arm A, reductions in NK subsets, including a 33% reduction in CD56dimCD16- cells, were observed, while in arm B, increases in naïve CD4+ T cells (+45%) and CD73+CD8+ T cells (+12%) and reductions in ki67+CD8+ T cells (-48%) were noted. In arm C, increases were observed in conventional dendritic cells (+36%), effector memory ki67+CD4+ T cells (+46%), and CD56dimCD16- NK cells (+29%). 33 pts underwent successful MRD analysis. 12/33 (36%) pts were MRD+ at baseline. 2/12 pts MRD+ at baseline subsequently cleared MRD, with undetectable ctDNA on future time points; neither patient has had recurrence to date. The remaining 10/12 MRD+ pts (83%) have experienced distance recurrence. 21/33 (64%) pts were ctDNA negative at baseline; 20/33 remained negative for all follow up timepoints. 10/11 pts experiencing distant recurrence were MRD+ at baseline, compared to 1/11 pt who became MRD+ at wk 6 post initiation of tx. At 12 mos of median follow-up, baseline MRD+ testing was significantly associated with an inferior DDFS ( p<0.0001 Log-rank test, median DDFS 4.0 mos vs. not reached) and OS (p=0.02 Log-rank test, median OS not reached for both groups). Results will be updated at the time of abstract presentation. Conclusions: Changes in PBMC subsets were associated with receipt of chemo and/or immunotherapy. Our results suggest that baseline MRD+ in pts without pCR is a poor prognostic factor. Future trials aiming to optimize adjuvant treatment with chemo and/or immunotherapy in residual TNBC should consider incorporating ctDNA as a selection marker of pts at higher risk of recurrence.
Citation Format: Filipa Lynce, Candace Mainor, Xue Geng, Greg Jones, Ilana Schlam, Hongkun Wang, Ute Feger, Renee Donahue, Nicole Toney, Caroline Jochems, Jeffrey Schlom, Christopher Gallagher, Rita Nanda, Deena Graham, Erica M Stringer-Reasor, Neelima Denduluri, Julie Collins, Asma A Dilawari, Ami Chitalia, Shruti Tiwari, Raquel Nunes, Rebecca Kaltman, Katia Khoury, Margaret Gatti-Mays, Sandra M Swain, Heather A. Parsons, Paula Pohlmann, Claudine Isaacs. Peripheral immune subsets and circulating tumor DNA (ctDNA) in patients (pts) with residual triple negative breast cancer (TNBC) treated with adjuvant immunotherapy and/or chemotherapy (chemo): The OXEL study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD9-02.
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Affiliation(s)
| | | | - Xue Geng
- Georgetown University, Washington, DC
| | | | - Ilana Schlam
- MedStar Washington Hospital Center, Washington, DC
| | | | | | | | | | | | | | | | | | - Deena Graham
- Hackensack University Medical Center, Hackensack, NJ
| | | | | | - Julie Collins
- MedStar Georgetown University Hospital, Washington, DC
| | | | - Ami Chitalia
- MedStar Washington Hospital Center, Washington, DC
| | | | - Raquel Nunes
- Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
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Rentscher KE, Zhou X, Small BJ, Cohen HJ, Dilawari AA, Patel SK, Bethea TN, Van Dyk KM, Nakamura ZM, Ahn J, Zhai W, Ahles TA, Jim HSL, McDonald BC, Saykin AJ, Root JC, Graham DMA, Carroll JE, Mandelblatt JS. Loneliness and mental health during the COVID-19 pandemic in older breast cancer survivors and noncancer controls. Cancer 2021; 127:3671-3679. [PMID: 34161601 PMCID: PMC8419003 DOI: 10.1002/cncr.33687] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 12/31/2022]
Abstract
Background The coronavirus disease 2019 (COVID‐19) pandemic has had wide‐ranging health effects and increased isolation. Older with cancer patients might be especially vulnerable to loneliness and poor mental health during the pandemic. Methods The authors included active participants enrolled in the longitudinal Thinking and Living With Cancer study of nonmetastatic breast cancer survivors aged 60 to 89 years (n = 262) and matched controls (n = 165) from 5 US regions. Participants completed questionnaires at parent study enrollment and then annually, including a web‐based or telephone COVID‐19 survey, between May 27 and September 11, 2020. Mixed‐effects models were used to examine changes in loneliness (a single item on the Center for Epidemiologic Studies–Depression [CES‐D] scale) from before to during the pandemic in survivors versus controls and to test survivor‐control differences in the associations between changes in loneliness and changes in mental health, including depression (CES‐D, excluding the loneliness item), anxiety (the State‐Trait Anxiety Inventory), and perceived stress (the Perceived Stress Scale). Models were adjusted for age, race, county COVID‐19 death rates, and time between assessments. Results Loneliness increased from before to during the pandemic (0.211; P = .001), with no survivor‐control differences. Increased loneliness was associated with worsening depression (3.958; P < .001) and anxiety (3.242; P < .001) symptoms and higher stress (1.172; P < .001) during the pandemic, also with no survivor‐control differences. Conclusions Cancer survivors reported changes in loneliness and mental health similar to those reported by women without cancer. However, both groups reported increased loneliness from before to during the pandemic that was related to worsening mental health, suggesting that screening for loneliness during medical care interactions will be important for identifying all older women at risk for adverse mental health effects of the pandemic. Older breast cancer survivors and matched noncancer controls experienced similar increases in loneliness from before to during the COVID‐19 pandemic. Women who reported increased loneliness also experienced worsening depression and anxiety symptoms and higher stress during the pandemic.
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Affiliation(s)
- Kelly E Rentscher
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California.,Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Xingtao Zhou
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, Florida
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Asma A Dilawari
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Sunita K Patel
- Outcomes Division, Population Sciences, City of Hope National Medical Center, Los Angeles, California
| | - Traci N Bethea
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Kathleen M Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, District of Columbia
| | - Wanting Zhai
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deena M A Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California.,Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Jeanne S Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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Carroll JE, Small BJ, Tometich D, Zhai W, Zhou X, Luta G, Ahles TA, Saykin AJ, Nudelman KNH, Clapp JD, Jim H, Jacobsen PB, Hurria A, Graham D, McDonald BC, Denduluri N, Extermann M, Isaacs C, Dilawari AA, Root J, Stern R, Mandelblatt JS. Sleep disturbance and neurocognitive outcomes in older patients with breast cancer: Interaction with genotype. Cancer 2019; 125:4516-4524. [PMID: 31553501 PMCID: PMC6891125 DOI: 10.1002/cncr.32489] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/03/2019] [Accepted: 07/09/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sleep disturbance and genetic profile are risks for cognitive decline in noncancer populations, yet their role in cancer-related cognitive problems remains understudied. This study examined whether sleep disturbance was associated with worse neurocognitive outcomes in breast cancer survivors and whether sleep effects on cognition varied by genotype. METHODS Newly diagnosed female patients (n = 319) who were 60 years old or older and had stage 0 to III breast cancer were recruited from August 2010 to December 2015. Assessments were performed before systemic therapy and 12 and 24 months later. Neuropsychological testing measured attention, processing speed, executive function, learning, and memory; self-perceived cognitive functioning was also assessed. Sleep disturbance was defined by self-report of routine poor or restless sleep. Genotyping included APOE, BDNF, and COMT polymorphisms. Random effects fluctuation models tested associations of between-person and within-person differences in sleep, genotype, and sleep-genotype interactions and cognition and controlled for age, reading level, race, site, and treatment. RESULTS One-third of the patients reported sleep disturbances at each time point. There was a sleep-APOE ε4 interaction (P = .001) in which patients with the APOE ε4 allele and sleep disturbances had significantly lower learning and memory scores than those who were APOE ε4-negative and without sleep disturbances. There was also a sleep disturbance-COMT genotype interaction (P = .02) in which COMT Val carriers with sleep disturbances had lower perceived cognition than noncarriers. CONCLUSIONS Sleep disturbance was common and was associated with worse cognitive performance in older breast cancer survivors, especially those with a genetic risk for cognitive decline. Survivorship care should include sleep assessments and interventions to address sleep problems.
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Affiliation(s)
- Judith E. Carroll
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, UCLA Cousins Center for PNI, Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | | | | | - Wanting Zhai
- Lombardi Comprehensive Cancer Center, Georgetown University
| | - Xiangtao Zhou
- Lombardi Comprehensive Cancer Center, Georgetown University
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University
| | - Tim A. Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J. Saykin
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Kelly N. H. Nudelman
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | - Paul B. Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD
| | | | | | - Brenna C. McDonald
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | - James Root
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Stern
- Boston University School of Medicine, Boston University
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Affiliation(s)
- Asma A Dilawari
- MedStar Georgetown University Hospital; Lombardi Comprehensive Cancer Center, Washington, DC; and MedStar Montgomery Medical Center, Olney, MD
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Sheppard VB, Cavalli LR, Dash C, Kanaan YM, Dilawari AA, Horton S, Makambi KH. Correlates of Triple Negative Breast Cancer and Chemotherapy Patterns in Black and White Women With Breast Cancer. Clin Breast Cancer 2017; 17:232-238. [PMID: 28189497 DOI: 10.1016/j.clbc.2016.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Triple negative breast cancer (TNBC) tumors are estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor-negative. TNBC is responsive to chemotherapy, but chemotherapy might be underused in some patient subgroups. The goal of the present study was to characterize the patterns of chemotherapy use (uptake and completion) in TNBC patients. PATIENTS AND METHODS Women with primary invasive, nonmetastatic breast cancer were recruited in Washington, DC, and Detroit. Data were collected using a standardized telephone survey that captured sociocultural and health care process factors. Clinical data were abstracted from the medical records. We used χ2 tests to access the association between the receipt of chemotherapy use (initiation and completion) and categorical variables, and t tests were used for continuous variables. Logistic regression models were used to evaluate the factors associated with chemotherapy uptake. RESULTS Women with TNBC (16% of sample) were more likely to be black than white (68% vs. 32%; P < .05). Among women with TNBC, 60% underwent chemotherapy. Chemotherapy uptake was greater for black than for white women (48.3% vs. 11.7%; P = .01) and in women without (vs. with) healthcare discrimination (35% vs. 25%; P = .04). In multivariable models, only race was associated with the receipt of chemotherapy. Black women were more likely to receive chemotherapy than were white women. The odds ratio of receiving chemotherapy by race was 4.1 (95% confidence interval, 1.3-13.1). Each 1-year increase in age was associated with a lower likelihood of chemotherapy completion (odds ratio, 0.9; 95% confidence interval, 0.826-0.981; P = .02). Women with at least some college were less likely to complete chemotherapy than were those with other education levels (P = .02). CONCLUSION A substantial number of TNBC patients failed to receive and/or complete chemotherapy. Differences in chemotherapy uptake by race and sociocultural factors diminished in multivariable models but age and stage remained significant. Suboptimal treatment among women with TNBC could contribute to adverse outcomes. Future investigations are necessary to assess whether the noninitiation and/or noncompletion of chemotherapy is clinically warranted.
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Affiliation(s)
| | | | | | - Yasmine M Kanaan
- Department of Microbiology, Howard University College of Medicine, Washington, DC
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Dilawari AA. Sharing yourself with your patients: an oncology fellow's experience during pregnancy. J Cancer Educ 2008; 23:272-273. [PMID: 19058080 DOI: 10.1080/08858190802463245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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