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Fauer AJ, Qiu W, Huang IC, Ganz PA, Casillas JN, Yabroff KR, Armstrong GT, Leisenring W, Howell R, Howell CR, Kirchhoff AC, Yasui Y, Nathan PC. Financial Hardship & Neighborhood Socioeconomic Disadvantage in Long-term Childhood Cancer Survivors. JNCI Cancer Spectr 2024:pkae033. [PMID: 38676662 DOI: 10.1093/jncics/pkae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Long-term survivors of childhood cancer face elevated risk for financial hardship. We evaluate whether childhood cancer survivors live in areas of greater deprivation and the association with self-reported financial hardships. METHODS Cross-sectional analysis of data from the Childhood Cancer Survivor Study (CCSS) between 1970 and 1999, and self-reported financial information from 2017-2019. We measured neighborhood deprivation with the Area Deprivation Index (ADI) based on current zip code. Financial hardship was measured with validated surveys that captured behavioral, material/financial sacrifice, and psychological hardship. Bivariate analyses described neighborhood differences between survivors and siblings. Generalized linear models estimated effect sizes between ADI and financial hardship adjusting for clinical factors and personal socioeconomic status. RESULTS Analysis was restricted to 3,475 long-term childhood cancer survivors and 923 sibling controls. Median ages at time of evaluation was 39 [IQR 33,46] and 47 [39,59] years, respectively. Survivors resided in areas with greater deprivation (ADI ≥ 50: 38.7% survivors vs 31.8% siblings, P < .001). One quintile increases in deprivation were associated with small increases in behavioral (2nd quintile P = .017) and psychological financial hardship (2nd quintile P = .009; 3rd quintile, P = .014). Lower psychological financial hardship was associated with individual factors including greater household income ($60,000+ income, P < .001) and being single (P = .048). CONCLUSIONS AND RELEVANCE Childhood cancer survivors were more likely to live in areas with socioeconomic deprivation. Both neighborhood level disadvantage and personal socioeconomic circumstances should be evaluated when trying to assist childhood cancer survivors with financial hardships.
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Affiliation(s)
- Alex J Fauer
- Family Caregiving Institute, Betty Irene Moore School of Nursing
- Comprehensive Cancer Center, University of California, Davis, Sacramento, CA, USA
| | - Weiyu Qiu
- University of Alberta; University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - I-Chan Huang
- St Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, Memphis, TN, USA
| | - Patricia A Ganz
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jacqueline N Casillas
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Gregory T Armstrong
- St Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, Memphis, TN, USA
| | - Wendy Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rebecca Howell
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Carrie R Howell
- Nutrition Obesity Research Center, Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, and University of Utah Department of Pediatrics, Salt Lake City, UT, USA
| | - Yutaka Yasui
- St Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, Memphis, TN, USA
| | - Paul C Nathan
- The Hospital for Sick Children, Division of Hematology/Oncology, The University of Toronto, Toronto, Ontario, Canada
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Berkman AM, Goodenough CG, Durakiewicz P, Howell CR, Wang Z, Easton J, Mulder HL, Armstrong GT, Hudson MM, Kundu M, Ness KK. Associations between mitochondrial copy number, exercise capacity, physiologic cost of walking, and cardiac strain in young adult survivors of childhood cancer. J Cancer Surviv 2024:10.1007/s11764-024-01590-7. [PMID: 38635100 DOI: 10.1007/s11764-024-01590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Childhood cancer survivors are at risk for cardiac dysfunction and impaired physical performance, though underlying cellular mechanisms are not well studied. In this cross-sectional study, we examined the association between peripheral blood mitochondrial DNA copy number (mtDNA-CN, a proxy for mitochondrial function) and markers of performance impairment and cardiac dysfunction. METHODS Whole-genome sequencing, validated by quantitative polymerase chain reaction, was used to estimate mtDNA-CN in 1720 adult survivors of childhood cancer (48.5% female; mean age = 30.7 years, standard deviation (SD) = 9.0). Multivariable logistic regression was performed to evaluate the associations between mtDNA-CN and exercise intolerance, walking inefficiency, and abnormal global longitudinal strain (GLS), adjusting for treatment exposures, age, sex, and race and ethnicity. RESULTS The prevalence of exercise intolerance, walking inefficiency, and abnormal GLS among survivors was 25.7%, 10.7%, and 31.7%, respectively. Each SD increase of mtDNA-CN was associated with decreased odds of abnormal GLS (adjusted odds ratio (OR) = 0.88, p = 0.04) but was not associated with exercise intolerance (OR = 1.02, p = 0.76) or walking inefficiency (OR = 1.06, p = 0.46). Alkylating agent exposure was associated with increased odds of exercise intolerance (OR = 2.25, p < 0.0001), walking inefficiency (OR = 2.37, p < 0.0001), and abnormal GLS (OR = 1.78, p = 0.0002). CONCLUSIONS Increased mtDNA-CN is associated with decreased odds of abnormal cardiac function in childhood cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS These findings demonstrate a potential role for mtDNA-CN as a biomarker of early cardiac dysfunction in this population.
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Affiliation(s)
- Amy M Berkman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chelsea G Goodenough
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN, 38105, USA
| | - Paul Durakiewicz
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN, 38105, USA
| | - Carrie R Howell
- Division of Preventive Medicine, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN, 38105, USA
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - John Easton
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Heather L Mulder
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN, 38105, USA
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN, 38105, USA
| | - Mondira Kundu
- Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN, 38105, USA.
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Howell CR, Zhang L, Mehta T, Wilkinson L, Carson AP, Levitan EB, Cherrington AL, Yi N, Garvey WT. Cardiometabolic Disease Staging and Major Adverse Cardiovascular Event Prediction in 2 Prospective Cohorts. JACC Adv 2024; 3:100868. [PMID: 38765187 PMCID: PMC11101198 DOI: 10.1016/j.jacadv.2024.100868] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Cardiometabolic risk prediction models that incorporate metabolic syndrome traits to predict cardiovascular outcomes may help identify high-risk populations early in the progression of cardiometabolic disease. OBJECTIVES The purpose of this study was to examine whether a modified cardiometabolic disease staging (CMDS) system, a validated diabetes prediction model, predicts major adverse cardiovascular events (MACE). METHODS We developed a predictive model using data accessible in clinical practice [fasting glucose, blood pressure, body mass index, cholesterol, triglycerides, smoking status, diabetes status, hypertension medication use] from the REGARDS (REasons for Geographic And Racial Differences in Stroke) study to predict MACE [cardiovascular death, nonfatal myocardial infarction, and/or nonfatal stroke]. Predictive performance was assessed using receiver operating characteristic curves, mean squared errors, misclassification, and area under the curve (AUC) statistics. RESULTS Among 20,234 REGARDS participants with no history of stroke or myocardial infarction (mean age 64 ± 9.3 years, 58% female, 41% non-Hispanic Black, and 18% diabetes), 2,695 developed incident MACE (13.3%) during a median 10-year follow-up. The CMDS development model in REGARDS for MACE had an AUC of 0.721. Our CMDS model performed similarly to both the ACC/AHA 10-year risk estimate (AUC 0.721 vs 0.716) and the Framingham risk score (AUC 0.673). CONCLUSIONS The CMDS predicted the onset of MACE with good predictive ability and performed similarly or better than 2 commonly known cardiovascular disease prediction risk tools. These data underscore the importance of insulin resistance as a cardiovascular disease risk factor and that CMDS can be used to identify individuals at high risk for progression to cardiovascular disease.
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Affiliation(s)
- Carrie R. Howell
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Zhang
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tapan Mehta
- Family and Community Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lua Wilkinson
- Medical Affairs, Novo Nordisk Inc, Plainsboro, New Jersey, USA
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Emily B. Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrea L. Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nengjun Yi
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - W. Timothy Garvey
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Howell CR, Zhu S, Malla G, Carson G, Cummings D, Uddin J, Levitan EB, Safford M, Cherrington AL, Long DL. Defining diabetes status using medication groups in Medicare data: Trends in prescribing diabetes medications to patients without a diabetes diagnosis over time. Diabetes Obes Metab 2024; 26:1548-1551. [PMID: 38253946 DOI: 10.1111/dom.15450] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sha Zhu
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gargya Malla
- Department of Medicine, University of Arizona, Tuscon, AZ, USA
| | - Gargya Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Doyle Cummings
- Departments of Public Health and Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Jalal Uddin
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika Safford
- Department of Medicine, Division of General Internal Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - Andrea L Cherrington
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Goggin KP, Lu L, Lee DE, Howell CR, Srivastava D, Brinkman TM, Armstrong GT, Bhakta N, Robison LL, Ehrhardt MJ, Hudson MM, Krull KR, Pui CH, Rubnitz J, Ness KK, Wolf J. Severe Sepsis During Treatment for Childhood Leukemia and Sequelae Among Adult Survivors. JAMA Netw Open 2024; 7:e242727. [PMID: 38497960 PMCID: PMC10949094 DOI: 10.1001/jamanetworkopen.2024.2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/24/2024] [Indexed: 03/19/2024] Open
Abstract
Importance Children undergoing treatment for leukemia are at increased risk of severe sepsis, a dysregulated immune response to infection leading to acute organ dysfunction. As cancer survivors, they face a high burden of long-term adverse effects. The association between sepsis during anticancer therapy and long-term organ dysfunction in adult survivors of childhood cancer has not been examined. Objective To determine whether severe sepsis during therapy for leukemia in childhood is associated with subsequent chronic health conditions in adult survivors. Design, Setting, and Participants This cohort study included 644 adult survivors of childhood leukemia who were diagnosed between January 1, 1985, and July 19, 2010, and participated in the St Jude Lifetime Cohort Study. Participants were excluded if they received hematopoietic cell transplant or had relapsed leukemia. Data collection ended June 30, 2017. Data were analyzed from July 1, 2020, to January 5, 2024. Exposures Severe sepsis episodes, defined according to consensus criteria as septic shock, acute respiratory distress syndrome, or multiorgan dysfunction associated with infection occurring during anticancer therapy, were abstracted by medical record review for all participants. Main Outcomes and Measures Common Terminology Criteria for Adverse Events-defined chronic health condition outcomes were independently abstracted. Associations between sepsis and cumulative incidence of chronic health conditions (eg, cardiovascular, pulmonary, kidney, neurological, and neurocognitive outcomes) were compared by adjusted hazard ratios from Cox proportional hazards logistic regression. Inverse propensity score weighting was used to adjust for potential confounders, including age, year of diagnosis, and leukemia type. Results The study sample consisted of 644 adult survivors of pediatric leukemia (329 women [51.1%] and 315 men [48.9%]; including 56 with a history of acute myeloid leukemia and 585 with a history of acute lymphoblastic leukemia) who were most recently evaluated at a median age of 24.7 (IQR, 21.2-28.3) years at a median time after leukemia diagnosis of 17.3 (IQR, 13.7-21.9) years. Severe sepsis during treatment of acute childhood leukemia occurred in 46 participants (7.1%). Participants who experienced severe sepsis during treatment were more likely to develop moderate to severe neurocognitive impairment (29 of 46 [63.0%] vs 310 of 598 [51.8%]; adjusted hazard ratio, 1.86 [95% CI, 1.61-2.16]; P < .001) significantly affecting attention, executive function, memory and visuospatial domains. Sepsis was not associated with long-term risk of cardiovascular, pulmonary, kidney, or neurological chronic health conditions. Conclusions and Relevance In this cohort study of long-term outcomes in survivors of pediatric leukemia, severe sepsis during anticancer therapy for leukemia was associated with a selectively increased risk for development of serious neurocognitive sequelae. Efforts to reduce the effects of anticancer therapy on long-term function and quality of life in survivors might include prevention of severe sepsis during therapy and early detection or amelioration of neurocognitive deficits in survivors of sepsis.
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Affiliation(s)
- Kathryn P. Goggin
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
- Now with Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Lu Lu
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Danielle E. Lee
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis
| | - Carrie R. Howell
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Deokumar Srivastava
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Tara M. Brinkman
- Department of Psychology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Mathew J. Ehrhardt
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kevin R. Krull
- Department of Psychology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jeffrey Rubnitz
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Joshua Wolf
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis
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Zhang L, Clay OJ, Lee SY, Howell CR. Analyzing Multiple Social Determinants of Health Using Different Clustering Methods. Int J Environ Res Public Health 2024; 21:145. [PMID: 38397636 PMCID: PMC10888224 DOI: 10.3390/ijerph21020145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Social determinants of health (SDoH) have become an increasingly important area to acknowledge and address in healthcare; however, dealing with these measures in outcomes research can be challenging due to the inherent collinearity of these factors. Here we discuss our experience utilizing three statistical methods-exploratory factor analysis (FA), hierarchical clustering, and latent class analysis (LCA)-to analyze data collected using an electronic medical record social risk screener called Protocol for Responding to and Assessing Patient Assets, Risks, and Experience (PRAPARE). The PRAPARE tool is a standardized instrument designed to collect patient-reported data on SDoH factors, such as income, education, housing, and access to care. A total of 2380 patients had complete PRAPARE and neighborhood-level data for analysis. We identified a total of three composite SDoH clusters using FA, along with four clusters identified through hierarchical clustering, and four latent classes of patients using LCA. Our results highlight how different approaches can be used to handle SDoH, as well as how to select a method based on the intended outcome of the researcher. Additionally, our study shows the usefulness of employing multiple statistical methods to analyze complex SDoH gathered using social risk screeners such as the PRAPARE tool.
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Affiliation(s)
- Li Zhang
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Olivio J. Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Seung-Yup Lee
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Carrie R. Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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Presley CA, Khodneva Y, Howell CR, Riggs KR, Huang L, Levitan EB, Cherrington AL. Patient-level factors associated with hemoglobin A1C testing in Alabama Medicaid beneficiaries with diabetes. Prim Care Diabetes 2023; 17:612-618. [PMID: 37858401 PMCID: PMC10841383 DOI: 10.1016/j.pcd.2023.10.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
AIM We evaluated patient-level factors associated with receipt of hemoglobin A1c (HbA1c) testing among Alabama Medicaid beneficiaries with type 2 diabetes. METHODS We conducted a retrospective analysis of person-year observations from Medicaid claims data from 2011 to 2020. Adults aged 19-64 years with type 2 diabetes and continuous enrollment in Medicaid for study year and year prior were included. Primary outcomes were ≥ 1 and ≥ 2 HbA1c test(s) per year. We conducted multivariable Poisson regression stratified by Medicaid eligibility reason (disability, poverty) examining the association of study year, demographics, clinical factors, and healthcare utilization with HbA1c testing. RESULTS We analyzed 288,379 observations, 51% with disability-based, 49% poverty-based eligibility. Overall, 57% observations had ≥ 1 HbA1c, 35% had ≥ 2 HbA1c tests. More observations with disability-based than poverty-based eligibility had ≥ 1 (76% vs. 38%) and ≥ 2 HbA1c tests (49% vs. 20%). Patient-level factors were associated with a higher likelihood of having ≥ 1 HbA1c: Black race and older age (disability-based eligibility); year after 2011, female sex, and younger age (poverty-based eligibility); and rurality, insulin use, endocrinology care, diabetes complications, and ambulatory care visits (both groups). CONCLUSIONS Just over one-third of adult Alabama Medicaid beneficiaries with diabetes had ≥ 2 HbA1c tests per year; testing frequency differed by Medicaid eligibility.
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Affiliation(s)
- Caroline A Presley
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States.
| | - Yulia Khodneva
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Carrie R Howell
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Kevin R Riggs
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Lei Huang
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrea L Cherrington
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
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Uddin J, Zhu S, Adhikari S, Nordberg CM, Howell CR, Malla G, Judd SE, Cherrington AL, Rummo PE, Lopez P, Kanchi R, Siegel K, De Silva SA, Algur Y, Lovasi GS, Lee NL, Carson AP, Hirsch AG, Thorpe LE, Long DL. Age and sex differences in the association between neighborhood socioeconomic environment and incident diabetes: Results from the diabetes location, environmental attributes and disparities (LEAD) network. SSM Popul Health 2023; 24:101541. [PMID: 38021462 PMCID: PMC10665656 DOI: 10.1016/j.ssmph.2023.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Worse neighborhood socioeconomic environment (NSEE) may contribute to an increased risk of type 2 diabetes (T2D). We examined whether the relationship between NSEE and T2D differs by sex and age in three study populations. Research design and methods We conducted a harmonized analysis using data from three independent longitudinal study samples in the US: 1) the Veteran Administration Diabetes Risk (VADR) cohort, 2) the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, and 3) a case-control study of Geisinger electronic health records in Pennsylvania. We measured NSEE with a z-score sum of six census tract indicators within strata of community type (higher density urban, lower density urban, suburban/small town, and rural). Community type-stratified models evaluated the likelihood of new diagnoses of T2D in each study sample using restricted cubic splines and quartiles of NSEE. Results Across study samples, worse NSEE was associated with higher risk of T2D. We observed significant effect modification by sex and age, though evidence of effect modification varied by site and community type. Largely, stronger associations between worse NSEE and diabetes risk were found among women relative to men and among those less than age 45 in the VADR cohort. Similar modification by age group results were observed in the Geisinger sample in small town/suburban communities only and similar modification by sex was observed in REGARDS in lower density urban communities. Conclusions The impact of NSEE on T2D risk may differ for males and females and by age group within different community types.
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Affiliation(s)
- Jalal Uddin
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
- Department of Community Health and Epidemiology, Dalhousie University, Faculty of Medicine, Halifax, Canada
| | - Sha Zhu
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - Samrachana Adhikari
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Cara M. Nordberg
- Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Carrie R. Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Gargya Malla
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Suzanne E. Judd
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Andrea L. Cherrington
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Pasquale E. Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Priscilla Lopez
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rania Kanchi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Karen Siegel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Shanika A. De Silva
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Yasemin Algur
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Nora L. Lee
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Lorna E. Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - D. Leann Long
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
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Presley CA, Khodneva Y, Juarez LD, Howell CR, Agne AA, Riggs KR, Huang L, Pisu M, Levitan EB, Cherrington AL. Trends and Predictors of Glycemic Control Among Adults With Type 2 Diabetes Covered by Alabama Medicaid, 2011-2019. Prev Chronic Dis 2023; 20:E81. [PMID: 37708338 PMCID: PMC10516203 DOI: 10.5888/pcd20.220332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Despite advances in diabetes management, only one-quarter of people with diabetes in the US achieve optimal targets for glycated hemoglobin A1c (HbA1c), blood pressure, and cholesterol. We sought to evaluate temporal trends and predictors of achieving glycemic control among adults with type 2 diabetes covered by Alabama Medicaid from 2011 through 2019. METHODS We completed a retrospective analysis of Medicaid claims and laboratory data, using person-years as the unit of analysis. Inclusion criteria were being aged 19 to 64 years, having a diabetes diagnosis, being continuously enrolled in Medicaid for a calendar year and preceding 12 months, and having at least 1 HbA1c result during the study year. Primary outcomes were HbA1c thresholds of <7% and <8%. Primary exposure was study year. We conducted separate multivariable-adjusted logistic regressions to evaluate relationships between study year and HbA1c thresholds. RESULTS We included 43,997 person-year observations. Mean (SD) age was 51.0 (9.9) years; 69.4% were women; 48.1% were Black, 42.9% White, and 0.4% Hispanic. Overall, 49.1% had an HbA1c level of <7% and 64.6% <8%. Later study years and poverty-based eligibility were associated with lower probability of reaching target HbA1c levels of <7% or <8%. Sex, race, ethnicity, and geography were not associated with likelihood of reaching HbA1c <7% or <8% in any model. CONCLUSION Later study years were associated with lower likelihood of meeting target HbA1c levels compared with 2011, after adjusting for covariates. With approximately 35% not meeting an HbA1c target of <8%, more work is needed to improve outcomes of low-income adults with type 2 diabetes.
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Affiliation(s)
- Caroline A Presley
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, MT-616, Birmingham, AL 35205
| | - Yulia Khodneva
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Lucia D Juarez
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Carrie R Howell
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - April A Agne
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Kevin R Riggs
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Lei Huang
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Maria Pisu
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Andrea L Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine
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Riggs KR, Presley CA, Agne AA, Howell CR, Huang L, Mugavero MJ, Levitan EB, Cherrington AL. Measuring continuity of care for diabetes: which visits to include? Am J Manag Care 2023; 29:e274-e279. [PMID: 37729533 DOI: 10.37765/ajmc.2023.89431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Continuity of care measures are widely used to evaluate the quality of health care delivery, but which visits are included vary across studies. Our objective was to determine how the provider specialties included affect continuity values, year-to-year stability, and association with emergency department (ED) visits. STUDY DESIGN Retrospective study of Alabama Medicaid administrative data. METHODS We included beneficiaries with diabetes who had at least 3 outpatient visits in each of 2018 and 2019 (N = 9578). We defined 3 provider groupings: all providers, diabetes-broad (primary care, cardiology, neurology, endocrinology, ophthalmology, nephrology, and psychiatry), and diabetes-narrow (primary care and endocrinology). Continuity of care was calculated using the Continuity of Care Index (COCI) for each provider grouping. We compared correlation between measures and from year to year using Spearman correlations, and we used multivariable logistic regression to determine association with ED visits. RESULTS The mean COCI was 0.54 using visits with all providers, 0.64 with diabetes-broad providers, and 0.83 with diabetes-narrow providers. COCI with diabetes-narrow providers was moderately correlated with the broader sets of providers (Spearman ρ, 0.52-0.65). Comparing each participant's COCI in 2018 with that in 2019, the mean intraperson difference was similar (0.16-0.22), and correlation was moderate (Spearman ρ, 0.41-0.47) for each measure. COCI had similar weak association with ED visits using each provider grouping (odds ratio, 0.99; 95% CI, 0.98-0.99 for each 0.1-unit difference in COCI). CONCLUSIONS Continuity values differed substantially depending on which provider specialties were included. The importance of this variation is uncertain, as continuity was weakly associated with ED visits using each of the measures.
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Affiliation(s)
- Kevin R Riggs
- University of Alabama at Birmingham, 1720 2nd Ave S, MT 610, Birmingham, AL 35294-4410.
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11
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Haselschwardt SJ, Lenardo BG, Daniels T, Finch SW, Friesen FQL, Howell CR, Malone CR, Mancil E, Tornow W. Observation of Low-Lying Isomeric States in ^{136}Cs: A New Avenue for Dark Matter and Solar Neutrino Detection in Xenon Detectors. Phys Rev Lett 2023; 131:052502. [PMID: 37595235 DOI: 10.1103/physrevlett.131.052502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/24/2023] [Accepted: 05/01/2023] [Indexed: 08/20/2023]
Abstract
We report on new measurements establishing the existence of low-lying isomeric states in ^{136}Cs using γ rays produced in ^{136}Xe(p,n)^{136}Cs reactions. Two states with O(100) ns lifetimes are placed in the decay sequence of the ^{136}Cs levels that are populated in charged-current interactions of solar neutrinos and fermionic dark matter with ^{136}Xe. Xenon-based experiments can therefore exploit a delayed-coincidence tag of these interactions, greatly suppressing backgrounds to enable spectroscopic studies of solar neutrinos and dark matter.
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Affiliation(s)
- S J Haselschwardt
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720, USA
| | - B G Lenardo
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - T Daniels
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - S W Finch
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - F Q L Friesen
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - C R Howell
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - C R Malone
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - E Mancil
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - W Tornow
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
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12
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Noyd DH, Liu Q, Yasui Y, Chow EJ, Bhatia S, Nathan PC, Landstrom AP, Tonorezos E, Casillas J, Berkman A, Ness KK, Mulrooney DA, Leisenring WM, Howell CR, Shoag J, Kirchhoff A, Howell RM, Gibson TM, Zullig LL, Armstrong GT, Oeffinger KC. Cardiovascular Risk Factor Disparities in Adult Survivors of Childhood Cancer Compared With the General Population. JACC CardioOncol 2023; 5:489-500. [PMID: 37614575 PMCID: PMC10443116 DOI: 10.1016/j.jaccao.2023.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 08/25/2023] Open
Abstract
Background It is unknown whether a history of childhood cancer modifies the established disparities in cardiovascular risk factors (CVRFs) observed in the general population. Objectives We sought to determine if disparities in CVRFs by race/ethnicity are similar among childhood cancer survivors compared with the general population. Methods The Childhood Cancer Survivor Study (CCSS) is a retrospective cohort with a longitudinal follow-up of 24,084 5-year survivors diagnosed between 1970 and 1999. Multivariable piecewise exponential regression estimated incidence rate ratios (IRRs) for hypertension, hyperlipidemia, diabetes, obesity, and ≥2 CVRFs by race/ethnicity. The CCSS sibling cohort and the National Health and Nutrition Examination Survey cohort were used to compare the sociodemographic-adjusted IRRs for same-race/same-ethnicity disparities. Results Non-Hispanic Black (NHB) (n = 1,092) and Hispanic (n = 1,405) survivors compared with non-Hispanic White (NHW) (n = 13,960) survivors reported a higher cumulative incidence of diabetes (8.4%, 9.7%, and 5.1%, respectively); obesity (47.2%, 48.9%, and 30.2%, respectively); multiple CVRFs (17.7%, 16.6%, and 12.3%, respectively); and, for NHB survivors, hypertension (19.5%, 13.6%, and 14.3%, respectively) by 40 years of age (P < 0.001). Controlling for sociodemographic and treatment factors compared with NHW survivors, IRRs for NHB were increased for hypertension (IRR: 1.4; 95% CI: 1.1-1.8), obesity (IRR: 1.7; 95% CI: 1.4-2.1), and multiple CVRFs (IRR: 1.6; 95% CI: 1.2-2.1). IRRs for Hispanic survivors were increased for diabetes (IRR: 1.8; 95% CI: 1.2-2.6) and obesity (IRR: 1.4; 95% CI: 1.2-1.7). The pattern of IRRs for CVRF differences was similar among CCSS sibling and National Health and Nutrition Examination Survey cohorts. Conclusions The higher burden of CVRFs among NHB and Hispanic survivors compared with NHW survivors was similar to the general population. The promotion of cardiovascular health equity is critical in this high-risk population.
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Affiliation(s)
- David H. Noyd
- Duke University Medical Center, Durham, North Carolina, USA
- The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Qi Liu
- University of Alberta, Edmonton, Canada
| | - Yutaka Yasui
- University of Alberta, Edmonton, Canada
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Eric J. Chow
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul C. Nathan
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Jacqueline Casillas
- University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Amy Berkman
- Duke University Medical Center, Durham, North Carolina, USA
| | - Kirsten K. Ness
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | | | | | | | | | - Rebecca M. Howell
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Leah L. Zullig
- Duke University Medical Center, Durham, North Carolina, USA
- Durham Veterans Administration Health Care System, Durham, North Carolina, USA
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Schwartz LF, Dhaduk R, Howell CR, Brinkman TM, Ehrhardt MJ, Delaney A, Srivastava DK, Lanctot JQ, Armstrong GT, Robison LL, Hudson MM, Ness KK, Henderson TO. The Association of Neighborhood Characteristics and Frailty in Childhood Cancer Survivors: A Report from the St. Jude Lifetime Cohort Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1021-1029. [PMID: 37040194 PMCID: PMC10524118 DOI: 10.1158/1055-9965.epi-22-1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/03/2023] [Accepted: 04/07/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Childhood cancer survivors experience reduced physiologic reserve, or frailty, earlier and more frequently than peers. In other populations, frailty is impacted by one's neighborhood. This study's purpose was to evaluate associations between neighborhood characteristics and frailty in childhood cancer survivors. METHODS Participants in the St. Jude Lifetime Cohort Study with geocoded residential addresses were analyzed. Pre-frailty/Frailty was defined as having 1-2/≥3 of sarcopenia, muscle weakness, poor endurance, slow walking speed, and exhaustion from direct assessments. Neighborhood characteristics [e.g., access to exercise opportunities and healthy food, neighborhood socioeconomic status (nSES), and rurality/urbanicity] were determined using publicly available geospatial data. Nested multivariable logistic regression models identified associations between neighborhood characteristics and pre-frailty/frailty, adjusting for chronic health conditions, individual health behaviors and socio-demographics, and high-risk cancer treatment exposures. RESULTS For our cohort (N = 3,806, 46.79% female, 81.40% white, mean age 33.63±9.91 years), compared with non-frail survivors (n = 2,573; 67.6%), pre-frail (n = 900; 23.6%) and frail survivors (n = 333; 8.7%) were more likely to live in neighborhoods with decreased exercise opportunities (frail OR: 1.62, 1.26-2.09), reduced healthy food access (pre-frail OR: 1.28, 1.08-1.51; frail OR: 1.36, 1.06-1.75), and lower nSES (pre-frail OR: 1.31, 1.12-1.52; frail OR: 1.64, 1.30-2.07). Participants had 8% increased odds (95% confidence interval, 2%-14%) of being pre-frail/frail if they lived in "resource poor" neighborhoods as opposed to "resource rich" neighborhoods after adjusting for other pre-frailty/frailty risk factors. CONCLUSIONS The neighborhood a childhood cancer survivor resides in as an adult is associated with pre-frailty/frailty. IMPACT This study provides valuable information for creating interventions using neighborhood-level factors to mitigate frailty and improve health outcomes in survivors. See related commentary by Bhandari and Armenian, p. 997.
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Affiliation(s)
- Lindsay F. Schwartz
- University of Chicago Comer Children’s Hospital, 5721 S. Maryland Avenue, Chicago, Illinois, 60637, United States
| | - Rikeenkumar Dhaduk
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Carrie R. Howell
- The University of Alabama at Birmingham, 1720 University Blvd, Birmingham, Alabama, 35294, United States
| | - Tara M. Brinkman
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Matthew J. Ehrhardt
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Angela Delaney
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Deo Kumar Srivastava
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Jennifer Q. Lanctot
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Gregory T. Armstrong
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Leslie L. Robison
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Melissa M. Hudson
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Kirsten K. Ness
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Tara. O. Henderson
- University of Chicago Comer Children’s Hospital, 5721 S. Maryland Avenue, Chicago, Illinois, 60637, United States
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14
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Howell CR, Harada CN, Fontaine KR, Mugavero MJ, Cherrington AL. Perspective: Acknowledging a Hierarchy of Social Needs in Diabetes Clinical Care and Prevention. Diabetes Metab Syndr Obes 2023; 16:161-166. [PMID: 36760578 PMCID: PMC9869784 DOI: 10.2147/dmso.s389182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/22/2022] [Indexed: 04/20/2023] Open
Abstract
The evidence of suboptimal social determinants of health (SDoH) on poor health outcomes has resulted in widespread calls for research to identify ways to measure and address social needs to improve health outcomes and reduce disparities. While assessing SDoH has become increasingly important in diabetes care and prevention research, little guidance has been offered on how to address suboptimal determinants in diabetes-related clinical care, prevention efforts, medical education and research. Not surprisingly, many patients experience multiple social needs - some that are more urgent (housing) than others (transportation/resources), therefore the order in which these needs are addressed needs to be considered in the context of diabetes care/outcomes. Here we discuss how conceptualizing diabetes related health through the lens of Maslow's hierarchy of needs has potential to help prioritize individual social needs that should be addressed to improve outcomes in the context of population-level determinants in the communities where people live.
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Affiliation(s)
- Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caroline N Harada
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin R Fontaine
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Al, USA
| | - Michael J Mugavero
- Department of Medicine, Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrea L Cherrington
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Howell CR, Bradley H, Zhang L, Cleveland JD, Long D, Horton T, Krantz O, Mugavero MJ, Williams WL, Amerson A, Cherrington AL. Real-world integration of the protocol for responding to and assessing patients' assets, risks, and experiences tool to assess social determinants of health in the electronic medical record at an academic medical center. Digit Health 2023; 9:20552076231176652. [PMID: 37252259 PMCID: PMC10214080 DOI: 10.1177/20552076231176652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Objective To describe the real-world deployment of a tool, the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE), to assess social determinants of health (SDoH) in an electronic medical record (EMR). Methods We employed the collection of the PRAPARE tool in the EMR of a large academic health system in the ambulatory clinic and emergency department setting. After integration, we evaluated SDoH prevalence, levels of missingness, and data anomalies to inform ongoing collection. We summarized responses using descriptive statistics and hand-reviewed data text fields and patterns in the data. Data on patients who were administered with the PRAPARE from February to December 2020 were extracted from the EMR. Patients missing ≥ 12 PRAPARE questions were excluded. Social risks were screened using the PRAPARE. Information on demographics, admittance status, and health coverage were extracted from the EMR. Results Assessments with N = 6531 were completed (mean age 54 years, female (58.6%), 43.8% Black). Missingness ranged from 0.4% (race) to 20.8% (income). Approximately 6% of patients were homeless; 8% reported housing insecurity; 1.4% reported food needs; 14.6% had healthcare needs; 8.4% needed utility assistance; and 5% lacked transportation related to medical care. Emergency department patients reported significantly higher proportions of suboptimal SDoH. Conclusions Integrating the PRAPARE assessment in the EMR provides valuable information on SDoH amenable to intervention, and strategies are needed to increase accurate data collection and to improve the use of data in the clinical encounter.
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Affiliation(s)
- Carrie R Howell
- Department of Medicine, Division of
Preventive Medicine, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Heather Bradley
- Care Transitions, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Li Zhang
- Department of Biostatistics, School of
Public Health, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - John D Cleveland
- Department of Biostatistics, School of
Public Health, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Dustin Long
- Department of Biostatistics, School of
Public Health, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Trudi Horton
- Department of Medicine, Division of
Preventive Medicine, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Olivia Krantz
- Department of Medicine, Division of
Preventive Medicine, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- Department of Medicine, Division of
Infectious Diseases, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Winter L Williams
- Department of Medicine, Division of
General Internal Medicine, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Alesha Amerson
- Department of Medicine, Division of
Preventive Medicine, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Andrea L Cherrington
- Department of Medicine, Division of
Preventive Medicine, University of Alabama at
Birmingham, Birmingham, AL, USA
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Howell CR, Juarez L, Agne AA, Nassel AF, Scarinci IC, Ayala GX, Cherrington AL. Assessing Hispanic/Latino and Non-Hispanic White Social Determinants of Obesity Among a Community Sample of Residents in the Rural Southeast US. J Immigr Minor Health 2022; 24:1469-1479. [PMID: 35174428 PMCID: PMC9980419 DOI: 10.1007/s10903-022-01334-8] [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] [Accepted: 01/24/2022] [Indexed: 02/01/2023]
Abstract
Employing an ecological approach, we sought to identify social determinants of obesity among Hispanics/Latinos and non-Hispanic whites living in the Southeast US. Data on social determinants of obesity (individual, family, community and cultural/contextual) were collected from 217 participants [106 Hispanics/Latinos; 111 non-Hispanic whites]; height and weight were objectively measured. We compared prevalence of overweight and obese between ethnic groups and BMI values within each group by social determinants. Hispanics had a 1.9-fold increase (OR 1.93, 95% CI: 1.05-3.55) in overweight prevalence compared to non-Hispanic whites after adjusting for age and gender. We found positive estimates between unfavorable family-level determinants and BMI among Hispanic/Latinos. In contrast, non-Hispanic whites who reported unfavorable neighborhood characteristics had higher BMI's. Findings highlight the need for targeted approaches for the prevention and control of obesity.
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Affiliation(s)
- Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 638 Medical Towers, 1717 11th Avenue South, Birmingham, AL, 35205, USA.
| | - Lucia Juarez
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 638 Medical Towers, 1717 11th Avenue South, Birmingham, AL, 35205, USA
| | - April A Agne
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 638 Medical Towers, 1717 11th Avenue South, Birmingham, AL, 35205, USA
| | - Ariann F Nassel
- School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Isabel C Scarinci
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 638 Medical Towers, 1717 11th Avenue South, Birmingham, AL, 35205, USA
| | - Guadalupe X Ayala
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Andrea L Cherrington
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 638 Medical Towers, 1717 11th Avenue South, Birmingham, AL, 35205, USA
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Howell CR, Zhang L, Yi N, Mehta T, Cherrington AL, Garvey WT. Associations between cardiometabolic disease severity, social determinants of health (SDoH), and poor COVID-19 outcomes. Obesity (Silver Spring) 2022; 30:1483-1494. [PMID: 35352489 PMCID: PMC9088642 DOI: 10.1002/oby.23440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/14/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study aimed to determine the ability of retrospective cardiometabolic disease staging (CMDS) and social determinants of health (SDoH) to predict COVID-19 outcomes. METHODS Individual and neighborhood SDoH and CMDS clinical parameters (BMI, glucose, blood pressure, high-density lipoprotein, triglycerides), collected up to 3 years prior to a positive COVID-19 test, were extracted from the electronic medical record. Bayesian logistic regression was used to model CMDS and SDoH to predict subsequent hospitalization, intensive care unit (ICU) admission, and mortality, and whether adding SDoH to the CMDS model improved prediction was investigated. Models were cross validated, and areas under the curve (AUC) were compared. RESULTS A total of 2,873 patients were identified (mean age: 58 years [SD 13.2], 59% were female, 45% were Black). CMDS, insurance status, male sex, and higher glucose values were associated with increased odds of all outcomes; area-level social vulnerability was associated with increased odds of hospitalization (odds ratio: 1.84, 95% CI: 1.38-2.45) and ICU admission (odds ratio 1.98, 95% CI: 1.45-2.85). The AUCs improved when SDoH were added to CMDS (p < 0.001): hospitalization (AUC 0.78 vs. 0.82), ICU admission (AUC 0.77 vs. 0.81), and mortality (AUC 0.77 vs. 0.83). CONCLUSIONS Retrospective clinical markers of cardiometabolic disease and SDoH were independently predictive of COVID-19 outcomes in the population.
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Affiliation(s)
- Carrie R. Howell
- Division of Preventive MedicineDepartment of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Li Zhang
- Department of BiostatisticsSchool of Public HealthUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Nengjun Yi
- Department of BiostatisticsSchool of Public HealthUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Tapan Mehta
- Department of Health Services AdministrationSchool of Health ProfessionsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Andrea L. Cherrington
- Division of Preventive MedicineDepartment of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - W. Timothy Garvey
- Department of Nutrition SciencesSchool of Health ProfessionsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Howell CR, Zhang L, Yi N, Mehta T, Garvey WT, Cherrington AL. Race Versus Social Determinants of Health in COVID-19 Hospitalization Prediction. Am J Prev Med 2022; 63:S103-S108. [PMID: 35725136 PMCID: PMC9212800 DOI: 10.1016/j.amepre.2022.01.034] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/30/2021] [Accepted: 01/28/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Including race as a biological construct in risk prediction models may guide clinical decisions in ways that cause harm and widen racial disparities. This study reports on using race versus social determinants of health (SDoH) in predicting the associations between cardiometabolic disease severity (assessed using cardiometabolic disease staging) and COVID-19 hospitalization. METHODS Electronic medical record data on patients with a positive COVID-19 polymerase chain reaction test in 2020 and a previous encounter in the electronic medical record where cardiometabolic disease staging clinical data (BMI, blood glucose, blood pressure, high-density lipoprotein cholesterol, and triglycerides) were available from 2017 to 2020, were analyzed in 2021. Associations between cardiometabolic disease staging and COVID-19 hospitalization adding race and SDoH (individual and neighborhood level [e.g., Social Vulnerability Index]) in different models were examined. Area under the curve was used to assess predictive performance. RESULTS A total of 2,745 patients were included (mean age of 58 years, 59% female, 47% Black). In the cardiometabolic disease staging model, area under the curve was 0.767 vs 0.777 when race was included. Adding SDoH to the cardiometabolic model improved the area under the curve to 0.809 (p<0.001), whereas the addition of SDoH and race increased the area under the curve to 0.811. In race-stratified models, the area under the curve for non-Hispanic Blacks was 0.781, whereas the model for non-Hispanic Whites performed better with an area under the curve of 0.821. CONCLUSIONS Cardiometabolic disease staging was predictive of hospitalization after a positive COVID-19 test. Adding race did not markedly increase the predictive ability; however, adding SDoH to the model improved the area under the curve to ≥0.80. Future research should include SDoH with biological variables in prediction modeling to capture social experience of race.
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Affiliation(s)
- Carrie R Howell
- Division of Preventive Medicine, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama.
| | - Li Zhang
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Nengjun Yi
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Tapan Mehta
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama
| | - W Timothy Garvey
- Department of Nutrition Sciences, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrea L Cherrington
- Division of Preventive Medicine, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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19
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Amerson AC, Juarez LD, Howell CR, Levitan EB, Agne AA, Presley CA, Cherrington AL. Diabetes distress and self-reported health in a sample of Alabama Medicaid-covered adults before and during the COVID-19 pandemic. Front Clin Diabetes Healthc 2022; 3:835706. [PMID: 36467509 PMCID: PMC9717612 DOI: 10.3389/fcdhc.2022.835706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/14/2022] [Indexed: 06/17/2023]
Abstract
Temporary closures of outpatient health facilities and transitions to virtual care during the COVID-19 pandemic interrupted the care of millions of patients with diabetes contributing to worsening psychosocial factors and enhanced difficulty in managing type 2 diabetes mellitus. We explored associations between COVID time period and self-reported diabetes distress on self-reported health among a sample of Alabama Medicaid-covered adults with diabetes pre-COVID (2017-2019) and during-COVID (2020-2021). Method In this cross-sectional study, we surveyed a population-based sample of adults with type 2 diabetes covered by the Alabama Medicaid Agency. Participants were dichotomized into pre-COVID (March 2017 to October 2019) vs during-COVID (October 2020 to May 2021) groups. Participants with missing data were removed from analyses. We assessed diabetes related stress by the Diabetes Distress Scale. We measured self-reported health using a single item with a 5-point Likert scale. We ran logistic regressions modeling COVID time period on self-reported poor health controlling for demographics, severity of diabetes, and diabetes distress. Results In this sample of 1822 individuals, median age was 54, 74.5% were female and 59.4% were Black. Compared to pre-COVID participants, participants surveyed during COVID were younger, more likely to be Black (64.1% VS 58.2%, p=0.01) and female (81.8% VS 72.5%, p<0.001). This group also had fewer individuals from rural areas (29.2% VS 38.4%, p<0.001), and shorter diabetes duration (7 years VS 9 years, p<0.001). During COVID individuals reported modestly lower levels of diabetes distress (1.2 VS 1.4, p<0.001) when compared to the pre-COVID group. After adjusting for demographic differences, diabetes severity, and diabetes distress, participants responding during COVID had increased odds of reporting poor health (Odds ratio [OR] 1.41, 95% Confidence Interval [CI] 1.11-1.80). Discussion We found respondents were more likely to report poorer health during COVID compared to pre-COVID. These results suggest that increased outreach may be needed to address diabetes management for vulnerable groups, many of whom were already at high risk for poor outcomes prior to the pandemic.
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Affiliation(s)
- Alesha C. Amerson
- School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Lucia D. Juarez
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Carrie R. Howell
- School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Emily B. Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - April A. Agne
- School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB) Diabetes Research Center, Birmingham, AL, United States
| | - Caroline A. Presley
- School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Andrea L. Cherrington
- School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB) Diabetes Research Center, Birmingham, AL, United States
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20
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Thorpe LE, Adhikari S, Lopez P, Kanchi R, McClure LA, Hirsch AG, Howell CR, Zhu A, Alemi F, Rummo P, Ogburn EL, Algur Y, Nordberg CM, Poulsen MN, Long L, Carson AP, DeSilva SA, Meeker M, Schwartz BS, Lee DC, Siegel KR, Imperatore G, Elbel B. Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes: Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples. Diabetes Care 2022; 45:798-810. [PMID: 35104336 PMCID: PMC9016733 DOI: 10.2337/dc21-1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined whether relative availability of fast-food restaurants and supermarkets mediates the association between worse neighborhood socioeconomic conditions and risk of developing type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS As part of the Diabetes Location, Environmental Attributes, and Disparities Network, three academic institutions used harmonized environmental data sources and analytic methods in three distinct study samples: 1) the Veterans Administration Diabetes Risk (VADR) cohort, a national administrative cohort of 4.1 million diabetes-free veterans developed using electronic health records (EHRs); 2) Reasons for Geographic and Racial Differences in Stroke (REGARDS), a longitudinal, epidemiologic cohort with Stroke Belt region oversampling (N = 11,208); and 3) Geisinger/Johns Hopkins University (G/JHU), an EHR-based, nested case-control study of 15,888 patients with new-onset T2D and of matched control participants in Pennsylvania. A census tract-level measure of neighborhood socioeconomic environment (NSEE) was developed as a community type-specific z-score sum. Baseline food-environment mediators included percentages of 1) fast-food restaurants and 2) food retail establishments that are supermarkets. Natural direct and indirect mediating effects were modeled; results were stratified across four community types: higher-density urban, lower-density urban, suburban/small town, and rural. RESULTS Across studies, worse NSEE was associated with higher T2D risk. In VADR, relative availability of fast-food restaurants and supermarkets was positively and negatively associated with T2D, respectively, whereas associations in REGARDS and G/JHU geographies were mixed. Mediation results suggested that little to none of the NSEE-diabetes associations were mediated through food-environment pathways. CONCLUSIONS Worse neighborhood socioeconomic conditions were associated with higher T2D risk, yet associations are likely not mediated through food-environment pathways.
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Affiliation(s)
- Lorna E. Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Samrachana Adhikari
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Priscilla Lopez
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Rania Kanchi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Leslie A. McClure
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | | | - Carrie R. Howell
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Aowen Zhu
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Farrokh Alemi
- Department of Health Administration and Policy, George Mason University, Fairfax, VA
| | - Pasquale Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Elizabeth L. Ogburn
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Yasemin Algur
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Cara M. Nordberg
- Department of Population Health Sciences, Geisinger, Danville, PA
| | | | - Leann Long
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - April P. Carson
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Shanika A. DeSilva
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Melissa Meeker
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Brian S. Schwartz
- Department of Population Health Sciences, Geisinger, Danville, PA
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - David C. Lee
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY
| | - Karen R. Siegel
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- New York University Wagner Graduate School of Public Service, New York, NY
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21
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Li X, Ahmed MW, Banu A, Bartram C, Crowe B, Downie EJ, Emamian M, Feldman G, Gao H, Godagama D, Grießhammer HW, Howell CR, Karwowski HJ, Kendellen DP, Kovash MA, Leung KKH, Markoff DM, McGovern JA, Mikhailov S, Pywell RE, Sikora MH, Silano JA, Sosa RS, Spraker MC, Swift G, Wallace P, Weller HR, Whisnant CS, Wu YK, Zhao ZW. Proton Compton Scattering from Linearly Polarized Gamma Rays. Phys Rev Lett 2022; 128:132502. [PMID: 35426711 DOI: 10.1103/physrevlett.128.132502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/14/2021] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
Differential cross sections for Compton scattering from the proton have been measured at scattering angles of 55°, 90°, and 125° in the laboratory frame using quasimonoenergetic linearly (circularly) polarized photon beams with a weighted mean energy value of 83.4 MeV (81.3 MeV). These measurements were performed at the High Intensity Gamma-Ray Source facility at the Triangle Universities Nuclear Laboratory. The results are compared to previous measurements and are interpreted in the chiral effective field theory framework to extract the electromagnetic dipole polarizabilities of the proton, which gives α_{E1}^{p}=13.8±1.2_{stat}±0.1_{BSR}±0.3_{theo},β_{M1}^{p}=0.2∓1.2_{stat}±0.1_{BSR}∓0.3_{theo} in units of 10^{-4} fm^{3}.
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Affiliation(s)
- X Li
- Department of Physics, Duke University, Durham, North Carolina 27708-0308, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - M W Ahmed
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina, 27707, USA
| | - A Banu
- Department of Physics and Astronomy, James Madison University, Harrisonburg, Virginia 22807, USA
| | - C Bartram
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA
| | - B Crowe
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina, 27707, USA
| | - E J Downie
- Institute for Nuclear Studies, Department of Physics, The George Washington University, Washington, D.C. 20052, USA
| | - M Emamian
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - G Feldman
- Institute for Nuclear Studies, Department of Physics, The George Washington University, Washington, D.C. 20052, USA
| | - H Gao
- Department of Physics, Duke University, Durham, North Carolina 27708-0308, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - D Godagama
- Department of Physics and Astronomy, University of Kentucky, Lexington, Kentucky 40506, USA
| | - H W Grießhammer
- Department of Physics, Duke University, Durham, North Carolina 27708-0308, USA
- Institute for Nuclear Studies, Department of Physics, The George Washington University, Washington, D.C. 20052, USA
| | - C R Howell
- Department of Physics, Duke University, Durham, North Carolina 27708-0308, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - H J Karwowski
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA
| | - D P Kendellen
- Department of Physics, Duke University, Durham, North Carolina 27708-0308, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - M A Kovash
- Department of Physics and Astronomy, University of Kentucky, Lexington, Kentucky 40506, USA
| | - K K H Leung
- Department of Physics, Duke University, Durham, North Carolina 27708-0308, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
- Department of Physics and Astronomy, Montclair State University, Montclair, New Jersey 07043, USA
| | - D M Markoff
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina, 27707, USA
| | - J A McGovern
- Theoretical Physics Group, Department of Physics and Astronomy, University of Manchester, Manchester M13 9PL, United Kingdom
| | - S Mikhailov
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - R E Pywell
- Department of Physics and Engineering Physics, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E2, Canada
| | - M H Sikora
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
- Institute for Nuclear Studies, Department of Physics, The George Washington University, Washington, D.C. 20052, USA
| | - J A Silano
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA
| | - R S Sosa
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina, 27707, USA
| | - M C Spraker
- Department of Physics and Astronomy, University of North Georgia, Dahlonega, Georgia 30597, USA
| | - G Swift
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - P Wallace
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - H R Weller
- Department of Physics, Duke University, Durham, North Carolina 27708-0308, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - C S Whisnant
- Department of Physics and Astronomy, James Madison University, Harrisonburg, Virginia 22807, USA
| | - Y K Wu
- Department of Physics, Duke University, Durham, North Carolina 27708-0308, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
| | - Z W Zhao
- Department of Physics, Duke University, Durham, North Carolina 27708-0308, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708-0308, USA
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22
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Lubas MM, Szklo-Coxe M, Mandrell BN, Howell CR, Ness KK, Srivastava DK, Hudson MM, Robison LL, Krull KR, Brinkman TM. Concordance between self-reported sleep and actigraphy-assessed sleep in adult survivors of childhood cancer: the impact of psychological and neurocognitive late effects. Support Care Cancer 2022; 30:1159-1168. [PMID: 34435211 PMCID: PMC8732302 DOI: 10.1007/s00520-021-06498-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To examine self-reported (30-day) sleep versus nightly actigraphy-assessed sleep concordance in long-term survivors of childhood cancer. METHODS Four hundred seventy-seven participants enrolled in the St. Jude Lifetime Cohort (53.5% female, median (range) age 34.3 (19.3-61.6) years, 25.4 (10.9-49.3) years from diagnosis) completed the Pittsburgh Sleep Quality Index and ≥ 3 nights of actigraphy. Participants had neurocognitive impairment and/or a self-reported prolonged sleep onset latency (SOL). Self-reported 30-day sleep and nightly actigraphic sleep measures for sleep duration, SOL, and sleep efficiency (SE) were converted into ordinal categories for calculation of weighted kappa coefficients. General linear models estimated associations between measurement concordance and late effects. RESULTS Agreements between self-reported and actigraphic measures were slight to fair for sleep duration and SOL measures (kw = 0.20 and kw = 0.22, respectively; p < 0.0001) and poor for SE measures (kw = 0.00, p = 0.79). In multivariable models, severe fatigue and poor sleep quality were significantly associated with greater absolute differences between self-reported and actigraphy-assessed sleep durations (B = 26.6 [p < 0.001] and B = 26.8 [p = 0.01], respectively). Survivors with (versus without) memory impairment had a 44-min higher absolute difference in sleep duration (B = 44.4, p < 0.001). Survivors with, versus without, depression and poor sleep quality had higher absolute discrepancies of SOL (B = 24.5 [p = 0.01] and B = 16.4 [p < 0.0001], respectively). Poor sleep quality was associated with a 12% higher absolute difference in SE (B = 12.32, p < 0.0001). CONCLUSIONS Self-reported sleep and actigraphic sleep demonstrated discordance in our sample. Several prevalent late effects were statistically significantly associated with increased measurement discrepancy. Future studies should consider the impacts of late effects on sleep assessment in adult survivors of childhood cancer.
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Affiliation(s)
- Margaret M Lubas
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
| | - Mariana Szklo-Coxe
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Belinda N Mandrell
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA.
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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23
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Lubas MM, Mandrell BN, Greene WL, Howell CR, Christensen R, Kimberg CI, Li C, Ness KK, Srivastava DK, Hudson MM, Robison LL, Krull KR, Brinkman TM. A randomized double-blind placebo-controlled trial of the effectiveness of melatonin on neurocognition and sleep in survivors of childhood cancer. Pediatr Blood Cancer 2022; 69:e29393. [PMID: 34674368 PMCID: PMC8859989 DOI: 10.1002/pbc.29393] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adult survivors of childhood cancer are at risk of developing sleep and neurocognitive problems, yet few efficacious interventions exist targeting these prevalent late effects. Melatonin has known sleep-promoting effects; however, it has not been well studied among childhood cancer survivors. METHOD Survivors (n = 580; mean age = 33.5 years; 26 years post-diagnosis) from the St. Jude Lifetime Cohort were randomized (1:1) to a six-month double-blind placebo-controlled trial of 3 mg time-release melatonin within three strata (stratum 1: neurocognitive impairment only; stratum 2: neurocognitive and sleep impairment; stratum 3: sleep impairment only). Neurocognitive performance was assessed at baseline and post-intervention using standardized measures. Sleep was assessed via self-report and actigraphy. Independent sample t tests compared mean change scores from baseline to six months. Post-hoc analyses compared the prevalence of clinically significant treatment responders among melatonin and placebo conditions within and across strata. RESULTS Intent-to-treat analyses revealed no statistically significant differences in neurocognitive performance or sleep from baseline to post-intervention. However, among survivors with neurocognitive impairment only, a larger proportion randomized to melatonin versus placebo demonstrated a treatment response for visuomotor speed (63% vs 41%, P = 0.02) and nonverbal reasoning (46% vs 28%, P = 0.04). Among survivors with sleep impairment only, a larger proportion treated with melatonin demonstrated a treatment response for shifting attention (44% vs 28%, P = 0.05), short-term memory (39% vs 19%, P = 0.01), and actigraphy-assessed sleep duration (47% vs 29%, P = 0.05). CONCLUSION Melatonin was not associated with improved neurocognitive performance or sleep in our intent-to-treat analyses; however, a subset of survivors demonstrated a clinically significant treatment response.
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Affiliation(s)
- Margaret M. Lubas
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital
| | | | - William L. Greene
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital
| | - Carrie R. Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham
| | - Robbin Christensen
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital
| | - Cara I. Kimberg
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital
| | - Chenghong Li
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital
| | | | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital,Department of Oncology, St. Jude Children’s Research Hospital
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital,Department of Psychology, St. Jude Children’s Research Hospital
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital,Department of Psychology, St. Jude Children’s Research Hospital
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24
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McCastlain K, Howell CR, Welsh CE, Wang Z, Wilson CL, Mulder HL, Easton J, Mertens AC, Zhang J, Yasui Y, Hudson MM, Robison LL, Kundu M, Ness KK. The Association of Mitochondrial Copy Number With Sarcopenia in Adult Survivors of Childhood Cancer. J Natl Cancer Inst 2021; 113:1570-1580. [PMID: 33871611 PMCID: PMC8562958 DOI: 10.1093/jnci/djab084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Adult childhood cancer survivors are at risk for frailty, including low muscle mass and weakness (sarcopenia). Using peripheral blood mitochondrial DNA copy number (mtDNAcn) as a proxy for functional mitochondria, this study describes cross-sectional associations between mtDNAcn and sarcopenia among survivors. METHODS Among 1762 adult childhood cancer survivors (51.6% male; median age = 29.4 years, interquartile range [IQR] = 23.3-36.8), with a median of 20.6 years from diagnosis (IQR = 15.2-28.2), mtDNAcn estimates were derived from whole-genome sequencing. A subset was validated by quantitative polymerase chain reaction and evaluated cross-sectionally using multivariable logistic regression for their association with sarcopenia, defined by race-, age-, and sex-specific low lean muscle mass or weak grip strength. All statistical tests were 2-sided. RESULTS The prevalence of sarcopenia was 27.0%, higher among female than male survivors (31.5% vs 22.9%; P < .001) and associated with age at diagnosis; 51.7% of survivors with sarcopenia were diagnosed ages 4-13 years (P = .01). Sarcopenia was most prevalent (39.0%) among central nervous system tumor survivors. Cranial radiation (odds ratio [OR] = 1.84, 95% confidence interval [CI] = 1.32 to 2.59) and alkylating agents (OR = 1.34, 95% CI = 1.04 to 1.72) increased, whereas glucocorticoids decreased odds (OR = 0.72, 95% CI = 0.56 to 0.93) of sarcopenia. mtDNAcn decreased with age (β = -0.81, P = .002) and was higher among female survivors (β = 9.23, P = .01) and among survivors with a C allele at mt.204 (β = -17.9, P = .02). In adjusted models, every standard deviation decrease in mtDNAcn increased the odds of sarcopenia 20% (OR = 1.20, 95% CI = 1.07 to 1.34). CONCLUSIONS A growing body of evidence supports peripheral blood mtDNAcn as a biomarker for adverse health outcomes; however, this study is the first to report an association between mtDNAcn and sarcopenia among childhood cancer survivors.
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Affiliation(s)
- Kelly McCastlain
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Carrie R Howell
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine E Welsh
- Department of Mathematics & Computer Science, Rhodes College, Memphis, TN, USA
| | - Zhaoming Wang
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Heather L Mulder
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - John Easton
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ann C Mertens
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Mondira Kundu
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
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25
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Delaney A, Howell CR, Krull KR, Brinkman TM, Armstrong GT, Chemaitilly W, Wilson CL, Mulrooney DA, Wang Z, Lanctot JQ, Johnson RE, Krull MR, Partin RE, Shelton KC, Srivastava DK, Robison LL, Hudson MM, Ness KK. Progression of Frailty in Survivors of Childhood Cancer: A St. Jude Lifetime Cohort Report. J Natl Cancer Inst 2021; 113:1415-1421. [PMID: 33720359 DOI: 10.1093/jnci/djab033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/02/2021] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Some adult survivors of childhood cancers develop frailty at higher rates than expected based on their chronological age. This study examined the incidence of frailty among survivors at 10 or more years after diagnosis, frailty prevalence 5 years later, and risk factors for becoming frail. METHODS Frailty was measured at study entry and 5 years later. Logistic regression tested the associations of several factors with having frailty at 5 years for all participants and separately by sex and by study entry frailty status. Cox models evaluated the hazard of death associated with entry frailty considering covariates. RESULTS Cancer survivors (range = 0-22 years at diagnosis, median = 7 years) were ages 18-45 years (median = 30 years) at study entry. Frailty prevalence increased from 6.2% (95% confidence interval [CI] = 5.0% to 7.5%) to 13.6% (95% CI = 11.9% to 15.4%) at 5 years. Risk factors for frailty at follow-up among all survivors included chest radiation 20 Gy or higher (odds ratio [OR] = 1.98, 95% CI = 1.29 to 3.05), cardiac (OR = 1.58, 95% CI = 1.02 to 2.46), and neurological (OR = 2.58, 95% CI = 1.69 to 3.92) conditions; lack of strength training (OR = 1.74, 95% CI = 1.14 to 2.66); sedentary lifestyle (OR = 1.75, 95% CI = 1.18 to 2.59); and frailty at study entry (OR = 11.12, 95% CI = 6.64 to 18.61). The strongest risk factor for death during follow-up was prior frailty (OR = 3.52, 95% CI = 1.95 to 6.32). CONCLUSIONS Prevalent frailty more than doubled at 5 years after study entry among adult childhood cancer survivors. Frailty at entry was the strongest risk factor for death. Because treatment exposures cannot be changed, mitigation of other risk factors for frailty, including lack of strength training and sedentary lifestyle, may decrease risk of adverse health events and improve longevity in survivors.
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Affiliation(s)
- Angela Delaney
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carrie R Howell
- Department of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Wassim Chemaitilly
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ruth E Johnson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kyla C Shelton
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
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26
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Borgatti AC, Schneider-Worthington CR, Stager LM, Krantz OM, Davis AL, Blevins M, Howell CR, Dutton GR. The COVID-19 pandemic and weight management: Effective behaviors and pandemic-specific risk factors. Obes Res Clin Pract 2021; 15:518-521. [PMID: 34244125 PMCID: PMC8492285 DOI: 10.1016/j.orcp.2021.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Obesity and comorbid conditions are associated with worse outcomes related to COVID-19. Moreover, social distancing adherence during the COVID-19 pandemic may predict weight gain due to decreased physical activity, increased emotional eating, and social isolation. While early studies suggest that many individuals struggled with weight management during the pandemic, less is known about healthy eating and weight control behaviors among those enrolled in weight loss programs. METHODS The present study evaluated weight management efforts among weight loss program participants during the COVID-19 pandemic. Participants' (N = 55, 90.9% female, 36% white, Mage = 49.8) demographics and body mass index were collected two months prior to the COVID-19 statewide shutdown. During the lockdown, an online survey assessed health behaviors, coping, COVID-19 experiences (e.g., social distancing, loneliness), and weight gain. Logistic regressions examined demographics, health behaviors, and COVID-19 factors as predictors of weight gain. RESULTS Most participants (58%) reported gaining weight during COVID-19. Weight gain was predicted by challenges with the following health behaviors: physical activity, monitoring food intake, choosing healthy foods, and emotional eating. Loneliness and working remotely significantly related to emotional eating, physical activity, and choosing healthy foods. CONCLUSIONS Loneliness and working remotely increased the difficulty of weight management behaviors during COVID-19 among weight loss program participants. However, staying active, planning and tracking food consumption, choosing healthy foods, and reducing emotional eating protected against weight gain. Thus, these factors may be key areas for weight management efforts during the pandemic.
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Affiliation(s)
- Alena C Borgatti
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, United States; Department of Psychology, University of Alabama at Birmingham, United States.
| | | | - Lindsay M Stager
- Department of Psychology, University of Alabama at Birmingham, United States
| | - Olivia M Krantz
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, United States
| | - Andrea L Davis
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, United States; Department of Psychology, University of Alabama at Birmingham, United States
| | - Magdalene Blevins
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, United States
| | - Carrie R Howell
- Department of Public Health, University of Alabama at Birmingham, United States
| | - Gareth R Dutton
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, United States
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27
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Jefferies JL, Mazur WM, Howell CR, Plana JC, Ness KK, Li Z, Joshi VM, Green DM, Mulrooney DA, Towbin JA, Martinez HR, Goldberg JF, Howell RM, Srivastava DK, Robison LL, Hudson MM, Armstrong GT. Cardiac remodeling after anthracycline and radiotherapy exposure in adult survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study. Cancer 2021; 127:4646-4655. [PMID: 34411296 DOI: 10.1002/cncr.33860] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/03/2021] [Accepted: 06/25/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Limited data exist regarding left ventricular remodeling patterns observed in adult survivors of childhood cancer after therapy. METHODS Among 1190 adult survivors diagnosed with childhood cancer (median age at diagnosis, 9 years [interquartile range (IQR), 3.8-14.4 years]; age at evaluation, 35.6 years [IQR, 29.5-42.8 years]), treatment exposures included anthracyclines (n = 346), chest radiotherapy (n = 174), both (n = 245), or neither (n = 425). Prospective echocardiographic assessment compared survivors with 449 noncancer controls classified according to left ventricle geometric patterns. Associations between left ventricle geometric patterns and decreased exercise tolerance were assessed. RESULTS Overall, 28.2% of survivors (95% confidence interval [CI], 25.6%-30.8%) exhibited concentric remodeling, 2.4% (95% CI, 1.6%-3.5%) exhibited eccentric hypertrophy, and 1.1% (95% CI, 0.6%-1.9%) exhibited concentric hypertrophy. A greater proportion of survivors who received only chest radiotherapy (41%) had concentric remodeling compared with those who received only anthracyclines (24%), both (27%), or neither (27%; all P < .001), and all were greater than the proportions in noncancer controls (18%; all P < .05). Concentric remodeling was associated with radiation exposure, but not with anthracycline exposure, in multivariable models. Survivors who had concentric remodeling were more likely to have a maximal oxygen uptake peak <85% compared with those who had normal geometry (81.0% vs 66.3%; odds ratio, 1.75; 95% CI, 1.15-2.68). CONCLUSIONS Chest radiation therapy, but not anthracycline therapy, increased the risk for concentric remodeling in survivors of childhood cancer. The presence of concentric remodeling was associated with increased exercise intolerance.
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Affiliation(s)
- John L Jefferies
- The Cardiovascular Institute, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, Alabama
| | - Juan C Plana
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhenghong Li
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Vijaya M Joshi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel M Green
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jeffrey A Towbin
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hugo R Martinez
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jason F Goldberg
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rebecca M Howell
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Deo Kumar Srivastava
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
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28
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Williams AM, Krull KR, Howell CR, Banerjee P, Brinkman TM, Kaste SC, Partin RE, Srivastava D, Yasui Y, Armstrong GT, Robison LL, Hudson MM, Ness KK. Physiologic Frailty and Neurocognitive Decline Among Young-Adult Childhood Cancer Survivors: A Prospective Study From the St Jude Lifetime Cohort. J Clin Oncol 2021; 39:3485-3495. [PMID: 34283634 DOI: 10.1200/jco.21.00194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Eight percent of young-adult childhood cancer survivors meet criteria for frailty, an aging phenotype associated with poor health. In the elderly general population, frailty is associated with neurocognitive decline; this association has not been examined in adult survivors of childhood cancer. METHODS Childhood cancer survivors 18-45 years old (≥ 10 years from diagnosis) were clinically evaluated for prefrailty or frailty (respectively defined as ≥ 2 or ≥ 3 of: muscle wasting, muscle weakness, low energy expenditure, slow walking speed, and exhaustion [Fried criteria]) and completed neuropsychologic assessments at enrollment (January 2008-June 2013) and 5 years later. Weighted linear regression using inverse of sampling probability estimates as weights compared differences in neurocognitive decline in prefrail and frail survivors versus nonfrail survivors, adjusting for diagnosis age, sex, race, CNS-directed therapy (cranial radiation, intrathecal chemotherapy, and neurosurgery), and baseline neurocognitive performance. RESULTS Survivors were on average 30 years old and 22 years from diagnosis; 18% were prefrail and 6% frail at enrollment. Frail survivors declined an average of 0.54 standard deviation (95% CI, -0.93 to -0.15) in short-term verbal recall, whereas nonfrail survivors did not decline (β = .22; difference of βs = -.76; 95% CI, -1.19 to -0.33). Frail survivors declined more than nonfrail survivors on visual-motor processing speed (β = -.40; 95% CI, -0.67 to -0.12), cognitive flexibility (β = -.62; 95% CI, -1.02 to -0.22), and verbal fluency (β = -.23; 95% CI, -0.41 to -0.05). Prefrail and frail survivors experienced greater declines in focused attention (prefrail β = -.35; 95% CI, -0.53 to -0.17; frail β = -.48; 95% CI, -0.83 to -0.12) compared with nonfrail survivors. CONCLUSION Over approximately 5 years, prefrail and frail young-adult survivors had greater declines in cognitive domains associated with aging and dementia compared with nonfrail survivors. Interventions that have global impact, designed to target the mechanistic underpinnings of frailty, may also mitigate or prevent neurocognitive decline.
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Affiliation(s)
- AnnaLynn M Williams
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN.,Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Carrie R Howell
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Pia Banerjee
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN.,Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Sue C Kaste
- Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Deokumar Srivastava
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
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29
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Howell CR, Bjornard KL, Ness KK, Alberts N, Armstrong GT, Bhakta N, Brinkman T, Caron E, Chemaitilly W, Green DM, Folse T, Huang IC, Jefferies JL, Kaste S, Krull KR, Lanctot JQ, Mulrooney DA, Neale G, Nichols KE, Sabin ND, Shelton K, Srivastava DK, Wang Z, Wilson C, Yasui Y, Zaidi A, Zhang J, Robison LL, Hudson MM, Ehrhardt MJ. Cohort Profile: The St. Jude Lifetime Cohort Study (SJLIFE) for paediatric cancer survivors. Int J Epidemiol 2021; 50:39-49. [PMID: 33374007 DOI: 10.1093/ije/dyaa203] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nicole Alberts
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tara Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Eric Caron
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Wassim Chemaitilly
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel M Green
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tim Folse
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - John L Jefferies
- Division of Adult Cardiovascular Disease, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sue Kaste
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Geoffrey Neale
- Hartwell Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kim E Nichols
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Noah D Sabin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kyla Shelton
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carmen Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alia Zaidi
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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30
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Dutton GR, Kinsey AW, Howell CR, Pisu M, Dobelstein AE, Allison DB, Xun P, Levitsky DA, Fontaine K. The daily Self-Weighing for Obesity Management in Primary Care Study: Rationale, design and methodology. Contemp Clin Trials 2021; 107:106463. [PMID: 34082075 DOI: 10.1016/j.cct.2021.106463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/18/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022]
Abstract
Background Daily self-weighing (DSW) may be an effective harm-reduction intervention to disrupt continued weight gain. Self-Weighing for Obesity Management in Primary Care (SWOP) is a 24-month randomized controlled trial in 400 adults with obesity (BMI: kg/m2 ≥ 30) receiving primary care through a clinical network affiliated with an academic medical center. Objective To test DSW as a potentially scalable way to deter age-related weight gain among primary care patients with obesity. Methods Randomized-controlled trial with two conditions: DSW (instruction to weigh daily and provision of a web-enabled digital scale with graphical weight feedback) or Standard Care (receive a monetary gift card equivalent to value of the scale). Both groups receive standardized weight management educational material. SWOP will test the causal effect of assignment to DSW (Aim 1) and adherence to DSW (Aim 2) on weight (primary outcome) and adoption of weight management practices (secondary outcomes), as well as evaluate the cost-effectiveness of DSW compared to standard care (Aim 3). Findings may inform clinical guidelines for weight management by providing evidence that DSW attenuates continued age-related weight gain among adults with obesity. This trial is registered with ClinicalTrials.gov (NCT04044794).
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Affiliation(s)
- Gareth R Dutton
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - Amber W Kinsey
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - Maria Pisu
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - Amy E Dobelstein
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - David B Allison
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University-Bloomington, 1025 E. 7th Street, Bloomington, IN 47405, USA.
| | - Pengcheng Xun
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University-Bloomington, 1025 E. 7th Street, Bloomington, IN 47405, USA
| | - David A Levitsky
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, 244 Garden Ave, Ithaca, NY 14853, USA.
| | - Kevin Fontaine
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35233, USA.
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Baedke JL, Lindsey LA, James AS, Huang IC, Ness KK, Howell CR, Brinkman TM, Bhakta N, Ehrhardt MJ, Im C, Letsou W, Liu Q, Robison LL, Hudson MM, Yasui Y. Forgoing needed medical care among long-term survivors of childhood cancer: racial/ethnic-insurance disparities. J Cancer Surviv 2021; 16:677-687. [PMID: 34046821 PMCID: PMC8626536 DOI: 10.1007/s11764-021-01061-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/19/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate racial/ethnic-related disparities by insurance status in "forgoing needed medical care in the last year due to finances" in childhood cancer survivors. METHODS Our study included 3310 non-Hispanic/Latinx White, 562 non-Hispanic/Latinx Black, and 92 Hispanic/Latinx survivors from the St. Jude Lifetime Cohort Study. Logistic regression analyses, guided by Andersen's Healthcare Utilization Model, were adjusted for "predisposing" (survey age, sex, childhood cancer diagnosis and treatment, and treatment era) and "need" (perceived health status) factors. Additional adjustment for household income/education and chronic health conditions was considered. RESULTS Risk of forgoing care was highest among non-Hispanic/Latinx Blacks and lowest among Hispanics/Latinxs for each insurance status. Among privately insured survivors, relative to non-Hispanic/Latinx Whites, non-Hispanic/Latinx Blacks were more likely to forgo care (adjusted OR: 1.82, 95% CI: 1.30-2.54): this disparity remained despite additional adjustment for household income/education (adjusted OR: 1.43, 95% CI: 1.01-2.01). In contrast, publicly insured survivors, regardless of race/ethnicity, had similar risk of forgoing care as privately insured non-Hispanic/Latinx Whites. All uninsured survivors had high risk of forgoing care. Additional chronic health condition adjustment did not alter these results. CONCLUSIONS Provision of public insurance to all childhood cancer survivors may diminish racial/ethnic disparities in forgoing care that exist among the privately insured and reduce the risk of forgoing care among uninsured survivors to that of privately insured non-Hispanic/Latinx Whites. IMPLICATIONS FOR CANCER SURVIVORS Under public insurance, childhood cancer survivors had low risk of forgoing care, at the similar level to privately insured non-Hispanic/Latinx Whites, regardless of race/ethnicity.
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Affiliation(s)
- Jessica L Baedke
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Lauren A Lindsey
- School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Aimee S James
- Department of Surgery, Washington University School of Medicine, Campus Box 8109, 4590 Children's Place, Suite 9600, St. Louis, MO, 63110, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers, MT-621, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Department of Psychology, St. Jude Children's Research Hospital, Mailstop 740, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Mailstop 721, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Department of Oncology, St. Jude Children's Research Hospital, Mailstop 260, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Department of Oncology, St. Jude Children's Research Hospital, Mailstop 260, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Cindy Im
- School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - William Letsou
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Qi Liu
- School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Department of Oncology, St. Jude Children's Research Hospital, Mailstop 260, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
- School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada.
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Noyd DH, Yasui Y, Li N, Chow EJ, Bhatia S, Landstrom A, Gilchrist S, Tonorezos ES, Zullig LL, Casillas JN, Berkman AM, Ness KK, Mulrooney DA, Leisenring WM, Howell CR, Shoag JM, Kirchhoff AC, Howell RM, Armstrong GT, Oeffinger KC. Disparities in cardiovascular risk factors by race/ethnicity among adult survivors of childhood cancer: A report from the Childhood Cancer Survivorship Study (CCSS). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10017 Background: Racial, ethnic, and socioeconomic disparities are documented in outcomes for childhood cancer survivors. Understanding whether childhood cancer modifies established disparities in cardiovascular risk factors (CVRFs) in the general population would inform strategies to reduce health inequities among survivors. Methods: The CCSS is a retrospectively constructed cohort with prospective follow-up consisting of 25,579 five year survivors of childhood cancer diagnosed between 1970 and 1999. We estimated the incidence of self-reported Common Terminology Criteria for Adverse Events (CTCAE) grade >2 CVRFs (hypertension, diabetes, dyslipidemia, and obesity) and multiple (>2) CVRFs among survivors. Multivariable Poisson regression estimated the rate ratios (RR) of CVRFs by race/ethnicity, adjusted for key treatment exposures and sociodemographics. Results: Within the CCSS cohort, there were 20,416 non-Hispanic White (NHW), 1625 non-Hispanic Black (NHB), and 2043 Hispanic survivors with the cumulative incidence estimates of each CVRF at age 40 displayed in Table. Survivors who self-reported “Other” or mixed race were excluded for this analysis (n=1495). NHB survivors were more likely to report hypertension (unadjusted RR 1.3; 95% Confidence Interval [CI] 1.0-1.6), diabetes (RR 1.6; 95% CI 1.0-2.4), obesity (RR 1.6; 95% CI 1.4-1.9), and multiple CVRF (RR 1.3; 95% CI 1.2-1.5), whereas Hispanic survivors were more likely to report diabetes (RR 1.7; 95% CI 1.2-2.4), obesity (RR 1.4; 95% CI 1.2-1.5), and multiple CVRFs (RR 1.1; 95% CI 1.0-1.3) compared with NHW survivors. These observed disparities in risks of CVRFs remained nearly unchanged even after adjustment for sociodemographic factors (age, sex, household income, education, marital status, employment, and insurance) and treatment exposures (Yes/No for anthracyclines, alkylators, and chest radiation). Conclusions: NHB and Hispanic adult survivors demonstrate a higher burden of CVRF compared with NHW survivors, particularly diabetes and obesity. The associated morbidity of these conditions and established increase they incur in risk of more severe cardiovascular disease emphasizes the need for interventions to mitigate CVRFs to promote health equity among these survivors.[Table: see text]
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Affiliation(s)
| | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, TN
| | - Nan Li
- St. Jude Children's Research Hospital, Memphis, TN
| | | | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | | | | | | | | | | | | | - Rebecca M. Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
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Juarez LD, Presley CA, Howell CR, Agne AA, Cherrington AL. The Mediating Role of Self-Efficacy in the Association Between Diabetes Education and Support and Self-Care Management. Health Educ Behav 2021; 49:689-696. [PMID: 33896236 DOI: 10.1177/10901981211008819] [Citation(s) in RCA: 2] [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] [Indexed: 11/16/2022]
Abstract
RESULTS A total of 1,318 participants were included in the study (mean age = 52.9 years, SD = 9.6; 72.5% female, 56.4% Black, 3.1% Hispanic). Diabetes education was associated with increases in self-care activity scores related to general diet, physical activity, glucose self-monitoring, and foot care; care coordination was associated with glucose self-monitoring. In addition, mediation analysis models confirmed that improvements in self-efficacy led to improved self-care activities scores, mediating the association of diabetes education and self-care activities. CONCLUSIONS Diabetes education and self-efficacy were associated with better self-care. Receiving diabetes education led to a higher likelihood of engaging in self-care activities, driven in part by increases in self-efficacy. Future interventions that aim to improve diabetes self-management behaviors can benefit from targeting self-efficacy constructs and from the integration of diabetes education in the care coordination structure.
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Affiliation(s)
- Lucía D Juarez
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - April A Agne
- University of Alabama at Birmingham, Birmingham, AL, USA
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Howell CR, Su W, Nassel AF, Agne AA, Cherrington AL. Area based stratified random sampling using geospatial technology in a community-based survey. BMC Public Health 2020; 20:1678. [PMID: 33167956 PMCID: PMC7653801 DOI: 10.1186/s12889-020-09793-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Most studies among Hispanics have focused on individual risk factors of obesity, with less attention on interpersonal, community and environmental determinants. Conducting community based surveys to study these determinants must ensure representativeness of disparate populations. We describe the use of a novel Geographic Information System (GIS)-based population based sampling to minimize selection bias in a rural community based study. METHODS We conducted a community based survey to collect and examine social determinants of health and their association with obesity prevalence among a sample of Hispanics and non-Hispanic whites living in a rural community in the Southeastern United States. To ensure a balanced sample of both ethnic groups, we designed an area stratified random sampling procedure involving three stages: (1) division of the sampling area into non-overlapping strata based on Hispanic household proportion using GIS software; (2) random selection of the designated number of Census blocks from each stratum; and (3) random selection of the designated number of housing units (i.e., survey participants) from each Census block. RESULTS The proposed sample included 109 Hispanic and 107 non-Hispanic participants to be recruited from 44 Census blocks. The final sample included 106 Hispanic and 111 non-Hispanic participants. The proportion of Hispanic surveys completed per strata matched our proposed distribution: 7% for strata 1, 30% for strata 2, 58% for strata 3 and 83% for strata 4. CONCLUSION Utilizing a standardized area based randomized sampling approach allowed us to successfully recruit an ethnically balanced sample while conducting door to door surveys in a rural, community based study. The integration of area based randomized sampling using tools such as GIS in future community-based research should be considered, particularly when trying to reach disparate populations.
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Affiliation(s)
- Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 62, 1717 11th Avenue South, Birmingham, AL, 35205, USA.
| | - Wei Su
- School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Ariann F Nassel
- School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - April A Agne
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 62, 1717 11th Avenue South, Birmingham, AL, 35205, USA
| | - Andrea L Cherrington
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 62, 1717 11th Avenue South, Birmingham, AL, 35205, USA
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35
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Dixon SB, Howell CR, Lu L, Plana JC, Joshi VM, Luepker RV, Durand JB, Ky B, Lenihan DJ, Jefferies JL, Green DM, Ehrhardt MJ, Mulrooney DA, Folse TE, Partin RE, Santucci AK, Howell RM, Srivastava DK, Hudson MM, Robison LL, Ness KK, Armstrong GT. Cardiac biomarkers and association with subsequent cardiomyopathy and mortality among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort. Cancer 2020; 127:458-466. [PMID: 33108003 DOI: 10.1002/cncr.33292] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Survivors of childhood cancer exposed to cardiotoxic therapies are at significant cardiovascular risk. The utility of cardiac biomarkers for identifying the risk of future cardiomyopathy and mortality is unknown. METHODS N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) were assessed in 1213 adults 10 or more years from a childhood cancer diagnosis; 786 were exposed to anthracycline chemotherapy and/or chest-directed radiation therapy (RT). NT-proBNP values above age- and sex-specific 97.5th percentiles were considered abnormal. Generalized linear models estimated cross-sectional associations between abnormal NT-proBNP and anthracycline or chest RT doses as risk ratios with 95% confidence intervals (CIs). A Poisson distribution estimated rates and a Cox proportional hazards model estimated hazard ratios (HRs) for future cardiac events and death. RESULTS At a median age of 35.5 years (interquartile range, 29.8-42.5 years), NT-proBNP and cTnT were abnormal in 22.5% and 0.4%, respectively. Exposure to chest RT and exposure to anthracycline chemotherapy were each associated with a dose-dependent increased risk for abnormal NT-proBNP (P for trend <.0001). Among exposed survivors with no history of Common Terminology Criteria for Adverse Events-graded cardiomyopathy and with normal systolic function, survivors with abnormal NT-proBNP had higher rates per 1000 person-years of cardiac mortality (2.93 vs 0.96; P < .0001) and future cardiomyopathy (32.10 vs 15.98; P < .0001) and an increased risk of future cardiomyopathy (HR, 2.28; 95% CI, 1.28-4.08) according to a multivariable assessment. CONCLUSIONS Abnormal NT-proBNP values were prevalent and, among survivors who were exposed to cardiotoxic therapy but did not have a history of cardiomyopathy or current systolic dysfunction, identified those at increased risk for future cardiomyopathy. Further longitudinal studies are needed to confirm this novel finding.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carrie R Howell
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lu Lu
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Juan C Plana
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Vijaya M Joshi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Russell V Luepker
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Jean B Durand
- Division of Cardiology, Department of Medicine, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel J Lenihan
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri
| | - John L Jefferies
- Cardiac Institute, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel M Green
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Timothy E Folse
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Aimee K Santucci
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rebecca M Howell
- Division of Radiation Oncology, Department of Radiation Physics, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Im C, Qin N, Wang Z, Qiu W, Howell CR, Sapkota Y, Moon W, Chemaitilly W, Gibson TM, Mulrooney DA, Ness KK, Wilson CL, Morton LM, Armstrong GT, Bhatia S, Zhang J, Hudson MM, Robison LL, Yasui Y. Generalizability of "GWAS Hits" in Clinical Populations: Lessons from Childhood Cancer Survivors. Am J Hum Genet 2020; 107:636-653. [PMID: 32946765 PMCID: PMC7536574 DOI: 10.1016/j.ajhg.2020.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
With mounting interest in translating genome-wide association study (GWAS) hits from large meta-analyses (meta-GWAS) in diverse clinical settings, evaluating their generalizability in target populations is crucial. Here, we consider long-term survivors of childhood cancers from the St. Jude Lifetime Cohort Study, and we show the limited generalizability of 1,376 robust SNP associations reported in the general population across 12 complex anthropometric and cardiometabolic phenotypes (n = 2,231; observed-to-expected replication ratio = 0.70, p = 6.2 × 10-8). An examination of five comparable phenotypes in a second independent cohort of survivors from the Childhood Cancer Survivor Study corroborated the overall limited generalizability of meta-GWAS hits to survivors (n = 4,212; observed-to-expected replication ratio = 0.55, p = 5.6 × 10-15). Finally, in direct comparisons of survivor samples against independent equivalently powered general population samples from the UK Biobank, we consistently observed lower meta-GWAS hit replication rates and poorer polygenic risk score predictive performance in survivor samples for multiple phenotypes. As a possible explanation, we found that meta-GWAS hits were less likely to be replicated in survivors who had been exposed to cancer therapies that are associated with phenotype risk. Examination of complementary DNA methylation data in a subset of survivors revealed that treatment-related methylation patterns at genomic sites linked to meta-GWAS hits may disrupt established genetic signals in survivors.
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37
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Wilson CL, Liu W, Chemaitilly W, Howell CR, Srivastava DK, Howell RM, Hudson MM, Robison LL, Ness KK. Body Composition, Metabolic Health, and Functional Impairment among Adults Treated for Abdominal and Pelvic Tumors during Childhood. Cancer Epidemiol Biomarkers Prev 2020; 29:1750-1758. [PMID: 32796078 PMCID: PMC7721344 DOI: 10.1158/1055-9965.epi-19-1321] [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: 10/22/2019] [Revised: 02/12/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We aimed to characterize body composition, metabolic impairments, and physical performance among survivors of pediatric abdominal and pelvic solid tumors. METHODS Participants included 431 survivors of abdominal or pelvic tumors [median attained age = 29.9 (range: 18.7-55.1) years]. Relative lean mass and fat mass were assessed with dual X-ray absorptiometry. Metabolic outcomes [insulin resistance (IR), high-density lipoprotein (HDL), low-density lipoprotein, and triglycerides] were based on laboratory values and medication usage. General linear regression evaluated associations between treatment and lifestyle with body composition; binomial regression evaluated associations between body composition and metabolic outcomes and physical performance. RESULTS Lean mass was lower than values from the National Health and Nutrition Examination Survey (NHANES) in males (Z-score = -0.67 ± 1.27; P < 0.001) and females (Z-score = -0.72 ± 1.28; P < 0.001). Higher cumulative abdominal and pelvic radiation doses were associated with lower lean mass among males [abdominal: β = -0.22 (SE) ± 0.07; P = 0.002 and pelvic: β = -0.23 ± 0.07; P = 0.002] and females (abdominal: β = -0.30 ± 0.09; P = 0.001 and pelvic: β = -0.16 ± 0.08; P = 0.037). Prevalence of IR (40.6% vs. 33.8%; P = 0.006), low HDL (28.9% vs. 33.5%; P = 0.046), and high triglycerides (18.4% vs. 10.0%; P < 0.001) was increased among survivors relative to NHANES. Compared with survivors with normal/high lean mass and normal/low fat mass, survivors with normal/high lean mass and high fat mass had an increased risk of IR (P < 0.001), low HDL (P < 0.001), reduced quadriceps strength at 60°/second (P < 0.001) and 300°/second (P < 0.001), and reduced distance covered in the 6-minute walk (P < 0.01). CONCLUSIONS Abdominal/pelvic radiotherapy is associated with body composition changes that can adversely influence metabolic outcomes and performance status among survivors. IMPACT Interventions targeting body composition may facilitate management of cardiovascular disease risk in this population.
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Affiliation(s)
- Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Wei Liu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wassim Chemaitilly
- Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carrie R Howell
- Division of Preventative Medicine, Department of Medicine, University of Alabama, South Birmingham, Alabama
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Mizrahi D, Fardell JE, Cohn RJ, Partin RE, Howell CR, Hudson MM, Robison LL, Ness KK, McBride J, Field P, Wakefield CE, Simar D. The 6-minute walk test is a good predictor of cardiorespiratory fitness in childhood cancer survivors when access to comprehensive testing is limited. Int J Cancer 2020; 147:847-855. [PMID: 31800093 PMCID: PMC7269841 DOI: 10.1002/ijc.32819] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 06/26/2019] [Revised: 11/06/2019] [Accepted: 11/20/2019] [Indexed: 12/20/2022]
Abstract
Cardiovascular disease is up to 10 times more likely among childhood cancer survivors compared to siblings. Low cardiorespiratory fitness is a modifiable risk-factor for cardiovascular diseases. Yet, cardiorespiratory fitness is not routinely screened in pediatric oncology, and healthy VO2max cut-points are unavailable. We aimed to predict cardiorespiratory fitness by developing a simple algorithm and establish cut-points identifying survivors' cardiovascular fitness health-risk zones. We recruited 262 childhood cancer survivors (8-18 years old, ≥1-year posttreatment). Participants completed gold-standard cardiorespiratory fitness assessment (Cardiopulmonary Exercise Test [CPET; VO2max ]) and 6-minute walk test (6MWT). Associations with VO2max were included in a linear regression algorithm to predict VO2max , which was then cross-validated. We used Bland-Altman's limits of agreement and Receiver Operating Characteristic curves using FITNESSGRAM's "Healthy Fitness Zones" to identify cut-points for adequate cardiorespiratory fitness. A total of 199 participants (aged 13.7 ± 2.7 years, 8.5 ± 3.5 years posttreatment) were included. We found a strong positive correlation between VO2max and 6MWT distance (r = 0.61, r2 = 0.37, p < 0.001). Our regression algorithm included 6MWT distance, waist-to-height ratio, age and sex to predict VO2max (r = 0.79, r2 = 0.62, p < 0.001). Forty percentages of predicted VO2max values were within ±3 ml/kg/min of measured VO2max . The cut-point for FITNESSGRAM's "health-risk" fitness zone was 39.8 ml/kg/min (males: AUC = 0.88), and 33.5 ml/kg/min (females: AUC = 0.82). We present an algorithm to reasonably predict cardiorespiratory fitness for childhood cancer survivors, using inexpensive measures. This algorithm has useful clinical application, particularly when CPET is unavailable. Our algorithm has the potential to assist clinicians to identify survivors below the cut-points with increased cardiovascular disease-risk, to monitor and refer for tailored interventions with exercise specialists.
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Affiliation(s)
- David Mizrahi
- School of Medical Sciences, UNSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
| | - Joanna E. Fardell
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- School of Women’s and Children’s Health, UNSW Sydney, Australia
| | - Richard J. Cohn
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- School of Women’s and Children’s Health, UNSW Sydney, Australia
| | - Robyn E. Partin
- Departments of Epidemiology and Cancer Control, United States of America
| | - Carrie R. Howell
- Departments of Epidemiology and Cancer Control, United States of America
| | - Melissa M. Hudson
- Departments of Epidemiology and Cancer Control, United States of America
- Oncology, St. Jude Children’s Research Hospital, Memphis, United States of America
| | - Leslie L. Robison
- Departments of Epidemiology and Cancer Control, United States of America
| | - Kirsten K. Ness
- Departments of Epidemiology and Cancer Control, United States of America
| | - Jamie McBride
- Respiratory Medicine, Sydney Children’s Hospital, Sydney, Australia
| | - Penelope Field
- Respiratory Medicine, Sydney Children’s Hospital, Sydney, Australia
| | - Claire E. Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- School of Women’s and Children’s Health, UNSW Sydney, Australia
| | - David Simar
- School of Medical Sciences, UNSW Sydney, Australia
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Christoffersen L, Gibson TM, Pui CH, Joshi V, Partin RE, Green DM, Lanctot JQ, Howell CR, Mulrooney DA, Armstrong GT, Robison LL, Hudson MM, Ness KK. Cardiac autonomic dysfunction in survivors of childhood acute lymphoblastic leukemia: The St. Jude Lifetime Cohort Study. Pediatr Blood Cancer 2020; 67:e28388. [PMID: 32383821 PMCID: PMC7302420 DOI: 10.1002/pbc.28388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiac autonomic dysfunction (CAD) is possible following treatment for childhood cancer. The aims of our analyses were to compare the prevalence of CAD between adult survivors of childhood acute lymphoblastic leukemia and controls, compare exercise response among survivors with and without CAD, and identify treatment-related risk factors for CAD. PROCEDURE Participants were treated for childhood acute lymphoblastic leukemia at St. Jude Children's Research Hospital between 1980 and 2003 (N = 338). A comparison group matched for race/ethnicity, age, and sex was also recruited (N = 325). Resting heart rate (HR) was assessed via electrocardiogram, and heart rate recovery (HRR) and exercise capacity were evaluated with submaximal cardiopulmonary exercise testing. RESULTS CAD was present in 33.7% of survivors and 27.6% of controls (P = 0.09). Although mean resting HR did not differ between survivors and controls (74 ± 12 vs 72 ± 12 beats per minute (bpm), P = 0.07), survivors had lower mean HRR than controls (22 ± 9 vs 25 ± 10 bpm; P < 0.001). Survivors with CAD had lower peak exercise tolerance (25.7 ± 6.5 vs 21.2 ± 4.9 mL/kg/min, P < 0.001) than those without. Survivors treated with cyclophosphamide in combination with vincristine ≥38 mg/m2 and/or glucocorticoids ≥10 000 mg/m2 were 1.56 (95% CI 1.09-2.24) times more likely to have CAD than those without this treatment. Obese survivors were 1.78 (95% CI: 1.31-2.40) times more likely to have CAD than nonobese survivors (P < 0.001). CONCLUSION CAD was present in over one third of survivors and was associated with lower exercise capacity. Obese survivors and those exposed to cyclophosphamide with high doses of vincristine and/or corticosteroids were at greatest risk.
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Affiliation(s)
- Lindsey Christoffersen
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Department of Rehabilitation Services, St. Jude Children’s Research Hospital, Memphis, TN
| | - Todd M. Gibson
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Ching-Hon Pui
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Vijaya Joshi
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Robyn E. Partin
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel M. Green
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer Q. Lanctot
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R. Howell
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel A. Mulrooney
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T. Armstrong
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Leslie L. Robison
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Kirsten K. Ness
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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Williams A, Krull KR, Howell CR, Banerjee P, Brinkman TM, Kaste SC, Partin, MS R, Srivastava D, Armstrong GT, Robison LL, Hudson MM, Ness KK. Frailty and neurocognitive decline in young adult survivors of childhood cancer: A longitudinal analysis from the St. Jude lifetime cohort. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10555 Background: Among young adult childhood cancer survivors, 8% meet the criteria for frailty, an aging phenotype associated with poor health. Frailty is associated with neurocognitive decline in the elderly general population, but this association has not been examined in young adult survivors of childhood cancer. Methods: Childhood cancer survivors (N = 845, mean [SD] age 30 [7] years, 22 [7] years post diagnosis, 52% male) were clinically evaluated for prefrailty/frailty (defined as ≥2/≥3 of muscle wasting, muscle weakness, low energy expenditure, slow walking speed, exhaustion) and completed neuropsychological assessments at baseline and five years later. Linear regression models estimated mean differences in neurocognitive decline in prefrail/frail survivors vs. non-frail survivors adjusting for age, sex, race, CNS therapy (cranial radiation, intrathecal chemotherapy, neurosurgery), and baseline neurocognitive performance. P-values were adjusted for multiple comparisons using false discovery rate (FDR). Results: 18% and 6% of survivors were prefrail and frail at baseline. Baseline frailty was associated with declines in visual-motor processing speed, short-term memory, and sustained attention (Table). Prefrailty and frailty were associated with declines in focused attention and executive function (Table). No significant associations were observed between prefrailty or frailty and decline in global cognition, academics, motor processing speed, long-term memory, verbal learning, or verbal fluency despite significant baseline cross-sectional associations. Conclusions: Young adult prefrail and frail survivors had greater declines in attention and executive function compared to non-frail survivors, domains commonly associated with aging. These findings suggest that interventions designed to mitigate components of frailty may also mitigate or prevent neurocognitive decline. [Table: see text]
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Affiliation(s)
| | | | | | - Pia Banerjee
- St. Jude Children's Research Hospital, Memphis, TN
| | | | - Sue C. Kaste
- St. Jude Children's Research Hospital, Memphis, TN
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Green DM, Wang M, Krasin MJ, Srivastava D, Relling MV, Howell CR, Ness KK, Kaste SC, Greene W, Jay DW, Davidoff AM, Pui CH, Jeha S, Bishop MW, Furman WL, Robison LL, Hudson MM. Longitudinal evaluation of alanine aminotransferase after treatment for childhood cancer. A report from the St. Jude Lifetime Cohort Study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22525 Background: Many childhood cancer survivors have been exposed to hepatotoxic agents. We assessed longitudinal hepatic injury, using alanine aminotransferase (ALT) elevation, and associated factors in a large cohort of long-term survivors. Methods: We evaluated SJLIFE participants ( > 10 years post-diagnosis, age ≥18 years) who had two or more determinations of ALT (T1 baseline, T2 last evaluation). Elevated ALT was defined as ALT > Upper Limit of Normal (ULN, 30 IU/mL for males and 19 IU/mL for females). Elastic net was used to perform model selection for elevated ALT at T2. Modified Poisson regression was used to identify risk factors for elevated ALT at T2. Results: Serial ALT assessments were available for 1941 survivors (49.6% female, 82.2% non-Hispanic white [NHW]). Their median age at diagnosis and T1 were 7.6 years (interquartile range [IQR] = 3.4-13.5) and 31.7 years (IQR = 26.1-38.1), respectively. Elapsed time from diagnosis to T1, and T1 to T2, were 23.3 years (IQR = 17.8-29.6) and 5.2 years (IQR = 4.4-5.7). ALT was normal at T1 and T2 in 45.7%, and persistently (25.9%) or newly (11.7%) abnormal in 37.6%. Compared to those with normal ALT at T1, those with elevated ALT at T2 were more likely to have NHW race/ethnicity, treatment with busulfan, increasing volume of the liver exposed to 10 Gray (Gy) or more (V10), body mass index (BMI) > 25 kg/m2, hepatitis C, metabolic syndrome, or treatment with atorvastatin, rosuvastatin or simvastatin at T2. History of hematopoietic stem cell transplantation (HSCT), but not busulfan, were additional risk factors included in the models for V15 and V20 (Table). Conclusions: Demographic, treatment, lifestyle, and non-oncologic interventions increase the risk for ALT elevation in survivors. These results may guide future treatment designs and lifestyle interventions. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - Sue C. Kaste
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | - Sima Jeha
- St. Jude Children's Research Hospital, Memphis, TN
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Krull MR, Howell CR, Partin RE, Lanctot J, Phipps S, Klosky JL, Carney G, Mulrooney DA, Robison LL, Hudson MM, Ness KK. Protein Supplementation and Resistance Training in Childhood Cancer Survivors. Med Sci Sports Exerc 2020; 52:2069-2077. [PMID: 32229771 DOI: 10.1249/mss.0000000000002345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Muscle weakness, low lean body mass, and poor physical performance are prevalent among adult survivors of childhood cancer (survivors). We evaluated the feasibility and effects of resistance training with and without protein supplementation on lean body mass and muscle strength among survivors. METHODS This double-blind placebo-controlled trial enrolled survivors ≥18 to <45 yr old. Participants were randomized to resistance training with protein supplement (21 g whey protein per day, 90 kcal) (RT + S) or resistance training with placebo (sucrose, 90 kcal) (RT + P). Participants received educational materials, access to a local fitness center, and a tailored resistance training program with tapered supervision. Participant retention and adherence were used to evaluate feasibility. Lean body mass and muscle strength were assessed at baseline and 24 wk, using dual x-ray absorptiometry, and dynamometer testing or one-repetition maximum testing, respectively. Mean changes were compared with two-way ANOVA. RESULTS Of 70 participants randomized, 57 completed the 24-wk intervention (24 in RT + S, 33 in RT + P). The RT + S group completed 74.8% and the RT + P group completed 67.0% of exercise sessions. Mean ± SD age for those who completed was 33.1 ± 7.0 yr, 67% were White and 47% female. There were no differences in change in lean mass (RT + S, 1.05 ± 2.34 kg; RT + P, 0.13 ± 2.19 kg; P = 0.10) or strength (grip RT + S, 1.65 ± 4.17 kg; RT + P, 1.63 ± 4.47 kg; P = 0.98; mean leg press RT + S, 58.4 ± 78.8 kg; RT + P, 51.0 ± 65.1 kg; P = 0.68) between groups. Both lean mass (P = 0.03) and strength (grip P = 0.003, leg press P < 0.001) increased over time. CONCLUSIONS Supervised resistance training among survivors with protein supplementation is feasible but not more effective at increasing total lean body mass than resistance training alone.
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Affiliation(s)
- Matthew R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Jennifer Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - James L Klosky
- Department of Pediatrics, Emory University School of Medicine, and the Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Ginger Carney
- Department of Clinical Nutrition, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
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Tonning Olsson I, Lubas MM, Li C, Mandrell BN, Banerjee P, Howell CR, Ness KK, Srivastava D, Robison LL, Hudson MM, Krull KR, Brinkman TM. Insomnia and Neurocognitive Functioning in Adult Survivors of Childhood Cancer. JNCI Cancer Spectr 2020; 4:pkaa008. [PMID: 32382693 PMCID: PMC7197383 DOI: 10.1093/jncics/pkaa008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/29/2019] [Accepted: 02/04/2020] [Indexed: 12/21/2022] Open
Abstract
Background In noncancer populations, insomnia is known to affect neurocognitive processes. Although the prevalence of insomnia appears to be elevated in survivors of childhood cancer, relatively little is known about its association with neurocognitive performance in this at-risk population. Methods A total of 911 survivors (51.9% female; mean [SD] age, 34 [9.0] years; time since diagnosis, 26 [9.1] years) completed direct assessments of attention, memory, processing speed, and executive functioning and self-reported symptoms of sleep (Pittsburgh Sleep Quality Index), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and daytime sleepiness (Epworth Sleepiness Scale). Sex-stratified general linear models were used to examine associations between insomnia and neurocognitive performance, with adjustment for treatment exposures and chronic health conditions. All statistical tests were two-sided. Results Insomnia was reported by 22.1% of females and 12.3% of males (P < .001). After adjustment for neurotoxic treatment exposures, insomnia (vs healthy sleepers with no daytime fatigue or sleepiness) was associated with worse neurocognitive performance in the domains of verbal reasoning, memory, attention, executive function, and processing speed (verbal reasoning: males β = −0.34, P = .04, females β = −0.57, P < .001; long-term memory: males β = −0.60, P < .001, females β = −0.36, P = .02; sustained attention: males β = −0.85, P < .001, females β = −0.42, P = .006; cognitive flexibility: males β = −0.70, P = .002, females β = −0.40, P = .02). Self-reported sleep disturbance without daytime fatigue or sleepiness or daytime fatigue or sleepiness alone were not consistently associated with poorer neurocognitive performance. Conclusions Insomnia was highly prevalent and contributed to the neurocognitive burden experienced by adult survivors of childhood cancer. Treatment of insomnia may improve neurocognitive problems in survivors.
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Affiliation(s)
- Ingrid Tonning Olsson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Margaret M Lubas
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chenghong Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Belinda N Mandrell
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pia Banerjee
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deokumar Srivastava
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
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44
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Song N, Li Z, Qin N, Howell CR, Wilson CL, Easton J, Mulder HL, Edmonson MN, Rusch MC, Zhang J, Hudson MM, Yasui Y, Robison LL, Ness KK, Wang Z. Shortened Leukocyte Telomere Length Associates with an Increased Prevalence of Chronic Health Conditions among Survivors of Childhood Cancer: A Report from the St. Jude Lifetime Cohort. Clin Cancer Res 2020; 26:2362-2371. [PMID: 31969337 DOI: 10.1158/1078-0432.ccr-19-2503] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/11/2019] [Accepted: 01/17/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE We aimed to analyze and compare leukocyte telomere length (LTL) and age-dependent LTL attrition between childhood cancer survivors and noncancer controls, and to evaluate the associations of LTL with treatment exposures, chronic health conditions (CHC), and health behaviors among survivors. EXPERIMENTAL DESIGN We included 2,427 survivors and 293 noncancer controls of European ancestry, drawn from the participants in St. Jude Lifetime Cohort Study (SJLIFE), a retrospective hospital-based study with prospective follow-up (2007-2016). Common nonneoplastic CHCs (59 types) and subsequent malignant neoplasms (5 types) were clinically assessed. LTL was measured with whole-genome sequencing data. RESULTS After adjusting for age at DNA sampling, gender, genetic risk score based on 9 SNPs known to be associated with telomere length, and eigenvectors, LTL among survivors was significantly shorter both overall [adjusted mean (AM) = 6.20 kb; SE = 0.03 kb] and across diagnoses than controls (AM = 6.69 kb; SE = 0.07 kb). Among survivors, specific treatment exposures associated with shorter LTL included chest or abdominal irradiation, glucocorticoid, and vincristine chemotherapies. Significant negative associations of LTL with 14 different CHCs, and a positive association with subsequent thyroid cancer occurring out of irradiation field were identified. Health behaviors were significantly associated with LTL among survivors aged 18 to 35 years (P trend = 0.03). CONCLUSIONS LTL is significantly shorter among childhood cancer survivors than noncancer controls, and is associated with CHCs and health behaviors, suggesting LTL as an aging biomarker may be a potential mechanistic target for future intervention studies designed to prevent or delay onset of CHCs in childhood cancer survivors.See related commentary by Walsh, p. 2281.
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Affiliation(s)
- Nan Song
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhenghong Li
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Na Qin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John Easton
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Heather L Mulder
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michael N Edmonson
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michael C Rusch
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee. .,Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Williams HE, Howell CR, Chemaitilly W, Wilson CL, Karol SE, Nolan VG, Smeltzer MP, Green DM, Ehrhardt MJ, Mulrooney DA, Pui CH, Hudson MM, Robison LL, Ness KK. Diabetes mellitus among adult survivors of childhood acute lymphoblastic leukemia: A report from the St. Jude Lifetime Cohort Study. Cancer 2019; 126:870-878. [PMID: 31714590 DOI: 10.1002/cncr.32596] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 07/10/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Greater than one-half of children who are treated for acute lymphoblastic leukemia (ALL) develop ≥1 treatment-related medical conditions in their lifetime, many of which are known risk factors for diabetes mellitus. In the current study, the authors evaluated the prevalence and risk factors of diabetes mellitus among clinically assessed adult survivors of childhood ALL METHODS: The authors performed a retrospective evaluation of data from survivors of ALL and community controls who were enrolled in the St. Jude Lifetime Cohort Study between October 1, 2007, and June 30, 2016. Participants were adults with ≥10 years of survival of childhood ALL and community controls who completed clinical and laboratory evaluations. Data for the current analysis were abstracted from medical records. Exposures evaluated herein included chemotherapy and radiation exposures and medical history, including drug-induced diabetes mellitus. RESULTS Of 1360 eligible adults who were ≥10-year survivors of childhood ALL, a total of 1044 completed the evaluations; these individuals had a mean age of 33.97±9.14 years and 50.86% were male. The 368 controls, 45.65% of whom were male, had a mean age of 35.33±10.21 years. Type 2 diabetes mellitus (T2DM) was found in approximately 7.47% of survivors and 3.80% of controls (odds ratio [OR], 2.07; 95% CI, 1.11-3.87). In adjusted models, among survivors, older age (OR, 1.05 for each additional year; 95% CI, 1.02-1.08), body mass index ≥30 kg/m2 (OR, 7.40; 95% CI, 2.61-20.97), and drug-induced diabetes mellitus occurring during ALL therapy (OR, 4.67; 95% CI, 2.53-8.61) were found to be associated with T2DM. CONCLUSIONS Adult survivors of childhood ALL are at an increased risk of T2DM. Adult survivors of childhood ALL who are of older age, with an overweight or obese body mass index, and/or who developed drug-induced diabetes mellitus during treatment should be closely monitored for T2DM during long-term follow-up.
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Affiliation(s)
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wassim Chemaitilly
- Department of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Seth E Karol
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Vikki G Nolan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Matthew P Smeltzer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Daniel M Green
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Howell CR, Wilson CL, Yasui Y, Srivastava DK, Lu W, Bjornard KL, Ehrhardt MJ, Brinkman TM, Chemaitilly W, Hodges JR, Lanctot JQ, Robison LL, Hudson MM, Ness KK. Neighborhood effect and obesity in adult survivors of pediatric cancer: A report from the St. Jude lifetime cohort study. Int J Cancer 2019; 147:338-349. [PMID: 31600422 DOI: 10.1002/ijc.32725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/26/2019] [Revised: 09/17/2019] [Accepted: 09/27/2019] [Indexed: 12/18/2022]
Abstract
Survivors of childhood cancer are at risk for obesity, a condition potentially modifiable if dietary intake and physical activity are optimized. These health behaviors are likely influenced by neighborhood of residence, a determinant of access to healthy, affordable food and safe and easy exercise opportunities. We examined associations between neighborhood level factors and obesity among survivors in the St. Jude Lifetime cohort and community comparison group members. Persons with residential addresses available for geocoding were eligible for analysis (n = 2,265, mean age 32.5 [SD 9.1] years, 46% female, 85% white). Survivors completed questionnaires regarding individual behaviors; percent body fat was assessed via dual X-ray absorptiometry (obesity: ≥25% males; ≥35% females); neighborhood effect was characterized using census tract of residence (e.g., neighborhood socioeconomic status [SES], rurality). Structural equation modeling was used to determine associations between neighborhood effect, physical activity, diet, smoking, treatment exposures and obesity. Obese survivors (n = 1,420, 62.7%) were more likely to live in neighborhoods with lower SES (RR: 1.23, 95% CI: 1.10-1.38) and rural areas (RR: 1.22, 95% CI: 1.07-1.39) compared to survivors with normal percent body fat. Resource-poor neighborhoods (standardized effect: 0.06, p < 0.001) and cranial radiation (0.16, p < 0.001) had direct effects on percent body fat. Associations between neighborhood of residence and percent body fat were increased (0.01, p = 0.04) among individuals with a poor diet. Neighborhoods where survivors reside as an adult is associated with obesity. Interventions targeting survivors should incorporate strategies that address environmental influences on obesity.
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Affiliation(s)
- Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Deo K Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Wei Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Kari L Bjornard
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Wassim Chemaitilly
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Pediatric Medicine-Endocrinology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jason R Hodges
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
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Phillips NS, Howell CR, Lanctot JQ, Partin RE, Pui CH, Hudson MM, Robison LL, Krull KR, Ness KK. Physical fitness and neurocognitive outcomes in adult survivors of childhood acute lymphoblastic leukemia: A report from the St. Jude Lifetime cohort. Cancer 2019; 126:640-648. [PMID: 31631333 DOI: 10.1002/cncr.32510] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 04/25/2019] [Revised: 06/26/2019] [Accepted: 08/02/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukemia (ALL) are at increased risk for both treatment-related exercise intolerance and neurocognitive deficits. This analysis aimed to identify the association between exercise intolerance and neurocognitive impairments in ALL survivors. METHODS Cardiopulmonary exercise testing, results from a 2-hour standardized neuropsychological assessment, and self-report questionnaires were obtained for 341 adult survivors of childhood ALL and 288 controls. Multivariable modeling was used to test associations between oxygen uptake at 85% estimated heart rate (rpkVO2 ) and neuropsychological test and self-reported questionnaire domains, adjusted for sex, age at diagnosis, cranial radiation, anthracycline, and methotrexate exposure and tobacco smoking status. RESULTS Compared with controls, survivors had worse rpkVO2 and performance on verbal intelligence, focused attention, verbal fluency, working memory, dominant/nondominant motor speed, visual-motor speed, memory span, and reading and math measures (all P < .001). In adjusted models, exercise intolerance was associated with decreases in performance of verbal ability, focused attention, verbal fluency, working memory, dominant motor speed, nondominant motor speed, visual-motor speed, memory span, reading academics, and math academics in survivors. CONCLUSION This study demonstrates an association between exercise intolerance and neurocognitive outcomes. Research is needed to determine whether interventions that improve exercise tolerance impact neurocognitive function in ALL survivors.
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Affiliation(s)
- Nicholas S Phillips
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pyschology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Dixon S, Howell CR, Lu L, Ness KK, Plana J, Joshi V, Luepker RV, Durand JB, Ky B, Lenihan DJ, Green DM, Partin, MS R, Santucci A, Howell RM, Srivastava D, Hudson MM, Robison LL, Armstrong GT. Serum biomarkers for detection of cardiomyopathy in survivors of childhood cancer: A report from the St. Jude Lifetime Cohort. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e21526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21526 Background: Childhood cancer survivors are at increased risk for cardiovascular morbidity and mortality. Little is known about the utility of cardiac biomarkers (NT-proBNP, cardiac troponin-T [TnT]) for long-term surveillance. Methods: Cross-sectional analyses of 1213 survivors ≥18 years of age and ≥10 years from cancer diagnosis (786 exposed to cardiotoxic therapy [174 radiation therapy (RT) alone, 366 anthracycline alone, 246 both] and 427 unexposed). TnT > 0.01 ng/ml and NT-proBNP levels > 97.5th percentile age- and sex-specific cutoffs were considered abnormal. Three-dimensional left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), diastolic function and cardiomyopathy (CM) according to the CTCAE v4.03 were evaluated. Generalized linear models estimated risk ratios (RR) and 95% confidence intervals (CI). Results: Among survivors (median 8.7 [range 0.0-23.6] years at diagnosis; 35.5 [range 19.1-62.2] years at evaluation), NT-proBNP and TnT were abnormal in 22.5% and 0.4%, respectively. A dose-dependent increased risk for abnormal NT-proBNP was seen with exposure to chest RT (referent no RT, 1- < 20 Gy RR 1.62 [CI 1.07-2.46], 20- < 30 Gy RR 1.68 [1.23-2.30], ≥30 Gy RR 3.66 [2.89-4.64]; p for trend < 0.0001) and anthracycline (referent no anthracycline, 1-200mg/m2 RR 1.39 [1.01-1.91], 201-350mg/m2 RR 2.28 [1.74-2.99], > 350mg/m2 RR 2.99 [2.27-3.95]; p for trend < 0.0001). Survivors with CM at the time of evaluation had abnormal NT-proBNP (grade 2 CM RR 1.46, CI 1.08-1.99; grade 3-4 CM 2.66, 2.02-2.39). However, among exposed survivors previously undiagnosed with clinical CM, NT-proBNP had poor sensitivity and moderate specificity in identifying those with new onset of abnormal LVEF ( < 53%), GLS or diastolic dysfunction: sensitivity (29%, 30%, 33%), specificity (75%, 77%, 76%). Also, 132 (20.2%) had abnormal NT-proBNP with normal LVEF (≥53%). Conclusions: Abnormal NT-proBNP levels were prevalent and associated with prior cardiotoxic therapy and established CM but were not sensitive for detection of new onset CM. Longitudinal follow-up is needed to determine whether abnormal NT-proBNP in the large number of survivors without CM is predictive of future CM.
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Affiliation(s)
| | | | - Lu Lu
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Vijaya Joshi
- University of Tennessee Health Sciences Center, Memphis, TN
| | | | - Jean-Bernard Durand
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bonnie Ky
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Rebecca M. Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
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Green DM, Wang M, Krasin MJ, Srivastava D, Howell CR, Jay DW, Ness KK, Greene W, Lanctot JQ, Shelton KC, Davidoff AM, Ehrhardt MJ, Mulrooney DA, Robison LL, Hudson MM. Renal function after treatment for childhood cancer: A report from the St. Jude Lifetime Cohort Study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10048 Background: We assessed renal function in a large, clinically assessed cohort of childhood cancer survivors. Methods: Creatinine and qualitative urine protein was measured in 2753 survivors (>10 years (years) post-diagnosis, age ≥18 years). Renal function was graded per the Kidney Disease International Global Outcomes 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD). Multivariable logistic regression was used to estimate associations between demographics, treatment exposures, and CKD (grades 1-5 and 3-5). Radiation treatment was expressed as percentage of total kidney volume treated with 5 (V5), 10 (V10), 15 (V15) and 20 (V20) Gray. Results: Among 2753 survivors, 48.7% were female and 82.5% non-Hispanic white. Median age at diagnosis - 7.3 years (interquartile range [IQR]=3.3-13.2), median age at evaluation - 31.4 years (IQR=25.8-37.8), and median time from diagnosis to evaluation - 23.2 years (IQR=17.6-29.7). Prevalence of grades 1-5 and 3-5 CKD was 7.4% and 2.1%, respectively (grade 1=113, grade 2=30, grade 3=44, grade 4=5, and grade 5=8). Individual and cumulative aminoglycoside doses and treatment with high-dose methotrexate were not associated with CKD (data not shown). Cumulative number of doses of ambisome/abelcet and of amphotericin B were significant risk factors for grades 1-5 and grades 3-5 CKD in models for V15 and V20 (data not shown). The multivariable results for V10 are shown in the Table. Conclusions: In addition to nephrotoxic antineoplastic and supportive care therapy, race, ethnicity, and body composition contribute to risk of CKD in long-term survivors. These novel results inform late effects reduction strategies for future treatment protocols and identify survivors at highest risk for CKD. [Table: see text]
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Krull MR, Howell CR, Partin, MS R, Carney G, Mulrooney DA, Robison LL, Hudson MM, Ness KK. Impact of protein supplementation on lean muscle mass in adult survivors of childhood cancer engaged in resistance training. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10027 Background: Muscle weakness, low lean muscle mass and poor physical performance are prevalent among adult survivors of childhood cancer. We evaluated the effects of resistance training with and without protein supplementation on lean muscle mass, and muscle strength among childhood cancer survivors. Methods: This double-blind placebo-controlled trial enrolled survivors aged ≥18 to < 45 years. Participants were randomized to resistance training with daily protein supplement (21g protein/day, 90kcal) (RT+S) or resistance training with placebo (sucrose, 90kcal) (RT+P). Both groups received educational materials, access to a local fitness center and a tailored resistance training program with tapered supervision. Lean muscle mass and muscle strength were assessed at baseline and 24 weeks, using dual x-ray absorptiometry and dynamometer testing respectively. Mean changes were compared within and between groups. Results: Of 93 participants randomized, 57 completed the 24-week intervention (24 in RT+S, 33 in RT+P). The mean age was 33.1 (SD 7.0), 67% were white and 47% female. The RT+S group had a significant increase in lean body mass (1.05 kg [SD 2.34], p = 0.04), while the RT+P group did not (0.13 kg [SD 2.19], p = 0.74). Mean change in handgrip strength also improved in the RT+S group (1.98 [SD 4.30], p = 0.03); change approached significance in the RT+P group (1.49 [SD 4.60], p = 0.07). All survivors significantly improved their strength over time (Table) as measured by one max repetition test at baseline and follow-up. Conclusions: Preliminary findings indicate that a supervised resistance training program among adult survivors of childhood cancer that includes protein supplementation is feasible and may increase total lean body mass and muscle strength. Clinical trial information: NCT02501460. [Table: see text]
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