188 results on '"Nichols HB"'
Search Results
2. Long-term Patterns of Excess Mortality among Endometrial Cancer Survivors
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Anderson, C, primary, Bae-Jump, V, additional, Broaddus, RR, additional, Olshan, AF, additional, and Nichols, HB, additional
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- 2021
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3. Weight change and risk of endometrial cancer
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Trentham-Dietz, A, Nichols, HB, Hampton, JM, and Newcomb, PA
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- 2006
4. Circulating Anti-Müllerian Hormone and Breast Cancer Risk: A Study in Ten Prospective Cohorts
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Ge, W, Clendenen, TV, Afanasyeva, Y, Koenig, KL, Agnoli, C, Brinton, LA, Dorgan, JF, Eliassen, AH, Falk, RT, Hallmans, G, Hankinson, SE, Hoffman-Bolton, J, Key, TJ, Krogh, V, Nichols, HB, Sandler, DP, Schoemaker, MJ, Sluss, PM, Sund, M, Swerdlow, AJ, Visvanathan, K, Liu, M, and Zeleniuch-Jacquotte, A
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Adult ,Anti-Mullerian Hormone ,Breast Neoplasms ,Middle Aged ,Risk Assessment ,Article ,Logistic Models ,Risk Factors ,Case-Control Studies ,Odds Ratio ,Humans ,Female ,Prospective Studies ,Aged - Abstract
A strong positive association has been observed between circulating anti-Müllerian hormone (AMH), a biomarker of ovarian reserve, and breast cancer risk in three prospective studies. Confirming this association is important because of the paucity of biomarkers of breast cancer risk in premenopausal women. We conducted a consortium study including ten prospective cohorts that had collected blood from premenopausal women. A nested case-control design was implemented within each cohort. A total of 2,835 invasive (80%) and in situ (20%) breast cancer cases were individually matched to controls (n = 3,122) on age at blood donation. AMH was measured using a high sensitivity enzyme-linked immunoabsorbent assay. Conditional logistic regression was applied to the aggregated dataset. There was a statistically significant trend of increasing breast cancer risk with increasing AMH concentration (p(trend) across quartiles < 0.0001) after adjusting for breast cancer risk factors. The odds ratio (OR) for breast cancer in the top versus bottom quartile of AMH was 1.60 (95% CI = 1.31-1.94). Though the test for interaction was not statistically significant (p(interaction) = 0.15), the trend was statistically significant only for tumors positive for both estrogen receptor (ER) and progesterone receptor (PR): ER+/PR+: OR(Q4-Q1) = 1.96, 95% CI = 1.46-2.64, p(trend)
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- 2018
5. Abstract P1-08-01: Withdrawn
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Schoemaker, MJ, primary, Nichols, HB, additional, Wright, LB, additional, Brook, MN, additional, Jones, ME, additional, O'Brien, KM, additional, Adami, H-O, additional, Baglietto, L, additional, Bernstein, L, additional, Bertrand, KA, additional, Boutron-Ruault, M-C, additional, Chen, Y, additional, Connor, AE, additional, Dorronsoro, M, additional, Dossus, L, additional, Eliassen, AH, additional, Giles, GG, additional, Gram, IT, additional, Hankinson, SE, additional, Kaaks, R, additional, Key, TJ, additional, Kirsh, VA, additional, Kitahara, CM, additional, Koh, W-P, additional, Larsson, SC, additional, Linet, MS, additional, Ma, H, additional, Masala, G, additional, Merritt, MA, additional, Milne, RL, additional, Overvad, K, additional, Ozasa, K, additional, Palmer, JR, additional, Riboli, E, additional, Rohan, TE, additional, Sadakane, A, additional, Sund, M, additional, Tamimi, RM, additional, Trichopoulou, A, additional, Ursin, G, additional, Van Gils, CH, additional, Visvanathan, K, additional, Weiderpass, E, additional, Willett, WC, additional, Wolk, A, additional, Yuan, J-M, additional, Zeleniuch-Jacquotte, A, additional, Sandler, DP, additional, and Swerdlow, AJ, additional
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- 2019
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6. Abstract P1-12-10: Regimen-specific rates of chemotherapy-related amenorrhea in breast cancer survivors
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Gast, KC, primary, Cathcart-Rake, EJ, additional, Norman, A, additional, Eshragi, L, additional, Obidegwu, N, additional, Yost, K, additional, Nichols, HB, additional, Rosenberg, S, additional, Su, HI, additional, Stewart, E, additional, Couch, F, additional, Vachon, C, additional, and Ruddy, KJ, additional
- Published
- 2019
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7. Birth Rates after Adolescent and Young Adult Cancer in North Carolina, 2000–2014
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Nichols, HB, primary, Anderson, C, additional, Black, KZ, additional, Engel, S, additional, and Mersereau, J, additional
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- 2017
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8. Active Tobacco Smoke and Environmental Tobacco Smoke Exposure During Potential Biological Windows of Susceptibility in Relation to Breast Cancer
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White, AJ, primary, D'Aloisio, AA, additional, Nichols, HB, additional, DeRoo, LA, additional, and Sandler, DP, additional
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- 2016
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9. Abstract P3-11-04: Prediagnosis Hysterectomy and Estrogen Therapy in Relation to Mortality after Breast Cancer
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Nichols, HB, primary, Trentham-Dietz, A, additional, Newcomb, PA, additional, Egan, KM, additional, Titus-Ernstoff, L, additional, Hampton, JM, additional, and Visvanathan, K., additional
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- 2010
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10. Weight change and risk of endometrial cancer
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Trentham-Dietz, A, primary, Nichols, HB, additional, Hampton, JM, additional, and Newcomb, PA, additional
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- 2005
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11. Postoophorectomy estrogen use and breast cancer risk.
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Nichols HB, Trentham-Dietz A, Newcomb PA, Titus LJ, Egan KM, Hampton JM, Visvanathan K, Nichols, Hazel B, Trentham-Dietz, Amy, Newcomb, Polly A, Titus, Linda J, Egan, Kathleen M, Hampton, John M, and Visvanathan, Kala
- Abstract
Objective: To estimate whether the protective effect of premenopausal bilateral oophorectomy on breast cancer risk is mitigated by estrogen therapy use after surgery.Methods: In pooled data from four population-based case-control studies spanning 1992-2007, we examined estrogen use after total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO) and subsequent breast cancer risk. We identified cases of postmenopausal invasive breast cancer in women (n=10,449) aged 50-79 years from three state tumor registries and age-matched control group participants without breast cancer (n=11,787) from driver's license and Medicare lists. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and estrogen use were queried during structured telephone interviews. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated with multivariable logistic regression.Results: Breast cancer risk comparisons were made relative to women who experienced natural menopause and never used hormones. Overall, breast cancer risk increased 14% among women currently using estrogens after TAHBSO (OR 1.14, 95% CI 1.03-1.28), 32% for estrogen durations less than 10 years (OR 1.32, 95% CI 1.11-1.57), and 22% for estrogen initiation within 5 years of TAHBSO (OR 1.22, 95% CI 1.09-1.37). Among women who underwent early TAHBSO (younger than 40 years), 24-30% decreases in breast cancer risk were observed among both never (OR 0.70, 95% CI 0.55-0.88) and current (OR 0.76, 95% CI 0.61-0.96) estrogen users.Conclusion: Unopposed estrogen use does not negate the reduction in breast cancer risk associated with early (younger than 40 years) bilateral oophorectomy. However, initiating estrogen therapy after TAHBSO at ages 45 and older can increase breast cancer risk and should be considered carefully. [ABSTRACT FROM AUTHOR]- Published
- 2012
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12. What causes cancer? Reports from sixth-grade girls.
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Nichols HB, Trentham-Dietz A, Newcomb PA, Yanke L, Remington PL, and Love RR
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Background: We evaluated students' perception of cancer causation among sixth-grade girls living in Wisconsin. Method: We asked female students to list up to 3 causes of cancer in a cross-sectional health survey. Results: A total of 141 answers were given by 53 students. The most frequently listed causes of cancer were cigarette smoking (91%), drugs (32%), an unhealthy diet (25%), and heredity (25%). Less than 10% of students listed other potentially modifiable risk factors such as exercise, sun exposure, or alcohol consumption. Conclusion: Students in this study appeared to link a range of high-risk behaviors with health consequences, although the specific health risks may not be understood. [ABSTRACT FROM AUTHOR]
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- 2006
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13. The University of North Carolina Cancer Survivorship Cohort: A resource for collaborative survivorship research.
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Anderson C, Bensen JT, Allott EH, Basta PV, Irwin DE, Gerstel A, Farnan L, Tan HJ, Kent EE, Kuo TM, Baggett CD, Olshan AF, Earp HS, and Nichols HB
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Background: Rapid growth in the number of U.S. cancer survivors drives the need for ongoing research efforts to improve outcomes and experiences after cancer. Here we describe the University of North Carolina (UNC) Cancer Survivorship Cohort, a medical center-based cohort of adults with cancer that integrates medical record-abstracted cancer information, patient-reported outcomes, and biologic specimens., Methods: Participants ages 18+ were recruited from UNC oncology clinics between April 2010 and August 2016. After enrollment, participants completed questionnaires on a range of topics including demographics, health history, health care access and utilization, quality of life, and symptoms. Blood samples and tumor tissue specimens were collected and processed by study staff, and cancer characteristics and other clinical data were abstracted from electronic medical records. Participants consented to recontact for future studies and linkage of their data with other data resources., Results: In total, 3,999 participants with a cancer diagnosis were enrolled in the cohort. The most common cancer types among those enrolled included breast (N=866), uterine (N=458), colorectal (N=300), prostate (N=296), and head and neck (N=248). Blood specimens were collected for 3,027 (76%). Additional participants without cancer (N=1,299) were also enrolled, and the majority (62%) provided biospecimen samples., Conclusions: We encourage wide collaboration with investigators across institutions seeking to advance research in cancer survivorship. Procedures are in place to support proposals for use of existing or linked data and for proposals that require participant recontact or analysis of biospecimens., Impact: The UNC Cancer Survivorship Cohort is a unique resource for cancer survivorship research.
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- 2024
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14. Cancer Diagnosis During Pregnancy and Livebirth Outcomes in the Adolescent and Young Adult Horizon Study.
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Cochrane C, Anderson C, Mitra S, Green L, Baggett CD, Mersereau JE, Getahun D, Kwan ML, Chao CR, Kushi LH, and Nichols HB
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Objective: To describe patterns of cancer treatment and live birth outcomes that followed a cancer diagnosis during pregnancy. Study Design: The Adolescent and Young Adult (AYA) Horizon Study is an observational study evaluating outcomes in survivors of the five most common types of cancer in this age group (15-39 years old). Of the 23,629 individuals identified diagnosed with breast, lymphoma, thyroid, melanoma, or gynecological cancer in North Carolina (2000-2015) and California (2004-2016), we identified 555 live births to individuals who experienced cancer diagnosis during pregnancy. Births to individuals diagnosed with cancer during pregnancy were matched ∼1:5 on maternal age and year of delivery to live births to individuals without a cancer diagnosis ( N = 2,667). Multivariable Poisson regression was used to compare birth outcomes between pregnancies affected by a cancer diagnosis and unaffected matched pregnancies. Results: Cancer diagnosis during pregnancy was associated with an increased risk of preterm delivery (prevalence ratio [PR] 2.70; 95% confidence interval [CI] 2.24, 3.26); very preterm delivery (PR 1.74; 95% CI 1.12, 2.71); induction of labor (PR 1.48; 95% CI 1.27, 1.73); low birth weight (PR 1.97; 95% CI 1.55, 2.50); and cesarean delivery (PR 1.18; 95% CI 1.04, 1.34) but not associated with low Apgar score (PR 0.90; 95% CI 0.39, 2.06). In our sample, 41% of patients received chemotherapy, half of whom initiated chemotherapy during pregnancy, and 86% received surgery, 58% of whom had surgery during pregnancy. Of the 19% who received radiation, all received radiation treatment following pregnancy. Conclusion: We identified an increased risk of birth outcomes, including preterm and very preterm delivery, induction of labor, low birth weight, and cesarean delivery, to those experiencing a cancer diagnosis during pregnancy. This analysis contributes to the available evidence for those experiencing a cancer diagnosis during pregnancy.
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- 2024
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15. A Patient-Centered Conceptual Model of AYA Cancer Survivorship Care Informed by a Qualitative Interview Study.
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Figueroa Gray MS, Shapiro L, Dorsey CN, Randall S, Casperson M, Chawla N, Zebrack B, Fujii MM, Hahn EE, Keegan THM, Kirchhoff AC, Kushi LH, Nichols HB, Wernli KJ, Sauder CAM, and Chubak J
- Abstract
Purpose : Conceptual models provide frameworks to illustrate relationships among patient-, provider-, system-, and community-level factors that inform care delivery and research. Existing models of cancer survivorship care focus largely on pediatric or adult populations whose needs differ from adolescents and young adults (AYAs). We developed a patient-centered conceptual model of AYA survivorship care. Methods: We conducted a narrative literature review of current conceptual and theoretical models of care. We engaged AYA cancer survivors (n = 25) in semi-structured one-hour telephone interviews. Most participants were in their 20s and 30s, and the majority (84%) were women. Recruitment was stratified by age and time since cancer diagnosis. We conducted a thematic analysis of interview transcripts to identify themes that exemplified patient-centered care. Results : Most participants identified as white and female. Leukemia and breast cancer were the most common cancer types. Main themes included the need for (1) care coordination, (2) ongoing mental health support, (3) connection to AYA peer support, (4) support during fertility preservation efforts, (5) support with financial burden, (6) support for quality of life, (7) information about and support with side effects and late effects, and (8) attention to the unique needs of young adults. Conclusions: We present a patient-centered conceptual model of AYA survivorship care needs that can inform future cancer care delivery and research.
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- 2024
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16. Geographic Access to Fertility Counseling among Adolescent and Young Adult Women with Cancer in North Carolina.
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Rodriguez-Ormaza N, Anderson C, Baggett CD, Delamater PL, Troester MA, Wheeler SB, Wardell AC, Deal AM, Smitherman A, Mersereau J, Baker VL, and Nichols HB
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- Humans, Female, Adolescent, North Carolina epidemiology, Young Adult, Adult, Registries, Fertility Preservation statistics & numerical data, Fertility Preservation methods, Neoplasms therapy, Neoplasms epidemiology, Health Services Accessibility statistics & numerical data, Counseling statistics & numerical data
- Abstract
Background: Fertility counseling is recommended for adolescent and young adult women facing gonadotoxic cancer therapy. However, fertility care is subspecialized medical care offered at a limited number of institutions, making geographic access a potential barrier to guideline-concordant care. We assessed the relationship between geographic access and receipt of fertility counseling among adolescent and young adult women with cancer., Methods: Using data from the North Carolina Central Cancer Registry, we identified women diagnosed with lymphoma, gynecologic cancer, or breast cancer at ages 15 to 39 years during 2004 to 2015. Eligible women were invited to complete an online survey on various topics, including fertility counseling. Geographic access was measured, using geocoded addresses, as vehicular travel time from residence to the nearest fertility clinic available at diagnosis. Multivariable regression models were used to examine the association between travel time and receipt of fertility counseling by provider type: health care provider versus fertility specialist., Results: Analyses included 380 women. The median travel time to a fertility clinic was 31 (IQR: 17-71) minutes. Overall, 75% received fertility counseling from a health care provider and 16% by a fertility specialist. Women who lived ≥30 minutes from a clinic were 13% less likely to receive fertility counseling by a health care provider (prevalence ratio: 0.87; 95% confidence interval, 0.75-1.00) and 49% less likely to receive counseling by a fertility specialist (prevalence ratio: 0.51; 95% confidence interval, 0.28-0.93)., Conclusions: Women who lived further away from fertility clinics were less likely to receive fertility counseling., Impact: Interventions to improve access to fertility counseling should include strategies to alleviate the burden of geographic access., (©2024 American Association for Cancer Research.)
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- 2024
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17. Chronic Health Conditions, Disability, and Physical and Cognitive Limitations Among LGBTQ+ Cancer Survivors.
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Waters AR, Jin M, Jones SR, Datta GD, Butler EN, Kent EE, Nichols HB, and Tan K
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Background: Cancer survivors are at high risk for chronic health conditions and physical and cognitive limitations. However, few studies have explored these outcomes among LGBTQ+ survivors., Methods: We used pooled, weighted Behavioral Risk Factor Surveillance System data from 23 states that completed two specific modules from 2020-2022. We calculated age-adjusted prevalence for heart disease, asthma, COPD, depressive disorders, myocardial infarction, kidney disease, stroke, diabetes, hearing disability, vision disability, cognitive limitations, and difficulty walking, dressing, and running errands in LGBTQ+, lesbian, gay, or bisexual (LGB), transgender or gender non-conforming (TGNC), and non-LGBTQ+ cancer survivors. Four multivariable logistic regression models controlling for different factors were run for each outcome., Results: Of 40,990 cancer survivors, 1,715 were LGBTQ+. LGBTQ+ survivors had significantly higher age-adjusted prevalence of all outcomes. The prevalence of all outcomes was highest among TGNC survivors except for depressive disorders and cognitive limitations. LGBTQ+ survivors had higher odds of reporting asthma (aOR: 1.5, 95%CI:1.2-1.9), depressive disorders (aOR: 1.9, 95%CI:1.6-2.4), kidney disease (aOR: 1.5, 95%CI:1.1-2.1), stroke (aOR: 1.7, 95%CI:1.3-2.3), diabetes (aOR: 1.3, 95%CI:1.0-1.6), vision disability (aOR: 1.6, 95%CI:1.2-2.2), cognitive limitations (aOR: 2.3, 95%CI:1.8-2.9), difficulty walking (aOR: 1.7, 95%CI:1.3-2.0), dressing (aOR: 2.0, 95%CI:1.5-2.7), and running errands (aOR: 1.6, 95%CI:1.3-2.1). In TGNC models, TGNC cancer survivors had increased odds of most outcomes., Conclusions: LGBTQ+ cancer survivors have an elevated burden of all chronic health conditions, disabilities, and limitations assessed. TGNC cancer survivors experience even higher burden of the same outcomes., Impact: Findings highlight substantial disparities regarding the health of LGBTQ+ cancer survivors.
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- 2024
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18. Lymphedema self-assessment among endometrial cancer survivors.
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Brown JA, Olshan AF, Bae-Jump VL, Ogunleye AA, Smith S, Black-Grant S, and Nichols HB
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- Humans, Female, Middle Aged, Aged, Surveys and Questionnaires, Self-Assessment, Adult, Incidence, Endometrial Neoplasms complications, Endometrial Neoplasms psychology, Cancer Survivors psychology, Lymphedema etiology, Lymphedema epidemiology, Lymphedema diagnosis, Lymphedema psychology
- Abstract
Purpose: Lower extremity lymphedema (LEL), which causes ankle, leg, and feet swelling, poses a significant challenge for endometrial cancer survivors, impacting physical functioning and psychological well-being. Inconsistent LEL diagnostic methods result in wide-ranging LEL incidence estimates., Methods: We calculated the cumulative incidence of LEL based on survivor-reported Gynecologic Cancer Lymphedema Questionnaire (GCLQ) responses in addition to survivor- and nurse-reported leg circumference measurements among a pilot sample of 50 endometrial cancer survivors (27 White, 23 Black) enrolled in the ongoing population-based Carolina Endometrial Cancer Study., Results: Self-leg circumference measurements were perceived to be difficult and were completed by only 17 survivors. Diagnostic accuracy testing measures (sensitivity, specificity, positive and negative predictive value) compared the standard nurse-measured ≥ 10% difference in leg circumference measurements to GCLQ responses. At a mean of ~11 months post-diagnosis, 54% of survivors met established criteria for LEL based on ≥ 4 GCLQ cutpoint while 24% had LEL based on nurse-measurement. Percent agreement, sensitivity, and specificity approximated 60% at a threshold of ≥ 5 GCLQ symptoms. However, Cohen's kappa, a measure of reliability that corrects for agreement by chance, was highest at ≥ 4 GCLQ symptoms (κ = 0.27)., Conclusion: Our findings emphasize the need for high quality measurements of LEL that are feasible for epidemiologic study designs among endometrial cancer survivors. Future studies should use patient-reported survey measures to assess lymphedema burden and quality of life outcomes among endometrial cancer survivors., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2024
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19. Follow-Up Colonoscopy for Detection of Missed Colorectal Cancer After Diverticulitis.
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Redd WD, Holub JL, Nichols HB, Sandler RS, and Peery AF
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Background & Aims: Colonoscopy often is recommended after an episode of diverticulitis to exclude missed colorectal cancer (CRC). This is a controversial recommendation based on limited evidence. We estimated the prevalence and odds of CRC and advanced colorectal neoplasia on colonoscopy in patients with diverticulitis compared with CRC screening., Methods: Using data from the Gastrointestinal Quality Improvement Consortium registry, we performed a cross-sectional study with patients ≥40 years old undergoing outpatient colonoscopy for an indication of diverticulitis follow-up evaluation or CRC screening. The primary outcome was CRC. The secondary outcome was advanced colorectal neoplasia. Odds ratios (ORs) and 95% CIs were calculated., Results: We identified 4,591,921 outpatient colonoscopies performed for screening and 91,993 colonoscopies for diverticulitis follow-up evaluation. CRC prevalence was 0.33% in colonoscopies for screening and 0.31% in colonoscopies for diverticulitis. Compared with screening, patients with diverticulitis were less likely to have CRC (adjusted OR, 0.84; 95% CI, 0.74-0.94). CRC prevalence decreased to 0.17% in colonoscopies performed for diverticulitis only. Compared with screening, patients with diverticulitis as the only indication were less likely to have CRC (adjusted OR, 0.49; 95% CI, 0.36-0.68). CRC prevalence increased to 1.43% in patients with complicated diverticulitis. Compared with screening, patients with complicated diverticulitis were more likely to have CRC (adjusted OR, 3.57; 95% CI, 1.59-8.01)., Conclusions: The risk of CRC cancer is low in most patients with diverticulitis. Patients with complicated diverticulitis are the exception. Our results suggest that colonoscopy to detect missed CRC should include diverticulitis patients with a complication and those not current with CRC screening., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)
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- 2024
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20. Late endocrine diseases in survivors of adolescent and young adult cancer in California: a population-based study.
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Abrahão R, Brunson A, Ruddy KJ, Li Q, Li J, Ryder MM, Chubak J, Nichols HB, Sauder CAM, Gray MF, Hahn EE, Wun T, and Keegan THM
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- Humans, Adolescent, Young Adult, Survivors, California epidemiology, Hematopoietic Stem Cell Transplantation, Neoplasms complications, Neoplasms epidemiology, Neoplasms therapy, Hodgkin Disease, Diabetes Mellitus, Hypothyroidism epidemiology
- Abstract
Background: Cancer survivors have increased risk of endocrine complications, but there is a lack of information on the occurrence of specific endocrinopathies at the population-level., Methods: We used data from the California Cancer Registry (2006-2018) linked to statewide hospitalisation, emergency department, and ambulatory surgery databases. We estimated the cumulative incidence of and factors associated with endocrinopathies among adolescents and young adults (AYA, 15-39 years) who survived ≥2 years after diagnosis., Results: Among 59,343 AYAs, 10-year cumulative incidence was highest for diabetes (4.7%), hypothyroidism (4.6%), other thyroid (2.2%) and parathyroid disorders (1.6%). Hypothyroidism was most common in Hodgkin lymphoma, leukaemia, breast, and cervical cancer survivors, while diabetes was highest among survivors of leukaemias, non-Hodgkin lymphoma, colorectal, cervical, and breast cancer. In multivariable models, factors associated with increased hazard of endocrinopathies were treatment, advanced stage, public insurance, residence in low/middle socioeconomic neighbourhoods, older age, and non-Hispanic Black or Hispanic race/ethnicity. Haematopoietic cell transplant was associated with most endocrinopathies, while chemotherapy was associated with a higher hazard of ovarian dysfunction and hypothyroidism., Conclusions: We observed a high burden of endocrinopathies among AYA cancer survivors, which varied by treatment and social factors. Evidence-based survivorship guidelines are needed for surveillance of these diseases., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)
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- 2024
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21. BMI and breast cancer risk around age at menopause.
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Von Holle A, Adami HO, Baglietto L, Berrington de Gonzalez A, Bertrand KA, Blot W, Chen Y, DeHart JC, Dossus L, Eliassen AH, Fournier A, Garcia-Closas M, Giles G, Guevara M, Hankinson SE, Heath A, Jones ME, Joshu CE, Kaaks R, Kirsh VA, Kitahara CM, Koh WP, Linet MS, Park HL, Masala G, Mellemkjaer L, Milne RL, O'Brien KM, Palmer JR, Riboli E, Rohan TE, Shrubsole MJ, Sund M, Tamimi R, Tin Tin S, Visvanathan K, Vermeulen RC, Weiderpass E, Willett WC, Yuan JM, Zeleniuch-Jacquotte A, Nichols HB, Sandler DP, Swerdlow AJ, Schoemaker MJ, and Weinberg CR
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- Adult, Female, Humans, Middle Aged, Young Adult, Body Mass Index, Premenopause, Prospective Studies, Risk Factors, Breast Neoplasms epidemiology, Breast Neoplasms etiology, Breast Neoplasms diagnosis, Menopause
- Abstract
Background: A high body mass index (BMI, kg/m
2 ) is associated with decreased risk of breast cancer before menopause, but increased risk after menopause. Exactly when this reversal occurs in relation to menopause is unclear. Locating that change point could provide insight into the role of adiposity in breast cancer etiology., Methods: We examined the association between BMI and breast cancer risk in the Premenopausal Breast Cancer Collaborative Group, from age 45 up to breast cancer diagnosis, loss to follow-up, death, or age 55, whichever came first. Analyses included 609,880 women in 16 prospective studies, including 9956 who developed breast cancer before age 55. We fitted three BMI hazard ratio (HR) models over age-time: constant, linear, or nonlinear (via splines), applying piecewise exponential additive mixed models, with age as the primary time scale. We divided person-time into four strata: premenopause; postmenopause due to natural menopause; postmenopause because of interventional loss of ovarian function (bilateral oophorectomy (BO) or chemotherapy); postmenopause due to hysterectomy without BO. Sensitivity analyses included stratifying by BMI in young adulthood, or excluding women using menopausal hormone therapy., Results: The constant BMI HR model provided the best fit for all four menopausal status groups. Under this model, the estimated association between a five-unit increment in BMI and breast cancer risk was HR=0.87 (95% CI: 0.85, 0.89) before menopause, HR=1.00 (95% CI: 0.96, 1.04) after natural menopause, HR=0.99 (95% CI: 0.93, 1.05) after interventional loss of ovarian function, and HR=0.88 (95% CI: 0.76, 1.02) after hysterectomy without BO., Conclusion: The BMI breast cancer HRs remained less than or near one during the 45-55 year age range indicating that the transition to a positive association between BMI and risk occurs after age 55., Competing Interests: Declaration of Competing Interest none., (Published by Elsevier Ltd.)- Published
- 2024
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22. International Pooled Analysis of Leisure-Time Physical Activity and Premenopausal Breast Cancer in Women From 19 Cohorts.
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Timmins IR, Jones ME, O'Brien KM, Adami HO, Aune D, Baglietto L, Bertrand KA, Brantley KD, Chen Y, Clague DeHart J, Clendenen TV, Dossus L, Eliassen AH, Fletcher O, Fournier A, Håkansson N, Hankinson SE, Houlston RS, Joshu CE, Kirsh VA, Kitahara CM, Koh WP, Linet MS, Park HL, Lynch BM, May AM, Mellemkjær L, Milne RL, Palmer JR, Ricceri F, Rohan TE, Ruddy KJ, Sánchez MJ, Shu XO, Smith-Byrne K, Steindorf K, Sund M, Vachon CM, Vatten LJ, Visvanathan K, Weiderpass E, Willett WC, Wolk A, Yuan JM, Zheng W, Nichols HB, Sandler DP, Swerdlow AJ, and Schoemaker MJ
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- Humans, Female, Risk Factors, Exercise, Cohort Studies, Obesity complications, Leisure Activities, Breast Neoplasms epidemiology, Breast Neoplasms etiology
- Abstract
Purpose: There is strong evidence that leisure-time physical activity is protective against postmenopausal breast cancer risk but the association with premenopausal breast cancer is less clear. The purpose of this study was to examine the association of physical activity with the risk of developing premenopausal breast cancer., Methods: We pooled individual-level data on self-reported leisure-time physical activity across 19 cohort studies comprising 547,601 premenopausal women, with 10,231 incident cases of breast cancer. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of leisure-time physical activity with breast cancer incidence. HRs for high versus low levels of activity were based on a comparison of risk at the 90th versus 10th percentiles of activity. We assessed the linearity of the relationship and examined subtype-specific associations and effect modification across strata of breast cancer risk factors, including adiposity., Results: Over a median 11.5 years of follow-up (IQR, 8.0-16.1 years), high versus low levels of leisure-time physical activity were associated with a 6% (HR, 0.94 [95% CI, 0.89 to 0.99]) and a 10% (HR, 0.90 [95% CI, 0.85 to 0.95]) reduction in breast cancer risk, before and after adjustment for BMI, respectively. Tests of nonlinearity suggested an approximately linear relationship ( P
nonlinearity = .94). The inverse association was particularly strong for human epidermal growth factor receptor 2-enriched breast cancer (HR, 0.57 [95% CI, 0.39 to 0.84]; Phet = .07). Associations did not vary significantly across strata of breast cancer risk factors, including subgroups of adiposity., Conclusion: This large, pooled analysis of cohort studies adds to evidence that engagement in higher levels of leisure-time physical activity may lead to reduced premenopausal breast cancer risk.- Published
- 2024
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23. Association between healthy dietary patterns and markers of oxidative stress in the Sister Study.
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Crawford B, Steck SE, Sandler DP, Nichols HB, Milne GL, and Park YM
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- Humans, Female, Cross-Sectional Studies, F2-Isoprostanes, Prospective Studies, Diet, Oxidative Stress, Dietary Patterns, Diet, Mediterranean
- Abstract
Purpose: We assessed the cross-sectional association between healthy dietary patterns [alternate Mediterranean diet (aMED), Dietary Approaches to Stop Hypertension (DASH), alternative Healthy Eating Index (aHEI), and Healthy Eating Index 2015 (HEI-2015)] and urinary biomarkers of oxidative stress., Methods: Between 2003 and 2009, the Sister Study enrolled 50,884 breast cancer-free US women aged 35 to 74 (non-Hispanic White, 83.7%). Data were analyzed for 844 premenopausal and 454 postmenopausal women who had urine samples analyzed for F
2 -isoprostanes and non-missing covariate data. Food frequency questionnaire responses were used to calculate dietary pattern scores. Concentrations of 8-iso-prostaglandin F2α (8-iso-PGF2α ) and its metabolite (8-iso-PGF2α -M) were measured in urine samples by GC/MS for premenopausal women and LC/MS for postmenopausal women. Multivariable linear regression models were used to estimate associations between aMED, DASH, aHEI, and HEI-2015 and urinary F2 -isoprostanes by menopausal status. Effect modification by sociodemographic, lifestyle, and clinical characteristics was also evaluated., Results: Among premenopausal women, the four dietary indices were inversely associated with 8-iso-PGF2α (aMED βQ4vsQ1 : - 0.17, 95% CI - 0.27, - 0.08; DASH βQ4vsQ1 : - 0.18, 95% CI - 0.28, - 0.08; aHEI βQ4vsQ1 : - 0.20, 95% CI - 0.30, - 0.10; HEI-2015 βQ4vsQ1 : - 0.19, 95% CI - 0.29, - 0.10). In contrast, inverse associations with 8-iso-PGF2α -M were found for the continuous aMED, aHEI, and HEI-2015. Associations between dietary indices and 8-iso-PGF2α were generally stronger among younger women, women with lower income, and women with higher BMI. Similar results were observed among postmenopausal women, though only the continuous DASH and aHEI models were statistically significant., Conclusion: Healthy dietary patterns were associated with lower levels of oxidative stress., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)- Published
- 2024
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24. Late venous thromboembolism in survivors of adolescent and young adult cancer: A population-based study in California.
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Abrahão R, Brunson A, Chubak J, Wernli KJ, Nichols HB, Chao C, Ruddy KJ, Hahn EE, Li Q, Malogolowkin MH, Sauder CAM, Kushi LH, Wun T, and Keegan THM
- Subjects
- Humans, Adolescent, Young Adult, Risk Factors, Proportional Hazards Models, Survivors, Venous Thromboembolism epidemiology, Venous Thromboembolism etiology, Venous Thromboembolism pathology, Neoplasms complications, Neoplasms epidemiology
- Abstract
Introduction: Venous thromboembolism (VTE), a common complication in cancer patients, occurs more often during the initial phase of treatment. However, information on VTE beyond the first two years after diagnosis ('late VTE') is scarce, particularly in young survivors., Methods: We examined the risk of, and factors associated with, late VTE among adolescents and young adults (AYA, 15-39 years) diagnosed with cancer (2006-2018) who survived ≥2 years. Data were obtained from the California Cancer Registry linked to hospitalization, emergency department and ambulatory surgery data. We used non-parametric models and Cox proportional hazard regression for analyses., Results: Among 59,343 survivors, the 10-year cumulative incidence of VTE was 1.93 % (CI 1.80-2.07). The hazard of VTE was higher among those who had active cancer, including progression from lower stages to metastatic disease (Hazard Ratio (HR) = 10.41, 95 % confidence interval (CI): 8.86-12.22), second primary cancer (HR = 2.58, CI:2.01-3.31), or metastatic disease at diagnosis (HR = 2.38, CI:1.84-3.09). The hazard of late VTE was increased among survivors who underwent hematopoietic cell transplantation, those who received radiotherapy, had a VTE history, public insurance (vs private) or non-Hispanic Black/African American race/ethnicity (vs non-Hispanic White). Patients with leukemias, lymphomas, sarcoma, melanoma, colorectal, breast, and cervical cancers had a higher VTE risk than those with thyroid cancer., Conclusions: VTE risk remained elevated ≥2 years following cancer diagnosis in AYA survivors. Active cancer is a significant risk factor for VTE. Future studies might determine if late VTE should prompt evaluation for recurrence or second malignancy, if not already known., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)
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- 2024
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25. Prevalence and impact of fertility concerns in young women with breast cancer.
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Mannion S, Higgins A, Larson N, Stewart EA, Khan Z, Shenoy C, Nichols HB, Su HI, Partridge AH, Loprinzi CL, Couch F, Olson JE, and Ruddy KJ
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- Humans, Female, Middle Aged, Prevalence, Cryopreservation, Fertility, Breast Neoplasms epidemiology, Breast Neoplasms therapy, Fertility Preservation
- Abstract
Survey data from the Mayo Clinic Breast Disease Registry were used to assess fertility counseling and fertility preservation strategies in a modern cohort of young women with breast cancer. One hundred respondents were identified who were under age 50 at the time of breast cancer diagnosis and who expressed interest in future childbearing near the time of diagnosis and/or 1 year later. Ninety-three percent of the 81 respondents to the year one survey recalled fertility counseling prior to cancer treatment. Most who reported a high level of fertility concern declared that this concern had impacted their treatment decisions, often shortening their planned duration of endocrine therapy. Approximately half had taken steps to preserve future fertility, and a third had used a gonadotropin-releasing hormone agonist either alone or combined with another method (e.g., embryo or oocyte cryopreservation)., (© 2024. The Author(s).)
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- 2024
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26. Exposure to indoor light at night in relation to multiple dimensions of sleep health: findings from the Sister Study.
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Sweeney MR, Nichols HB, Jones RR, Olshan AF, Keil AP, Engel LS, James P, Sandler DP, White AJ, and Jackson CL
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- Humans, Female, Sleep Deprivation, Cross-Sectional Studies, Sleep, Ethnicity, Sleep Initiation and Maintenance Disorders epidemiology, Sleep Initiation and Maintenance Disorders etiology, Sleep Wake Disorders epidemiology
- Abstract
Study Objective: To examine the association between light at night (LAN) and multiple sleep health dimensions., Methods: Among 47 765 Sister Study participants, indoor LAN (TV on in the room, light(s) on in room, light from outside the room, nightlight, no light) and sleep dimensions were self-reported at baseline (2003-2009). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the cross-sectional associations between LAN and short sleep duration (<7 hours/night), insomnia symptoms (difficulty falling or staying asleep), frequent napping (≥3 naps/week), inconsistent sleep/wake time (differed day-to-day and week-to-week), sleep debt (≥2 hours between longest and shortest duration), recent sleep medication use, and a cumulative poor sleep score (≥3 poor sleep dimensions). Population-attributable risks (PARs) were determined for any light exposure vs. none by race/ethnicity., Results: Compared to sleeping with no light in the bedroom, sleeping with a TV on was associated with a higher prevalence of most dimensions of poor sleep (e.g. short sleep duration: PR = 1.38, 95% CI: 1.32 to 1.45; inconsistent sleep/wake time: PR = 1.55, 95% CI: 1.44 to 1.66; sleep debt: PR = 1.36, 95% CI: 1.29 to 1.44; poor sleep score: PR = 1.58, 95% CI: 1.48-1.68). PARs tended to be higher for non-Hispanic black women compared to non-Hispanic white women., Conclusions: Sleeping with a TV on was associated with poor sleep health among US women, and non-Hispanic black women may be disproportionately burdened., (Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2023.)
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- 2024
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27. Health Care Access Barriers and Self-Reported Health Among Adolescent and Young Adult Cancer Survivors.
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Meernik C, Dorfman CS, Zullig LL, Lazard AJ, Fish L, Farnan L, Nichols HB, Oeffinger KC, and Akinyemiju T
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- Humans, Adolescent, Young Adult, Self Report, Survivors, Health Services Accessibility, Cancer Survivors, Neoplasms epidemiology, Neoplasms therapy, Neoplasms complications
- Abstract
Purpose: Adolescents and young adult (AYA) cancer survivors (15-39 years at diagnosis) are at risk for treatment-related late effects but face barriers in accessing survivorship care. We examined the prevalence of five health care access (HCA) barriers: affordability, accessibility, availability, accommodation, and acceptability. Methods: We identified AYA survivors from the University of North Carolina (UNC) Cancer Survivorship Cohort who completed a baseline questionnaire in 2010-2016. Participants had a history of cancer, were ≥18 years of age, and receiving care at a UNC oncology clinic. The sample was restricted to AYA survivors who were interviewed ≥1 year postdiagnosis. We used modified Poisson regression to estimate prevalence ratios (PRs) for the association between HCA barriers and self-reported fair or poor health, adjusted for sociodemographic and cancer characteristics. Results: The sample included 146 AYA survivors who were a median age of 39 at the time of the survey. The majority (71%)-and 92% of non-Hispanic Black survivors-reported at least one HCA barrier, including acceptability (40%), accommodation (38%), or affordability (31%). More than one-quarter of survivors (28%) reported fair or poor health. Affordability barriers (PR: 1.89, 95% confidence interval [CI]: 1.13-3.18) and acceptability barriers (PR: 1.60, 95% CI: 0.96-2.66) were associated with a higher prevalence of fair/poor health, as were the cumulative effects of multiple HCA dimensions reported as barriers. Conclusions: Barriers across multiple HCA dimensions were prevalent and associated with worse health in AYA survivors. Findings highlight the need to better understand and target specific barriers to care for diverse AYA survivors to improve their long-term health.
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- 2024
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28. Patterns of chemotherapy receipt among patients with hormone receptor-positive, HER2-negative breast cancer.
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Olsson LT, Hamilton AM, Van Alsten SC, Lund JL, Stürmer T, Nichols HB, Reeder-Hayes KE, and Troester MA
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- Humans, Female, Breast pathology, Chemotherapy, Adjuvant, Neoadjuvant Therapy, Antineoplastic Combined Chemotherapy Protocols adverse effects, Receptor, ErbB-2 genetics, Breast Neoplasms drug therapy, Breast Neoplasms genetics, Breast Neoplasms pathology
- Abstract
Background: Breast cancer chemotherapy utilization not only may differ by race and age, but also varies by genomic risk, tumor characteristics, and patient characteristics. Studies in demographically diverse populations with both clinical and genomic data are necessary to understand potential disparities by race and age., Methods: In the Carolina Breast Cancer Study Phase 3 (2008-2013), chemotherapy receipt (yes/no) and regimen type were assessed in association with age and race among hormone receptor (HR) positive and HER2-negative tumors (n = 1862). Odds ratios were estimated for the association between demographic factors and chemotherapy receipt., Results: Monotonic decreases in frequency of adjuvant chemotherapy receipt were observed over time during the study period, while neoadjuvant chemotherapy was stable. Younger age was associated with chemotherapy receipt (OR [95% CI]: 2.9 [2.4, 3.6]) and with anthracycline-based regimens (OR [95% CI]: 1.7 [1.3, 2.4]). Participants who had Medicaid (OR [95% CI]: 1.8 [1.3, 2.5]), lived in rural settings (OR [95% CI]: 1.4 [1.0, 2.0]), or were Black (OR [95% CI]: 1.5 [1.2, 1.8]) had slightly higher odds of chemotherapy, but these associations were non-significant with adjustment for stage and grade. Associations between younger age and chemotherapy receipt were strongest among women who did not receive genomic testing., Conclusions: While race was not strongly associated with chemotherapy receipt, younger age remains a strong predictor of chemotherapy receipt, even with adjustment for clinical factors and among women who receive genomic testing., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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29. Caring for Children in Relation to Financial Hardship, Advance Care Planning, and Genetic Testing Among Adolescent and Young Adults with Cancer.
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Tan KR, Meernik C, Anderson C, Deal AM, Engel S, Getahun D, Kent EE, Kirchhoff AC, Kwan ML, Mitra S, Park EM, Smitherman A, Chao CR, Kushi L, and Nichols HB
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- Child, Humans, Female, Young Adult, Adolescent, Financial Stress, Genetic Testing, Neoplasms epidemiology, Thyroid Neoplasms, Cancer Survivors psychology, Advance Care Planning
- Abstract
Purpose: When a cancer diagnosis coincides with caring for children, it may influence the financial impacts of cancer and decisions to pursue advance care planning (ACP) or genetic testing. We examined associations between caring for children and financial hardship, ACP, and genetic testing among female adolescent and young adult (AYA) cancer survivors in North Carolina and California. Methods: Participants were diagnosed at ages 15-39 years with breast, melanoma, gynecologic, lymphoma, or thyroid cancer during 2004-2016. We estimated adjusted prevalence differences (aPDs) and ratios (aPRs) for each outcome by child caring status using marginal structural binomial regression models. Results: Among 1595 women ages 19-54 years at survey (median = 7 years since diagnosis), 819 (51.3%) reported that they were caring for children at diagnosis. Women caring for children had a higher prevalence of material financial hardship (e.g., medical debt; 30% vs. 21.9%; aPD = 9%, 95% confidence interval [CI]: 3 to 14; aPR = 1.39, 95% CI: 1.12 to 1.72) but similar levels of psychological financial hardship compared to noncaregivers. Women caring for children were more likely to complete ACPs (42.2% vs. 30.7%; aPD = 9%, 95% CI: 3 to 16; aPR = 1.30, 95% CI: 1.08 to 1.57). Among the 723 survivors of breast, endometrial, and ovarian cancer, the prevalence of genetic testing was higher among women caring for children (89%) than noncaregivers (81%); this difference was not statistically significant. Conclusion: Women caring for children at diagnosis may be at elevated risk for adverse financial outcomes and may benefit from additional financial navigation support. Childcare responsibilities may further complicate health decision-making for AYAs diagnosed with cancer.
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- 2024
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30. Physical Activity Intervention Characteristics and Effects on Behavioral and Health-Related Outcomes Among Adolescents and Young Adults Living with and Beyond Cancer: A Systematic Review.
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Hoover RL, Xu J, Conklin JL, Nichols HB, Smitherman A, Valle CG, Schwartz T, Mayer DK, and Hirschey R
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- Adolescent, Humans, Young Adult, Wearable Electronic Devices, Cancer Survivors, Exercise, Neoplasms therapy
- Abstract
Participation in physical activity (PA) during and after cancer treatment is safe and beneficial in the adolescent and young adult (AYA) cancer population. PA can positively impact health-related outcomes; however, participation remains low. This systematic review aims to describe PA intervention characteristics and outcomes in AYA survivors of cancer (AYASCa). This review followed Preferred Reporting Index for Systematic Reviews and Meta Analyses (PRISMA) guidelines and was registered with Prospero (CRD42022365661). PubMed, CINAHL, and Scopus databases were searched for randomized control trials (RCTs) and pre/post-test studies without a control group through December 31, 2022. Data included: participant demographics, PA intervention characteristics, and health-related outcomes. Studies were assessed using the National Institute of Health Critical Appraisal Tools, and findings were synthesized to identify common characteristics of PA interventions and outcomes. Twenty-three studies were included: 15 RCTs and 8 pre/post-test studies. Heterogeneity existed across design, sample demographics, intervention timing, and observed outcomes. The most common characteristics of PA interventions were supervision of PA, wearable device use, tailored/individualized PA prescriptions, and goal setting. PA interventions positively affected health-related outcomes, with 21 studies reporting statistically significant findings. Implementing personalized PA prescriptions, utilizing wearable devices, and incorporating goal setting as characteristics in PA interventions hold potential benefits for AYASCa, leading to improved outcomes. Still, additional research is needed to explore interventions that utilize these PA characteristics and determine which ones are most effective for AYASCa. By further investigating and identifying optimal PA characteristics, interventions can be better tailored to meet this population's specific needs and preferences, ultimately enhancing their overall well-being and recovery.
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- 2024
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31. Risk of adverse birth outcomes after adolescent and young adult cancer.
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Anderson C, Baggett CD, Engel SM, Getahun D, Cannizzaro NT, Mitra S, Meernik C, Moy LM, Laurent CA, Zhou X, Xu L, Kwan ML, Wood WA, Luke B, Chao CR, Kushi LH, and Nichols HB
- Subjects
- Child, Female, Infant, Newborn, Adolescent, Young Adult, Humans, Adult, Infant, Small for Gestational Age, Premature Birth epidemiology, Breast Neoplasms, Pregnancy Complications, Cancer Survivors
- Abstract
Background: Many women diagnosed with cancer as adolescents and young adults (AYAs, age 15-39 years) want biological children after cancer but lack information on the potential impact of their cancer history on future reproductive outcomes. We investigated the risk of adverse birth outcomes among AYA cancer survivors., Methods: We identified insured women diagnosed with AYA breast cancer, thyroid cancer, gynecologic cancers, lymphoma, or melanoma from 2003 to 2016 in the state of North Carolina or the Kaiser Permanente health care systems in northern and southern California. Post-diagnosis births to cancer survivors were each matched with up to 5 births to women without cancer. Risk ratios for preterm birth (<37 completed weeks), very preterm birth (<34 completed weeks), low birth weight (<2500 g), and small for gestational age (SGA, <10th percentile of weight for gestational age) were estimated using modified Poisson regression., Results: Analyses included 1648 births to 1268 AYA cancer survivors and 7879 births to 6066 women without cancer. Overall, risk of preterm birth, very preterm birth, low birth weight, and SGA did not significantly differ between births to women with and without cancer. However, births to women with gynecologic cancers had a significantly increased risk of low birth weight (risk ratio = 1.82; 95% confidence interval: 1.03 to 3.21) and suggested increased risk of preterm birth (risk ratio = 1.59; 95% confidence interval: 0.99 to 2.54). Chemotherapy exposure was not associated with increased risk of adverse birth outcomes., Conclusions: Women with gynecologic cancers, but not other cancers, had an increased risk of adverse birth outcomes compared to women without cancer., (© The Author(s) 2023. Published by Oxford University Press.)
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- 2024
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32. Sleep disturbances among cancer survivors.
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Yarosh RA, Jackson CL, Anderson C, Nichols HB, and Sandler DP
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- Humans, Female, Aged, Survivors, Sleep, Cancer Survivors, Breast Neoplasms complications, Breast Neoplasms epidemiology, Sleep Initiation and Maintenance Disorders epidemiology, Sleep Initiation and Maintenance Disorders etiology, Sleep Wake Disorders epidemiology, Sleep Wake Disorders etiology
- Abstract
Purpose: We investigated sleep disturbances among cancer survivors compared to similarly aged women without cancer history., Methods: We identified 2067 women with a history of cancer other than breast or non-melanoma skin cancer at enrollment in the Sister Study, a US-wide cohort of women with a family history of breast cancer. Cancer survivors were matched with up to 5 cancer-free women (N = 9717) on age at enrollment. An index age (for covariate classification) was defined as the age at cancer diagnosis for survivors and the same age for their matched comparators. Sleep disturbances included duration, sleep medication usage, insomnia symptoms, long sleep-latency onset (≥30 min to fall asleep), frequent night awakenings (waking ≥3/night, ≥ 3 times/week), frequent napping (≥ 3 times/week), and a composite outcome of ≥ 1sleep disturbance. Multivariable linear regression (effect estimate, 95% confidence interval (CI)) and logistic regression (odds ratio, OR, 95% CI) were used for continuous and dichotomous outcomes, respectively., Results: At enrollment, cancer survivors were on average 13.8 years (range=0, 62) from diagnosis. After adjustment for age at enrollment and depression, diabetes, hypertension, and menopausal status prior to the index age, sleep disturbances were generally not more common among cancer survivors compared to those without cancer. However, among cancer survivors, those > 2 years from diagnosis were more likely to report ≥ 1 sleep disturbance (OR=1.44; 1.07, 1.93) compared to survivors 0-2 years from diagnosis., Conclusion: Addressing sleep disturbances may improve well-being for cancer survivors., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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- 2023
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33. Additive subdistribution hazards regression for competing risks data in case-cohort studies.
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Wogu AF, Li H, Zhao S, Nichols HB, and Cai J
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- Humans, Proportional Hazards Models, Survival Analysis, Probability, Computer Simulation, Cohort Studies
- Abstract
In survival data analysis, a competing risk is an event whose occurrence precludes or alters the chance of the occurrence of the primary event of interest. In large cohort studies with long-term follow-up, there are often competing risks. Further, if the event of interest is rare in such large studies, the case-cohort study design is widely used to reduce the cost and achieve the same efficiency as a cohort study. The conventional additive hazards modeling for competing risks data in case-cohort studies involves the cause-specific hazard function, under which direct assessment of covariate effects on the cumulative incidence function, or the subdistribution, is not possible. In this paper, we consider an additive hazard model for the subdistribution of a competing risk in case-cohort studies. We propose estimating equations based on inverse probability weighting methods for the estimation of the model parameters. Consistency and asymptotic normality of the proposed estimators are established. The performance of the proposed methods in finite samples is examined through simulation studies and the proposed approach is applied to a case-cohort dataset from the Sister Study., (© 2023 The International Biometric Society.)
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- 2023
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34. Associations between birth defects with neural crest cell origins and pediatric embryonal tumors.
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Wong EC, Lupo PJ, Desrosiers TA, Nichols HB, Smith SM, Poole C, Canfield M, Shumate C, Chambers TM, Schraw JM, Nembhard WN, Yazdy MM, Nestoridi E, Janitz AE, and Olshan AF
- Subjects
- Infant, Child, Humans, Neural Crest, Cohort Studies, Risk Factors, Hepatoblastoma epidemiology, Hepatoblastoma genetics, Wilms Tumor epidemiology, Wilms Tumor genetics, Neuroblastoma epidemiology, Neuroblastoma genetics, Liver Neoplasms, Kidney Neoplasms
- Abstract
Background: There are few assessments evaluating associations between birth defects with neural crest cell developmental origins (BDNCOs) and embryonal tumors, which are characterized by undifferentiated cells having a molecular profile similar to neural crest cells. The effect of BDNCOs on embryonal tumors was estimated to explore potential shared etiologic pathways and genetic origins., Methods: With the use of a multistate, registry-linkage cohort study, BDNCO-embryonal tumor associations were evaluated by generating hazard ratios (HRs) and 95% confidence intervals (CIs) with Cox regression models. BDNCOs consisted of ear, face, and neck defects, Hirschsprung disease, and a selection of congenital heart defects. Embryonal tumors included neuroblastoma, nephroblastoma, and hepatoblastoma. Potential HR modification (HRM) was investigated by infant sex, maternal race/ethnicity, maternal age, and maternal education., Results: The risk of embryonal tumors among those with BDNCOs was 0.09% (co-occurring n = 105) compared to 0.03% (95% CI, 0.03%-0.04%) among those without a birth defect. Children with BDNCOs were 4.2 times (95% CI, 3.5-5.1 times) as likely to be diagnosed with an embryonal tumor compared to children born without a birth defect. BDNCOs were strongly associated with hepatoblastoma (HR, 16.1; 95% CI, 11.3-22.9), and the HRs for neuroblastoma (3.1; 95% CI, 2.3-4.2) and nephroblastoma (2.9; 95% CI, 1.9-4.4) were elevated. There was no notable HRM by the aforementioned factors., Conclusions: Children with BDNCOs are more likely to develop embryonal tumors compared to children without a birth defect. Disruptions of shared developmental pathways may contribute to both phenotypes, which could inform future genomic assessments and cancer surveillance strategies of these conditions., (© 2023 American Cancer Society.)
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- 2023
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35. Financial hardship differences by LGBTQ+ status among assigned female at birth adolescent and young adult cancer survivors: a mixed methods analysis.
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Waters AR, Kent EE, Meernik C, Getahun D, Laurent CA, Xu L, Mitra S, Kushi LH, Chao C, and Nichols HB
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- Infant, Newborn, Humans, Female, Adolescent, Young Adult, Financial Stress, Surveys and Questionnaires, Cancer Survivors, Neoplasms epidemiology, Sexual and Gender Minorities
- Abstract
Background: Adolescent and young adult (AYA) cancer survivors are at an elevated risk of financial hardship. However, financial hardship among LGBTQ+ AYAs has not been widely explored. Thus, we used qualitative and quantitative survey data from the Horizon Study cohort to assess financial hardship of AYAs by LGBTQ+ status., Methods: Multivariable logit models, predicted probabilities, average marginal effects or differences in predicted probabilities (AME) and 95% confidence intervals (CI) were used to assess the association of LGBTQ+ status and two components of financial hardship: material and psychological. Qualitative content analysis of an open-ended survey question about financial sacrifices was used to describe the third component of financial hardship, behavioral., Results: Among 1,635 participants, 4.3% self-identified as LGBTQ+. Multivariable logit models controlling for demographic factors revealed that LGBTQ+ AYAs had an 18-percentage point higher probability of experiencing material financial hardship (95%CI 6-30%) and a 14-percentage point higher probability of experiencing psychological financial hardship (95%CI 2-26%) than non-LGBTQ+ AYAs. Controlling for economic factors attenuated the association of LGBTQ+ status with psychological financial hardship (AME = 11%; 95%CI - 1-23%), while the material financial hardship association remained statistically significant (AME = 14%; 95%CI 3-25%). In the qualitative analysis, LGBTQ+ AYAs frequently reported educational changes and costs (e.g., quitting school), unpaid bills and debt (e.g., medical debt, taking on credit card debt), as well as changes in housing and poor housing conditions (e.g., moving into less expensive house)., Conclusions: LGBTQ + targeted and tailored interventions are needed to move toward equity for LGBTQ+ AYAs-an overlooked minority population., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2023
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36. Disparities in fertility preservation use among adolescent and young adult women with cancer.
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Meernik C, Engel SM, Wardell A, Baggett CD, Gupta P, Rodriguez-Ormaza N, Luke B, Baker VL, Wantman E, Rauh-Hain JA, Mersereau JE, Olshan AF, Smitherman AB, Cai J, and Nichols HB
- Subjects
- Female, Humans, Cryopreservation, Fertility Preservation, Cancer Survivors, Neoplasms therapy, Neoplasms epidemiology, Infertility
- Abstract
Purpose: Women face multiple barriers to fertility preservation after cancer diagnosis, but few studies have examined disparities in use of these services., Methods: Women aged 15-39 years diagnosed with cancer during 2004-2015 were identified from the North Carolina Central Cancer Registry and linked to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Women who cryopreserved oocytes or embryos for fertility preservation (n = 96) were compared to women who received gonadotoxic treatment but did not use fertility preservation (n = 7964). Conditional logistic and log-binomial regression were used to estimate odds ratios (ORs) or prevalence ratios (PRs) and 95% confidence intervals (CIs)., Results: Few adolescent and young adult women with cancer in our study (1.2%) used fertility preservation. In multivariable regression, women less likely to use fertility preservation were older at diagnosis (ages 25-29 vs. 35-39: OR = 6.27, 95% CI: 3.35, 11.73); non-Hispanic Black (vs. non-Hispanic White: PR = 0.44, 95% CI: 0.24, 0.79); and parous at diagnosis (vs. nulliparous: PR = 0.24, 95% CI: 0.13, 0.45); or lived in census tracts that were non-urban (vs. urban: PR = 0.12, 95% CI: 0.04, 0.37) or of lower socioeconomic status (quintiles 1-3 vs. quintiles 4 and 5: PR = 0.39, 95% CI: 0.25, 0.61)., Conclusions: Women with cancer who were older, non-Hispanic Black, parous, or living in areas that were non-urban or of lower socioeconomic position were less likely to use fertility preservation., Implications for Cancer Survivors: Clinical and policy interventions are needed to ensure equitable access to fertility services among women facing cancer treatment-related infertility., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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37. Challenges and Opportunities of Epidemiological Studies to Reduce the Burden of Cancers in Young Adults.
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Nichols HB, Wernli KJ, Chawla N, O'Meara ES, Gray MF, Green LE, Baggett CD, Casperson M, Chao C, Jones SMW, Kirchhoff AC, Kuo TM, Lee C, Malogolowkin M, Quesenberry CP, Ruddy KJ, Wun T, Zebrack B, Chubak J, Hahn EE, Keegan THM, and Kushi LH
- Abstract
There are >1.9 million survivors of adolescent and young adult cancers (AYA, diagnosed at ages 15-39) living in the U.S. today. Epidemiologic studies to address the cancer burden in this group have been a relatively recent focus of the research community. In this article, we discuss approaches and data resources for cancer epidemiology and health services research in the AYA population. We consider research that uses data from cancer registries, vital records, healthcare utilization, and surveys, and the accompanying challenges and opportunities of each. To illustrate the strengths of each data source, we present example research questions or areas that are aligned with these data sources and salient to AYAs. Integrating the respective strengths of cancer registry, vital records, healthcare data, and survey-based studies sets the foundation for innovative and impactful research on AYA cancer treatment and survivorship to inform a comprehensive understanding of diverse AYA needs and experiences., Competing Interests: Conflicts of interest/Competing interests The authors declare there are no potential conflicts of interest.
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- 2023
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38. Gastrointestinal outcomes among older women with endometrial cancer.
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Anderson C, Peery AF, Bae-Jump VL, Brewster WR, Lund JL, Olshan AF, and Nichols HB
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- Aged, Female, United States epidemiology, Humans, Medicare, Abdominal Pain epidemiology, Abdominal Pain etiology, Constipation, Endometrial Neoplasms epidemiology, Gastrointestinal Diseases epidemiology, Gastrointestinal Diseases etiology, Ileus epidemiology, Ileus etiology
- Abstract
Objective: Treatment for endometrial cancer may contribute to bowel dysfunction and other gastrointestinal outcomes. We investigated the risk of several gastrointestinal diagnoses among older women with endometrial cancer and matched women without a history of cancer., Methods: Women aged 66 years and older diagnosed with endometrial cancer during 2004-2017 (N = 44,386) and matched women without a known cancer history (N = 221,219) were identified in the SEER-Medicare linked data. An index date was defined as the endometrial cancer diagnosis date in that matched set. ICD-9 and -10 diagnosis codes were used to define gastrointestinal outcomes, including constipation, abdominal pain, IBS, fecal incontinence, bowel obstruction, ileus, radiation enteritis or proctitis, colonic stricture, and vascular insufficiency of the bowel in the Medicare claims. Hazard ratios (HRs) for incident gastrointestinal diagnoses were estimated using multivariable Cox proportional hazards regression models., Results: Compared to women without cancer, women with endometrial cancer had an increased risk of gastrointestinal symptoms after the index date, including constipation (HR = 2.27; 95% CI: 2.22-2.32), abdominal pain (HR = 2.94; 95% CI: 2.89-2.99), and fecal incontinence (HR = 1.96; 95% CI: 1.83-2.10). The risk of other gastrointestinal diagnoses was also higher among women with endometrial cancer (e.g., bowel obstruction: HR = 5.72; 95% CI: 5.47-5.98; ileus: HR = 7.22; 95% CI: 6.89-7.57). These associations were also apparent in sensitivity analyses limited to 1+ and 5+ years after the index date., Conclusions: Older women with endometrial cancer experience an excess risk of gastrointestinal diagnoses that may persist long after cancer diagnosis. Surveillance for these conditions may be a critical part of survivorship care., Competing Interests: Conflicts of interest Dr. Lund's spouse was formerly employed by GSK and previously owned stock in the company., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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39. Hypertensive conditions of pregnancy, preterm birth, and premenopausal breast cancer risk: a premenopausal breast cancer collaborative group analysis.
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Nichols HB, House MG, Yarosh R, Mitra S, Goldberg M, Bertrand KA, Eliassen AH, Giles GG, Jones ME, Milne RL, O'Brien KM, Palmer JR, Sandin S, Willett WC, Yin W, Sandler DP, Swerdlow AJ, and Schoemaker MJ
- Subjects
- Pregnancy, Infant, Newborn, Female, Humans, Risk Factors, Hypertension, Pregnancy-Induced epidemiology, Hypertension, Pregnancy-Induced diagnosis, Pre-Eclampsia epidemiology, Pre-Eclampsia diagnosis, Breast Neoplasms epidemiology, Breast Neoplasms etiology, Premature Birth epidemiology, Premature Birth etiology
- Abstract
Purpose: Women with preeclampsia are more likely to deliver preterm. Reports of inverse associations between preeclampsia and breast cancer risk, and positive associations between preterm birth and breast cancer risk are difficult to reconcile. We investigated the co-occurrence of preeclampsia/gestational hypertension with preterm birth and breast cancer risk using data from the Premenopausal Breast Cancer Collaborative Group., Methods: Across 6 cohorts, 3096 premenopausal breast cancers were diagnosed among 184,866 parous women. We estimated multivariable hazard ratios (HR) and 95% confidence intervals (CI) for premenopausal breast cancer risk using Cox proportional hazards regression., Results: Overall, preterm birth was not associated (HR 1.02, 95% CI 0.92, 1.14), and preeclampsia was inversely associated (HR 0.86, 95% CI 0.76, 0.99), with premenopausal breast cancer risk. In stratified analyses using data from 3 cohorts, preterm birth associations with breast cancer risk were modified by hypertensive conditions in first pregnancies (P-interaction = 0.09). Preterm birth was positively associated with premenopausal breast cancer in strata of women with preeclampsia or gestational hypertension (HR 1.52, 95% CI: 1.06, 2.18), but not among women with normotensive pregnancy (HR = 1.09, 95% CI: 0.93, 1.28). When stratified by preterm birth, the inverse association with preeclampsia was more apparent, but not statistically different (P-interaction = 0.2), among women who did not deliver preterm (HR = 0.82, 95% CI 0.68, 1.00) than those who did (HR = 1.07, 95% CI 0.73, 1.56)., Conclusion: Findings support an overall inverse association of preeclampsia history with premenopausal breast cancer risk. Estimates for preterm birth and breast cancer may vary according to other conditions of pregnancy., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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40. Discrimination between Precancerous Gastric Lesions and Gastritis Using a Gastric Cancer Risk Stratification Model.
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Murphy JD, Epplein M, Lin FC, Troester MA, Nichols HB, Butt J, Pan K, You W, and Olshan A
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- Humans, Risk Assessment, Stomach Neoplasms pathology, Gastritis, Atrophic diagnosis, Helicobacter Infections complications, Helicobacter Infections diagnosis, Helicobacter Infections pathology, Gastritis diagnosis, Gastritis pathology, Precancerous Conditions pathology, Helicobacter pylori
- Abstract
Background: Seropositivity to certain Helicobacter pylori proteins may affect development of gastric lesions that could become cancerous. Previously, we developed a model of gastric cancer risk including gender, age, HP0305 sero-positivity, HP1564 sero-positivity, UreA antibody titer and serologically defined chronic atrophic gastritis (termed: "Lasso model")., Methods: We evaluated the Lasso model's ability to discriminate individuals with precancerous gastric lesions (n=320) from individuals with superficial or mild atrophic gastritis (n=226) in Linqu County, China, a population at high risk for gastric cancer. We also compared its performance to the ABC Method, a gastric cancer risk stratification tool currently used in East Asia., Results: For distinguishing precancerous lesions from those with gastritis, the receiver operating characteristic curve had an area under the curve (AUC) of 73.41% (95% CI: 69.10%, 77.71%) and, at Youden's Index, a sensitivity of 78.44% (59.38%, 82.50%) and specificity of 64.72% (95% CI: 58.85%, 81.42%). Positive predictive value (PPV) was 75.38% (72.78%, 82.51%). Specificity, AUC and PPV were significantly greater (p < 0.05) than those of the ABC Method. When specificity was held constant, the Lasso model had greater sensitivity, PPV and negative predictive value (NPV) than the ABC Method. However, adjusting the ABC Method for age and gender negated the Lasso model's significant improvement in AUC., Conclusions: The Lasso model for gastric cancer risk prediction can classify precancerous lesions with significantly greater AUC than the ABC Method and, at constant specificity, with greater sensitivity, PPV and NPV. However, adding age and gender to the ABC Method, as included in the Lasso model, substantially improved its performance and negated the Lasso model's advantage.
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- 2023
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41. Adjuvant radiation therapy and health-related quality of life among older women with early-stage endometrial cancer: an analysis using the SEER-MHOS linkage.
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Park J, Kent EE, Lund JL, Anderson C, Olshan AF, Brewster WR, and Nichols HB
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- Aged, Female, Humans, United States epidemiology, Quality of Life, Radiotherapy, Adjuvant methods, Medicare, Neoplasm Staging, Endometrial Neoplasms radiotherapy, Brachytherapy
- Abstract
Purpose: Radiation therapy (RT) has been associated with decreased health-related quality of life (HRQOL) in clinical trials of early-stage endometrial cancer (EC), but few studies have examined the association in real-world settings. We assessed HRQOL associated with adjuvant RT for older women with early-stage EC within a large U.S. population-based registry resource., Methods: The Surveillance Epidemiology and End Results and the Medicare Health Outcomes Survey linkage (1998-2017) was used to identify women with early-stage EC aged ≥ 65 years at survey who received surgery and were diagnosed ≥ 1-year prior (n = 1,140). HRQOL was evaluated with the 36-item Short-Form Health Survey (SF-36) until 2006 and the Veterans RAND 12-Item Health Survey (VR-12) post 2006. Ordinary least squares regression was used to estimate mean difference (MD) in T scores and 95% confidence intervals (CIs) comparing treatment groups (surgery alone, adjuvant external beam radiation therapy [EBRT], or adjuvant vaginal brachytherapy [VBT]) after accounting for confounders using propensity score weighting., Results: Overall, RT was not associated with physical health (MD = 0.97; 95% CI = - 1.13, 3.07) or mental health (MD = - 0.78; 95% CI = - 2.60, 1.05) relative to surgery alone. In analyses by RT type, adjuvant VBT was associated with better general health on the SF-36/VR-12 subscale (MD = 3.59; 95% CI = 0.56, 6.62) relative to surgery alone. No statistically significant associations were observed for adjuvant VBT and physical or mental health, or for adjuvant EBRT and any HRQOL domain., Conclusion: Older women with early-stage EC treated with adjuvant RT did not report worse physical and mental HRQOL scores compared to those treated with surgery alone, though relevant symptoms should be evaluated further to fully understand the disease and treatment specific aspects of the HRQOL., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2023
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42. Pregnancy attempts among adolescent and young adult cancer survivors.
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Anderson C, Fitz V, Deal A, Getahun D, Kwan ML, Mersereau JE, Kushi LH, Chao CR, and Nichols HB
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- Pregnancy, Humans, Female, Cross-Sectional Studies, Reproduction, Cancer Survivors, Fertility Preservation, Neoplasms diagnosis, Neoplasms epidemiology, Neoplasms therapy
- Abstract
Objective: To examine whether demographic and cancer-related characteristics and factors such as fertility discussion with a medical provider and fertility preservation use are associated with attempting pregnancy after adolescent and young adult cancer., Design: Cross-sectional online survey., Setting: Not applicable., Patient(s): Women with lymphoma, breast cancer, thyroid cancer, or gynecologic cancer diagnosed at 15-39 years from 2004 to 2016 were identified from the North Carolina Cancer Registry and the Kaiser Permanente Northern and Southern California health care systems and responded to an online survey addressing survivorship concerns, including fertility and reproductive outcomes., Exposures: Demographic characteristics, cancer characteristics, fertility discussion with a medical provider or fertility specialist between cancer diagnosis and starting cancer treatment, use of fertility preservation strategies (freezing embryos or oocytes) after cancer diagnosis., Main Outcome Measure(s): Pregnancy attempt after cancer diagnosis, defined by either a pregnancy or 12 months of trying to become pregnant without pregnancy., Result(s): Among 801 participants who had not reached their desired family size at diagnosis, 77% had a fertility discussion with any medical provider between cancer diagnosis and treatment initiation, and 8% used fertility preservation after cancer diagnosis. At survey (median =7 years after diagnosis; interquartile range, 4-10), 32% had attempted pregnancy. Neither fertility discussion with any medical provider nor fertility counseling with a fertility specialist was significantly associated with pregnancy attempts. However, the use of fertility preservation was significantly associated with attempting pregnancy (prevalence ratios = 1.74; 95% confidence interval: 1.31-2.32). Other characteristics positively associated with pregnancy attempts included younger age at diagnosis, longer time since diagnosis, having a partner (at diagnosis or at survey), and having a history of infertility before cancer diagnosis., Conclusion(s): Use of fertility preservation strategies was uncommon in our cohort but was associated with attempting pregnancy after cancer. Ensuring access to fertility preservation methods may help adolescent and young adult cancer survivors to plan and initiate future fertility., (Copyright © 2022 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2023
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43. Disparities in the use of assisted reproductive technologies after breast cancer: a population-based study.
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Meernik C, Jorgensen K, Wu CF, Murphy CC, Baker VL, Brady PC, Nitecki R, Nichols HB, and Rauh-Hain JA
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- Female, Humans, Pregnancy, Cohort Studies, Reproductive Techniques, Assisted, Pregnancy Outcome, Ethnicity, Breast Neoplasms epidemiology, Breast Neoplasms therapy
- Abstract
Purpose: Equitable access to oncofertility services is a key component of cancer survivorship care, but factors affecting access and use remain understudied., Methods: To describe disparities in assisted reproductive technology (ART) use among women with breast cancer in California, we conducted a population-based cohort study using linked oncology, ART, and demographic data. We identified women age 18-45 years diagnosed with invasive breast cancer between 2000 and 2015. The primary outcome was ART use-including oocyte/embryo cryopreservation or embryo transfer-after cancer diagnosis. We used log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) to identify factors associated with ART use., Results: Among 36,468 women with invasive breast cancer, 206 (0.56%) used ART. Women significantly less likely to use ART were age 36-45 years at diagnosis (vs. 18-35 years: PR = 0.17, 95% CI 0.13-0.22); non-Hispanic Black or Hispanic (vs. non-Hispanic White: PR = 0.31, 95% CI 0.21-0.46); had at least one child (vs. no children: adjusted PR [aPR] = 0.39, 95% CI 0.25-0.60); or lived in non-urban areas (vs. urban: aPR = 0.28, 95% CI 0.10-0.75), whereas women more likely to use ART lived in high-SES areas (vs. low-/middle-SES areas: aPR = 2.93, 95% CI 2.04-4.20) or had private insurance (vs. public/other insurance: aPR = 2.95, 95% CI 1.59-5.49)., Conclusion: Women with breast cancer who are socially or economically disadvantaged, or who already had a child, are substantially less likely to use ART after diagnosis. The implementation of policies or programs targeting more equitable access to fertility services for women with cancer is warranted., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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44. Disparities in Fertility-Sparing Treatment and Use of Assisted Reproductive Technology After a Diagnosis of Cervical, Ovarian, or Endometrial Cancer.
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Jorgensen K, Meernik C, Wu CF, Murphy CC, Baker VL, Jarmon P, Brady PC, Nitecki R, Nichols HB, and Rauh-Hain JA
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- Pregnancy, Female, Humans, Cohort Studies, Ethnicity, Minority Groups, Reproductive Techniques, Assisted, Carcinoma, Ovarian Epithelial pathology, Neoplasm Staging, Retrospective Studies, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Neoplasms therapy, Uterine Cervical Neoplasms pathology, Endometrial Neoplasms diagnosis, Endometrial Neoplasms therapy, Endometrial Neoplasms pathology, Ovarian Neoplasms diagnosis, Ovarian Neoplasms therapy, Ovarian Neoplasms pathology, Fertility Preservation methods
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Objective: To assess the presence of sociodemographic and clinical disparities in fertility-sparing treatment and assisted reproductive technology (ART) use among patients with a history of cervical, endometrial, or ovarian cancer., Methods: We conducted a population-based cohort study of patients aged 18-45 years who were diagnosed with cervical cancer (stage IA, IB), endometrial cancer (grade 1, stage IA, IB), or ovarian cancer (stage IA, IC) between January 1, 2000, and December 31, 2015, using linked data from the CCR (California Cancer Registry), the California Office of Statewide Health Planning and Development, and the Society for Assisted Reproductive Technology. The primary outcome was receipt of fertility-sparing treatment , defined as surgical or medical treatment to preserve the uterus and at least one ovary. The secondary outcome was fertility preservation , defined as ART use after cancer diagnosis. Multivariable logistic regression analysis was used to estimate odds ratios and 95% CIs for the association between fertility-sparing treatment and exposures of interest: age at diagnosis, race and ethnicity, health insurance, socioeconomic status, rurality, and parity., Results: We identified 7,736 patients who were diagnosed with cervical, endometrial, or ovarian cancer with eligible histology. There were 850 (18.8%) fertility-sparing procedures among 4,521 cases of cervical cancer, 108 (7.2%) among 1,504 cases of endometrial cancer, and 741 (43.3%) among 1,711 cases of ovarian cancer. Analyses demonstrated nonuniform patterns of sociodemographic disparities by cancer type for fertility-sparing treatment, and ART. Fertility-sparing treatment was more likely among young patients, overall, and of those in racial and ethnic minority groups among survivors of cervical and ovarian cancer. Use of ART was low (n=52) and was associated with a non-Hispanic White race and ethnicity designation, being of younger age (18-35 years), and having private insurance., Conclusion: This study demonstrates that clinical and sociodemographic disparities exist in the receipt of fertility-sparing treatment and ART use among patients with a history of cervical, endometrial, or ovarian cancer., Competing Interests: Financial Disclosure Caitlin C. Murphy reports receiving payment from Freenome. Jose Alejandro Rauh-Hain reports receiving payment from the Schlesinger Group and Guidepoint. The other authors did not report any potential conflicts of interest., (Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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45. Time to cancer treatment and reproductive outcomes after fertility preservation among adolescent and young adult women with cancer.
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Meernik C, Engel SM, Baggett CD, Wardell A, Zhou X, Ruddy KJ, Wantman E, Baker VL, Luke B, Mersereau JE, Cai J, Olshan AF, Smitherman AB, and Nichols HB
- Subjects
- Pregnancy, Female, Young Adult, Adolescent, Humans, Reproductive Techniques, Assisted, Live Birth, North Carolina, Fertility Preservation, Neoplasms therapy, Neoplasms diagnosis
- Abstract
Background: Fertility preservation (FP) may be underused after cancer diagnosis because of uncertainty around delays to cancer treatment and subsequent reproductive success., Methods: Women aged 15 to 39 years diagnosed with cancer between 2004 and 2015 were identified from the North Carolina Central Cancer Registry. Use of assisted reproductive technology (ART) after cancer diagnosis between 2004 and 2018 (including FP) was assessed through linkage to the Society for Assisted Reproductive Technology. Linear regression was used to examine time to cancer treatment among women who did (n = 95) or did not (n = 469) use FP. Modified Poisson regression was used to estimate risk ratios (RRs) and 95% CIs for pregnancy and birth based on timing of ART initiation relative to cancer treatment (n = 18 initiated before treatment for FP vs n = 26 initiated after treatment without FP)., Results: The median time to cancer treatment was 9 to 33 days longer among women who used FP compared with women who did not, matched on clinical factors. Women who initiated ART before cancer treatment may be more likely to have a live birth given pregnancy compared with women who initiated ART after cancer treatment (age-adjusted RR, 1.47; 95% CI, 0.98-2.23), though this may be affected by the more frequent use of gestational carriers in the former group (47% vs 20% of transfer cycles, respectively)., Conclusions: FP delayed gonadotoxic cancer treatment by up to 4.5 weeks, a delay that would not be expected to alter prognosis for many women. Further study of the use of gestational carriers in cancer populations is warranted to better understand its effect on reproductive outcomes., (© 2022 American Cancer Society.)
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- 2023
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46. Outcomes after assisted reproductive technology in women with cancer: a systematic review and meta-analysis.
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Meernik C, Poole C, Engel SM, Rauh-Hain JA, Luke B, and Nichols HB
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- Pregnancy, Female, Humans, Embryo Transfer methods, Live Birth, Oocytes, Fertilization in Vitro methods, Pregnancy Rate, Retrospective Studies, Birth Rate, Reproductive Techniques, Assisted, Neoplasms therapy
- Abstract
Study Question: What are the associations between a history of cancer and outcomes after ART?, Summary Answer: Compared to women without cancer, on average, women with cancer had a lower return for embryo transfer and a lower likelihood of clinical pregnancy and live birth after ART., What Is Known Already: Small, single-institution studies have suggested that cancer and its treatment may negatively affect ART outcomes., Study Design, Size, Duration: We conducted a systematic review with meta-analysis of studies comparing ART outcomes between women with and without cancer. PubMed, Embase and Scopus were searched for original, English-language studies published up to June 2021., Participants/materials, Setting, Methods: Inclusion criteria required reporting of ART outcomes after controlled ovarian stimulation (COS) among women with a history of cancer compared to women without cancer who used ART for any indication. Outcomes of interest ranged from duration of COS to likelihood of live birth after embryo transfer. Random-effects meta-analysis was used to calculate mean differences and odds ratios (ORs) with 95% CIs and 95% prediction intervals (PIs). We assessed heterogeneity by age-adjustment, referent group indication for ART, study location and among women with breast cancer and women who initiated ART before cancer treatment. We used visual inspection, Egger's test and the trim-and-fill method to assess funnel plot asymmetry., Main Results and the Role of Chance: Of 6094 unique records identified, 42 studies met inclusion criteria, representing a median per study of 58 women with cancer (interquartile range (IQR) = 159) and 114 women without cancer (IQR = 348). Compared to women without cancer, on average, women with cancer had a lower return for embryo transfer (OR: 0.22; 95% CI: 0.07, 0.74; 95% PI: 0.00, 64.98); lower likelihood of clinical pregnancy (OR: 0.51; 95% CI: 0.35, 0.73; 95% PI: 0.19, 1.35); and lower likelihood of live birth (OR: 0.56; 95% CI: 0.38, 0.83; 95% PI: 0.19, 1.69). Substantial among-study heterogeneity was observed for COS duration, gonadotropin dose, cycle cancellation, total oocytes and mature oocytes. Fertilization percentage showed less heterogeneity, but study-specific estimates were imprecise. Similarly, number of embryos showed less heterogeneity, and most studies estimated minimal differences by cancer history. Funnel plot asymmetry was observed for estradiol peak and oocyte maturation percentage., Limitations, Reasons for Caution: Appreciable confounding is possible in 11 studies that lacked adequate control for group differences in age, and among-study heterogeneity was observed for most outcomes. Lack of data limited our ability to assess how cancer clinical factors (e.g. cancers other than breast, cancer stage and treatment) and ART cycle characteristics (e.g. fresh versus frozen embryo transfers and use of gestational carriers) may affect outcomes., Wider Implications of the Findings: Women with cancer may be less likely to achieve pregnancy and live birth after embryo transfer. Further examination of reproductive outcomes and sources of heterogeneity among studies is warranted to improve evidence of the expected success of ART after a cancer diagnosis., Study Funding/competing Interest(s): This research was supported in part by R01 CA211093 and P30 ES010126. C.M. was supported by the University of North Carolina Lineberger Cancer Control Education Program (T32 CA057726) and the National Cancer Institute (F31 CA260787). J.A.R.-H. was supported by the National Cancer Institute (K08 CA234333, P30 CA016672). J.A.R.-H. reports receiving consulting fees from Schlesinger Group and Guidepoint. The remaining authors declare no competing interests., Registration Number: N/A., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2023
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47. Contextual influences across the cancer control continuum.
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Datta GD and Nichols HB
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- Humans, Female, Breast, Survivors, Breast Neoplasms, Cardiovascular Diseases, Cancer Survivors
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- 2023
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48. Patient characteristics and health system factors associated with adjuvant radiation therapy receipt in older women with early-stage endometrial cancer.
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Park J, Lund JL, Kent EE, Anderson C, Brewster WR, Olshan AF, and Nichols HB
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- Aged, Humans, Female, United States, Medicare, Radiotherapy, Adjuvant, Neoplasm Staging, Retrospective Studies, Frailty, Endometrial Neoplasms
- Abstract
Introduction: Among women with early-stage endometrial cancer (EC), age, stage, grade, and histology are used to determine fitness for adjuvant radiation therapy (RT) administration. We examined non-cancer factors associated with adjuvant RT receipt in older women with early-stage EC., Materials & Methods: Using data from the Surveillance Epidemiology and End Results cancer registry program linked with Medicare claims, we identified 25,654 women (aged ≥66 years) diagnosed with first primary stage I-II EC during 2004-2017 who underwent a hysterectomy. Diagnosis and procedure codes were used to identify adjuvant RT claims filed for the seven-month period post-hysterectomy. Multivariable log-binomial regression was used to estimate adjuvant RT prevalence associated with patient characteristics and health system factors after adjustment for age, frailty, and endometrial factors., Results: Adjuvant RT was less commonly administered to Asian American and Pacific Islander patients than non-Hispanic White patients (Prevalence ratio [PR], 0.84; 95% confidence interval [CI], 0.73 to 0.97). Compared to women treated in the Northeast region, women treated other regions of the US were less likely to undergo adjuvant RT (PR, 0.75; 95% CI, 0.71 to 0.79). Residing in rural or high neighborhood-poverty counties was associated with lower adjuvant RT administration. Higher comorbidity score was not associated with reduced prevalence of adjuvant RT receipt; however, women with high probability of predicted probability of frailty were less likely to undergo adjuvant RT (PR, 0.67; 95% CI, 0.55 to 0.81) compared to women with low probability of frailty. Women who received lymph node assessment were more likely to undergo adjuvant RT compared to women who did not (PR, 1.43; 95% CI, 1.34 to 1.51). Women treated by a gynecologic oncologist were more likely to undergo adjuvant RT compared to women treated by a non-gynecologic oncologist (PR 1.09; 95% CI, 1.04 to 1.14). Adjuvant RT was more commonly administered to women treated in larger academic hospitals., Discussion: Findings suggest that various non-cancer factors affect the delivery of adjuvant RT to older women with early-stage EC in real-world oncology practice. Advancing our understanding of factors associated with adjuvant RT administration may help expand equitable access to RT., Competing Interests: Declaration of Competing Interest Jennifer L. Lund receives salary support to the University of North Carolina at Chapel Hill from the Center for Pharmacoepidemiology (current members: GlaxoSmithKline, UCB BioSciences, Takeda, AbbVie, Boehringer Ingelheim) and from other pharmaceutical companies (AbbVie, Roche). Her spouse was formerly employed by GlaxoSmithKline and previously owned stock in the company. Jihye Park, Erin E. Kent, Chelsea Anderson, Andrew F. Olshan, Wendy R. Brewster, and Hazel B. Nichols have no conflicts of interest to disclose., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
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- 2023
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49. Obstetric and Neonatal Outcomes 1 or More Years After a Diagnosis of Breast Cancer.
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Jorgensen K, Nitecki R, Nichols HB, Fu S, Wu CF, Melamed A, Brady P, Chavez Mac Gregor M, Clapp MA, Giordano S, and Rauh-Hain JA
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- Pregnancy, Infant, Newborn, Humans, Female, Infant, Child, Preschool, Infant, Small for Gestational Age, Cesarean Section, Fetal Growth Retardation, Retrospective Studies, Premature Birth epidemiology, Premature Birth etiology, Breast Neoplasms diagnosis, Breast Neoplasms epidemiology
- Abstract
Objective: To evaluate obstetric and neonatal outcomes of the first live birth conceived 1 or more years after breast cancer diagnosis., Methods: We performed a population-based study to compare live births between women with a history of breast cancer (case group) and matched women with no cancer history (control group). Individuals in the case and control groups were identified using linked data from the California Cancer Registry and California Office of Statewide Health Planning and Development data sets. Individuals in the case group were diagnosed with stage I-III breast cancer at age 18-45 years between January 1, 2000, and December 31, 2012, and conceived 12 or more months after breast cancer diagnosis. Individuals in the control group were covariate-matched women without a history of breast cancer who delivered during 2000-2012. The primary outcome was preterm birth at less than 37 weeks of gestation. Secondary outcomes were preterm birth at less than 32 weeks of gestation, small for gestational age (SGA), cesarean delivery, severe maternal morbidity, and neonatal morbidity. Subgroup analyses were used to assess the effect of time from initial treatment to fertilization and receipt of additional adjuvant therapy before pregnancy on outcomes of interest., Results: Of 30,021 women aged 18-45 years diagnosed with stage I-III breast cancer during 2000-2012, 553 met the study inclusion criteria. Those with a history of breast cancer and matched women in the control group had similar odds of preterm birth at less than 37 weeks of gestation (odds ratio [OR], 1.29; 95% CI 0.95-1.74), preterm birth at less than 32 weeks of gestation (OR 0.77; 95% CI 0.34-1.79), delivering an SGA neonate (less than the 5th percentile: OR 0.60; 95% CI 0.35-1.03; less than the 10th percentile: OR 0.94; 95% CI 0.68-1.30), and experiencing severe maternal morbidity (OR 1.61; 95% CI 0.74-3.50). Patients with a history of breast cancer had higher odds of undergoing cesarean delivery (OR 1.25; 95% CI 1.03-1.53); however, their offspring did not have increased odds of neonatal morbidity compared with women in the control group (OR 1.15; 95% CI 0.81-1.62)., Conclusion: Breast cancer 1 or more years before fertilization was not strongly associated with obstetric and neonatal complications., Competing Interests: Financial Disclosure Mark A. Clapp received payment from Delfina Care for serving on the advisory board (no relation to content of submitted work) and was not included in the decision to publish this. Jose Alejandro Rauh-Hain received payment from the NIH, Guidepoint, and the Schlesinger Group. He also received payment once as a speaker for J&J. The other authors did not report any potential conflicts of interest., (Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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50. Patterns of care amongst older adults diagnosed with locally advanced esophageal cancer: A cohort study.
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Gaber CE, Shaheen NJ, Sandler RS, Edwards JK, Nichols HB, Sanoff HK, and Lund JL
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- Aged, Humans, United States epidemiology, Carboplatin, Cisplatin, Cohort Studies, Medicare, Esophagectomy, Neoadjuvant Therapy, Chemoradiotherapy, Neoplasm Staging, Esophageal Neoplasms therapy, Esophageal Neoplasms drug therapy, Frailty, Carcinoma, Squamous Cell pathology, Adenocarcinoma therapy, Adenocarcinoma drug therapy
- Abstract
Introduction: Since the early 2010s, neoadjuvant chemoradiation followed by esophagectomy (trimodal therapy) has been a recommended treatment for patients diagnosed with locally advanced esophageal cancer. However, it may also add treatment-related toxicity, particularly for older adults with significant comorbidity and frailty burdens. We examined contemporary patterns of care in older adults, which have not been well characterized., Materials and Methods: We used the Surveillance Epidemiology and End Results-Medicare database to identify a cohort of US adults aged 66 years and older diagnosed with incident locally advanced esophageal cancer between 2004 and 2017. Calendar year age-standardized percentages of treatment receipt were calculated. Joinpoint regression was used to detect temporal trends in treatment receipt. Descriptive associations between patient factors and treatment were assessed. Trend analyses quantified how the percentage of trimodal and definitive chemoradiation (no surgery) patients receiving cisplatin-based, carboplatin-based, and other chemotherapy regimens evolved over time., Results: In total, 4332 adults aged ≥66 years with locally advanced esophageal cancer were included. The age-standardized percentage of patients receiving trimodal therapy increased from 16.7% in 2004 to 26.1% in 2017 (annual percent change = 3.5%; 95% confidence interval [CI], 0.7%-6.4%) in adenocarcinomas and from 7.3% in 2004 to 9.1% in 2017 (annual percent change = 0.4%; 95% CI, -4.1%-5.1%) in squamous cell carcinomas. By 2017, definitive chemoradiation became the most frequently used treatment modality for adenocarcinomas (49.8%; 95% CI, 43.5-56.0) and squamous cell carcinomas (59.5%; 95% CI, 50.8-68.2). Patients with higher comorbidity and frailty burdens were less likely to be treated with trimodal therapy. Amongst patients receiving chemoradiation as part of their treatment, a large and swift channeling away from cisplatin and towards carboplatin-based regimens was observed., Discussion: In practice, definitive chemoradiation is the most commonly received treatment by older adults with locally advanced esophageal cancer. Four out of five older adults do not receive trimodal therapy, some of whom are potentially undertreated., Competing Interests: Declaration of Competing Interest Dr. Lund's spouse was employed by GlaxoSmithKline (within the last 12 months) and owned stock in the company (within the last 12 months). In addition, Dr. Lund receives research support to UNC from AbbVie and F. Hoffmann-La Roche AG., (Copyright © 2022. Published by Elsevier Ltd.)
- Published
- 2022
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