Explore the vast range of titles available.

The National Lung Screening Trial investigators report that persons undergoing three annual screening examinations with low-dose computed tomography had a 20% reduction in lung-cancer mortality as compared with those screened with annual chest radiography. Lung cancer is an aggressive and heterogeneous disease. 1 , 2 Advances in surgical, radiotherapeutic, and chemotherapeutic approaches have been made, but the long-term survival rate remains low. 3 After the Surgeon General's 1964 report on smoking and health, mortality from lung cancer among men peaked and then fell; among women, the peak occurred later and a slight decline has occurred more recently. 4 Even though the rate of heavy smoking continues to decline in the United States, 5 94 million current or former smokers remain at elevated risk for the disease, 6 and lung cancer remains the leading cause of death from cancer in this . . .

In this study involving nearly 77,000 men, investigators analyzed the effect of screening with prostate-specific–antigen testing and digital rectal examination on the rate of death from prostate cancer, as compared with usual care. After a follow-up of 7 years, the death rates from prostate cancer did not differ significantly between the two study groups. Data from the 10-year follow-up (which were 67% complete) also showed no significant difference in prostate-cancer mortality. The benefit of screening for prostate cancer with serum prostate-specific–antigen (PSA) testing, digital rectal examination, or any other screening test is unknown. There has been no comprehensive assessment of the trade-offs between benefits and risks. Despite these uncertainties, PSA screening has been adopted by many patients and physicians in the United States and other countries. The use of PSA testing as a screening tool has increased dramatically in the United States since 1988. 1 Numerous observational studies have reported conflicting findings regarding the benefit of screening. 2 As a result, the screening recommendations of various organizations differ. The American Urological Association and . . .

Purpose Breast cancer patients aged 65+ (“older”) vary in frailty status. We tested whether a deficits accumulation frailty index predicted long-term mortality. Methods Older patients ( n  = 1280) with non-metastatic, invasive breast cancer were recruited from 78 Alliance sites from 2004 to 2011, with follow-up to 2015. Frailty categories (robust, pre-frail, and frail) were based on 35 baseline illness and function items. Cox proportional hazards and competing risk models were used to calculate all-cause and breast cancer-specific mortality for up to 7 years, respectively. Potential covariates included demographic, psychosocial, and clinical factors, diagnosis year, and care setting. Results Patients were 65–91 years old. Most (76.6%) were robust; 18.3% were pre-frail, and 5.1% frail. Robust patients tended to receive more chemotherapy ± hormonal therapy (vs. hormonal) than pre-frail or frail patients (45% vs. 37 and 36%, p  = 0.06), and had the highest adherence to hormonal therapy. The adjusted hazard ratios for all-cause mortality ( n  = 209 deaths) were 1.7 (95% CI 1.2–2.4) and 2.4 (95% CI 1.5–4.0) for pre-frail and frail versus robust women, respectively, with an absolute mortality difference of 23.5%. The adjusted hazard of breast cancer death ( n −99) was 3.1 (95% CI 1.6–5.8) times higher for frail versus robust patients (absolute difference of 14%). Treatment differences did not account for the relationships between frailty and mortality. Conclusions Most older breast cancer patients are robust and could consider chemotherapy where otherwise indicated. Patients who are frail or pre-frail have elevated long-term all-cause and breast cancer mortality. Frailty indices could be useful for treatment decision-making and care planning with older patients.

Purpose To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ (“older”). Methods Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors ( n  = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy ( n  = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0–100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1–3 years); and late discontinuation (>3–5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. Results Survivors were 65–91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09–1.40, p  < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods. Conclusions Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1–3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.

Purpose Survivorship care plans (SCP) are recommended for all cancer patients and could be especially useful to survivors 65 years and over (“older”). This study examined receipt of SCPs among older breast cancer survivors and whether SCPs were associated with improved patient-reported outcomes. Methods Three hundred and twenty-eight older women diagnosed with invasive, nonmetastatic breast cancer between 2007–2011 were recruited from 78 cooperative-group sites. Participants completed telephone interviews at baseline and 1-year posttreatment. Regression analyses examined SCP receipt (yes/no) and functioning (EORTC-QLQ-C30), cancer worry, and experiences of survivorship care (care coordination, knowledge). Results Only 35 % of women received SCPs. For each 1-year increase in age, there was a 5 % lower odds of receiving an SCP (odds ratio (OR) = 0.94, 95 % confidence interval (CI) 0.91–0.98, p  = 0.007). Besides age, no other factor predicted SCPs. SCP receipt was associated with greater knowledge and understanding of requisite follow-up care ( p  < 0.05); however, functioning was not significantly different among those with vs. without SCPs. Conclusions Receipt of care plans was limited. SCPs improved understanding of breast cancer follow-up care among older survivors, but did not impact functioning one year post-treatment. Implications for Cancer Survivors To impact functioning and salient needs of the growing cohort of older survivors, survivorship care plans likely should be tailored to geriatric-specific issues. To improve functioning, SCP content should expand to include exercise, nutrition, polypharmacy, social support and management of symptom burden from cancer, and other comorbid conditions. To improve follow-up care for cancer survivors, SCPs should delineate shared care roles between oncology and primary care in managing recurrence surveillance, screening, and cancer sequelae.

The purpose of this dissertation is to utilize and compare two existing approaches for modeling nonlinear change in cognitive functioning in cancer patients over time and to assess alternative study designs to better capture chemotherapy-related cognitive impairment using simulation data. Using data from the Thinking and Living with Cancer study, trend analysis with orthogonal polynomials (OP) and piecewise (PW) regressions approaches used to analyze cognitive functioning trajectories. Simulated datasets tested the impact of study design parameters including measurement test-retest reliability (.6 or .8), sample size (100, 200, or 300), and the number of data collection time points (4 or 5) on observed power and effect size under different conditions. In the TLC data, the PW approach accounted for a higher amount of the group by time interaction effect compared to the OP approach (71.3% vs. 56.1%, respectively). For the values used in present simulations, sample sizes and test-retest reliabilities were the predominant factors affecting statistical power for detecting significant group by time interactions. Focusing on the effect sizes of the interaction terms, it was clear that reliability was the most important factor regardless of the approach being used. Cancer patients are reporting smaller cognitive deficits compared to patients with other illnesses, which dictates samples will need to be quite large in order to have adequate power. However, higher reliability gets more power and adding time points can improve power, but instruments with lower reliability tend to make power worse.

IntroductionTo describe ANP role within current CTCA service, including administering beta-blockade, and future progression to ANP-led CTCA listsMethodsOur CTCA service started in 2015 with a Cardiologist/Radiologist, 2 radiographers and 1 ANP per list, and expanded with updated stable chest pain NICE guideline (CG95) 2016. At CTCA the ANP administers rate control up to a total of 50mg IV Metoprolol and GTN. We formally agreed a betablockade protocol and referrals detail drug suitability. The ANP has access to patient notes and collaborative decision-making support within the team. The ANP must have Advanced Life Support Provider qualification to support lists. The ANP role also includes history taking, diagnosis and treatment of patients with potential cardiac disease including patients with chest pain. ANPs request investigations and prescribe pre-procedural rate control medication. ANPs interpret reported findings and commence appropriate treatment. Satisfaction questionnaires were obtained from patients alongside regular audit of CTCA service. Standardisation of the service was met with clear pharmaceutical protocols and referral guidelines.ResultsData from local audit has highlighted positive CTCA outcomes and high level of patient satisfaction. This supported expansion of the service, including team, lists and advancing technologies. The ANP-led service has freed up consultant time for reporting.ConclusionANP-led patient care and drug administration at CTCA improves continuity of care for patients, provides efficient team structure for supporting cardiac imaging and facilitates consultant reporting time. Fully ANP-led lists with our new scanners in 2024 should reduce ongoing service costs and further increase consultant reporting time.

Purpose Tools to estimate survival, such as ePrognosis ( ), were developed for general, not cancer, populations. In older patients with breast cancer, accurate overall survival estimates would facilitate discussions about adjuvant therapies. Methods Secondary analyses were performed of data from two parallel breast cancer studies (CALGB/Alliance 49907/NCT000224102 and CALGB/Alliance 369901/NCT00068328). We included patients (n = 971) who were age 70 years and older with complete baseline quality of life data (194 from 49907; 777 from 369901). Estimated versus observed all-cause two-year mortality rates were compared. ePrognosis score was calculated based on age, sex, and daily function (derived from EORTC QLQ-C30). ePrognosis scores range from 0 to 10, with higher scores indicating worse prognosis based on mortality of community-dwelling elders and were categorized into three groups (0-2, 3-6, 7-10). Observed mortality rates were estimated using Kaplan-Meier methods. Results Patient mean age was 75.8 years (range 70-91) and 73% had stage I-IIA disease. Most patients were classified by ePrognosis as good prognosis (n = 562, 58% 0-2) and few (n = 18, 2% 7-10) poor prognosis. Two-year observed mortality rates were significantly lower than ePrognosis estimates for patients scoring 0-2 (2% vs 5%, p = 0.001) and 3-6 (8% vs 12%, p = 0.01). The same trend was seen with scores of 7-10 (23% vs 36%, p = 0.25). Conclusions ePrognosis tool only modestly overestimates mortality rate in older breast cancer patients enrolled in two cooperative group studies. This tool, which estimates non-cancer mortality risk based on readily available clinical information may inform adjuvant therapy decisions but should be validated in non-clinical trial populations.

Purpose Tools to estimate survival, such as ePrognosis ( http://eprognosis.ucsf.edu/carey2.php ), were developed for general, not cancer, populations. In older patients with breast cancer, accurate overall survival estimates would facilitate discussions about adjuvant therapies. Methods Secondary analyses were performed of data from two parallel breast cancer studies (CALGB/Alliance 49907/NCT000224102 and CALGB/Alliance 369901/NCT00068328). We included patients ( n  = 971) who were age 70 years and older with complete baseline quality of life data (194 from 49907; 777 from 369901). Estimated versus observed all-cause two-year mortality rates were compared. ePrognosis score was calculated based on age, sex, and daily function (derived from EORTC QLQ-C30). ePrognosis scores range from 0 to 10, with higher scores indicating worse prognosis based on mortality of community-dwelling elders and were categorized into three groups (0–2, 3–6, 7–10). Observed mortality rates were estimated using Kaplan–Meier methods. Results Patient mean age was 75.8 years (range 70–91) and 73% had stage I–IIA disease. Most patients were classified by ePrognosis as good prognosis ( n  = 562, 58% 0–2) and few ( n  = 18, 2% 7–10) poor prognosis. Two-year observed mortality rates were significantly lower than ePrognosis estimates for patients scoring 0–2 (2% vs 5%, p  = 0.001) and 3–6 (8% vs 12%, p  = 0.01). The same trend was seen with scores of 7–10 (23% vs 36%, p  = 0.25). Conclusions ePrognosis tool only modestly overestimates mortality rate in older breast cancer patients enrolled in two cooperative group studies. This tool, which estimates non-cancer mortality risk based on readily available clinical information may inform adjuvant therapy decisions but should be validated in non-clinical trial populations.

An extensive sampling study ot reservoir water quality was conducted in Azusa, Calif. Primary emphasis was placed on providing a better understanding of the dynamics of hydraulic mixing and free chlorine residual concentration distribution in the reservoir. The reservoir approached completely mixed behavior with two exceptions: a degree of short-circuiting between the inlet and outlet (which significantly affected the T₁₀ time) and the presence of a stagnant zone in the center core of the reservoir where there was less mixing and thus older water. These results support the assumption of stratification or partitioning in reservoirs. Regular field sampling is recommended to facilitate the effective management of distribution system water quality. In particular, interior sampling of reservoirs can provide useful information that could not be inferred otherwise.