Alfred I. Neugut

Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer.

Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as two or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional-stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC). Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White [NHW]) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use. Our sample included 13,753 women aged 20–79xa0years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR]xa0=xa00.82; [CI] 0.71–0.96 and [OR]xa0=xa00.78; [CI] 0.63–0.98, respectively). Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other insured populations and the reasons for under-initiation among these groups need to be explored.

Cardiac Effects of Anticancer Therapy in the Elderly

Cancer incidence increases with age, and as life expectancy increases, the number of elderly patients with cancer is increasing. Cancer treatments, including chemotherapy and radiotherapy, have significant short- and long-term effects on cardiovascular function. These cardiotoxic effects can be acute, such as changes in electrocardiogram (ECG), arrhythmias, ischemia, and pericarditis and/or myocarditis-like syndromes, or they can be chronic, such as ventricular dysfunction. Anticancer therapies can also have indirect effects, such as alterations in blood pressure, or can cause metabolic abnormalities that subsequently increase risk for cardiac events. In this review, we explore both observational and clinical trial evidence of cardiac risk in the elderly. In both observational and clinical trial data, risk of cardiotoxicity with anthracycline-based chemotherapy increases with age. However, it is less clear whether the association between age and cardiotoxicity exists for newer treatments. The association may not be well demonstrated as a result of under-representation of elderly patients in clinical trials and avoidance of these therapies in this population. In addition, we discuss strategies for surveillance and prevention of cardiotoxicity in the elderly. In the elderly, it is important to be aware of the potential for cardiotoxicity during long-term follow-up and to consider both prevention and surveillance of these late effects.

Physician, affective, and cognitive variables differentially predict 'initiation' versus 'maintenance' PSA screening profiles in diverse groups of men

OBJECTIVESnTo evaluate the relevance of demographic, physician, and psychological characteristics to PSA screening in ethnic subpopulations and ascertain whether the same characteristics distinguish men who have never had a PSA from those who screen infrequently and those who screen yearly (adhere).nnnDESIGN AND METHODSnStratified cluster-sampling was used to recruit 533 men (45-70 years) from four ethnic groups: African-American; European-American; immigrant Jamaican; and immigrant men from Trinidad and Tobago. Men provided demographic and structural (insurance, regular physician, annual exam, and physician recommendation), cognitive (risk and efficacy perceptions, knowledge), and emotional variables (cancer worry and embarrassment), and reported on PSA screening history. Multinomial logistic regression used these variables to predict three screening classifications (never screened, partially adherent, and adherent).nnnRESULTSnMultinomial logistic regression showed that minority men were less likely to report either never screening or yearly screening, while younger men were more likely. Lack of a regular physician (OR=2.87, 95% CI 1.39-5.84), an annual exam (OR=1.73, 95% CI 0.91-3.28), and low recommendation (OR=3.76, 95% CI 2.13-6.66) were associated with being categorized as a never (vs. partially adherent) screener, but only annual exam (OR=0.26, 95% CI 0.10-0.63) was associated with yearly screening. Lower cancer worry was marginally associated with never screening (OR=0.59, 95% CI 0.38-1.04), while knowledge was associated with screening yearly over time (OR=0.46, 95% CI 0.28-0.77).nnnCONCLUSIONSnDemographic, physician, and psychological variables are differentially associated with never, less than yearly, and yearly screening classifications. Minority men were unlikely to have never screened, but were also less likely to screen yearly. Physician variables were associated with the difference between not screening and partially adherent, but not between partially adherent and yearly screening suggesting that the role of physicians in PSA behaviour over time would benefit from further study.

Fear and loathing in the Caribbean: three studies of fear and cancer screening in Brooklyn's immigrant Caribbean subpopulations

Email: Nathan S Consedine* nconsedi@liu.edu; Brenda A Adjei brenda.adjei@liu.edu; David Horton dhorton79@gmail.com; Andrew K Joe akj3@columbia.edu; Luisa N Borrell lnb2@columbia.edu; Paul Michael Ramirez paul.ramirez@liu.edu; Tracey Ungar tracey.ungar@liu.edu; James M McKiernan jmm23@columbia.edu; Judith S Jacobson jsj4@columbia.edu; Carol Magai cmagai@liu.edu; Alfred I Neugut ain1@columbia.edu * Corresponding author

Hey Mr. Sandman: dyadic effects of anxiety, depressive symptoms and sleep among married couples.

AbstractnThis study examined associations among anxiety, depressive symptoms, and sleep duration in a sample of middle-aged couples using the actor–partner interaction model with dyadic data. Self-report measures were completed independently by both partners as part of the health histories obtained during their annual preventive medical examinations in 2011 and 2012. Results showed that husbands’ anxiety and depressive symptoms had a stronger effect on their wives’ anxiety and depression than the other way around, but this was not moderated by one’s own sleep duration. For both wives and husbands, higher levels of depressive symptoms and anxiety predicted shorter sleep duration for their partner 1xa0year later, although the effect of husbands’ mental health on their wives’ was again stronger. The findings suggest that sleep problems might better be treated as a couple-level phenomenon than an individual one, particularly for women.

Phase Ib Randomized, Double-Blinded, Placebo-Controlled, Dose Escalation Study of Polyphenon E in Patients with Barrett's Esophagus

This study was conducted to determine the safety and efficacy of the green tea–derived Polyphenon E (Poly E) in patients with Barretts Esophagus (BE). Subjects were randomized to a 6-month, twice daily (BID) oral treatment of placebo or Poly E (200, 400, or 600 mg). Endoscopic evaluation, including biopsies, was performed before and after treatment. The primary objective was to demonstrate safety; secondary objectives investigated catechin accumulation and effects in clinical specimens. Of the 44 enrolled subjects, 11 received placebo, and 33 received Poly E. No dose-limiting toxicities were encountered, and a maximum tolerated dose (MTD) was not reached. The recommended phase II dose was 600 mg twice daily. The most common treatment-related adverse events (AE) in Poly E–treated subjects were grade I and II nausea, grade I belching, and grade I lactate dehydrogenase (LDH) elevation. No treatment-related AEs were reported in placebo-treated subjects, aside from grade I laboratory abnormalities. Pill counts and subject diaries were not consistently collected, and compliance was difficult to determine. However, on the basis of an intention-to-treat analysis, there was a significant relationship between Poly E dose and esophageal EGCG level—mean changes (pmol/g) of 0.79 (placebo), 6.06 (200 mg), 35.67 (400 mg), and 34.95 (600 mg); P = 0.005. There was a possible relationship between Poly E dose and urine PGE-M concentration. In conclusion, Poly E was well-tolerated, and treatment with Poly E (400 and 600 mg) but not Poly E (200 mg) or placebo resulted in clinically relevant and detectable EGCG accumulation in the target organ, esophageal mucosa. Cancer Prev Res; 8(12); 1131–7. ©2015 AACR.

Nationwide practice patterns for the use of venous thromboembolism prophylaxis among men undergoing radical prostatectomy

PurposeTo examine the practice patterns and predictors of VTE prophylaxis following radical prostatectomy (RP).MethodsThis was a population-based observational study of 94,709 men with a diagnosis of prostate cancer (ICD-9 code 185) who underwent RP were identified from a hospital-based database from 2000 to 2010, including 68,244 (72.1xa0%) open RP (ORP) and 26,465 (27.9xa0%) robotic-assisted laparoscopic RP (RALP). VTE prophylaxis was classified as none, mechanical, pharmacologic, or combination.ResultsFollowing RP, 35,591 (52.2xa0%) received mechanical, 4,945 (7.2xa0%) pharmacologic, 7,720 (10.6xa0%) combination, and 20,438 (30.0xa0%) no VTE prophylaxis. A total of 245 VTE events (145 DVT, 114 PE) were identified, representing 0.25xa0% of all procedures. Men with >2 comorbidities (ORxa0=xa02.44; 95xa0% CI 1.78–3.35) and those who were black (ORxa0=xa01.44; 95xa0% CI 1.06–1.97) were more likely to have a VTE. Men who had RALP (ORxa0=xa00.61; 95xa0% CI 0.45–0.99), surgery at high-volume hospitals (ORxa0=xa00.45; 95xa0% CI 0.28–0.73), or received prophylaxis (ORxa0=xa00.67; 95xa0% CI 0.50–0.88) were less likely to develop a VTE.ConclusionDespite the observation that VTE prophylaxis reduces the risk of VTE by 40xa0%, VTE prophylaxis was not used in almost one-third of men who underwent radical prostatectomy.

Is the prevalence of colorectal neoplasm higher in patients with coronary artery disease

DESIGN AND INTERVENTION This cross-sectional study was carried out between November 2004 and June 2006 in Hong Kong. Patients with suspected CAD who presented for coronary angiography for the first time were eligible for screening colono scopy. Patients who had been receiving a statin or aspirin for more than a year, had a >1-year history of CAD, or who presented for coronary angiography for reasons other than CAD, were not included. Patients were defined as CADpositive if at least 50% diameter stenosis was found in any of the major coronary arteries on coronary angiography. All other patients were classified as CAD-negative. A control group, matched for age and sex to the CADpositive group, was recruited from the general population. Information on sex, age, history of smoking, diabetes mellitus, hypertension, family history of colorectal cancer and use and duration of use of aspirin and statins was documented. All Is the prevalence of colorectal neoplasm higher in patients with coronary artery disease?

Prediagnosis aspirin use and outcomes in a prospective cohort of esophageal cancer patients

Background: Esophageal cancer remains associated with poor outcomes, yet little is known regarding factors that influence survival. Aspirin use prior to cancer diagnosis may influence outcomes. We aimed to assess the effects of prediagnosis aspirin use in patients with esophageal cancer. Methods: We conducted a prospective cohort study of newly-diagnosed esophageal cancer patients at two tertiary care centers. We assessed history of prediagnosis aspirin use, and prospectively followed patients and assessed mortality, cause of death, and development of metastases. Results: We enrolled 130 patients, the majority of whom were male (81.5%) and had adenocarcinoma (80.8%). Overall, 57 patients (43.9%) were regular aspirin users. In unadjusted analyses, we found no difference in all-cause mortality between aspirin users and nonusers. In multivariate analyses, prediagnosis aspirin use was not associated with all-cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.48–1.57] or esophageal cancer-specific mortality (HR 1.07, 95% CI 0.52–2.21). Prediagnosis aspirin use was associated with a significantly increased risk of interval metastasis (HR 3.59, 95% CI 1.08–11.96). Conclusions: In our cohort of esophageal cancer patients, prediagnosis aspirin use was not associated with all-cause or cancer-specific mortality. However, risk of interval metastatic disease was increased among those who took aspirin regularly prediagnosis. Future studies are warranted to assess whether aspirin influences the molecular characteristics of esophageal tumors, with potential prognostic and therapeutic implications.

Increased sedation requirements during endoscopy in patients with celiac disease.

BackgroundCeliac disease (CD) is associated with increased rates of neuropsychiatric disease and irritable bowel syndrome, and patients may exhibit visceral hypersensitivity.AimThe purpose of this study was to determine whether patients with CD have increased sedation requirements during endoscopic procedures.MethodsIn this retrospective cohort study, we identified CD patients undergoing either a colonoscopy or esophagogastroduodenoscopy (EGD), but not a dual procedure. CD patients were matched with control patients according to age, gender and endoscopist. For sedation requirements we defined “high” as falling outside of the 75th percentile of the entire cohort.ResultsIn the colonoscopy analysis we identified 113 CD patients and 278 controls. In the CD group, 29 individuals (26%) required high amounts of both opioids and midazolam, as compared to 46 (17%) controls (Pxa0=xa00.05). Differences were similar when considering only opioids (Pxa0=xa00.06) and midazolam (Pxa0=xa00.06). In the EGD analysis we identified 314 CD patients and 314 controls who met the inclusion criteria. Among the CD patients, 70 (22%) required high amounts of both opioids and midazolam compared to 51 (16%) controls (Pxa0=xa00.05). Differences were similar when considering only opioids (Pxa0=xa00.06) and midazolam (Pxa0=xa00.04).ConclusionsPatients with CD require higher doses of sedation during upper and lower endoscopy compared to age and gender-matched controls. Putative explanations, such as visceral hypersensitivity, chronic opioid/anxiolytic use, or underlying neuropsychiatric illness, should be evaluated prospectively.