Depression Moderates the Effect of Physical Functioning Over Time in Cancer Survivors

Cancer survivors are at-risk for physical functioning (PF) decrements particularly among older adults. However, few studies have examined moderators of PF over time which may guide rehabilitation interventions. This study examined the moderating effect of depressive symptoms on the association between PF at 6 months following cancer diagnosis and PF 18 months after diagnosis controlling for age, education, and treatment status (whether still in treatment). We hypothesized that the association between PF (T1) and PF (T3) would be attenuated by higher depression scores 12 months after diagnosis (T2). Participants (N = 170; Mage 65.3 +/- 9.17, 98.2% male; 81.2% White) with head and neck, esophageal, gastric, or colorectal cancers were recruited from tumor registries at two VAMCs. Self-report measures included demographics, treatment status, depression symptoms (PHQ-9), and physical functioning (PROMIS) were collected. Performance-based measure of PF (SPPB) was administered. Depression symptoms at Time 2 moderated the relation between performance-based PF (SBBP: ΔR2 = .07, F(6, 103) = 10.1, p < .001) but not self-reported PF, PROMIS: ΔR2 = .001, F(6, 110) = 15.3, p =.733. The turning point of non-significance to significance of SBPP T1-T3 was a PHQ-9 score of 7.2. In the absence of depression, the best predictor of future functioning is prior functioning. For those with PHQ-9 scores > 7.2 (28% of the sample), prior functioning does not predict future functioning. Depression should be measured closely with performance-based measures of PF, including gait speed, to improve prediction of future functioning and guide personalized interventions.

Paradigmaváltás a csontmetasztázisok sebészetében. I. Végtagi és medencelokalizációjú áttétek

According to the statistical data of tumor registries the incidence of cancer has increased in the last decade, however the mortality shows only a slight change due to the new and effective multimodal treatments. The aim of our overview article is to present the changes in the survival of the metastatic patients, and to demonstrate which factors influence their prognosis. The improvement of survival resulted in a more active surgical role both in metastases of the bone of the extremities and the pelvis. We present a diagnostic flow chart and current options for the reconstruction of the different regions of the bone and skeleton, and we will discuss their potential advantages, disadvantages and complications. It is evident that apart from the impending and pathological fracture surgery it is not the first choice of treatment but rather a palliative measure. The aim of surgery is to alleviate pain, to regain mobility and improve quality of life. If possible minimal invasive techniques are performed, as they are less demanding and allow fast rehabilitation for the patient, and they are solutions that last for a lifetime. In optimal conditions radical curative surgery can be performed in about 10 to 15 per cent of the cases, and better survival is encouraging. Orv Hetil. 2017; 158(40): 1563–1569.

Roadmap to a Comprehensive Clinical Data Warehouse for Precision Medicine Applications in Oncology

Leading institutions throughout the country have established Precision Medicine programs to support personalized treatment of patients. A cornerstone for these programs is the establishment of enterprise-wide Clinical Data Warehouses. Working shoulder-to-shoulder, a team of physicians, systems biologists, engineers, and scientists at Rutgers Cancer Institute of New Jersey have designed, developed, and implemented the Warehouse with information originating from data sources, including Electronic Medical Records, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology and Pathology archives, and Next Generation Sequencing services. Innovative solutions were implemented to detect and extract unstructured clinical information that was embedded in paper/text documents, including synoptic pathology reports. Supporting important precision medicine use cases, the growing Warehouse enables physicians to systematically mine and review the molecular, genomic, image-based, and correlated clinical information of patient tumors individually or as part of large cohorts to identify changes and patterns that may influence treatment decisions and potential outcomes.

Analysis of Surveillance, Epidemiology, and End Results Program (SEER) PSA coding error using primary data.

21 Background: SEER did not report PSA values for the 2014 submission because of inaccurate coding. This inaccuracy was a result of a confusing data entry guideline where PSA is coded in a 3-digit field with an implied decimal between digits 2 and 3. Our study uses original registry data to assess the magnitude and implications of these coding errors. Methods: The National Oncology Data Alliance is a database of more than 150 Commission-on-Cancer compliant tumor registries that use proprietary cancer registry software sold by Elekta AB (Stockholm, Sweden) and contains the same data sent to state tumor registries and SEER. De-identified data from all newly diagnosed prostate cancer cases from 2005-2013 were extracted (n = 89,379). PSA data were acquired from both the Collaborative Staging (CS) Site Specific Factor 1 (SSF1) for prostate cancer and from de-identified text fields. SSF1 contained the error prone datum that was transferred to SEER. The PSA data contained in the text fields, which are used to record lab results, etc. verbatim, were taken to be definitive. PSA values from both SSF1 and text fields were complete in 63,051 patients. AJCC Stage was determined using the clinical T stage field and the SSF fields that code for Gleason score. We calculated the error rates and their directions for PSA stratification into three levels (0 to < 10, 10 to < 20, and ≥ 20) and for the AJCC stage. Results: The measured error rate in PSA values in SSF1 caused by erroneous decimal placement was 9.0%. The resulting error rate in PSA stratification was 7.5%, with the SSF1 PSA value giving a higher PSA category in 4.8% of cases and lower in 2.7%. The consequent error rate in AJCC staging was 2.8% overall, with the PSA error resulting in a higher stage group in 1.9% and lower in 0.9%. Conclusions: Many factors can contribute to the overall error rate in PSA values in SEER data, but we are addressing only the errors associated with the implied decimal. The consequences of this error are modest despite a 9% error rate. However, SSF1 for prostate cancer is not the only confusing SSF introduced by the CS system. The current cancer registry database design is derived from outdated technology and needs restructuring to be a more effective surveillance and research tool.

The Value of Serum CA125 in the Diagnosis of Borderline Tumors of the Ovary: A Subanalysis of the Prospective Multicenter ROBOT Study

ObjectiveThe value of the serum tumor marker CA125 in borderline tumors of the ovary (BOTs) is not well defined, with unclear benefit in both diagnosis and follow-up. The aim of the present project was to identify the predictive value of CA125 for stage and relapse.MethodsCA125 data were extracted from the ROBOT multicenter study of patients with BOT treated between 1998 and 2008 in 24 German centers. While patients’ data were retrieved retrospectively from hospital records and clinical tumor registries, follow-up and independent central pathology review were performed prospectively.ResultsWe identified 127 patients from the ROBOT database fulfilling the eligibility criterion of available CA125 at initial diagnosis. Eighty-three (65.3%) patients had increased CA125 levels (>35 U/L). Of the patients, 85.0% presented with serous and 13.4% with mucinous BOT histology, whereas 29.9% had stage I disease. Fifteen (11.8%) patients experienced a relapse. Multivariate analysis identified raised CA125, young age, and serous histology as independent predictors of peritoneal implants of any type at initial presentation. Raised CA125 at initial diagnosis was, however, not an independent predictor of future relapse.DiscussionElevated CA125 seems to be associated with the presence of peritoneal implants of any type at initial diagnosis of serous BOT, but failed to have any independent predictive value on future relapse. Prospective multicenter studies are warranted to evaluate CA125 measurements in the follow-up management of BOT.

Increase in higher risk prostate cancer cases following new screening recommendation by the US Preventive Services Task Force (USPSTF).

143 Background: In 2011, the USPSTF issued a draft recommendation that PSA not be used for prostate cancer screening in men irrespective of age. Here we present early measures of the potential consequences of this recommendation. Methods: Data on men diagnosed with prostate cancer from January, 2005 through June, 2013 were extracted from the National Oncology Data Alliance (Elekta/IMPAC Medical Systems, Inc., Sunnyvale, CA). This proprietary database of merged tumor registries captures newly diagnosed cancer cases at more than 150 hospitals in the United States. Data were available through 2013 compared to 2011 in Surveillance, Epidemiology, and End Results (SEER). The data in the NODA are identical to the data sent to state tumor registries and SEER in regions that participate in SEER. Date of diagnosis, age, race, T stage, Gleason score, and PSA were collected. Patients were classified into their respective National Comprehensive Cancer Network (NCCN) risk group. Data were available and analyzed for 87,562 men. Frequencies were examined by date of diagnosis, grouped in six-month intervals. Trends were assessed using linear regression. Results: From 2005 to 2011, the percentage of men with PSA>10 decreased gradually. From 2011 to 2013, the percentage increased by 3.0% per year (p<0.0004). The fraction of men with age ≥75 years to present with PSA>10 increased by nearly double the rate for men of all ages from 2011 to 2013. No significant trends in Gleason score were observed; the frequency of men with higher T stages generally decreased over the entire period without a notable change after 2011. The percentage of men with intermediate or higher risk cancer was stable at 70-73% prior to 2011, but rose by 2.9 % per year after 2011 (p<0.003) without evidence of a plateau. Conclusions: The proportion of men diagnosed with intermediate or higher risk cancer increased by nearly 6% from 2011 to 2013. Given an estimated 233,000 new prostate cancers in 2014, approximately 14,000 men per year will shift from low risk into a higher risk disease group. Our findings suggest an increase in the fraction of men diagnosed with higher risk prostate cancer after 2011.

Closing the Quality Loop: Facilitating Improvement in Oncology Practice Through Timely Access to Clinical Performance Indicators

Complete cancer pathology reports are important for contemporary oncologic practice and for secondary users of pathology information, including tumor registries, health planners, epidemiologists, and others involved in quality-improvement activities and research.