Browsing by Subject "neoplasms"

Now showing 1 - 6 of 6
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    Clinical, Pathological, and Surgical Outcomes for Adult Pineoblastomas
    (Elsevier, 2015-12) Gener, Melissa; Conger, Andrew R.; Van Gompel, Jamie; Ariai, Mohammad S.; Jentoft, Mark; Meyer, Fredric B.; Cardinal, Jeremy S.; Bonnin, José M.; Cohen-Gadol, Aaron A.; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Introduction Pineoblastomas are uncommon primitive neuroectodermal tumors that occur mostly in children; they are exceedingly rare in adults. Few published reports have compared the various aspects of these tumors between adults and children. Methods The authors report a series of 12 pineoblastomas in adults from 2 institutions over 24 years. The clinical, radiologic, and pathologic features and clinical outcomes were compared with previously reported cases in children and adults. Results Patient age ranged from 24 to 81 years, and all but 1 patient exhibited symptoms of obstructive hydrocephalus. Three patients underwent gross total resection, and subtotal resection was performed in 3 patients. Diagnostic biopsy specimens were obtained in an additional 6 patients. Pathologically, the tumors had the classical morphologic and immunohistochemical features of pineoblastomas. Postoperatively, 10 patients received radiotherapy, and 5 patients received chemotherapy. Compared with previously reported cases, several differences were noted in clinical outcomes. Of the 12 patients, only 5 (42%) died of their disease (average length of survival, 118 months); 5 patients (42%) are alive with no evidence of disease (average length of follow-up, 92 months). One patient died of unrelated causes, and one was lost to follow-up. Patients with subtotal resections or diagnostic biopsies did not suffer a worse prognosis. Of the 9 patients with biopsy or subtotal resection, 4 are alive, 4 died of their disease, and 1 died of an unrelated hemorrhagic cerebral infarction. Conclusions Although this series is small, the data suggest that pineoblastomas in adults have a less aggressive clinical course than in children.
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    Comparing oncologic outcomes in patients undergoing surgery for oncocytic neoplasms, conventional oncocytoma, and chromophobe renal cell carcinoma
    (Elsevier, 2019-11) Flack, Chandra K.; Calaway, Adam C.; Miller, Brady L.; Picken, Maria M.; Gondim, Dibson D.; Idrees, Muhammad T.; Abel, E. Jason; Gupta, Gopal N.; Boris, Ronald S.; Urology, School of Medicine
    Introduction Oncocytic neoplasms are renal tumors similar to oncocytoma, but their morphologic variations preclude definitive diagnosis. This somewhat confusing diagnosis can create treatment and surveillance challenges for the treating urologist. We hypothesize that these subtle morphologic variations do not drastically affect the malignant potential of these tumors, and we sought to demonstrate this by comparing clinical outcomes of oncocytic neoplasms to those of classic oncocytoma and chromophobe. Methods We gathered demographic and outcomes data for patients with variant oncocytic tumors. Oncologic surveillance was conducted per institutional protocol in accordance with NCCN guidelines. Descriptive statistics were used to compare incidence of metastasis and death against those for patients with oncocytoma and chromophobe. Three hundred and fifty-one patients were analyzed: 164 patients with oncocytoma, 28 with oncocytic neoplasms, and 159 with chromophobe tumors. Results Median follow-up time for the entire cohort was 32.4 months, (interquartile range 9.2–70.0). Seventeen total patients (17/351, 4.9%) died during the course of the study. In patients with oncocytoma or oncocytic neoplasm, none were known to metastasize or die of their disease. Only chromophobe tumors >6 cm in size in our series demonstrated metastatic progression and approximately half of these metastasized tumors demonstrated sarcomatoid changes. Conclusion Variant oncocytic neoplasms appear to have a natural course similar to classic oncocytoma. These tumors appear to have no metastatic potential, and oncologic surveillance may not be indicated after surgery.
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    Mediators and Moderators of Active Music Engagement to Reduce Traumatic Stress Symptoms and Improve Well-being in Parents of Young Children With Cancer
    (Sage, 2023-12-25) Robb, Sheri L.; Stegenga, Kristin; Perkins, Susan M.; Stump, Timothy E.; Moody, Karen M.; Henley, Amanda K.; MacLean, Jessica; Jacob, Seethal A.; Delgado, David; Haut, Paul R.; School of Nursing
    Objective: This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes. Methods: Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models. Results: No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 (P = .01) and avoidance subscale scores at T3 (P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 (P = .01). There were no moderation effects for child age. Conclusions: AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.
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    Psychological processes and symptom outcomes in cancer survivors following a mindfulness-based stress reduction intervention
    (2017-07) Chinh, Kelly; Mosher, Catherine E.; McGrew, John; Rand, Kevin L.
    Mindfulness-based interventions targeting psychological and physical symptoms in cancer survivors have been shown to be efficacious. However, little is known about theory-based psychological processes through which mindfulness-based interventions may decrease symptoms. The present study is a secondary analysis of data from a mindfulness-based stress reduction (MBSR) pilot trial targeting cancer-related fatigue (CRF) in cancer survivors. Thirty-five persistently fatigued cancer survivors were recruited from a university hospital and various community clinics in Indianapolis, Indiana. Participants were randomized to either a 7-week MBSR intervention for CRF or a waitlist control (WC) condition. Measures were administered at pre-intervention, post-intervention, and 1-month follow-up and included levels of mindfulness, acceptance, and self-compassion as well as the symptom outcomes of fatigue interference, sleep disturbance, and distress. I hypothesized that MBSR would lead to increased levels of five facets of mindfulness (i.e., observing, describing, acting with awareness, nonjudging of inner experience, nonreactivity to inner experience), self-compassion, and acceptance as compared to the WC condition. Using a linear mixed modeling approach, significant group by time interactions were only found for observing, acting with awareness, nonjudging, and self-compassion, such that the MBSR group showed steady increases in these processes over time, whereas the WC group’s scores remained relatively stable. In addition, I examined whether positive changes in the five facets of mindfulness were associated with reductions in the three symptoms using multiple linear regression. This hypothesis was partially supported; acting with awareness was the only facet of mindfulness to show a modest association with a decrease in fatigue, but this result fell short of statistical significance. In addition, decreased sleep disturbance was predicted by increases in acting with awareness and nonjudging, while decreased distress was predicted by increases in observing, acting with awareness, nonjudging, and nonreactivity. Results point to specific psychological processes that may be targeted to maximize the efficacy of future MBSR interventions for cancer survivors.
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    Toward Timely Data for Cancer Research: Assessment and Reengineering of the Cancer Reporting Process
    (JMIR Publications, 2018-03-01) Jabour, Abdulrahman M.; Dixon, Brian E.; Jones, Josette F.; Haggstrom, David A.; BioHealth Informatics, School of Informatics and Computing
    Background Cancer registries systematically collect cancer-related data to support cancer surveillance activities. However, cancer data are often unavailable for months to years after diagnosis, limiting its utility. Objective The objective of this study was to identify the barriers to rapid cancer reporting and identify ways to shorten the turnaround time. Methods Certified cancer registrars reporting to the Indiana State Department of Health cancer registry participated in a semistructured interview. Registrars were asked to describe the reporting process, estimate the duration of each step, and identify any barriers that may impact the reporting speed. Qualitative data analysis was performed with the intent of generating recommendations for workflow redesign. The existing and redesigned workflows were simulated for comparison. Results Barriers to rapid reporting included access to medical records from multiple facilities and the waiting period from diagnosis to treatment. The redesigned workflow focused on facilitating data sharing between registrars and applying a more efficient queuing technique while registrars await the delivery of treatment. The simulation results demonstrated that our recommendations to reduce the waiting period and share information could potentially improve the average reporting speed by 87 days. Conclusions Knowing the time elapsing at each step within the reporting process helps in prioritizing the needs and estimating the impact of future interventions. Where some previous studies focused on automating some of the cancer reporting activities, we anticipate much shorter reporting by leveraging health information technologies to target this waiting period.
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    Use of Survivorship Care Plans in the United States: Associations With Survivorship Care
    (Oxford Journals, 2013-10-16) Forsythe, Laura P.; Parry, Carla; Alfano, Catherine M.; Kent, Erin E.; Leach, Corinne R.; Haggstrom, David A.; Ganz, Patricia A.; Aziz, Noreen; Rowland, Julia H.; Department of Medicine, IU School of Medicine
    Background Survivorship care plans (SCPs), including a treatment summary and follow-up plan, intend to promote coordination of posttreatment cancer care; yet, little is known about the provision of these documents by oncologists to primary care physicians (PCPs). This study compared self-reported oncologist provision and PCP receipt of treatment summaries and follow-up plans, characterized oncologists who reported consistent provision of these documents to PCPs, and examined associations between PCP receipt of these documents and survivorship care. Methods A nationally representative sample of medical oncologists (n = 1130) and PCPs (n = 1020) were surveyed regarding follow-up care for breast and colon cancer survivors. All statistical tests were two-sided. Multivariable regression models identified factors associated with oncologist provision of treatment summaries and SCPs to PCPs (always/almost always vs less frequent). Results Nearly half of oncologists reported always/almost always providing treatment summaries, whereas 20.2% reported always/almost always providing SCPs (treatment summary + follow-up plan). Approximately one-third of PCPs indicated always/almost always receiving treatment summaries; 13.4% reported always/almost always receiving SCPs. Oncologists who reported training in late- and long-term effects of cancer and use of electronic medical records were more likely to report SCP provision (P < .05). PCP receipt of SCPs was associated with better PCP-reported care coordination, physician–physician communication, and confidence in survivorship care knowledge compared to receipt of neither treatment summaries nor SCPs (P < .05). Conclusions Providing SCPs to PCPs may enhance survivorship care coordination, physician–physician communication, and PCP confidence. However, considerable progress will be necessary to achieve implementation of sharing SCPs among oncologists and PCPs.