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1.
Gynecol Oncol ; 139(3): 541-5, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26456812

ABSTRACT

OBJECTIVES: Changes in cognitive function have been identified in and reported by many cancer survivors. These changes have the potential to impact patient quality of life and functional ability. This prospective longitudinal study was designed to quantify the incidence of change in cognitive function in newly diagnosed ovarian cancer patients throughout and following primary chemotherapy. METHODS: Eligible patients had newly diagnosed, untreated ovarian cancer and had planned to receive chemotherapy. Web-based and patient reported cognitive assessments and quality of life questionnaires were conducted prior to chemotherapy, prior to cycle four, after cycle six, and six months after completion of primary therapy. RESULTS: Two-hundred-thirty-one evaluable patients entered this study between May 2010 and October 2011. At the cycle 4 time point, 25.2% (55/218) of patients exhibited cognitive impairment in at least one domain. At the post-cycle 6 and 6-month follow up time points, 21.1% (44/208) and 17.8% (30/169) of patients, respectively, demonstrated impairment in at least one domain of cognitive function. There were statistically significant, but clinically small, improvements in processing speed (p<0.001) and attention (p<0.001) but not in motor response time (p=0.066), from baseline through the six-month follow up time period. CONCLUSIONS: This was a large, prospective study designed to measure cognitive function in ovarian cancer. A subset of patients had evidence of cognitive decline from baseline during chemotherapy treatment in this study as measured by the web-based assessment; however, changes were generally limited to no more than one domain.


Subject(s)
Antineoplastic Agents/adverse effects , Cognition Disorders/chemically induced , Cognition/drug effects , Fallopian Tube Neoplasms/drug therapy , Ovarian Neoplasms/drug therapy , Peritoneal Neoplasms/drug therapy , Adult , Aged , Attention/drug effects , Female , Humans , Longitudinal Studies , Middle Aged , Ovarian Neoplasms/psychology , Prospective Studies , Quality of Life , Reaction Time/drug effects , Surveys and Questionnaires , Time Factors
2.
Gynecol Oncol ; 133(1): 11-5, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24680585

ABSTRACT

OBJECTIVE: There is a lack of reliable indicators to predict who will benefit most from anti-angiogenic therapy, such as bevacizumab. Recognizing obesity is associated with increased levels of VEGF, the main target of bevacizumab, we sought to assess if adiposity, measured in terms of BMI, subcutaneous fat area (SFA), and visceral fat area (VFA) was prognostic. METHODS: Reviewed 46 patients with advanced EOC who received primary treatment with bevacizumab-based chemotherapy (N=21) or chemotherapy alone (N=25) for whom complete records, CT prior to the first cycle of chemo, and serum were available. CT was used to measure SFA and VFA by radiologists blinded to outcomes. ELISA was used to measure serum levels of VEGF and angiopoietin-2 in the bevacizumab group. RESULTS: BMI, SFA, and VFA were dichotomized using the median and categorized as "high" or "low". In the bevacizumab group median PFS was shorter for patients with high BMI (9.8 vs. 24.7months, p=0.03), while in the chemotherapy group median PFS was similar between high and low BMI (17.6 vs. 11.9months, p=0.19). In the bevacizumab group patients with a high BMI had higher median levels of VEGF and angiopoietin-2, 371.9 vs. 191.4pg/ml (p=0.05) and 45.9 vs. 16.6pg/ml (p=0.09) respectively. On multivariate analysis neither BMI, SFA, nor VFA were associated with PFS (p=0.13, p=0.86, p=0.16 respectively) or OS (p=0.14, p=0.93, p=0.28 respectively) in the chemotherapy group. However, in the bevacizumab group BMI was significantly associated with PFS (p=0.02); accounting for confounders adjusted HR for high vs. low BMI was 5.16 (95% CI 1.31-20.24). Additionally in the bevacizumab group SFA was significantly associated with OS (p=0.03); accounting for confounders adjusted HR for high vs. low SFA was 3.58 (95% CI 1.12-11.43). CONCLUSION: Results provide the first evidence in EOC that patients with high levels of adiposity may not derive benefit from bevacizumab and that measurements of adiposity are likely to be a useful biomarker.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Intra-Abdominal Fat/diagnostic imaging , Neoplasms, Glandular and Epithelial/drug therapy , Obesity/complications , Ovarian Neoplasms/drug therapy , Subcutaneous Fat/diagnostic imaging , Adiposity , Bevacizumab , Body Mass Index , Carboplatin/administration & dosage , Carcinoma, Ovarian Epithelial , Female , Humans , Middle Aged , Multivariate Analysis , Neoplasms, Glandular and Epithelial/blood , Neoplasms, Glandular and Epithelial/complications , Obesity/blood , Ovarian Neoplasms/blood , Ovarian Neoplasms/complications , Overweight/blood , Overweight/complications , Paclitaxel/administration & dosage , Pilot Projects , Prognosis , Proportional Hazards Models , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Vascular Endothelial Growth Factor A/blood
3.
Clin Linguist Phon ; 22(8): 589-609, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18770094

ABSTRACT

The current article describes the results, inter-scorer reliability, and potential sources of bias in conducting speech-language assessments with Aboriginal children in remote Ontario communities using videoconferencing. A main focus of this pilot study was to examine scoring bias, an issue that might arise with videoconferencing for any population but that could potentially interact with test and cultural bias to negatively affect the diagnosis of Aboriginal children. Assessments were administered by a remote-site speech-language pathologist (SLP), while an on-site SLP served as an assistant. Responses were scored simultaneously by both SLPs and the results and their degree of correspondence were compared. Percentage agreement ranged from 96-100% for language tests and from 66-100% for the articulation measure. Results suggest that videoconferencing can be an effective complement to service provision when procedures are organized so as to minimize bias in test administration and in the interpretation of test performance.


Subject(s)
Communication Disorders/epidemiology , Population Groups , Telecommunications , Child , Communication Disorders/diagnosis , Culture , Humans , Language Tests , Pilot Projects , Residence Characteristics
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