Provider Involvement in Care During Initial Cancer Treatment and Patient Preferences for Provider Roles After Initial Treatment.

PURPOSE: Patients report strong preferences regarding which provider-oncologist or primary care provider (PCP)-handles their primary care after initial cancer treatment (eg, other cancer screenings, preventive care, comorbidity management). Little is known about associations between provider involvement during initial cancer treatment and patient preferences for provider roles after initial treatment. METHODS: Women who received a diagnosis of early-stage breast cancer in 2014 to 2015 were identified from the Georgia and Los Angeles County SEER registries and surveyed (N = 2,502; 68% response rate). Women reported the level of their providers' involvement in their care during initial cancer treatment. Associations between level of medical oncologist's participation and PCP's engagement during initial cancer treatment and patient preferences for oncologist led ( v PCP led) other cancer screenings after initial treatment were examined using multivariable logistic regression models. RESULTS: During their initial cancer treatment, 20% of women reported medical oncologists participated substantially in delivering primary care and 66% reported PCPs were highly engaged in their cancer care. Two-thirds (66%) of women preferred medical oncologists to handle other cancer screenings after initial treatment. Women who reported substantial medical oncologist participation in primary care were more likely (adjusted odds ratio, 1.42; 95% CI, 1.05 to 1.91) and those who reported high PCP engagement in cancer care were less likely (adjusted odds ratio, 0.41; 95% CI, 0.31 to 0.53) to prefer oncologist-led other cancer screenings after initial treatment. CONCLUSIONS: Providers' involvement during initial cancer treatment may affect patient preferences regarding provision of follow-up primary care. Clarifying provider roles as early as during cancer treatment may help to better delineate their roles throughout survivorship.

Review and Comparison of Computational Approaches for Joint Longitudinal and Time-to-Event Models.

Joint models for longitudinal and time-to-event data are useful in situations where an association exists between a longitudinal marker and an event time. These models are typically complicated due to the presence of shared random effects and multiple submodels. As a consequence, software implementation is warranted that is not prohibitively time consuming. While methodological research in this area continues, several statistical software procedures exist to assist in the fitting of some joint models. We review the available implementation for frequentist and Bayesian models in the statistical programming languages R, SAS, and Stata. A description of each procedure is given including estimation techniques, input and data requirements, available options for customization, and some available extensions, such as competing risks models. The software implementations are compared and contrasted through extensive simulation, highlighting their strengths and weaknesses. Data from an ongoing trial on adrenal cancer patients is used to study different nuances of software fitting on a practical example.

Patient Preferences for Primary Care Provider Roles in Breast Cancer Survivorship Care.

Purpose Prior studies have suggested a need for greater clarity about provider roles in team-based cancer care; however, little is known about patients' preferences regarding which providers handle their care needs after primary cancer treatment. Methods We surveyed women with newly diagnosed stages 0 to II breast cancer who were treated in 2014 and 2015 as reported to the Georgia and Los Angeles SEER registries (N = 2,372; 68% response rate). Patient preferences regarding which provider handles the following care needs after treatment were ascertained: follow-up mammograms, screening for other cancers, general preventive care, and comorbidity management. Associations between patient demographic factors with preferences for provider roles-oncology-directed care versus primary care provider (PCP)-directed care-were assessed by using multivariable logistic regression. Results The majority of women preferred that their PCPs handle general preventive care (79%) and comorbidity care (84%), but a notable minority of women preferred that their oncologists direct this care (21% and 16%, respectively). Minority women-black and Asian versus white-and women with a high school education or less-versus undergraduate college education or more-displayed greater odds of preferring oncology-directed care-versus PCP-directed care-for their general preventive care (black odds ratio [OR], 2.01; 95% CI, 1.43 to 2.82; Asian OR, 1.74; 95% CI, 1.13 to 2.69; high school education or less OR, 1.51; 95% CI, 1.10 to 2.08). Similar variations existed for comorbidity care. Conclusion In this sample, minority women and those with less education more often preferred that oncologists direct certain aspects of their care after breast cancer treatment that are normally delivered by a PCP. Efforts to clarify provider roles in survivorship care to patients may be effective in improving team-based cancer care.

A biobehavioural model of the night eating syndrome.

This paper will propose a biobehavioral mechanism for the Night Eating Syndrome (NES), a disorder characterized by a delayed circadian rhythm of food intake and neuroendocrine function. Food intake consists of at least 25% of daily caloric intake after the evening meal and/or at least two nighttime awakenings with ingestions per week. This will be explored by reviewing neuroimaging of brain serotonin transporters (SERT) and treatment with selective serotonin reuptake inhibitors (SSRIs). SERT binding is elevated in the midbrain of night eaters, causing dysregulation of the circadian rhythm of both food intake and neuroendocrine function. The administration of SSRIs blocks the reuptake of serotonin and restores the circadian rhythm of both food intake and neuroendocrine function. This hypothesis implies that reduction of SERT activity should increase postsynaptic serotonin transmission and relieve NES. This is precisely the effect of SSRIs. NES is a function of elevated SERT, and blocking of SERT with an SSRI resolves NES. This model of NES attests to the validity of the diagnosis of NES and the criteria by which it is identified, and it provides an explanation of the mechanism.

Differences in serotonin transporter binding affinity in patients with major depressive disorder and night eating syndrome.

OBJECTIVE: We examined serotonin transporter (SERT) binding affinity using single photon emission computed tomography (SPECT) in patients with major depressive disorder (MDD) and night eating syndrome (NES). There are similarities between MDD and NES in affective symptoms, appetite disturbance, nighttime awakenings, and, particularly, response to selective serotonin reuptake inhibitors (SSRIs). METHODS: Six non-depressed patients with NES and seven patients with MDD underwent SPECT brain imaging with 123I-ADAM, a radiopharmaceutical agent selective for SERT sites. Uptake ratios of 123I-ADAM SERT binding were obtained for the midbrain, basal ganglia, and temporal lobe regions compared to the cerebellum reference region. RESULTS: Patients with NES had significantly greater SERT uptake ratios (effect size range 0.64-0.84) in the midbrain, right temporal lobe, and left temporal lobe regions than those with MDD whom we had previously studied. CONCLUSIONS: Pathophysiological differences in SERT uptake between patients with NES and MDD suggest these are distinct clinical syndromes.

Psychopathology and treatment of night eating syndrome: a review.

The article reviews the international literature about psychopathological aspects and treatments of Night Eating Syndrome (NES). Studies were found using Medline; data from recent international books and conferences about ED are included, but single case descriptions are not included in the study. NES seems to be consistently related to mood disorders and anxiety. There is a low overlap between other eating disorders, including binge eating disorder (BED), and NES. The relationship between the syndrome and substance abuse is unclear and needs further study. Sleep architecture seems not to be severely altered among those with NES. A limited number of treatment studies for NES have been published or presented. Most of the literature focuses on pharmacological treatment, with fewer psychotherapeutic approaches reported at this time. Larger, multi-site treatment studies would serve to confirm the findings of this first wave of clinical trials.

Induction of IL-5 receptors on normal B cells by cross-linking surface Ig with anti-Ig-dextran.

Regulation of IL-5R expression in normal, non-Ly-1 (CD5) B cells was evaluated. Freshly isolated unfractionated spleen B cells express little or no detectable IL-5R. In contrast, B cells stimulated with anti-Ig-dextran conjugates express substantial numbers of IL-5R. Phenotypic analysis of the B cells responding to anti-Ig-dextran, and expressing IL-5R, demonstrates that these cells do not express Ly-1 or Mac-1. Scatchard analysis of B cells stimulated with anti-IgD-dextran reveals two classes of IL-5R: a high affinity receptor with a Kd of 17 pM and approximately 300 receptors/cell, and a low affinity receptor with a Kd of 0.6 nM and approximately 1000 receptors/cell. Peak receptor expression in response to anti-IgD-dextran is seen 72 h after stimulation and with a dose of 10 ng/ml. The induced receptors are functional, because both proliferation and Ig secretion by B cells treated with anti-IgD-dextran are enhanced by IL-5. Other B cell mitogens such as LPS, soluble anti-Ig/IL-4, or phorbol esters/ionomycin are poor inducers of the IL-5R. Finally, not only does LPS fail to induce significant IL-5R expression on spleen B cells, it suppresses both high and low affinity IL-5R expression induced by anti-IgD-dextran. These data indicate that normal, non-Ly-1 B cells are capable of expressing both high and low affinity IL-5R but that receptor expression is critically dependent on the type of stimulus provided to the B cell. A stimulus that produces extensive cross-linking of surface Ig on B cells, i.e., anti-Ig-dextran, is very effective in inducing IL-5R whereas a variety of other B cell mitogens are ineffective.

High-level production of murine interleukin-5 (IL-5) utilizing recombinant baculovirus expression. Purification of the rIL-5 and its use in assessing the biologic role of IL-5 glycosylation.

We describe here a recombinant baculovirus expression system useful for high level production of murine recombinant interleukin-5 (rIL-5). In addition, we describe a single-step technique of purification of the rIL-5 from the baculovirus-infected Sf9 cell supernatants, using an anti-IL-5 affinity column. The baculovirus-derived rIL-5 has physical properties and functional activities in various lymphoid cell assays similar to those of natural T cell-derived IL-5 and reacts with anti-IL-5 antibodies. Finally, the rIL-5 is similar to natural T cell-derived IL-5 in manifesting heterogeneous glycosylation; however, glycosylation does not appear to be necessary for biologic function, at least in a lymphoid cell proliferation assay.

Expression of IL-5 receptors on B cells: role in mucosal B cell responses.

IL-5 plays an important role in mucosal B cell responses. An in vitro model of IgA B cell differentiation, CH12LX, has been used to demonstrate that IL-5R are expressed on both IgM+ and IgA+ B cells and that IL-5 will enhance secretion of both IgM and IgA by CH12LX B cells, depending on the surface isotype of individual cells. Further, the enhanced secretion of Ig in response to IL-5 is associated with increased steady-state levels of Ig mRNA. Finally, normal Peyer's patch B cells are also capable of expressing IL-5R in response to appropriate stimuli (i.e. anti-IgM- or anti-IgD-dextran). Thus, mucosal B cell responses to IL-5 are brought about by interaction of IL-5 with specific receptors expressed on the surface of those cells.

Memory for noun pairs in the same or different underlying strings.

A number of studies have shown that children learn noun pairs faster when they have been presented in a noun-verb-noun context than when they are presented in a noun-conjunction-noun context. Suzuki and Rohwer (1969) hypothesized that the underlying strings of sentences correspond to memory units, making it easier to recall two nouns from the same underlying string than from two different underlying strings. They reported that data from fifth graders supported this hypothesis but that data from college students did not. The experiments reported here were done to determine whether the hypothesis would be supported (a) if the test rate were faster than that used by Suzuki and Rohwer or (b) if sentences longer and more complex than those used by them were employed. The recall data accorded with some predictions derived from the hypothesis. However, data from Ss' posttraining reports on how they learned the pairs suggest that Ss, particularly adults, often made up their own strings rather than using those provided, and raise the question of the adequacy of Suzuki and Rohwer's procedure for testing this hypothesis, particularly in adults.