Angels Camp, CA, United States
Angels Camp, CA, United States

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Lai L.,City of Hope Medical Center | Hurria A.,City of Hope Medical Center
Journal of Cancer Survivorship | Year: 2014

Background: The co-occurrence of multiple chronic conditions in cancer patients is common and can have negative impact on cancer and cancer survivorship outcomes. This study aimed to document comorbidity occurrence among African-American and Latina (English language preferred (ELP) and Spanish language preferred (SLP)) breast cancer survivors (BCS). Methods: Eighty-eight African-American, 95 ELP Latina, and 137 SLP Latina BCS were recruited via case ascertainment from the California Cancer Registry and hospital registries. BCS completed a self-report questionnaire assessing demographic and cancer characteristics, and presence of comorbidities. Results: Overall, 75 % of BCS reported at least one comorbidity with arthritis (37 %), high blood pressure (37 %), psychological difficulties (29 %), and diabetes (19 %) being most commonly endorsed. SLP Latinas were more likely to report diabetes (29 %), psychological difficulties (42 %), and >3 comorbidities (p < 0.05). Latina BCS were twice as likely to report osteoporosis and headaches compared to African-Americans; while one in two African-Americans reported hypertension and arthritis. Older age was correlated with arthritis, diabetes, glaucoma, high blood pressure, and osteoporosis. Conclusions: Our findings suggest that investigating the occurrence of comorbidities across ethnic groups may shed some light in understanding cancer survivorship risk for poor health outcomes and health disparities. Having a better grasp of comorbid conditions may aid in more appropriate early assessment, better follow-up care, surveillance, and management of the cancer and the comorbid condition(s). Implications for Cancer Survivors: Integrated control and management of comorbidities among cancer survivors has the potential to improve quality care for the whole person, and increase survival and decrease morbidity. © 2014 Springer Science+Business Media New York.


Fenton J.J.,University of California | Xing G.,University of California | Elmore J.G.,University of Washington | Bang H.,University of California at Davis | And 3 more authors.
Annals of Internal Medicine | Year: 2013

Background: Computer-aided detection (CAD) has rapidly diffused into screening mammography practice despite limited and conflict-ing data on its clinical effect. Objective: To determine associations between CAD use during screening mammography and the incidence of ductal carcinoma in situ (DCIS) and invasive breast cancer, invasive cancer stage, and diagnostic testing. Design: Retrospective cohort study. Setting: Medicare program. Participants: Women aged 67 to 89 years having screening mam-mography between 2001 and 2006 in U.S. SEER (Surveillance, Epidemiology and End Results) regions (409 459 mammograms from 163 099 women). Measurements: Incident DCIS and invasive breast cancer within 1 year after mammography, invasive cancer stage, and diagnostic testing within 90 days after screening among women without breast cancer. Results: From 2001 to 2006, CAD prevalence increased from 3.6% to 60.5%. Use of CAD was associated with greater DCIS incidence (adjusted odds ratio [OR], 1.17 [95% CI, 1.11 to 1.23]) but no difference in invasive breast cancer incidence (adjusted OR, 1.00 [CI, 0.97 to 1.03]). Among women with invasive cancer, CAD was associated with greater likelihood of stage I to II versus III to IV cancer (adjusted OR, 1.27 [CI, 1.14 to 1.41]). In women without breast cancer, CAD was associated with increased odds of diagnos-tic mammography (adjusted OR, 1.28 [CI, 1.27 to 1.29]), breast ultrasonography (adjusted OR, 1.07 [CI, 1.06 to 1.09]), and breast biopsy (adjusted OR, 1.10 [CI, 1.08 to 1.12]). Limitation: Short follow-up for cancer stage, potential unmeasured confounding, and uncertain generalizability to younger women. Conclusion: Use of CAD during screening mammography among Medicare enrollees is associated with increased DCIS incidence, the diagnosis of invasive breast cancer at earlier stages, and increased diagnostic testing among women without breast cancer. © 2013 American College of Physicians.


Inghirami G.,University of Turin | Inghirami G.,New York University | Inghirami G.,New York Medical College | Chan W.C.,City of Hope Medical Center | Pileri S.,University of Bologna
Immunological Reviews | Year: 2015

Summary: T-cell lymphoproliferative disorders are a heterogeneous group of neoplasms with distinct clinical-biological properties. The normal cellular counterpart of these processes has been postulated based on functional and immunophenotypic analyses. However, T lymphocytes have been proven to be remarkably capable of modulating their properties, adapting their function in relationship with multiple stimuli and to the microenvironment. This impressive plasticity is determined by the equilibrium among a pool of transcription factors and by DNA chromatin regulators. It is now proven that the acquisition of specific genomic defects leads to the enforcement/activation of distinct pathways, which ultimately alter the preferential activation of defined regulators, forcing the neoplastic cells to acquire features and phenotypes distant from their original fate. Thus, dissecting the landscape of the genetic defects and their functional consequences in T-cell neoplasms is critical not only to pinpoint the origin of these tumors but also to define innovative mechanisms to re-adjust an unbalanced state to which the tumor cells have become addicted and make them vulnerable to therapies and targetable by the immune system. In our review, we briefly describe the pathological and clinical aspects of the T-cell lymphoma subtypes as well as NK-cell lymphomas and then focus on the current understanding of their pathogenesis and the implications on diagnosis and treatment. © 2015 John Wiley & Sons A/S.


Raz D.J.,City of Hope Medical Center | Nelson R.A.,City of Hope Medical Center | Grannis F.W.,City of Hope Medical Center | Kim J.Y.,City of Hope Medical Center
Chest | Year: 2015

Background: The natural history of typical pulmonary carcinoid tumors has not been described and has important implications for counselingelderly patients or patients with high operative-risk about surgical resection. Methods: Data from the Surveillance, Epidemiology, and End Results Program were used to identify 4,111 patients with biopsy specimen-proven lymph node-negative typical carcinoid tumor of the lung between 1988 and 2010; 306 had no resection, 929 underwent sublobar resection, and 2,876 underwent lobectomy. Overall survival and disease-specific survival (DSS) were analyzed using Kaplan-Meier plots. Multivariate analysis was used to determine predictors of survival. Results: Five-year overall survival in patients who underwent lobectomy, sublobar resection, or no surgery was 93%, 92%, and 69%, respectively (P <.0001); 5-year DSS was 97%, 98%, and 88%, respectively (P <.0001). Among T1 tumors, DSS was 98% for patients who underwent lobectomy and sublobar resection and 92% for no surgery; among T2 tumors, DSS was 97%, 100%, and 87%, respectively, and among T3 and T4 tumors, it was 96%, 100%, and 75%, respectively. On multivariate analysis, nonoperative management was associated with an increased risk for disease-specific mortality compared with lobectomy (hazard ratio, 2.14; 95% CI, 1.35-3.40; P =.0013). Conclusions: In this population-based cohort, surgical resection of lymph node-negative carcinoid tumors is associated with a survival advantage over nonoperative treatment. However, the DSS at 5 years was still high without any treatment, suggesting that observation of asymptomatic peripheral typical carcinoid tumors orendoscopic management of symptomatic central carcinoid tumors may be considered in patients at high risk for surgical resection. © 2015 AMERICAN COLLEGE OF CHEST PHYSICIANS.


Groot Koerkamp B.,Rotterdam University | Fong Y.,City of Hope Medical Center
Journal of Surgical Oncology | Year: 2014

The biliary malignancies that are reviewed here are gallbladder cancer (GBC), intrahepatic cholangiocarcinoma (IHC), and perihilar cholangiocarcinoma (PHC). The focus is on outcomes after potentially curative resection of biliary malignancies. Key outcomes are postoperative mortality, median and 5-year overall survival (OS), recurrence-free survival, and recurrence patterns. Poor prognostic factors for recurrence and survival as well as prognostic models are also discussed. The incidence of biliary malignancies in the United States is about 5 in 100,000. Postoperative mortality for resection of GBC and IHC is similar to that of liver resections for other indications. However, 90 day postoperative mortality after liver resection for PHC is about 10%. For GBC, median OS depends strongly on the T-stage and ranges from 8 months (pT3) to 79 months (pT1b). Median OS after resection for IHC is about 30 months, and for PHC about 38 months. The majority of patients with biliary malignancies develop a recurrence after resection. Patients with GBC recur early with a median time to recurrence of 12 months, versus about 20 months for IHC and PHC. In patients with resected IHC or PHC locoregional recurrence was the only site of recurrence in about 60% of patients, versus 15% in patients with GBC. Poor prognostic factors after resection of all biliary malignancies include the presence of lymph node metastasis, a positive surgical resection margin, and moderate or poor tumor differentiation. Several prognostic nomograms have been developed to predict long-term outcomes of biliary cancer resection. © 2014 Wiley Periodicals, Inc.


Pullarkat V.,City of Hope Medical Center
Advances in Hematology | Year: 2010

Recipients of hematopoietic stem cell transplantation (HSCT) frequently have iron overload resulting from chronic transfusion therapy for anemia. In some cases, for example, in patients with myelodysplastic syndromes and thalassemia, this can be further exacerbated by increased absorption of iron from the gut as a result of ineffective erythropoiesis. Accumulating evidence has established the negative impact of elevated pretransplantation serum ferritin, a surrogate marker of iron overload, on overall survival and nonrelapse mortality after HSCT. Complications of HSCT associated with iron overload include increased bacterial and fungal infections as well as sinusoidal obstruction syndrome and possibly other regimen-related toxicities. Based on current evidence, particular attention should be paid to prevention and management of iron overload in allogeneic HSCT candidates, especially in patients with thalassemia and myelodysplastic syndromes. The pathophysiology of iron overload in the HSCT patient and optimum strategies to deal with iron overload during and after HSCT require further study. © 2010 Vinod Pullarkat.


Ferrell B.,City of Hope Medical Center
Nursing Science Quarterly | Year: 2010

The focus of this column is to describe a body of research on palliative care and end-of-life that has been the focus of Dr. Betty Ferrell's career and her work at the City of Hope. The impact of this work on the nursing workforce is described and research resources for nurses are included. © The Author(s) 2010.


Glackin C.A.,City of Hope Medical Center
Maturitas | Year: 2014

Breast cancer is the leading cause of cancer-related deaths in the United States with over 232,000 new diagnoses expected in 2014 and almost 40,000 deaths. While treatment of primary breast cancer is often well-managed with surgery and radiation, metastatic breast cancer (MBC) that has spread to the brain, bones, liver, and lungs is often incurable. One of the major challenges in the treatment of breast cancer is the presence of a subpopulation of cancer cells that are chemoresistant and metastatic. Given that metastasis is the driving force behind mortality for breast cancer patients, it is essential to identify the characteristics of these aberrant cancer cells that allow them to spread to distant sites in the body and develop into metastatic tumors. Understanding the metastatic mechanisms driving cancer cell dispersal will open the door to developing novel therapies that prevent metastasis and improve long-term outcomes for patients. In this review we assess the feasibility of targeting the Twist and Wnt signaling pathways in breast cancer. These pathways mediate epithelial-mesenchymal transition (EMT), a process that can give rise to chemoresistance. We review potential treatment strategies for targeting EMT and drug resistance as well as the problems that may arise with these targeted delivery therapeutic approaches. Finally, we examine recent advances in the field, including nanoparticle delivery and small interfering RNA (siRNA) technology, and discuss the impact that these approaches may have on translating much needed therapeutic approaches into the clinic, for the benefit of patients battling MBC. © 2014 Elsevier Ireland Ltd.


Patent
California Institute of Technology and City Of Hope Medical Center | Date: 2012-11-17

Embodiments in accordance with the present invention relate to packed-column nano-liquid chromatography (nano-LC) systems integrated on-chip, and methods for producing and using same. The microfabricated chip includes a column, flits/filters, an injector, and a detector, fabricated in a process compatible with those conventionally utilized to form integrated circuits. The column can be packed with supports for various different stationary phases to allow performance of different forms of nano-LC, including but not limited to reversed-phase, normal-phase, adsorption, size-exclusion, affinity, and ion chromatography. A cross-channel injector injects a nanolitre/picolitre-volume sample plug at the column inlet. An electrochemical/conductivity sensor integrated at the column outlet measures separation signals. A self-aligned channel-strengthening technique increases pressure rating of the microfluidic system, allowing it to withstand the high pressure normally used in high performance liquid chromatography (HPLC). On-chip sample injection, separation, and detection of mixture of anions in water is successfully demonstrated using ion-exchange nano-LC.


Pullarkat V.,City of Hope Medical Center | Aldoss I.,City of Hope Medical Center
Critical Reviews in Oncology/Hematology | Year: 2015

Early assessment of disease response to induction chemotherapy is important in acute myeloid leukemia (AML) in order to plan future therapy and identify chemorefractory disease. Such assessment is customarily performed by examining the bone marrow at around day 14 after initiation of chemotherapy. However, criteria for assessment of residual leukemia in day 14 bone marrow specimens as well as the significance of partial response on long term outcomes remain unclear. Clinical practices vary regarding the therapeutic intervention for residual disease and include readministration of the original induction therapy or use of a different reinduction regimen. In this article, we critically examine the prognostic significance of residual disease detected on interim bone marrow examination as well as data on reinduction therapy with the original induction regimen versus an alternate regimen. We emphasize the need for standardizing reporting of interim bone marrow assessment as well as evaluating new technologies and biomarkers for early assessment of disease response and chemosensitivity in AML. © 2015 Elsevier Ireland Ltd.

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