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Croft L.,University of Maryland, Baltimore | Sorkin J.,University of Maryland Baltimore County | Gallicchio L.,University of Maryland, Baltimore | Gallicchio L.,The Prevention and Research Center
Supportive Care in Cancer | Year: 2014

Purpose: There are an increasing number of breast cancer survivors, but their psychosocial and supportive care needs are not well-understood. Recent work has found marital status, social support, and optimism to be associated with quality of life, but little research has been conducted to understand how these factors relate to one another.Methods: Survey data from 722 breast cancer survivors were analyzed to estimate the association between marital status and optimism score, as measured using the Life Orientation Test-Revised. Linear regression was used to estimate the relationship of marital status and optimism, controlling for potential confounding variables and assessing effect modification.Results: The results showed that the association between marital status and optimism was modified by time since breast cancer diagnosis. Specifically, in those most recently diagnosed (within 5 years), married breast cancer survivors had a 1.50 higher mean optimism score than unmarried survivors (95 % confidence interval (CI) 0.37, 2.62; p = 0.009). The difference in optimism score by marital status was not present more than 5 years from breast cancer diagnosis.Conclusions: Findings suggest that among breast cancer survivors within 5 years since diagnosis, those who are married have higher optimism scores than their unmarried counterparts; this association was not observed among longer-term breast cancer survivors. Future research should examine whether the difference in optimism score among this subgroup of breast cancer survivors is clinically relevant. © 2014, Springer-Verlag Berlin Heidelberg.

Olufade T.,The Prevention and Research Center | Gallicchio L.,The Prevention and Research Center | MacDonald R.,The Prevention and Research Center | Helzlsouer K.J.,The Prevention and Research Center
Supportive Care in Cancer | Year: 2014

Objective: This study aims to examine the associations between musculoskeletal pain and health-related quality of life (HR-QOL) among breast cancer patients on aromatase inhibitors (AIs) and women without a history of breast cancer.Methods: A cross-sectional study was conducted among 68 breast cancer patients on AIs for an average of 3.5 years and 137 postmenopausal women without a history of cancer. Musculoskeletal pain was assessed using a 10-cm visual analog scale; HR-QOL was examined using the Medical Outcomes Study Short Form (SF-36) health survey. Linear regression was used to estimate the associations between pain and HR-QOL in both groups.Results: Approximately 64 % of the breast cancer patients and women in the comparison group reported musculoskeletal pain. Among women with breast cancer, those with pain had significantly lower HR-QOL scores in the physical (52.2 vs. 42.6; p < 0.001) and mental (52.7 vs. 45.5; p = 0.01) component summary scores compared with those without pain. In the comparison group, pain was associated with significantly lower scores in the physical (55.4 vs. 46.0; p < 0.001), but not the mental, component summary score (52.1 vs. 52.4; p = 0.82). The significant associations between pain and HR-QOL persisted after confounder adjustment in both groups. Among women with similar severity of pain, breast cancer patients reported significantly lower HR-QOL in the mental summary component compared with the women in the comparison group.Conclusions: Among breast cancer patients, musculoskeletal pain adversely affects both mental and physical components of HR-QOL. Preventing or treating AI-associated musculoskeletal pain may improve overall HR-QOL among breast cancer patients treated with AIs. © 2014, Springer-Verlag Berlin Heidelberg.

PubMed | Hokkaido University, University of Occupational and Environmental Health Japan, Kyoto Prefectural University of Medicine, Victoria University of Melbourne and 24 more.
Type: Journal Article | Journal: Cancer research | Year: 2016

The role of insulin-like growth factors (IGF) in prostate cancer development is not fully understood. To investigate the association between circulating concentrations of IGFs (IGF-I, IGF-II, IGFBP-1, IGFBP-2, and IGFBP-3) and prostate cancer risk, we pooled individual participant data from 17 prospective and two cross-sectional studies, including up to 10,554 prostate cancer cases and 13,618 control participants. Conditional logistic regression was used to estimate the ORs for prostate cancer based on the study-specific fifth of each analyte. Overall, IGF-I, IGF-II, IGFBP-2, and IGFBP-3 concentrations were positively associated with prostate cancer risk (Ptrend all 0.005), and IGFBP-1 was inversely associated weakly with risk (Ptrend = 0.05). However, heterogeneity between the prospective and cross-sectional studies was evident (Pheterogeneity = 0.03), unless the analyses were restricted to prospective studies (with the exception of IGF-II, Pheterogeneity = 0.02). For prospective studies, the OR for men in the highest versus the lowest fifth of each analyte was 1.29 (95% confidence interval, 1.16-1.43) for IGF-I, 0.81 (0.68-0.96) for IGFBP-1, and 1.25 (1.12-1.40) for IGFBP-3. These associations did not differ significantly by time-to-diagnosis or tumor stage or grade. After mutual adjustment for each of the other analytes, only IGF-I remained associated with risk. Our collaborative study represents the largest pooled analysis of the relationship between prostate cancer risk and circulating concentrations of IGF-I, providing strong evidence that IGF-I is highly likely to be involved in prostate cancer development. Cancer Res; 76(8); 2288-300. 2016 AACR.

Warren J.W.,University of Maryland Baltimore County | Morozov V.,University of Maryland Baltimore County | Howard F.M.,University of Rochester | Wesselmann U.,University of Alabama | And 4 more authors.
Journal of Psychosomatic Research | Year: 2014

Objective: Certain functional somatic syndromes (FSSs) such as fibromyalgia and irritable bowel syndrome are accompanied by diffuse pain amplification. Women with interstitial cystitis/bladder pain syndrome (IC/BPS) have numerous FSSs, as well as other non-bladder syndromes (NBSs) that are linked to the FSSs. They also report multiple surgeries. Since pain is a common indication for surgery, we tested the hypothesis that NBSs were associated with surgeries. Methods: We interviewed 312 incident IC/BPS cases and controls on NBSs and number of surgeries before the index date (for cases, IC/BPS onset date). Poisson and logistic regression analyses adjusted for age, race, educational level, and menopause. Results: Number of surgeries increased with number of NBSs in both cases and controls whether chronic pelvic pain (CPP), the only NBS generally accepted as an indication for surgery, was present or not. Logistic regression analysis showed that among cases CPP was the only individual NBS associated with a history of multiple surgeries, and then only modestly [odds ratio (OR) 1.9, confidence intervals (CI) 1.06, 3.2]. By far the strongest association was the number of NBSs. The OR for multiple surgeries increased with number of NBSs: for cases with 4-5 NBSs the OR was 14.1 (1.8, 113) and with 6-9 NBSs, 33.1 (3.9, 279). Controls had fewer syndromes and fewer surgeries and this linkage was less prominent. Conclusion: Among IC/BPS cases, the number of NBSs was strongly correlated with the number of surgeries. Understanding temporal relationships will be necessary to explore causal linkages and may modify surgical practice. © 2013 Elsevier Inc.

Crawford G.B.,University of Maryland, Baltimore | Khedkar A.,University of Maryland, Baltimore | Flaws J.A.,Urbana University | Sorkin J.D.,University of Maryland, Baltimore | Gallicchio L.,The Prevention and Research Center
Preventive Medicine | Year: 2011

Objective: To examine the association between depressive symptoms and fast-food intake in midlife women. Methods: Data were analyzed from a cross-sectional study of 626 women aged 45-54. years conducted from 2000 to 2004 in Baltimore, Maryland. The presence of depressive symptoms was measured using the Center for Epidemiologic Studies - Depression scale and defined as a score of 16 or greater. The frequency of fast-food intake was assessed using self-reported questionnaire data, and was categorized as "at least weekly", "at least monthly, but less than weekly" and "less than monthly". Results: Approximately 25% of the study sample reported depressive symptoms; 14% consumed fast-food "at least weekly," and 27% "at least monthly, but less than weekly". Compared to their counterparts, women with depressive symptoms had significantly greater odds of reporting higher fast-food intake (confounder-adjusted odds ratio: 1.54; 95% confidence interval: 1.06-2.25). Other covariates associated with a higher frequency of fast-food intake included black race and body mass index ≥30kg/m2. Conclusions: Findings from this study indicate that the presence of depressive symptoms is positively associated with fast-food intake in midlife women. These results may have important health implications given that both depression and dietary consumption patterns are risk factors for a number of diseases. © 2011 Elsevier Inc.

Helzlsouer K.J.,The Prevention and Research Center | Helzlsouer K.J.,Johns Hopkins University | Gallicchio L.,The Prevention and Research Center | Gallicchio L.,Johns Hopkins University | Gallicchio L.,University of Maryland, Baltimore
Anti-Cancer Agents in Medicinal Chemistry | Year: 2013

Cancer is a broad term for many disparate diseases with different etiologies, commonly classified by affected organ site. This review summarizes the published evidence from prospective cohort studies examining the associations between vitamin D, measured as serum 25-hydroxyvitamin D (25OHD) concentrations, and the risk of rarer cancer sites including pancreatic, non-Hodgkin lymphoma, ovarian, endometrial, kidney, gastric and esophageal cancer. Overall, evidence from prospective cohort studies provides little support for a protective association between adequate or higher serum 25OHD concentrations and risk of these rarer cancer sites. Additionally, controversy persists concerning a potential increased risk of pancreatic cancer associated with serum 25OHD levels >100 nmol/L due to conflicting results reported by two large prospective pooling projects. © 2013 Bentham Science Publishers.

PubMed | The Prevention and Research Center, Johns Hopkins University and Illinois College
Type: Journal Article | Journal: PloS one | Year: 2016

To identify risk factors associated with the duration of hot flashes and the time of peak hot flash severity in mid-life women.A cohort of 647 women reporting hot flashes were followed for 1-7 years, with survey data and hormone measurements. Survival analysis determined the association of risk factors with the duration of hot flashes. Linear regression determined the association of risk factors with the time of peak severity. Final models were determined through stepwise model selection.Average hot flash duration was 2.5 years (range: 1-33), with peak severity on average at 2.96 years (range: 1-20). Duration of hot flashes was associated with race, education, menopause status, smoking history, BMI, alcohol consumption, leisure activity levels, and levels of estradiol and progesterone. In the final model, only race, alcohol consumption, leisure activity, and menopause were retained. White women had significantly shorter hot flash durations than non-white women. Women consuming at least 12 alcoholic drinks in the previous year had a significantly shorter duration of hot flashes with a smaller effect of hot flash duration on increasing in time to peak severity compared to those who consumed less than 12 alcoholic drinks in that year. Higher serum progesterone levels were associated with later peak severity if the duration of the hot flashes was less than 2 years and an earlier peak severity otherwise.These results suggest that some behaviors (such as moderate alcohol consumption) are associated with shorter durations of hot flashes, and that progesterone was associated with the dynamics of hot flash severity.

Ruble K.,Johns Hopkins University | George A.,Johns Hopkins Hospital | Gallicchio L.,The Prevention and Research Center | Gamaldo C.,Johns Hopkins University
Pediatric Blood and Cancer | Year: 2015

Background: Sleep disordered breathing (SDB) is emerging as a significant health condition for children. The purpose of this study is to evaluate SDB symptoms in childhood cancer survivors and identify associations with quality of life (QOL) and psychological symptoms. Procedure: A sample of 62 survivors aged 8-18 years were recruited during routine survivorship visits. All subjects and their parents completed questionnaires to evaluate sleep, QOL and psychological symptoms; scales included were: Pediatric Sleep Questionnaire, Sleep Disordered Breathing Subscale (PSQ-SDBS), Pediatric Quality of Life Inventory (PedsQL) and Depression Anxiety Stress Scale (DASS-21). Continuous data were used for all scales and a threshold score of >0.33 on the PSA-SDBS was used to identify risk of SDB. The relationships between measures of sleep and independent variables were examined using Pearson correlations and multiple linear regression models for significant associations. Results: Of the 62 subjects enrolled, underlying diagnoses included 29 leukemias, 30 solid tumors and 3 non-malignant diseases. Nineteen percent of subjects were identified as having SDB risk on the PSQ-SDBS. The lowest mean PedsQL subscale score for parent and child ratings were school QOL; Parent mean 73(±SD 19) and Child mean 71(±SD 20). The severity of SDB per the PSQ was significantly associated with reduced total and school QOL which remained significant after adjusting for stress. Conclusions: Symptoms suggestive of SDB are common in childhood cancer survivors with negative implications for overall quality of life and school performance. Pediatr Blood Cancer 2015;62:693-697. © 2015 Wiley Periodicals, Inc.

Gallicchio L.,The Prevention and Research Center | Miller S.R.,Johns Hopkins University | Zacur H.,Johns Hopkins University | Flaws J.A.,Urbana University
Maturitas | Year: 2010

Objectives: Recent epidemiological studies suggest that hot flashes may have a detrimental impact on the cardiovascular system. The purpose of this study was to examine the associations between hot flashes and blood pressure among women aged 45-54 years who had never used hormone therapy. Study design: Data were analyzed from 603 women who participated in the Midlife Health Study, a cross-sectional study conducted in the Baltimore Metropolitan region. Main outcome measures: All participants came to the clinic where systolic and diastolic blood pressures were measured, height and weight were assessed, and a questionnaire was administered that ascertained detailed data on history of hot flashes and participant demographics and health habits. Results: The data showed that 56.9% of the participants reported ever experiencing hot flashes. In the age-adjusted analyses, both systolic and diastolic blood pressures were significantly and positively associated with hot flashes. However, the estimates were markedly attenuated and not statistically significant after adjustment for age, race, smoking status, current alcohol use, body mass index, and use of an anti-hypertensive agent or a cholesterol-lowering medication. Similar results were observed for moderate or severe hot flashes, hot flashes experienced for one or more years, and hot flashes experienced within the previous 30 days. Conclusions: These findings indicate that hot flashes are not significantly associated with blood pressure during midlife. © 2009 Elsevier Ireland Ltd. All rights reserved.

Gallicchio L.,The Prevention and Research Center
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research | Year: 2012

The objectives of this study were to examine: (1) changes in bone formation (osteocalcin) and bone resorption (cross-linked N-telopeptides of bone type I collagen [NTXs]) markers, as well as calcium, phosphorus, and intact parathyroid hormone, over the first 6 months of aromatase inhibitor (AI) therapy among a cohort of breast cancer patients compared with a group of unexposed women without a history of cancer; and (2) whether bone marker changes were associated with musculoskeletal pain. Eligible breast cancer patients (n = 49) and postmenopausal women without a history of cancer (n = 117) were recruited and followed for 6 months. At baseline, 3 months, and 6 months, a questionnaire was administered to assess pain and medication use, and a blood sample was drawn. Results showed that, among the breast cancer patients, calcium concentrations decreased significantly (-7.8% change; p = 0.013) and concentrations of NTXs increased significantly from baseline to 6 months (9.6% change; p = 0.012). Changes were not observed for women in the comparison group. Statistically significant differences in percent change between the breast cancer patients and the women in the comparison group were observed for calcium at 6 months (-7.8% versus 0.0%; p = 0.025), phosphorus at 6 months (-5.1% versus 16.7%; p = 0.003), NTXs at 6 months (9.6% versus -0.7%; p = 0.017), and osteocalcin at 6 months (11.5% versus -3.6%; p = 0.016). No statistically significant associations were observed between bone turnover marker changes and musculoskeletal pain among the breast cancer patients, although baseline NTXs were higher among women with onset or increase in pain compared with those reporting no pain (p = 0.08). Findings from this study suggest that AIs cause changes in bone turnover during the first 6 months of treatment; however, these changes are not associated with musculoskeletal pain. Breast cancer patients initiating AI therapy should be assessed and monitored for fracture risk using known clinical risk factors, including bone density, and managed appropriately. Copyright © 2012 American Society for Bone and Mineral Research.

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