Citations

BACKGROUND Patients with myeloproliferative neoplasms (MPNs) experience a high persistence, prevalence, and severity of fatigue. There is currently only limited information regarding factors that contribute to fatigue in patients with MPNs. METHODS A 70‐item, Internet‐based survey regarding fatigue was developed by MPN investigators and patients/advocates and hosted by the Mayo Clinic Survey Research Center. RESULTS Fatigue was found to be prevalent and severe among international survey respondents (1788 respondents). Higher body mass index ( P <.001), current use of alcohol ( P <.001), and current tobacco use ( P = .0025) were found to be significantly associated with greater fatigue. Moderate/severe fatigue was present more frequently in those individuals who did not exercise compared with those who reported exercising at least once per week ( P <.001). Medical comorbidities found to be significantly associated with greater fatigue included restless leg syndrome ( P = .006), diabetes mellitus ( P = .045), fibromyalgia ( P < 0.001), chronic fatigue syndrome ( P = .006), and chronic kidney disease ( P = .02). Current use of antidepressants ( P <.001), antihistamines ( P = .0276), antianxiety medications ( P = .0357), and prescription pain medications ( P <.001) were found to be associated with worsened fatigue. Nearly 25% of respondents scored > 2 on the Patient Health Questionnaire, indicating a high probability of depression. Higher Brief Fatigue Inventory score, Myeloproliferative Neoplasm Total Symptom Score, and individual symptom items were all associated with a higher likelihood of depressive symptoms ( P <.0001). CONCLUSIONS The management of fatigue should be multifactorial, with a comprehensive assessment and treatment plan to address all modifiable fatigue etiologies. Patients with MPNs likely have a higher prevalence of mood disturbances compared with the general population, suggesting the need to assess and intervene in this domain. Cancer 2016;122:477–485. © 2015 American Cancer Society .

ABSTRACTBackgroundThe objective of this study was to investigate cardiovascular disease risk factor (cvRF) profiles and compare their trends over 17 years in patients with and without acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).HypothesisTime trends of cvRF are different between ACS and non‐ACS patients.MethodsThis study was a time‐trend analysis from 1994 to 2010 within the Mayo Clinic PCI registry. Outcome measures were incidence and prevalence of cvRF, including the Framingham Risk Score (FRS), at the time of admission for PCI.ResultsAge of non‐ACS patients was higher than that of ACS patients, and age distribution slightly shifted toward older age in both groups (P for trend <0.001). There was no difference in FRS between the 2 groups; however, 10‐year cardiovascular disease risk (%) remained higher in non‐ACS than in ACS patients, decreasing over time. Diastolic blood pressure and high‐density lipoprotein cholesterol were higher in non‐ACS patients, but total cholesterol and low‐density lipoprotein cholesterol were higher in ACS patients, with an improving trend over time. Prevalence of diabetes mellitus, hypertension, and history of hypercholesterolemia were higher in non‐ACS patients, increasing over time. Smoking did not change over time. Use of most medications increased over time in both groups.ConclusionsMost cvRFs and their time trends exhibited statistically significant differences between ACS and non‐ACS patients, except systolic blood pressure, body mass index, and history of myocardial infarction. A new risk‐factor profile assessment may be needed for stratification of PCI patients according to ACS and non‐ACS status. Clinical and public‐health interventions should consider different approaches to ACS and non‐ACS patients.

AbstractBackgroundFactors predicting locoregional relapse after surgery for oropharyngeal squamous cell carcinoma (SCC) were identified in the pre‐human papillomavirus (HPV) era. We examined whether traditional indications for adjuvant radiotherapy (RT) or adjuvant chemoradiotherapy (CRT) still correlate with locoregional relapse in HPV‐positive patients after transoral robotic surgery (TORS).MethodsRetrospective review of oropharyngeal SCC cases identified patients with HPV‐positive tumors who did not receive adjuvant therapy after TORS despite intermediate or high‐risk features.ResultsMedian follow‐up was 26.7 months (range, 4.9–73.1 months). Five of 25 eligible patients (20%) relapsed at a median 4.8 months (range, 3.2–7.8 months). Two of 18 (11%) intermediate and 3 of 7 (43%) high‐risk patients relapsed. Kaplan–Meier 2‐year locoregional relapse‐free survival estimates for intermediate and high‐risk patients were 88% and 57% (p = .078), respectively.ConclusionTraditional indications for adjuvant RT or CRT were associated with high risk of locoregional relapse in HPV‐positive patients treated with TORS alone. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1674–E1679, 2016