Publications by authors named "Elizabeth Vera"

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  • Glioblastoma (GBM) is a severe brain cancer that can lead to toxic side effects during treatment, prompting this study to explore genetic and clinical factors associated with vascular toxicities such as thrombosis and hypertension in patients.
  • A total of 591 Non-Hispanic White GBM patients were analyzed, with 62 experiencing thrombosis and 59 hypertension, revealing that hypertensive patients had improved survival rates compared to those without hypertension.
  • The study found that genetic factors significantly predicted hypertension better than clinical data alone, while corticosteroid use was identified as a notable risk factor for thrombosis, suggesting a need for further research into these associations in cancer treatments.
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Patients with myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) experience a wide range of symptoms due both to their underlying disease and the effects of treatment. Designing early phase trials to explore effective therapies in these patients should not only examine anti-tumor activity, but also consider the effects of treatments on how patients feel and function. Assessing symptomatic toxicities associated with new therapies in early phase trials from the patient perspective is best measured using patient-reported outcomes (PROs) and offers valuable insight and complementary information to the traditional adverse event reporting in cancer clinical trials.

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  • Sleep-wake disturbances are prevalent among primary brain tumor patients, and this study explores the relationship between patient-reported outcomes (PROs) and data from smart wearables like Fitbits over a 4-week period.
  • Fifty-four patients participated, wearing Fitbits to track their sleep patterns and completing various PROs at the start and end of the study, showing high compliance and reliability in the data collected.
  • Results indicated that while some patients experienced significant improvements in sleep disturbance, a notable correlation was found between wake after sleep onset and sleep disturbance, highlighting a need for further research into sleep mechanics in this patient population.
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  • * A web-based study involving 158 adult patients revealed that low self-efficacy levels were linked to longer symptom durations before surgery and were influenced by factors such as gender and education.
  • * The study found that individuals with lower self-efficacy experienced more severe mood-related issues, highlighting the need for tailored interventions to improve self-efficacy in cancer care.
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  • - Burnout in the medical field is linked to emotional exhaustion, depersonalization, and a decreased sense of achievement, and younger professionals are particularly at risk; this study focused on SNO Young Investigators to better understand their experiences.
  • - An anonymous survey was conducted in 2019 among eligible SNO members, gathering data on their characteristics and using the Maslach Burnout Inventory to assess burnout levels, with analysis including various statistical methods.
  • - The results showed that YI members reported higher levels of emotional exhaustion and depersonalization than the general population, with 30% classified as overextended and 15% experiencing burnout; stress was largely attributed to organizational challenges, indicating a need for systemic interventions.
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Background: Glioblastoma (GBM) is the most aggressive primary brain malignancy with <45% living a year beyond diagnosis. Previously published investigations of long-term survivors (LTS) provided clinical data but rarely incorporated a comprehensive clinical and molecular analysis. Herein, we identify clinical, imaging, molecular, and outcome features for 23 GBM-LTS patients and compare them with a matched cohort of short-term survivors (STS).

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This study investigated the redox exsolution of Ni nanoparticles from a nanoporous LaSrTiNiO perovskite. The characteristics of exsolved Ni nanoparticles including their size, population, and surface concentration were deeply analyzed by environmental scanning electron microscopy (ESEM), transmission electron microscopy-energy dispersive X-ray spectroscopy (TEM-EDX) mapping, and hydrogen temperature-programmed reduction (H-TPR). Ni exsolution was triggered in hydrogen as early as 400 °C, with the highest catalytic activity for low-temperature CO oxidation achieved after a reduction step at 500 °C, despite only a 10% fraction of Ni exsolved.

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Background: Gliosarcoma, an isocitrate dehydrogenase wildtype (IDH-WT) variant of glioblastoma, is defined by clonal biphasic differentiation into gliomatous and sarcomatous components. While the transformation from a glioblastoma to gliosarcoma is uncommon, the subsequent transformation to osteosarcoma is rare but may provide additional insights into the biology of these typically distinct cancers. We observed a patient initially diagnosed with glioblastoma, that differentiated into gliosarcoma at recurrence, and further evolved to osteosarcoma at the second relapse.

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  • The study aimed to categorize long-term survivors of primary central nervous system tumors (PCNST) based on health-related quality of life (HRQOL) to improve personalized survivorship care.
  • Analysis of data from 298 survivors revealed two distinct HRQOL classes: one with good (61%) quality of life exhibiting few physical problems, and another with poor (39%) quality of life facing significant physical and emotional challenges.
  • Factors such as older age, unemployment, presence of spine tumors, ongoing treatment, tumor recurrence, and lower performance status were linked to membership in the poor HRQOL class.
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Background: Hypersomnolence is a common and disruptive side effect of cranial radiotherapy and is associated with fatigue and disturbances in mood and cognition in primary brain tumor (PBT) patients. The biological underpinnings of this effect are not understood. Our laboratory has previously found that the presence of a single nucleotide polymorphism (rs934945, G-E mutation) in the PERIOD2 (PER2) clock gene was associated with a decreased likelihood of fatigue in PBT patients.

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Background: Primary brain tumor (PBT) patients experience higher levels of distress and anxiety than other solid tumor patients, particularly at the time of clinical evaluation when uncertainty about disease status is high ("scanxiety"). There is promising evidence supporting use of virtual reality (VR) to target psychological symptoms in other solid tumor patients, though PBT patients have not been studied extensively in this context. The primary aim of this phase 2 clinical trial is to establish the feasibility of a remote VR-based relaxation intervention for a PBT population, with secondary aims designed to determine preliminary efficacy of improving distress and anxiety symptoms.

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Purpose: Cancer patients experience distress and anxiety when undergoing imaging studies to monitor disease status, yet these symptoms are not always appropriately identified or well-managed. This interim analysis of a phase 2 clinical trial explored feasibility and acceptability of a virtual reality relaxation (VR) intervention for primary brain tumor (PBT) patients at the time of clinical evaluation.

Methods: English speaking, adult PBT patients with previous reports of distress and upcoming neuroimaging were recruited between March of 2021 and March 2022.

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Primary brain tumor (PBT) patients experience higher levels of distress and anxiety than other solid tumor patients, particularly at the time of clinical evaluation when uncertainty about disease status is high ("scanxiety"). There is promising evidence supporting use of virtual reality (VR) to target psychological symptoms in other solid tumor patients, though PBT patients have not been studied extensively in this context. The primary aim of this phase 2 clinical trial is to establish the feasibility of a remote VR-based relaxation intervention for a PBT population, with secondary aims designed to determine preliminary efficacy of improving distress and anxiety symptoms.

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Article Synopsis
  • Precision health strategies are essential for managing symptom burden in primary brain tumor patients, addressing the complex and diverse nature of their symptoms.
  • The study used network analysis and unsupervised clustering on data from 1,128 patients to uncover symptoms' interconnections, revealing four key dimensions of symptom burden: cognitive, physical, focal neurologic, and affective.
  • The results indicated four patient subgroups, with notable distinctions in their symptom patterns and severities, potentially guiding the development of personalized symptom management approaches in the future.
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  • Cancer patients often face anxiety during imaging studies, leading to the need for effective management of their distress.
  • A phase 2 clinical trial tested a virtual reality relaxation (VR) intervention for primary brain tumor patients, assessing its feasibility and acceptability before neuroimaging.
  • Out of 55 approached, 20 patients enrolled, with high satisfaction reported (90%) and minimal adverse effects, indicating the potential of VR as a supportive tool for managing psychological symptoms in this population.
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  • Financial toxicity, especially linked to unemployment, has a significant impact on cancer survivors, prompting an evaluation of how it relates to patient-reported outcomes (PROs) in individuals with primary CNS tumors (PCNST).
  • The study, conducted between September 2016 and December 2019 with 277 participants, revealed that Hispanic individuals faced higher unemployment rates and reported greater functional impairments and reduced health-related quality of life (HRQOL) than employed counterparts.
  • Unemployed participants exhibited notably higher levels of depressive (25% vs. 8%) and anxiety symptoms (30% vs. 15%), highlighting the mental health challenges associated with unemployment in this patient group.
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  • Astroblastoma, -altered is a new classification of rare CNS tumors added by the WHO in 2021, characterized by unique DNA methylation patterns and specific genetic fusions but has variable histological features.
  • These tumors are most frequently found in children, especially females, and their clinical outcomes vary widely, with some patients facing multiple recurrences despite aggressive treatment while others do well after surgery alone.
  • The report details the cases of three female adults with these tumors, highlights the need for better clinical data collection, and suggests a standardized method for gathering neuropathological and patient-reported outcomes to enhance understanding of the tumor's clinical diversity.
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Purpose: Preclinical data showed that prophylactic, low-dose temozolomide (TMZ) significantly prevented breast cancer brain metastasis. We present results of a phase I trial combining T-DM1 with TMZ for the prevention of additional brain metastases after previous occurrence and local treatment in patients with HER2+ breast cancer.

Patients And Methods: Eligible patients had HER2+ breast cancer with brain metastases and were within 12 weeks of whole brain radiation therapy (WBRT), stereotactic radiosurgery, and/or surgery.

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  • * Patients with sleep disturbances also experienced a higher overall symptom burden, including significantly more depressive and anxiety symptoms, as well as increased feelings of drowsiness and distress.
  • * The findings suggest that addressing sleep disturbances in PBT patients could improve their overall symptom experience and quality of life, highlighting the need for future research on sleep patterns and potential interventions.
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  • The study focused on the importance of clinical outcomes assessments (COAs) for patients with malignant glioma, specifically looking at symptoms and functions recommended by the RANO-PRO Working Group.
  • Using a cohort of 336 patients from a larger study, researchers analyzed how symptoms like pain and cognitive issues and functions like weakness and ability to work relate to disease progression over time.
  • Findings suggest that these COAs are relevant indicators of disease status and may change as the disease progresses, providing vital information for both clinical care and research.
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Background: We sought to identify clinical and genetic predictors of temozolomide-related myelotoxicity among patients receiving therapy for glioblastoma.

Methods: Patients ( = 591) receiving therapy on NRG Oncology/RTOG 0825 were included in the analysis. Cases were patients with severe myelotoxicity (grade 3 and higher leukopenia, neutropenia, and/or thrombocytopenia); controls were patients without such toxicity.

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  • Cognitive impairments are common in patients with primary CNS tumors, and traditional neuropsychological assessments are often too lengthy for routine use, prompting the study of the brief Montreal Cognitive Assessment (MoCA) during in-person and telehealth visits.
  • The study involved 71 adults with CNS tumors who took the MoCA, revealing an average score of 25 in-person and 26 via telehealth, with a notable percentage scoring abnormally; satisfaction surveys indicated healthcare providers found the MoCA useful in both settings.
  • Findings demonstrated a correlation between lower MoCA scores and worse symptoms, emphasizing the importance of incorporating both objective cognitive measures and patient-reported outcomes for a comprehensive understanding of patient cognition in neuro-oncology care.
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Introduction: Despite an increasing aging population, older adults (≥ 65 years) with primary brain tumors (PBTs) are not routinely assessed for geriatric vulnerabilities. Recent reports of geriatric assessment (GA) in patients with glioblastomas demonstrated that GA may serve as a sensitive prognosticator of overall survival. Yet, current practice does not include routine evaluation of geriatric vulnerabilities and the relevance of GA has not been previously evaluated in broader cohorts of PBT patients.

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  • Patients with primary brain tumors often experience mobility issues, and this study assesses the effectiveness of two mobility tests, Timed-Up-and-Go (TUG) and Five-Times Sit-to-Stand (TSS), in evaluating these challenges in a neuro-oncology clinic setting.
  • During a 6-month period, 66 adult patients completed these tests alongside the MD Anderson Symptom Inventory, revealing that 94% successfully completed the mobility assessments, highlighting the tests' feasibility.
  • Results indicated that factors like older age, being newly diagnosed, corticosteroid use, and poorer performance status significantly correlated with longer test completion times, suggesting these tests could be useful in clinical settings for better understanding patient mobility.
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  • Survivorship for individuals with primary CNS cancers starts at diagnosis and presents both opportunities and challenges that require collaboration among stakeholders to improve care.
  • In June 2021, a virtual workshop was held by NCI-CONNECT, where experts made recommendations and working groups analyzed key issues related to advancing survivorship care in neuro-oncology.
  • The workshop resulted in several action items, including improving access to care, enhancing education for patients and providers, creating a toolkit for support, and establishing competencies for training neuro-oncology providers.
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