Identification Of Survivors Research Articles

Beyond Victim Identification: A Practitioner’s Guide to Designing a Youth Anti-Sex Trafficking Advocacy Program

ABSTRACT Thousands of youth are sexually trafficked each year in the United States. In order to address this concern, anti-trafficking advocates often emphasize the importance of uniform screening protocols to assist with the identification of survivors. Unfortunately, an oft-overlooked component of sex trafficking identification is what to do once a victim has been identified, and how to best meet survivors’ complex needs. In this article, the authors provide social work practitioners and other advocates with best practice guidelines for how to design and evaluate anti-sex trafficking advocacy programs for children and youth. These guidelines include considerations related to direct services with clients, community partnerships, and organizational capacity, as well as recommendations for how to begin and then evaluate programming. Regardless of the form selected for the program, all anti-sex trafficking programs should be designed to provide effective, client-centered follow-up and advocacy once a positive identification is made in the community. The recommendations included in this paper are based upon extant literature, the authors’ practice experience with survivors, and insights from anti-sex trafficking program evaluations.

Abstract 3764: Epigenome-wide association study of blood lipids among survivors of childhood cancer in the St. Jude Lifetime Cohort

Abstract Epigenetic studies of blood lipid traits have identified genes underlying lipid metabolism in the general population. However, investigation of this association has not been conducted in survivors of childhood cancer, a population with a much higher burden of dyslipidemia and other cardiometabolic conditions due to exposures of genotoxic cancer therapies. We performed epigenome-wide association studies (EWAS) to identify blood DNA methylation (DNAm) 5’-cytosine-phosphate-guanine-3′ (CpGs) associated with lipid concentrations, including high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC), and triglycerides (TG), for childhood cancer survivors from the St. Jude Lifetime (SJLIFE) cohort. DNAm was generated with blood derived DNA using Illumina MethylationEPIC BeadChip array. Adjusted M-value of DNAm for each CpG was calculated based on a linear regression of M-value against a set of covariates, including sex, age at DNA sampling, leukocyte subtype proportions, top four significant genetic principal components, and top four methylation principal components. In the exposure EWAS, a linear regression model was used for lipid levels prior to DNA sampling as an exposure variable and DNAm as an outcome variable, adjusting for cancer treatments, age at lipid measurement, BMI, cigarette smoking and lipid lowering medicine use. In the outcome EWAS, a linear regression model was used for DNAm as an exposure variable and lipid levels after DNA sampling as outcome variables, adjusting for cancer treatments, age at lipid measurement, BMI, smoking, lipid lowering medicine use, lipid levels measured at DNA sampling, age at DNA sampling, and polygenic risk score for specific lipid levels. Among survivors of European ancestry (N=2052), we identified 43 significant CpGs (P<9×10-8) associated with HDL (n=7), TC (n=3) and TG (n=33) as exposures; and 106 CpGs associated with HDL (n=5), LDL (n=3), TC (n=4), and TG (n=94) as outcomes. Among survivors of African ancestry (N=370), we identified 3 CpGs associated with TG as an exposure, and 5 CpGs associated with LDL (n=1) and TC (n=4) as outcomes. A comparison of effect sizes of significant CpGs between survivors of European and African ancestry suggests moderate to substantial racial differences in epigenetic associations with lipid exposures (14/46 with I2>50) and lipid outcomes (106/111 with I2>50). Additionally, no overlap between CpGs associated with lipid exposures and lipid outcomes suggests that the DNAm levels of these CpGs could be either the cause or consequence of lipid levels. Examination of the EWAS catalog and recent literature, suggests that most of the lipid associated CpGs identified in our study are novel. Blood lipid associated CpGs may be epigenetic biomarkers for identification of survivors with higher risk of dyslipidemia and may inform potential drug targets for future interventions. Citation Format: Qian Dong, Nan Song, Cheng Chen, Zhenghong Li, John Easton, Heather Mulder, Jinghui Zhang, Geoffrey Neale, Emily Walker, I-Chan Huang, Kirsten K. Ness, Melissa M. Hudson, Leslie L. Robison, Zhaoming Wang. Epigenome-wide association study of blood lipids among survivors of childhood cancer in the St. Jude Lifetime Cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3764.

Impact of cisplatin-induced hearing loss (CIHL) on patient-reported social and emotional functioning.

12120 Background: Cisplatin is one of the most commonly used ototoxic drugs, but no study has quantified the handicap imposed by CIHL in U.S. adult-onset cancer survivors. Identification of survivors with high degrees of handicap and related risk factors is vital, as hearing loss (HL) in the general population is strongly related to adverse health outcomes, including cognitive decline, dementia, and poor mental health and social well-being. Methods: Eligible testicular cancer survivors (TCS) (age < 60 y at diagnosis, given first line cisplatin) completed comprehensive health surveys, including the validated 25-item Hearing Handicap Inventory for Adults (HHIA). HHIA quantifies emotional (13 items) and social difficulties (12 items) related to HL; for each scale (0-100%), based on their responses, TCS were grouped into 3 handicap levels: 0-16% (none/minimal), 17-42% (mild/moderate), and 43-100% (significant) following HHIA recommendations. A Spearman correlation evaluated the associations between increasing HL severity and HHIA group. The association between HL and reported cognitive dysfunction was evaluated by a logistic regression analysis adjusted for age, income, education, yrs since therapy, cisplatin dose, BMI, smoking, and hypertension, with results presented as OR[CI], p-value. Results: Among 213 TCS [median age at evaluation, 46 y (IQR: 38-52 y); median time since cisplatin completion, 10.6 y (IQR: 6.8-16.6 y)], CIHL was reported by 127 TCS (60%). Of TCS with CIHL, 31% reported some degree of related handicap (for total HHIA scale: 13% TCS and 18% TCS reporting mild/moderate and significant handicap, respectively). HL severity was significantly correlated with handicap level in all domains (social, ρ = 0.85, p <.001; emotional, ρ = 0.72, p <.001; and total, ρ = 0.81, p <.001). Cognitive dysfunction was more commonly reported by TCS with CIHL than TCS without (35% and 22%, p =.049). HL was a significant independent predictor of cognitive dysfunction, 2.20 [1.09-4.47], p =.028. Since many patients with HL in the general population report tinnitus (TINN), and TINN may suggest a worse HL phenotype, we additionally adjusted for TINN severity and found a significant independent association for TINN and cognitive dysfunction, 1.49 [1.05-2.11], p = 0.027. Despite these outcomes, only 10% of TCS with HL used hearing aids (n = 13). Conclusions: After cisplatin chemotherapy, 60% TCS report CIHL, and TCS with CIHL report poorer social and emotional function. One in 5 TCS with CIHL reported significant overall handicap. Despite these outcomes, the low prevalence of hearing aid use suggests a potential clinical intervention that could improve social and emotional well-being. If confirmed, the possible association between CIHL with TINN and cognitive dysfunction may be of particular interest, as the Lancet Commission on Dementia Prevention (2020) identified untreated HL as a key modifiable risk factor.

Abstract 904: Epigenome-wide association study of dyslipidemia in survivors of childhood cancer: A report from the St. Jude lifetime cohort

Abstract Background: Epigenetic research of blood lipids has been conducted in the general population with some robust findings. However, there is lack of similar studies that explore epigenetic effects among childhood cancer survivors who have elevated risk of dyslipidemia. We aimed to utilize epigenome-wide approach to search for DNA methylation (DNAm) sites influencing lipid metabolism among survivors of childhood cancer. Methods: Epigenome-wide methylation data were generated with Infinium EPIC BeadChip on blood derived DNA of survivors from the St. Jude Lifetime Cohort Study. Chemotherapy agents and region-specific radiation exposures were abstracted from medical records. Two forms of dyslipidemia, i.e. hypertriglyceridemia (HTG) or hypercholesteremia (HCL) were clinically assessed. Multivariable logistic regression was used to evaluate associations between each DNAm site with incident cases of HTG or HCL adjusting for age, sex, and cancer treatment exposures. Analysis was stratified by genetically determined races, i.e. survivors of European ancestry (EA) and survivors of African ancestry (AA). Significant DNAm sites were correlated with mRNA expression of the mapped genes using RNA sequencing data available for blood samples of 87 survivors. Results: 2,052 EA (median age=34.7 years, 47.1% female, 26.6% HTG, 32.0% HCL) and 370 AA survivors (median age=32.1 years, 53.2% female, 15.9% HTG, 26.8% HCL) were included. Among EA survivors, six DNAm sites were associated with HTG risk at epigenome-wide significance level (P<9×10-8): CPT1A (cg00574958, cg05325763, cg17058475, cg09737197), SLC43A1 (cg11376147), and LINC01934 (cg22050199). These DNAm sites were also associated with HCL with P value ranging from 1.9×10-4 to 2.1×10-7. There was no single DNAm site associated with HCL risk reaching over epigenome-wide significance level. Search of differentially methylated regions for HTG status identified one additional statistically significant (PFDR<0.05) genomic region of chr1:120255941-120256112 encompassing PHGDH with three DNAm sites (cg16246545, cg14476101, cg26457483). Furthermore, DNAm of cg00574958 and cg14476101 located in CPT1A and PHGDH, respectively, were both inversely correlated with gene expression (CPT1A: r = -0.33, P=2.0×10-3; PHGDH: r=-0.46, P=9.1×10-6). In contrast, none of these DNAm sites showed associations with risk of HTG or HCL among AA survivors. Conclusion: We identified one or more DNAm sites, residing in each of CPT1A, SLC43A1, and PHGDH genes, associated with dyslipidemia among EA survivors. Lack of associations among AA survivors may partially contribute to lower risk of dyslipidemia among AA survivors. The findings demonstrated epigenetic roles in dyslipidemia among survivors, suggesting epigenetic biomarkers for identification of survivors with higher dyslipidemia risk and new targets for future interventions. Citation Format: Qian Dong, Nan Song, Yadav Sapkota, Yinan Zheng, I-Chan Huang, Deo Kumar Srivastava, John Easton, Heather Mulder, Geoffrey Neale, Emily Walker, Jinghui Zhang, Melissa M. Hudson, Leslie L. Robison, Zhaoming Wang. Epigenome-wide association study of dyslipidemia in survivors of childhood cancer: A report from the St. Jude lifetime cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 904.

Predictors of quality of life in allogeneic hematopoietic stem cell transplantation survivors

Objectives To establish the demographic, medical, transplant, and lifestyle factors that impact Quality of Life (QoL) in long-term survivors of allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT). Design Cross-sectional study utilizing self-report measures. Sample/Methods In this cross-sectional study of 441 adult survivors of allo-HSCT, participants completed questionnaires assessing QoL, psychological, social, demographic, and clinical variables. Findings Factors associated with improved QoL post-allo-HSCT included time since transplant, female gender, attendance at outpatient appointments, health screening uptake, exercise, and resumption of travel. Factors significantly associated with impaired QoL included chronic morbidities (GVHD), taking psychotropic medication, failure to resume sexual activity (in men), male gender, psychological distress, low income or decline in work status, transition to non-physical work, and necessity for post-allo-HSCT care from various health professionals. Implications for Psychosocial Providers Identification of survivors more likely to experience a reduced QoL following allo-HSCT may enable the targeting of health services to the most vulnerable, and the development of interventions and resources. The data from this study led to the development of HSCT Long-Term Follow Up Clinical Guidelines in New South Wales.

Exercise cardiac MRI unmasks cardiac dysfunction in childhood and adolescent cancer survivors with reduced cardiopulmonary fitness

Abstract Background Young cancer survivors are at increased risk of impaired cardiopulmonary fitness (VO2peak) and heart failure. Assessment of exercise cardiac reserve may reveal sub-clinical abnormalities that better explain impairments in fitness and long term heart failure risk. Purpose To investigate the presence of impaired VO2peak in pediatric cancer survivors with increased risk of heart failure, and to assess its relationship with resting cardiac function and cardiac reserve Methods Twenty pediatric cancer survivors (aged 8–24 years) treated with anthracycline chemotherapy underwent cardiopulmonary exercise testing to quantify VO2peak, with a value <85% of predicted defined as impaired VO2peak. Resting cardiac function was assessed using 3-dimensional echocardiography, with cardiac reserve quantified from resting and peak exercise heart rate (HR), stroke volume index (SVi) and cardiac index (CI) using exercise cardiac magnetic resonance imaging. Results 12 of 20 survivors (60%) had impaired VO2peak (97±14% vs. 70±16% of age and gender predicted). There were no differences in echocardiographic or CMR measurements of resting cardiac function between survivors with normal or impaired VO2peak. However, those with reduced VO2peak had diminished cardiac reserve, with a lesser increase in CI (Fig. 1A) and SVi (Fig. 1B) during exercise (Interaction P=0.001 for both), whilst the HR response was similar (Fig. 1C; P=0.71). Conclusions Resting measures of cardiac function are insensitive to significant cardiac dysfunction amongst pediatric cancer survivors with reduced VO2peak. Measures of cardiopulmonary fitness and cardiac reserve may aid in early identification of survivors with heightened risk of long-term heart failure. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): National Heart Foundation

Cancer survivorship needs in Brazil: Patient and family perspective.

IntroductionCancer Survivorship is a growing public health challenge. Effective responses from health care and social services depend on appropriate identification of survivors and their families´ specific needs. There are few studies on survivorship in low and middle-income countries, therefore, more evidence-based studies are necessary to develop a comprehensive approach to cancer survivorship.ObjectivesIdentify the needs of cancer survivors and their relatives, specifically those of individuals with breast, cervical or prostate cancer, and with acute lymphocytic leukemia (ALL).MethodsA qualitative, exploratory study conducted in two referral institutions in Brazil, located in Rio de Janeiro (Southeast region) and Fortaleza (Northeast region). The study included 47 patients of public and private health services and 12 family members. We used script-based semi-structured interviews. The discursive material obtained was categorized and analyzed using the Thematic Analysis approach.ResultsThe analysis identified three central themes: 1) consequences of cancer treatment; 2) Changes in daily life associated with cancer survivorship; and 3) Unmet structural needs in cancer survivorship.ConclusionSocial and cancer control policies in Brazil should provide resources, specific care standards and clinical, psychological and social support. Cancer survivors should also receive rehabilitation and work reintegration guidelines. This matter requires broader access to qualified cancer information, development of an integrated patient-centered care and care model, and more research resources for the country's post-treatment cancer period.

Exercise intolerance among survivors of childhood cancer exposed to cardiotoxic therapy: Identification of survivors at increased risk through myocardial strain and ejection fraction.

10565Background: Exercise intolerance is an established risk factor for heart failure and death in the general population. Exercise capacity and factors associated with intolerance have not been ex...

Differences in Circulating Endothelial Progenitor Cells among Childhood Cancer Survivors Treated with and without Radiation.

Radiation during childhood cancer treatment increases the propensity to atherosclerotic cardiovascular disease among adult survivors of childhood cancer. This is thought to be mediated through the damage to the underlying vascular endothelium. Endothelial progenitor cells (EPCs) involved in vascular endothelial repair after its damage may be affected by radiation therapy but have never been investigated in adult survivors of childhood cancer. In this pilot study, utilizing multi-parametric flowcytometry, endothelial colony forming cells (ECFCs), which are the bonafide EPCs, and circulating endothelial cells (CECs), which are not EPCs, were compared between adult survivors of childhood cancer with or without radiation exposure. In addition, their associations with blood-pressure, physical activity and diet were examined. Survivors who received radiotherapy had lower ECFCs and CECs (p<0.05) compared to those without it. Significant positive correlations included physical activity with ECFCs and diet with CECs, while blood-pressure negatively correlated with ECFCs. Further evaluation is needed to examine the effect of radiation and modifiable risk factors on ECFCs and CECs. The preliminary findings from this study suggest evidence of the role of ECFCs as biomarkers of vascular injury following treatment for childhood cancer that may help in early identification of survivors at risk for cardiovascular disease.

Rethinking Human Trafficking in India: Nature, Extent and Identification of Survivors

The scale and extent of trafficking in people remain little explored in the Indian context. Trafficking in human beings, especially in women and children, has become a matter of serious concern in India. Bonded and sex labour comprise the vast majority of human trafficking in India, though child soldiering, forced begging and organ harvesting have also been identified. The accessibility of the trafficker to the prospective victim is an important factor in trafficking. The method adopted is usually influenced by the proximity or otherwise of the trafficker to the victim. Human trafficking poses enormous challenges to governance and law enforcement, and, at times, these challenges seem to be overwhelming. Even if it is something that is unlikely to be eliminated, however, more effective steps can be taken to contain or even reduce the scope of the problem by a concerted effort to raise the priority of combating human trafficking and by both exerting pressure on and enhancing capacity in a country such as India, which still lacks legal instruments and serious anti-trafficking activities.

The feasibility of psychosocial screening for adolescent and young adult brain tumor survivors: the value of self-report

Psychosocial screening is increasingly applied to childhood cancer survivors generally, but less so with pediatric brain tumor survivors despite their psychosocial risks. This study examined the utility and acceptability of psychological screening in pediatric brain tumor survivors. Eighty-four adolescents (age 12-18) completed the Beck Youth Inventory-II and 79 young adults (age 19-30) completed the Brief Symptom Inventory-18. Their scores were compared to clinician ratings on the global assessment of functioning following clinical interviews. Eighty-four percent of participants completed measures in <30min, 90% reported no associated distress, and 98% found measures easy to understand. Using established cut-off scores, 14 adolescents (17%) and 21 young adults (27%) were identified as clinical cases by self-report. Agreement with clinician report was generally low (kappa = .19, p = .077, adolescents; kappa = .34, p = .003, young adults), with clinicians tending to rate a higher proportion of both groups as having significant distress (24% in adolescents; 32% in young adults). Low self-concept scores in adolescents and deficits in social and vocational functioning in young adults contributed significantly to the discrepancies between self-report and clinician ratings. Pediatric brain tumor survivors are capable of completing self-report psychological measures without distress or burden. Self-report can be a valuable tool in the assessment of pediatric brain tumor survivors, particularly in adolescents, who may provide information not revealed in a clinical interview. However, self-report, should not be used as a "stand-alone" assessment because important areas of functioning may be minimized in survivors' reports. Utilizing self-report for psychosocial screening of adolescent and young adult brain tumor survivors may enhance clinical care and allow for better identification of survivors in need of psychological services.

Self-reported global function among adult survivors of childhood lower-extremity bone tumors: a report from the Childhood Cancer Survivor Study (CCSS)

Adult survivors of childhood lower-extremity bone tumors may experience physical and psychosocial late effects that impact physical performance, global function and quality of life. The identification of survivors at greatest risk for poor outcomes will inform potential intervention targets. Study participants were selected from the Childhood Cancer Survivor Study (CCSS), a multi-institutional study of childhood cancer survivors. Adult survivors (n = 629) of either childhood onset osteosarcoma or Ewing's sarcoma, with a primary tumor location in the lower-extremity were identified and contacted via mail to complete an additional questionnaire. Participants completed the Reintegration into Normal Living Index (RNL) to evaluate global function (maximum score of 22), daily function (maximum score of 16) and self perception (maximum score of 6). Survivors reported high levels of global function with an adjusted mean overall RNL index score of 20.6 (SE 0.14), mean daily function score of 15.0 (SD 0.10) and mean self perception score of 5.6 (SE 0.05). While female gender and increasing age were associated with lower RNL scores, the magnitude of difference is of questionable clinical significance. Global function was only moderately correlated with physical performance (r = 0.56) and QOL (r = 0.59). Based upon the RNL index, the vast majority of long-term survivors of childhood lower extremity bone tumors adapt well to their environment. While some long-term survivors of lower-extremity bone tumors may report measurable limitations in physical performance and quality of life, the majority do not report moderate or severe difficulties with social integration.

Abstract 74: Prognostic markers in Myocardial Infarction complicated by Cardiogenic Shock

Objectives . Despite aggressive therapy (including PCI and IABP use), survival following acute myocardial infarction complicated by cardiogenic shock (MI-CS) is poor. Early identification of survivors from non-survivors enables better, patient tailored therapy. We hypothesised that APACHE II scoring and other common markers may provide prognostic information in patients receiving contemporary, PCI based therapy for MI-CS. Methods. We conducted the IABP-shock-trial (a monocentric, prospective, randomized, controlled, IABP intervention trial) and analysed potential prognostic markers amongst the whole study population. Forty consecutive patients with acute MI-CS were enrolled and APACHE II scores, Cardiac index (CI), BNP and IL-6 levels were measured at enrolment and daily for 4 days before correlation with subsequent 28 day mortality. Results . The mean age was 64±1.9 years, 52% were mechanically ventilated, the mean ejection fraction was 27±2.1% and overall 28 day survival was 67%. The initial (on admission to hospital) and serial (over the 4 days) APACHE II scores successfully discriminated between survivors and non-survivors (initial APACHE II scores, 18.1±1.66 and 29.9±2.88, respectively, p&lt;0.05). Following receiver operating curve (ROC) analysis, APACHE II scores were most predictive of survival followed (in order of predictive value) by CI, IL-6 and BNP (Table 1 ). Values for APACHE II scores and cardiac index were significantly predictive of survival. Conclusions . We conclude that both initial and serial APACHE II scores provide reliable prognostic information for MI-CS patients treated with contemporary, PCI centred therapy. Cardiac index was also of some predictive value. However, in contrast to previous data (applicable mainly to chronic heart failure patients), serial BNP values were not predictive of mortality in this cohort of patients. Table 1: ROC analysis

How can we identify low- and high-risk patients among unselected patients with possible acute coronary syndrome?

Objective Prognosis among patients admitted with possible acute coronary syndrome (ACS) may differ from that of patients with definite ACS. The aim of this study was to identify risk factors for mortality among unselected patients and to use the statistical model to identify patients at low or high mortality risk. Methods From April 1, 2000, to March 31, 2002, we identified all consecutive patients aged 30 to 69 years admitted to the 2 coronary care units covering the municipality of Aarhus, Denmark (population, 138 290). ACS was considered a possible diagnosis if the physician at admission (1) had noted the presence or absence of chest pain, (2) performed a 12-lead electrocardiogram, and (3) measured markers of myocardial necrosis. In 1576 consecutive patients these criteria were fulfilled. Results By logistic regression, predictors of mortality were age 60 and older, ST elevation, right bundle-branch block, arrhythmia, elevated markers of myocardial necrosis, and the diagnosis of ACS. The predictive validity of the model, as indicated by receiver operating characteristic curve area, was 85.7%, 87.8%, and 80.1% for 7-, 30-, and 365-day mortality, respectively. Conclusions Mortality may be predicted with high precision based on a statistical model. Identification of survivors by the use of a statistical model was superior as compared to simply ruling out the clinical diagnosis of ACS.