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Papers by Evan Morgan

Annals of Oncology, 2013

Background: The granulocyte colony-stimulating factor (G-CSF) is utilized to reduce neutropenic c... more Background: The granulocyte colony-stimulating factor (G-CSF) is utilized to reduce neutropenic complications in patients receiving cancer chemotherapy. This study represents a systematic review and evidence summary of the impact of G-CSF support on chemotherapy dose intensity and overall mortality. Materials and methods: All randomized controlled trials (RCTs) comparing chemotherapy with or without G-CSF support and reporting all-cause mortality with at least 2 years of follow-up were sought. Dual-blind data abstraction of disease, treatment, patient and outcome study results with conflict resolution by third party was carried out. Results: The search revealed 61 randomized comparisons of chemotherapy with or without initial G-CSF support. Death was reported in 4251 patients randomized to G-CSFs and in 5188 controls. Relative risk (RR) with G-CSF support for all-cause mortality was 0.93 (95% confidence interval: 0.90-0.96; P < 0.001). RR for mortality varied by intended chemotherapy dose and schedule: same dose and schedule (RR = 0.96; P = 0.060), dose dense (RR = 0.89; P < 0.001), dose escalation (RR = 0.92; P = 0.019) and drug substitution or addition (RR = 0.94; P = 0.003). Greater RR reduction was observed among studies with longer follow-up (P = 0.02), where treatment was for curative intent (RR = 0.91; P < 0.001), and where survival was the primary outcome (RR = 0.91; P < 0.001). Conclusions: All-cause mortality is reduced in patients receiving chemotherapy with primary G-CSF support. The greatest impact was observed in RCTs in patients receiving dose-dense schedules.

DIGITAL HEALTH

Background Outpatient portal technology can improve patient engagement. For pregnant individuals,... more Background Outpatient portal technology can improve patient engagement. For pregnant individuals, the level of engagement could have important implications for maternal and infant outcomes. Objective This study: (1) cross-sectionally and temporally characterized the outpatient portal use among pregnant individuals seen at our academic medical center; and (2) identified clusters of the outpatient portal user groups based on the cross-sectional and temporal patterns of use. Methods We used outpatient portal server-side log files to execute a hierarchical clustering algorithm to group 7663 pregnant individuals based on proportions of outpatient portal function use. Post-hoc analyses were performed to further assess outpatient portal use on key encounter characteristics. Results The most frequently used functions were MyRecord (access personal health information), Visits (manage appointments), Messaging (send/receive messages), and Billing (view bills, insurance information). Median out...

ObjectiveTo report the relationship of Outpatient Patient Portal (OPP) use with clinical risk, ar... more ObjectiveTo report the relationship of Outpatient Patient Portal (OPP) use with clinical risk, area social determinants of health (SDoH), and race/ethnicity among pregnant women.MethodsRegression models predicting overall and individual portal feature use (main effects and interactions) based on key variables were specified using logfiles and clinical data.ResultsOverall OPP use among non-Hispanic Black women or patients who lived in lower SDoH neighborhoods were significantly less. High-risk pregnancy patients were likely to use the OPP more than those with normal-risk pregnancy. We found similar associations with individual OPP features, like the Visit (scheduling) and My Record (test results). We also found significant interactive associations between race, clinical risk, and SDoH. Non-Hispanic Black women living in lower SDoH areas used OPP less than non-Hispanic White women from similar or affluent areas.ConclusionMore research must be conducted to learn of OPP implications for...

Proceedings of the 2017 ACM Conference Companion Publication on Designing Interactive Systems, 2017

Research indicates that new technologies, such as smart meters, can motivate domestic energy savi... more Research indicates that new technologies, such as smart meters, can motivate domestic energy savings via behavioural change. Using participatory and co-design methods, our research is exploring how technological innovations might also facilitate behaviour-based energy savings in large organisations. By establishing 'living labs', we are working closely with two public-sector organisations in order to understand behaviours surrounding energy use, and to subsequently engage relevant stakeholders in a process of co-designing innovations focused upon achieving energy savings. This paper introduces our research approach and describes how initial workshops are informing an ongoing process of co-development within our two living labs.

Rural and Remote Health, 2016

Context: Cancer is a challenging experience and there is evidence that psychosocial interventions... more Context: Cancer is a challenging experience and there is evidence that psychosocial interventions are effective at improving adjustment following treatment. At our cancer center, 14 cancer survivors (breast, prostate and blood cancers) completed a foursession cognitive-behavioral stress program. The first session was delivered at the survivor's local cancer center, where they were provided with a loaner tablet. The three subsequent sessions were delivered through group-based videoconference on the tablet. Session content was supplemented with a tailored ebook, designed specifically for this program. Participants provided feedback about the program as well as a standardized measure of perceived stress. Issues: Despite evidence that psychosocial programs are effective, there are significant barriers to dissemination, particularly for those residing in rural areas who do not live near academic medical centers where such programming is more readily available. Our experiences delivering a group-based videoconference program in cancer survivors are described, including positives and challenges associated with its design and implementation. Lessons learned: Study participants enrolled from across four different US states, and the majority reported at least a 30-minute commute to their cancer center. This travel burden played a meaningful role in their desire to participate in our videoconferencebased program. Although participants reported that session content was well suited to addressing stress management concerns, and session facilitators were able to effectively teach program techniques (eg progressive muscle relaxation, cognitive-reframing) and that the program was helpful overall, only modest improvements in perceived stress were seen. Participants noted challenges of the delivery including feeling disconnected from others, difficulty focusing, technical problems, and a desire for a longer program. Thus, although the novel delivery of a group-based, psychosocial program using tablet videoconference is feasible in a survivorship program, and desired by cancer survivors, key improvements must be made in future efforts. Our enthusiasm about the potential of telehealth must be tempered with the reality that such delivery can present challenges that interfere with the intervention

Cardio-Oncology, 2020

Background Trastuzumab-induced cardiotoxicity (TIC) can lead to early discontinuation of adjuvant... more Background Trastuzumab-induced cardiotoxicity (TIC) can lead to early discontinuation of adjuvant therapy, however there is limited evidence on long-term survival outcomes in patients with operable human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) experiencing treatment interruption or discontinuation. Methods The primary objective of the study was to evaluate disease-free survival (DFS) in non-metastatic, HER2-positive, female BC patients who experienced treatment interruption or early discontinuation of trastuzumab therapy. Clinical and histopathological data were collected on 400 patients at The Ohio State University, an NCI-designated comprehensive cancer center between January 2005 and December 2015. Treatment interruption was defined as any delay of ≥2 weeks during trastuzumab therapy, including permanent cessation prior to completing planned therapy. TIC was defined as LVEF < 50% or > 15 points decline from baseline as evaluated by 2D echocardi...

European Journal of Breast Health, 2020

Male breast cancer (MBC) is a rare disease, accounting for approximately 1-2% of all documented b... more Male breast cancer (MBC) is a rare disease, accounting for approximately 1-2% of all documented breast cancer cases (1). Compared to female breast cancer, MBC generally presents at an older age and later stage, with larger tumor sizes, higher nuclear grades and higher frequency of lymph node involvement (2, 3). Such differences may arise due to the rarity of MBC, resulting in lower patient awareness and subsequent delays in proper diagnostic workup. In addition, there is a lack of level-one evidence for the best management strategies of MBC, as it is exceedingly difficult to accrue sufficient numbers of MBC patients to prospective clinical trials. To date, many MBC studies have been retrospective and descriptive in nature and do not have a formal comparison to female subjects. Larger studies often rely on unmatched population-level comparisons and lack detailed patient management information (4, 5). The few MBC studies that have used matched female cohorts, have often not sufficiently controlled for potential cofounding factors, such as date of diagnosis, age at diagnosis and hormone (HR) or human epidermal growth factor receptor 2 (HER2) receptors status (6-8). As such, current treatment practices for patients with MBC are largely based on extrapolation from clinical trials enrolling female breast cancer patients with a similar stage and histopathologic subtype. Furthermore, in the MBC literature, it is uncertain whether prognostic genomic tests, such as Oncotype DX recurrence score (RS) (RS; Genomic Health, Redwood City, CA), can be used to help estimate prognosis and identify MBC patients who will benefit from chemotherapy, given that these scores are based on studies performed in female breast cancer patients (9-11). Limited data exists on the utility of

Investigational New Drugs, 2020

Upregulation of Notch pathway is associated with poor prognosis in breast cancer. We present the ... more Upregulation of Notch pathway is associated with poor prognosis in breast cancer. We present the results of a phase I study of an oral selective gamma secretase (GS) inhibitor (critical to Notch signaling), RO4929097 in combination with neoadjuvant chemotherapy for operable triple negative breast cancer. The primary objective was to determine the maximum tolerated dose (MTD) of RO4929097. Secondary objectives were to determine real-time pharmacokinetics of RO4929097 and paclitaxel, safety and pathologic (pCR) complete response to study treatment. Eligible patients, initiated carboplatin at AUC 6 administered intravenously (IV) on day 1, weekly paclitaxel at 80 mg/m2 IVand RO4929097 10 mg daily given orally (PO) on days 1-3, 8-10 and 15-17 for six 21-day cycles. RO4929097 was escalated in 10 mg increments using the 3 + 3 dose escalation design. Two DLTs were observed in 14 patients-Grade (G) 4 thrombocytopenia in dose level 1 (10 mg) and G3 hypertension in dose level 2 (20 mg). Protocol-defined MTD was not determined due to discontinuation of RO4929097 development. However, 4 of 5 patients enrolled to 20 mg dose of RO4929097 required dose reduction to 10 mg due to toxicities (including neutropenia, thrombocytopenia and hypertension) occurring during and beyond the DLT observation period. Thus, 10 mg would have been the likely dose level for further development. G3 or higher hematologic toxicities included neutropenia (N = 8, 57%) and thrombocytopenia (N = 5, 36%) patients. Six (43%) patients had G2-3 neuropathy requiring paclitaxel dose reduction. No signs of drug-drug interaction between paclitaxel and RO4929097 were evident. Five patients (36%) had pCR.

World Journal of Surgical Oncology, 2020

Background Metaplastic breast cancer remains poorly characterized given its rarity and heterogene... more Background Metaplastic breast cancer remains poorly characterized given its rarity and heterogeneity. The majority of metaplastic breast cancers demonstrate a phenotype of triple-negative breast cancer; however, differences in clinical outcomes between metaplastic breast cancer and triple-negative breast cancer in the era of third-generation chemotherapy remain unclear. Methods We compared the clinical outcomes between women with metaplastic breast cancer and women with triple-negative breast cancer diagnosed between 1994 and 2014. Metaplastic breast cancer patients were matched 1:3 to triple-negative breast cancer patients by stage and age at diagnosis. Distant disease-free survival (DDFS) and overall survival (OS) were estimated using Kaplan Meier methods and Cox proportional hazard regression models. Immune checkpoint markers were characterized by immunohistochemistry in a subset of samples. Results Forty-four metaplastic breast cancer patients (stage I 14%; stage II 73%; stage I...

Investigational New Drugs, 2020

Purpose Capecitabine is widely used as a single agent on a 21-day cycle in the management of meta... more Purpose Capecitabine is widely used as a single agent on a 21-day cycle in the management of metastatic breast cancer (MBC). Our primary objective was to compare the standard dosing of capecitabine (Arm A: days 1-14 on 21-day cycle) to biweekly dosing (Arm B: days 1-7 and 15-21 on 28-day cycle) using retrospective data analysis. Methods 166 patients with MBC treated with single agent capecitabine at The Ohio State University from 2002 to 2014 were considered eligible. Median time to treatment failure (TTF) and overall survival (OS) were estimated using Kaplan-Meier (KM) methods. KM curves were compared using log-rank tests with Holm's correction for multiplicity. Results Patients were grouped by dose schedule into one of three arms: Arm A (21-day cycle; capecitabine given at 1000 mg/m 2 orally, twice daily on days 1-14 of 21-day cycle); Arm B (28day cycle; capecitabine given at 1000 mg/m 2 orally, twice daily on days 1-7 and 15-21 of 28-day cycle); and Arm C (changeover regimen where patients started on the 21-day cycle, but changed to a 28-day cycle for tolerability). No difference was found in TTF or OS for patients with MBC between those who received capecitabine on either standard dosing (Arm A) and those on a biweekly cycle (Arm B or C). Overall, 41% of patients required dose reduction. Conclusions Our single institution experience showed that alternate dosing of capecitabine (biweekly, 28-day cycle) may be a reasonable alternative to standard 21-day cycle with similar efficacy and fewer dose reductions.

Journal of Health Politics, Policy and Law, 2019

Context: Many observers believe that the policy response to the opioid crisis is less punitive th... more Context: Many observers believe that the policy response to the opioid crisis is less punitive than the crack scare and that the reason is that victims are (stereotypically) white.Methods: To assess this conjecture, we compile new longitudinal data on district-level drug-related deaths and (co)sponsorship of legislation on drug abuse in the House of Representatives over the past four decades. Using legislator fixed effects models, we then test how changes in drug-related death rates in legislators' districts predict changes in (co)sponsorship of treatment-oriented or punitive legislation in the subsequent year and assess whether these relationships vary by race of victim or drug type.Findings: Policy makers were more likely to introduce punitive drug-related bills during the crack scare and are more likely to introduce treatment-oriented bills during the current opioid crisis. The relationship between district-level drug deaths and subsequent sponsorship of treatment-oriented le...

Journal of Clinical Oncology, 2019

e13554 Background: Leptomeningeal carcinomatosis (LMC) is a complication of advanced malignancies... more e13554 Background: Leptomeningeal carcinomatosis (LMC) is a complication of advanced malignancies wherein primary tumors metastasize to the leptomeninges surrounding brain and spinal cord. LMC complicates 4-15% of malignant solid tumors with incidence increasing as survival of patients with advanced cancer improves. Diagnostic methods include magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) cytology. MRI findings may be nonspecific, and the gold standard of diagnosis is malignant cytology on CSF analysis. We assessed detection methods, incidence, and outcomes of LMC at The Ohio State University Comprehensive Cancer Center from 2005-2015. Methods: This was an IRB-approved single-institution retrospective study of 160 patients with confirmed diagnosis of LMC who were treated at the OSUCCC-James between Jan 1, 2005 and Dec 31, 2015. Patients with hematologic and central nervous system malignancies were excluded. Descriptive statistics were used to summarize demographic an...

Journal of the National Comprehensive Cancer Network, 2019

Background: Invasive lobular carcinoma (ILC) accounts for 5%–15% of all invasive breast cancer ca... more Background: Invasive lobular carcinoma (ILC) accounts for 5%–15% of all invasive breast cancer cases. ILC has the propensity for distant late recurrence with widespread metastatic disease. To our knowledge, there is limited data on the clinical outcomes and treatment strategies of metastatic ILC. This retrospective study evaluates the overall survival (OS) and progression-free survival (PFS) in the metastatic ILC population at a single institution, focusing on first line treatment received in the metastatic setting. Methods: A retrospective chart review was performed on patients (Pts) diagnosed with metastatic ILC diagnosed at The Ohio State University Comprehensive Cancer Center between January 1, 2004 and December 31, 2014 using an IRB approved protocol. Patient demographics, clinical characteristics, and treatment modalities were summarized with descriptive statistics. OS (time from metastasis to death or last known follow-up) and PFS (time from diagnosis of metastasis to progres...

Political Behavior, 2019

Social media has increasingly enabled "fake news" to circulate widely, most notably during the 20... more Social media has increasingly enabled "fake news" to circulate widely, most notably during the 2016 U.S. presidential campaign. These intentionally false or misleading stories threaten the democratic goal of a well-informed electorate. This study evaluates the effectiveness of strategies that could be used by Facebook and other social media to counter false stories. Results from a pre-registered experiment indicate that false headlines are perceived as less accurate when people receive a general warning about misleading information on social media or when specific headlines are accompanied by a "Disputed" or "Rated false" tag. Though the magnitudes of these effects are relatively modest, they generally do not vary by whether headlines were congenial to respondents' political views. In addition, we find that adding a "Rated false" tag to an article headline lowers its perceived accuracy more than adding a "Disputed" tag (Facebook's original approach) relative to a control condition. Finally, though exposure to the "Disputed" or "Rated false" tags did not affect the perceived accuracy of unlabeled false or true headlines, exposure to a general warning decreased belief in the accuracy of true headlines, suggesting the need for further research into how to most effectively counter false news without distorting belief in true information.

Journal of Clinical Oncology, 2016

202 Background: Posttraumatic stress disorder (PTSD) is associated with morbidity and mortality i... more 202 Background: Posttraumatic stress disorder (PTSD) is associated with morbidity and mortality in affected populations. Cancer survivors experience PTSD at a rate higher than the general population, with young age and female gender identified as risk factors. While young women with breast cancer experience greater psychosocial distress in general following diagnosis (dx), little is known about PTSD in this population. Methods: Women dx’d with Stage I-III breast cancer at age ≤ 40 were surveyed as a part of a multi-site cohort study. Demographic, treatment, psychosocial characteristics (including self-reported psychiatric conditions and use of psychiatric medications prior to dx), anxiety and depression (Hospital Anxiety and Depression Scale), fear of recurrence (Lasry Scale), and social support (Medical Outcomes Study) were assessed within 1 year after dx. PTSD was measured at 30 months post-dx using the PTSD Checklist – Civilian Version; a score ≥ 50 was considered positive for PT...

Lecture Notes in Computer Science, 2015

This paper describes the LuminUs-a device that we designed in order to explore how new technologi... more This paper describes the LuminUs-a device that we designed in order to explore how new technologies could influence the interpersonal aspects of co-present musical collaborations. The LuminUs uses eye-tracking headsets and small wireless accelerometers to measure the gaze and body motion of each musician. A small light display then provides visual feedback to each musician, based either on the gaze or the body motion of their co-performer. We carried out an experiment with 15 pairs of music students in order to investigate how the LuminUs would influence their musical interactions. Preliminary results suggest that visual feedback provided by the LuminUs led to significantly increased glancing between the two musicians, whilst motion based feedback appeared to lead to a decrease in body motion for both participants.

Cancer Research, 2015

Background: There is an increasing recognition that many young women with breast cancer will have... more Background: There is an increasing recognition that many young women with breast cancer will have favorable outcomes without chemotherapy. We sought to characterize decision-making surrounding adjuvant chemotherapy treatment (CT) in this population for whom chemotherapy has historically been a standard of care. Methods: As part of an ongoing, multi-center, prospective cohort of young women diagnosed with breast cancer at age 40 and younger, we identified 657 women with Stage I-III breast cancer. Participants were asked to complete surveys by mail that included questions about socio-demographics, decision-making, and treatment history within the first year following diagnosis. Tumor characteristics were ascertained via pathology and medical record review. We used Chi-square tests to compare: decisional involvement (patient-driven vs. shared vs. physician-driven), degree of confidence, and feeling informed about the CT decision (the latter two measured on a 0-10 scale, categorized as ...

When developing public installations, interaction designers are able to utilise increasingly natu... more When developing public installations, interaction designers are able to utilise increasingly natural modes of expression such as speech, gesture and touch. Conversely the resulting installations often place users in situations where they are confronted with entirely unnatural forms of interaction. How do we establish an understanding of peoples' behaviour in such situations, and what bearing could this have on the design of better interactive experiences? This paper addresses these questions, drawing upon a study of a high profile installation that invited members of the public to control the lights on the London Eye using hand movements and heart rate measurements.

Psycho-Oncology, 2015

Objective: Using a large prospective cohort of women age 40 or younger diagnosed with breast canc... more Objective: Using a large prospective cohort of women age 40 or younger diagnosed with breast cancer, we examined the relationship between perceived partner support and anxiety. Methods: Six hundred seventy-five young women with breast cancer Stages I-III, median age 36, completed a self-report baseline questionnaire. Perceived partner support was assessed using items extracted from the marital subscale of the Cancer Rehabilitation Evaluation System; generalized social support was assessed with the Medical Outcomes Study-Social Support Survey. Anxiety was measured using the anxiety subscale of the Hospital Anxiety and Depression Scale. Multivariable logistic regression analyses evaluated the association between partner support, other sociodemographic factors, and anxiety. Results: Mean age at diagnosis was 35.4 years. Fourteen percent of the women were not partnered, and among those who were partnered or in a significant relationship, 20% were categorized as unsupported. In univariate and multivariable analysis adjusting for sociodemographic factors, women in an unsupported-partnered relationship had higher odds of anxiety symptoms compared with women in a supported-partnered relationship. Young age and being financially insecure were also both independently associated with anxiety. Conclusions: Our findings suggest that partner support may play a key role in a young woman's adjustment to a serious stressor such as breast cancer. In addition, younger age increases vulnerability to anxiety as does struggling with finances. Because supportive efforts of a partner have potential to protect against the impact of stress, interventions to enhance partner support and reduce anxiety might be beneficial to address challenges experienced as a couple in this setting.

Annals of Oncology, 2013

Background: The granulocyte colony-stimulating factor (G-CSF) is utilized to reduce neutropenic c... more Background: The granulocyte colony-stimulating factor (G-CSF) is utilized to reduce neutropenic complications in patients receiving cancer chemotherapy. This study represents a systematic review and evidence summary of the impact of G-CSF support on chemotherapy dose intensity and overall mortality. Materials and methods: All randomized controlled trials (RCTs) comparing chemotherapy with or without G-CSF support and reporting all-cause mortality with at least 2 years of follow-up were sought. Dual-blind data abstraction of disease, treatment, patient and outcome study results with conflict resolution by third party was carried out. Results: The search revealed 61 randomized comparisons of chemotherapy with or without initial G-CSF support. Death was reported in 4251 patients randomized to G-CSFs and in 5188 controls. Relative risk (RR) with G-CSF support for all-cause mortality was 0.93 (95% confidence interval: 0.90-0.96; P < 0.001). RR for mortality varied by intended chemotherapy dose and schedule: same dose and schedule (RR = 0.96; P = 0.060), dose dense (RR = 0.89; P < 0.001), dose escalation (RR = 0.92; P = 0.019) and drug substitution or addition (RR = 0.94; P = 0.003). Greater RR reduction was observed among studies with longer follow-up (P = 0.02), where treatment was for curative intent (RR = 0.91; P < 0.001), and where survival was the primary outcome (RR = 0.91; P < 0.001). Conclusions: All-cause mortality is reduced in patients receiving chemotherapy with primary G-CSF support. The greatest impact was observed in RCTs in patients receiving dose-dense schedules.

DIGITAL HEALTH

Background Outpatient portal technology can improve patient engagement. For pregnant individuals,... more Background Outpatient portal technology can improve patient engagement. For pregnant individuals, the level of engagement could have important implications for maternal and infant outcomes. Objective This study: (1) cross-sectionally and temporally characterized the outpatient portal use among pregnant individuals seen at our academic medical center; and (2) identified clusters of the outpatient portal user groups based on the cross-sectional and temporal patterns of use. Methods We used outpatient portal server-side log files to execute a hierarchical clustering algorithm to group 7663 pregnant individuals based on proportions of outpatient portal function use. Post-hoc analyses were performed to further assess outpatient portal use on key encounter characteristics. Results The most frequently used functions were MyRecord (access personal health information), Visits (manage appointments), Messaging (send/receive messages), and Billing (view bills, insurance information). Median out...

ObjectiveTo report the relationship of Outpatient Patient Portal (OPP) use with clinical risk, ar... more ObjectiveTo report the relationship of Outpatient Patient Portal (OPP) use with clinical risk, area social determinants of health (SDoH), and race/ethnicity among pregnant women.MethodsRegression models predicting overall and individual portal feature use (main effects and interactions) based on key variables were specified using logfiles and clinical data.ResultsOverall OPP use among non-Hispanic Black women or patients who lived in lower SDoH neighborhoods were significantly less. High-risk pregnancy patients were likely to use the OPP more than those with normal-risk pregnancy. We found similar associations with individual OPP features, like the Visit (scheduling) and My Record (test results). We also found significant interactive associations between race, clinical risk, and SDoH. Non-Hispanic Black women living in lower SDoH areas used OPP less than non-Hispanic White women from similar or affluent areas.ConclusionMore research must be conducted to learn of OPP implications for...

Proceedings of the 2017 ACM Conference Companion Publication on Designing Interactive Systems, 2017

Research indicates that new technologies, such as smart meters, can motivate domestic energy savi... more Research indicates that new technologies, such as smart meters, can motivate domestic energy savings via behavioural change. Using participatory and co-design methods, our research is exploring how technological innovations might also facilitate behaviour-based energy savings in large organisations. By establishing 'living labs', we are working closely with two public-sector organisations in order to understand behaviours surrounding energy use, and to subsequently engage relevant stakeholders in a process of co-designing innovations focused upon achieving energy savings. This paper introduces our research approach and describes how initial workshops are informing an ongoing process of co-development within our two living labs.

Rural and Remote Health, 2016

Context: Cancer is a challenging experience and there is evidence that psychosocial interventions... more Context: Cancer is a challenging experience and there is evidence that psychosocial interventions are effective at improving adjustment following treatment. At our cancer center, 14 cancer survivors (breast, prostate and blood cancers) completed a foursession cognitive-behavioral stress program. The first session was delivered at the survivor's local cancer center, where they were provided with a loaner tablet. The three subsequent sessions were delivered through group-based videoconference on the tablet. Session content was supplemented with a tailored ebook, designed specifically for this program. Participants provided feedback about the program as well as a standardized measure of perceived stress. Issues: Despite evidence that psychosocial programs are effective, there are significant barriers to dissemination, particularly for those residing in rural areas who do not live near academic medical centers where such programming is more readily available. Our experiences delivering a group-based videoconference program in cancer survivors are described, including positives and challenges associated with its design and implementation. Lessons learned: Study participants enrolled from across four different US states, and the majority reported at least a 30-minute commute to their cancer center. This travel burden played a meaningful role in their desire to participate in our videoconferencebased program. Although participants reported that session content was well suited to addressing stress management concerns, and session facilitators were able to effectively teach program techniques (eg progressive muscle relaxation, cognitive-reframing) and that the program was helpful overall, only modest improvements in perceived stress were seen. Participants noted challenges of the delivery including feeling disconnected from others, difficulty focusing, technical problems, and a desire for a longer program. Thus, although the novel delivery of a group-based, psychosocial program using tablet videoconference is feasible in a survivorship program, and desired by cancer survivors, key improvements must be made in future efforts. Our enthusiasm about the potential of telehealth must be tempered with the reality that such delivery can present challenges that interfere with the intervention

Cardio-Oncology, 2020

Background Trastuzumab-induced cardiotoxicity (TIC) can lead to early discontinuation of adjuvant... more Background Trastuzumab-induced cardiotoxicity (TIC) can lead to early discontinuation of adjuvant therapy, however there is limited evidence on long-term survival outcomes in patients with operable human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) experiencing treatment interruption or discontinuation. Methods The primary objective of the study was to evaluate disease-free survival (DFS) in non-metastatic, HER2-positive, female BC patients who experienced treatment interruption or early discontinuation of trastuzumab therapy. Clinical and histopathological data were collected on 400 patients at The Ohio State University, an NCI-designated comprehensive cancer center between January 2005 and December 2015. Treatment interruption was defined as any delay of ≥2 weeks during trastuzumab therapy, including permanent cessation prior to completing planned therapy. TIC was defined as LVEF < 50% or > 15 points decline from baseline as evaluated by 2D echocardi...

European Journal of Breast Health, 2020

Male breast cancer (MBC) is a rare disease, accounting for approximately 1-2% of all documented b... more Male breast cancer (MBC) is a rare disease, accounting for approximately 1-2% of all documented breast cancer cases (1). Compared to female breast cancer, MBC generally presents at an older age and later stage, with larger tumor sizes, higher nuclear grades and higher frequency of lymph node involvement (2, 3). Such differences may arise due to the rarity of MBC, resulting in lower patient awareness and subsequent delays in proper diagnostic workup. In addition, there is a lack of level-one evidence for the best management strategies of MBC, as it is exceedingly difficult to accrue sufficient numbers of MBC patients to prospective clinical trials. To date, many MBC studies have been retrospective and descriptive in nature and do not have a formal comparison to female subjects. Larger studies often rely on unmatched population-level comparisons and lack detailed patient management information (4, 5). The few MBC studies that have used matched female cohorts, have often not sufficiently controlled for potential cofounding factors, such as date of diagnosis, age at diagnosis and hormone (HR) or human epidermal growth factor receptor 2 (HER2) receptors status (6-8). As such, current treatment practices for patients with MBC are largely based on extrapolation from clinical trials enrolling female breast cancer patients with a similar stage and histopathologic subtype. Furthermore, in the MBC literature, it is uncertain whether prognostic genomic tests, such as Oncotype DX recurrence score (RS) (RS; Genomic Health, Redwood City, CA), can be used to help estimate prognosis and identify MBC patients who will benefit from chemotherapy, given that these scores are based on studies performed in female breast cancer patients (9-11). Limited data exists on the utility of

Investigational New Drugs, 2020

Upregulation of Notch pathway is associated with poor prognosis in breast cancer. We present the ... more Upregulation of Notch pathway is associated with poor prognosis in breast cancer. We present the results of a phase I study of an oral selective gamma secretase (GS) inhibitor (critical to Notch signaling), RO4929097 in combination with neoadjuvant chemotherapy for operable triple negative breast cancer. The primary objective was to determine the maximum tolerated dose (MTD) of RO4929097. Secondary objectives were to determine real-time pharmacokinetics of RO4929097 and paclitaxel, safety and pathologic (pCR) complete response to study treatment. Eligible patients, initiated carboplatin at AUC 6 administered intravenously (IV) on day 1, weekly paclitaxel at 80 mg/m2 IVand RO4929097 10 mg daily given orally (PO) on days 1-3, 8-10 and 15-17 for six 21-day cycles. RO4929097 was escalated in 10 mg increments using the 3 + 3 dose escalation design. Two DLTs were observed in 14 patients-Grade (G) 4 thrombocytopenia in dose level 1 (10 mg) and G3 hypertension in dose level 2 (20 mg). Protocol-defined MTD was not determined due to discontinuation of RO4929097 development. However, 4 of 5 patients enrolled to 20 mg dose of RO4929097 required dose reduction to 10 mg due to toxicities (including neutropenia, thrombocytopenia and hypertension) occurring during and beyond the DLT observation period. Thus, 10 mg would have been the likely dose level for further development. G3 or higher hematologic toxicities included neutropenia (N = 8, 57%) and thrombocytopenia (N = 5, 36%) patients. Six (43%) patients had G2-3 neuropathy requiring paclitaxel dose reduction. No signs of drug-drug interaction between paclitaxel and RO4929097 were evident. Five patients (36%) had pCR.

World Journal of Surgical Oncology, 2020

Background Metaplastic breast cancer remains poorly characterized given its rarity and heterogene... more Background Metaplastic breast cancer remains poorly characterized given its rarity and heterogeneity. The majority of metaplastic breast cancers demonstrate a phenotype of triple-negative breast cancer; however, differences in clinical outcomes between metaplastic breast cancer and triple-negative breast cancer in the era of third-generation chemotherapy remain unclear. Methods We compared the clinical outcomes between women with metaplastic breast cancer and women with triple-negative breast cancer diagnosed between 1994 and 2014. Metaplastic breast cancer patients were matched 1:3 to triple-negative breast cancer patients by stage and age at diagnosis. Distant disease-free survival (DDFS) and overall survival (OS) were estimated using Kaplan Meier methods and Cox proportional hazard regression models. Immune checkpoint markers were characterized by immunohistochemistry in a subset of samples. Results Forty-four metaplastic breast cancer patients (stage I 14%; stage II 73%; stage I...

Investigational New Drugs, 2020

Purpose Capecitabine is widely used as a single agent on a 21-day cycle in the management of meta... more Purpose Capecitabine is widely used as a single agent on a 21-day cycle in the management of metastatic breast cancer (MBC). Our primary objective was to compare the standard dosing of capecitabine (Arm A: days 1-14 on 21-day cycle) to biweekly dosing (Arm B: days 1-7 and 15-21 on 28-day cycle) using retrospective data analysis. Methods 166 patients with MBC treated with single agent capecitabine at The Ohio State University from 2002 to 2014 were considered eligible. Median time to treatment failure (TTF) and overall survival (OS) were estimated using Kaplan-Meier (KM) methods. KM curves were compared using log-rank tests with Holm's correction for multiplicity. Results Patients were grouped by dose schedule into one of three arms: Arm A (21-day cycle; capecitabine given at 1000 mg/m 2 orally, twice daily on days 1-14 of 21-day cycle); Arm B (28day cycle; capecitabine given at 1000 mg/m 2 orally, twice daily on days 1-7 and 15-21 of 28-day cycle); and Arm C (changeover regimen where patients started on the 21-day cycle, but changed to a 28-day cycle for tolerability). No difference was found in TTF or OS for patients with MBC between those who received capecitabine on either standard dosing (Arm A) and those on a biweekly cycle (Arm B or C). Overall, 41% of patients required dose reduction. Conclusions Our single institution experience showed that alternate dosing of capecitabine (biweekly, 28-day cycle) may be a reasonable alternative to standard 21-day cycle with similar efficacy and fewer dose reductions.

Journal of Health Politics, Policy and Law, 2019

Context: Many observers believe that the policy response to the opioid crisis is less punitive th... more Context: Many observers believe that the policy response to the opioid crisis is less punitive than the crack scare and that the reason is that victims are (stereotypically) white.Methods: To assess this conjecture, we compile new longitudinal data on district-level drug-related deaths and (co)sponsorship of legislation on drug abuse in the House of Representatives over the past four decades. Using legislator fixed effects models, we then test how changes in drug-related death rates in legislators' districts predict changes in (co)sponsorship of treatment-oriented or punitive legislation in the subsequent year and assess whether these relationships vary by race of victim or drug type.Findings: Policy makers were more likely to introduce punitive drug-related bills during the crack scare and are more likely to introduce treatment-oriented bills during the current opioid crisis. The relationship between district-level drug deaths and subsequent sponsorship of treatment-oriented le...

Journal of Clinical Oncology, 2019

e13554 Background: Leptomeningeal carcinomatosis (LMC) is a complication of advanced malignancies... more e13554 Background: Leptomeningeal carcinomatosis (LMC) is a complication of advanced malignancies wherein primary tumors metastasize to the leptomeninges surrounding brain and spinal cord. LMC complicates 4-15% of malignant solid tumors with incidence increasing as survival of patients with advanced cancer improves. Diagnostic methods include magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) cytology. MRI findings may be nonspecific, and the gold standard of diagnosis is malignant cytology on CSF analysis. We assessed detection methods, incidence, and outcomes of LMC at The Ohio State University Comprehensive Cancer Center from 2005-2015. Methods: This was an IRB-approved single-institution retrospective study of 160 patients with confirmed diagnosis of LMC who were treated at the OSUCCC-James between Jan 1, 2005 and Dec 31, 2015. Patients with hematologic and central nervous system malignancies were excluded. Descriptive statistics were used to summarize demographic an...

Journal of the National Comprehensive Cancer Network, 2019

Background: Invasive lobular carcinoma (ILC) accounts for 5%–15% of all invasive breast cancer ca... more Background: Invasive lobular carcinoma (ILC) accounts for 5%–15% of all invasive breast cancer cases. ILC has the propensity for distant late recurrence with widespread metastatic disease. To our knowledge, there is limited data on the clinical outcomes and treatment strategies of metastatic ILC. This retrospective study evaluates the overall survival (OS) and progression-free survival (PFS) in the metastatic ILC population at a single institution, focusing on first line treatment received in the metastatic setting. Methods: A retrospective chart review was performed on patients (Pts) diagnosed with metastatic ILC diagnosed at The Ohio State University Comprehensive Cancer Center between January 1, 2004 and December 31, 2014 using an IRB approved protocol. Patient demographics, clinical characteristics, and treatment modalities were summarized with descriptive statistics. OS (time from metastasis to death or last known follow-up) and PFS (time from diagnosis of metastasis to progres...

Political Behavior, 2019

Social media has increasingly enabled "fake news" to circulate widely, most notably during the 20... more Social media has increasingly enabled "fake news" to circulate widely, most notably during the 2016 U.S. presidential campaign. These intentionally false or misleading stories threaten the democratic goal of a well-informed electorate. This study evaluates the effectiveness of strategies that could be used by Facebook and other social media to counter false stories. Results from a pre-registered experiment indicate that false headlines are perceived as less accurate when people receive a general warning about misleading information on social media or when specific headlines are accompanied by a "Disputed" or "Rated false" tag. Though the magnitudes of these effects are relatively modest, they generally do not vary by whether headlines were congenial to respondents' political views. In addition, we find that adding a "Rated false" tag to an article headline lowers its perceived accuracy more than adding a "Disputed" tag (Facebook's original approach) relative to a control condition. Finally, though exposure to the "Disputed" or "Rated false" tags did not affect the perceived accuracy of unlabeled false or true headlines, exposure to a general warning decreased belief in the accuracy of true headlines, suggesting the need for further research into how to most effectively counter false news without distorting belief in true information.

Journal of Clinical Oncology, 2016

202 Background: Posttraumatic stress disorder (PTSD) is associated with morbidity and mortality i... more 202 Background: Posttraumatic stress disorder (PTSD) is associated with morbidity and mortality in affected populations. Cancer survivors experience PTSD at a rate higher than the general population, with young age and female gender identified as risk factors. While young women with breast cancer experience greater psychosocial distress in general following diagnosis (dx), little is known about PTSD in this population. Methods: Women dx’d with Stage I-III breast cancer at age ≤ 40 were surveyed as a part of a multi-site cohort study. Demographic, treatment, psychosocial characteristics (including self-reported psychiatric conditions and use of psychiatric medications prior to dx), anxiety and depression (Hospital Anxiety and Depression Scale), fear of recurrence (Lasry Scale), and social support (Medical Outcomes Study) were assessed within 1 year after dx. PTSD was measured at 30 months post-dx using the PTSD Checklist – Civilian Version; a score ≥ 50 was considered positive for PT...

Lecture Notes in Computer Science, 2015

This paper describes the LuminUs-a device that we designed in order to explore how new technologi... more This paper describes the LuminUs-a device that we designed in order to explore how new technologies could influence the interpersonal aspects of co-present musical collaborations. The LuminUs uses eye-tracking headsets and small wireless accelerometers to measure the gaze and body motion of each musician. A small light display then provides visual feedback to each musician, based either on the gaze or the body motion of their co-performer. We carried out an experiment with 15 pairs of music students in order to investigate how the LuminUs would influence their musical interactions. Preliminary results suggest that visual feedback provided by the LuminUs led to significantly increased glancing between the two musicians, whilst motion based feedback appeared to lead to a decrease in body motion for both participants.

Cancer Research, 2015

Background: There is an increasing recognition that many young women with breast cancer will have... more Background: There is an increasing recognition that many young women with breast cancer will have favorable outcomes without chemotherapy. We sought to characterize decision-making surrounding adjuvant chemotherapy treatment (CT) in this population for whom chemotherapy has historically been a standard of care. Methods: As part of an ongoing, multi-center, prospective cohort of young women diagnosed with breast cancer at age 40 and younger, we identified 657 women with Stage I-III breast cancer. Participants were asked to complete surveys by mail that included questions about socio-demographics, decision-making, and treatment history within the first year following diagnosis. Tumor characteristics were ascertained via pathology and medical record review. We used Chi-square tests to compare: decisional involvement (patient-driven vs. shared vs. physician-driven), degree of confidence, and feeling informed about the CT decision (the latter two measured on a 0-10 scale, categorized as ...

When developing public installations, interaction designers are able to utilise increasingly natu... more When developing public installations, interaction designers are able to utilise increasingly natural modes of expression such as speech, gesture and touch. Conversely the resulting installations often place users in situations where they are confronted with entirely unnatural forms of interaction. How do we establish an understanding of peoples' behaviour in such situations, and what bearing could this have on the design of better interactive experiences? This paper addresses these questions, drawing upon a study of a high profile installation that invited members of the public to control the lights on the London Eye using hand movements and heart rate measurements.

Psycho-Oncology, 2015

Objective: Using a large prospective cohort of women age 40 or younger diagnosed with breast canc... more Objective: Using a large prospective cohort of women age 40 or younger diagnosed with breast cancer, we examined the relationship between perceived partner support and anxiety. Methods: Six hundred seventy-five young women with breast cancer Stages I-III, median age 36, completed a self-report baseline questionnaire. Perceived partner support was assessed using items extracted from the marital subscale of the Cancer Rehabilitation Evaluation System; generalized social support was assessed with the Medical Outcomes Study-Social Support Survey. Anxiety was measured using the anxiety subscale of the Hospital Anxiety and Depression Scale. Multivariable logistic regression analyses evaluated the association between partner support, other sociodemographic factors, and anxiety. Results: Mean age at diagnosis was 35.4 years. Fourteen percent of the women were not partnered, and among those who were partnered or in a significant relationship, 20% were categorized as unsupported. In univariate and multivariable analysis adjusting for sociodemographic factors, women in an unsupported-partnered relationship had higher odds of anxiety symptoms compared with women in a supported-partnered relationship. Young age and being financially insecure were also both independently associated with anxiety. Conclusions: Our findings suggest that partner support may play a key role in a young woman's adjustment to a serious stressor such as breast cancer. In addition, younger age increases vulnerability to anxiety as does struggling with finances. Because supportive efforts of a partner have potential to protect against the impact of stress, interventions to enhance partner support and reduce anxiety might be beneficial to address challenges experienced as a couple in this setting.