Purpose Our analysis follows the implementation of Public Law 107–260, the Benign Brain Tumor Cancer Registries Act mandating collection of non-malignant brain tumors including meningiomas. Methods Meningiomas were selected from the Surveillance, Epidemiology, and End Results (SEER) Program database for 2004–2011. Demographic and clinical characteristics, initial treatment patterns, and survival outcomes were evaluated. Results The average annual age-adjusted incidence rates were 7.62 per 100,000 population, 7.50 non-malignant (7.18 benign; 0.32 borderline malignancy), and 0.12 malignant. Annual rates increased for benign and borderline malignancy but decreased for malignant tumors. Female rates exceeded male rates and were even twice those for benign tumors. Black rates were significantly higher than other races for all three behavior types. Rates increased with advancing age. More than 80% tumors were located in cerebral meninges. Diagnostic confirmation through pathology occurred for about 50% benign, 90% borderline malignancy, and 80% malignant tumors. No initial treatment was reported for approximately 60% benign, 30% borderline malignancy, and 30% malignant meningiomas. Five-year relative survival estimates for benign, borderline malignancy, and malignant were 85.6%, 82.3%, and 66.0%, respectively. Predictors of poorer survival were advanced age, male, black race, no initial treatment, and malignant behavior whereas younger age, female, spinal meningioma, any initial treatment and benign or borderline malignancy were associated with better survival. Conclusion Our analysis demonstrates an increasing incidence of non-malignant meningiomas at the population level. Treatment patterns and survival outcomes is concerning for a substantial percentage not receiving surgical or radiation treatments for higher grade meningiomas.

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Cardiac injury is a major cause of death in cancer survivors, and biomarkers for it are detectable only after tissue injury has occurred. Extracellular vesicles (EV) remove toxic biomolecules from tissues and can be detected in the blood. Here, we evaluate the potential of using circulating EVs as early diagnostic markers for long-term cardiac injury. Using a mouse model of doxorubicin (DOX)-induced cardiac injury, we quantified serum EVs, analyzed proteomes, measured oxidized protein levels in serum EVs released after DOX treatment, and investigated the alteration of EV content. Treatment with DOX caused a significant increase in circulating EVs (DOX_EV) compared with saline-treated controls. DOX_EVs exhibited a higher level of 4-hydroxynonenal adducted proteins, a lipid peroxidation product linked to DOX-induced cardiotoxicity. Proteomic profiling of DOX_EVs revealed the distinctive presence of brain/heart, muscle, and liver isoforms of glycogen phosphorylase (GP), and their origins were verified to be heart, skeletal muscle, and liver, respectively. The presence of brain/heart GP (PYGB) in DOX_EVs correlated with a reduction of PYGB in heart, but not brain tissues. Manganese superoxide dismutase (MnSOD) overexpression, as well as pretreatment with cardioprotective agents and MnSOD mimetics, resulted in a reduction of EV-associated PYGB in mice treated with DOX. Kinetic studies indicated that EVs containing PYGB were released prior to the rise of cardiac troponin in the blood after DOX treatment, suggesting that PYGB is an early indicator of cardiac injury. EVs containing PYGB are an early and sensitive biomarker of cardiac injury. .

Glioblastoma in children is an aggressive disease with no defined standard therapy. We evaluated hospital‐based demographic and survival patterns obtained through the National Cancer Database to better characterize children with glioblastoma. Our study identified 1173 patients from 0 to 19 years of age between 1998 and 2011. Comparisons were made among demographics, clinical characteristics, treatment, and survival variables. Fifty‐four percent of patients were over 10 years of age. Approximately 80% of patients underwent either partial or complete resection. Adjuvant therapy was used variably, and its use increased with patient age. Forty‐eight percent of patients received the combination of surgery, radiation, and chemotherapy, and 4% did not receive any treatment. As expected, patients ≤5 years of age had better 5‐year survival than those ages 6–10 (P = 0.01) or 11–19 years (P = 0.0077). Other factors associated with poor survival included black race and central tumor location. Better outcomes were associated with treatment that included surgery, radiotherapy, and chemotherapy compared to any other treatment combinations. Radiotherapy had no impact on survival in the 0 to 10‐year‐old age group, but was associated with improved survival for patients 11–19 years. We report an extensive demographic and survival analysis of pediatric glioblastoma. The observed differences likely reflect variances in tumor biology and likelihood of treatment receipt. Improved survival was associated with the use of surgery, radiotherapy, and chemotherapy. Radiation therapy was not associated with survival in patients younger than 10 years of age.

Purpose Uptake and completion of the 3-dose human papillomavirus (HPV) vaccine is important for the primary prevention of cervical cancer. However, HPV vaccination rates among adolescent females and young women remain low in certain geographic areas of the United States, including Appalachia. Although greater fatalistic beliefs have been previously associated with lower rates of preventive cancer behaviors among adults, little research exists on the impact of fatalism on HPV vaccination behaviors, especially among younger individuals. Therefore, the purpose of this study was to examine the association between fatalistic beliefs and completion of the full HPV vaccine series among young women, ages 18–26, in Appalachian Kentucky. Results Data from this study were from a baseline survey completed by 344 women randomized into a communication intervention trial focused on increasing adherence to the 3-dose HPV vaccine series. Principal components analysis was used to construct 2 fatalism-related subscales from 8 survey questions. Findings In a controlled analysis, 1 subscale—“lack of control over cancer”— was significantly associated with not completing the full HPV vaccine series. In a rural area that experiences higher rates of cervical cancer, poverty, limited access to health care, and negative cancer-related attitudes and experiences, fatalism may be common, even among young people. Conclusion Future educational and interventional research addressing fatalistic beliefs in a culturally sensitive manner may be warranted to improve HPV vaccination behaviors and impact cancer disparities among Appalachian women.

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Background We evaluated the American College of Surgeon’s National Cancer Data Base (NCDB) to describe current hospital-based epidemiologic frequency, survival, and patterns of care of pediatric medulloblastoma. Methods We analyzed NCDB 1998–2011 data on medulloblastoma for children ages 0–19 years using logistic and poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. Results 3,647 cases of medulloblastoma in those aged 0–19 years were identified. Chemotherapy was received by 79% and 74% received radiation, with 65% receiving both therapies. Those who received radiation were more likely to be older than four, while those who received chemotherapy were more likely to be age four and younger. Variables associated with receipt of neither radiation nor chemotherapy included age at diagnosis of <1 year, female gender, being of race other than black or white, having no insurance, and living in a residential area with a low level of high school graduates. Better overall survival was observed as age at diagnosis increased, in females, and having received radiation. Compared to medulloblastoma, NOS, better survival was observed for those with demoplastic medulloblastoma, with worse survival in those with large cell medulloblastoma. Conclusion Majority received multi- disciplinary therapy and radiation had the greatest effect on survival. Ages four and under were most likely to receive chemotherapy and least likely to receive radiation. Suboptimal treatment included 17.8% that did not receive chemotherapy, of which 11.8% received neither chemotherapy nor radiation. Disparities associated with medical access were characteristics for not receiving standard treatment, which resulted in poor outcome.

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