Medicine and Health Sciences Commons^™

Advanced Prognostic Modeling For Breast Cancer Patients: Leveraging Data-Driven Approaches For Survival Analysis, Theophilus Gyedu Baidoo

Theses and Dissertations

Breast cancer is the second most prevalent form of cancer in women in the United States. Each year, about 264,000 cases of breast cancer are diagnosed in women and of this number, about 42,000 women lose their lives as reported by the Centers for Disease Control and Prevention. Early detection and effective treatment are crucial for improving survival rates and reducing mortality. This study aimed to explore the influential factors that may risk the survival of women with the disease and compare their predictive abilities using several error and performance metrics. The study uses a dataset from the National Cancer …

Heparan Sulfate, A New Target For Platinum In Metastatic Tnbc, Samantha J. Katner

Theses and Dissertations

Abstract

Heparan Sulfate, A New Target for Platinum in Metastatic TNBC

Author: Samantha J. Katner, Ph.D.

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy

Virginia Commonwealth University, 2018

Advisor: Dr. Nicholas Farrell, Professor, Chemistry Department

Heparan sulfate proteoglycans (HSPGs), composed of the linear polysaccharide heparan sulfate (HS) conjugated to a protein core, are located on the cell surface and extracellular matrix. The HS chains display varying degrees of sulfation, which constitutes the molecular recognition motif for many HS-protein interactions. HSPGs, associated growth factors, and heparanase promote tumor progression by facilitating invasion, angiogenesis, …

The Impact Of False Positive Mammography Results On Breast Cancer Screening Intention Among Black Women, Deeonna E. Farr

Theses and Dissertations

Extensive research indicates that false-positive mammograms (FPM) have been associated with negative psychosocial and cancer-related beliefs, but only a handful of studies examine Black women’s reactions to this experience. Additionally, these studies do not investigate how organizational and provider-level factors in concert with individual patient characteristics shape Black women’s experiences and reactions to FPM results. The purpose of this study was to determine the impact of organizational, provider, and individual-level factors on the processes and outcomes associated with FPM results in Black women. This study had two specific aims:

1) To describe, using a mixed methods approach, the organizational and …

Chemotherapy Knowledge And Health Literacy Among Women With Breast Cancer, Pearman Detreville Parker

Theses and Dissertations

Chemotherapy education is imperative for patients to gain the knowledge to manage side effects, adhere to prescribed cycles, and recognize the severity of symptoms that require immediate provider contact. Two vital factors – the readability of teaching materials and the patient’s health literacy – must be considered during chemotherapy education. However, materials are often not assessed for readability. Further, the influence of a patient’s health literacy level and demographic factors on chemotherapy knowledge has not yet been investigated. The specific aims are to: (1) critique the readability and format of chemotherapy education materials; (2) explore how women with breast cancer …

Racial And Ethnic Differences In Receipt Of Immediate Breast Reconstruction Surgery: Do Hospital Characteristics Matter?, Jaya Shankar Khushalani

Theses and Dissertations

Immediate Breast Reconstruction Surgery (IBRS) is associated with better quality of life among women who undergo a mastectomy. Despite insurance coverage for IBRS, utilization of IBRS remains low. Data from publicly available sources for 2010-2012 are used to examine the association between hospital characteristics receipt of IBRS by patients. Minority-serving status, low bed size, for-profit ownership, non-teaching status, high competition, low density of plastic surgeons in the market and non-metropolitan location are associated with lower likelihood of receipt of IBRS.

Racial and ethnic minorities are less likely to receive IBRS. A mixed effects logistic regression model with interactions between Black/Hispanic …

The Impact Of Autoimmune Disease On Breast Cancer Survival, Samantha Truman

Theses and Dissertations

Background Breast cancer is the second leading cause of cancer death for women in developed countries, while autoimmune disease effects approximately 10 million people in the United States, of which approximately 80% are female. Both diseases are associated with hormonal risk factors and are related to the divergent effects of the cellular and humoral immunity that is associated with the T-helper 1 and T-helper 2 immune response. To investigate the potential implications that autoimmune disease may have on breast cancer-specific mortality, we have conducted a population-based retrospective cohort study of women who were diagnosed with breast cancer between January 1, …

The Impact Of Chemotherapy And Radiotherapy For Breast Cancer On Cognition And Functional Performance: A Comparative Analysis Of Survey Data Taken At Three Time Points Post-Treatment, Ann Marie Potter

Theses and Dissertations

Cognitive impairment related to treatment for breast cancer, affects as many as 75% of patients in study samples (Jansen, Cooper, Dodd & Miaskowski, 2011). Deficits in the cognitive domains of short-term memory, attention, speed of information processing, judgment, reasoning, spatial attention, and verbal memory have been documented. The extent to which these deficits impact functional performance within this population has not yet been quantified. The purpose of this study was to investigate the impact of breast cancer on self-reported cognition and functional performance in the six months post-completion in two groups of breast cancer survivors, a chemotherapy group and chemotherapy …

Development Of An Estrogen-Related Dietary Pattern And Lifestyle Score To Examine Breast Cancer Risk In Postmenopausal Women, Mark Andrew Guinter

Theses and Dissertations

Introduction: Studies examining the association between individual dietary components and breast cancer have been inconclusive. The use of dietary patterns is a holistic approach which may yield stronger associations. We sought to develop a dietary pattern based on an estrogen metabolite (EM) profile hypothesized to increase breast cancer risk (high unconjugated estradiol and low ratio of 2- to 16-hydroxylated EMs (2/16 ratio)). This estrogen-related dietary pattern (ERDP) was examined for associations with postmenopausal breast cancer in two study populations and was incorporated into an estrogen-related lifestyle score (ERLS) with other modifiable risk factors for breast cancer.

Methods: EM …

The Effect Of Depression And Antidepressants On Cost, Survival And Adherence To Hormone Therapy In Breast Cancer, Virginia Noxon

Theses and Dissertations

Introduction: Breast cancer patients with a depression diagnosis before or after cancer diagnosis have increased cost, shorter survival time and reduced adherence to hormone therapy. Treating depression in these patients should improve these outcomes; however, there is scarce literature on this topic. Currently, no study has determined the association of concurrent depression while adjusting for a history of depression or treating depression with antidepressants with cost, survival and adherence to hormone therapy. This study has two objectives: 1) to determine the association of concurrent depression with cost, survival and adherence to hormone therapy adjusting for a history of depression 2) …

"I Know I Can't Be The Only Lesbian Out There:" An Inductive Thematic Analysis Of A Virtual Community Of Lesbian Breast Cancer Survivors, Rachael Lynn Wandrey

Theses and Dissertations

Sexual minority women are at a significantly greater risk for developing breast cancer (BC) than heterosexual women. Little is known about the unique BC experiences of lesbian women. The present thesis describes the findings of an inductive thematic analysis of messages posted to a large lesbian-specific discussion forum found on breastcancer.org. Fifteen themes were identified, including privileging sensation over appearance, experiencing heterosexism in medical contexts, believing others perceive a lack of distress over breast loss because of patient’s lesbian sexual orientation, feeling pressure from surgeons to get reconstructive surgery, and viewing the BC journey as a sexual-identity disclosure crisis. In …

Immunotherapy Of Cancer: Reprogramming Tumor/Immune Cellular Crosstalk To Improve Anti-Tumor Efficacy, Kyle K. Payne

Theses and Dissertations

Immunotherapy of cancer has been shown to be promising in prolonging patient survival. However, complete elimination of cancer and life-long relapse-free survival remain to be major challenge for anti-cancer therapeutics. We have previously reported that ex vivo reprogramming of tumor-sensitized immune cells by bryostatin 1/ionomycin (B/I) and the gamma-chain (γ-c) cytokines IL-2, IL-7, and IL-15 resulted in the generation of memory T cells as well as CD25+ NKT cells and CD25+ NK cells. Adoptive cellular therapy (ACT) utilizing these reprogrammed immune cells protected FVBN202 mice from tumor challenge, and overcame the suppressive functions of myeloid-derived suppressor cells (MDSCs). We then …

Treatment Decision Making In African American Women Diagnosed With Advanced Breast Cancer, Dauphne Annette Sims

Theses and Dissertations

ABSTRACT

TREATMENT DECISION MAKING IN AFRICAN AMERICAN WOMEN DIAGNOSED WITH ADVANCED BREAST CANCER

by

Dauphne Annette Sims

When diagnosed with breast cancer African American women have more advanced stage breast disease and encounter disparities throughout the cancer care continuum. The process of making treatment decisions can widen or narrow disparities in health outcomes. The decision making process in African American women may be influenced by several dynamics that influence how treatment decisions are made and have been previously unexplained. Guided by the conceptual framework of Cultural Capital, this grounded theory study explored the treatment decision making process of 12 African …

The Cytotoxic Effect Of The Bcl-2 Family Of Proteins In Breast Cancer Cells, Yamileth Chin

Theses and Dissertations

Breast cancer is the second leading cause of death amongst women ages 20 to 59. Despite advancements in cancer therapies, more research is necessary to improve the diagnoses and treatment of several types of breast cancer. Paclitaxel (Taxol) is a commonly utilized anti-cancer drug for various types of solid tumors. However, the molecular mechanism utilized by paclitaxel to induce cell death is still elusive. Previous studies in our laboratory have shown that the pro-apoptotic BCL-2 family protein, BAK (BCL-2 homologous antagonist/killer) plays an important role in paclitaxel-induced cell death. In untreated breast cancer cells, BAK is associated with the anti-apoptotic …

Adhesion Molecule Regulation Of Regulatory T Cell Migration, Jessica Jean Loppnow

Theses and Dissertations

Regulatory T (Treg) cells mediate tumor immune evasion by suppressing anti-tumor effector T cell responses in peripheral lymphoid tissues and within the tumor. While elevated Treg cell numbers have been shown to correlate with increased tumor growth, mechanisms that regulate their distribution within secondary lymphoid tissue and tumor tissue are not well understood. L-selectin, an adhesion molecule constitutively expressed on all classes of leukocytes, functions early in the adhesion cascade and regulates the migration of lymphocytes to lymph nodes through high endothelial venules. In addition, L-selectin can mediate migration of lymphocytes to sites of inflammation by binding to ligands present …

Geographical Proximity To Health Facilities And Breast Cancer Morbidity And Mortality Among Women In South Carolina's Best Chance Network, Leepao Khang

Theses and Dissertations

Death rates for breast cancer have steadily decreased in women due to early detection, such as mammography, and improved treatments. Despite the benefit of mammography, many women are not up-to-date on screening and do not receive timely follow-up after abnormal mammogram finding. Breast cancer is a major contributor to morbidity and mortality among women in South Carolina. To reduce the disproportionate burden of breast cancer and cervical cancer among women in South Carolina, the South Carolina Best Chance Network (BCN) was established to provide service delivery and ensures timely and complete diagnostic follow-up and treatment initiation for underserved women.

The …

Examining The Role Of Electronic Medical Record Generated Provider Reminders On Provider Offering Of Breast Cancer Screening Services, Charles Beverley, Jr.

Theses and Dissertations

Introduction:Breast cancer affects the lives of millions of women each year in the United States. Early detection by mammography screening can reduce the risk for advanced stages of breast cancer and improve the probability of long-term survival in women. Electronic medical records (EMRs) have been identified as a successful approach for increasing the offering of preventive care in breast cancer. This study examines the impact of EMR usage, and EMR generated provider reminders on physician ordering or providing of mammography screenings.

Methods:This study used survey data from the 2008-2010 National Ambulatory Medical Care Survey (NAMCS). Our sample included non-federal office-based …

Characterizing The Role Of Nucleosome Remodeling Factor (Nurf) In Tumorigenesis And Metastatic Progression Using Mouse Models Of Breast Cancer., Suehyb Alkhatib

Theses and Dissertations

Increasingly the role of epigenetic machinery as a bridge between underlying DNA sequence and cellular phenotype is being discovered. The establishment of a myriad of unique cellular types sharing identical gene sequences in a multicellular organism gives a broad sense for the inherent role of epigenetic influence on cell differentiation. Importantly, the epigenetic mechanisms involved in establishing cell identity unsurprisingly contribute to diseased states, including cancer. Recent research continues to elucidate contributory roles of epigenetic mechanisms, such as DNA methylation, histone modification, and microRNA regulation, in human cancers. Additionally, chromatin remodelers, such as the Nucleosome Remodeling Factor (NURF), have been …

Radiation Sensitization Of Breast Cancer Cells By Vitamin D Through The Promotion Of Autophagic Cell Death, Eden Wilson

Theses and Dissertations

Radiation therapy is a widely used tool in cancer therapy and is frequently offered as the first line of treatment for cancers of the breast. While radiotherapy is often initially effective in killing tumor cells or suppressing their growth, there are factors that confer tumor cell resistance to irradiation. Development of resistance may lead to disease recurrence despite the use of surgery, chemotherapy and radiation therapy. A primary goal of the studies in Dr. Gewirtz’s laboratory is to develop strategies to overcome resistance to radiation (and chemotherapy) in breast cancer, with the ultimate goal of preventing or attenuating disease recurrence. …

Role Of Autophagy In Radiosensitization Of Breast Tumor Cells, Molly L. Bristol

Theses and Dissertations

In MCF-7 breast tumor cells, ionizing radiation promoted autophagy that was cytoprotective; pharmacological or genetic interference with autophagy induced by radiation resulted in growth suppression and/or cell killing (primarily by apoptosis). The hormonally active form of vitamin D, 1,25D3, also promoted autophagy in irradiated MCF-7 cells, sensitized the cells to radiation and suppressed the proliferative recovery that occurs after radiation alone. 1,25D3 also enhanced radiosensitivity and promoted autophagy in MCF7 cells that overexpress Her-2/neu as well as in p53 mutant Hs578t breast tumor cells. In contrast, 1,25D3 failed to alter radiosensitivity or promote autophagy in the BT474 breast tumor cell …

The Role Of Myeloid-Derived Suppressor Cells In The Immunotherapy Of Breast Carcinomas, Johanna Morales

Theses and Dissertations

Myeloid-derived suppressor cells (MDSC) are a heterogeneous population of immature cells at various stages of differentiation. These cells are broadly characterized by the simultaneous expression of the surface markers CD11b and Gr1 and have been found to accumulate in large numbers in response to many different tumors in both mice and humans, including HER2/neu+ breast cancers. The adoptive immunotherapy of cancers has been a promising field, yet the clinical efficacy of adoptive immunotherapies targeted against human breast cancers and many other cancers has been extremely limited. Given the influx of MDSC in tumor-bearing individuals, we hypothesized that these cells were …