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Article ; Online: Applications of Immunohistochemistry to Endocrine Pathology.

Higgins, Sara E / Barletta, Justine A

2018 Volume 25, Issue 6, Page(s) 413–429

Abstract: The role of immunohistochemistry (IHC) in endocrine pathology is similar to that in other organ systems in that it can aid in the subclassification of tumors within an organ, confirm site of primary in metastatic disease, provide prognostic information, ... ...

Abstract	The role of immunohistochemistry (IHC) in endocrine pathology is similar to that in other organ systems in that it can aid in the subclassification of tumors within an organ, confirm site of primary in metastatic disease, provide prognostic information, identify underlying genetic alterations, and predict response to treatment. Although most endocrine tumors do not require IHC to render a diagnosis, there are certain scenarios in which IHC can be extremely helpful. For example, in thyroid, IHC can be used to support tumor dedifferentiation, in the adrenal it can aid in the diagnosis of low-grade adrenocortical carcinomas, and in paragangliomas it can help identify tumors arising as part of an inherited tumor syndrome. This review will focus on the applications of IHC in tumors of the thyroid, parathyroids, adrenals, and paraganglia in adults.
MeSH term(s)	Adrenal Gland Neoplasms/diagnosis ; Adrenal Gland Neoplasms/metabolism ; Adrenal Gland Neoplasms/pathology ; Biomarkers, Tumor/metabolism ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Parathyroid Neoplasms/diagnosis ; Parathyroid Neoplasms/metabolism ; Parathyroid Neoplasms/pathology ; Thyroid Neoplasms/diagnosis ; Thyroid Neoplasms/metabolism ; Thyroid Neoplasms/pathology
Chemical Substances	Biomarkers, Tumor
Language	English
Publishing date	2018-08-29
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1212493-x
ISSN	1533-4031 ; 1072-4109
ISSN (online)	1533-4031
ISSN	1072-4109
DOI	10.1097/PAP.0000000000000209
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Article ; Online: Can Cytologic and Sonographic Features Help Prevent Overtreatment of Bethesda V Thyroid Nodules?

Higgins, Sara / James, Benjamin C / Sacks, Barry / Mowschenson, Peter / Nishino, Michiya / Hasselgren, Per-Olof

The Journal of surgical research

2021 Volume 268, Page(s) 112–118

Abstract: Background: Although nearly half of thyroid nodules with Bethesda V cytology (suspicious for malignancy) may be benign or harbor low-grade neoplasms that can be sufficiently treated with lobectomy, many patients with Bethesda V cytology continue to be ... ...

Abstract	Background: Although nearly half of thyroid nodules with Bethesda V cytology (suspicious for malignancy) may be benign or harbor low-grade neoplasms that can be sufficiently treated with lobectomy, many patients with Bethesda V cytology continue to be treated with total thyroidectomy. The objectives of this study were to establish whether cytomorphologic and ultrasonographic features can determine appropriate surgery for thyroid nodules with Bethesda V cytology and how often patients are overtreated with total instead of partial thyroidectomy. Methods: Utilizing a 10-y prospective database starting January 1, 2004, cytomorphologic and ultrasonographic features of thyroid nodules with Bethesda V cytology were reviewed. Overtreatment was defined as total thyroidectomy when histopathology revealed benign nodule, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) or a unilateral < 4 cm low risk cancer. Results: Sixty-three patients were included in the study. Seventeen (27%) had benign, 14 (22%) NIFTP, and 32 (51%) malignant nodules. On cytology, nuclear pseudoinclusions, and on ultrasound, taller-than-wide configuration, were more common in malignant than benign or NIFTP nodules. Among 56 patients who underwent total thyroidectomy, 14 and 11 had a benign or NIFTP nodule, respectively, and 13 had a unilateral < 4 cm low risk cancer, suggesting that 68% (38/56) were overtreated. Conclusions: Total thyroidectomy for Bethesda V thyroid nodules may result in overtreatment in more than half of the patients. Although certain cytomorphologic and ultarsonographic features may be helpful in determining appropriate surgery for Bethesda V thyroid nodules, additional characteristics are needed to reduce overtreatment of these nodules.
MeSH term(s)	Adenocarcinoma, Follicular/diagnostic imaging ; Adenocarcinoma, Follicular/pathology ; Adenocarcinoma, Follicular/surgery ; Biopsy, Fine-Needle ; Humans ; Overtreatment ; Retrospective Studies ; Thyroid Neoplasms/diagnostic imaging ; Thyroid Neoplasms/pathology ; Thyroid Neoplasms/surgery ; Thyroid Nodule/diagnostic imaging ; Thyroid Nodule/pathology ; Thyroid Nodule/surgery
Language	English
Publishing date	2021-07-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2021.05.050
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Article ; Online: Vascular invasion predicts the subgroup of lung adenocarcinomas ≤2.0 cm at risk of poor outcome treated by wedge resection compared to lobectomy.

Ma, Lina / Sullivan, Travis B / Rieger-Christ, Kimberly M / Yambayev, Ilyas / Zhao, Qing / Higgins, Sara E / Yilmaz, Osman H / Sultan, Lila / Servais, Elliot L / Suzuki, Kei / Burks, Eric J

JTCVS open

2023 Volume 16, Page(s) 938–947

Abstract: Background: Recent randomized control trials (JCOG0802 and CALGB140503) have shown sublobar resection to be noninferior to lobectomy for non-small cell lung cancer (NSCLC) ≤2.0 cm. We have previously proposed histologic criteria stratifying lung ... ...

Abstract	Background: Recent randomized control trials (JCOG0802 and CALGB140503) have shown sublobar resection to be noninferior to lobectomy for non-small cell lung cancer (NSCLC) ≤2.0 cm. We have previously proposed histologic criteria stratifying lung adenocarcinoma into indolent low malignant potential (LMP) and aggressive angioinvasive adenocarcinomas, resulting in better prognostication than provided by World Health Organization grade. Here we determine whether pathologic classification is reproducible and whether subsets of adenocarcinomas predict worse outcomes when treated by wedge resection compared to lobectomy. Methods: A retrospective cohort of 108 recipients of wedge resection and 187 recipients of lobectomy for stage I/0 lung adenocarcinomas ≤2.0 cm was assembled from 2 institutions. All tumors were classified by a single pathologist, and interobserver reproducibility was assessed in a subset (n = 92) by 5 pathologists. Results: Angioinvasive adenocarcinoma (21%-27% of cases) was associated with worse outcomes when treated with wedge resection compared to lobectomy (5-year recurrence-free survival, 57% vs 85% [ Conclusions: The majority (∼75%) of lung adenocarcinomas ≤2 cm are adequately managed with wedge resection; however, angioinvasive adenocarcinomas (∼25%) treated by wedge resection with suboptimal nodal sampling exhibit poor outcomes, with a 40% to 45% rate of recurrence within 5 years and 60% to 65% overall mortality at 7 years.
Language	English
Publishing date	2023-11-13
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-2736
ISSN (online)	2666-2736
DOI	10.1016/j.xjon.2023.11.003
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Article: Disease investigations for equine infectious anemia in Canada (2009-2012) - Retrospective evaluation and risk factor analysis.

Lohmann, Katharina L / James, Carolyn R / Higgins, Sara N / Howden, Krista J / Epp, Tasha

The Canadian veterinary journal = La revue veterinaire canadienne

2019 Volume 60, Issue 11, Page(s) 1199–1206

Abstract: This retrospective study describes the detection of equine infectious anemia (EIA) during Canadian Food Inspection Agency (CFIA) disease investigations in Canada, examines aspects of importance for disease control, and evaluates potential animal-level ... ...

Abstract	This retrospective study describes the detection of equine infectious anemia (EIA) during Canadian Food Inspection Agency (CFIA) disease investigations in Canada, examines aspects of importance for disease control, and evaluates potential animal-level risk factors for EIA in high-risk horses. Based on review of all EIA-positive samples and all samples collected during disease investigations (N = 4553) over a 4-year period (2009 to 2012), 409 EIA cases were detected. Horse owners with EIA cases owned between 1 and 60 affected animals, and 49 horses seroconverted during a disease investigation period. Twenty-nine percent of cases (
MeSH term(s)	Animals ; Canada ; Equine Infectious Anemia ; Factor Analysis, Statistical ; Horses ; Infectious Anemia Virus, Equine ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2019-11-06
Publishing country	Canada
Document type	Journal Article
ZDB-ID	41603-4
ISSN	0008-5286
ISSN	0008-5286
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Article ; Online: Tall Cell Variant of Papillary Thyroid Carcinoma: Impact of Change in WHO Definition and Molecular Analysis.

Wong, Kristine S / Higgins, Sara E / Marqusee, Ellen / Nehs, Matthew A / Angell, Trevor / Barletta, Justine A

Endocrine pathology

2018 Volume 30, Issue 1, Page(s) 43–48

Abstract: The morphologic criteria for tall cell variant (TCV) of papillary thyroid carcinoma (PTC) were modified in the 2017 WHO Classification of Tumors of Endocrine Organs, with a decrease in the requirements for both the height of cells and in the percentage ... ...

Abstract	The morphologic criteria for tall cell variant (TCV) of papillary thyroid carcinoma (PTC) were modified in the 2017 WHO Classification of Tumors of Endocrine Organs, with a decrease in the requirements for both the height of cells and in the percentage of tumor demonstrating a tall cell morphology. The aim of this study was to determine if the change in criteria would result in a significant increase in the percentage of tumors that meet criteria for TCV. In addition, we evaluated the correlation between morphology, molecular alterations, and clinical behavior of TCV. We studied three cohorts to evaluate the above stated questions. The first cohort was comprised of 97 PTC consecutively resected over a 12-month period that were originally diagnosed as classic PTC, PTC with tall cell features, or TCV. Tumor slides of each case were reviewed to determine the percentage of the tall cell component (< 30%, 30-49%, and > 50%) and the height of the cells in this component. This cohort was evaluated to determine if the change in WHO criteria would result in a significant increase in the percentage of tumors that meet criteria for TCV. Our second cohort consisted of nine consecutively resected PTC with a tall cell component > 30% (with tall cells defined as at least 2-3× as tall as wide) that had molecular characterization through a targeted, next-generation sequencing (NGS) assay. The molecular characteristics were correlated with the percentage of the tall cell component. Finally, a third cohort comprised of seven clinically aggressive TCV (defined as those with T4 disease, disease recurrence, or subsequent tumor dedifferentiation) was evaluated to determine histologic and molecular characteristics. In cohort 1, the number of cases classified as TCV increased significantly with the change in definition of TCV: 8 (8%) cases met the previous criteria for TCV (cells 3× as tall as wide in > 50% of the tumor), whereas 24 (25%) cases met the new 2017 WHO criteria (cells 2-3× as tall as wide in > 30% of the tumor) (p = 0.0020). Molecular analysis of cohort 2 revealed that all 9 cases harbored a BRAF V600E mutation. Pathogenic secondary mutations were absent in cases with < 50% tall cells, but they were detected in 2 (33%) of 6 cases with > 50% tall cells (2 cases with TERT promoter mutations, including 1 that also had an AKT2 mutation). Histologic and molecular analysis of the clinically aggressive cohort (cohort 3), revealed that all cases had > 50% tall cells and 3 (43%) had secondary oncogenic mutations (all TERT promoter mutations). We found that the modified morphologic criteria put forth in the 2017 WHO tripled the number of cases that would be classified as TCV. Moreover, clinically aggressive tumors and those harboring secondary oncogenic mutations all had a tall cell component > 50%. Additional large multi-institutional studies incorporating clinical outcome and molecular data would be valuable to determine the best histologic definition of TCV.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Pathology, Molecular ; Thyroid Cancer, Papillary/metabolism ; Thyroid Cancer, Papillary/pathology ; Thyroid Gland/metabolism ; Thyroid Gland/pathology ; Thyroid Neoplasms/metabolism ; Thyroid Neoplasms/pathology ; World Health Organization ; Young Adult
Language	English
Publishing date	2018-12-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1033267-4
ISSN	1559-0097 ; 1046-3976
ISSN (online)	1559-0097
ISSN	1046-3976
DOI	10.1007/s12022-018-9561-4
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Article: A retrospective study of owner-requested testing as surveillance for equine infectious anemia in Canada (2009-2012).

Higgins, Sara N / Howden, Krista J / James, Carolyn R / Epp, Tasha / Lohmann, Katharina L

The Canadian veterinary journal = La revue veterinaire canadienne

2017 Volume 58, Issue 12, Page(s) 1294–1300

Abstract: This retrospective study was undertaken to estimate i) the surveillance coverage for equine infectious anemia (EIA) based on owner-requested testing, and ii) the incidence of case detection from this surveillance activity to inform a review of Canada's ... ...

Abstract	This retrospective study was undertaken to estimate i) the surveillance coverage for equine infectious anemia (EIA) based on owner-requested testing, and ii) the incidence of case detection from this surveillance activity to inform a review of Canada's national disease control strategy. Based on sample submissions by accredited veterinarians to laboratories CFIA-approved for EIA testing between 2009 and 2012, the estimated national surveillance coverage was 14% for all years, and 72 cases of EIA were detected. The annual national incidence of EIA detection ranged from 0.03 to 0.08 cases/1000 horses. On average, a greater proportion of the horse population was tested in eastern Canada (32%) than in western Canada (6%,
MeSH term(s)	Animals ; Canada/epidemiology ; Equine Infectious Anemia/diagnosis ; Equine Infectious Anemia/epidemiology ; Equine Infectious Anemia/prevention & control ; Horses ; Incidence ; Population Surveillance ; Retrospective Studies
Language	English
Publishing date	2017-12
Publishing country	Canada
Document type	Journal Article
ZDB-ID	41603-4
ISSN	0008-5286
ISSN	0008-5286
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Article ; Online: A potential diagnostic pitfall for hobnail variant of papillary thyroid carcinoma.

Wong, Kristine S / Chen, Tiffany Y / Higgins, Sara E / Howitt, Brooke E / Lorch, Jochen H / Alexander, Erik K / Marqusee, Ellen / Cho, Nancy L / Nehs, Matthew A / Doherty, Gerard M / Barletta, Justine A

Histopathology

2020 Volume 76, Issue 5, Page(s) 707–713

Abstract: Aims: Hobnail variant of papillary thyroid carcinoma (PTC) is an aggressive PTC subtype characterised by a hobnail cytomorphology. However, some classic PTC have a 'hobnail-like' cytomorphology associated with thick, hyalinised, variably oedematous ... ...

Abstract	Aims: Hobnail variant of papillary thyroid carcinoma (PTC) is an aggressive PTC subtype characterised by a hobnail cytomorphology. However, some classic PTC have a 'hobnail-like' cytomorphology associated with thick, hyalinised, variably oedematous fibrovascular cores that appears to be a form of ischaemic/degenerative atypia. Methods and results: We studied three cohorts to compare the histopathological characteristics and clinical outcome of 'hobnail-like' classic PTC and true hobnail variant of PTC: cohort 1, PTC consecutively resected between 2016 and 2017 (to assess frequency of 'hobnail-like' cytomorphology); cohort 2, 20 'hobnail-like' classic PTC resected between 2005 and 2007 (to assess clinical outcome); and cohort 3, seven true hobnail variant of PTC. A 'hobnail-like' cytomorphology was identified in 16% of consecutively resected PTC. Compared with true hobnail variant, 'hobnail-like' classic PTC occurred in younger patients (mean age 40 years versus 68 years, P < 0.001), were smaller tumours (mean tumour size 2.1 cm versus 4.4 cm, P < 0.001), had a lower rate of gross extrathyroidal extension (0% versus 71%, P < 0.001), had a lower proliferative rate (≥3 mitoses per 10 high-power fields seen in 0% versus 71%, P < 0.001; Ki67 index ≥5% in 0% versus 86%, P < 0.001), a lower rate of secondary pathogenic mutations (for cases with molecular data, 0% versus 100%, P = 0.0061) and improved survival (for cases with sufficient clinical outcome data, 10-year disease-free survival of 93% versus 0%, P = 0.0016). Conclusion: Classic PTC can show ischaemic/degenerative atypia that mimics the hobnail cytomorphology of true hobnail variant; however, these tumours lack aggressive histopathological features and pursue an indolent clinical course.
MeSH term(s)	Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Thyroid Cancer, Papillary/pathology ; Thyroid Neoplasms/pathology ; Young Adult
Language	English
Publishing date	2020-04-13
Publishing country	England
Document type	Journal Article
ZDB-ID	131914-0
ISSN	1365-2559 ; 0309-0167
ISSN (online)	1365-2559
ISSN	0309-0167
DOI	10.1111/his.14042
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Article ; Online: Distinctive pseudopalisaded histiocytic hyperplasia characterizes the transition of exudative to proliferative phase of diffuse alveolar damage in patients dying of COVID-19.

Kritselis, Michael / Yambayev, Ilyas / Prilutskiy, Andrey / Shevtsov, Artem / Vadlamudi, Charitha / Zheng, Hanqiao / Elsadwai, Murad / Ma, Lina / Aniskovich, Emily / Kataria, Yachana / Higgins, Sara / Sarita-Reyes, Carmen / Zuo, Tao / Zhao, Qing / Quillen, Karen / Burks, Eric J

Human pathology

2021 Volume 116, Page(s) 49–62

Abstract: Severe COVID-19 results in a glucocorticoid responsive form of acute respiratory distress (ARDS)/diffuse alveolar damage (DAD). Herein we compare the immunopathology of lung tissue procured at autopsy in patients dying of SARS-CoV-2 with those dying of ... ...

Abstract	Severe COVID-19 results in a glucocorticoid responsive form of acute respiratory distress (ARDS)/diffuse alveolar damage (DAD). Herein we compare the immunopathology of lung tissue procured at autopsy in patients dying of SARS-CoV-2 with those dying of DAD prior to the COVID-19 pandemic. Autopsy gross and microscopic features stratified by duration of illness in twelve patients who tested positive for SARS-CoV-2 viral RNA, as well as seven patients dying of DAD prior to the COVID-19 pandemic were evaluated with multiplex (5-plex: CD4, CD8, CD68, CD20, AE1/AE3) and SARS-CoV immunohistochemistry to characterize the immunopathologic stages of DAD. We observed a distinctive pseudopalisaded histiocytic hyperplasia interposed between the exudative and proliferative phase of COVID-19 associated DAD, which was most pronounced at the fourth week from symptom onset. Pulmonary macrothrombi were seen predominantly in cases with pseudopalisaded histiocytic hyperplasia and/or proliferative phase DAD. Neither pseudopalisaded histiocytic hyperplasia nor pulmonary macrothrombi was seen in non-COVID-19 DAD cases, whereas microthrombi were common in DAD regardless of etiology. The inflammatory pattern of pseudopalisaded histiocytic hyperplasia may represent the distinctive immunopathology associated with the dexamethasone responsive form of DAD seen in severe COVID-19.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; COVID-19/pathology ; Cell Proliferation/physiology ; Female ; Histiocytes/pathology ; Humans ; Hyperplasia/pathology ; Lung/pathology ; Male ; Middle Aged ; Pulmonary Alveoli/pathology
Language	English
Publishing date	2021-07-14
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	207657-3
ISSN	1532-8392 ; 0046-8177
ISSN (online)	1532-8392
ISSN	0046-8177
DOI	10.1016/j.humpath.2021.06.008
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Article ; Online: Pulmonary Adenocarcinomas of Low Malignant Potential: Proposed Criteria to Expand the Spectrum Beyond Adenocarcinoma In Situ and Minimally Invasive Adenocarcinoma.

Yambayev, Ilyas / Sullivan, Travis B / Suzuki, Kei / Zhao, Qing / Higgins, Sara E / Yilmaz, Osman H / Litle, Virginia R / Moreira, Paulo / Servais, Elliot L / Stock, Cameron T / Quadri, Syed M / Williamson, Christina / Rieger-Christ, Kimberly M / Burks, Eric J

The American journal of surgical pathology

2020 Volume 45, Issue 4, Page(s) 567–576

Abstract: Lung cancer screening has improved mortality among high-risk smokers but has coincidentally detected a fraction of nonprogressive adenocarcinoma historically classified as bronchoalveolar carcinoma (BAC). In the National Lung Screening Trial (NLST) the ... ...

Abstract	Lung cancer screening has improved mortality among high-risk smokers but has coincidentally detected a fraction of nonprogressive adenocarcinoma historically classified as bronchoalveolar carcinoma (BAC). In the National Lung Screening Trial (NLST) the majority of BAC-comprising 29% of computed tomography-detected stage I lung adenocarcinoma-were considered overdiagnosis after extended follow-up comparison with the control arm. In the current classification, adenocarcinoma in situ and minimally invasive adenocarcinoma have replaced BAC but together comprise only ∼5% of stage I lung adenocarcinoma. Lepidic and subsets of papillary and acinar adenocarcinoma also infrequently recur. We, therefore, propose criteria for low malignant potential (LMP) adenocarcinoma among nonmucinous adenocarcinoma measuring ≤3 cm in total, exhibiting ≥15% lepidic growth, and lacking nonpredominant high-grade patterns (≥10% cribriform, ≥5% micropapillary, ≥5% solid), >1 mitosis per 2 mm2, angiolymphatic or visceral pleural invasion, spread through air spaces or necrosis. We tested these criteria in a multi-institutional cohort of 328 invasive stage I (eighth edition) and in situ adenocarcinomas and observed 16% LMP and 7% adenocarcinoma in situ/minimally invasive adenocarcinoma which together (23%) approximated the frequency of overdiagnosed stage I BAC in the NLST. The LMP group had 100% disease-specific survival. The proposed LMP criteria, incorporating multiple histologic parameters, may be a clinically useful "low-grade" prognostic group. Validation of these criteria in additional retrospective cohorts and prospective screen-detected cohorts should be considered.
MeSH term(s)	Adenocarcinoma in Situ/mortality ; Adenocarcinoma in Situ/pathology ; Adenocarcinoma in Situ/surgery ; Adenocarcinoma of Lung/mortality ; Adenocarcinoma of Lung/pathology ; Adenocarcinoma of Lung/surgery ; Aged ; Databases, Factual ; Female ; Humans ; Lung Neoplasms/mortality ; Lung Neoplasms/pathology ; Lung Neoplasms/surgery ; Male ; Middle Aged ; Mitosis ; Neoplasm Grading ; Neoplasm Invasiveness ; Neoplasm Staging ; Retrospective Studies ; Tumor Burden ; United States
Language	English
Publishing date	2020-11-11
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	752964-8
ISSN	1532-0979 ; 0147-5185
ISSN (online)	1532-0979
ISSN	0147-5185
DOI	10.1097/PAS.0000000000001618
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Article: Effect of pretreatment distress on daily fatigue after chemotherapy for breast cancer.

Higgins, Sara C / Montgomery, Guy H / Raptis, George / Bovbjerg, Dana H

Journal of oncology practice

2010 Volume 4, Issue 2, Page(s) 59–63

Abstract: Purpose: Fatigue is one of the most frequently reported and adverse effects of cancer chemotherapy. The present study tested the hypothesis that women's levels of emotional distress at the time of their initial outpatient chemotherapy treatment would ... ...

Abstract	Purpose: Fatigue is one of the most frequently reported and adverse effects of cancer chemotherapy. The present study tested the hypothesis that women's levels of emotional distress at the time of their initial outpatient chemotherapy treatment would predict the severity of their postinfusion fatigue. Methods: Sixty stage I (32.6%) and II (67.4%) patients with breast cancer (mean age, 44.5 years) who were receiving standard outpatient chemotherapy participated. The independent variable, emotional distress, was assessed for "last night," "this morning," and "right now" with a visual analog scale (0 to 100). The dependent variable, post-treatment fatigue (PTF), was assessed (0 to 100) over each of the subsequent 6 days using end-of-day diaries, which also included assessments of distress and nausea (0 to 100). For the statistical analyses, post-treatment fatigue was divided into three phases with means calculated for days 1 through 2 (phase 1), 3 to 4 (phase 2), and 5 to 6 (phase 3). Results: Consistent with the study hypothesis, patients' pretreatment distress level in the clinic was a significant (P < .001) predictor of PTF. There was also a significant (P < .025) interaction with phase, with distress becoming a predictor of PTF after phase 1. Multivariate analysis indicated that prior levels of distress were not independent predictors of PTF. Conclusions: This study is the first to demonstrate time-specific effects of pretreatment distress on PTF. Possible mechanisms of these effects now warrant investigation, as do possible benefits of brief interventions to reduce patient distress immediately before treatment.
Language	English
Publishing date	2010-09-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2236338-5
ISSN	1935-469X ; 1554-7477
ISSN (online)	1935-469X
ISSN	1554-7477
DOI	10.1200/JOP.0822002
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