The iTHRIV Commons: a cross-institution information and health research data sharing architecture and web application.

OBJECTIVE: The integrated Translational Health Research Institute of Virginia (iTHRIV) aims to develop an information architecture to support data workflows throughout the research lifecycle for cross-state teams of translational researchers. MATERIALS AND METHODS: The iTHRIV Commons is a cross-state harmonized infrastructure supporting resource discovery, targeted consultations, and research data workflows. As the front end to the iTHRIV Commons, the iTHRIV Research Concierge Portal supports federated login, personalized views, and secure interactions with objects in the ITHRIV Commons federation. The canonical use-case for the iTHRIV Commons involves an authenticated user connected to their respective high-security institutional network, accessing the iTHRIV Research Concierge Portal web application on their browser, and interfacing with multi-component iTHRIV Commons Landing Services installed behind the firewall at each participating institution. RESULTS: The iTHRIV Commons provides a technical framework, including both hardware and software resources located in the cloud and across partner institutions, that establishes standard representation of research objects, and applies local data governance rules to enable access to resources from a variety of stakeholders, both contributing and consuming. DISCUSSION: The launch of the Commons API service at partner sites and the addition of a public view of nonrestricted objects will remove barriers to data access for cross-state research teams while supporting compliance and the secure use of data. CONCLUSIONS: The secure architecture, distributed APIs, and harmonized metadata of the iTHRIV Commons provide a methodology for compliant information and data sharing that can advance research productivity at Hub sites across the CTSA network.

Relationship between hot flashes and distress in men receiving androgen deprivation therapy for prostate cancer.

OBJECTIVE: Side effects of cancer treatment have been found to have a significant impact on patients' psychological well-being. Each of the primary treatment options for prostate cancer is associated with significant side effects that can have a dramatic impact on quality of life. Hot flashes are a notable side effect of androgen deprivation therapy (ADT) and a potential source of distress due to their episodic nature and low frequency in a normal aging male population. The current study sought to examine the relationship between hot flashes and cancer-related distress during the first three months of ADT. METHODS: Participants were 68 men with various stages of prostate cancer scheduled to begin ADT for the first time. Study measures were completed at the beginning of treatment and 3 months later. RESULTS: Repeated measures ANOVA indicated that men who did not experience hot flashes had a significant decrease in total cancer-related distress and avoidance over the 3-month period, while men with hot flashes exhibited no change in distress. Among men with hot flashes, results of hierarchical regression analyses indicated that a worse experience with hot flashes was a significant predictor of greater increases in intrusion and total cancer-related distress over the 3-month period. CONCLUSIONS: These results suggest that hot flashes serve to maintain levels of distress during the treatment period. Further research should extend these findings by lengthening the follow-up period and using ecological momentary assessment to refine measurement of these constructs and provide evidence for the direction of causality between hot flashes and distress.

Management of androgen-independent prostate cancer.

BACKGROUND: Although androgen withdrawal can control prostate cancer for long periods in many patients, controversy exists regarding management when the tumor becomes androgen independent. Several options are now available. METHODS: A review of the pertinent literature of the last 20 years was conducted to provide guidance in defining and managing hormone-refractory prostate cancer. RESULTS: Stage D prostate cancer can be subclassified to correlate tumor biology with disease stage. Secondary hormone manipulations may induce responses in patients after failure of initial androgen suppression, and chemotherapy with docetaxel has prolonged survival in patients with androgen-independent prostate cancer (AIPC). The weight of evidence supports the maintenance of castrate levels of testosterone in metastatic AIPC. Bisphosphonates decrease skeletal complications. CONCLUSIONS: Secondary hormone therapy, chemotherapy, and bisphosphonate therapy may provide benefits for selected patients. Correlation of disease stage with biologic characteristics of the tumor and host facilitates proper choices of interventions. Docetaxel-based chemotherapy regimens should be considered for first-line treatment of patients with progressive metastatic AIPC.

Management of hot flashes in men with prostate cancer being treated with androgen deprivation therapy.

The use of androgen deprivation therapy (ADT) to treat prostate cancer has favorably impacted outcomes for men with prostate cancer. Androgen deprivation therapy is effective in reducing painful bony metastases and soft tissue visceral disease in advanced-stage prostate cancer. The use of ADT has expanded beyond the metastatic setting and can also be used as adjuvant therapy for patients with locally advanced prostate cancer who received surgery or localized radiation therapy. Luteinizing hormone-releasing hormone agonists are the most common medical therapy used to deprive men of androgen production. Despite the beneficial effects that ADT has on prostate cancer, ADT causes side effects that can impair quality of life. This article will review the impact and treatment of hot flashes in men treated for prostate cancer.

Abbreviated rasburicase dosing for the prevention and treatment of hyperuricemia in adults at risk for tumor lysis syndrome.

BACKGROUND: The purpose of this study is to report the experience of using abbreviated rasburicase dosing for adult patients at risk for developing hyperuricemia secondary to tumor lysis syndrome. PATIENTS AND METHODS: All patients who received rasburicase from January 2003 through March 2004 were identified, and a retrospective chart review was conducted. RESULTS: Thirteen patients received >/= 1 dose of rasburicase for the prevention or treatment of hyperuricemia. Of these patients, 8 patients received 1 dose, 3 patients received 2 doses, and 2 patients received 3 doses of rasburicase. All 13 patients experienced normalization of plasma uric acid levels within 24 hours (mean uric acid decreased from 9.1 mg/dL to 0.68 mg/dL). Mean serum creatinine decreased from 2.3 mg/dL to 1.6 mg/dL. No patients required hemodialysis. CONCLUSION: Our experience supports that abbreviated courses of rasburicase are effective in managing hyperuricemia in patients at risk for tumor lysis syndrome.

Controversies surrounding androgen deprivation for prostate cancer.

BACKGROUND: Management of metastatic prostate cancer continues to evolve. The widespread use of the prostate-specific antigen (PSA) assay has led to earlier diagnosis and earlier detection of recurrent disease. Debates continue regarding the proper use and timing of endocrine therapy with orchiectomy, estrogen agonists, luteinizing hormone-releasing hormone (LHRH) analogs, LHRH antagonists, and androgen antagonists. METHODS: The authors reviewed the significant published materials of the last 20 years that have shaped hormonal management of metastatic and progressive prostate cancer. Major areas of controversy were also identified. RESULTS: The present approach to hormonal management is summarized. Five potential pathways to the development of androgen-independent prostate cancer are described. Controversial topics of hormonal management, including immediate vs delayed hormonal therapy, monotherapy vs maximal androgen blockade (MAB), and intermittent hormonal therapy, are discussed. CONCLUSIONS: Orchiectomy, estrogen agonists, and LHRH analogs have therapeutic equivalence. Patients who have a rising PSA after definitive treatment for prostate cancer and high risk of recurrent disease may warrant early androgen deprivation. MAB does not appear to be significantly better than single-agent LHRH analog therapy. Intermittent therapy may delay emergence of androgen independence and maintain or improve quality of life.