bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk-assessed exercise and diet in prostate cancer survivors: Consequences of cancer treatment on cardiopulmonary fitness and cardiovascular risk.
Authors: Faithfull Sara , Aning Jonathan , Poole Karen , Saxton John , Griffin Bruce , Manders Ralph , Lemanska Agnieszka , Gasson Sophie , Langley Stephen , Wainwright Joe , Marshall John , Heyworth John , Winters-Stone Kerri M.
Published: March 2017

142

Background: Evidence from large observational studies suggests that men with prostate cancer have a higher risk of cardiovascular events due to accelerated atherosclerosis linked to androgen deprivation therapy (ADT). Adults > 70 years of age have poorer outcomes from cancer treatment in the UK. However, it is not yet clear what might be contributing to poorer outcomes among older men with prostate cancer. Thus the purpose of this study was to assess the health and fitness of a cohort of prostate cancer survivors, from 2 regions in the UK, and identify factors that may influence cardiovascular health. Methods: Baseline assessments from 83 men with prostate cancer with no evidence of distant disease particpated. Men undertook a Cardiopulmonary Exercise Test (CPET), sit to stand, step test, grip strength, hip to waist ratio, self-reported exercise questionnaire (Godin), and co-morbidity index. Men were 1-3 years post diagnosis. Age-group comparisons were made using analysis of covariance against cardiac risk profile (QRisk2). Results: Men who were older ( > 75) were more likely to have poorer cardiopulmonary fitness, as measured by VO2 Peak , and worse grip strength than age standardised values. Increased obesity across all groups (raised BMI) and higher B/P all contributed to a raised QRisk2 (mean: 36.9±6.1), which is higher than men of a similar age. Older men perceived themselves to be less physically active and were more likely to be on ADT. Conclusions: In our sample, men older than 75 had greater CVD risk, poorer physical function and lower strength. Improvements in diet and physical activity could improve physical function and reduce cardiovascular risk factors. Older men were more likely to be on ADT so to reduce long term co-morbidities other risk factors need to be addressed. More comprehensive functional health assessment at point of treatment could help clinicians optimise therapy to reduce long term comorbidities. [Table: see text]
Patient reported symptom severity in cancer survivors.
Authors: Bugos Kelly , Foran Jessica , Pose Sabati Katrina , Valdez Andre , Petree Janis M. , Wellman Caitlin , Blayney Douglas W.
Published: March 2017

143

Background: At Stanford Health Care, patient-reported symptom severity is routinely assessed during cancer survivorship visits. Aim: Our objective is to identify the proportion of moderate to severe symptoms reported during first visit by patient group (breast cancer, lymphoma, allogeneic BMT recipients). Methods: Our cohort were unique patients evaluated in a cancer survivorship clinic between 9/1/15 and 8/31/16. Cohort patient report of presence and severity of 23 symptoms using a six-point Likert scale on a paper-based written instrument were collected and analyzed (0 = absent, 1-2 = mild, 3-4 = moderate, 5 = severe). Symptoms include fatigue, pain, constipation, diarrhea, uncontrolled loss of urine, limb swelling, shortness of breath, oral problems, trouble swallowing, muscle weakness, unusual sweating, ability to exercise, numbness in limbs, depression, fear, changes in sleep, body image, skin/hair, appetite, weight, sexual health, cognition and/or balance. Results: 337 unique patients (median age 50, female 64%) were a median of 140 days and mean of 851 days after treatment completion. Overall, the symptoms that have the highest responses in the moderate to severe range (score 3-5) are fatigue (31%), sleep change (23%), memory change (17%), depression (14%) and fear (19%). Breast cancer survivors had similar symptoms overall, but lymphoma survivors reported a higher rate of moderate to severe fatigue (49%), sleep change (38%), memory change (33%) and fear (29%), and the alloBMT group reported a higher rate of moderate to severe fatigue (39%), depression (20%) and fear (25%). Conclusions: Standard use of patient-reported symptom severity assessment shows a high prevalence of moderate to severe physical and psychological symptoms among patients seen in a cancer survivorship clinic. These findings can help focus management on the most prevalent and severe symptoms based on cancer type and time from treatment.
Does menopausal status influence the symptom experience of women prior to breast cancer surgery?
Authors: Mazor Melissa , Paul Steven M. , Miaskowski Christine
Published: March 2017

149

Background: Breast cancer treatments can change women’s hormonal milieu and alter their symptom experience. Little is known about associations between menopausal status and menopausal symptoms in women with breast cancer prior to treatment with surgery, chemotherapy, and/or hormonal therapy. The purpose of this study was to evaluate for differences in menopausal symptom experience between pre- and post-menopausal women prior to breast cancer surgery. Methods: A total of 312 women with breast cancer completed the Menopausal Symptoms Scale, a self-report measure that evaluates the occurrence, severity, and distress of 46 common symptoms associated with menopause. Results: Of the 312 patients enrolled, 37.4% (n=116) were premenopausal and 62.6% (n=196) were postmenopausal. No differences were found in the total number of symptoms reported between premenopausal (x̅ = 13.3±7.8) and postmenopausal (x̅ = 12.0±8.6; t = 1.35, p=.177) patients. Premenopausal patients reported higher occurrence rates for tearful/crying spells, painful/tender breasts, anxiety, lost interest in things, anger, tension, lost sexual interest, fatigue or tiredness, impatience, headache, and nervousness (p<.05 for all). Premenopausal patients reported lower occurrence rates for joint pain/stiffness (p=.011), difficulty falling asleep, vaginal dryness, daytime sweats, and hot flashes (p<.01 for all). A significant interaction was found between age and menopausal status. In the premenopausal group, as age increased, these women were significantly more likely to have hot flashes (p=.033). In the postmenopausal group, as age increased, these women were significantly less likely to have hot flashes, wake during the night, have headaches, and report nervousness (p<.01 for all). In the bivariate and multivariate analyses, none of the symptom severity or distress scores were significantly different between the pre- and post-menopausal patients. Conclusions: Findings from this study suggest that, regardless of menopausal status, women report a high occurrence of menopausal symptoms. The association between menopausal symptom occurrence and menopausal status depends on the specific menopausal symptom and the patient’s age. Clinical trial information: NCT00769821.
Cancer survivorship in the primary care setting: A new medical school elective.
Authors: Fogarasi Miklos C. , Berg Gerald R , Eichengreen Roy P
Published: March 2017

15

Background: Responding to calls for education in Cancer Survivorship, the Frank H. Netter MD School of Medicine introduced new content using an interactive student elective for Y2 medical students with the goal of improving medical knowledge and confidence in caring for survivors. Methods: Learning objectives and course content were developed based upon the ASCO curriculum (ASCO Core Curriculum for Cancer Survivorship Education Shapiro, CL et al, Journal of Oncology Practice Feb 2016 Vol. 12 (2) p 145-e117). Seven medical and one biomedical science student enrolled to complete the Sep-Dec 2016 course. Weekly sessions, facilitated by an Oncologist, utilize independent and collaborative learning, small group role playing, concept maps, algorithms and multiple case scenarios to identify and analyze key issues of survivorship. Co-facilitators with varied expertise and cancer survivors are invited weekly. Successful completion requires active participation, reading and discussion of required articles, contributing to a Glossary, and constructing a Survivorship Care Plan after independently interviewing a cancer survivor. A pre/post course questionnaire and reflective writing is used to assess change in knowledge and attitudes. Results: Weekly attendance was excellent, and students remained highly engaged. Sessions involving a geneticist, social worker, hospice nurse or APRN were well received. Students built a Glossary of cancer-terms, and practiced “Skills of the Week”. Pass/fail data and questionnaire data are pending, as the course is ongoing. Conclusions: Teaching cancer survivorship is feasible for Y2 students. Motivation and interest in the topic is high for this self-selected course. Based upon early observations and feedback the small group setting is valuable for interactions with survivors and inter-professional staff. Students recognize complex social factors influencing survivors’ care and combine knowledge from prior molecular biology, genetics, and physiology classes with the humanistic aspects of patient-centered care. If course evaluation data confirms its value, this curriculum may serve as one element of a multi-level graduate/post-graduate curriculum in Survivorship education.
Behavioral adjustments, supplements, and medications to manage bowel dysfunction in rectal cancer survivors.
Authors: Sun Virginia , Wendel Christopher , Grant Marcia , Bulkley Joanna E , McMullen Carmit K. , Hornbrook Mark C. , Herrinton Lisa J. , Krouse Robert S.
Published: March 2017

150

Background: Bowel dysfunction is a common long-term treatment effect that adversely impacts the quality of life (QOL) of rectal cancer (RC) survivors. Research suggests that self-care strategies such as behavioral adjustments and supplements/medications are used to achieve bowel control. Evidence describing the specific types of self-care strategies is lacking. The purpose of this study is to describe behavioral adjustments and supplement/medications use in long-term ( ≥ 5 years) RC survivors for managing bowel dysfunction. Methods: Long-term RC survivors with or without permanent ostomies who were enrolled in two Kaiser Permanente Regions completed a survey that included questions eliciting behavioral adjustments and supplements/medications used for bowel control. Written comments from the questions were coded for content and themes. The themes were reviewed and agreed upon by the research team. Responses mentioned < 9 times were combined into broader categories; those mentioned ≥ 9 times were coded separately. Results: A total of 577 RC survivors responded to the survey. 118 survivors (20.4%) responded to the behavioral adjustment question, while 248 (43%) responded to the helpful supplements/medications question. Behavioral adjustments included controlling meal portions (38.9%), eating meals at regular times (19.4%), not eating late or before bedtime (10.1%), and grazing (8.4%); they mitigated constipation, obstruction, bloating, frequency, urgency, and improved bowel predictability. Other behavioral adjustments include not eating before or after activities (5.9%), not eating (5.1%), snacking at regular times (2.5%), and eating less when traveling (1.6%). Helpful supplements/medications include anti-diarrheals (23.6%), dietary fiber supplements (16.6%), stool softeners (15.0%), laxatives (12.6%), antacid (5.6%), probiotics (5.0%), and opioids (3.6%). Conclusions: RC survivors used multiple behavioral adjustments and supplements/medications to achieve bowel control. The specific adjustments and strategies varied greatly. Findings will aid in developing personalized strategies to manage bowel symptoms during survivorship.
Cancer-related side effects and diabetes self-management.
Authors: Murari Keerti , Brown Jordonna , Wisnivesky Juan P. , Lin Jenny J
Published: March 2017

152

Background: Cancer survivors often experience cancer and treatment-related side effects and may also have comorbidities that may further impact their quality of life. Little is known about how cancer-related side effects and health status impact survivors’ beliefs and management of comorbidities. We undertook this study to assess the relationship between cancer-related side effects and diabetes (DM) self-management behaviors (SMB) and beliefs in cancer survivors with comorbid diabetes. Methods: We recruited diabetes patients recently diagnosed with early-stage breast or prostate cancer who were taking at least one oral hypoglycemic agent. Side effects for prostate cancer survivors were assessed using the Expanded Prostate Cancer Index Composite; side effects for breast cancer survivors were assessed using a standardized questionnaire for hormonal therapy-related side effects. Patients were asked to rate their overall health status and about the perceived impact of cancer treatment on DM. We measured DM medication adherence using the 8-item Morisky Medication Adherence Scale, and DM SMB were evaluated using the Summary of Diabetes Self-Care Activities. Descriptive and univariate analyses were used to assess factors associated with DM SMB. Results: Of the 52 patients recruited, 32 (62%) were male. Twenty-four (46%) patients reported cancer or treatment related side effects, with most (21, 88%) being moderately or severely bothered by these symptoms. Of these patients, 20 (83%) reported non-adherence to their DM medications and 18 (71%) reported checking their fingersticks < 5 times a week. Yet most patients (20, 84%) felt that their diabetes care was at least equally as important as their cancer care. Neither the presence nor severity of side effects was associated with DM SMB. However, patients who reported poorer overall health status were more likely to be worried about the impact of cancer treatment on diabetes management (75% vs. 25%, p < 0.01). Conclusions: Many cancer survivors report moderate to severe treatment-related side effects, although severity of side effects was not found to be associated with DM SMB. Further effort should focus on addressing survivors’ concerns about the impact of cancer treatment on comorbid disease management.
Subgroups of survivors with distinct aggravating factors associated with chemotherapy-induced neuropathy (CIN) in the hands.
Authors: Mausisa Grace , Mastick Judy , Mazor Melissa , Paul Steven M. , Cooper Bruce A. , Smoot Betty , Topp Kimberly , Abrams Gary , Chen Lee-may , Chesney Margaret , Kober Kord , Conley Yvette , Levine Jon , Miaskowski Christine
Published: March 2017

157

Background: CIN is the most prevalent neurologic complication of cancer treatment. Inter-individual variability exists in survivors’ reports of the factors that aggravate CIN in their hands. The purpose of this study was to identify groups of survivors with CIN in their hands based on distinct aggravating factors and evaluate for differences in demographic, clinical, symptom characteristics and quality of life (QOL) based on group membership. Methods: Cancer survivors (n = 307) who received a platinum and/or a taxane and rated their altered sensation/pain in their hands at > 3 on 0-10 scale were enrolled and completed study questionnaires, including a list of 22 factors that could make pain worse. Medical records were reviewed and sensory and motor tests were done. Latent class analysis was used to identify groups of survivors based on the occurrence rates for aggravating factors. Differences among the groups were evaluated using parametric and nonparametric statistics. Results: Three groups were identified based on occurrence rates for aggravating factors in the hands (i.e., Activity and Temperature (41.0%), Activity (8.7%), Few Factors (52.2%)). No differences were found among the groups in demographic characteristics, or sensory (light touch, temperature, pain, vibration) and motor (grip strength, pegboard) tests. Compared to the Few Factors group, the Activity and Temperature group had more comorbidities, poorer sleep, greater fatigue, and more anxious and depressive symptoms. Survivors who received a platinum compound were more likely to be in the Activity and Temperature group. Those who received a taxane compound were more likely to be in the Few Factors or Activity groups. Conclusions: Survivors who reported a higher occurrence of aggravating factors had a higher symptom burden and poorer QOL. Most differences were found between the Few Factors group and the Activity and Temperature group which may be due to the small sample size of the Activity group. Objective measures did not differ among the groups. Findings suggest that subgroups of survivors can be identified based on their reports of CIN aggravating factors.
Prevalence of sarcopenia and predictors of body composition among women with early-stage breast cancer.
Authors: (Cespedes) Feliciano Elizabeth , Caan Bette Jane , Prado Carla , Kroenke Candyce , Alexeeff Stacey , Bradshaw Patrick T , Weltzien Erin , Castillo Adrienne , Chen Wendy Y.
Published: March 2017

160

Background: Body mass index (BMI) does not accurately reflect body composition, particularly among cancer survivors. Sarcopenia (low skeletal muscle mass) and low muscle radio-density (MD; suggesting fat infiltration into muscle, compromising function) increase risk of surgical complications and chemotherapy toxicity and are associated with worse survival in advanced cancer. Little is known about the prevalence or predictors of sarcopenia and low MD in early-stage breast cancer. Methods: We studied 2,914 Kaiser Permanente members diagnosed with Stage I-III breast cancer from 2005-2013. Using computed tomography (CT) scans of the third lumbar vertebra from clinical care, we determined sarcopenia (skeletal muscle index < 41 muscle [cm2]/height [m2]) and low MD ( < 25-Hounsfield Units for non-obese; < 33 for obese) using published cut points. We assessed associations with characteristics including age, race, BMI, age, stage, lifestyle and co-morbidities with logistic regression. We also examined moderate/vigorous physical activity among a subset of 672 women with activity questionnaires. Results: At diagnosis, mean age was 56 years and time to CT was 1 month. Both sarcopenia and low MD were common among early-stage breast cancer survivors (40% and 38% respectively). In multivariate analyses, the odds of sarcopenia and low MD increased with age (per 5 years, Odds Ratio [OR] 95% Confidence Interval [CI] of OR = 1.33; 95%CI: 1.27, 1.39 and OR = 1.41; 95%CI: 1.35, 1.47 respectively). The odds of sarcopenia decreased with greater BMI (OR = 0.80; 95%CI: 0.78, 0.82 per kg/m2), while the odds of low MD increased (OR = 1.03; 95%CI: 1.01, 1.04 per kg/m2). Black race was associated with lower odds of sarcopenia and low MD, while physical activity levels were associated with lower odds of sarcopenia and more favorable MD. Conclusions: Sarcopenia and low MD are highly prevalent among breast cancer survivors. While older age is strongly associated with these conditions, they occur across ages and stages. Differences in body composition by race and age may underlie differences in the association of BMI with cancer outcomes; understanding these may help guide clinical interventions.
Milk and other dairy foods in relation to prostate cancer progression: Data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CAPSURE).
Authors: Tat David , Van Blarigan Erin , Kenfield Stacey A. , Broering Jenny , Cowan Janet E. , Carroll Peter , Chan June M.
Published: March 2017

168

Background: Recent research suggests a positive relationship between intake of high-fat dairy, particularly whole milk, and prostate cancer (PC) mortality. However, data are limited in men after PC diagnosis. Methods: We conducted a prospective cohort study among 1336 men with non-metastatic PC in CaPSURE. The men answered a food frequency questionnaire (FFQ) in 2004-2005 (median time from diagnosis to the FFQ: 2 y) and were followed for PC progression until April 2016. PC progression was defined as: prostate cancer death, bone metastasis from PC, biochemical recurrence, or secondary treatment. Multivariate Cox Proportional Hazards regression was used to calculate hazards ratios (HR) and 95% confidence intervals (CI) for associations between total, whole fat, and low-fat milk; total, high-fat, and low-fat dairy; and specific dairy items and PC progression. We adjusted for time from diagnosis to FFQ, calories, age at diagnosis, CAPRA score, smoking, BMI, walking pace, and primary PC treatment. Results: 314 events were observed (mean follow-up: 7.2 y). Whole milk was associated with an increased risk of PC progression when adjusting for age, calories, and time since diagnosis (HR ≥1 vs. <1 serving/wk: 1.37; 95% CI: 1.03, 1.84; p-value: 0.03). This association was slightly attenuated, and not statistically significant, when adjusting for clinical and other lifestyle factors (HR: 1.27; 95% CI: 0.91, 1.77; p-value: 0.15). High-fat dairy intake also appeared associated with an increased risk of PC progression, but the association was not statistically significant (adjusted HR ≥4 vs. <1 servings/day: 1.40; 95% CI: 0.92, 2.13; p-trend: 0.18). Post-diagnostic intakes of low-fat milk and other dairy foods were not associated with PC progression. Conclusions: Post-diagnostic intake of milk and other dairy foods was not associated with PC progression. Research in populations with greater intake of whole milk is warranted to further investigate whether post-diagnostic whole milk intake increases risk of PC progression. Funding: This work was funded by the DOD Prostate Cancer Research Program (W81XWH-13-2-0074) and the NIH (K07CA197077).
Mind-body medicine epigenetic technique (MET), cognitive flexibility, and brain-derived neurotrophic factor (BDNF) gene expression.
Authors: Munoz Francisco Ventura
Published: March 2017

172

Background: This is a pilot study update on the potential of MET to up-regulate BDNF gene expression with breast cancer patients assessed with high cognitive flexibility. MET is a technique developed to manage chronic stress and anxiety. BDNF gene expression is associated with learning and memory. Cognitively flexibility is defined as the ability to focus and sustain attention. It also implies vivid imagination and holistic thinking. Methods: The selection process for the study participants was nonrandom. The following was the eligibility criteria. 1. Inclusion Criteria: Breast Cancer, Stages II, III 2. Exclusion Criteria: Cognitively impaired, weak or ill. The study utilized two groups. Each group was assigned two research participants. Group One received one session of MET. Group Two received two sessions of MET. Each MET session was approximately 25-35 minutes in duration. Blood samples were taken at baseline and post-MET sessions to provide evidence in gene expression changes. For Group Two, the post-MET session blood draw was done 7 days after baseline. 1. Primary Endpoint: To determine whether MET can up-regulate BDNF gene expression. 2. Secondary Endpoint:To determine whether there is a correlation between up-regulated BDNF gene expression and cognitive flexibility. The blood samples were sent to genomics labs at the Children’s Hospital of Los Angeles and the University of Nevada Las Vegas for mRNA extraction and microarray analysis. The gene expression was measured by DNA microarray results using the “PrimeView gene chip” and “Partek Genomics Suite” statistical software. Results: One participant from Group 1 evidenced a biologically significant up-regulation of BDNF gene expression. This participant was assessed with high cognitive flexibility. One major limitation of these findings is the statistical insignificance of the results due to the small number of participants. Conclusions: This pilot study evidenced the up-regulation of BDNF gene expression potentially due to MET and provided evidence for the potential correlation of BDNF gene expression and cognitive flexibility. This study also provided a foundation for a larger study with more participants.
Complementary and alternative medicine (CAM) use among patients with cancer undergoing palliative care: A pilot study of a single institution in Poland.
Authors: Wojtacki Janusz , Pawlowski Leszek , Pawlowska Iga , LichodziejewskaNiemierko Monika
Published: March 2017

178

Background: Real life observations suggest CAM is frequently used by cancer patients. The profound knowledge of CAM use details is crucial for both efficacy and safety of anticancer and supportive therapy. Methods: Semi-structured pilot questionnaire about details of CAM use was presented to all 202 consecutive patients of Palliative Care Outpatient Clinic, E. Dutkiewicz SAC Hospice, Gdańsk, Poland (April-22 and September-30/2016). After excluding 112 patients (no-responders group = N-RES) due to low performance status (N = 64), lack of written agreement (n = 10), diagnosis of non-malignant disease (N = 26), others (N = 12), the final analysis included 90 patients (female: 72,0%, median age: 63,5, range: 24-94 yrs) with advanced cancer (responders = RES). Demographic and clinical data were collected at the same time, then statistically related to CAM use details. Results: RES patients were significantly younger (p = 0,0045) and in better performance status (p < 0,05) as compared to N-RES group (no difference with regard to gender, education level, primary cancer location, duration of malignant disease, marital status). Since the primary cancer diagnosis, CAM was used by 56 (62,2%) RES patients and mostly included vitamin/mineral formulations (36,7%), herbs (32,2%), alternative nutrition (24,4%), music therapy (11,1%) and Chinese medicine (5,6%). The main reasons for CAM use were: to enhance the effects of anticancer therapy (48,9%), to treat its side-effects (15,6%) or the lack of conventional therapy possibilities (5,6%). CAM was used more frequently by patients who experienced weight loss since diagnosis of cancer (p = 0,0028) or those who used CAM methods to control symptoms not related to cancer (p = 0,0109); age, gender, education level, marital status, religious practices frequency were not significantly related to CAM use. Conclusions: 1) CAM use is common among patients with advanced cancer under palliative care; 2) some factors might be in relation to higher CAM use (weight loss, CAM use to control symptoms not related to cancer); 3) further research is required to investigate better different aspects of CAM use such as safety, efficacy and outcomes in this population.
What I wish I had known: Young breast cancer survivors reflect on their experiences after breast cancer surgery.
Authors: Rosenberg Shoshana M. , Greaney Mary , Patenaude Andrea Farkas , Meyer Meghan E , Partridge Ann H.
Published: March 2017

180

Background: Breast cancer (BC) surgery can have a profound impact on aspects of quality of life (QOL) particularly for young breast cancer survivors, given their life stage. Using a series of focus groups (FG), we explored post-surgical experiences of young survivors who had elected lumpectomy, unilateral or bilateral mastectomy. Methods: Women who had surgery for their stage 0-3 BC and who were 1-3 years from their diagnosis (dx) at age ≤ 40 were recruited to participate. We conducted 4 FG: 2 with women who had bilateral mastectomy, 2 with women who kept their contralateral breast. FG were recorded and transcribed with identifiers removed. FG transcripts were coded using NVivo, and emergent themes were identified by thematic content analysis. At the end of the FG, participants completed a demographic/medical history survey. Results: Of 20 participants (4-6 per FG), median age at dx was 37 yrs; 10% (2/20) identified as Hispanic; most (19/20) were married/partnered; 70% had Stage 1 (4/20) or 2 (10/20) disease. Almost all women who had mastectomies also had reconstruction. Emergent themes included: the unexpectedness of certain physical experiences post-surgery (e.g., surgical drains, pain, numbness), psychological impact of surgery (e.g., vulnerability, self image changes), and short and long-term adjustment to a “new normal”, irrespective of which surgery they had. While participants generally felt their doctors communicated key information about surgery and recovery, some expressed dissatisfaction with how this information was communicated, including feeling pressured to choose a particular surgical option. Conclusions: Young BC survivors have many physical and emotional concerns after BC surgery for which they may not feel prepared. Communicating balanced and relevant information prior to surgery about what to expect afterwards is essential and can potentially help survivors with their transition to a “new normal,” as they move from active treatment to survivorship. Informational resources and decision aids may enhance patient-doctor communication in this setting and help young survivors manage expectations surrounding short and longer-term physical and emotional effects after surgery.
Utilization of patient pager for preservation of privacy in clinic waiting room.
Authors: Kaleem Tasneem , Miller Daniel , Yanez Maresciel , Buskirk Steven J.
Published: March 2017

192

Background: Patient privacy is of the utmost importance for the emotional needs of a cancer patient and their family. As an effort to improve privacy, quality, and coordination of care within our Radiation Oncology department, in 2016 a patient pager system was devised to inform patients to prepare for daily treatment rather than verbally call the patient's name in waiting rooms. Methods: During June 2016, patients undergoing daily radiation therapy participated in a six-question survey addressing various aspects of the paging service, privacy prior to pager use, and demographics. Six radiation therapists also participated in a 7-question survey addressing privacy and workflow. Participants rated their experience on a scale of 1 to 5 (1 being poor, 5 being excellent). Surveys were collected and retrospectively reviewed. Results: 42 patients completed the survey. Patients rated "Very Good" to "Excellent" for the following categories: “Paging system more convenient than being called”(4.6), “Protection of privacy”(4.6), “Easiness”(4.7) and whether “Pager should be utilized for all appointments” (4.3). Patients rated “Patient privacy when name is called” as "Good" to "Very Good" (3.7). Seven patients also underwent therapy prior to pager implementation and rated the new system in comparison as "Very Good" to "Excellent" for “Privacy protection”(4.6), “Efficiency” (4.6), and “Satisfaction” (4.6). Only 24 filled out demographic information. Of the 24 patients, 54% of patients were female, 87% were above the age of 50, and all patients were receiving at least 10 treatments. Staff rated "Fair" to "Very Good" for “More preparation time” (2.8), “Patient use difficulty”(3.2), “Patient positive feedback”(2.3), “Receiving patients” (2.2) and “Workflow” (2). However, “Patient privacy” was rated as "Very Good" to "Excellent" (4.2). Conclusions: Overall, patients and staff highly rated the paging system for protecting privacy in the waiting room. Patients who experienced waiting room procedure prior to pager implementation display greater satisfaction with a paging system. However, it did not change overall workflow. Our study shows clinics should prioritize patient privacy in the waiting room to improve the emotional needs of the patient.
Patterns of cancer-related health information seeking and receipt among Hispanic and non-Hispanic childhood cancer survivors.
Authors: Miller Kimberly A , Ramirez Cynthia N , Wojcik Katherine , Ritt-Olson Anamara , Baezconde-Garbanati Lourdes , Thomas Stefanie Marie , Freyer David Robert , Hamilton Ann S. , Milam Joel
Published: March 2017

197

Background: Because childhood cancer survivors (CCS) report a high number of unmet cancer-related information needs, knowing where CCS access information may provide insights into appropriate delivery systems to address information deficits. Active seeking of health information among CCS is associated with positive health behaviors, including adherence to follow-up care. This study examined patterns of cancer-related health information seeking as an indicator of health care engagement. Methods: Participants (N = 193) were young adult CCS diagnosed with any cancer type in Los Angeles County, 54% Hispanic, with a mean age of 19.87, and at least two years from treatment. CCS were asked where they accessed health information related to their cancer with 8 response options which were categorized into four information domains: hospital resources, social media, other survivors, and family members. Multivariable logistic regression was used to assess correlates of each information domain, including sociodemographic information, post-traumatic growth, and health care engagement, controlling for age, ethnicity, sex, education, and health insurance status. Results: Hospital resources were the most frequently endorsed information domain (65.3%), and Hispanic CCS (vs. non-Hispanic) were more likely to access this source. Online sources were more likely accessed by female CCS. Seeking information from other cancer survivors was associated with follow-up care and post-traumatic growth after cancer. Hispanic CCS were less likely to seek information from other survivors and their family than non-Hispanics. Conclusions: While CCS obtain information from a variety of sources, hospital resources were the most commonly accessed, particularly for Hispanics. Information sharing between survivors may promote positive health care engagement; however, Hispanics may be less likely to pursue this resource. Future work should address barriers Hispanic CCS face in information sharing with other cancer survivors. [Table: see text]
Psychosocial distress screening at a single urban community oncology center: Trends among Hispanic and Caucasian women with newly diagnosed breast cancer.
Authors: Britt Gregory Joseph , Shay Rebecca C. , Rassmusen Monica , Vannice Sandra , Bolduan Lomax Jana M
Published: March 2017

198

Background: We aim to describe our psychosocial distress screening program with attention to our female breast cancer population and symptoms of anxiety and depression among English-speaking Caucasians and Spanish speaking Hispanics. Methods: We retrospectively examined the emotional distress scores of 170 women with newly diagnosed breast cancer at the Cancer Centers of Colorado at SCL Heath/Saint Joseph Hospital from January-December 2015. SCL Health IRB approval was obtained. Patients were provided a distress screening questionnaire (English or Spanish) at their initial visit. Data points included: gender, age, ethnicity, primary language, emotional distress (worry/nervousness or anxiety/fears and sadness/depression) and degree of distress (“thermometer” scale 0-10 or not at all, slightly, moderately, seriously or very seriously). The degree of distress measures were revised in August 2015 from a “thermometer” scale to a descriptive scale. Results: Of 170 women studied, there were 104 Caucasian, 49 Hispanic, and 17 other race/ethnicity (including Black, Asian, Native American, and Pacific Islander). 76 women (40 Caucasian, 31 Hispanic, 5 other) did not participate in filling out the questionnaire. Of the 94 patients responding, 68% were Caucasian (n=64), 19% Hispanic (n=18), and 13% other (n=12). With regard to symptoms, 55% of Caucasians (n=35), 44% of Hispanics (n=8), and 50% of other (n=6) reported anxiety. Moreover, 36% of Caucasians (n=23), 56% of Hispanics (n=10), and 33% of other (n=4) recorded sadness/depression. Among the descriptive scale scores from August-December 2015, Hispanics were the only group to record “seriously” or “very seriously” in regard to anxiety or sadness/depression. Conclusions: Our retrospective study of emotional distress screening demonstrated lower participation among Hispanics with breast cancer. Concerns of anxiety and depression were common among all groups, with a small number of Hispanics reporting the highest levels. Emotional distress screening is an important component of cancer care for women with breast cancer and barriers for non-English speaking Hispanic patients need to be examined.
Using the symptom distress thermometer (SDT) in patients with breast cancer to identify psychosocial supportive needs.
Authors: Gillego Alyssa , Singh Rohan , Chen Siyung , Parris Celina , Winell Jeremy
Published: March 2017

200

Background: Psychological distress is common among cancer patients. In order to optimize patient care there is a need to understand the type of patient problems contributing to distress. SDT is a well-recognized tool for assessing distress in 5 broad problem categories including, practical, family, emotional, spiritual/religious, and physical (NCCN distress guidelines: Cancer 2005). The objective of this study was to evaluate categories of distress commonly experienced by breast cancer patients undergoing radiation therapy (RT). Methods: This is a retrospective study on patient symptoms of distress as recorded on SDT surveys. Patients completing SDT have the opportunity to score distress on a scale of 0-10 and list the category of distress. For the purpose of this study, we defined low distress score to be ≤ 3, and high distress score of ≥ 4 requiring referral/intervention. Patient population included 121 patients receiving a 3-6 week course of breast RT and who completed ≥ 2 weekly surveys during therapy. A total of 433 surveys were reviewed for score and category of distress. Results: Median age was 56 years (range 32-88). Each patient completed an average of 3.58 surveys. The median distress score was 3 (range 0-10). Overall distribution of any distress by problem category was 1.6% spiritual/religious, 3.7% family, 10.6% practical, 23.3% emotional, and 60.8% physical. Further, we noted that 63 patients (53%) described a high distress score (≥ 4). Among this cohort, 47 patients (74.6%) reported that their distress was secondary to emotional problems. We observed no association between high distress score and patient age or stage of disease. Conclusions: Physical problems were the most common symptom reported on SDT in our study population. However, among the patients identified to have high distress score, emotional problems emerged as the most common cause of distress. These observations suggest that although patients undergoing treatment have many physical complaints, the more significant symptoms requiring referral/intervention were in the emotional category. The identification of more significant problems experienced by patients would help optimize their psychosocial supportive needs.
Implementation of distress testing: Lessons learned at the Kaiser Permanente Oakland Medical Center.
Authors: Washington Pamela Kim , Belote Lisa , Harder Rosalind , Livingston Patricia , Nguyen Kevin , Piper Sarah , Chen Bonnie , Piper Carol , Warren Nakeia , Stodd Kay , Carraway Raymond , Roston Richard , Barnett Nicole M , Duffy James
Published: March 2017

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Background: The Commission on Cancer (CoC) requires accredited facilities to evaluate cancer patients for distress a minimum of one time at a pivotal visit during their cancer journey. Here we describe lessons learned with the implementation of distress testing at the Kaiser Permanente Oakland Medical Center. Methods: The implementation timeframe was April to December 2015. Testing guidelines were created including a definition of pivotal visit. Use of the validated NCCN Distress Thermometer was approved by the East Bay Comprehensive Cancer Committee. A workflow was developed whereby a paper copy of the tool was given to patients at their first cycle of chemotherapy. A RN Case Manager or Social Worker then triaged completed forms. Referrals were made by the case manager, social worker, or attending physician based on patients’ self-reported disposition and level of distress. This information was subsequently entered into patients’ electronic medical record. Completed forms were then entered into an Excel database to facilitate data analysis. Results: Overall, patients were receptive to testing. 232 tests were completed. 55.7% (n = 125) self-reported a score between 0 to 3 (low distress). Worry, fatigue, problems with sleep, financial issues, and problems with transportation were the most common stressors. 42.7% patients received a referral. Referrals to a MSW or RN Case Manager were most common. Interestingly, there were no referrals to psychiatric services. Conclusions: Careful consideration to workflow processes be must factored into implementing distress testing. Findings from our 2015 pilot informed the expansion of testing in all outpatient cancer clinics in 2016.
Biopsychosocial distress assessment among testicular cancer survivors (TCS) using electronic patient reported outcomes (PROs).
Authors: Guancial Elizabeth A. , Peckham Jennifer , Baumhauer Judith , Mohile Supriya Gupta , Sahasrabudhe Deepak M. , Duberstein Paul , Fung Chunkit
Published: March 2017

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Background: Distressis a frequently endorsed experience by cancer patients.Many organizations advocate formal distress screening as part of clinical care in order to better meet the “psychological, social, and/or spiritual needs of patients that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatments.” The primary objective of this study is to characterize distress levels among TCS using electronic PROs via a modified version of the National Comprehensive Cancer Network Distress Thermometer (DT) and Patient Reported Outcomes Measurement System (PROMIS). Methods: Eligible TCS ( < 69 years at diagnosis, any treatments, not in active or maintenance stage of exercise behavior) enrolled onto a pilot study of an electronic, self-directed, individually tailored “EXercise for CAncer Patients” (EXCAP) program were offered iPad-based distress screening during routine medical oncology clinic visits. Screening consisted of a modified DT, where patients self-report distress on a scale of 1-10, wherein scores of greater than 4 refer to increased distress, as well as PROMIS domains for anxiety and depression, where scores range from 0-100, 50 is the average for the United States (US) general population, and higher values indicate more anxiety or depression. Results: A total of 18 TCS (median age 44) enrolled in the EXCAP study as of May 31, 2016. Among participants, 56%, 28% and 17% had stage I, II, and III testicular cancer, respectively. Treatment modality and median time from treatment to enrollment were: 78% orchiectomy, 23.5 months (range 1-204); 33% retroperitoneal lymph node dissection, 8 months (range 1-48); and 72% chemotherapy, 22 months (range 3-587). TCS completed a median of 2 distress screenings (range 1-8). The median DT score was 3 (range 1-8). Median PROMIS anxiety and depression scores were 52.88 (32.87-69.36) and 51.02 (34.17-6.65). Conclusions: TCS self-report low levels of distress on the DT and PROMIS scores for anxiety and depression that are comparable to the US general population. Future research will explore associations between patient- and disease-specific factors and distress in TCS.
From helplessness to self help: Breast cancer surviorship in India.
Authors: DeSouza Rebecca , Nag Shona Milon , Sivaram Rama , Mane Anupama Dutt
Published: March 2017

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Background: In The Indian Scenario, a diagnosis of cancer is accompanied with social stigma and emotional upheavals, especially in breast cancer patients. They are typically thinking: “I would be less of a woman,” “I don’t know if people understand me,” “I feel isolated from myself, my family and my friends,” “Would I be normal again?” “Do I know how to help myself?” or “What will happen in the future, to my kids, to my husband?” Methods: All of these concerns are not always addressed by the medical professions. To address these issues, the Indian Breast Cancer Survivors Conference was organized as an annual conference with an attendance of 200-250 breast cancer survivors from the state of Maharashtra, India. The conference would address the psychological, emotional and social distress experienced by the patients with an aim from living a longer life to living a better and fulfilled life. Results: The emphasis of the sessions were educational (with recent updates on the surgical, medical and radiation therapy aspects of breast cancer treatment), practical (emphasized important issues like side-effects of treatment, patient advocacy, complementary therapies, spirituality, lifestyle changes, etc.), and entertaining. The summary and outcomes of the last 5 annual survivorship conferences will be described and enumerated. Results of questionnaires administered during the last 2 conferences and addressing health behavior patterns of survivors will be presented. Conclusions: We can evaluate through post conference support group discussions and conference feedback, qualify patient psychological and social health as 1) Physical:There are side effects but I choose to go on; 2) Mental: There are times that I am low, depressed, anxious, scared, guilty, but this is my new normal; 3) Emotional:Little things upset me, angry quickly but I am dealing with it; 4)Spiritual:Moved away from bargaining with God to accepting, from rituals to spiritual; 5) Social:don’t hesitate to reach out for support and to support; and 5) Intellectual:Knowledge is power, so I have learned to ask, to question, and then to decide. Achieving psychological and social health is the effort of the patient, the treating team and the support group.
Loss in working years after a breast cancer diagnosis: A population-based study (Sweden).
Authors: Lambe Mats , Lambert Paul , Fredriksson Irma , Plym Anna
Published: March 2017

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Background: More than half of all women with breast cancer are diagnosed during working age. We present a new measure of clinical and public health relevance to estimate the loss in working years after a breast cancer diagnosis. Methods: Women of working age diagnosed with breast cancer between 1997 and 2012 were identified in the Breast Cancer Data Base Sweden (N = 19,661), together with a breast cancer-free comparison cohort (N = 81,303). Women were followed until permanent exit from the labour market (defined as receipt of disability pension, old-age retirement or death) or censoring. Using flexible parametric survival modelling, the loss in working years was calculated as the difference in the remaining years in the work force between women with and women without breast cancer. Results: The loss in working years was most pronounced in women of younger ages and in women with advanced stage disease. Women aged 50 years at diagnosis with stage I disease lost on average 0.6 years (95% CI, 0.4-0.8) of their remaining working time; the corresponding estimates were 1.2 years (1.0-1.5) in stage II, 3.2 years (2.7-3.7) in stage III, and 8.8 years (7.9-9.8) in stage IV disease. Type of treatment was a clear determinant in women with early stage disease, with a higher loss in working years among women treated with axillary surgery, mastectomy and chemotherapy. Conclusions: Our measure provides a new perspective of the burden of breast cancer in women of working age. The modest loss in working years in women with early stage disease is reassuring, although the economic consequences on a population-level are likely to be high given the large number of women diagnosed with breast cancer every year.