bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating cancer-related employment assessments into oncology care.
Authors: Nellis Rebecca , Morales Joanna , Bryant Monica
Published: February 2017

224

Background: This presentation will provide oncology healthcare professionals with information and tools to help navigate their patients through the employment-related legal and practical issues that arise after a cancer diagnosis. These issues include working though treatment and/or taking time off work for treatment and recovery, deciding whether or not to disclose their diagnosis, returning to the workplace, managing side effects on-the-job and maintaining income. The Institute of Medicine (IOM) has called on healthcare teams to address the whole patient and warned that failing to address employment and financial concerns may threaten a patient's health. Methods: Attendees will be given information about state and federal laws that may apply to patients in the workplace, including protections against discrimination and access to reasonable accommodations. Attendees will also learn about the different needs of individuals along the continuum of care. Results: Healthcare professionals can play a meaningful role in helping patients navigate these decisions around work. Cancer and Careers surveyed oncology professionals about their patients’ work-related issues and 77.56% said their patients are asking for guidance on working through treatment (2009-2015). Seventy-seven percent of oncology healthcare professionals surveyed by Triage Cancer said it was important to include employment issues in distress screening tools, but only 25% felt comfortable or very comfortable in answering patients’ questions about the Americans with Disabilities Act (ADA), a primary tool in assisting patients navigate work and cancer. Healthcare professionals surveyed after attending a similar event responded that (a) 99.5% would recommend a similar event to others; (b) 98% said the information received can be applied to their daily patient interactions; and (c) 97.1% rated the overall usefulness of information as good or excellent. Similar responses can be expected from attendees of this presentation. Conclusions: It is critical for oncology healthcare professionals to receive education in this area, because they are uniquely positioned to help patients navigate balancing cancer and work, provided they receive appropriate training and resources.
Was it worth it (WIWI)? An OHSU Knight Cancer Institute retrospective analysis of patient satisfaction following radiotherapy.
Authors: Fain Robert , Chen Yiyi , Rana Shushan Rajesh , Dang Julie , Haly Ashley , Franklin Angel , Mirly Brandy , Lockart Jennifer , Applegate-King Kristin , Wade Michelle , Bedtelyon Sarah , Daffe Racky , Park Byung , Thomas Charles R.
Published: February 2017

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Background: Existing data on patient satisfaction after radiotherapy (RT) is scarce. The specific aim of this analysis is to describe the clinical experience for cancer patients (pts) completing a course of RT at OHSU’s Knight Cancer Institute. Methods: The records of 200 OHSU pts that completed a 5-item “Was It Worth It (WIWI)?” questionnaire highlighting pt satisfaction were reviewed. These data were collected upon the completion of treatment and, if available, first follow-up (f/u). Univariate analysis & logistic regression modeling were performed on pt demographic and treatment characteristics to ascertain predictors of satisfaction. Results: 200 pts (M = 174; F = 26) completed the questionnaire on their last day of treatment and 60 upon their first f/u. The median elapsed days of treatment was 34. The median days from end of RT to f/u were 46 (range: 17-302). More pts were treated for curative intent (73%) than palliative (27%). 71% and 90% stated RT was ‘worth it’ at end of treatment and at first f/u, respectively. Upon therapy completion, 52% were ‘uncertain’ if quality of life (QOL) improved. However, at first f/u, 58% reported improved QOL. Temporal differences in treatment time favored morning treatment time over evening being ‘worthwhile’ (77% vs 61%; p = 0.015). This difference remained significant on multivariate analysis (p = 0.02). Longer elapsed days conferred higher likelihood of treatment being ‘worthwhile’ compared to ‘uncertain’ (30 days vs 24 days; p = 0.023), also significant on multivariate analysis (p = 0.029). Treatment time and elapsed days were not predictive of improved QOL. Age, gender, race, marital status, employment, treatment intent or modalities, treatment delays, distance travelled, insurance type, anatomic site of treatment, and cancer stage, did not predict pt satisfaction. Conclusions: RT as being ‘worthwhile’ was associated with morning treatment times and total duration of treatment as measured by total elapsed days. Among variables analyzed, there were no significant predictors of improved QOL. The majority of patients are satisfied with RT but there is room for improvement with those treated in afternoon or in shorter durations.
Assessing the quality of life of non–Hodgkin lymphoma survivors: A population-based study.
Authors: Holland Rebecca Anne , Bird Brian Richard , Cahill Mary , Murphy Conleth G. , O'Reilly Seamus , O'Connor Emily , Boyce Maria , Crotty Rory
Published: February 2017

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Background: Non-Hodgkin Lymphoma survival in Ireland has improved significantly over recent years. However, little survivorship research has been conducted in this country. The aim of this study is to assess the quality of life (QOL) in an Irish population of Non-Hodgkin Lymphoma (NHL) survivors. Methods: High–grade NHL survivors treated in 2 University Hospitals participated in this cross–sectional study by completing the validated Lymphoma specific Functional Assessment of Cancer Therapy (FACT–Lym) questionnaire and Symptom Index–18. Scales were measured using a score from 1 (not at all) to 4 (very much). Raw data was transformed to linear scores, with high scores indicating a higher level of functioning. Linear regression analysis was used to compare scores according to time since diagnosis. Results: Of 87 questionnaires, 47 were completed and returned by NHL survivors (54% response rate). QOL scores improved from time of diagnosis, with the exception of 4–5 years where scores decreased before again improving in the following years. After adjusting for age and sex, statistically significant differences were identified 5+ years after diagnosis in emotional, functional wellbeing and global FACT-Lym scores when compared to 1-2 years after diagnosis. Conclusions: QOL improves post diagnosis with a transient decrease at year 4-5 which may represent anxiety prior to being declared ‘cured’ or being discharged from follow–up. Our small, mostly private patient population reported higher QOL than larger government insured American groups (Smith et. al. Health status and quality of life among Non-Hodgkin lymphoma survivors. Cancer. 2009.). Patients reported on–going symptoms after treatment ended. These findings may help to develop a focused cancer survivorship programme in the future. [Table: see text]
Quality of life in thyroid cancer: Physician perceptions.
Authors: James Benjamin Christopher , Aschebrook-Kilfoy Brisa , Kaplan Sharone , Kaplan Edwin L , Angelos Peter , Grogan Raymon
Published: February 2017

228

Background: In a multicenter cohort of over 1,200 patients, we have shown that thyroid cancer survivors report a decrease in quality of life (QoL) that is significant and equal to other common cancers. While these findings are striking, there have been no studies assessing physician perceptions regarding how a diagnosis of thyroid cancer affects QoL. We hypothesize that there is a large discrepancy between what physicians perceive the diagnosis and treatment of thyroid cancer has on QoL and what patients report. Methods: Physicians were recruited from two national organizations. A 37-question survey was administered evaluating demographic and treatment-related information as well as questions specific to perceptions of patient satisfaction with various aspects of treatment, complications and overall effects on QoL. Responses were categorized into physical, psychological, social and outcomes. Regression analysis was performed to determine trends in physician perceptions. Results: 105 physicians completed the survey. The majority of participants were endocrine surgeons (n=59, 56.2%), followed by endocrinologists (n= 31, 29.5%), general surgeons (n=8, 7.6%), otolaryngologists (n=2, 1.9%), and medical oncologists (n=1, 1%). The mean number of years in practice was 18.78 years (n=80). There was no difference in response by physician specialty. There was no difference in physician perception on psychological and social effects of thyroid cancer compared to those reported by patients (p=0.643). However, regarding physical concerns, physicians report significantly lower rates of physical concerns than reported by patients with regards to fatigue (p<0.01), weight gain (p<0.01), voice changes (p=0.0427), and heat/cold intolerance (p<0.01). Conclusions: There is a discrepancy between physician perceptions on the effect of thyroid cancer on QoL in thyroid cancer survivors and what these survivors report. As such, there needs to be greater awareness about the effects of thyroid cancer on QoL. In order to better assess and monitor QoL in thyroid cancer survivors, a validated thyroid cancer-specific survivorship care plan incorporating these findings should be created to better assess and monitor patients with a diagnosis of thyroid cancer.
Health-related quality of life (HRQL) in Hodgkin lymphoma (HL): A systematic review (SR).
Authors: Linendoll Nadine , Saunders Tully , Burns Rebecca , Nyce Jonathan , Wendell Kristen , Evens Andrew M. , Parsons Susan K.
Published: February 2017

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Background: AlthoughHL is highly curable with well-established treatment regimens, the impact on patients' HRQL from diagnosis through survivorship is unclear. This SR aimed to: (1) describe the literature on HRQL in HL, (2) assess the quality of these studies and (3) identify gaps for future research. Methods: We performed a PRISMA-guided SR on HRQL in HL patients. Identified articles were double-screened and data extracted; quality was evaluated using a 6-point scale adapted from published HRQL SR. Results: Sixty-two articles published between 1986- 2014 met inclusion criteria. These included 50 (81%) cross-sectional studies and 12 (19%) longitudinal studies of which three were embedded in randomized trials (RTC). Only two of the RCTs followed patients from diagnosis into survivorship; three additional longitudinal studies began assessments at diagnosis. The majority (75%) of longitudinal studies were performed over the last decade. The sample size of HL patients varied considerably with only five (41%) longitudinal studies including >50 patients. On average, patients in the cross sectional studies were 10-plus years off treatment. Multidimensional HRQL was assessed in 40 studies, single HRQL domains in 21 studies, and symptoms, including fatigue, in 24 studies. Quality varied by study design. Conclusions: The number and quality of studies on HRQL in HL have increased over time. To capture HRQL trajectory from diagnosis through survivorship, we recommend that future research include prospective, longitudinal randomized design across treatment and time. [Table: see text]
Health behaviors in survivors of aggressive NHL.
Authors: Rosenthal Allison Claire , Maurer Matthew J. , Allmer Cristine , Ansell Stephen Maxted , Farooq Umar , Habermann Thomas Matthew , Link Brian K. , Witzig Thomas E. , Yost Kathleen J. , Cerhan James Robert , Thompson Carrie A.
Published: February 2017

236

Background: Patients (pts) with aggressive lymphoma are generally treated with curative intent and many become long-term survivors. There is little data on health behaviors after lymphoma diagnosis and their effect on QOL and long-term outcomes. Methods: Lymphoma pts were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource (MER) and systematically followed. We measured QOL (FACT-G) and health behaviors (tobacco/alcohol use; diet/exercise habits) 3 years after diagnosis. For this study, “survivor” was defined as alive at 3 years from diagnosis with no active disease or treatment within the previous year. Results: From 2002-2012, 671 patients with aggressive lymphoma were enrolled, met survivor definition, and completed 3-year QOL and health behavior questionnaires. At 3-years, 31% of female (F) and 48% of male (M) reported a history of tobacco use for 6+ months. Of these, 13% of F and 7% of M were still smoking; 52% reported decreased use from baseline. 66% reported no change in alcohol intake at 3-years while 25% of F and 34% of M reported decreased intake. 60% often chose whole grains and 65% get 2+ servings of vegetables daily. 42% of F and 38% of M “somewhat” believed diet could change the course of their lymphoma. Most pts endorsed no significant change in diet as a result of diagnosis. Those who made changes did so primarily out of concern for “health problems other than cancer”. Overweight/obese responders were 72% pre- and 66% post-treatment. A desire to lose weight was reported by 55% of pts. 14% of F and 23% of M often engaged in regular physical activity (PA). Nearly 50% reported a decrease in PA. Pts with advanced stage (p = 0.006), age > 60 (p = 0.001), ECOG PS > 2 (p = 0.04), and worse prognostic score (p = 0.006) were more likely to report decreased PA since diagnosis. 68% of F and 61% of M intend to become more active in the next months. Regular PA (p = < 0.0001) was associated with higher QOL, while increased alcohol intake was associated with lower QOL (p = 0.009) at 3 years. Conclusions: Many survivors of aggressive NHL strive to adopt healthy behaviors and these behaviors are associated with higher QOL. Interventions aimed at emphasizing these behaviors may have potential to improve long-term outcomes and QOL.
Exploring factors influencing sexual satisfaction among breast cancer survivors: The role of sexual communication.
Authors: Lawsin Catalina Rosario , Ballard Angela
Published: February 2017

251

Background: Changes to sexual wellbeing after cancer treatment can impact sexual satisfaction, depending on sexual function and relationship satisfaction. While communication has been shown to be a critical component of supportive relationships, it is unclear how it impacts sexual satisfaction, particularly amongst cancer survivors. This study aims to develop a model to understand factors of sexual satisfaction amongst breast cancer (BC) survivors and explore the role of communication. Methods: Adult (18+) BC survivors were invited to participate in an online survey via Register4. Measures included: demographics, the PROMIS Global Satisfaction with Sex Life Scale, Female Sexual Function Index, Sexual Self-Disclosure Questionnaire, The Dyadic Sexual Communication Scale, Dyadic Adjustment Scale, the Hospital Anxiety and Depression Scale. Research questions were addressed using correlations and a hierarchical Multiple Linear Regression. Results: 238 BC survivors (ave age=53) reported lower levels of sexual function within this sample when compared to other studies (FSFI M =17.96, SD =10.39). Higher levels of education (r=.17), dating or de facto relationships (r=.19) and living separately(r=.23), younger age (r=-.16) and shorter relationship length (r=-.14) were associated with higher levels of sexual satisfaction (p<.01). Education level, sexual function and sexual communication explained 78.5% of the variance in sexual satisfaction. There was a significant interaction of sexual function and sexual communication where the effect of high levels of sexual communication was increased at high levels of sexual function compared to lower levels of sexual function (β=.101, p=.005). Conclusions: Sexual function and communication play a significant role in sexual satisfaction amongst BC survivors. While many strategies to improve sexual function may be handled by women themselves, others require effective sexual communication with their partners. These results highlight the need for interventions to teach patients effective sexual communication after sexual changes due to cancer treatment.
How clinicians make decisions regarding surveillance and treatment of colorectal cancer (CRC) patients.
Authors: Cuddy Amanda , Van Loon Katherine , You Y. Nancy , Hu Chung-Yuan , Francescatti Amanda Beth , Greenberg Caprice Christian , Venook Alan P. , Schrag Deborah , Chang George J.
Published: February 2017

263

Background: The goal of post-treatment surveillance of CRC patients is to identify recurrences among patients eligible for salvage surgery or palliative chemotherapy. However, patient ineligibility for treatment of recurrence may contribute to variation in surveillance practices. The aim of this study was to evaluate patient factors that affect clinician decisions regarding surveillance and salvage treatment eligibility among CRC patients. Methods: A custom 41-item survey was developed, incorporating modified criteria for adult comorbidity evaluation. A convenience sample of physicians who treat CRC was recruited from the ALLIANCE GI Cancer Committee. All participants completed an anonymous written survey of objective and subjective information about salvage treatment eligibility and the impact on surveillance in these patients. Results: Respondents were medical oncologists (n = 16; n = 11 with > 10 yrs experience) and surgical oncologists (n = 4). Patients with average comorbidity were considered ineligible for curative salvage surgery at median age 85 yrs (IQR: 80, 90), life expectancy 3 yrs (IQR: 2, 4.8) or ECOG ≥ 2 (IQR: 2,3). Patients were considered ineligible for palliative chemotherapy at median age 90 (IQR: 80, 92.5), life expectancy ≤ 2 years (IQR: 1.5, 3) or ECOG status ≤ 3 (IQR: 3, 3). Patients with above average comorbidity were considered ineligible for salvage surgery at median age 80 yrs (IQR: 75, 80) and palliative chemotherapy at median age 80 yrs (IQR: 75, 85). 8 comorbidities were identified by > 75% of the respondents as determinants of treatment ineligibility. 12 respondents (60%) indicated follow-up of patients ineligible for treatment should be continued based on patient desire, ongoing management of late effects, and continuity of care. However, a majority (n = 15) responded that clinic visits only should be continued without further testing. Conclusions: Considerable agreement was observed regarding patient characteristics that lead to ineligibility for treatment of recurrent disease. This information can aid shared clinical decision-making for post-treatment surveillance strategies and may potentially reduce variation in surveillance practice.
The True NTH Prostate Cancer Survivorship Care programme: Development and evaluation of a model for delivering follow-up care to men with prostate cancer.
Authors: Richardson Alison , Frankland Jane , Brodie Hazel , Cooke Deborah , Pickering Ruth , Gage Heather , Foster Rebecca , Foster Claire
Published: February 2017

42

Background: Increasing use of prostate specific antigen (PSA), improvements in treatment and aging population have led to the escalating incidence of prostate cancer. 5 year survival rate is relatively high and men who have completed treatment require long-term follow-up to detect recurrence or progression of disease, monitor adverse effects of treatment and identify and address psychosocial needs. Studies demonstrate men have a range of unmet physical and psychosocial needs, and health services are struggling to cope with the growing numbers. Changes is critical for long-term sustainability of the health system in many developed nations Methods: This presentation presents a model of follow up care centered on remote surveillance of PSA combined with promoting patient self-management. This initiative is part of the True NTH programme of developments initiated in the UK with funding from Movember Foundation and Prostate Cancer UK. Traditional face to face clinic follow up consultations are replaced with: patient directed individually tailored care and surveillance programme which involves: a 4 hour preparatory patient workshop, remote assessment of unmet needs and symptoms and surveillance of PSA, patient information resources, survivorship care plan, communication of treatment summary and management plan to primary care, and rapid recall system for assessment in secondary care should the need arise. The care programme is mediated through clinician and patient access to an IT portal enabling communication. Results: The second part of the presentation will describe the evaluation protocol. A historical cohort design is comparing a group of men receiving clinic follow up care (N = 300) with men enrolled on the care programme (N = 300) in 3 centers. Patient-reported outcomes are collected at baseline, 4 months and 8 months. Health economic evaluation will compare costs of clinic based follow up with those of the care programme from both a health service and patient perspective. Conclusions: The evaluation will generate data on impact, acceptability and cost of this model of follow-up care.
A new survivorship model for adolescents and young adults (AYA).
Authors: Barthel Erin Marie , Karim Sabrina , Kiernan Elizabeth , Spencer Katherine , Murphy-Banks Rachel , Burns Rebecca , Lin Mingqian , Linendoll Nadine , Saunders Tully , Parsons Susan K.
Published: February 2017

43

Background: The AYA population is a growing group of cancer survivors, currently exceeding 600,000 in the US, with 70,000 new diagnoses each year. These survivors experience deficits in general health, mental health, and functional status. Unfortunately, many are lost to follow-up after the completion of active therapy. They lack clarity about where to go for care and why such care is needed. To further complicate this, many have not established a primary care provider (PCP). Methods: We present a model of survivorship care tailored to the AYA population. Our clinic has dedicated physical space and is staffed by pediatric- and adult-trained oncologists. Survivors are paired with age-matched peer navigators to guide them through the logistics of follow-up care and assist with age- related transitions in education, housing, and insurance. Additionally, we have established a new model of survivorship care, introduced immediately at the end of active therapy, utilizing a staged curriculum, survivorship care plans, and point-of-care health-related quality of life assessment. Results: Fifty-five unique patients seen in 182 visits provided data for this report. The median age was 26 years (range 18-40). Twenty-nine (53%) of the patients were female. The majority of patients (58%) had been treated for a hematologic malignancy. One third of patients had completed college (31%). Most were employed (71%), but a majority still lived with their parents (64%). The majority of patients had more than one late effect (62%). Twenty-three (43%) reported mental health symptoms, including anxiety, mood swings, or sleep problems. Conclusions: A survivorship clinic with tailored programs for AYAs is feasible and necessary. In our sample, many AYA survivors have late effects and almost half reported psychosocial distress. Clinicians need to monitor this age group closely to ensure that patients are not lost to follow-up as they transition from active treatment to survivorship care and from pediatric to adult-based care. Our clinic provides an integrated medical home for the AYA survivor that continues to care for them when active treatment comes to completion and provides ongoing care coordination with PCPs and subspecialists to co-manage their complex health issues.
The Bon Secours St. Francis Cancer Survivorship Program: A model for community-based multidisciplinary survivorship care.
Authors: Bomar Kaitlin , Vickery Nicole , Duggan Meagan , Redenz Tina , Lukker Tracey , Jensen Kristin , Paciarelli Eugene , Dillard Terra , Siegel Robert D. , Crosswell Hal E.
Published: February 2017

45

Background: In 1974, Giulio D' Angio,MD, stated “Cure Is Not Enough” and the concept of Survivorship was ignited. Multidisciplinary survivorship clinics have since become a mainstay of many pediatric cancer programs; few such clinics exist in adult cancer programs, especially in community practice. We report on the development of a survivorship care plan and a community-based clinic designed to provide guideline-driven after care for cancer survivors. Methods: An overview of the vision and mission of the Bone Secours St. Francis Cancer Center Survivorship Program is provided. Descriptive analysis of the components and metrics of success are provided, in the context of accrediting organizations requirements for current and future goals for survivorship care. Results: BSSF, which is a non-academic, community-based cancer program, and receives over 1300 referrals annually from a referral population of 1.32 million in 10 counties. St. Francis , accredited by both the Commission on Cancer and National Accreditation Program for Breast Centers, has been providing cancer‐related services to the Upstate South Carolina region for a decade. The survivorship program at St. Francis is a STAR‐certified program and is a patient‐centered service provided in a comprehensive and coordinated multidisciplinary team approach, including integrated psychologic care. A custom survivorship care plan was developed and efforts, including successes and barriers, to implementation of plans for all cancer survivors in accordance with CoC and NAPBC goals are addressed. Conclusions: The BSSF Cancer Center Survivorship Program has developed a practical, yet comprehensive SCP, which is risk-adapted and guideline-driven in order to provide customized survivorship education and monitoring. The MDC provides comprehensive evaluations and recommendations in order to maximize health and well-being of patients navigating life after cancer diagnosis and treatment. Our efforts have demonstrated that survivorship clinics of this nature can be established and successful in a non-academic community setting.
Using Canadian administrative data to evaluate primary and oncology care of breast cancer patients post-treatment: Subset of the CanIMPACT Study.
Authors: McBride Mary L , Groome Patti , Turner Donna , Jorgensen Margaret , Kendell Cynthia , Porter Geoff , Jiang Li , Krzyzanowska Monika , Lofters Aisha , Moineddin Rahim , Grunfeld Eva , Winget Marcy
Published: February 2017

5

Background: CanIMPACT is a multi-provincial Canadian research team funded to identify and address key issues faced by cancer patients and providers at the intersection of primary and specialist oncology care. Canada has national healthcare standards, but provincial/territorial healthcare delivery systems. One facet will use administrative data from the population-based, publicly-funded healthcare system to evaluate issues during pre-diagnosis, treatment, and post-treatment survivorship for breast cancer patients. For the survivorship phase, we aim to conduct the following analyses and compare across provinces: 1) Utilization of physician services overall and by specialty, including oncologists, non-oncology specialists, and primary care; 2) Assessment of adherence to ASCO and Canadian follow-up guideline for breast cancer care, use of surveillance breast imaging, and metastatic investigations; 3) Assessment of adherence to recommended care of chronic illness and preventive care; 4) Quantification of the cost of follow-up overall and by specialty; 5) Comparison of inter- and intra-provincial variation for all outcomes by health administrative region and for vulnerable groups (age ≥ 75 at diagnosis, northern/rural/remote, low income, immigrants), and examine the effect of continuity of primary care and chronic disease on post-treatment care. Methods: Patients will be identified from provincial cancer registries and linked to data extracted from: outpatient physician service claims, hospital inpatient and outpatient data, and cancer facility medical records. Results: Participating provinces have finalized the core questions and detailed protocols, and assessed data comparability. They are in the process of obtaining the required ethics and data access approvals, and data acquisition for processing and analysis. Conclusions: Results will address existing information gaps that can be used to improve transition and care across the cancer care trajectory. Importantly, results will be combined with those of a CanIMPACT qualitative study to inform design of a pragmatic randomized trial focused on improving coordination and quality of care.
Survivors' narratives of the value of cancer survivorship care plans and clinical services.
Authors: Palos Guadalupe R. , Hebdon Megan , McComb Sara , Wagner Richard W , Rodriguez Maria Alma
Published: February 2017

57

Background: Providers in primary care practice can benefit from having a better understanding of cancer survivors’ perceptions of the value of survivorship treatment summaries and care plans. Our objective was to qualitatively explore survivors’ perceptions of care received in dedicated outpatient clinics for survivors of breast, genitourinary (GU), and head/neck cancers. Methods: This study was conducted from August 8, 2014 to October 2, 2014 in 3 clinics, selected on variation in infrastructure, patient populations, and disease site. A convenience sample of survivors scheduled for an appointment in these clinics was eligible. Semi-structured interviews were conducted by research staff trained in qualitative methodology. Demographic and clinical data were collected. Groups explored a) experience with care/services, b) value of care plan, service coordination and clinic operations and c) gaps/strengths in transition to clinics. Descriptive statistics were used to summarize and analyze demographic and clinical data. Discussions were transcribed verbatim with confirmation of themes among a team of researchers. Results: A total of 36 survivors, X= 62.3 (SD = 10.9) years, were interviewed. Of these 27.8% breast survivors, 38.9% head/neck, and 33.3% GU, with X= 8.33 (SD = 5.83) years since their cancer diagnosis. Of these, 80.5% were Caucasian, 8.3% Hispanic/Latino, and 5.6% Asian/Pacific Islander, and 5.6% African-American. 61.1% were male and 78.6% married or living with someone. Survivors cited concerns about inconsistency in methods used to distribute care plans to survivors, inadequate communication about the purpose of the care plan, and vague recall of receiving care plans. Survivors reported the value of receiving survivorship care were “having an awareness of what’s up the road, establishing a constant relationship with their provider and addressing gaps in care”. Conclusions: The value of offering survivorship care is supported by the narratives of these survivors. Additional training and education on effective communication about survivorship care plans may be useful to oncology specialists and primary care providers.
Developing infrastructure to improve research and care for cancer survivors: A pilot study.
Authors: Rosenberg Shoshana M. , Ligibel Jennifer A. , Meyerhardt Jeffrey A. , Jacobsen Eric D. , Garber Judy Ellen , Nekhlyudov Larissa , Bunnell Craig A. , Walsh Sarah , Partridge Ann H.
Published: February 2017

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Background: Despite a growing number of clinical trials and supportive care programs for cancer survivors, recruitment of patients (pts) for these opportunities during the survivorship phase of care is challenging. We piloted a program to systematically share available research studies and supportive care programs with pts as part of their treatment summary and survivorship care plan (TS/SCP) visit at our institution. Methods: Between 3/2015-8/2015, pts seen in the Adult Survivorship Program who had not previously received a TS/SCP were provided with one that included a list of survivorship research studies and care programscustomized to their diagnosis. Survivorship providers discussed the opportunities and recorded whether the pt was interested in relevant studies and placed referrals to study staff. Following the visit, we tracked study enrollment and surveyed pts about their experience. Results: 50/56 (89%) pts who participated in the pilot responded to the survey.Median age was 51 (range: 26-73); 78% were female; 54% were survivors of breast cancer; 42%, lymphoma; 2%, breast and lymphoma; 2%, colorectal cancer. Only 34% knew what a TS/SCP was before their visit; however 96% said having a TS/SCP would be helpful when visiting a primary care or other provider; 92% said the TS/SCP visit and document had or will help with knowledge of research opportunities and supportive care interventions. 90% responded that the study information they received was useful; 44% were interested in at least 1 study and would follow-up with a research coordinator. Of the 30 survivors eligible for ≥ 1 study, 5 have enrolled to date. Conclusions: This pilot program demonstrated that the systematic sharing of relevant clinical studies and supportive care programming as part of a TS/SCP visit is feasible and well-received by cancer survivors. Expansion of this novel program should help to enhance clinical research accrual for cancer survivors as well as ensure awareness of available supportive care interventions.
Late-stage lung cancer patient preferences about chemotherapy treatment adverse side effects.
Authors: Islam K. M , Ryan June , Fetrick Ann , Ganti Apar Kishor
Published: February 2017

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Background: Patients’ preferences regarding treatment adverse events are not systematically considered when choosing a treatment for stage lung cancer. Further, there is no clinical guide for patients or physicians on how to integrate patient preferences of adverse events in treatment and care decisions. Although it is assumed that most cancer patients prefer either an active or a shared role in decision making, particularly in late stage cancers. Our specific aim of this abstract is: Aim: Determine whether individual patients’ preferences, characteristics, and treatment experiences affect the meaning of chemotherapy treatment success. Methods: We have completed two years of our three-year research using a mixed method study design, which includes focus groups, cross-sectional, prospective, and randomized experimental designs. We initially selected three cancer centers in Nebraska and one in South Dakota for patient and provider recruitment. Currently, we have six cancer centers participating in this multi-center Patient Centered Outcomes Research. Results: Four focus groups were conducted with 36 participants that included patients, family members and caregivers and oncology providers. Patients and caregivers confirmed that survival alone is not their measure of lung cancer treatment success Definition of treatment success should emphasize effective clinical guidance throughout treatment, symptom management, functionality, and quality of life Definition of treatment success evolves over time, appearing to be linked to patients’ experiences with chemotherapy. Participants advocated for better patient-provider communication practices as well as the expanded use of patient navigation and new patient orientation programs. Conclusions: Late stage lung cancer patients have definite opinions about the impact of adverse treatment effects on their quality of life.
Cancer survivorship in Germany: Education of GPS—Why and how?
Authors: Schilling Georgia , Niebling Wilhelm , Mack-Hennes Angelika , Arnold Dirk
Published: February 2017

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Background: General Practitioners (GP) play a pivotal role in caring for patients with malignant diseases in screening and detection, additional supporting care whilst treatment, and (long-term) follow-up. They often do not feel to be qualified enough for this task, and as well claim to lack support by specialists. This is a well-known problem, already addressed by the Institute of Medicine a few years ago. As an increasing number of patients will be diagnosed with cancer – and will survive for many years, following curatively intended treatment or with a chronic cancer disease, Cancer Survivorship was identified as the area of utmost importance. The relevance of this field was underlined by the disappointing results of the simple question we asked GPs: “When and how often should the tumor markers CEA, CA 15.3, and PSA be assessed during standardized follow-up of patients with early breast cancer, colorectal cancer or prostate cancer?”. Only one out of 30 answered it correctly. Together with the State Chamber of Medicine of Südbaden, we started an education program for GPs to improve this critical interface. Methods: During a full day training, we provided an educational program covering the most relevant topics in Cancer Survivorship: physical long-term sequelae and late complications after multimodal therapy strategies, their prevention and treatment; fatigue and self management, reasonable complementary and alternative medicine; management of chronic pain syndromes, recommendations for tertiary prevention, physical activities, nutrition and a guideline conform follow-up. Training was completed by a knowledge test and an overall evaluation. Results: All participants welcomed this newly implemented training program and considered it as very useful for their daily practice. Further support was urgently requested by the GPs, preferably in the format of (defined) Survivorship Care plans and follow-up schedules. Conclusions: GPs need more support and information in Cancer Survivorship. Widespread trainings programs should be developed and offered, in close collaboration with the respective State Chambers of Medicine and cancer specialists, and GPs, and further improve the outpatient care of cancer survivors.
Personalized medicine as a model of care to improve patient outcomes, communication, and reduce cost.
Authors: Millis Sherri Z. , Davis John M , Ratliff Stephanie Marie , Ray Melissa Lorraine , Schroeder Wendy M , Townsend Tim , LoBello Janine R , Demeure Michael J. , Staren Edgar Donald
Published: February 2017

e270

Background: Cancer treatment based on an individual’s tumor profiling has been associated with increased time to progression. Despite this, adoption has been impeded by various technical, financial, legislative, and ethical issues. Implementation of a personalized medicine program into a healthcare system with a goal of improving patient outcomes includes clinician and patient education, increased tumor profiling of patients, data sharing/analysis, expanded research, and billing/reimbursement practices. Methods: A personalized medicine program was implemented at a hospital system. Measures of physician practice included attendance at genomic medicine education sessions, utilization of genetic/genomic tests, enrollment of patients into clinical trials, modifications in billing practices, and submission of data for analysis. Reimbursement of off-label pharmaceutical agents as well as use of aggregate data to inform treatment and enrollment in biomarker-based clinical trials was recorded. Frequency of genetic and/or genomic tests relative to physician and patient education and access to research opportunities was also assessed. Early patient outcomes, overall costs of care, access to clinical trials, and changes in knowledge and communication are also being monitored. Results: Although analysis is ongoing, the initial assessment indicates an increased utilization of genetic and genomic tests, clarity in billing practices, improved reimbursement for off label therapies, and consumption of educational opportunities from clinicians to patients/caregivers. Analysis of the first year implementation will be reported, including evaluation of preliminary results relative to quality of life and survivorship. Conclusions: Preliminary analysis of data from implementation of a personalized medicine program indicates that utilizing relevant education, research, aggressive billing and reimbursement processes, and IT infrastructure, can provide patients with the individual therapies which reduce cost and improve survivorship.
"3 Steps 4 Health" in survivorship.
Authors: Fonfa Ann , Waldman Helayne
Published: February 2017

e273

Background: As patient advocates we have spent years gathering and sharing information about simple, natural strategies to reduce risk of treatment-related toxicities and strengthen the immune system in survivorship. Sadly it is well known that many suffer long-term toxicities and are at higher risk for secondary cancers. Survivorship plans are created to help people move forward with their lives; we suggest the “3 Steps 4 Health” program as an addition. Methods: We created a simple 3-step program that absolutely anyone with cancer can incorporate into their own healthful protocol as they move into complete recovery. Since it involves no tools and can be used at the level that an individual is at the time they start, we consider it appropriate for all. Further, we cannot see any objection from the oncologist or staff members. Step 1: Eat one more fruit and one more vegetable every day. This is helpful since studies show few Americans are getting enough fruits or vegetables. The National Cancer Institute considers “Five a Day” a minimum. We want to get people started on the correct path simply and easily. Step 2: Take a walk around the room or neighborhood depending on ability and health status. This has been shown by many studies to help anyone with cancer, undergoing treatment, or in recovery. We are not asking people to become athletes; we are involving them in a plan to improve their health. Step 3:Seven deep breaths in a stressful situation or at bedtime. This step is important to reduce stress and encourage relaxation. Results: As patient advocates, we conduct no research; we scour journals for studies supporting our evidence-based concept. There are now many studies showing the value of one or more of the three steps. Rarely does research examine the concept as a whole. We believe this will occur soon. Conclusions: Every step moves people forward into better health. We believe taking these first steps will lead to more healthful behaviors, better ability to handle conventional cancer treatments, and an easier recovery. In this era of interest in immune response, it makes perfect sense for each individual to strive to be their personal best. Clearly, the “3 Steps 4 Health” program is a beginning at an important time for those who have survived cancer. We will share some of the studies that led us to this position.
Can we improve on patient, caregiver, and family engagement for better outcomes?
Authors: Korber Kenneth E
Published: February 2017

e289

Background: Use of multimedia characters have been a mainstay of commercial consumer marketing for decades; albeit to the detriment of healthy lifestyle and purchasing choices. Methods: We set out to change this paradigm by providing a socially-beneficial multimedia character concept as a community outreach engagement tool AND to provide a health champion for at-risk pediatric patient cohorts, their caregivers, and families. Results: A children's book series was written with the hypothesis that tested whether combining music and health would be a positive and measureable tool for audience engagement. A secondary goal was to create a platform wherenby this notion could be leveraged in multiple therapeutic areas and across multi-disciplinary professional groups. Conclusions: The Musical Adventures of Grace ((ISBN 978-1-68097-094-4) has been produced and is being integrated into two curricula: (i) a national music immersion education program for cognitive | neurophysiological | emotional wellness, and (ii) as a classroom-clinic longitudinal tool for elevating awareness of healthy living and reinforced choices in families at-risk for cardiovascular disease. This new model can be adapted to multiple challenges of childhood cancer nad will contribute to clinicians' communication armamentarium.
Mind-body medicine epigenetic technique (MET) and TP53AIP1 gene expression.
Authors: Munoz Francisco Ventura
Published: February 2017

e292

Background: This is a pilot study update on the potential of MET to up-regulate TP53AIP1 gene expression correlated with the up-regulation TP53 gene expression in patients diagnosed with breast cancer. 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 TP53AIP1 gene expression. 2.) Secondary Endpoint:To determine whether there is a correlation between up-regulated TP53AIP1 gene expression and up-regulated TP53 gene expression. The blood samples were sent to genomics labs at the Childrens 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: For three participants, there was no statistical or biologically significant up-regulation in TP53AIP1 gene expression. However, one participant from Group 1 evidenced a biologically significant up-regulation of TP53AIP1 gene expression along with a biologically significant up-regulation of TP53 gene expression. 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 TP53AIP1 gene expression potentially due to MET and provided evidence supporting the established correlation between TP53 and TP53AIP1 gene expression that could induce apoptosis. This study also provided a foundation for a larger study with more participants.