bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of multidisciplinary rehabilitation on physical well-being and quality of life of breast cancer survivors.
Authors: Adriaenssens Nele , Fontaine Christel , Vanhoeij Marian , Lamote Jan , De Greve Jacques
Published: February 2017

143

Background: Breast cancer treatment has adverse effects. The aim of this study was to examine the effects of a multidisciplinary oncologic rehabilitation program on health related quality of life (HRQoL), cancer related fatigue (CRF), muscle strength, physical fitness and anthropometrics in breast cancer survivors. Methods: This quasi-experimental study included 30 early breast cancer patients in the first year following treatment. Patients completed a 12-week exercise program for 4 hours a week combined with lifestyle guidance for 2 hours a week. The supervised training sessions consisted of aerobic exercises combined with muscular strengthening exercises. Measurements were carried out at baseline (T0), at the end of the intervention (T1) and at 12-weeks follow-up (T2). HRQoL (EORTC QLQ-C30 questionnaire) and CRF (FACIT-Fatigue questionnaire), were measured at T0, T1 and T2. Muscle strength (handgrip dynamometer) was measured at T0 and T1. Physical fitness and anthropometrics were assessed at T0 and T1 using spiro ergometrics, bioimpedance and waist- and hip circumference. Results: Significant positive changes in HRQoL were found, especially for physical functioning (p = 0.004) and dyspnea (p = 0,003) at T1, but HRQoL decreased at T2. Weight, BMI, waist - and hip circumference and fat free mass decreased significantly (respectively p = 0,030; p = 0,047; p = 0,020; p = 0,041 and p = 0,003). Body impedance increased significantly over time (p = 0,034). There was a significant improvement in CRF at T1 (p = 0.03), that was no longer significant at T2. No significant improvements were found in muscle strength at the affected side (p = 0.16) and the non-affected side (p = 0.95). Physical fitness increased significantly for VO2max at the maximal progressive cycle test (p = 0.005). Conclusions: This study reports significant improvements in HRQoL, anthropometric characteristics, CRF and physical fitness after a 12-week rehabilitation program. The declines between T1 and T2 may be explained by discontinuation of physical activity. Further research should use randomized clinical trials to examine the effectiveness of rehabilitation programs with different contents, duration and initiation.
Variation among follow-up survivorship guidelines for adolescent and young adults (AYA).
Authors: Barthel Erin Marie , Kiernan Elizabeth , Banco Darcy , Spencer Katherine , Parsons Susan K.
Published: February 2017

147

Background: The AYA population is a growing group of survivors, exceeding more than 600,000 who are at high risk for late effects of cancer-directed therapy. While many guidelines exist for cancer survivorship care, choosing which to use for an AYA cancer survivor is challenging, yet essential, to ensure comprehensive follow-up care. Methods: Survivorship care plans, including treatment summaries and follow-up care plans, were created for three clinical vignettes (acute lymphoblastic leukemia, osteosarcoma, and Hodgkin Lymphoma). Four sets of guidelines were used including the Children’s Oncology Group Long-Term Follow-Up Guidelines (COG LTFU), National Comprehensive Cancer Network (NCCN) Guidelines for Age- Related Recommendations: AYA Oncology (NCCN-AYA), NCCN Guidelines for Treatment of Cancer by Site (NCCN-Site), and NCCN Guidelines for Supportive Care: Survivorship (NCCN-Survivor) and NCCN supplemental cancer screening guidelines. The follow-up care plans were compared across guidelines to determine the extent and nature of the similarities and differences concerning AYA survivorship care. Results: The guidelines differ widely on surveillance recommendations based on risk, test, and frequency. The COG LTFU recommends screening all individuals with a specific treatment exposure, whereas the NCCN-AYA recommends screening based on risk and the NCCN-Survivor recommends testing individuals with a positive review of systems and other health risk factors. To illustrate this, in the follow-up care plan for our Hodgkin Lymphoma case, recommended monitoring for cardiac toxicity varied from annual screening (COG LTFU) to ten year intervals (NCCN-Survivor), based on which guideline was used. Conclusions: The guidelines disagree on the link between treatment exposures and late effects, on the population to be screened, on the screening test to be used, and on the time interval of testing. This has significant implications for the long-term follow-up care an AYA survivor will receive. We highlight differences across the guidelines and offer solutions to harmonize guidelines to ensure comprehensive, quality survivorship care for this population.
Predictors of trajectories of cognitive change in women with breast cancer.
Authors: Bender Catherine M , Merriman John , Gentry Amanda , Ahrendt Gretchen M. , Brufsky Adam , Sereika Susan M.
Published: February 2017

149

Background: Subgroups of women with breast cancer may be vulnerable to cognitive changes with systemic therapy. Given our previous findings of changes in concentration and working memory (WM), we sought to identify subgroups of women with distinct trajectories of concentration and WM and determine predictors of subgroup membership. Methods: Cognitive function was assessed before systemic therapy and semi-annually to 18 months post-therapy initiation in 181 postmenopausal women with breast cancer who received the AI, anastrozole, or chemotherapy+anastrozole and at matched time points for 110 healthy controls. Group-based trajectory modeling identified subgroups of women with distinct trajectories of concentration and WM (as measured by composites of mean z-scores for neuropsychological tests). Multinomial logistic regression identified predictors of subgroup membership. Results: A 3-group model was found for concentration: low and constant (25%; b0 = -0.84), normal but declining (65%; b0 = 0.05, b1 = -0.04), and high and constant (10%; b0 = 1.29). At baseline, the low subgroup was older (p = .009) and had lower psychomotor speed (p = .035) than the normal subgroup. Controlling for baseline concentration z-scores, membership in the low concentration subgroup was associated with greater age (p < .001), more fatigue (p < .001), and poorer self-reported cognitive function (p = .001). For WM, a 2-group model was identified: low and increasing (35%; b0 = -0.67, b1 = 0.11) and high and increasing (65%; b0 = 0.32, b1 = 0.07). At baseline, the low WM subgroup was older (p = .008), had less education (p < .001), and scored lower on the NART verbal IQ test (p < .001). Controlling for baseline WM z-scores, membership in the low WM subgroup was associated with poorer executive function (p < .001), receipt of anastrozole alone (p = .011), and worse pain (p = .002) and anxiety (p = .008). Conclusions: Subgroups of women are more vulnerable to poorer concentration and WM during adjuvant therapy for breast cancer. Advancing age, less education, and co-occurring symptoms are associated with membership in these vulnerable subgroups.
Oncologists' perception of residual cancer recurrence risk and recommended follow-up care.
Authors: Basu Arnab , Miller Kenneth David
Published: February 2017

151

Background: Many medical oncologists avoid using the word "cure" even at 20 years post-diagnosis. Little data has been reported on oncologists' perceptions of patients’ residual risk of recurrence and their recommendations for follow-up care. Methods: E-mail requests were sent to oncologists to review four brief case scenarios and to indicate their perception of the patients’ residual risk of recurrence (Essentially Zero, 1-10%, 11-25%, 26-50%, 51-75%, 76-100%) and their recommended follow-up care. We also conducted a literature review to estimate actual recurrence risks for these stated scenarios. Results: 130 medical oncologists responded. The percentage who perceived a zero or essentially zero risk of recurrence steadily increased at the 5,10, 15, and 20+ year post-diagnosis time points in patients with Stage II triple negative breast, Stage II colon, Stage II lung, and Diffuse Large B-cell Lymphoma. Follow-up for 20+ years was recommended by 43%, 27%, 32%, and 38% of respondents respectively. Among respondents who recommended this long-term follow-up 37%, 63%, 57%, and 58% perceived no residual risk of recurrence after 20 years. There was no statistically significant relationship between recommending follow-up at > 20 years and the perception of the patient having a non-zero risk of recurrence. Even at twenty years post-diagnosis a > 10% risk of recurrence was expected by 14%, 8%, 10%, and 11% of respondents.However,a literature review indicated recurrence risks of < 5% after 10 years of disease free survival for patients with each described scenario. At 10 and 15 years, participants indicated the two most common reasons for follow up were screening for late and long-term effects followed by screening for new cancer Conclusions: The risk of cancer recurrence is typically greatest in the initial years after diagnosis and then decreases, especially after 10 years. In this study, many medical oncologists still perceived a > 10% residual risk of recurrence at 10, 15, and 20 years post-diagnosis and recommended follow-up visits.
Tart cherry juice as a treatment for chemotherapy-induced peripheral neuropathy.
Authors: Carson Cindy Alberts
Published: February 2017

153

Background: CIPN is believed to affect up to 30% of cancer patients, particularly recipients of platinum compounds, plant alkaloids, and taxanes. Conventional treatments, such as antiepileptics, antidepressants, NSAIDs, and narcotics, usually provide only partial relief, and may have significant adverse effects. Tart cherries have a long history as a treatment for arthritides. It is believed that acanthocyanin pigments found in tart cherries modulate cytokines, decrease capillary permeability, and inhibit cyclooxygenase, which would be expected to reduce inflammation and pain. Methods: The study group consisted of 17 primary care patient volunteers with painful CIPN. This is a subset of a larger ongoing study of tart cherry juice as a treatment for PN generally. All study patients had carried a diagnosis of PN for 1-5 years, and had no symptoms of PN prior to cancer treatment. All patients described 7-10/10 pain more than 50% of the time. All study patients were allowed to remain on their prescribed doses of AEDs and antidepressants during the study. The patients agreed not to use NSAIDs, steroids, lidocaine, and narcotics during the study. There were no other restrictions. 12 patients had received platinum compounds and/or taxanes, 4 had received plant alkaloids, and 1 bortezomib. All patients drank 4 oz. of tart cherry juice BID for 14 days. The juice was a combination of 4 species imported from the Caucasus and sold commercially as “100% Cherry Juice from Concentrate.” Results: After 14 days of treatment, the patients were questioned regarding pain level. Three patients (carboplatin+taxol) reported no improvement. Seven patients (platinum, taxanes, alkaloids, and bortezomib) reported a decrease of maximum pain to 5-6/10. Five patients (alkaloids, platinum) reported a decrease of maximum pain to 3-4/10. Two patients (alkaloids) reported a decrease of maximum pain to 0-2/10. Overall, greater than 70% of the patients reported a greater than 25% reduction in maximum pain. Conclusions: While there are significant limitations to this study, a 14 day course of tart cherry juice appeared to improve CIPN in the majority of patients, with no reported adverse effects.
Late effects of pelvic radiation treatment (EAGLE study).
Authors: Taylor Sophia Emily , Muls Ann , Andreyev Jervoise , Green John , Farnell Damian , Smith Lesely , Ahmedzai SAM H. , Pickett Sara , Ferguson Catherine , Fitzsimmons Deborah , Cambell Susan , O'Shea Raymond , Nelson Annmarie , Staffurth John
Published: February 2017

159

Background: Radiotherapy treatment for prostate cancer can cause severe long –term bowel problems, including limiting travel, work or socialising. Around half of patients suffer from late effects, appearing more than six months after radiotherapy. These symptoms often remain unmonitored in follow up care, despite the existence of effective treatment if referred to gastroenterology departments. This study focuses on the early identification and treatment of neglected late effect symptoms. Methods: Novel healthcare interventions are often difficult to embed in local clinical settings. Implementation research methodology will be used to evaluate experiences of a multi-component intervention aimed at prompting referrals to an enhanced gastroenterology service, making real time adjustments as needed, with the ultimate aim of successfully embedding the intervention into practice across the UK. The intervention, introduced in three UK centres, comprises a brief, standardised clinical assessment of relevant symptoms and rapid referral to a gastroenterological service, with staff trained to use a validated investigation and treatment algorithm. Evaluation of the intervention and its acceptability within local practices will be conducted using longitudinal mixed methods research. All prostate cancer patients attending follow up clinics, meeting the eligibility criteria will be invited to be screened (n = 300) and offered a referral to gastroenterology if appropriate. A cost effectiveness analysis of health-related quality of life and resource utilisation data will be undertaken and contrasts made between participants and a comparison group. Results: Interim results will focus on interview data from healthcare professionals and how they are working locally to embed practice, sharing learning points with other locations whilst working towards a sustainable service. Conclusions: This study evaluates the effectiveness of an enhanced assessment and treatment service spanning oncology and gastroenterology services in improving the outcome of men with prostate cancer after radiotherapy. Successful implementation will act as examples of best practice for a network of centres of excellence in this area.
Utilization of sexual health and pelvic floor physiotherapy services in Vancouver’s Prostate Cancer Supportive Care (PCSC) Program.
Authors: Higano Celestia S. , Zarowski Christine , Dayan Marcy , Pollock Phil , Elliott Stacy , Mahovlich Sarah , Sundar Monita , Goldenberg Larry
Published: February 2017

163

Background: The Vancouver Prostate Centre established PCSC in January 2013 to provide education and clinical services to men with prostate cancer (pts) and their partners. The program includes a dedicated sexual health (SH) clinician and physiotherapist (PT) with expertise in male pelvic floor anatomy and physiology. Educational and clinical services are available to pts without charge. We examined the use of the SH and PT services in PCSC to better understand how the services are utilized. Methods: Pts who are pre-treatment or within 6 months of surgery or radiation are offered a group educational (ED) session regarding sexual rehabilitation with the option of visits to the SH clinic. Those who were > 6 months from surgery or radiation were offered evaluation in the SH clinic. Pts who are about to undergo surgery or who have postoperative incontinence are offered attendance at a group ED session and/or 3 visits with the PT clinician. We gathered data from PCSC logs, clinic schedules, and patient records to assess utilization of SH and PT services. Results: SH and PT ED sessions and clinics (CLIN) were initiated in July and October 2013 respectively. Of 802 pts oriented to PCSC, 400 pts, median age 64 (42-92), participated in the SH module and 229, median age 66 (range 42-88) in the PT module. 90% of patients in each module had been treated with surgery; 10% were on ADT. Details of utilization of the ED and CLIN components by pts for both modules are shown in the table below. There was a total of 781 SH clinic visits: 141 pts had one visit, the remainder had a median of 3 visits (range 2-8). For PT, there were 334 visits, with a median of 2 (range 1-4) per pt. 37% of pts who were seen by SH were also seen by PT and 65% of those seen in PT were seen in SH. Conclusions: Sexual dysfunction and urinary incontinence can be significant problems, and often occur together. The PCSC Program offers both educational and clinical services to address these issues, and continues to modify its programs to best serve patient and partner needs at various time points after therapy. [Table: see text]
Associations between peripheral neuropathy and nausea/vomiting in survivors of ovarian cancer: Evidence of persistent vagal neuropathies?
Authors: Donovan Heidi AS , Horn Charles , Campbell Grace , Hagan Teresa , Bovbjerg Dana H.
Published: February 2017

165

Background: Persistent numbness and tingling in extremities are reported by many ovarian cancer survivors and are widely recognized symptoms of chemotherapy-induced peripheral neuropathy. Minimal research has addressed the possibility that chemotherapy may also result in vagal neuropathy, with associated adverse effects on somatosensory input to the brain. We hypothesize that ovarian cancer survivors with persistent numbness and tingling, hallmark symptoms of peripheral neuropathy, will report higher levels of nausea and vomiting, consistent with vagal neuropathy. Methods: A secondary analysis was conducted with data from 713 respondents to a survey of randomly selected members of the National Ovarian Cancer Coalition with a history of ovarian cancer. A validated questionnaire was used to assess symptom severity (0-10) at it worst over the past week for 22 commonly reported symptoms. For the present study, analyses were limited to women reporting no evidence of disease following chemotherapy (n = 362) at a mean of 50.3 months post-treatment. The mean age of the sample was 53.1y; 71.7% were married; 54.5% were college graduates. The symptom experiences of women with persistent numbness and tingling , N/T, (n = 206) were statistically compared to those without numbness and tingling (n = 156) with age and time since treatment included as covariates. Results: Ovarian cancer survivors with N/T had significantly higher levels of nausea (p < 0.001) and vomiting (p < 0.001), as well as several other symptoms consistent with vagal neuropathy, compared to women without N/T. Sensitivity analysis indicated that among women with the highest N/T severity (7-10), nausea severity was nearly three times higher than among women with the lowest levels of N/T severity (1-3), p < 0.002. Conclusions: Consistent with the study hypothesis, ovarian cancer survivors with persistent numbness and tingling also reported higher levels of nausea and vomiting. These results suggest the importance of new research efforts to examine vagal neuropathy in ovarian cancer survivors.
A randomized trial of a clinic-based weight loss intervention in cancer survivors.
Authors: Yung Rachel Lynn , Giobbie-Hurder Anita , Shockro Laura , O'Connor Keelin , Campbell Nancy , Kasper Jocelyn , Overmoyer Beth , Mayer Erica L. , Tolaney Sara M. , Partridge Ann H. , Ligibel Jennifer A.
Published: February 2017

167

Background: Evidence increasingly links obesity to increased risk of cancer recurrence and mortality in breast and other cancers, but few studies have evaluated weight loss interventions in cancer patients. We evaluated the impact of a group-based weight loss intervention implemented through an oncology clinic on weight and other outcomes in a mixed population of cancer survivors. Methods: Overweight and obese cancer survivors were randomized 1:1 to immediate or delayed participation in a 15-week group-based weight loss program focused on calorie restriction and increased physical activity. Weight, body composition, physical activity, fitness and quality of life were assessed at baseline and 15 weeks. Changes in measurements between baseline and 15 weeks were compared using Wilcoxon rank sum tests. The primary outcome was change in weight between baseline and 15 weeks between groups. Results: 60 participants were randomized; 30 to intervention and 30 to control. Median age was 52, average BMI was 31.8 kg/m2, 97% of participants were women, and 80% had breast cancer. Intervention participants lost 5.3% of baseline weight at 15 weeks vs 0.2% weight gain in controls (P < 0.001) (Table). Improvements in fitness (6-minute walk test) and physical functioning (EORTC QLQ C30) were also observed in the intervention group vs. controls. Conclusions: We found thatparticipation in a 15-week group-based intervention resulted in weight loss and improvements in fitness and physical functioning in overweight and obese cancer survivors. More work is needed to evaluate the feasibility and sustainability of weight loss programs implemented through oncology practices. Clinical trial information: NCT01978899. [Table: see text]
Implementation of an integrative wellness program for pediatric cancer survivors at risk for cardiac late-effects.
Authors: DiSipio Theresa C , Zappalla Frances , Quillen Joanne
Published: February 2017

168

Background: Many adult childhood cancer survivors are at risk of developing adverse health outcomes as a result of their previous diagnosis and treatments. Cardiac events are the most common cause of non-malignant mortality among pediatric cancer survivors; one in eight will develop severe cardiac disease (Lipshultz et al, 2012). The use of integrative therapies in the survivorship setting has the potential to reduce risk of developing late effects and assist with positive coping mechanisms (Kelly, 2009). Early exposure to anti-inflammatory nutrition, yoga and relaxation techniques in combination with thorough cardiac monitoring has the potential to reduce feelings of anxiety and fear of recurrence while catalyzing positive lifestyle modifications and improving overall wellness. Methods: In partnership with the Department of Cardiology at AIDHC, childhood cancer survivors at moderate-to-high risk were identified and referred for integrative cardiology consults (ICC) with a goal of providing an introduction to integrative medicine approaches, and a long-term emphasis on decreasing the incidence of future adverse cardiac events. Patients were approached during their routine post-therapy follow-up appointments. Cardiology consult orders were placed by the oncology provider through the electronic medical record (EPIC) via smart phrasing. Results: A total of 15 patients and families were approached. All 15 complied to ICC in conjunction with their routine ECHO/EKG testing. 47% of the referred patients were exposed to both anthracycline chemotherapy and radiation. 17% presented with significant cardiac related family medical history and 40% had existing comorbidities or lifestyles that may affect future cardiac health. Conclusions: Implementing an ICC standard for childhood cancer survivors at moderate-to-high risk for cardiac late-effects has been successful for AIDHC’s Cancer Survivorship Clinic and shows promise as a preventative intervention. Efficacy will be assessed by measuring patient and family knowledge pre and post ICC in the future.
The feasibility and utility of a protein sparing modified fast (PSMF) in obese endometrial cancer survivors: A pilot study.
Authors: Lawler Thomas Patrick , Kavanagh Mary Beth , Nagel Christa Irene , Ruckstuhl Kristen Taylor , Singh Sareena , Resnick Kimberly Erin
Published: February 2017

170

Background: Endometrial cancer affects 50,000 women a year. Obesity plays a significant role in the pathogenesis of endometrial cancer. Obese endometrial cancer survivors (ECS) are at significant lifetime risk of diabetes, cardiovascular disease (CVD), recurrence and death. There are no prospective studies examining the role of diet only in attempting to achieve weight loss in obese ECS. Protein sparing modified fast (PSMF), an approach to rapid weight loss, has been used to treat obesity in a safe manner. A pilot study is underway to investigate the feasibility of a PSMF for weight loss in this high risk population. Methods: To date, seven obese (BMI > 30kg/m^2) ECS have been placed on a PSMF under the supervision of a physician and dietitian. Patients provided demographic information and Obesity Quality of Life (OQOL) questionnaire. Comprehensive metabolic panel with lipid panel and biomarkers of inflammation were drawn. Patients were instructed to eliminate carbohydrate containing foods and to augment with 1.2g/kg of protein per obesity-adjusted ideal body weight. Primary objectives are: total weight loss, subject retention, compliance, side effects, QOL and alterations in markers of obesity and inflammation. Results: The median age of the patient group was 56 years. Median baseline weight was 292.4 pounds (185.9-369). Median BMI was 44.5 kg/m2 (37.5-61.4). Mean baseline leptin level was 54.3 ng/ml (normal: 2.5-21.8). Mean baseline C-reactive protein level, a strong marker for CVD, was 4.574 (high risk for CVD > 3). At 4 weeks median percent body weight lost was -6.48% (5.19%-7.00%). At 3 months the median loss nearly doubled to -13% (8.31%-14.11%). Significant reduction in CRP and leptin occurred in 2 patients: mean decrease was 3.9 and 28 points respectively. Conclusions: Our early data demonstrate that significant weight loss in obese endometrial cancer survivors is achievable in a standard outpatient gynecologic oncology practice. While long term follow up data and elucidation of the true significance of improvement in serum inflammatory markers are needed, we do know that even a 5-10% loss of body weight can lead to substantial improvement in CVD and diabetes risk.
Health care satisfaction among older cancer survivors.
Authors: Halpern Michael T. , Urato Matthew , Kent Erin E.
Published: February 2017

18

Background: Cancer survivors experience unique challenges in receiving needed health care services. There is little information on individual-level factors affecting satisfaction with health care services among survivors. Methods: This study used satisfaction ratings provided by cancer survivors in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare Survey linked to data from NCI’s SEER Program (SEER-CAHPS). CAHPS data on self-reported general and mental health status and five composite measures of satisfaction with health care interactions (customer service, doctor communications, getting care quickly, getting needed care, and getting prescription drugs) were linked to patient sociodemographic and cancer characteristics from SEER. Medicare beneficiaries diagnosed with cancer in SEER regions 1997-2011 participating in CAHPS Medicare Survey > 1 year after cancer diagnosis were included. The study included individuals alive > 1 year following CAHPS completion, at least age 66, and diagnosed with non-metastatic breast, colorectal, lung, or prostate cancer. Analyses were performed separately by cancer type. Results: Among 23,969 cancer survivors with linked SEER-CAHPS data, higher general health was associated with higher satisfaction for all survivors except those diagnosed with lung cancer; higher mental health predicted higher satisfaction only among lung and prostate cancer survivors. Higher education predicted lower satisfaction among breast cancer survivors. Non-white survivors generally had lower satisfaction, although results were mixed. Among breast and prostate cancer survivors, fee-for-services Medicare (vs. Medicare advantage) was associated with lower customer service satisfaction but higher satisfaction with getting prescription drugs. Breast cancer patients diagnosed with stage 3 disease reported greater satisfaction than did those diagnosed at stage 1. Conclusions: Factors associated with health care satisfaction ratings for cancer survivors showed substantial variations by cancer types. Programs to improve survivorship care and outcomes need to be tailored to survivors’ clinical and sociodemographic characteristics.
Parenting experiences of cancer survivors with young children in the 2012 LIVESTRONG Survey for People Affected by Cancer.
Authors: Whitney Robin L. , Bell Janice , Reed Sarah C. , Blackmon Emma , Kim Katherine K. , Joseph Jill G.
Published: February 2017

189

Background: When a parent is diagnosed with cancer, family functioning may be disrupted, placing children at risk. Little is known, however, about the parenting experiences of cancer survivors. Methods: Among cancer survivors with children age ≤ 20 years at diagnosis (n = 2,375) in the 2012 LIVESTRONG Survey for People Affected by Cancer, we used logistic regression to model the odds that 1) children were not fully emotionally supported or that 2) cancer affected survivors’ ability to provide care for their children. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Predictors included age of youngest child at diagnosis ( ≤ 10 years versus 11-20 years), survivor report of high distress, and confidence obtaining emotional support. Models also controlled for important sociodemographic covariates. Results: Among survivors, 50% reported that their children were not fully emotionally supported, and 58% reported that cancer affected their ability to provide care for their children. Significant predictors of children not being fully emotionally supported included: government insurance (OR 1.5; 95% CI 1.0-2.1); annual income ≤ $60,000 (OR 1.6; 95% CI 1.3-2.1); being retired (OR 1.7; 95% CI 1.2-2.4); or female (OR 1.4; 95% CI 1.1-1.7). Significant predictors of cancer interfering with the ability to provide care for children included: female sex (OR 2.2; 95% CI 1.8-2.7), survivor report of high distress (OR 1.6, 95% CI 1.4-2.0), having a child ≤ 10 years (OR 2.5; 95% CI 2.0-3.2), or a child who was not fully emotionally supported (OR 1.5; 95% CI 1.3-1.9). Survivors with confidence in their ability to obtain emotional support were less likely to report that cancer interfered with their ability to provide care (OR 0.8; 95% CI 0.6-0.9). Conclusions: Many cancer survivors with young children at diagnosis report that cancer or its treatment affects their ability to provide care, or that their children are not fully emotionally supported. Increased attention to the psychosocial needs of parenting cancer survivors is warranted, particularly among women, those with public insurance, lower incomes, children ≤ 10 years and survivors who report high distress levels or inadequate emotional support.
Evaluation of an interactive portal for breast cancer survivors: Use, satisfaction, and preliminary effects.
Authors: Kuijpers Wilma , Groen Wim G , Oldenburg Hester SA , Wouters Michel W.J.M. , Aaronson Neil K , van Harten Wim H
Published: February 2017

200

Background: MijnAVL is an interactive portal that includes patient education, an overview of appointments, access to the electronic medical record (EMR), patient-reported outcomes plus feedback and physical activity support. The aim of this feasibility study was to evaluate use, satisfaction and preliminary effects among breast cancer survivors. Methods: We included women currently or recently treated for breast cancer with curative intent. At baseline, they completed a questionnaire on sociodemographics, expectations of MijnAVL and three effect measures: patient activation (PAM), quality of life (SF-36), and physical activity (IPAQ). MijnAVL could be used noncommittally for 4 months. Log data were collected retrospectively and participants completed questions on satisfaction and effect measures. This process was conducted twice, to be able to improve MijnAVL iteratively. Results: We included 92 women (mean age 49.5 years, 59% on-treatment). Mean number of logins was 8.7 and mean duration 13.1 minutes. Overview of appointments (80% of participants) and access to the EMR (90%) were most frequently used and most appreciated. Website user satisfaction was rated 3.8 on a 1-5 scale on average and participants were primarily positive about the accessibility of information. We did not find an effect on the PAM. For the SF-36, we found significant improvements on the role functioning – emotional (65.3 to 78.5, p< .01), mental health (69.8 to 76.5, p< .01) and social functioning (71.2 to 80.5, p< .01) domains. Median vigorous physical activity significantly increased from 0 to 360 MET-minutes per week (p< .05); levels of walking and moderate physical activity did not change significantly over time. These effects were not related to the intensity of use of MijnAVL. Conclusions: This study showed that user experiences were positive and that exposure to MijnAVL resulted in improvements on three quality of life domains and vigorous physical activity. More tailored, interactive features might be needed to substantially change empowerment, quality of life and physical activity. Research with a controlled design and possibly a more sensitive measure for patient empowerment are needed to substantiate our findings.
Psychological benefits of theater-depicting cancer treatment.
Authors: Carlson Samantha , Jones Becky , Grossheim Linda , Mirro Joseph
Published: February 2017

203

Background: The number of cancer survivors in the United States is increasing and estimated to exceed 13 million. Consequently, the quality of life of these patients and their family members has become a high priority. The best interventions to decrease distress, improve coping and quality of life for survivors are poorly understood but are becoming an important focus of research. We therefore, undertook a prospective pilot study using a questionnaire to measure the emotional impact of a play depicting cancer treatment on cancer survivors and their family members. This research project was reviewed and approved by the West Michigan Cancer Center Institutional Review Board (IRB). Methods: The emotional feelings and perceived levels of coping were measured and compared before and after the play. Statistical analyses of responses included chi-square and t-tests for continuous variables, or Fisher’s test or Wilcoxon’s test where parametric assumptions were not met. Results: A total of 60 survivors and 49 family members completed the research questionnaire. The most promising finding was that a majority of survivors and family members 51.0% (n = 50) felt they were coping better (p < 0.0001) after the play. Of the survivors, 73.0% said the play reflected their experiences and 78.0% felt it was helpful dealing with their emotions. Overall, 94.0% of those attending the play requested additional theater performances. Conclusions: Our preliminary data demonstrates that theater depicting cancer treatment has a strong emotional impact and potential therapeutic effects for cancer survivors and family members. Increased feelings of coping with the diagnosis occurred following the play. Attendees also felt less alone (59.5%) and more hopeful (53.4%) after the play.
Psychosocial distress screening and the survivorship care plan in the community oncology setting.
Authors: Dolezal Milana V. , Prishtina Mary , Ridgley Luanne , Hart-Inkster Beverly , Christensen Kimberly , Orange Dana
Published: February 2017

206

Background: Alta Bates Summit Medical Center (ABSMC) is a Commission on Cancer (CoC) accredited comprehensive community oncology program in the San Francisco Bay Area with an annual adult cancer program of approximately 1700 patients. To satisfy CoC accreditation standards 3.2 (Psychosocial Distress Screening) and 3.3 (Survivorship) the cancer survivorship program has a collaborative nurse-led and primary oncologist-led model utilizing Journey Forward software for survivorship care plans (SCP) and the Distress Tool (DT). National standards include distress screening as an important assessment in cancer care, in order to provide interventions Methods: The self reporting DT was sent to adult cancer patients prior to a survivorship visit. Oncology nurse navigator and oncologist reviewed the DT and discussed concerns with the patient. Patients scoring 5 or greater on DT were referred to psychosocial services. Interventions based on patients’ needs include the Cancer Transitions Program(CTP), support groups and classes. Results: 100 patient charts were reviewed for DT and SCP. 95% of patients were female; 5% were male. Patients ranged in age from 22 to 92 years. 36 patients were enrolled in the 2015 CTP and 63% of those participants had completed SCP. Conclusions: The prevalence of psychosocial distress in our community oncology practice was lower than expected, in part due to the robust supportive care environment that patients actively partake in at the Cancer Center. Implementing the DT also improved patient and clinician communication resulting in more timely intervention. [Table: see text]
Patient distress and survival in palliative radiotherapy.
Authors: Habboush Jacob , Shannon Robert P. , Hollant Laeticia , Single Megan Paige , Gaines Katherine , Smart Bridget , Buskirk Steven J. , Vallow Laura , Tzou Katherine S. , Ko Stephen , Peterson Jennifer Layton , Biers Heather , Day Atiya , Miller Robert Clell
Published: February 2017

211

Background: Distress is known to be elevated in patients receiving cancer therapy, such as palliative radiotherapy (PRT). Many patients will experience distress during treatment and it is not always addressed in part due to a lack of guidance regarding the significance of distress. Methods: All RT patients in our clinic are asked to complete a patient reported distress (PRD) survey during treatment course. PRD forms consist of 30 categorical questions that assess distress subscales. Patients have the option to rate each question from 1 (low distress) to 5 (high distress). The survey also includes the National Comprehensive Cancer Network distress thermometer, which allows patients to rate overall distress level from 0 (no distress) to 10 (extreme distress). Patients’ records were retrospectively reviewed to abstract the needed information to assess survivorship. Results: 270 patients were included from 01/18/2012-08/07/2015. Overall PRD was analyzed as a continuous and a categorical variable (low: 0-3, moderate: 4-6, high: 7-10). Continuous and categorical variable PRD did not show a correlation of distress to survival (P = 0.26) and (P = 0.10) respectively. A correlation was noted in moderate distress category (RR: 1.51, P = 0.034), however, this was not noted in high distress category (RR: 1.25, P = 0.33). There was no statistical significant correlation with the adjusted variables. Patients with primary site of gastrointestinal cancer had worst prognosis (RR: 1.34, P: 0.14), while hematological origin had best prognosis (RR: 0.35, P: 0.038).Age had the strongest correlation with survival, as older patients receiving RT had poorer survival (RR: 1.13, P: 0.079). Conclusions: This study suggests that PRD is not predictive of survival in PRT. The primary goal of PRT is to improve quality of life (QoL) by assessing, anticipating and alleviating suffering; not necessarily improve survival. It also demonstrated that the most common stressors were related to reversible short-term side effects of RT such as fatigue and pain rather than long-term stressors related to daily activities and social measures which might affect QoL. It is imperative to explore assessment tools to mitigate suffering and improve strategies to enhance QoL in all medical disciplines.
Measuring knowledge gained for young breast cancer survivors and co-survivors.
Authors: Atkinson Lori , Esser Michelle , Singh Nirmala , Rowe Jean , McCann Megan , Lewis Stacy , Sutliff Medha
Published: February 2017

213

Background: Cancer impacts not just the survivor, but those caring for her. Young Survival Coalition (YSC) is the premier global organization dedicated to critical issues in young breast cancer survivors (YBCS) and co-survivors. In 2015, targeted programming was introduced at YSC’s Northeast Regional Symposium. Prior to the event, YSC crafted pre- and post-surveys to measure knowledge gained through the Symposium as an intervention for YBCS and co-survivors. Methods: YSC disseminated pre- and post-event evaluations via online surveys. The pre-survey was sent to registrants (240; 75 completed), and the post-survey was sent to attendees (178; 99 completed). The surveys were designed to measure baseline and increased knowledge in the 4 areas presented at the Symposium: Sex and Intimacy (S&I), Practical Matters (PM), Resiliency and Communication. Questions included demographics, diagnosis, identification as YBCS/co-survivor and baseline knowledge in the 4 areas. Questions in the post-survey followed the same format and measured knowledge gained from the Symposium. Results: In pre-survey data, YBCS and co-survivors most wanted knowledge and resources in S&I and PM. Seventy-five percent reported S&I as a challenge since diagnosis, and 51% stated communication in relationships was difficult. Twenty-two percent felt they did not have the resources they needed to address PM, while 20% felt unsure about what resources they needed. Following the Symposium, 74% felt that they had tools and resources to help in their everyday life as it relates to S&I after the Symposium. Sixty-seven percent reported gaining knowledge they did not have prior to attending. S&I as it relates to YBCS (partnered or single) and rebuilding self-confidence were areas where more information was desired. Seventy-five percent indicated they received information on PM of which they were unaware prior to attending. Follow-up care, financial concerns and career were areas where more information was desired. Conclusions: YBCS and their co-survivors are in need of support and information that is targeted and easily accessible. YSC will continue crafting specific programming for YBCS and co-survivors and measuring the knowledge of both to stay current with their needs.
Emotional/psychological characteristics of women diagnosed with breast cancer following treatment: Participation versus nonparticipation in survivorship programs.
Authors: Swiger Kathleen Dickerson , Guglielmino Janine , Labban Jeffrey D. , Rugo Hope S. , Anders Carey K. , Hanson Arin Ahlum , Henry Catherine Creme
Published: February 2017

216

Background: Women diagnosed with breast cancer responded to an 80-question online assessment to determine their education, information, and support needs. All responses were self-reported, including those about treatment stage, emotional/psychological characteristics, and level of emotion experienced. Methods: A total of 1,443 responses were analyzed. Responses from 776 women (53.8%) who reported participation in survivorship programs were compared to responses from 667 women (46.2%) who did not report participation. On a scale of none, low, moderate, or high, respondents rated the degree to which they experienced anxiety, fear, anger, worry, sadness, and confusion following treatment. Examination of histograms revealed that emotion ratings were not normally distributed. Therefore, differences in ratings between the two groups were tested using Mann-Whitney U analyses, a nonparametric alternative to the independent samples t-test. Results: Respondents who participated in survivorship programs reported significantly higher ratings of emotional experience for anxiety (p < .001), fear (p = .004), worry (p = .002), sadness (p < .001), and confusion (p = .005). A similar trend was observed for anger, which approached significance (p = .051). Overall, survivorship program participants reported more intense experiences of negative emotions following treatment than did non-participants. Conclusions: Self-referral to survivorship programs may reflect continued patient concerns about diagnosis and prognosis, offering insights into patient populations with greater need for support following completion of treatment. Availability of programs and heterogeneity of disease characteristics and treatment may impact these results. The difference in ratings supports the importance of continued monitoring and evaluation of the emotional/psychological needs of women diagnosed with breast cancer following treatment, and especially of those women participating in survivorship programs.
Psychosocial outcomes among cancer survivors who receive a treatment summary or survivorship care plan.
Authors: Reed Sarah C. , Bell Janice , Whitney Robin L. , Blackmon Emma , Kim Katherine K. , Joseph Jill G.
Published: February 2017

217

Background: Treatment summaries (TSs) and survivorship care plans (SCPs) were expected to bridge patient-provider communication challenges and better address the unique needs of cancer survivors. While interest in TSs and SCPs has been growing, acceptance and implementation has been slow and findings from studies of their effectiveness have been mixed, overall. Our study examines independent associations of receipt of TSs and SCPs with psychosocial outcomes of cancer survivors. Methods: The study sample included survivors completing the 2012 LIVESTRONG Survey for People Affected by Cancer (n = 5,156). Logistic regression was used to model three distinct psychosocial outcomes: having relationship concerns (yes/no), distress (defined as a rating of 6 or higher on the NCCN Distress Thermometer), and moderate or severe cancer-specific worry (yes/no) as functions of TS receipt, SCP receipt and important confounding variables (age, sex, race/ethnicity, marital status, employment, income, education and health insurance). Results: Among cancer survivors, only 51% received a TS and only 16% received a SCP. Survivors who received a TS or SCP had significantly lower odds of relationship concerns (TS: OR = 0.62; 95% CI 0.52, 0.75; SCP: OR = 0.73; 95% CI 0.57, 0.94); distress (TS: OR = 0.74; 95% CI 0.65, 0.85; SCP: OR = 0.81; 95% CI 0.68, 0.97); and moderate or severe cancer-specific worry (TS: OR = 0.76; 95% CI: 0.67-0.85; SCP: OR = 0.78; 95% CI: 0.67-0.92). Other covariates consistently associated with psychosocial concerns included younger age, being unemployed and income ≤ $60,000. Conclusions: Many cancer survivors do not receive a TS or SCP. Receipt of either document was associated with reporting better psychosocial outcomes, suggesting that TSs and SCPs may not be reaching cancer survivors with psychosocial health problems. Survivors with psychosocial concerns may benefit from targeted survivorship care.