bluuebunny/crossref_metadata_2025 huggingface dataset:
The evidence base in support of breast cancer surveillance guidelines: Flying without a net?
Authors: Baxi Shrujal S. , Yeahia Rubaya , Korenstein Deborah
Published: February 2017

25

Background: There are a growing number of breast cancer survivors, and they are often followed by primary care providers (PCP). With limited specialized cancer knowledge, PCPs may rely on guidelines (GL), but surveillance recommendations vary based on source. The data informing post-treatment surveillance is limited. We reviewed the evidence in support of varying breast cancer surveillance recommendations found in national GLs. Methods: We included breast cancer GLs containing surveillance recommendations from professional societies and government organizations in North America, the UK, and Europe (2010-5). We used online search engines and organization websites to identify GLs. Surveillance testing recommendations were recorded; relevant citations for each recommendation were identified and classified by evidence type. Results: We identified 6 breast cancer GLs from US, UK, and Europe; all recommended mammography. Other recommendations varied, with contradictory recommendations regarding MRI and US. Overall, 13 systematic reviews (SR) were cited; 9 related to mammography. One SR of MRI and one of mammography were cited by 2 GLs; remaining SRs were each cited by 1 GL. Other references included 34 primary studies, 9 narrative reviews and 11 older GLs. Among 23 surveillance testing recommendations from the 6 GLs, the highest level of supporting evidence was a SR in 44% and a primary study in 22%; the remainder cited no direct evidence. At times, the same citation supported contradictory recommendations in different guidelines. Conclusions: Evidence for surveillance recommendations is often low-level and cited references vary across GLs; the same evidence is used to support contradictory recommendations. Better evidence and its more consistent application would facilitate high quality breast cancer survivorship care.
Risk of secondary cancers after breast conserving therapy in Japan.
Authors: Shiraishi Kenshiro , Shinozaki Tomohiro
Published: February 2017

256

Background: There is a growing body of evidence that vast majority of patients with early breast cancer who underwent breast conserving therapy (BCT) live their longer ‘cancer survivor’ lives through modern sophisticated treatment. Accordingly, second malignancies after BCT are on the rise, which are sticky dilemmas accompanied by additional anxiety and need for further medical care. Investigation of secondary malignancies should be made the first priority in Japan as the world's top country for longevity. Methods: In order to investigate the second malignancies after BCT, a cohort study was conducted based on our database from 1982 to mid-2015. Actuarial rates of second malignancies, overall (OS) and cause-specific survival (CSS), were calculated by using the Kaplan-Meier method. We calculated standardized incidence ratios (SIR) for each cancer type corresponding to the national registry. Results: 1,557 patients (49.5%) were followed-up for more than 10 years. At a median follow-up of 113 months, 180 patients had developed a second malignancy. The increases in risk were for leukemia (SIR: 3.89 (1.76–6.84)) and ovarian cancer (SIR: 3.65 (2.26–5.38)). Trends toward increased risk was seen in reno-ureteral cancer (SIR: 2.25 (0.96–4.08)) and endometrial cancer (SIR: 1.59 (0.92–2.43)) though it was not statistically significant. No increased risk was observed for other gastrointestinal and genitourinary cancer, malignant melanoma, lymphoma, thyroid or head and neck cancer. Overall 10-year cumulative incidence of OS was 93.3%, and overall 10-year cumulative incidence of CSS was 95.0%. Overall 10-year incidence of secondary cancer was 5.9%. A total number of secondary malignancies within 10 years was 157 and this number explained 84.4% of all cases observed during follow-up. Secondary cancers continued to occur afterward, and cumulative incidence at 15- and 20-years were 8.4% , and 9.6%, respectively. Conclusions: Secondary cancers after BCT continue to arise as long as patients survive. Given its nature of life-threatening to cancer survivors, attending care team must pay persistent attention to secondary malignancies especially in Japan with the longest life-span.
Preparing nurses for cancer survivorship care.
Authors: McCabe Mary S. , Economou Denice , Grant Marcia
Published: February 2017

27

Background: Although the 2006 IOM report on Cancer Survivorship calls for the education of health professionals, few formal programs have been instituted and evaluated. This NCI R25 grant focused on the preparation of nurses to provide comprehensive survivorship care. The program included didactic and interactive sessions, as well as goal development focused on plans for implementation of survivorship activities post course. This abstract will describe the goal analysis at 6, 12, and 18 months post course provided by the 113 nurses in the first two courses. Methods: Goals focused on survivorship activities to be implemented at the home institution/practice. Goals were coded using the results-based S.M.A.R.T. framework and they could have more than one code if they reflected multiple activities. Goal achievement was measured using a 5 point scale with 0 = never started, 1 = stopped or cancelled, 2 = Stalled, 3 = In Process or 4 = Completed at 6, 12 and 18 months post course. Results: A total of 403 goals were coded for the first 2 courses. The most frequent goal for both courses was Professional Education (23.1%, 21%). The second most frequent goal was -Institution of Survivorship Care (13%, 9.8%). The third most frequent goal for Course 1 was Evaluation of Survivor Needs. For course 2 the third most frequent goals were Evaluation of Survivor Needs and Team Development. Goal achievements for course 1: 70% completed or in process, 4.4% stalled or stopped and 25% never started. Course 2: 62% completed or in process, 18.3% stalled or stopped and 20% never started. Conclusions: While participants from our 2 first courses represented a variety of academic and community settings, their goals were quite similar and reflected the basic need for staff education and plans for clinical services. Barriers to success were met by approximately 29% of the participants in Course 1 & approximately 38% in Course 2. These data demonstrate that Survivorship remains in the early stages as a formal period of care and ongoing development of experts/resources continues to be needed. Identification of barriers and facilitators to address them is critical.
The role of a geriatrician in a cancer center.
Authors: Korc-Grodzicki Beatriz , Sun Sung W. , Shahrokni Armin , Alexander Koshy , Kim Soo Jung , McMillan Sincere , Bosl George J.
Published: February 2017

39

Background: Older adults are likely to have coexisting health conditions, polypharmacy and functional limitations. The geriatrician may have a pivotal role in risk assessment, prevention and treatment of comorbidities and addressing geriatric syndromes. The purpose of this study is to describe the growth and development of, and the role of a Geriatrics Service (GS) in a cancer center. Methods: A GS was founded in MSKCC in 2009. Since then it has grown to provide inpatient (IP) and outpatient (OP) care for older adults undergoing cancer diagnosis, surveillance or active treatment. It offers preoperative evaluations, geriatric assessment (GA) and follow-up shared- care. Recently, a Transitional Care Management (TCM) program was established for patients at increased risk of rehospitalization. The GS strives to develop an interprofessional educational geriatrics curriculum and to participate in quality and research projects focused on cancer and aging. Results: Between 2009 and 2014 a total of 6679 new patients were evaluated by the GS. 16% of the patients were 65-75, 70% were 76-85 and 14% were older than 85. 46% were male and 84% were white. 15% were IP and 85% were OP consultations. 13% of the OP consults were for GA, the rest were preoperative evaluations. All patients seen preoperatively who are admitted after surgery, are followed postoperatively by the IP geriatrics team. In total, 4 Geriatricians, 2 Geriatric Nurse Practitioners (GNP) and 3 RNs were recruited. The number of follow-up visits increased from 143 in 2009 to 733 in 2014. The new TCM program based on close communication between the IP and OP GNP has been successful in keeping frail patients from frequent rehospitalizations. Noon conferences on geriatrics for the house staff, a biannual course on “Advancing Nursing Expertise in the Care of Older Adults with Cancer” and a monthly interprofessional meeting for the discussion of Geriatric Clinical Complex Cases (GCCC) are ongoing. Research has focused on risk assessment and the use of telemedicine in geriatric patient care. Conclusions: The establishment of a GS in a cancer center was very well received and embraced by the oncologists showing an unmet need in the care of the older cancer patient. The potential reproducibility beyond the cancer center will be discussed.
A new paradigm for patient-centered breast cancer care.
Authors: Diaz Kristina M , Paul Edward , Yang Gregory John C. , Phillips Shirley , Bowles John , Milner Trudie
Published: February 2017

46

Background: The active role of a primary care physician has been shown to improve outcomes for patients in all areas of health management. Cancer care is rapidly evolving as a result of major advances in cancer genomics and the production of new, mostly oral, chemotherapeutic agents targeted to specific patients. The estimated number of cancer survivors is expected to dramatically increase in the next decade. One good example of a new model of cancer care that relies upon the steady presence and involvement of the primary care physician is the care of patients with non-metastatic breast cancer. The current model of breast cancer care includes the primary physician identifying a lesion, obtaining required imaging, making a preliminary diagnosis of presumptive breast cancer, referring to the surgeon and/or oncologist, then resuming care of the patient post survivorship. In the new model of care described here, oncologists play a peripheral role and once therapy is initiated, care by the primary care physician in an integrated, team-oriented, system becomes ideal. Methods: Via a shared care model in which the primary physician is trained to provide direct oncologic care for the patient. They will thereafter initiate a survivor plan that will allow the patient to return to their own medical ecosystem with the least delay and compromise. The primary physician is anticipated to actively direct care for the cancer patient including prescribing recommended cancer treatment, managing medication side effects, and making appropriate referrals when necessary. Results: see below Conclusions: There is good evidence that outcomes by a primary care physician throughout the entire breast cancer treatment phase are comparable to care provided by oncologists in the current model. When the primary care physician is given the right tools and empowered to lead the care for the patient, improved compliance, improved psychosocial quality, and appropriate survivorship follow up can be achieved. With the ability to care for all aspects of their patient’s needs, both biomedical and emotional, the primary physician can, and should, start taking a more active and holistic role in providing care for their patients. Never was this more true then now.
Moving forward after cancer: Implementation of transition appointments and follow-up care plans in Manitoba.
Authors: Carpenter-Kellett Tara , Sisler Jeffrey James
Published: February 2017

50

Background: Patient experience and local and international clinical research have focused attention on transitions in cancer care from treatment to follow-up. Deficiencies in the quality of survivorship care, including necessary testing, have been demonstrated. The Canadian Partnership Against Cancer has funded projects designed to enhance the implementation of survivorship care plans (SCPs) and to improve cancer system-primary care coordination. CancerCare Manitoba, a provincial agency, is a leader in this work. Methods: The Moving Forward After Cancer initiative combines the generation of standardized written SCPs from the EMR with enhanced patient assessment at the end of curative systemic / radiation therapy. A transition appointment (TA) is provided by the patient’s usual oncology providers and includes screening for distress, appropriate referrals, and provision of a personalized treatment summary and SCP to the patient, with copies to the primary care physician and surgeon. The TA often marks the transfer of medical responsibility to the primary care provider (PCP). Results: Transition appointments have been implemented for colorectal (2012), breast (2014), and lymphoma and gynecologic cancer patients (2015). A total of 364 TAs were done in Manitoba in 2014, of which 140 were with colorectal (stage II and III) and 224 with breast (stage I – III) patients, about 59% and 35% respectively of eligible patients. This is an increase of 385% from the 75 TAs done in 2013. Other patient outcomes being collected include perceptions of continuity of care, confidence in survivorship information, evaluation of the care plan documents and also PCP and oncology team perceptions. In order to support practice change, a workflow solution led by a designated team that is adaptable by all sites across the province has been developed. Conclusions: The provision of TAs and SCPs is being well adopted in Manitoba. We expect that this intervention willimprove the experience of both patients and health care providers and the quality of care at the time of transition to survivorship. Implementation is underway with other disease site groups with the goal of all patients receiving a TA as they transition into survivorship.
Nurse and nurse practitioner use and satisfaction of an online survivorship care plan builder.
Authors: Vachani Carolyn , Hampshire Margaret K. , Hill-Kayser Christine , Arnold-Korzeniowski Karen , Bach Christina , Metz James M.
Published: February 2017

58

Background: A cornerstone to cancer survivorship care is the education provided to patients regarding late and long-term effects, follow up care, and healthy living after a cancer diagnosis and treatment. Nurses have long provided patient education in oncology care. The provision of survivorship care is a natural extension of this role. An online survivorship care plan (SCP) builder can facilitate this and reduce the resources required for implementation of a survivorship program. Methods: We examined nurse and nurse practitioner (NP) use and satisfaction of two free online SCP builders, OncoLife on http://www.oncolink.org , and the LIVESTRONG Care Plan, between May 2010 and July 2015. Users of the program were queried about their satisfaction with the information provided, if their practice had an established survivorship program and if they would use the program for other patients. Time to complete a SCP was measured. Results: Healthcare providers completed 16,302 SCPs during the timeframe examined. The majority of plans were completed by nurses (n = 7393, 45%) and nurse practitioners (NPs) (n = 6296, 39%), while the remaining were completed by physicians (n = 754, 5%) and unknown users (n = 1859, 11%). When compared to University-based cancer centers (UCC), SCPs completed in community settings were more often delivered by nurses, as opposed to NPs (UCC: Nurses 22%, NPs 53%; community setting: Nurses 57%, NPs 31%; p < 0.001). A satisfaction survey was completed by 415 Nurse and NP users. They reported high satisfaction with the information provided (31% excellent, 33% very good, 26% good); 75% reported that the plan provided “just enough information”, whereas 11% felt it “could use more information”, and 6% felt there was “too much information”. Sixty-four percent had an established survivorship program and 100% would use it for other patients. The median time to complete an SCP was 4 min 17 sec (IQR 2:38-7:19). Conclusions: Nurse and NP users report high satisfaction using an online SCP builder. In community settings, nurses were completing the plan significantly more often than NPs. The short time required to create the SCPs may allow practices to efficiently meet regulatory requirements with minimal resources.
Improving patient participation in a breast cancer survivorship program at a safety net hospital.
Authors: Shrestha Shakuntala , Khosla Pam , Molnar Janos , Corona Maria Eugenia , Garcia Sofia M
Published: February 2017

60

Background: To provide comprehensive services and meet Commission on Cancer (CoC) accreditation requirements, we developed and evaluated a customized breast cancer SCP template and delivery model. Objective: To implement and pilot test survivorship care plan (SCP) delivery for breast cancer survivors. Methods: Clinicians at a safety net hospital partnered with investigators at an academic institution to start a breast cancer survivorship care program. We developed an SCP template that is CoC-complaint and responsive to input gathered in 2 focus groups with breast cancer survivors (n = 12) and interviews with staff (n = 8). Oncologists and nurses identified and referred English-speaking women who had completed breast cancer treatment. Participants completed baseline measures prior to receiving individualized SCPs in a survivorship consultation visit with a dedicated APN. In response to high no-show rates, we expanded clinic scheduling to harmonize with participants' other medical appointments. Interim feasibility results for our ongoing study are presented here. Results: A total of 154 patients were screened to reach target enrollment (n= 80) within 20 months. Participant median age was 60 ± 11; 71% were African American, 14% Hispanic; 11% Non-Hispanic White and 92% had household incomes < $20,000. Average times were: 30 ± 13.4 minutes for abstracting patient clinical information in preparation for the survivorship visit; 25 ± 16 minutes for completing individual SCPs; 22±7.65 minutes to review / deliver the SCPs with patients. The difference in no-show rate between first 3-month recruitment period (clinic limited to one day/week) and next 17 months (clinic appointment expanded to accommodate patients' schedule) was statistically significant, p = 0.028. Conclusions: Tailoring SCP templates and delivery models to the needs of a safety net hospital aided the sustainability of a new survivorship clinic. Patient non-adherence to scheduled visits was significantly improved by expanding clinic hours. Significant clinician time was spent preparing SCPs and a level 4 visit (25 minutes) does not adequately reflect this effort. This study is funded by the American Cancer Society, Illinois Division (Grant# 254698).
Evaluation of patient characteristics that are associated with response to a survivorship care planning intervention.
Authors: Kvale Elizabeth Ann , Huang Chao-Hui , Bae Sejong , Demark-Wahnefried Wendy , Meneses Karen , Azuero Casey Ballentine , Ritchie Christine
Published: February 2017

8

Background: Appropriate targeting of survivorship care planning interventions to patient need is essential, but little evidence exists to support systematic triaging according to survivor needs. We demonstrated the positive impact of a self-management focused survivorship care planning (SCP) intervention on patient outcomes including wellbeing and depressive symptomology; herein we report how patient characteristics predict response to that intervention. Methods: Newly-diagnosed breast cancer survivors (Stage 0-IIIB) were randomized to receive the patient owned survivorship care planning intervention (n = 40) or usual care (n = 39). The intervention arm demonstrated improvements from baseline to 3-month follow-up in self-reported health and depressive symptom burden as measured with SF-36 Health Survey and Personal Health Questionnaire Depression Scale. We examined patient characteristics associated with response to the intervention. Results: Baseline characteristics including younger age, lower perceived finance adequacy, higher medical comorbidity, burden of depression, as well as anxious/preoccupation coping were significantly associated with greater self-reported health change (p < 0.05). Additionally, higher levels of cancer symptom severity, fatigue, lower social functioning and mental health status at baseline were significantly correlated with greater reductions in depressive symptoms (p < 0.05). Race, education, health literacy level, and cancer stage were not associated with improved outcomes. Conclusions: While SCP is an important step to improving care for cancer survivors, it is likely that some cancer survivors may need a robust intervention to support self-management of survivorship issues. Our preliminary findings suggest that younger patients with higher perceived financial, emotional, and cancer symptom burden may benefit from a focused SCP intervention to a greater extent than patients without these characteristics. A larger scale pragmatic study is needed to further confirm the associations, investigate the mechanism of effective interventions, and develop pragmatic strategies that target survivors who need robust SCP support.
Evaluation of electronic care plan usage and usefulness among breast cancer survivors.
Authors: Sesto Mary , Hocking William Gray , Wiegmann Douglas , Yen Thomas Y , Gribble Mindy , Zeal Jamie , Koehn Tamara , Sun Wenjun , Tevaarwerk Amye
Published: February 2017

83

Background: Survivorship care plans (SCP) are recommended to improve communication between breast cancer survivors (BCS), primary care, and oncology. Objective evaluation of survivor access of specific care plan content is challenging as commonly-used formats (e.g., paper or electronic file) prevent tracking of usage. This project aimed to evaluate the usage and usefulness of an electronic survivorship care plan (eSCP) that could track access and pages visited. Methods: We recruited 128 BCS from outpatient oncology clinics. 121 BCS received eSCP access via an online secure patient portal; seven received paper copies and are not included in this analysis. The research team customized the portal to track eSCP usage and page visits during the study period (at least 12 weeks of eSCP access). The eSCP consisted of four internal pages (Guide, Treatment Summary, Followup Plan, and Glossary) plus 21 external hyperlinks to survivorship resources. eSCP usefulness and understandability were evaluated using 10-item Likert scales: 1 (not at all useful/very hard to understand to 10 very useful/very easy to understand). Results: 90 out of 121 (74.38%) participants accessed the eSCP. The majority accessed the eSCP within two days of receiving access (N = 70/90, 77.8%) and visited 1 to 3 times (N = 81/90, 90%). Treatment Summary was the most frequently visited internal page (158 visits by 69 participants). Other page usage: Followup Plan (124 visits by 65 participants), Guide (113 visits by 62 participants), and Glossary (46 visits by 31 participants). 34 participants (37.78%) accessed external pages from the eSCP. Participants perceived the overall care plan as useful (8.78, 95% CI [8.38, 9.19]) and easy to understand (8.81, 95% CI [8.47, 9.16]). Conclusions: We found high usage rates among BCS provided an eSCP and the majority perceived the eSCP as useful and easy to understand. Based on favorable assessment and use, it is reasonable for eSCPs to serve as a tool to facilitate communication and care coordination for survivors, especially as access to and use of mobile device technology and electronic patient health portals increase. Minority and rural survivors access and use of such features may require further research.
Nurse navigation: The key to a seamless transition.
Authors: Fulbright Joy M. , McClellan Wendy , Doolittle Gary C. , Krebill Hope , Ryan Robin , Alsman Kyla , Lowry Becky N.
Published: February 2017

84

Background: Children's Mercy (CM) established a cancer survivorship clinic that cares for approximately 180 survivors a year. A third of the survivors are 18 years or older requiring transition to adult care. The importance of transitioning childhood cancer survivors from pediatric oncology care to adult primary care has been acknowledged in literature, but obstacles remain. Barriers include patient and provider anxiety, difficulty navigating the complex health care system and lack of knowledge regarding late effects. CM and The University of Kansas Cancer Center (KUCC) collaborated to decrease barriers to transition for childhood cancer survivors. Methods: The work group met for 2 years to develop the clinic at KUCC. Models and delivery of survivorship care, including the breast cancer survivorship clinic at KUCC, were reviewed. A shared nurse navigator was identified as an essential component to a seamless transition. Philanthropic support was obtained and job description was developed. Contracts were negotiated to allow the navigator to be present at both institutions. Results: The Survivorship Transition Clinic (STC) at KUCC launched July 2014, with a navigator supporting patients at CM as they begin their transition. The same navigator then meets with the patient at KUCC STC as they initiate care. The navigator provides treatment summaries, patient education and navigates the referral services for survivors. Since clinic launch, 16 survivors out of 16 have successfully transitioned from pediatric to adult survivorship care. Positive feedback was received from patient satisfaction surveys that were administered. A common theme showed a relief from anxiety due to having a contact person to facilitate communication among providers in a complex healthcare system. Conclusions: The nurse navigator has minimized anxiety about transition for patients and parents as she establishes a relationship with patients at CM, and then is able to provide continuity as they transition to the STC at KUMC. The navigator also improves communication between pediatric providers, adult primary care providers and sub-specialists caring for the patients. Overall, our transition process has been effective and is now serving as a model across both institutions.
Parental preparedness for late effects in survivors of childhood cancer.
Authors: Greenzang Katie , Cronin Angel , Mack Jennifer W.
Published: February 2017

85

Background: Parents of children with cancer desire information on late effects of treatment. In a prior study conducted at diagnosis, we found that parents felt they received better quality information about treatment than about late effects. Methods: We conducted a cross-sectional survey of parents of children with cancer at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center at least 5 years after diagnosis; all parents had previously participated in a study about communication at diagnosis. In this follow-up study, 65% of parents of children who were still living, and whom we were able to contact, participated (n = 90). 77% of respondents (n = 69) were parents of disease-free survivors; 23% (n = 21) were parents of children with relapsed disease. We assessed parental preparedness for cancer care and late effects of treatment. Results: Most parents reported feeling extremely or very well prepared for their child’s pediatric oncology treatment (86%), daily care needs during treatment (85%), and for the chance of their child being cured (87%). Compared with preparation for treatment, fewer parents felt extremely or very well prepared for future limitations experienced by their children (63/88 = 72%, McNemar’s Test p = 0.003) or for life after cancer (42/66 = 64%, p < 0.001). In bivariable analysis among parents of disease-free survivors, parents were more likely to feel prepared for future limitations when they believed their child had no limitations in quality of life (OR 4.00, 95% CI 1.32, 12.1; p = 0.01), and when they felt that communication with their child’s oncologist had helped them deal with worries about the future (OR 4.38, 95% CI 1.31, 14.7; p = 0.02). Conclusions: Parents feel prepared to manage their child’s cancer treatment, but they feel less prepared for survivorship. High quality communication with providers may help parents feel more prepared for life after cancer therapy.
Opportunities for precision medicine: Factors associated with participation in genetic research among breast cancer survivors.
Authors: Sheppard Vanessa , Zheng Ling , Graves Kristi D , Hurtado-de-Mendoza Alejandra , Tadasse Mahlet
Published: February 2017

94

Background: Finding unique cancer therapies based on the specific genomic profiles of a person’s tumor is a national priority. Precision medicine can reduce disparate outcomes – particularly among Black breast cancer survivors who have higher mortality rates. Black women tend to be underrepresented in genomic research. Methods: Hormone receptive positive breast cancer survivors (Whites = 334, Blacks = 124, Other = 23) were recruited via hospitals and outreach. Data were collected via telephone interviews to assess sociocultural and health care processes; clinical data were abstracted from charts. Cell pellets were harvested from mouthwashes by centrifugation, followed by washing with PBS solution twice. After the baseline, women had a brief telephone information session. Low literacy materials explaining biospecimen collection were mailed. The primary outcome was receipt of the biospecimen sample in three months. Logistic regression assessed factors associated with biospecimens receipt. Results: Most (69%) survivors provided biospecimens. Most (92.8%) samples had good size cell pellets. Most (93%) of the mouth wash samples will have sufficient DNA for genotyping assays. In bivariate analysis, race, education, and mistrust were not associated with biospecimen receipt (p> .05). Survivors more likely to provide biospecimens had higher ratings of: confidence in physicians’ technical skills, communication with providers, satisfaction with time with providers, and overall satisfaction with care (p< .05). Health literacy and functional well-being were also associated with biospecimen receipt. In multivariate models, only survivor’s ratings of their level of confidence in her oncologists’ technical skills remained significant (OR: 1.6 per 1 point increase; CI: 1.1, 2.5). Conclusions: Regardless of race, most breast cancer survivors are willing to provide biospecimens for genomics research. Brief informational sessions and simple low-literacy materials may enhance participation. Relationships with oncologists are salient to promoting survivors participation in genomics research.
Active surveillance for early stage prostate cancer: What do men and their partners think?
Authors: Xu Jinping , Mallapareddi Arun , Ruterbusch Julie , Reamer Elyse , Eggly Susan
Published: February 2017

95

Background: Despite growing recognition over the last decade that active surveillance (AS) is a reasonable management option for men diagnosed with localized prostate cancer (LPC), only a minority of men choose AS. This study examines the conceptualizations, experiences, and reasons for choosing AS among men with LPC and their partners. Methods: We conducted three focus groups with men with LPC who had chosen AS (7 black, 5 white) and two focus groups with their partners (all women, 2 black, 4 white). Men were identified from a cancer registry or from an academic urologists’ practice. Focus groups were video/audio recorded, transcribed and analyzed using qualitative thematic analysis. Results: Men’s median time on AS was 18 months (range 6-72) and median age was 61 years (range 47-71). Men used many different terms (mostly “wait and see”) to describe similar AS protocols. AS was seen as delaying unnecessary treatment and keeping current function with curable treatment available later if needed. Black men mentioned concerns that some physicians profit by providing unnecessary treatments. Reasons for choosing AS included seeing their cancer as “small” or “low-risk” and trusting their physician’s advice/monitoring, despite reported concerns about PSA being an unreliable test and painful biopsies. Men recognized, but were comfortable with, the small but real threat their cancer could grow. Men found they had to justify their choice to other family members, even when their partners were supportive. Partners saw themselves as very involved and influential in the treatment decision. They were comfortable with AS because of their trust in physicians. Partners believed they know their husband’s physical and mental health better than the men themselves. Conclusions: Physician trust and description of the cancer as low-risk were the most cited reasons for adopting AS. Emphasizing the low-risk nature of the cancer and enhancing physician trust may increase the acceptability of AS.
Effect of novel peptide vaccines on secondary recurrences and survivorship.
Authors: Valentine Marye Ellen , Chance Lacey , Gompper Peter Todd , Choy Gavin S.
Published: February 2017

e274

Background: According to the NCI Office of Cancer Survivorship, in 2014, it is estimated there are 14.5 million cancer survivors in the US. By 2024, it is projected there will be 19 million cancer survivors. Peptide-based vaccines are being developed to prevent recurrence in cancer patients following standard of care and increase survivorship by inducing immune responses using antigenic epitopes derived from tumor associated antigens. Two peptide vaccines, nelipepimut-S, a HLA-A2/A3-restricted immunogenic peptide derived from the HER2 protein and E39, a HLA-A2-restricted, folate binding protein (FBP) derived peptide, are being developed to prevent breast cancer and gynecological cancers recurrence, respectively. Methods: Early phase dose finding clinical trials results for both agents have been previously reported by Mittendorf et al. (2014) and Greene et al. (2015). Both agents are concomitantly administered with GM-CSF in the adjuvant setting. Toxicity was monitored and recurrences were documented. Disease free survival (DFS) was analyzed by Kaplan-Myers curves and groups were compared by log-rank test. Results: In the nelipepimut-S Phase 1/2 trial, 97 patients were enrolled in the node positive group. The reported 3-year DFS was 100% in the optimally dosed (1000 mcg vaccine + 250 mcg GM-CSF) vaccinated group vs. 77.8% in the control (p = 0.035, n = 45). In the E39 Phase 1/2 trial, with 9.8 months median follow-up, among optimally dosed (1000 mcg), there is only one recurrence (6.7% vs. 5I% CG, p = 0.01). The 2-year DFS estimate is 19.2% (CG) vs. 85.7% (1000 mcg) (p = 0.09). Nelipepimut-S and E39 were well tolerated. Conclusions: Preliminary results from both Phase 1/2 trials indicate these peptide vaccines derived from the HER2 protein and FBP may be administered chronically, thereby preventing recurrence and increase survivorship in patients with breast, ovarian, and endometrial cancers. Nelipepimut-S is currently being investigated in three ongoing adjuvant clinical trials – 1) single agent in a registrational Phase 3, PRESENT, under a FDA-approved SPA; 2) combination with trastuzumab in IHC 1+/2+ and IHC 3+. Early results of E39 are encouraging and a Phase 2b is being planned in gynecological malignancies. Clinical trial information: NCT00841399, NCT00584789.
A model for delivering survivorship care: Integrating the oncology and the primary care setting—An Italian experience.
Authors: Lorenzi Elena , Morello Lucia , Mazza Rita , Garassino Isabella , Cavina Raffaele , Carlo-Stella Carmelo , Santoro Armando
Published: February 2017

e275

Background: The population of cancer-survivors faces different lifetime health risk. Thus, models for high-quality and personalized care delivery are strongly needed. ASCO provides different models for survivorship care delivery but there is not an agreement on what is the best in meeting patients’ needs and in terms of cost-effectiveness. In our institution we started a program that tries to integrate survivors’ health care provided by the oncologist and by the Primary Care Physician (PCP). Methods: We included patients (pts) aged more than 18 yrs-old at the time of diagnosis, affected by hematologic or solid tumors. Pts had no evidence of disease from at least 5 yrs from the diagnosis. They are referred to the PCP with the following documents: Survivorship Care-Plan, Survivorship Care-Program, letter to the PCP. Recurrence rate, death rate, treatment related serious clinical events will be calculated after 12 months from the start of the project. Results: We includedin our program 269 cancer-survivors (60% of pts referred to our survivorship-clinic from April to July 2015). The median age was 67 yrs, they were mainly females. The different cancer types were: breast (157), colorectal (36), hematologic (30), gynecologic (11), gastric (9), melanoma (6) lung (5), genitourinary (5), head/neck (3), sarcoma (3) and others (4). 189 of pts had an early stage disease (stage I-II) at diagnosis. 234 of pts underwent surgical treatment and 161 received chemotherapy with different schedules based on tumor types. 59% of pts received anthracycline-based-chemotherapy, 78% at a cumulative dose > 240 mg/m2 . 154 of pts underwent radiation therapy (90% in thoracic field) with a median dose of 60 Gy. We observed 11 cases of secondary cancer after a median of 2.7 yrs from the first diagnosis. The median observation time from the diagnosis to the inclusion in our program was 10 yrs (range 2-31). Conclusions: The observation period from the beginning of the program is too short to provide follow-up data. A high percentage of pts present a high risk of cardiologic late toxicities, therefore they need a more intensive cardiologic follow-up. We will present the first follow-up analysis of this cohort of pts in April 2016.
Conversations about cancer-related infertility: An exploration of online discussion forums.
Authors: Sands Taylor J , Smeltzer Stephanie , Covarrubias Laura , Woodard Terri Lynn
Published: February 2017

e279

Background: Many patients use Internet discussion forums to seek support and advice on medical conditions, including cancer and fertility. Online discussions about medical issues have been demonstrated to influence patients’ decisions about their care. The objective of this study was to explore online discussions that patients have about cancer and infertility. Methods: An initial search identified the three most popular forums that contained discussions about cancer-related infertility. Within these forums, a search of “cancer” and “infertility” was performed. All threads posted between June 1, 2010, and June 1, 2015 were identified. Qualitative research methods were used to identify, code, and analyze themes within the data. Results: A total of 14 threads and 133 posts were identified. Participants were both male and female and the age range of those disclosing demographic information was 21 to 44 years old. The major themes that were identified were: 1) use of forums as a supportive network, 2) sharing of experiences with fertility counseling and/or treatment, 3) consideration of alternative methods of family building, and 4) challenges encountered when seeking fertility counseling and services. Conclusions: Individuals affected by cancer-related infertility may use online discussion forums to seek information and advice from others who have gone through similar experiences, or to share their personal stories with fertility preservation with the online community. Understanding the role that these online forums play can help health care providers address the unique concerns of this population.
Using Chinese herbal medicine among cancer survivors: Data from a community hospital in China.
Authors: Wang Ying , Wang Hui , Wan Yu , Wang Xiaoyan , Jiang Yiling , Zhang Han , Zhao Yuhua , Chai Feng , Fang Hongming , Lu Weidong
Published: February 2017

e284

Background: Chinese Herbal Medicine (CHM) is a major component of Traditional Chinese Medicine (TCM) that is widely used in Asian countries. In China, an estimated 397.7 million outpatients and 14.8 million inpatients were cared by TCM physicians and hospitals annually. TCM usage is even higher among pts with cancer. It is reported that 80% of pts with cancer use CHM and 90% of oncologists have prescribed CHM in practice. We reviewed CHM practice among cancer survivors in our hospital, a community general hospital with 800 beds located in the east coast of China. Methods: A retrospective review was conducted by searching outpatient medical records from June 2012 to August 2015. Pts were eligible if pts have pathologically proven cancer and who have completed main anticancer therapies and used CHM prescribed in the outpatient clinic. Descriptive statistical and survival analysis were performed using SPSS. Results: A total of 300 pts were identified, with a median age of 62 years (31-90), 53% were male, with 36 types of cancers. The most common cancers were lung (32%), breast (15%), colorectal (12%), stomach (9%) and liver (6%). 48% pts had stage IV disease. 47% pts used CHM for health maintenance and 53% pts used CHM for anticancer intent. 57% pts used CHM exclusively and 43% used CHM in addition to standard therapies. The median number of outpatient visits was 17 (1-158) with an average of 19 prescribed herbs per person at each visit. During the period, 36% pts passed away with a median overall survival of 24. 9 months (2-108 months). Conclusions: Using CHM for health maintenance or anticancer intent is common among Chinese cancer survivors. A majority of cancer survivors used CHM exclusively without other interventions. Future research should focus on whether using CHM has any survival benefits in cancer survivors.
Assessing the impact of an online survivorship program.
Authors: Waldman Helayne , Fox Shani
Published: February 2017

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Background: In the report From Cancer Patient to Cancer Survivor: Lost in Transition (2006), the Institute of Medicine identified follow-up of cancer survivors as a missing link in cancer care and made recommendations to the medical establishment to fill that gap. So far, studies of recommendation effectiveness have revolved around survivorship care plan implementation. However, a 2013 study indicated that use of SCPs is still more the exception than the rule. Methods: We have created a unique online program that is intended to address two key mandates of the IOM report: 1) Educationfor theprevention of recurrent and new cancers, and 2) Self-carestrategiesto help deal with consequences of cancer and its treatment i.e. lymphedema, fatigue; [and] psychological distress. Dr. Helayne Waldman and Dr. Shani Foxhave fashioned an online, real time, 12 week education and support program for cancer survivors, the first of its type in the U.S. The focus of the content is on maintaining wellness after treatment and includes topics such as physical activity, dietary guidelines, inflammation control and stress management. The program also contains a coaching component, where participants track their activities and share information via live discussion and interactive blogs. Results: We have established a framework for gathering, analyzing and reporting our data. Our target sample size is 40-50 participants. At the program’s outset we will administer a 20 question self-assessment to test participants’ knowledge of self-care practices and attitudes about their current state of wellness. At the program’s end in December we'll readminister in order to measure the change in both knowledge and attitude. We’ll then conduct an analysis of the data, and will report our findings at the ASCO meeting in January. Conclusions: We believe that education and support for survivors is critical to their physical and emotional well-being. Unfortunately, there is currently no program available to do this in a live, interactive format from the comfort of one’s home. We believe PCPs, hospital support groups and other non-profits will find this type of program to be an invaluable resource in serving to educate and manage the concerns of cancer survivors and to move closer to realizing the promise of the IOM report.
Thoughts and experience 10 years post surgery from a cancer researcher and survivor: The burdens of a prostate cancer survivor.
Authors: Jurgens Raymond W.
Published: February 2017

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Background: There are a myriad of experiences reported from various cancer survivors, but few individuals have been involved with cancer drug development, speaking publicly to prostate cancer groups, working privately with prostate cancer survivors and studying the psychosocial aspects of post treatment patients. Methods: N/A Results: The postsurgical and post treatment issues , particularly ED are either not discussed by the patient due to embarrassment or lack of knowledgeable of the type of questions to ask, or not addressed directly by the HCP. Unlike other oncological disciplines, the prostate cancer patient is confronted with major decisions on which treatment approach to choose from which therapeutic discipline. The clinicians they are meeting are explaining their expertise on radiation, surgery, chemo, or other interventions leading the patient to become overwehlemed at these choices. There are few “neutral” voices talking to the patient on which procedure or treatment would suit him best. In addition to the treatment decisions the patient is also told about watch and wait approach. Besides the tough decision for the patient to choose the right approach for himself, he is shown data by each treatment specialty from postsurgical & other treatments relative to the percentage success rates for ED and continence that the patient may expect. These numbers through data from the participating surgical centers etc are typically very inflated. Many patients leave thinking they will return to normal function in x amount of months, only to find that they are quite dysfunctional for much longer or in some cases never gaining functionality. The last part of the discussion is what is available for these men with continuing dysfunction. Potential options exist but for many men they are met with mixed results. The treatments for ED are quite expensive to most men, and in many cases do not work. When the diesterase inhibitors fail to work for the patient, options for ED remain vary greatly-from mechanical interventions to various chemical and pharmacological approaches, and the patient has no voice to turn to get non biased information needed to help with the next steps. Conclusions: Suggestions for the HCP.