bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-melanoma skin cancer in childhood cancer survivors previously treated with radiotherapy: Clinical findings, histology, and management.
Authors: Thorsness Stefanie , Freites-Martinez Azael , Lacouture Mario E. , Marchetti Michael A. , Navarrete-Dechent Christian P. , Tonorezos Emily S.
Published: May 2018

131

Background: Radiotherapy is a well-known risk factor for non-melanoma skin cancer (NMSC), but whether diagnosis, histologic features, or natural history of NMSC after radiotherapy resemble those observed in the general population is unknown. This study aims to describe clinical findings, histology, and management of NMSC on the skin of childhood cancer survivors previously treated with radiotherapy. Methods: A retrospective chart review (2000-2017) was performed including adult survivors of childhood cancer referred to the Adult Long-Term Follow-Up Program or the dermatology service at Memorial Sloan Kettering Cancer Center. Data was obtained from electronic medical records, including demographics, histologic subtype and treatment received for NMSC (basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)). Clinical features were assessed with clinical images. Results: 960 (mean age 40 years, SD ± 13) patients were assessed for the diagnosis of BCC/SCC after radiotherapy for cancer. The mean age of cancer diagnosis was 15 years (range: birth-39 years). The most common primary diagnosis was Hodgkin lymphoma. 82 patients developed NMSC; 67 of these developed NMSC in the field of prior radiotherapy. 283 in-field lesions were counted, of which 275 were BCC and 8 were SCC. Of the 275 BCC, 261 (95%) were primary lesions and 14 (5%) were recurrent lesions. All SCC were primary lesions. Based on clinical images, 30% of BCC were clinically pigmented; the most common presentation was macule (46%). The mean intervals for BCC and SCC from time of radiotherapy to diagnosis of the first in-field lesion were 24 years (range, 2-44 years) and 32 years (range, 14-46 years), respectively. Histologically, superficial subtype was most prevalent in the BCC subgroup, comprising 47% of all cases. Mohs surgery was the most common therapy (43% of BCC cases; 37% of SCC cases). Conclusions: Among survivors of childhood and young adult cancer, BCC was the most prevalent NMSC. Most of BCC arising in sites of prior radiotherapy for cancer treatment were of low-risk histologic subtype and had low rates of recurrence. An expanded role for topical therapy may be appropriate, but further research is needed.
The association of hospital visits with executive functioning among childhood cancer survivors.
Authors: Gorsi Hamza , Trask Christine
Published: May 2018

133

Background: Childhood cancer survivors are at increased risk of executive dysfunction related to treatment. In addition to the direct effect of treatment, hospital visits may also impact development. Children with complicated health issues visit Emergency Departments (ED) multiple times and spend a very high number of days in the hospital, which can interfere with normal development. Methods: Information from 77 childhood cancer survivors, ranging in age from 6-18, was examined. Parents completed several surveys, including the Behavior Rating Inventory of Executive Functioning (BRIEF). Additional information was collected from the medical record and administrative data sets, including total number of days in the hospital and number of ED visits. Multiple linear regressions were used to determine the relationship between total hospital days/number of ED visits and BRIEF scores, as well as potential confounders, such as socioeconomic factors and treatment factors. Results: The survivors were 11 years old, on average, at the time of participation and evenly divided between boys (49.4%) and girls (50.6%). In the sample, 26% had been treated with cranial radiation and 55% had been treated with intrathecal chemotherapy. On average, this group had 47.0 inpatient days in the hospital with 6.8 visits to the ED. There was a positive correlation between both number of ED visits and number of inpatient days with executive functioning (GEC; r = .33, p = .004; r = .23, p = .05, respectively). In multiple linear regressions, after controlling for time since diagnosis, a higher number of ED visits was associated with greater reported executive dysfunction ( R2= .12; F (2, 74) = 5.2, p = .008). Conclusions: An association was found between ED visits and length of hospitalizations on parent-reported executive functioning. ED visits and hospitalization are often related to medical complications, and may reflect severity of illness, but may also influence children’s ability to participate in school and other aspects of normal development. Follow-up prospective studies with a longer duration are needed to understand the course of this relationship in terms of predicting long-term risk.
Perceptions of unintentional weight loss among cancer survivors.
Authors: Zaleta Alexandra Katherine , McManus Shauna , LeBlanc Thomas William , Buzaglo Joanne S
Published: May 2018

138

Background: Unintentional weight loss (WL) can be a disruptive symptom of cancer, yet its psychosocial impact is not well understood. We examined cancer survivors’ experiences with unintentional WL. Methods: 320 cancer survivors completed an online survey, provided demographic, health, and unintentional WL history, and rated (0 = not at all; 4 = extremely) 19 statements about WL outcomes. We examined bivariate associations between weight status, unintentional WL, and WL outcomes. Results: Participants were 90% White; mean age = 58.8 years, SD= 11; 41% breast cancer, 23% blood cancer, 8% prostate cancer, mean time since diagnosis = 6.0 years, SD= 5; 18% metastatic, 22% current recurrence/relapse, 51% remission. 55 participants (17%) reported unintentional WL in the past 6 months (mean = 16lbs; range = 2-70; mean BMI = 27.6, SD= 6.3). These participants were less likely to be in disease remission ( p< .05). Participants with unintentional WL tended to underestimate their weight category (e.g., of BMI-classified healthy weight participants, 26% believed they were underweight); κ = -.17, p< .01. 51% of participants felt (somewhat to extremely) positive about WL, 49% said their health care team was supportive of WL; these statements were more strongly endorsed by people describing themselves as overweight ( ps < .05). 27% believed WL caused physical weakness, 23% said WL resulted in lost control over nutrition/eating, 16% said WL made them feel like a burden, 14% said WL caused them to lose their identity; these statements were more strongly endorsed by people describing themselves as underweight ( ps < .01). 20% viewed their WL as a sign of approaching end of life, 13% believed WL meant they would not be able to continue treatment; these views did not differ by perceived weight status. Conclusions: Many cancer survivors experience unintentional weight loss and associate their weight loss with negative outcomes. Survivors also often underestimate their weight status, which is notable given that personal views of one’s weight status, not BMI-derived weight status, is associated with beliefs about the impact of unintentional weight loss. Our findings suggest that people believe unintentional WL meaningfully affects their quality of life.
Dietary modifications for bowel dysfunction in rectal cancer survivors: The Altering Intake, Managing Symptoms (AIMS) intervention study.
Authors: Sun Virginia , Crane Tracy E , Slack Samantha D , Yung Angela , Wright Sarah , Sentovich Stephen , Melstrom Kurt , Fakih Marwan , Krouse Robert S. , Thomson Cynthia A.
Published: May 2018

141

Background: Rectal cancer survivors often experience persistent long-term effects of treatment. Functional deficits, such as bowel dysfunction, are associated with poor quality of life (QOL). There is a lack of evidence-based interventions to address bowel dysfunction symptoms in rectal cancer survivors. The purpose of this abstract is to describe the development and design of the Altering Intake, Managing Symptoms (AIMS) intervention to manage bowel dysfunction in rectal cancer survivors. Methods: Survivors with stage I-III rectosigmoid colon or rectal cancer who are 6 months post-treatment, > 21 years, and English-speaking are eligible to participate. The AIMS intervention is a ten (30-40 minute) session, 4 month, telephone-based intervention delivered by trained health coaches. Outcome measures are assessed at baseline, 4 and 6 months, and include the MSKCC Bowel Function Tool, the COH-QOL-CRC, and adherence to cancer survivorship diet guidelines. Results: Based on the Chronic Care Self-Management Model (CCM), the AIMS intervention applies social cognitive theory to improve self-efficacy and self-management of bowel symptoms by coaching survivors to modify their diets to attenuate symptoms and enhance diet quality. Motivational interviewing-based behavioral approaches are applied, such as goal setting, self-monitoring, identification of barriers, and problem-solving. Monitoring of diet health involves review of 24 hour dietary recalls in conjunction with food and symptom diaries to promote survivor-directed behavior change resulting in improved bowel health. Conclusions: The AIMS intervention is among the first and few to address diet behavior changes for symptom management in rectal cancer survivors. It has the potential to positively impact the quality of long-term rectal cancer survivorship by integrating classic behavior change theories for cancer symptom management. Findings from the study will inform the design and development of future multi-institutional Phase II and III randomized trials. Clinical trial information: NCT03063918.
Integrative therapies for symptom management in cancer survivors: Assessment of an on-site integrative medicine (IM) program.
Authors: Dilawari Asma Ali , Gilboa Leatt , Kakareka Renee , Ratner Emily
Published: May 2018

142

Background: Up to 89% of oncology patients utilize integrative therapies with reported improvements in quality of life. However, less than half of patients report IM use to providers, potentially impeding optimal care. In September 2016, MedStar Montgomery Medical Center (MMMC), part of the MedStar Georgetown Cancer Network, opened the Center for Integrative Medicine (CIM) with support from MedStar’s Institute for Innovation (MI2). This clinical program offers IM consultation, acupuncture, mindfulness, psychology services, nutrition, and reiki. The purpose of this analysis is to examine oncology patient utilization of the CIM. Methods: Medical records of 174 patients seen September 2016 - October 2017 were reviewed, and 39 patients with a cancer diagnosis identified. Data regarding chief complaints, treatments, number of visits, and outcomes were analyzed. Results: 39 (22%) of 174 patients had a cancer diagnosis. After initial consultation, 29 of these patients received IM treatment; 14 returned for ≥5 treatments. Most common chief complaints were pain, stress/anxiety, fatigue, insomnia, and arthralgias (Table 1). The majority of CIM’s oncology patients was female and referred from in-network clinicians. The CIM referred 7 patients to other medical providers for unexpected medical issues and 2 required same-day appointments arranged by the CIM. Conclusions: These data illustrate oncology patients’ utilization and benefit of IM services within a hospital network. Communication between IM and referring providers may address unexpected clinical situations, potentially avoiding care delays and facilitating transparency with the use of IM services. Unpleasant symptom treatment may improve therapy adherence and quality of life. This review illustrates feasibility for an on-site CIM and the benefit to cancer survivors when IM services are offered collaboratively.[Table: see text]
The caregiver voice: Insights into caring for the young adult colorectal cancer patient.
Authors: Raymond Martha , Simonetta Margaret-Ann
Published: May 2018

148

Background: According to data from the National Cancer Institute’s Surveillance, Epidemiology & End Results (SEER) Program, since 1994 statistics show a 50% increase in young onset colorectal cancer incidence in the 20-49 age group. Researchers estimate that by 2030, more than 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in young adults under 50 years of age. Based on these alarming statistics and understanding the vital role caregivers play throughout the cancer continuum, our study explores the emotional and psychosocial implications for caregivers of young adult colorectal cancer survivors. Methods: From September 2015 – September 2017, our professional facilitator with over 25 years of cancer advocacy work hosted nationwide caregiver focus groups. Primary goals included reaching caregivers in rural, urban and community oncology settings to gain perspective from diverse populations. During the study period, we spoke with caregivers in 32 states via traditional focus group settings and online via Skype format. Results: 576 caregivers (37% male, 63% female) participated in our national focus groups. When asked to describe in one word their current feelings, the top ten responses were: Stressed, Anxious, Alone, Exhausted, Angry, Needed, Guilty, Burned-Out, Overwhelmed, Frustrated. 55% of the young caregivers reported they were experiencing self-health decline ( Can’t sleep, can’t focus – feel sad all the time). 73% reported they felt lost and totally helpless ( No control over situation or outcome). 89% reported depression ( We hurt because we can’t take their pain away). 76% reported they felt ill-equipped to help their loved one leading to stress and anxiety ( Desperate for whatever might help). Conclusions: New and expanded caregiver support services are needed. Emotional and psychosocial support are essential to the well-being of our caregivers as they provide vital support to patients in need throughout the cancer care continuum. We will continue the conversation with caregivers as we create programs and expand support services.
The humanistic burden of advanced non-small cell lung cancer: What are the key drivers of caregiver burden?
Authors: Wood Robert , Taylor-Stokes Gavin , Smith Fiona , Chirita Oana Christina , Chaib Torralba Carlos
Published: May 2018

149

Background: Advanced Non-Small Cell Lung Cancer (aNSCLC) impacts the lives of patients and their caregivers. This analysis aimed to provide insight into the clinical, patient and caregiver factors associated with increased caregiver burden. Methods: Data from a cross-sectional study of aNSCLC patients and informal (unpaid) caregivers in France, Germany and Italy, were collected from May 2015 to June 2016, consisting of a chart review and patient and caregiver surveys. Caregiver burden was assessed using the Zarit Burden Interview (ZBI), measured on a 0-88 scale. An ordinary least square regression model was constructed to assess clinical, patient and caregiver factors associated with ZBI. Measured at time of survey completion, covariates included: country, patient age, sex, body mass index, stage of NSCLC, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), disease duration, smoking status, presence of brain metastases, histology, comorbidities, chemotherapy treatment, caregiver age and sex, and the number of formal (paid) and informal caregiver hours provided per week by additional caregivers. A significance level of 0.05 was used. Results: 331 caregivers were analysed. Mean (SD) caregiver age was 53.8 years (12.4), 239 (72.2%) were female. Caregivers provided a mean (SD) of 17.8 (23.4) hours of care per week. Mean (SD) formal / informal caregiver hours provided by other caregivers was 3.9 (13.3) / 3.9 (12.0). Many caregivers did not receive support from additional formal (75.5%) or informal (68.6%) caregivers. Mean (SD) ZBI score was 31.3 (14.8). Significant independent predictors of ZBI were patient’s ECOG-PS and number of additional informal caregiver hours provided. ZBI scores for caregivers of patients with an ECOG-PS of 3-4 were 7.68 units higher compared to those with an ECOG-PS of 0-2 (p = 0.006). Also, ZBI scores increased by 0.16 units per hour of informal caregiver provided by additional caregivers (p = 0.008). Conclusions: The key drivers of caregiver burden found in the study reinforce the need to develop supportive and personalised interventions to maintain patient performance status by delaying progression, and reduce informal caregiver hours supporting the patient.
Does depression affect illness beliefs in cancer survivors?
Authors: Prieto Sarah , Muellers Kimberly A. , Wisnivesky Juan P. , Jenny Lin J.
Published: May 2018

156

Background: As cancer survivors live longer and many die from their comorbidities rather than from cancer, it is important to understand how a cancer diagnosis may impact survivors’ perception of their other comorbidities. In addition, cancer is associated with increased risk for depression. We aim to assess the relationship between depressive symptoms and illness beliefs in cancer survivors with diabetes (DM). Methods: We recruited 75 patients with DM who were newly diagnosed with early-stage breast, prostate, lung or colon cancer. Depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale; illness beliefs were assessed with the Brief Illness Perception Questionnaire. Illness belief questions were dichotomized at the median, and non-parametric analyses were used to assess the relationship between depressive symptom scores and presence of illness beliefs. Results: Seventy-five patients with DM and a new diagnosis of cancer were enrolled. The average age was 61.8 years, 47% were male, 45% had breast cancer, 42% prostate cancer, 8% colon cancer, and 4% had lung cancer. Patients who perceived having more control over their DM had lower depression scores (median 26 vs. 20, p = 0.01). Furthermore, those who did not feel their health depended on their DM medications at present (median score 21 vs. 26, p = 0.007) had lower depression scores. Regarding beliefs about cancer, those who reported being less concerned about cancer had lower depression scores (median 21 vs. 25, p = 0.01). Additionally, patients who did not feel that cancer affected their lives much (median 19 vs. 26, p = 0.001) or who did not report that cancer affected them emotionally (median 19 vs. 26, p = 0.001) had lower depression scores. Patients’ perception of their control over their cancer was not associated with depression scores. Conclusions: Cancer survivors with higher depression scores report being more affected by cancer and simultaneously feel they have less control over DM. It is important to support survivors emotionally while increasing their self-efficacy over their comorbidity management to improve survivors’ health outcomes.
Analysis of psychosocial distress screening and needs assessment in adult survivors of childhood cancer.
Authors: Lowry Becky N. , Alsman Kyla , Krigel Susan , Hein Wendy , Krebill Hope , Doolittle Gary C. , Mount Rebecca , Shankweiler Caylin , Gibson Cheryl
Published: May 2018

160

Background: Childhood cancer survivors (CCS) face complex psychological late effects. The need for systematic screening for psychosocial distress has been clearly identified; however, less clarity exists around characterizing factors that might identify patients at higher risk to support targeted treatment. The purpose of this study was to examine the results of psychological screening in a clinic for adult survivors of childhood cancer using the validated NCCN Distress Screening Thermometer and modified Needs Assessment and exploring the results with other patient factors. Methods: Retrospective chart review was completed on 117 CCS seen in our Survivorship Transition Clinic (STC) between 2014 and 2017. The NCCN Distress Thermometer and Needs Assessment were administered to patients attending the STC. Results were then analyzed with a number of additional factors to explore association. These factors included intensity of treatment (by Children’s Hospital of Philadelphia Intensity of Treatment Rating scale or ITR3), gender, and age at diagnosis. Results: Of 117 patients, 54 had low intensity ITR3 scores (1 or2) and 63 had high intensity ITR3 scores (3 or 4). Mean distress score was 2.669 for the group. A weak but statistically significant association existed between ITR3 scores and distress scale scores (r = 0.2, n = 117, p = 0.022). Mean distress scale scores did not differ between men (2.26 +/- 2.09) and women (2.92 +/- 2.6) nor were they significantly related to age at diagnosis (p = 0.242). Needs assessment identified emotional, nutritional, and physical as the most frequent concerns. Care needs mostly commonly identified were feeling anxious/worried/irritable, being concerned with weight control, or problems with pain / fatigue. Conclusions: While we did not identify statistically significant differences in distress based on gender or age at diagnosis, we did find weak statistical association between higher treatment intensity and higher distress scores. Needs assessment helped guide care plan development. As childhood cancer survivor rates increase, we have an obligation to evolve our understanding of not only physical late effects but also psychological late effects.
Effect of physical activity trackers and daily text messages on quality-of-life in colorectal survivors (Smart Pace): A pilot randomized controlled trial.
Authors: Chan Hilary , Van Loon Katherine , Kenfield Stacey A. , Chan June M. , Mitchell Emily , Zhang Li , Paciorek Alan T , Joseph Galen , Laffan Angela , Fukuoka Yoshimi , Miaskowski Christine , Meyerhardt Jeffrey A. , Venook Alan P. , Van Blarigan Erin
Published: May 2018

168

Background: There are over 1.3 million colorectal cancer (CRC) survivors in the United States, and many of whom suffer from lower health-related quality-of-life (HRQoL) years after diagnosis and treatment. Physical activity may improve survival outcomes and HRQoL for CRC survivors. Feasible interventions to support physical activity after CRC diagnosis are needed. Methods: We conducted a two-arm randomized controlled trial of 41 men and women who had completed treatment for CRC. Participants in the intervention arm were given a Fitbit Flex™ and received daily text messages for 12 weeks. HRQoL was assessed in both arms at baseline and 12 weeks using the RAND Short Form Survey (SF-36) and the Functional Assessment of Cancer Treatment – Colorectal (FACT-C). Survey score changes from baseline to 12 weeks were compared between the two arms using independent t-tests, and scores at baseline and 12 weeks were compared using paired t-tests. SAS was used for analysis, and statistical significance was declared at p < 0.05. Results: We observed a statistically significant increase in the FACT-C functional well-being sub-scale in individuals in the intervention arm pre- and post- intervention (mean ∆ 1.81 ± 2.76; p: 0.02). There was no change in functional well-being in the control arm (mean ∆ -0.35 ± 4.12; p: 0.71). The between-arm comparison of change from baseline to 12 weeks was not statistically significantly ( p: 0.08). There was a statistically significant increase in the FACT-C emotional well-being sub-scale in the control arm (mean ∆ 1.20 ± 2.48; p: 0.04) and in the SF-36 role physical sub-scale in the control arm (mean ∆ 22.5 ± 38.8; p: 0.02). No other measures of HRQoL were statistically significantly different within groups, across time points, or between groups. Conclusions: A 12-week physical activity intervention using a Fitbit Flex and daily text messages may improve functional well-being among CRC survivors. Larger randomized studies are needed to definitively determine if a digital physical activity intervention improves functional well-being among CRC survivors, and if the improvement can be sustained over time. Clinical trial information: NCT02966054.
Multidisciplinary conference to standardize survivorship care.
Authors: Rudge Beth , Lanigan Megan , Lee Theresa M. , Torp Lisa , Lu Kit Yu
Published: May 2018

17

Background: Survivors of breast cancer can face a multitude of long term and late effects after completing active treatment. Recommendations for side effect management can vary widely based on professional society guidelines, a provider’s clinical experience, and patient preference. When providing survivorship care in a multidisciplinary institution, maintaining consistent recommendations between providers and disciplines can be a daunting challenge. A cohesive approach is extremely important for a satisfying patient-clinician relationship and for patient safety. Our objective is to create standardized management of breast cancer survivorship issues. Methods: A quarterly Survivorship Multidisciplinary Conference (SMC) was initiated for case review and education on side effect management. The multidisciplinary group included medical and radiation oncologists, surgeons, nurse practitioners, nurse navigators, dieticians, physical therapists, social workers, spiritual care, and a genetic counselor. We used an evidence-based approach, including ASCO and NCCN guidelines as well as published peer-reviewed recommendations to create a treatment consensus for side effect management. Clinicians attending SMC were surveyed regarding their approach to late and long term effects of breast cancer pre- and post-SMC and their overall satisfaction with the conference. Results: Prior to involvement in SMC, most providers based their treatment of side effects on their own professional society’s guidelines and their personal clinical experience. After implementing SMC, 60% of providers reported a change in their practice and there was a 37.5% reported increase in the use of ASCO and NCCN survivorship guidelines across disciplines. 94% of providers reported the SMC is effective in providing evidence based guidelines. Providers also reported a high level of satisfaction and that SMC provided opportunity for a more collaborative multidisciplinary approach. Conclusions: Survivorship Multidisciplinary Conference brings multiple specialties together for review of evidence-based approaches to survivorship care, increasing consistency in management of survivors' late and long term effects after completing breast cancer treatment.
Quality of life and current needs of cancer survivors enrolled in Humanitas Research Hospital's survivorship care model.
Authors: Lorenzi Elena , Morello Lucia , Giordano Laura , Agostinetto Elisa , Grosso Camille , Nicolosi Matteo , Garassino Isabella Maria Giovanna , Cavina Raffaele , Mazza Rita , Carlo-Stella Carmelo , Santoro Armando
Published: May 2018

170

Background: While there are different studies investigating the quality of life (QoL) of cancer patients (pts) during active treatment, few studies report QoL of cancer survivors (CS) after at least 5 years (yrs) from achieving complete remission. We have investigated QoL and concerns about physical\psychological symptom of CS enrolled in our survivorship program from April 2015 to December 2016. Methods: We included pts > 18 yrs affected by hematologic or solid tumors after at least 5 yrs from achieving complete remission. A cross-sectional survey was carried out using validated scales: Cancer Survivors Survey of Needs subscale and a single-item measure of global QoL perception. Results: We analyzed data from 178 CS. The median age was 62 yrs (52 yrs at diagnosis), 70% were females. The most frequent histological types were breast (50%), colorectal (11%) and hematologic tumors (16%). Most pts received both chemotherapy and radiation therapy. With a median observation time of 139 months, the 10-yrs cumulative incidence of second neoplasm and cardiac adverse event was 8% and 7% respectively. 133 pts (65%) reported a good QoL (score > 3). The most frequent symptoms reported were weight changes (77%), memory\concentration deficit (65%), dental\mouth problems (61%). The most common physical\psychological symptoms were fear of relapse (83%), genetic counseling (68%), living with uncertainty (66%). A positive statistically significant association (p < 0.05) was observed between previous hormonal therapy and the following concerns (score ≥2): sleep disturbance (42% vs 35%); weight gain (31% vs 24%), osteoporosis (35% vs 18%), living with uncertainty (44% vs 38%). Female reported more fear of relapse (p 0.023) and sense of uncertainty (p 0.006) than males. 92% of pts have fully or partially adhered to the survivorship care plan. Conclusions: Most CS have a good QoL perception but we observed a high percentage of pts with a low score indicating different needs to be addressed. Pts treated with hormonal therapy are at higher risk of having both physical and psychological concerns. So far, the compliance of pts with the program was high.
Development of novel emoji scale to measure patient-reported outcomes in cancer patients.
Authors: Thompson Carrie A. , Novotny Paul J , Bartz Alicia , Yost Kathleen J. , Sloan Jeff A.
Published: May 2018

174

Background: Patient-reported outcomes (PROs), including physical function and quality of life (QOL), are important outcomes in cancer patients. Emoji are a near-universal, popular form of communication, understandable by diverse populations, including those with low health literacy. We aimed to explore whether emoji could be a valid, reliable scale for assessing PROs in cancer patients. Methods: To develop the emoji scale, 5 emoji faces were selected from the Apple emoji dictionary by study authors. 20 cancer patients participated in a card-sorting exercise to rank the emoji from negative to positive; 19 out of 20 selected the same order, which exceeded Coomb’s criteria for being a valid ordinal scale. Patients were recruited from Mayo Clinic practices. Eligibility included: adult patients with a diagnosis of lymphoma, multiple myeloma, brain, pancreatic, breast, and ovarian cancer within the past 5 years; life expectancy of > 6 months; and own an iPhone version ≥ 5.0. All patients were provided with an Apple Watch and downloaded the study app. Baseline PRO data was collected on the iPhone, including single-item linear analog self-assessments (LASA) and emoji scales for fatigue, physical function, emotional well-being, and overall QOL. Results: From 2/2017-8/2017, 294 eligible patients were recruited. 25% were male, and median age was 53 years (range 20-79). The median time since diagnosis was 8.4 months (range 0-60); 63% were on active therapy, 27% were in observation post-treatment, and 10% had not been treated. All patients were “extremely” confident filling out forms, 99% had used a computer in the past 12 months, and 27% had ever used a smart watch. Emoji responses were significantly associated with validated measures of PROs; the Spearman correlations between the ordinal emoji scales and LASAs were -0.83 for fatigue, 0.72 for physical well-being, 0.72 for emotional well-being, and 0.77 for overall QOL (all p < 0.0001). Of the 75 patients who have completed the study thus far, 92% reported they would use emoji scales again and 89% would recommend that others use emoji scales. Conclusions: A novel ordinal emoji scale is strongly associated with accepted measures of PROs in cancer patients and should be studied further.
Marijuana/tobacco use and patient-reported outcomes (PROs) in adult survivors of childhood cancer.
Authors: Huang I-Chan , Klosky James L. , Bhakta Nickhill , Hudson Melissa M. , Robison Leslie L.
Published: May 2018

175

Background: In 2017, the National Academy of Medicine reported adverse physical and psychosocial outcomes associated with marijuana use, and an increased risk of marijuana use among those who use tobacco. However, the association of marijuana and/or tobacco use with PROs has not been well-studied in survivors of childhood cancer. Methods: A random sample (stratified on self-reported smoking status) of 287 adult survivors of childhood cancer was selected from the St. Jude Lifetime Cohort Study. Chemotherapy and radiotherapy were abstracted from medical records. Marijuana use was self-reported and classified as past/current vs. never use. Current tobacco use was determined using serum cotinine concentrations by liquid chromatography tandem mass spectrometry. PROs were evaluated by physical and mental component summary (PCS and MCS) scores from the Medical Outcomes Study SF-36. Linear regression was used to evaluate associations of marijuana and tobacco use with PROs after adjusting for covariates, and the results were stratified by treatment modality. Results: Survivors’ mean age at study participation was 33.6 years (SD = 9.1), mean years from diagnosis was 24.2 (SD = 6.2). 61.3% used marijuana and 39.4% were current tobacco users. 79.3% of the tobacco users had marijuana use. Marijuana and tobacco were independently associated with lower PCS (βs = -3.1 and -2.9, respectively, p’s < 0.05) and MCS (βs = -3.3 and -3.2, respectively, p’s < 0.01). Among survivors who received chemotherapy, marijuana and tobacco were associated with lower PCS (β = -4.3, p < 0.01; β = -2.8, p < 0.05, respectively) and MCS (βs = -4.8 and -3.1, respectively, p’s < 0.05). In survivors who received radiotherapy, marijuana, but not tobacco, use was associated with lower PCS (β = -3.6, p < 0.05) and MCS (β = -4.6, p < 0.05). Among those who received neither chemotherapy nor radiotherapy, each substance was independently associated, but not significantly, with lower PCS and MCS. Conclusions: Among adult survivors of childhood cancer, marijuana users likely co-used tobacco, and both substances were independently associated with lower PROs. When associations with treatment exposures were assessed, different profiles of PRO scores were identified.
The Detroit Research on Cancer Survivors (ROCS) study: A focus on outcomes after cancer in a racially diverse patient population.
Authors: Beebe-Dimmer Jennifer Lynn , Albrecht Terrance Lynn , Ruterbusch Julie J. , Baird Tara , Hastert Theresa A. , Harper Felicity W. K. , Schwartz Kendra L. , Simon Michael S. , Schwartz Ann G.
Published: May 2018

177

Background: Although we continue to make progress in reducing the incidence and mortality for most cancers in the United States, African Americans (AA) continue to experience higher cancer incidence rates and have worse survival than other populations. The causes of these poorer outcomes, from higher mortality to poorer quality of life, in AA cancer survivors are not well understood. The Detroit ROCS study was initiated to improve our understanding of the experience of AAs living with cancer. Methods: 1,000 AA and non-Hispanic white (NHW) patients with primary lung, female breast, prostate or colorectal cancer diagnosed on or after January 1, 2013, and/or treated at the Karmanos Cancer Institute in Detroit, MI were recruited to participate in a cohort study with planned follow-up for 4 years. At baseline, participants completed a web-based survey to gather information about their medical history, family history of cancer, treatment and medication use, behavioral risk factors and self-assessed quality of life. Statistical analyses were performed to examine racial differences in the distribution of patient characteristics including comorbid conditions, stage at diagnosis, first course treatment and reported health-related quality of life (HRQOL). Results: The majority of patients were AA (60%) and female (61%), with a median age at diagnosis of 60 years. AAs were older, more likely to report use of cigarettes and alcohol and report a greater number of comorbidities compared with NHW patients; they were less educated and less likely to be employed full time or married (all p-values < 0.001). AA patients reported poorer overall HRQOL compared with NHW patients (p-value < 0.001). Controlling for marital status and employment attenuated the observed racial differences in mean HRQOL scores across all measured domains. Conclusions: We observed significantly lower self-reported HRQOL among AA cancer survivors compared with NHW, which could be partially explained by differences in specific socioeconomic factors but interestingly, not the presence of multiple comorbidities. Future research efforts will evaluate the relative contribution of social and financial support to HRQOL in AAs.
Lifestyle and outcomes after gastrointestinal cancer: A prospective cohort study (LOGIC).
Authors: Savoie Marissa Barbara , Van Loon Katherine , Laffan Angela , Bocobo Andrea Grace , Zhang Li , Paciorek Alan T , Atreya Chloe Evelyn , Anwar Mekhail , Rowen Tami , Smith James F , Shumay Dianne , Kenfield Stacey A. , Chan June M. , Venook Alan P. , Van Blarigan Erin
Published: May 2018

180

Background: The number of individuals living after a diagnosis of gastrointestinal (GI) cancer is increasing. Emerging data suggest modifiable lifestyle factors impact survival after colorectal cancer (CRC), however very little is known about survivorship in other GI cancers. Given the common thread of multimodality therapy among many GI cancer survivors, there is a paucity of data on sexual function, fertility, anxiety/depression, changes in comorbidities, and quality of life after cancer treatment. Additionally, existing cohort studies of GI survivors are primarily European, and further data are needed from survivor populations in the US . Methods: Patients of the University of California, San Francisco GI Oncology Survivorship Clinic who are designated disease-free are recruited by mail or in clinic. We send secure online questionnaires to participants every six months for five years and annually thereafter. At varying intervals, questionnaires solicit sociodemographics, diet, physical activity, fertility, medical and smoking history, fear of cancer recurrence, sexual health, quality of life, psychological well-being, and sleep quality. Pathoclinical disease characteristics, treatment, and recurrence status are abstracted from the medical record at baseline and updated annually. Results: Between February and August 2017, 111 patients were enrolled; 68% of participants completed ≥1 and 57% completed all baseline questionnaires. Most patients had a history of colon cancer (52%, n = 58) or rectal cancer (31%, n = 34). Other diseases include: anal cancer (12%, n = 13), gastrointestinal stromal tumor (3%, n = 3), and other GI cancers (3%, n = 3). Fifty-eight percent of patients were female, 76% identified as white and median age at diagnosis was 55 (range 20-81). Median time from initial GI cancer diagnosis to study entry was 27 months. Following the initial recruitment wave of established patients, the average rate of enrollment is ~3 patients/week. Conclusions: Results from this ongoing cohort study will improve our understanding of modifiable risk factors for GI cancer recurrence and key survivorship issues related to psychological well-being, sexual function, fertility management, and quality of life.
Adult cancer survivorship referrals for hereditary cancer genetic testing.
Authors: Walcott Farzana L. , Kaltman Rebecca Davidson , Hatcher Elizabeth , Ha Cam , Biagi Tara , Stark Elizabeth , McHenry Allison , Barbour April
Published: May 2018

183

Background: Genetic testing for hereditary cancer syndromes is underutilized among cancer patients. Cancer survivorship clinics may identify individuals at risk for hereditary cancer. We present the number of referrals from George Washington (GW) Adult Cancer Survivorship Clinic (ACS) to the GW Ruth Paul Hereditary Cancer Program (RPHCP) to demonstrate the feasibility of identifying high risk individuals in cancer survivorship. Methods: We reviewed the number of patients seen at the GW ACS and subsequent referrals to the GW RPHCP for genetic counseling/testing. An IRB approved research registry was used for retrieval of the data. The ACS clinic is staffed by a physician internist trained in clinical cancer genetics and a nurse practitioner trained in cancer survivorship. Results: 261 patients were seen in ACS from January 1, 2016, to September 30, 2017. Twenty patients (7.6%) were referred to RPHCP based on personal/family cancer history. Three patients were not consented for the research registry, leaving a total of 17 patients for this analysis. Fifteen (88.2%) patients were referred by the physician and 2/17 (11.7%) were referred by the nurse practitioner. Sixteen patients had genetic testing (94.1%) and results were: 5/16 (31.2%) positive, 6/16 (37.5%) negative, and 3/16 (18.7%) had a variant of unknown significance (VUS). Results on 2 patients are pending. One patient deferred testing. Of the 17 patients referred, 14/17 (82.3%) had personal/family history of cancer and had seen an oncologist. Cancer sites and germline mutations identified were: bilateral breast cancer and bladder cancer (BRCA2), prostate cancer (MUTYH), breast and ovarian cancer (BRCA1), endometrial cancer (APC). One patient without cancer was referred by an oncologist for a previously identified familial MLH1 mutation, and was positive. Conclusions: Cancer survivorship clinics may identify individuals appropriate for genetic testing for hereditary cancer syndromes. This is likely an underestimate as not all cancer patients are seen in survivorship clinic. Systematic capture of personal and family history of cancer in cancer survivors may enhance utilization of genetic testing services among cancer survivors and identification of high risk individuals.
Utilization of a web-based survivorship and supportive oncology training curriculum for clinicians.
Authors: Penedo Frank J. , Roggenkamp Betty , Rosenberg Carol A. , Trosman Julia Rachel , Robinson Patricia A. , Knightly Eileen , Pasquinelli Mary , Khosla Paramjeet , Bowman Anne , Lillis Teresa , Gerhart James , Slocum Megan , Garcia Sofia F. , Berardi Rosa , Martin Joanna , Lo Shelly S. , Weldon Christine B.
Published: May 2018

19

Background: A challenge in supportive oncology, integral to patient care, is training the health professional workforce. A collaborative funded by The Coleman Foundation of 30+ clinicians (faculty) from 25 institutions (academic, community & safety net) developed a unique fundamental survivorship care (Weldon JCO 2017) and supportive oncology training curriculum (Trosman JNCCN 2017). Methods: Using data from The National Comprehensive Cancer Network Continuing Education team, we analyzed utilization of survivorship and supportive oncology education courses using simple frequencies. Results: Over 3200 courses were completed (pretest, course, post-test, evaluation) and 4850 accessed. Nurses completed 56%, physicians 15%, social workers/psychologists/support staff 14%, advance practice clinicians 8%, and various roles for the rest. Courses in table. Conclusions: NCCN’s education portal achieved strong utilization from a variety of healthcare professionals in these courses. The Coleman Supportive Oncology Collaborative supports improvement in supportive care with tools, processes and training and will continue to update/offer courses through this portal.[Table: see text]
Impact of cancer survivorship care plans (SCPs) on health outcomes and health care delivery: A systematic review.
Authors: Jacobsen Paul B. , Derosa Antonio P. , Henderson Tara O. , Mayer Deborah , Moskowitz Chaya S. , Paskett Electra D. , Rowland Julia Howe
Published: May 2018

2

Background: In 2006, the Institute of Medicine recommended that patients at or near completion of active treatment be provided with a SCP (treatment summary, relevant health information, and follow-up care plan) to improve care delivery and outcomes in the post-treatment period. We systematically reviewed published research to determine if SCPs have a positive impact on health outcomes and healthcare delivery. Methods: Randomized and nonrandomized studies evaluating patient-reported outcomes, healthcare utilization, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, and Cochrane Library. Data were extracted by independent raters and summarized based on qualitative synthesis. Results: Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer diagnoses, timing of SCP delivery in relation to treatment completion, SCP delivery method and recipients, SCP content, SCP-related counseling, and outcomes assessed. Findings from nonrandomized studies yielded descriptive information only on outcomes such as satisfaction with care and reactions to SCPs. Among randomized studies, findings were near uniformly negative for the impact of SCPs on the most commonly assessed outcomes (physical, functional, and psychological well-being); findings were positive in single studies for other outcomes including amount of information received, satisfaction with care, and physician implementation of recommended survivorship care. Conclusions: Existing research provides minimal evidence that SCPs improve quality of life in cancer survivors. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal health outcomes. Findings are very limited but more positive for proximal outcomes (e.g., information received) and for care delivery, especially when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. In light of current findings, future research should focus to a greater extent on evaluating ways to ensure SCP recommendations are subsequently implemented as part of ongoing care.
Nutrition services for men with prostate cancer: A health professional survey.
Authors: McLaughlin Kaity , Hedden Lindsay , Pollock Phil , Higano Celestia S. , Murphy Rachel A
Published: May 2018

25

Background: Nutrition is a key part of prostate cancer (PC) survivorship for management of PC, treatment side effects, and overall health. The Prostate Cancer Supportive Care (PCSC) Program is one of only a few PC survivorship programs in Canada that provide nutrition support as part of standard care. A survey was conducted as part of a broader needs assessment to understand health care professionals’ (HCPs) perspectives on nutrition services for men with PC and inform nutrition programs. Methods: An online survey was administered to British Columbia (BC) HCPs caring for men with PC including urologists, radiation oncologists, medical oncologists, registered dietitians and researchers. We used purposive sampling to identify relevant HCPs. HCPs were asked about the importance of oncological nutrition services and how they should be delivered to men with PC. We summarized the percent agreement for each question and across professions then thematically analyzed qualitative data. Results: Of the 56 HCPs invited to participate in the survey, 38 (68%) responded. The majority (61%) agreed that men with PC require more nutritional support. HCPs indicated nutrition services should be offered multiple times throughout survivorship and facilitated through online resources, individual consultations with registered dietitians and consecutive group education sessions. Most (75%) urologists, radiation oncologists and medical oncologists responded that weight management should be the focus for nutrition services, whereas 90% of dietitians responded that nutrition for reducing the risk of PC progression should be the focus. The main themes that arose from the survey suggested that nutrition services should be available in different forms to facilitate individual needs and adapted based on cultural and community settings. Conclusions: HCPs confirm that there is an unmet need for nutrition services for men with PC in BC as existing services prioritize and offer services for cancer-related weight loss. Special consideration should be given to the focus of nutrition service provided, and when and how it is offered. These results will inform the development of additional resources for men with PC to support their nutritional needs.