bluuebunny/crossref_metadata_2025 huggingface dataset:
Early post-therapy prescription drug usage among survivors of childhood cancers.
Authors: Smitherman Andrew Brian , Mohabir Danielle , Wilkins Tania , Blatt Julie , Nichols Hazel , Dusetzina Stacie
Published: March 2017

147

Background: Childhood cancer survivors often develop treatment-associated morbidities. We hypothesized that emerging treatment-related medical morbidities would be reflected in patterns of prescription drug usage among survivors in the first three years after therapy completion. Methods: Using the Truven Health MarketScan Commercial Claims database, we identified survivors of childhood (0-21 years-old at diagnosis) leukemia, lymphoma, central nervous system (CNS), bone, or gonadal tumors who completed therapy during 2000 - 2011. Patients were identified using diagnosis codes and cancer-specific procedure codes for chemotherapy, surgery, or radiation therapy. Prescription fills during the first three years following therapy completion were examined and categorized by drug class. Median numbers of prescriptions per survivor were compared to age- and sex-matched children without cancer. Relative risks (RR) for any prescription and for prescriptions by drug class were calculated comparing survivors to children without cancer. Results: We identified 1,414 survivors and 14,140 children without cancer. The median number of unique drug class prescriptions among survivors ranged from 4 [gonadal] to 8 [CNS] in year 1 and from 2 [gonadal] to 6 [CNS] in year 3 compared to a median of 1 among children without cancer (p < 0.001 for all comparisons). Increased risks for fills of antibiotics (RR in year 1: 1.5 [CNS, gonadal], 1.7 [bone], and 1.8 [leukemia, lymphoma]) and opioids (RR in year 1: 2.4 [lymphoma], 2.7 [gonadal], 4.0 [CNS], and 4.8 [leukemia, bone]) persisted throughout the three years among all cancer groups. Survivors of leukemia, lymphoma, CNS, and bone tumors had 2-4 times the risk for antidepressant prescriptions and 4-10 times the risk for anxiolytics. Survivors of leukemia, lymphoma, and bone tumors had 8-10 times the risk for ACE inhibitor prescriptions by the third year off therapy. Conclusions: Compared to children without cancer, childhood cancer survivors have higher rates of prescription drug use across many drug classes indicative of their higher burden of medical morbidities. Careful attention should be given to emerging morbidities during the early off-therapy period.
A multidisciplinary clinic to mitigate the toxicity of therapy for newly diagnosed metastatic prostate cancer undergoing chemohormonal therapy: A feasibility study.
Authors: Hough Jeffrey , Rodvelt Tammy J. , Thomas Miles , Ma Brian , Rabow Michael W. , Weinberg Rami , Macaire Greta , Shepard Nancy , Chan June M. , Van Blarigan Erin , Choque-Gonzales Gonzalo , Lee Mina , Friedlander Terence W. , Kim Won , Ryan Charles J. , Small Eric Jay , Aggarwal Rahul Raj
Published: March 2017

153

Background: Chemohormonal therapy is standard of care for newly diagnosed metastatic prostate cancer (mPC) patients (pts) but is associated with significant adverse effects and negative metabolic changes. We performed a pilot study to investigate whether participation in a multi-disciplinary clinic to mitigate adverse effects of treatment is feasible. Methods: Pts with recently diagnosed mPC who were planning to start or had recently started chemohormonal therapy were prospectively enrolled in a multi-disciplinary clinic that included individualized monthly counseling from a physical therapist, oncology dietitian, and palliative care specialist on a rotating basis for 12 months. Patients were assessed quarterly for changes in % body fat, weight, serum levels of 25-OH vitamin D, fasting lipids/glucose/insulin, and quality of life (QOL). DXA bone density scans were performed at baseline and end of 12 months. The primary endpoint was the completion rate of scheduled visits. Results: 7 pts were enrolled between September 2015 and June 2016. All patients had extensive disease ( > 4 bone metastases and/or visceral metastases) at the time of study entry, and all 7 patients completed six cycles of docetaxel-based chemotherapy, and remained on hormone therapy for the duration of study. The percentage of completed visits was 98% (54/55 planned visits). The percentage of completed assessments including QOL questionnaires was 81%. No skeletal-related complications were observed. Median percent increase from baseline in body weight and % body fat was 3.51% and 20%, respectively. Four of the seven patients had osteopenia at baseline. Patient reported satisfaction was high and positive impact on psychosocial well-being was observed. Conclusions: Participation in a multi-disciplinary clinic by men receiving intensive chemohormonal therapy for metastatic prostate cancer was feasible. Patients are at risk for adverse metabolic and bone toxicity with therapy, underscoring the potential positive impact of a multi-disciplinary clinic. A randomized study to detect objective improvements in health outcomes is underway. Clinical trial information: NCT02168062.
Integrating the patient (pt) voice with clinician reports to identify cancer-specific subsets of symptomatic adverse events (SymAE).
Authors: Shaw Jim , Speck Rebecca , Lenderking William , Quach Caroleen
Published: March 2017

155

Background: The Pt-Reported Outcomes Version of the Common Terminology Criteria for AE (PRO-CTCAE) was developed for pts to report on the frequency, severity, and interference of SymAE. A study was conducted to identify a hepatocellular carcinoma (HCC)-relevant subset of the PRO-CTCAE's 124 items to enhance evaluation of SymAE in HCC trials and long-term effects in survivorship. Methods: Qualitative and quantitative data were collected from medical oncologists specializing in HCC and pts diagnosed with HCC stratified by Child-Pugh class and treatment. Oncologists were asked about HCC diagnosis, treatment, and SymAE and provided ratings (ranging from 0 = unimportant to 10 = very important) of the following: 1) importance to pts of 34 prevalent SymAE from past HCC trials (all phases); 2) importance to pts of each PRO-CTCAE item; and 3) their own perceived importance of each PRO-CTCAE item with regard to tolerability. Pts were asked about their diagnosis, treatment, and experience of SymAE after which they completed the PRO-CTCAE and were debriefed on the importance of each item. Results: Four medical oncologists from Spain, Taiwan, Korea, and Hong Kong with ≥ 20 years of experience completed interviews. SymAE from prior trials rated highly important to pts (mean rating across oncologists ≥ 7) included hand-foot syndrome, diarrhea, fatigue, decreased appetite, rash, vomiting, and weight loss. PRO-CTCAE items rated highly important to pts included diarrhea, vomiting, shivering or shaking chills, hand-foot syndrome, rash, fatigue, difficulty swallowing, and loss of control of bowel movements. Items rated highly for tolerability included diarrhea, shivering or shaking chills, and hand-foot syndrome. Pt interviews (planned up to 24) are ongoing. Conclusions: Oncologists identified 10 clinically relevant items from sponsor SymAE data and the PRO-CTCAE for use in HCC trials. Findings from pt interviews will compare provider and pt perspectives about SymAE and strengthen the set of selected items. Combining clinician and pt ratings with clinical trial data may be a promising method for identifying cancer-specific PRO-CTCAE item sets for use throughout the cancer care continuum.
Using the NCCN survivor assessment questionnaire as a tool to tailor educational needs of cancer survivors.
Authors: Crabbe Wendy , Iruku Praveena
Published: March 2017

156

Background: Survivor care after cancer treatment includes assessment of fatigue, pain, cognitive dysfunction, cardiac toxicity, sexual function, and the patient’s habits related to nutrition, physical activity, sleep and stress management. Using a tool to evaluate these symptoms and lifestyle habits is needed to determine the educational needs of the cancer survivor for the survivor treatment summary visit. Methods: We have used the National Comprehensive Cancer Network (NCCN) Survivorship Assessment tool for the past 12 months to develop a survivor care plan. It is a pre-visit 25 question survey completed by the patient. The patient responses help focus education based on current symptoms and lifestyle habits. A total of 50 questionnaires were completed over the past year. Results: Of the 50 patients, 46 were women, 45 had breast cancer, 3 colorectal and 2 other. The average age was 56 years old, 70% were Hispanic, 86% received chemotherapy and there were 4 recurrences. The average time from finishing adjuvant therapy to the survivor treatment summary visit was 7 months. Fifty percent of patients were on adjuvant hormonal therapy (Aromatase Inhibitor or Tamoxifen). Persistent symptoms at the time of the survivor visit are detailed in the table below. Regarding nutrition and physical activity, 44% of survivors were obese with 44% who said they get regular physical activity. Of the 44% who get regular physical activity, it can be further broken down to 1-3 days a week (10%), 4-7 days a week (28%) and 46% of patients said they ate 2.5 cups of fruits and vegetables per day. Conclusions: At the time of the survivor treatment summary visit there are still residual side effects from treatment including cognitive dysfunction, pain, fatigue, trouble sleeping and problems with sexual function. The NCCN Survivor Assessment questionnaire is a good tool to determine persistent side effects from treatment and educational needs of cancer survivors.[Table: see text]
Feasibility of an electronic implementation method of an evidence-based exercise intervention among testicular cancer survivors (TCS).
Authors: Fung Chunkit , Peckham Jennifer , Porto Michelle , Lin Po-Ju , Sahasrabudhe Deepak M. , Guancial Elizabeth A. , Ky Bonnie , Storozynsky Eugene , Janelsins Michelle Christine , Heckler Charles E. , Bruckner Lauren B. , Mohile Supriya Gupta , Mustian Karen Michelle
Published: March 2017

161

Background: Cardiovascular (CV) disease results in significant morbidity among TCS. The effects of exercise on mitigating these late effects remain unknown in this population. Exercise for Cancer Patients (EXCAP) is a self-directed, individually tailored intervention that has been shown to improve CV fitness in cancer patients. We conducted a randomized phase II feasibility study of a novel electronic implementation method (mHealth) of EXCAP. Methods: We developed mHealth-EXCAP that integrates data from a wearable digital activity tracker (DAT) into a patient’s electronic medical record (EMR), allowing providers to monitor and adjust EXCAP prescriptions via a patient-centered virtual portal. We randomized TCS ( < 69 yr at diagnosis, any treatments, not in active or maintenance stage of exercise behavior) into 3 study arms: Arm 1 (mHealth-EXCAP), Arm 2 (EXCAP) and Arm 3 (usual care). Both Arm 1 and 2 completed a 12 week EXCAP program with the goal of 12,000 daily steps and daily resistance exercises and Arm 1 has integration of mHealth. Arm 3 received a TCS care plan that encourages exercises. Results: 52 TCS were screened (23 ineligible; 12 declined), 17 consented and 13 (80.9%) completed study (3 withdrew; 1 lost to follow up) as of May 31, 2016. Median age (yr) was 34 (Arm 1; n = 6), 52 (Arm 2; n = 3), and 48 (Arm 3; n = 4). In Arm 1, 83% TCS wore DAT and synced daily step data to EMR > 90% of days. Further, EXCAP prescriptions were adjusted via EMR portal on average 5 times over 12 weeks for each TCS and their weekly daily step goals were met 73% of the time. The number of daily steps recorded by DAT and those synced from DAT to EMR differed by a mean of 1.5% steps (±1.8). Median baseline number of daily steps were 5,432 (Arm 1), 6,737 (Arm 2), and 5,875 (Arm 3) and increased by 6,161, 1,742, and 1,921 respective steps, with only Arm 1 (50% TCS) achieving > 12,000 daily steps at study completion. On average, TCS in Arm 1 and 2 performed resistance exercises 15 minutes a day/2 times a week and 34 minutes a day/3 times a week, respectively. Conclusions: mHealth-EXCAP is feasible to implement among TCS and may decrease sedentary behavior. Ongoing research will examine its effects on CV risk factors and cardiopulmonary function.
Factors and barriers associated with changes in physical activity after cancer diagnosis.
Authors: Romero Sally A. D. , Li Qing Susan , Mao Jun J.
Published: March 2017

162

Background: Cancer patients experience a variety of symptoms (e.g., pain, fatigue) that can impact their ability to maintain physical activity (PA) levels. The objectives of this study were to examine factors associated with decreased levels of PA following cancer diagnosis and to identify barriers to PA. Methods: We recruited cancer patients from one urban academic medical center and 11 affiliated community hospitals to participate in a cross-sectional study. We conducted chi-square tests and multivariate logistic regression models to examine patient demographics, clinical characteristics and self-reported barriers associated with decrease in PA levels since cancer diagnosis. Results: Among 662 participants, mean age (SD) was 59.9 (11.6) years. The majority were female (65%), White (81%), and overweight/obese (65%). Common cancer types were breast (32%), lung/thoracic (15%), and hematological (15%), 53% had non-metastatic disease, and 53% were > 12 months post-cancer diagnosis. The majority received chemotherapy (88%), radiation (53%), and/or surgery (53%). Since their cancer diagnosis, 499 (75%) participants reported decreasing their PA levels, 16% maintained, and 4% increased their PA levels. In multivariate analyses, decreased PA levels were significantly associated with receiving chemotherapy [Adjusted Odds Ratio (AOR) 3.54, 95% CI 2.06-6.06] and having metastatic disease (AOR 1.64, 95% CI 1.07-2.52). For barriers to PA, the most common were fatigue (78%), pain (71%), difficulty getting motivated (68%) and difficulty remaining disciplined (65%). In bivariate analyses, the presence of symptoms (i.e., pain, nausea, fatigue, treatment side effects, or surgical complications), difficulty getting motivated, difficulty remaining disciplined, and sadness were significantly associated (p < 0.05) with decreasing PA levels. Conclusions: The majority of cancer patients, especially those who received chemotherapy and those with advanced disease, decreased their PA levels since cancer diagnosis. In addition, physical and psychological barriers exist that influence PA levels. Interventions targeting these barriers are needed to promote maintenance of PA levels throughout the cancer continuum.
Building a healthy body after cancer: Results of a focus group with young adult survivors to inform an intervention for exercise after treatment.
Authors: Kimball Brittany , Asiedu Gladys , Thompson Carrie A.
Published: March 2017

164

Background: Adolescent and young adult (AYA) cancer survivors have distinctive and often unmet needs, may lead long lives after treatment, and are a population for whom targeted health supports are limited. Exercise in particular has become increasingly recognized as a vital part of cancer survivors’ health needs, yet, little is known about what interventions would be most appropriate for this population. This ongoing study reports early data on barriers and facilitators to exercise in AYA lymphoma survivors. Methods: We conducted a focus group with five young adult lymphoma survivors. Participants completed questionnaires to assess quality of life, exercise habits, and knowledge about evidence for exercise after cancer treatment. Charts were abstracted for demographic and treatment-related details. The focus group was audio recorded and transcribed. Data is being analyzed thematically to generate applied findings and identify areas for action. Results: Participants were 24-35 years old, 60% male, and an average of 2.97 years from the time of diagnosis. All reported some form of physical activity, with 80% active and 20% moderately active. Preliminary analysis identified fatigue, weight gain, and lack of time as barriers to exercise. Participants identified fatigue particularly in the early survivorship period, and discussed the issue of non-cancer survivor peers not relating with or recognizing fatigue after treatment. 100% of participants reported that someone from their doctor’s office had talked with them about exercise, but indicated during the focus group that this recommendation did not motivate them to exercise. Other themes revolve around the relationship between healthy diet and physical activity. In terms of an intervention, survivors were interested in activity trackers and fitness apps, exercise variety, and fitness groups targeted specifically for AYA survivors. Conclusions: Fatigue, weight gain, and time are barriers to exercise for AYA survivors. Interventions that incorporate fitness tracking technology, provide variety, and/or include other AYA survivors may be successful in this unique population.
The long-term benefits of the LIVESTRONG at the YMCA program.
Authors: Ratterman Erin L , Standage Kelly , Beaupin Lynda M.
Published: March 2017

167

Background: Up to 35% of cancer survivors report physical dysfunction. Exercise programs are beneficial for cancer survivors, yet adherence to exercise long-term remains a challenge. This study examines the efficacy of the Livestrong at the YMCA Program on the physical function of cancer survivors and its influence on habitual exercise. Methods: This retrospective study analyzed data from 158 participants between 2013-16. Each 12-week program consisted of two 1.5 hour sessions per week led by YMCA trainers with LIVESTRONG certification. Sessions included group exercises and education on nutrition and healthy eating, yoga and meditation. Demographic forms completed upon enrollment and Functional Assessments performed at the beginning and close of each 12-week program were analyzed. The demographic data was compiled to produce aggregate characteristics and matched Functional Assessments scores were used to determine changes in each measure over the course of the program. Data analysis included who obtained YMCA membership and continued to have active membership. Results: Matched pre- and post-program Functional Assessments and demographic data were available for 112 participants (71%). Thirty-four percent were over 65 years of age, 94% Caucasian, 52% had breast cancer, and 55% completed treatment within the past two years. We observed improvements in all measures within the Functional Assessment, including upper and lower body strength, flexibility, balance, and 6-minute walk test. Thirty-nine percent are currently YMCA members, and 78% of those have checked into the YMCA within the last 3 months. A post-program potluck dinner is hosted and attendance from prior participants is over 50%. Participant feedback indicates that the program promotes socialization and peer support among cancer survivors. Conclusions: Similar to other exercise programs, the Livestrong at the YMCA program improves physical function scores. Nearly 40% of participants maintain a YMCA membership and over 75% of these members continue to exercise at the YMCA. Promotion of peer support and education on healthy lifestyle behaviors by the Livestrong at the YMCA program may have an impact on the long-term adherence to exercise among cancer survivors.
Introducing medical students to survivorship care through an elective oncology summer program.
Authors: McKillip Ryan Patrick , Hahn Olwen Mary , Rosenberg Carol A. , Olopade Olufunmilayo I. , Arora Vineet M , Golden Daniel William
Published: March 2017

17

Background: Advancing the quality of cancer care requires that physicians be trained in survivorship care. An oncology seminar series was designed and implemented for first year medical students (MS1s) to improve their knowledge of oncologic disciplines, including survivorship care, by educating them about these disciplines from both a research and clinical perspective. Methods: In 2015 and 2016, MS1s at a single US medical school were invited to participate in the Scholars in Oncology-Associated Research (SOAR) summer program, which included a series of 10 lectures to provide a general survey of how clinical care, basic sciences, and social sciences apply to oncology as a multidisciplinary specialty. Lectures included topics specific to cancer genetics, medical, surgical, and radiation oncology, hospice/palliative medicine, and survivorship care. The students also attended a multidisciplinary tumor board and had the opportunity to shadow a pharmacist, radiation therapist, or palliative care advanced practice nurse. Students completed self-assessments of their understanding of oncology and its related disciplines before and after SOAR. Likert-type scores were 1=not at all, 2=somewhat, 3=moderately, 4=quite, and 5=extremely and are reported as median [interquartile range]. Results: Twenty-seven students successfully completed SOAR. Thirty-three pre- and 25 post-assessments were completed. Student self-reported understanding of oncology as a clinical discipline (2[2-3] vs. 4[4-4] p<.01) and as a research discipline (2[2-3] vs. 4[4-4] p<.01) improved after SOAR. Student understanding of survivorship care as a clinical discipline (1[1-2] vs. 3[2-4] p<.01) and as a research discipline (1[1-1] vs. 2.5[2-3] p<.01) also improved. All students indicated they would be "quite" or "extremely" likely to recommend SOAR to future students. Conclusions: A structured didactic introduction to oncology, SOAR, was successfully piloted. MS1s report improved understanding of oncology and survivorship care as clinical and research disciplines. Additional curricular content is required during subsequent years to further improve student understanding of oncology and survivorship care.
Patient and family caregiver perceptions of a cancer-related in-home Reiki experience.
Authors: Alhawatmeh Hossam , Chen Yea-Jyh , Radziewicz Rosanne M.
Published: March 2017

174

Background: Complementary care modalities are needed for residential patients and family caregivers, in addition to traditional cancer treatments, to effectively alleviate associated symptoms. Reiki is one of the biofield energy modalities which is generally known to provide non-invasive, non-pharmacological, and beneficial relaxation. It has been commonly practiced to cancer patients in clinical and cancer support facilities. However, little is known about providing Reiki at home especially by informal caregivers. This study aims to describe and understand the perceptions of an in-home Reiki practice as experienced by patients with cancer and their family caregivers. Research Question: What are the perceptions of patients and caregivers of their experiences with an in-home Reiki practice? Methods: A descriptive phenomenological approach (Husserl) was used to explore the perceptions of cancer patients and family caregivers of an in-home Reiki practice through narratives of six dyads of participants; six patients with active cancer and six family caregivers were interviewed. Participants were recruited at three sites in Northeast Ohio. Participants’ narratives were analysed according to Colaizzi’s thematic analysis method. Bracketing, peer debriefing, and external audits were performed to enhance the trustworthiness of findings. Results: Seven major themes were identified: 1) exchange of emotional energies, 2) sensory experiences of energy exchange, 3) physical symptom relief, 4) detachment from stressful circumstances, 5) restoration of spiritual wellbeing, 6) recognition of a valued technique, and 7) lifestyle accommodation. Conclusions: Study participants perceived that in-home Reiki was a beneficial self-care practice that improved the health of patients with cancer. An understanding of patient and caregiver perceptions of Reiki practice in home settings may lead to the development of stand practice and guidelines for a successful patient–caregiver intervention, suitable for a daily schedule or lifestyle. Further study is needed to understand the process underlying in-home Reiki in connection with health outcomes related to cancer.
Creating an integrative survivorship program within a conventional medical culture within a lean economic environment.
Authors: Lawrence Francinne , Reeves Brandon
Published: March 2017

177

Background: The Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition (2005) identified gaps in services for cancer patients upon completion of their initial phase of treatment. In response to these needs, the Commission on Cancer (CoC) (2015) defined survivorship as an official phase of treatment along the cancer care continuum. This case study examined the process of developing an integrative survivorship program that introduces complementary health approaches within a conventional oncology setting using limited financial resources. Methods: A case study design was applied to examine using complementary health approaches as the foundation of a newly implemented cancer survivorship program. A regional CoC accredited community was the research site. Data was collected from: empirical literature, a self-report inventory completed by participants, and archival data and was interpreted using the logic model framework. Results: Findings revealed that using a survivorship model with complementary health approaches as its foundation within a conventional cancer treatment facility resulted in positive outcomes for cancer survivors. Seven core concepts were identified as significant to the process of developing an integrative program. Findings also showed that using a volunteer-staffed program was an effective implementation plan within a lean economic environment. Additionally, this case demonstrated that complementary components resulted in self-reported improvements among cancer survivors in mood, pain, social connectedness, stress, fatigue, and coping capacity. Conclusions: Within this case study, there were seven elements significant to the process of successfully developing and implementing an integrative survivorship program within a conventional medical cancer setting. A cancer survivorship program that integrates complementary health approaches within a conventional cancer treatment facility appears efficacious in assisting cancer survivors in addressing long-term and late-onset side effects of cancer treatment. Using a volunteer-staffed program model was effective for implementing the program within a lean economic environment.
Awareness among patients with cancer of the harms of continued smoking.
Authors: Eng Lawson , Alton Devon , Che Jiahua , Song Yuyao , Su Jie , Farzanfar Delaram , Mohan Rahul , Krys Olivia , Yoannidis Tom , Milne Robin , Brown M Catherine , Vennettilli Ashlee , Hope Andrew J. , Howell Doris , Jones Jennifer M. , Selby Peter , Xu Wei , Goldstein David Paul , Giuliani Meredith Elana , Liu Geoffrey
Published: March 2017

179

Background: Smoking cessation is becoming an integral part of cancer survivorship. To help improve survivorship education, clinicians need an understanding of patient knowledge of the harms of continued smoking. Methods: Patients with various cancer subtypes were surveyed with respect to self-awareness of the harms of continued smoking on cancer outcomes. Multivariable logistic regression models assessed factors associated with the level of awareness. Results: Among 985 patients, 23% smoked at diagnosis; 34% quit > 1 year prior to diagnosis; 25% had lung, 30% had head and neck cancers; 77% received curative therapy. Many patients reported being unaware that smoking can negatively impact cancer surgery (65%), radiation (74%), chemo outcomes (64%), treatment efficacy (70%), cancer prognosis (54%) and second primary development (52%). Among all patients, those smoking at diagnosis were significantly more likely to be unaware of radiation (aOR = 1.73, 95% CI [1.16-2.57]) and chemo (aOR = 2.10 [1.17-3.79]) toxicities, cancer prognosis (aOR = 1.63 [1.16-2.29]) and second primary risk (aOR = 1.61 [1.14-2.26]). Those with poorer health status were more likely unaware of effects on prognosis (aOR = 1.56 [1.18-2.08]) and second primaries (aOR = 1.54 [1.14-2.08]). Patients with non-tobacco related cancers (non-TRCs) were more likely unaware smoking impacts cancer surgery (aOR = 1.45 [1.04-2.04]) and radiation (aOR = 1.37 [1.01-1.85]). Among smokers at diagnosis, those with non-TRCs (aOR = 4.00 [1.45-11.11]) were more likely unaware smoking can impact chemo outcomes. Awareness was not associated with stage, second-hand smoke exposure, cessation or interest in a smoking cessation program (SCP), but was associated with patients believing that a SCP would be beneficial to their health (aORs = 2.33-4.35, P < 0.03). Among smokers at diagnosis, believing that a SCP is beneficial (51%) was associated with both interest in an in-patient (aOR = 4.65 [2.15-10.03]) and ambulatory (aOR = 4.08 [2.14-7.79]) SCP. Conclusions: Many cancer patients were unaware of the harms of continued smoking; mainly smokers at diagnosis and those with non-TRCs. Patient education should focus on emphasizing awareness, which may help improve patient interest in smoking cessation.
A randomized control trial (RCT) of an online, symptom self-management curriculum (Reimagine) among breast cancer survivors.
Authors: Smith Sophia Kustas , MacDermott Kristin , Amarasekara Sathya
Published: March 2017

182

Background: Chronic pain, depression, and fatigue are common effects resulting from the cancer experience (e.g., disease, treatment); new interventions are needed. Reimagine is an online symptom self-management program that teaches coping skills. This presentation will report on the impact of Reimagine on key health outcomes. Methods: Adult breast cancer survivors with chronic pain were recruited from the Susan Love Army of Women volunteer registry. Consenting participants were randomized 1:1 to the treatment or usual care condition and completed surveys at Baseline and 18 weeks (post-intervention). Treatment arm participants accessed content online; required activities included viewing online videos, attending online group meetings, and completing cognitive reframing exercises. Surveys were administered via REDCap to assess for pain severity and interference (primary outcome), depression, fatigue, and program satisfaction. An independent-samples t-test was conducted to compare change in pain, depression, and fatigue outcomes in treatment and usual care conditions. Results: Participants (n = 91) were: mean age 56.4 ± 8.8 years; 99% female; 94% white; 67% married; 46% employed; mean time since diagnosis 7.9 ± 6.4 years; and 89% were in remission or cured of their breast cancer. There was a significant difference in the change in depression scores for treatment (M = -1.7, SD = 4.7) and usual care (M = 0.3, SD = 3.8) conditions; t (82) = -2.1, p = 0.035. Difference in the change in fatigue scores was significant for treatment (M = 4.8, SD = 9.1) and usual care (M = 1.2, SD = 6.6) conditions; t (84) = 2.1, p = .038. No significant differences were found in the change in pain outcomes for treatment and usual care conditions (p > .05). Most treatment arm participants (94%) would recommend Reimagine to others and 85% felt more resilient at study completion. Conclusions: These results suggest that Reimagine has an effect on depression and fatigue symptoms for breast cancer survivors. Additional research is recommended with larger and more diverse samples. Trial (NCT02465892) was funded by Pfizer, Inc. Clinical trial information: NCT02465892.
A survivorship program to improve quality of life of Hispanic/Latino breast cancer (BC) survivors.
Authors: Nahleh Zeina A. , Heydarian Rosalinda , Dwivedi Alok , Pasillas Rebecca , Sanchez Luis , Liss Danielle
Published: March 2017

183

Background: We sought to determine whether Hispanic BC survivors in El Paso, TX would benefit from participating in a comprehensive multidisciplinary cancer survivorship program, by improvement of performance using the validated questionnaires: 1) Patient Health Questionnaire 9(PHQ9), 2) General Anxiety Disorder 7 (GAD 7), and SF36 Health related quality of life (HRQOL) questionnaires. Methods: After IRB approval, we recruited consecutive patients within the first 5 years post-diagnosis with Stages I-III BC and have completed active therapy. The program was staffed by an oncologist, a nurse practitioner, a nutritionist and a clinical psychologist. Survivors were seen every 3 months and questionnaires obtained. They were provided with a personalized treatment summary, dietary advices, in-depth one on one psychological assessment and interventions and an 8 week course based on Mindfulness Based Stress Reduction (MBSR). Results: 94 patients were recruited, 60 completed 12 months follow ups, and 33 completed 2 years follow ups. 91% were Hispanics. Mean age 55 years. 31% of participants were younger than 50 years. Stage 1 BC 38%, Stage 2 43% and stage 3 19%.75% received chemotherapy; and 74% received endocrine therapy. At baseline, PSC representing the mean for the SF-36 QOL Physical Health was 45.75, and the MSC for Mental Health was 43.7, both below the population norm (50.0). Mean scores for GAD7 was 7.3 and for PHQ9 7.62, both abnormal (< 5). At 12 months PSC 46.02, MSC 46.1, GAD7 was 4.92; and PHQ9 was 5. At 24 months, PSC 45.65; MSC 47.02; GAD7 4.88; and PHQ9 4.52. Patients older than 50 years who attended the MBSR courses showed the most improvement in MSC and PHQ scores. Conclusions: BC survivors, predominantly Hispanics, benefited from participating in this program with improved mental SF36- HRQOL, a significant and long - lasting improvement in anxiety and depression at 12months and 24 months. Future efforts should focus on programs targeting younger cancer survivors who did not appear to derive a significant benefit overall. Also, additional efforts are needed to address physical -health related quality of life in cancer survivorship programs by introducing, as an example, exercise and pain control interventions.
Partners of young breast cancer survivors: A cross-sectional evaluation of psychosocial issues and mental health.
Authors: Borstelmann Nancy , Rosenberg Shoshana M. , Gelber Shari I. , Meyer Meghan E , Ruddy Kathryn Jean , Schapira Lidia , Come Steven E. , Borges Virginia F. , Cadet Tamara , Maramaldi Peter , Partridge Ann H.
Published: March 2017

184

Background: While evidence of the challenges of cancer caregiving has been growing, scant research addresses the experience of partners of young adults with cancer. These individuals and their relationships may be particularly vulnerable to stress, especially when managing the complexity of cancer care and survivorship with their partner. We sought to evaluate psychosocial concerns and mental health in the partners of young survivors of early stage breast cancer (BC). Methods: We invited partners of young women w/BC diagnosed at age ≤ 40 yrs enrolled in a prospective cohort study to participate in a one-time survey evaluating psychosocial concerns including quality of life, coping, social support, financial insecurity, partnership concerns, parenting concerns, anxiety and depression. Logistic regression was used to explore predictors of anxiety (score > 8 on Hospital Anxiety and Depression Scale (HADS)). Results: Most respondents (284/289) were male, with median age 43 yrs (range 27-65). The median time of survey completion was 62 months (range 16 -114) after their partner’s dx. Respondents were mostly white (93%), working full time (94%), and college educated (78%); 29% reported some financial stress, 74% were parenting children < 18 yrs, and 32% reported at least a fair amount of relationship concern. 42% (106/250) had anxiety (39/289 respondents (13%) had incomplete/missing HADS). In univariable analyses, lower education, working full time, parenting concerns, insufficient social support and maladaptive coping were associated (p < .05) with anxiety. In the multivariable model, only maladaptive coping remained significantly associated with anxiety (p < .01, OR = 2.32 (95% CI: 1.22, 4.39)). Conclusions: Partners of young BC survivors who used less constructive/more maladaptive coping strategies experience negative mental health outcomes after tx has ended. Caregivers’ anxiety may have implications for both their own and survivors’ health and QOL. Future interventions might focus on the development of constructive coping strategies to enhance adjustment and role effectiveness in dealing with the impact of cancer.
Caregiver preferences for increasing patient survival in advanced melanoma.
Authors: Hauber A. Brett , González Juan M. , Posner Joshua , Lees Michael
Published: March 2017

185

Background: Patients with advanced cancer and their caregivers may often accept shorter life expectancy to ensure higher quality of remaining months of life. Our objective was to elicit caregiver preferences for quality-adjusted survival associated with treatments for advanced melanoma using a discrete-choice experiment. Methods: Adults in Germany and Sweden caring for people with diagnoses of advanced melanoma completed a web-enabled, discrete-choice experiment. The survey presented caregivers with a series of 10 choice questions, each including three profiles – a pair of hypothetical melanoma treatments and standard of care. Each profile was defined by survival time (24 months, 12 months, 6 months), severity (mild, moderate, severe) of melanoma symptoms, nausea and vomiting, diarrhea, skin problems, and out-of-pocket cost. Treatment profile pairs in choice questions were based on an experimental design with known statistical properties. Standard of care was constant across all choice questions. Regression analysis related respondents’ choice to treatment characteristics and estimate preference weights in each country. Results: 188 respondents in Germany and 202 in Sweden completed the survey. Caregivers choices were consistent with accepting tradeoffs among efficacy, symptom severity, severity of toxicities and cost. Severity of melanoma symptoms was the most important outcome for Swedish caregivers and was approximately as important as survival time for German caregivers. German caregivers placed positive value on each additional month of survival regardless of symptom severity. In Sweden, additional months of survival were of positive value to caregivers except when melanoma symptoms were severe or patients experienced severe nausea, vomiting, and diarrhea concurrently. In all cases where additional months of survival had positive value, the incremental value of each additional month diminished as overall survival increased. Conclusions: Additional months of life with severe symptoms or toxicities may not be viewed as unambiguously good outcomes. Quality of survival is not only a key consideration, but may determine whether a given treatment for melanoma is considered better or worse than standard of care.
The forgotten children.
Authors: Kuo Chris , Kent Paul , Ording Jeff
Published: March 2017

188

Background: The “forgotten children” of pediatric cancer are the siblings. There is a dearth of literature published on the effects of cancer on the siblings’ psychosocial state. Despite significant improvements made in the survival of pediatric cancer patients, the psychosocial health of the siblings remains the same. We hope to shed light on siblings, as well as recognize the emotional and psychological toll they endure as the “forgotten children.” Methods: Selective, narrative review of psychosocial consequences of being the siblings of children with cancer was performed from January 1980 through October 2016 using key words: pediatrics, oncology, psychosocial care, siblings, forgotten children, psycho-oncology, bereavement, caregivers. Results: Compared with siblings of children with other chronic illnesses, siblings of children with cancer endure more emotional distress and adaptive difficulties. From the moment the diagnosis is given, until their sibling’s death, siblings of children with cancer are unmoored. Throughout the cancer trajectory, they are isolated from support systems both inside and outside the family. They experience a wide spectrum of emotional turmoil from intrusive thoughts (anger, unworthiness, jealously, fear, loneliness or guilt), to post-traumatic growth (appreciation of life, desire to pay back society, greater self-knowledge). Since 1990s, various qualitative and quantitative studies have been published for siblings of children with cancer, but little has changed since these reports. Siblings continue to be the “forgotten children” in the family and their needs remain unmet. Siblings endure various distresses throughout the different stages of cancer trajectory. The complexity of the roots of their distress requires meticulous attention to dissect and unravel. Conclusions: Research on the psychosocial well-being for siblings of children with cancer remains limited. Consistencies with screening and supportive interventions continue to be lacking. A standardized screening tool with early interventional services should be implemented. Additionally, interdisciplinary awareness of the siblings’ psychosocial issues should be increased in order to shed light to their invisibility. The goal is to remember the “forgotten children.”
Supportive oncology and survivorship care: Initial impact of the Coleman Supportive Oncology Collaborative.
Authors: Trosman Julia Rachel , Weldon Christine B. , Rosenberg Carol A. , Gerhart James , Garcia Sofia F. , Dale William , Patel Urjeet , Khosla Pam , Lo Shelly S. , Macias Javier , Robinson Patricia A. , Danciu Oana Cristina , Boecher Stephanie , Berardi Rosa , Diaz Aidnag , Penedo Frank J.
Published: March 2017

2

Background: The Institute of Medicine (IOM) and Commission on Cancer (CoC) recommend supportive oncology and survivorship care. The Coleman Supportive Oncology Collaborative (CSOC) aims to improve quality of supportive care and survivorship in Chicago. Methods: CSOC includes 35 institutions (cancer centers, support and hospice), structured in two design teams (Distress & Survivorship and Palliative). Participants identified opportunities and gaps in supportive and survivorship care in an iterative development of: screening tools, follow-up processes, provider training, and quality metrics to assess CSOC impact. Six process improvement sites (2 safety-net, 3 academic & 1 public) reviewed patient charts at baseline and Q1 2015, compared by Fisher’s exact test. Results: Eight metrics contained patient data at the 2 time points; improvements were seen in 6/8 metrics. Conclusions: CSOC successfully developed supportive oncology, survivorship screening, and care processes aligned with IOM and CoC standards. Significant improvements were shown after implementation in diverse settings. Ongoing work will continue to evaluate the impact of the CSOC on patient care. [Table: see text]
Patient distress assessment in a VA oncology clinic: A quality improvement project.
Authors: Jayani Reena , Kumar Geetika , Markert Ronald , Heard Amy
Published: March 2017

203

Background: Distress in oncology patients (pts) has a negative impact on quality of life, survival, and healthcare satisfaction. Higher distress is related to lower compliance with treatment and follow-up. The 2012 American College of Surgeons Commission on Cancer (CoC) standard of care for oncology pts included an assessment for distress. A screening process for distress allows the healthcare team to address these issues early and refer to appropriate resources. This project was initiated to meet National Comprehensive Cancer Network (NCCN) and CoC standard of care; identify distress in veterans with cancer; and address these concerns. Presented here are preliminary results. Methods: Pts who attended the Tuesday oncology clinic at the Dayton VAMC were given the NCCN Distress Thermometer (DT) during triage. The treating physician addressed problems identified. The Wilcoxon Signed Rank Test and the Friedman Test were used. Results: DTs were completed by 232 pts from March to September 2016. Mean age was 68, 93% male, 83% white, 54% married, and 93% without PTSD. The distress level was not different from T1 through T3. Number of problems decreased over three time periods, and Referrals to nutrition, mental health, and social work services increased over time (see Table). Conclusions: Although over time periods we found no decrease in distress scores, there was a decline in number of problems. The mean distress score at all but Time 4 was <4, which is considered mild distress. The mean distress score at T4 was 4.36 (n=14), suggesting that the few pts who return to clinic more than three times may be experiencing more difficult personal and environmental circumstances. This pt sample ranged from those undergoing intensive cancer treatment (e.g., chemotherapy) to less intensive treatment (e.g., hormone injections) to those who completed treatment. As this tool was implemented only on one clinic day, some time points were missed if a pt was seen on a different day. [Table: see text]
Dermal biomarkers in cancer patients: Monitoring subjective health objectively
Authors: Li David G , LeCompte Gabrielle , Mo Lihong , Weintraub Miranda , Irwin David , Cecchi Gary , Matecki Amy
Published: March 2017

205

Background: Breast cancer is the most prevalent malignancy among women worldwide. Increased levels of oxidative stress are associated with breast cancer incidence. This study assesses physical, behavioral, and subjective health correlates of oxidative stress and associations between oxidative stress and breast cancer stage. Methods: Current and previous breast cancer patients were asked to participate in this cross-sectional study. After assessing Electronic Medical Record (EMR), a sample of 149 patients met the inclusion criteria. A final sample of 102 (68%) were enrolled. Patients’ skin carotenoid scores (SCS), a dermal measure of oxidative stress, were recorded. Patient demographics, physical health (breast cancer stage, treatment status, weight, height) health behaviors (smoking status, diet) and subjective health (anxiety and self-rated health) were ascertained. Results: No correlation between breast cancer stage and SCS was found. SCS was associated with behavioral health, weight and height (p<0.05), a finding consistent with previous research. A multivariate linear regression analysis, controlling for all covariates, found the two subjective health measures to be associated with SCS scores; the presence of anxiety was associated with lower SCS scores, a novel finding (β=-0.48, 95% CI -0.93, -0.035). Moreover, self-rated health was inversely correlated with SCS, showing those with lower self-reported quality levels paradoxically had higher levels of SCS (β=19.89, 95% CI 6.12, 33.67). Conclusions: Although oxidative stress as measured by SCS may not be associated with breast cancer staging, future research should explore the causal relationship between oxidative stress and subjective stress. Results suggest an unknown biochemical mechanism linking increased levels of oxidative stress with lower subjective health scores. Findings of the study indicate the possibility of utilizing SCS as an objective correlate to gauge an individual’s subjective stress levels in order to optimize cancer treatment.