bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of stress on diabetes self-management in cancer survivors.
Authors: James Janey , Coppa Natalie , Rosenberg Alexandra , Wisnivesky Juan P. , Lin Jenny J
Published: February 2017

11

Background: Few studies have evaluated the impact of stress on diabetes self- management among cancer survivors. We undertook this study to assess factors associated medication adherence and diabetes self-management in a cohort of diabetic patients with recently-diagnosed early-stage cancer. Methods: We recruited diabetes patients recently diagnosed with early-stage breast, prostate, lung or colorectal cancer on at least one oral hypoglycemic agent and used the Impact of Event Scale (IES) to assess the subjective distress caused by cancer. The 15-item IES consists of 2 subscales assessing avoidant and intrusive feelings about cancer. We measured medication adherence using the 8-item Morisky Medication Adherence Scale, and diabetes self-management behaviors were evaluated using the Summary of Diabetes Self-Care Activities. Participants were surveyed at baseline and after 3 months. Descriptive and univariate analyses were used to assess baseline factors associated with diabetes self-management at 3 months. Results: Of the 36 participants recruited to date, 20 (56%) were male. At baseline, 70% reported adherence to their diabetes medications which dropped to 63% at 3 months. There were no gender differences between IES scores at baseline; however, at 3 months women were more stressed (p = 0.02) and had more intrusive thoughts (p = 0.005) about cancer. Higher baseline total IES scores were associated with lack of a general healthy diet (p = 0.01). Patients who had trouble falling asleep from thoughts about cancer felt more hassled sticking to their diabetes medication treatment at 3 months (p = 0.02). Those who had dreams about cancer (p = 0.007) and those who tried to stay away from reminders about cancer (p = 0.04) were more likely to forget their diabetes medications when travelling. Lastly, patients who felt that the cancer wasn’t real were more likely to have difficulty remembering to take medications (p = 0.03). Conclusions: Cancer survivors with comorbid diabetes who have higher stress are less likely to follow a healthy diet and more likely to report trouble with taking their diabetes medications. Providers should be aware of the impact of stress caused by cancer to better support diabetes self-management among early cancer survivors.
Survival and fertility in women with malignant peritoneal mesothelioma.
Authors: Bates Gleneara Elizabeth , Taub Robert N. , Jin Zhezhen , Ramos-Jimenez Elvia , Ali Saba Imran , Hashmi Anisah Khurshid , Bressler Yaakov , Bressler Toby , Hesdorffer Mary , Kluger Michael D.
Published: February 2017

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Background: The prognosis of malignant peritoneal mesothelioma (MPM) has improved over the past decade in patients undergoing operative extirpation and intraperitoneal chemotherapy (IC). This study investigates the time from diagnosis to treatment intervention in premenopausal women and its impact on fertility and childbearing options. Methods: A retrospective analysis of 195 patients diagnosed with peritoneal mesothelioma between 1995 and 2015. Patients with unresectable or bicavity disease were not excluded. Kaplan-Meier curves and univariate cox proportional hazards model were used to estimate survival and significant treatment and prognosis factors. Results: The median survival time of all peritoneal mesothelioma patients (n = 195) was 3.21 years with (95% CI: 2.38- 5.53), with median follow-up of 3.44 years (SD = 3.4, minimum = 0.014 and maximum = 16.752) years from first operation. Patient set included 111 men (57%) and 84 women (43.1%) with female sex having favorable survival [HR: 0.442 95% CI: 0.296-0.659), p < 0.001] of 110.1 months with (95% CI: lower bond: 48.3). Of these women, their mean age at diagnosis was 52 years, (SD = 14.5, minimum = 14.7 – maximum = 79.9), with a mean time of 8.20 months from diagnosis to the start of treatment (SD = 18.6, minimum = 0 and maximum = 128.6 months). Overall survival of premenopausal women (N = 23) during follow-up was 72.2% (SE = 27.8%). Mean age at time of diagnosis was 34.7 years, (SD = 9.26, minimum = 14.7, maximum = 48.1), with a mean time of 10.6 months from diagnosis to treatment (SD = 17.9, minimum = 0.63, maximum = 86.7). Of the 195 patients who received a full treatment course, 66 (33.8% CI: 95%) were still alive at the median follow-up, of those alive 37 are female: 7 are premenopausal and have presented with gynecological symptoms, and 17 are premenopausal and have presented with abdominal discomfort. Conclusions: This data suggests that women preparing for treatment of MPM should not be precluded from exploring fertility options. With a mean time of 10.6 months from diagnosis to treatment, it is possible for premenopausal women to take advantage of fertility preservation before starting treatment.
Fertility Attitudes and Cancer Treatment Study (FACTS).
Authors: Flink Dina M , Kellar-Guenther Yvonne , Sheeder Jeanelle , Kondapalli Laxmi A
Published: February 2017

112

Background: Approximately 140,000 people under 45 year old are diagnosed with cancer annually in the US. Survivorship is high and many of these individuals desire future fertility. Although fertility preservation (FP) services are increasing, utilization rates remain low. Methods: We conducted a 2-phase study to identify factors for FP decisions among newly diagnosed males and females receiving fertility consultation, 18-45 years old. Phase 1 was a chart review; Chi-square and t-tests were used to determine potential factors associated with FP decision. Phase 2 consisted of face-to-face interviews. Content analysis was used to identify relevant themes associated with reasons, priorities, support, and satisfaction for FP decision. Results: In Phase 1, 108 charts were reviewed; FP utilization rate was 50%. Those who chose FP were more likely to be male (73.6% vs. 26.4%, p < 0.001), Caucasian (90.6% vs. 9.4%, p = 0.042), have a solid tumor (98.1% vs. 1.9% p = 0.032), and a shorter time from diagnosis to fertility consult (29.5 vs. 58.8 days, p = 0.017). Age, relationship, education, parity, or treatment plan did not differ with FP decision. In phase 2, we assessed reasons why patients chose FP; 27 participants were interviewed. Primary reasons for choosing FP were: future fertility and access to FP services. Main reasons for not choosing FP were: concerns with future conception and lack of access to FP services. Cost ranked 4thamong reasons to not choose FP; however 50% of patients overcame the cost to prioritize future fertility. Males top priorities were: future parenthood, cancer treatment, and survivorship QOL. Females top priorities were: future parenthood, decisional conflict, and cancer treatment. Patients greatest concerns with FP were: birth defects, future conception, and success of FP. Conclusions: Future fertility is a priority for newly diagnosed young adults. All patients should receive a referral to a reproductive specialist, regardless of patient factors or diagnosis. While patients expressed feeling well-informed to make FP decisions following fertility consult, some still had concerns with the safety and success of FP. Adequate FP consultation should include discussion of all treatment options and concerns for FP.
Novel intervention for decision support and distress in female cancer survivors considering fertility preservation.
Authors: Bradford Andrea Michele , Covarrubias Laura , Schover Leslie R. , Woodard Terri Lynn
Published: February 2017

114

Background: Treatment-related infertility is a source of long-term psychological distress in cancer survivors, particularly among women. Decisions about fertility preservation (FP) are made under conditions of high stress and time pressure, which may contribute to the relatively low uptake of FP among women with cancer. Little is known about the effect of interventions to support the decision-making process and reduce fertility-related distress in cancer survivors considering FP. We describe the design and preliminary data from a randomized trial to determine whether incorporating psychological assessment and intervention into the standard FP consultation enhances satisfaction with decision-making and psychosocial outcomes. Methods: We developed a brief intervention for women referred to our institution’s oncofertility service for consideration of FP. The intervention focuses on values clarification for decision support, identification of unmet psychosocial needs, and mindfulness and acceptance-based skills. Participants were randomized to usual care (consultation with a reproductive endocrinologist and nurse) or the intervention (usual care plus a 1-hour visit with a psychologist and two follow-up calls). Outcomes included feasibility measures and measures of decisional conflict (Decisional Conflict Scale) and satisfaction with the FP program (Client Satisfaction Questionnaire-8). Results: All 14 participants randomized to date have completed baseline and 1-month assessments. The mean age was 32 (SD = 7.5, range 20-44), and the majority were nulliparous (n = 9, 64%). All 7 intervention participants completed at least 1 follow-up call, and 5 (71%) completed both follow-up calls. Across all participants, Decisional Conflict Scale scores decreased from baseline (M = 24.8, SD = 17.2) to 1 month (M = 22.2, SD = 16.3). Overall satisfaction with the program at 1 month was high (M = 29 out of a possible 32). Conclusions: Incorporating a psychological assessment and intervention into a standard FP consultation appears feasible and may improve levels of decisional conflict over time. Women appeared to find the intervention helpful when contemplating FP.
Hepatic adenoma among adult survivors of childhood cancer.
Authors: Tonorezos Emily S. , Barnea Dana , Abou-Alfa Ghassan K. , Bromberg Jacqueline , D'Angelica Michael Ian , Sklar Charles A. , Oeffinger Kevin C.
Published: February 2017

117

Background: Hepatic adenoma is a rare and poorly understood benign epithelial neoplasm. Because of the potential for spontaneous hemorrhage, rupture, or malignant transformation; hepatic adenoma over 5 cm require resection. In the general population, the prevalence of hepatic adenoma is estimated at 1 in 100,000 and identified predominantly in obese females on oral contraceptives. An increased risk for hepatic adenoma among adult survivors of childhood and young adult cancer has not been previously reported Methods: Cancer diagnosis and treatment, as well as demographic factors, medications, and comorbidities, were collected from the medical chart among patients with pathological confirmation of hepatic adenoma. All cases were patients diagnosed with a non-hepatic cancer before the age of 40 and seen at Memorial Sloan Kettering Cancer Center. Results: Twelve cases of hepatic adenoma were pathologically confirmed; seven patients (58%) had more than one adenoma. Eleven (92%) cases were female. The most common preceding cancer diagnosis was leukemia (N = 4; 33%). Five (42%) had undergone allogeneic hematopoietic cell transplant with total body irradiation (TBI) as part of their preconditioning regimen. Cases were not as a rule obese; median body mass index was 22.2 kg/m2 (range, 17.6-31.0 kg/m2). All eleven females had a history of current or prior hormone therapy with estrogen and progesterone; the single male case was hypogonadal as a result of radiation therapy to the testes during treatment for acute myelogenous leukemia (AML) and was receiving testosterone therapy at the time of chart review. Eight patients (67%) had hypothyroidism and two (17%) were taking anti-epileptic drugs. Only two patients (17%) were monitored radiographically following biopsy; seven patients (58%) underwent hepatic resection and three (25%) underwent embolization. No patient had significant blood loss or has been observed to undergo malignant transformation, although follow-up is ongoing. Conclusions: Adult survivors of childhood and young adult cancer, particularly females with a history of current or prior hormone therapy, may be at increased risk for hepatic adenoma. Further investigation of this potentially morbid condition is warranted.
Utilization of sperm banking in men undergoing chemotherapy for testis cancer.
Authors: Brames Mary J. , Einhorn Lawrence H. , Case-Eads Somer , Sonnenburg Daniel
Published: February 2017

122

Background: Testicular cancer is the most common carcinoma in men ages 18-35. Eighty percent of patients with metastatic disease will be cured with cisplatin based chemotherapy. However, approximately 40% of patients receiving chemotherapy will have permanent azospermia or oligospermia, impairing future fertility. Sperm banking prior to chemotherapy is an effective method of maintaining fertility. This retrospective study was performed to assess utilization and results from sperm banking, as well as the barriers to its use. Methods: Patients 18 and older who were 1-year post chemotherapy were given a 5-item questionnaire on follow-up visit. The questionnaire included a mix of quantitative and qualitative questions. Results: 200 patients with metastatic testicular cancer including patients who started initial chemotherapy at other institutions, enrolled in the study and all completed the questionnaire. 139/200 (70%) chose not to bank sperm: 71 (51%) of those were not interested, 25 (18%) declined due to desire to start immediate chemotherapy, 24 (17%) were not offered, 6% of those not offered were from Indiana University, 12 (9%) declined due to cost, and 7 (5%) answered "other". The average age at cancer diagnosis of patients who banked sperm was 28.4 as opposed to 32.6 for patients who did not bank sperm (p = 0.003). The percentage of patients who had children before their diagnosis was 21% in the sperm banking group and 50% in the group that did not (p = 0.0002). Sixty-one (30%) chose to bank sperm, 11 of 61 patients (18%) utilized the banked sperm. 9 of 11 (82%) that utilized the banked sperm resulted in successful paternity: 3 of 9 (33%) produced twins. There were no birth defects. Conclusions: Sperm banking provides the opportunity for paternity in testicular cancer patients. However, the majority of these patients chose not to bank sperm or was not offered the opportunity. A range of factors such as time, emotional state, patient age, disease stage, prior children, institutional practices, and cost all influence whether sperm banking is offered and taken up. Physicians and patients need to be aware of the potential benefit of sperm banking.
Preliminary results from the Sexual Therapy and Rehabilitation after Treatment for Ovarian Cancer (START-OC) study.
Authors: Bober Sharon L. , Blackmon Jaime E. , Recklitis Christopher J. , Wright Alexi A.
Published: February 2017

127

Background: For ovarian cancer (OC) survivors, serious sexual dysfunction is one of the most distressing long-term side effects of treatment, with up to 90% survivors reporting a loss of interest in sexual activity for years after diagnosis. Despite the prevalence and magnitude of the problem, treatment-related sexual dysfunction and accompanying psychological distress are not addressed for most survivors. There is a critical need to address these problems for OC survivors. Methods: We are currently piloting a novel psychosexual intervention to help women manage sexual changes and improve sexual functioning after ovarian cancer treatment. Guided by Self-Determination Theory, this group-based intervention also aims to enhance women’s self-efficacy to address problems. Eligibility criteria include: OC diagnosis, functional ability, and sexual dysfunction. Women participate in a single half-day workshop, complete questionnaires, and engage in a booster telephone session. Detailed workshop evaluations are collected to assess women’s feedback of the group session. This study is currently enrolling. Results: To date, 369 women have been contacted, of which 45 (12.2%) have attended or are scheduled to attend a group session. Preliminary feedback data indicate high favorability of the group session; 100% of the women (N = 16) agreed or strongly agreed that the content of the group session was easy to understand and that the group session gave helpful information for addressing treatment-related sexual problems. Additionally, 100% of participants agreed that they were satisfied with the group session and enjoyed participating in it. Conclusions: Preliminary data show that women report multiple benefits from the session content and are highly satisfied with the group session. However, low response rates raise several questions with regard to timing and recruitment of a sexual health intervention after OC treatment. Next steps include quantitative analyses of changes in sexual function, sexual knowledge, and sexual self-efficacy consequent to the group intervention. Clinical trial information: NCT02287519.
Bridging the gap: The design of a survivorship curriculum for interspecialty collaboration.
Authors: Ozokwelu Emmanuel , Sisler Jeffrey James , Sussman Jonathan , Mukherjee Som , Mowat Stephanie , Ens Anita , Moser Cheryl , Konrad Gerald , Gingerich Joel Roger
Published: February 2017

13

Background: Interspecialty learning between trainees from different postgraduate training programs is unusual in Canada. Primary care providers (PCPs) have an increasing role in the provision of survivorship care in collaboration with cancer specialists (ONC), but coordination of care is often lacking and avenues for joint learning and interaction among these physicians are limited during residency. We are piloting a learning suite (LS) for PCP and ONC trainees in MB, ON & BC as part of a pan-Canadian study on integration of care between primary and cancer specialty care. Methods: Using Kern’s Six-Step Approach to Curriculum Design, a national team of experts conducted surveys and focus groups with postgraduate program directors, cancer survivors, and trainees. We set learning objectives as informed by the needs assessment and used constructive alignment to build the curriculum in a blended learning format: online, workshop and clinical. We are assessing inter-disciplinary learning outcomes comparing pre and post results on a modified Readiness for Interprofessional Learning Scale (M-RIPLS) in three pilot sites in 2015 with about 40 family medicine and oncology trainees. Results: Learning materials have been developed for a mixed audience of trainees. The interactive, one hour online session addresses cancer epidemiology, the domains of survivorship care, and specific issues in follow-up care for three cancer types, as well as province-specific survivorship initiatives. This is followed by a two hour, case-based learning workshop that focuses on collaboration and shared care. A clinical experience in cancer follow-up clinics concludes the LS. In PCP training sites without a nearby cancer centre, trainees are able to review videos of actual transitional appointments and follow-up clinics and of the cancer centre/oncologist perspective on shared care. Pilots are ongoing in 2015 with national rollout in 2016. Conclusions: We expect that learning together in residency will impact on attitudes towards interspecialty collaboration in the care of cancer survivors. This interspecialty, blended learning curriculum will enhance the place of survivorship training in the postgraduate education of Canadian physicians.
Cardiovascular risk factors in young adult survivors of childhood malignancies.
Authors: Sulicka-Grodzicka Joanna , Surdacki Andrzej , Krolczyk Jaroslaw , Grodzicki Tomasz
Published: February 2017

138

Background: Survivors of childhood cancer are at increased risk of early cardiovascular (CV) diseases related to previous cancer therapy, chronic stress and unhealthy behaviors, as well as traditional cardiovascular risk factors. The aim of the study was to assess the prevalence of cardiovascular risk factors in young adult survivors of childhood malignancies. Methods: Medical records of 155 adult childhood cancer survivors were analyzed to extract data on cancer treatment, demographical characteristics, family history, smoking, blood pressure (BP), lipids, fasting glucose, creatinine measured during a routine visit in our follow-up clinic for adult childhood cancer survivors. Results: The prevalence of traditional CV risk factors was high, with 55% of patients presenting with prehypertension (office systolic BP 120-139 mmHg or diastolic 80-89 mmHg) and 15,4% with hypertension (BP ≥ 140 mmHg and/or ≥ 90 mmHg or being on antihypertensive drugs). The prevalence of overweight and obesity was 23,5% and 3,7%, respectively. A classic “atherogenic lipid profile” (28% patients with elevated total cholesterol and 27% with elevated LDL cholesterol) was more common than a dyslipidemic pattern (elevated triglycerides 11% and reduced HDL cholesterol 7,8%). Two or more CV risk factors were found in 50% of patients and only 16% did not have any of traditional risk factors. Conclusions: Major CV risk factors are common in very young adults with cancer history in the childhood and may substantially increase risk for future CV events in this population. These finding support the need for screening of adult survivors of childhood malignancy for early detection and treatment of modifiable risk factors. [Table: see text]
Feasibility and acceptability of integrated cardiac rehabilitation in outpatients referred for autologous bone marrow transplantation.
Authors: Pituskin Edith , Rothe Derek , Cox-Kennett Nanette , Gyenes Gabor , Paterson Ian , Sandhu Irwindeep , Venner Chris
Published: February 2017

139

Background: High-dose chemotherapy (HDCT) and bone marrow/hematopoietic cell transplantation (BMT) is established therapy for many malignancies. While advances in transplant practise have led to improved cancer-specific outcomes, HDCT negatively impacts healthy organ function via direct effects (ie high-dose cytotoxic injury to organ systems) and indirect effects (i.e., functional disability). The resulting cardiometabolic sequelae such as dyslipidemia, hypertension, diabetes, and weight gain (with lean body mass loss) contribute to the significantly increased rates of cardiovascular (CV) mortality and heart failure (HF) observed in HDCT survivors. Cardiac rehabilitation/secondary prevention (CR/SP) programs are a level 1 recommendation in multiple CV diseases, reducing CV risk and events. Currently, the feasibility of integrating standard CR/SP programs in outpatients (PTS) referred for HDCT is unknown. Aim: To prospectively evaluate feasibility and acceptability of routine referral tocardiovascular rehabilitation/secondary prevention (CR/SP) in unselected lymphoma PTSreferred for autologous HDCT/BMT. Methods: Lymphoma PTS referred for HDCT/BMT were screened and referred to the CR/SP program. Baseline exercise testing was performed prior to HDCT/BMT. Upon recovery (6 weeks) testing was repeated, and PTS were invited to participate in a 6-week standard CR/SP program of exercise rehabilitation and CV risk reduction education. Results: 20 PTS were referred for HDCT/BMT from January 1, 2015 to July 1, 2015. All were referred to the CR/SP program. 100% underwent exercise testing, and all proceeded to BMT without adverse cardiovascular outcomes or mortality. High levels of satisfaction of CR/SP program components were reported. Conclusions: In unselected PTS, seamless integration of CR/SP within standard HDCT/BMT care is feasible and acceptable. We expect short term measurable impacts including reduced symptom burden and improved quality of life. Longer term impacts will evaluate CV morbidity and mortality. This work will inform patient-centered care and improve supportive and survivorship care across the cancer continuum.
Patient preferences for research access to administrative data in Ontario.
Authors: Tian Chenchen , Brown Catherine , Perez Cosio Andrea , Leung Yvonne , Lagrotteria Alisa , Liang Mindy , Gill Gursharan , Wong Lauren , Sinnesael Kendra , Noronha Cheryl , Willing Stephanie , Bell Erin N , Vennettilli Ashlee , Edwards Jackie , Pater Joseph L. , Howell Doris , Kassam Zahra , Liu Geoffrey , Hay Annette E.
Published: February 2017

144

Background: Clinical trials collect outcome data until the trial ends. Subsequent health data is often available in government or health care administrative databases, yet this information is often not made available to researchers. We assessed patient preferences of long-term linkage of such administrative databases to clinical trials databases. Methods: A self-reported questionnaire was administered to outpatients in clinics of academic and community cancer centres. Cancer patients were presented with a hypothetical scenario of a clinical trial and asked about their willingness to allow confidential research access to their personal health information contained in administrative databases. Results: Of 524 patients, 54% were females, median age was 60 (range 19–93), 81% were Caucasian, and 61% had post-secondary education. Of cancer sites, 20% had breast cancer, 17% GI, 14% GU, 13% hematology, 12% thoracic, 12% head/neck and 11% gynecologic cancers. One-third (33%) had participated in a clinical trial. An overwhelming 93% allowed confidential access to health information in administrative databases (59% always, 34% depending on circumstances) including access to initials and birth dates, to be used to match information across databases (70% always, 23% depending on circumstances). Only 3% were unwilling to release their information under any circumstances. When asked about other identifiable information, such as name and address, more than 74% allowed the secure storage of this information at the central study coordinating center. In a new cohort of 103 patients, 84% preferred long-term data to be continually available to researchers after the clinical trial has ended; only 9% did not want this option. Results were similar across all sociodemographic subgroups studied including patients who had prior participation in clinical trials, although older patients were even more likely to allow access than younger patients (p = 0.02). Conclusions: The vast majority of patients were willing to have their long-term outcome data collected through government and health care administrative databases made available to clinical trial researchers, to improve our understanding of long-term outcomes of trial procedures and drugs.
Identifying dehydration risk in head and neck cancer patients undergoing radiation therapy using remote, sensor-based monitoring: A randomized controlled trial.
Authors: Peterson Susan K. , Shinn Eileen H. , Garden Adam S. , Patrick Kevin , Shete Sanjay , Shen Chan , Martch Stephanie L. , Farcas Emilia , Lin Kai , Raab Frederic , Asomaning Nancy , Christie Israel , Nandigam Viswanath , Chen Tony , Yan Yan , Beadle Beth Michelle
Published: February 2017

152

Background: Early identification and mitigation of cancer therapy-induced complications can improve quality of life and reduce complications and health care costs. We are evaluating the efficacy of a system, called CYCORE (CYberinfrastructure for Comparative effectiveness Research), to systematically and accurately collect daily weight, blood pressure, pulse and symptom data from head and neck cancer (HNC) survivors during their 6 to 7-week radiation treatment (RT) regimen using home-based biometric and other sensors integrated with a cyber-physical system. Aims include: 1) evaluate CYCORE’s efficacy in reducing hospitalization and emergency room visits related to dehydration; and, 2) evaluate related impact on costs related to treating dehydration. Methods: Remote, sensor-based monitoring via CYCORE identifies HNC survivors at increased risk for dehydration (i.e., reduced blood pressure and weight, increased pulse, and patient-reported outcomes (PROs) including decreased food and fluid intake). Upon initation of RT, HNC survivors are randomized to either: 1) standard care plus use of the CYCORE system, wherein biometric sensor data and PROs (e.g., pain, nausea, medications, food/fluid intake) are collected ; or, 2) standard care. Outcomes include hospital and emergency room admissions, and related costs. Results: To date, 113 survivors are enrolled (88.9% recruitment and 90.3% retention rates). Those randomized to CYCORE take daily home readings of weight, blood pressure and pulse via Bluetooth-enabled devices, and complete daily PRO assessments on a mobile application. Survivors’ data are available for viewing and clinical decision-making via a Web-based interface by their physicians and other providers. Previously, 59% of HNC survivors on RT showed physiologic signs of dehydration while using the CYCORE system. Worse ratings of nausea and vomiting predicted dehydration risk. Conclusions: CYCORE may serve as one model for integrating mobile and sensor technologies during critical periods of cancer care that occur outside of the clinic setting, and may improve management of treatment side effects, quality of life, and greater satisfaction with care. Clinical trial information: NCT02253238.
Chemotherapy-induced peripheral neuropathy management.
Authors: Schloss Janet Margaret , Colosimo Maree , Vitetta Luis
Published: February 2017

154

Background: Neurological complications such as chemotherapy-induced peripheral neuropathy (CIPN) and neuropathic pain are frequent side-effects of neurotoxic chemotherapy agents. An increasing survival rate and frequent administration of adjuvant chemotherapy treatments involving neurotoxic agents makes it imperative that accurate diagnosis, prevention and treatment of these neurological complications be implemented to minimize the burden experienced by patients undergoing these treatments. Methods: To determine the potential use of pharmaceuticals, nutraceuticals and herbal medicines as adjuvants in cancer treatments a critical literature review was conducted by electronic and manual search on nine databases. These include PubMed, the Cochrane Library, Science Direct, Scopus, EMBASE, MEDLINE, Google Scholar and two Chinese databases CNKI and CINAHL. Thirty studies were selected for pharmaceutical agents, twenty-four studies for nutraceuticals and thirty-four studies for herbal medical trials. Seven acupuncture trials were also identified in relation to CIPN management. Data was collated and organised into chemotherapy drugs, agent’s trialled, number of participants, results and recommendations. Results: For pharmaceutical agents, amifostine has possible ototoxicity protection for children in cisplatin and duloxetine as a treatment option for pain. For nutraceuticals, vitamin E was found to have protective abilities for cisplatin ototoxicity, omega 3 fatty acids for taxane administration and vitamin B6 and lipoic acid for oxaliplatin CIPN. In herbal medicine, Goshajinkigan showed great promise for oxaliplatin-IPN protection. Vitamin B12 deficiencies have also been found to increase the onset and severity of CIPN. Conclusions: Currently, no pharmaceutical, nutraceutical or complementary agent has been found to be completely beneficial in preventing or treating CIPN. It is suggested clinicians identify the best option from the research to assist patients in both possible prevention and treatment of CIPN. In addition, research has found that a vitamin B12 deficiency may potentiate moderate to severe CIPN presentation and testing of this vitamin is suggested.
Patient-provider communication and decision making regarding adjuvant endocrine therapy-related symptom management: Provider perspectives.
Authors: Turner Kea , Samuel Cleo A. , Donovan Heidi AS , Van Londen G J.
Published: February 2017

156

Background: Adjuvant endocrine therapy (AET)-related symptom management (SM) among breast cancer survivors (BCS) is greatly influenced by the quality of patient-provider communication; yet, few studies have examined provider perspectives on patient-provider communication and decision-making for AET-related SM. We assessed provider perspectives on AET-related SM to identify challenges and opportunities for improvement in patient-provider communication and decision-making. Methods: We conducted 3 focus groups (FGs) with a multidisciplinary group of health care providers (n = [6] physician; n = [7] non-physician) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on patient-provider communication and decision-making for AET-related SM as well as recommendations for improvement. All FGs were held at the University of Pittsburgh, audiotaped, and transcribed. We analyzed FG transcripts using qualitative software to identify key themes. Results: Providers described multiple challenges to patient-provider communication and decision-making for AET-related SM. Providers reported that BCS are often uncertain whether their symptoms are related to AET and unsure of whom to speak with about their symptoms. Providers also felt that patients are reluctant to bring up symptoms for fear that bringing up symptoms would detract from their care. Providers agreed that patient-provider communication influences BCS’ awareness and beliefs about SM. Providers indicated that provider communication strategies such as probing for symptoms, setting realistic treatment expectations, and assessing patient satisfaction with their SM plan enhances patient decision-making about AET-related SM. Conclusions: Although providers identified several challenges related to patient-provider communication and decision-making, many of these challenges are amenable to change through provider-level interventions. Future efforts aimed at improving AET-related SM should include strategies that address patient-provider communication and decision-making.
Improved Nutrition in Adolescents and Young Adults after childhood cancer: INAYA—A pilot study.
Authors: Quidde Julia , Koch Barbara , Bokemeyer Carsten , Escherich Gabriele , Buchholz Daniel , Valentini Luzia , Stein Alexander , von Grundherr Julia
Published: February 2017

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Background: By the use of multimodal therapies the chance of cure and survival improves and thus the risk for long-term side effects are increasing in „Adolescents and Young Adult“ cancer survivors (AYAs) . Compared to the general population AYAs have a 5 to 15-fold increased risk of cardiovascular diseases. Therefore, the improvement of modifiable lifestyle risk factors is of importance. Besides general information supplied during survivorship care nutrition habits in AYAs remain bad. Methods: The INAYA trial enrolled AYAs between 18-39 years to receive an intensified individual nutrition counseling based on a 3-day dietary records at 4 defined timepoints. At week 0 and 12 AYAs got personal counseling during follow-up care and consultation hours and at week 2 and 6 by telephone. Primary endpoint was change in nutritional intake measured by the Healthy Eating Index of the European Prospective Investigation into Cancer and Nutrition (HEI-EPIC). Secondary endpoints were (selection): quality of life (QoL), change in weight and waist-hip ratio. Results: 23 AYAs (11 female, 12 male, 21.9 ± 4.3 years of age, BMI: 21.6 ± 1.7 kg/m²) after treatment for childhood malignancies (12x hodgkin lymphoma, 6x leukaemia, 2x sarcoma, 2x carcinoma, 1x blastoma) were included. At baseline 14 patients (pts) were of normal weight, 4 pts overweight and 5 pts underweight (WHO criteria). 56.5% (n = 13) reported gastrointestinal symptoms (e.g. flatulence, change in stool consistency, stomach pain). According to HEI-EPIC a good, moderate and bad nutritional intake was seen in 4.3%, 73.9% and 21.7% of the pts. A high salt intake was seen in 6 pts (26%). Dietary habits improved after nutrition counseling at week 0, 2 and 6. 43.7% (n = 10) took more time to eat, 47.8% (n = 11) increased their fluid intake to ≥ 1.5 l/d and 21.7% (n = 5) changed their weight positively. Up to now 8 pts completed the study. Median HEI-EPIC score improved from 46 points (baseline) to 66 points (week 12). Final results are expected for November 2015. Conclusions: Intensified nutrition counselling improves dietary intake and nutrition status in AYAs.
Effect of weight history on ability to lose weight after a 6-month randomized controlled weight loss trial in overweight breast cancer survivors: The Lifestyle, Exercise and Nutrition (LEAN) study.
Authors: Sanft Tara Beth , Harrigan Maura , Cartmel Brenda , Playdon Mary , Zhou Yang , Loftfield Erikka , Irwin Melinda L
Published: February 2017

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Background: Because obesity portends a higher risk of breast cancer mortality, achieving a healthy weight is recommended for breast cancer survivors. The impact of weight history on the ability to lose weight is unclear. We previously reported a 6.2 + 0.7% vs. 2.1 + 0.9% weight loss (p = .0003) in 100 breast cancer survivors randomized to a 6-month weight loss intervention vs. usual care. We examined whether weight history modified the effect of the intervention on body weight changes. Methods: Breast cancer survivors with a BMI > 25 kg/m2were randomized to usual care or 6-month, 11-session diet and exercise-counseling intervention. Baseline and 6 month weight and height were measured; weight at ages 18 and 35, 5 years and 1 year before and at diagnosis were self-reported. We defined weight history as: 1) change in weight between each time point and baseline; and 2) duration of obesity (i.e., number of years of having a BMI > 30 between age 18 and baseline). Generalized linear models were used to evaluate mean changes at 6 months between the intervention and usual care groups, adjusted and stratified by weight history variables. Results: Mean age and time since diagnosis were 59 + 7 years and 2.9 + 2.1 years, respectively. BMI increased over time (age 18 BMI = 21.8 + 2.9; baseline BMI = 32.4 + 6.5). Number of years being obese was 5.3 + 8.2 years (range 0-40 years). BMI at baseline, change in BMI from various time points to baseline, and years of obesity did not modify weight loss results. After adjusting for weight history, women randomized to intervention vs. usual care lost 6.1 + 0.7% vs. 2.0 + 0.9%, p = .0006, respectively. Conclusions: Participants reported a history of steady weight gain over time. The duration of obesity did not modify weight loss results. Weight history did not hinder survivors’ ability to lose clinically meaningful weight via a structured intervention.
Support for physical activity among young cancer survivors.
Authors: Washington Pamela Kim
Published: February 2017

177

Background: There is strong evidence that physical activity mitigates negative psychosocial effects and sequelae associated with adjuvant chemotherapy among cancer survivors. Given the many benefits of physical activity in this population, it is important to understand the factors that influence continued participation post diagnosis. One possible determinant that has received little attention to date is the influence of social support. This study is unique in that it is the first to explore the role of social support for physical activity among young survivors of breast cancer through the use of mixed methods. Methods: Survey data (n = 273) were used to determine actual levels of moderate and vigorous physical activity. These data were subsequently used to identify women of interest to participate in face-to-face qualitative interviews. Semi-structured interviews (n = 31) were conducted with a subset of women from the quantitative sample. Participants were Bay Area women who were age 55 or less and premenopausal at the time of diagnosis and who also received adjuvant chemotherapy. Following qualitative analyses, hypotheses were developed to test the association between social support and obtaining recommended levels of physical activity through the use of logistic regression analyses using a sample of 273 women. Results: Qualitative analyses indicated that women who have a partner with whom they engage in physical activity are more likely to adopt and maintain physical activity behaviors over time. Regression analyses provide evidence that women who have support specifically for physical activity are more likely to meet recommended activity guidelines (b = .030, OR = 1.030 per unit of scale, p = .003, C.I. = 1.01 – 1.05). Conclusions: When considering correlates of physical activity, social support specific to physical activity may be important or even pivotal in assisting survivors to adopt and/or maintain participation in a given activity at recommended levels.
Breast cancer recurrence risk-reduction beliefs and behaviors among African American breast cancer survivors.
Authors: Smith Selina , Ansa Benjamin E. , Yoo Wonsuk , Whitehead Mary S. , Coughlin Steven S.
Published: February 2017

180

Background: A growing body of evidence suggests that breast cancer (BC) recurrence risk is linked to lifestyle behaviors. This study examined correlations between BC recurrence, risk reduction beliefs and related behaviors among African American (AA) breast cancer survivors (BCSs). Methods: 191 AA BCSs, mean age = 56.3 years (standard deviation = 11.4 years) completed a lifestyle assessment tool. Results: Most respondents believed that being overweight (52.7%), lack of physical activity (48.7%) and a high fat diet (63.2%) are associated with BC recurrence. 66.3% considered themselves overweight; one third (33.5%) endorsed that losing weight could prevent BC recurrence; another third (33%) did not, while the remainder (33.5%) don’t know; and nearly half (47.9%) believed that BC recurrence could be prevented by increasing physical activity. 87.3% survivors with BMI < 25 Kg/M2 reported no recurrence compared to 75.7% with BMI > 25 Kg/M2 (p = 0.0580); almost all the women (99.2%) answered ‘yes’ to seeking professional help to lose weight, 79.7% of which were recurrence-free (p = 0.0508). Conclusions: These results provide information about AA BCSs’ beliefs and behaviors protective against BC recurrence. Additional research is warranted to determine the effectiveness of educational interventions for AA BCSs that promote consumption of a healthy diet and engaging in regular physical activity.
Implementation of distress screening for breast cancer patients.
Authors: Bryant Jill , Silva Helen Colleen , Mapp Greg , Terrell Daphne
Published: February 2017

196

Background: Cancer is a complex disease process. Patients experience psychological, social, financial, and behavioral issues that can interfere with their treatment plan and adversely affect their outcomes. Distress should be measured as the 6th Vital Sign. Consequences of distress can cause deterioration of Quality of Life; produce higher levels of pain; longer rehabilitation; reduced adherence to treatment with less efficacy; and shorter survival expectancy. Methods: Problem exists with a lack of screening patients’ level of distress during breast cancer experience within their cancer care continuum. Goal was to improve the prevalence of distress screening of breast cancer patients from 0% to 50% within 3 months. Cause and effect analysis showed evidence of areas for improvement. Improvements and interventions included: education on stress and psychosocial assessment; developing a distress screening tool; and developing inclusion criteria for patient screening. Screenings were completed on first follow-up visit after diagnosis with continuation of assessment every three months for the first year. A distress screening tool with a thermometer illustration was provided to the patients for them to rate amount of distress experienced in the past week. Scoring was “0 = no distress to 10 = extreme stress.” The tool also included Yes/No questions. A value of 4 or greater on the thermometer or any question marked “Yes” on the questionnaire was considered a positive screen. Results: In addition to developing a tool, a template was implemented in the electronic medical record. Opportunities for assistance with distress were discovered based on patients’ responses where interventions and follow-ups with the patient were provided. Conclusions: A process was developed and implemented to integrate and monitor on-site psychosocial distress screening and referral for provision of psychosocial care. A small number of patients analyzed met criteria during a short period of time. The percentage of distress screenings completed improved from 0% to 92%. [Table: see text]
Impact of health care costs on utilization of needed health care in the Childhood Cancer Survivor Study (CCSS).
Authors: Fair Douglas Beaty , Kirchhoff Anne C. , Nipp Ryan David , Leisenring Wendy M. , Nathan Paul C. , Oeffinger Kevin C. , Armstrong Gregory T. , Robison Leslie L. , Park Elyse
Published: February 2017

20

Background: Survivors of childhood cancer face increased risks for morbidity and premature mortality due to the sequelae of their primary disease and its treatment. Survivors may be socioeconomically vulnerable, which could negatively impact their healthcare utilization. We investigated sociodemographic factors associated with forgoing needed healthcare due to cost among long-term survivors within the CCSS. Methods: From a survey of insured and uninsured survivors conducted in 2011-12, forgoing needed healthcare due to cost was determined by the question “In the past year, was there a time when you did any of the following because you were worried about the cost? (Yes/No)” with 10 response categories (e.g., skipping a test/treatment, postponing medical care, taking a smaller cost of a prescription). ‘Yes’ responses were summarized using a categorical outcome variable of 0, 1-2, or ≥ 3 instances of forgoing healthcare. Ordinal logistic regression models assessed the association of sociodemographic factors with increased instances of forgoing healthcare due to cost, including survey weights to account for stratified sampling. Results: Of 1,110 mailed surveys, we received 698 (64%) responses. Mean age at time of survey was 39.6 (range 24-60) years and average time since diagnosis was 31.3 (SD = 4.6) years. 23% of survivors reported 1-2 instances of foregoing needed healthcare and 31% reported 3 or more. Odds of more forgone needed healthcare due to costs were increased for those who were uninsured, female, and had a chronic medical condition. [Table: see text]
Young cancer survivors’ expectations of physicians for issues of mental health, interpersonal relationships, and reintegration to society.
Authors: Wang Ying , Camateros Pierre , Cheung Winson Y.
Published: February 2017

208

Background: As patients transition from cancer treatment to survivorship, issues surrounding the social and mental health impacts of survivorship gain increased importance. In this study, we examined young cancer survivors’ expectations of their physicians with respect to mental health, interpersonal relationships, and reintegration back to work and school. We also explored factors associated with these expectations. Methods: We surveyed patients aged 20 to 39 years who were diagnosed with solid tumors, evaluated at any 1 of 5 regional cancer centers in British Columbia, and alive at 2 or more years after their diagnosis. We explored the relationship between patient factors and expectations, adjusting for confounders through the use of multivariate regression models. Results: With a survey response rate of 57%, a total of 447 patients were analyzed: median age was 35 years (IQR 31-38), 30% were men, and 89% had ECOG 0. Tumor sites included breast (222; 50%), testicular (126; 28%), gynecological (76; 17%), and colorectal (23; 5%). Decreasing levels of expectations of cancer specialist (CS) were seen with 72%, 48%, and 28% of patients indicating that their CS should have some to full responsibility on issues related to mental health, social counselling, and reintegration, respectively. Compared to CS, patients held much higher expectations of their primary care physician (PCP) taking some to full responsibility for these same issues (see Table). Expectations of their PCP were further increased when there was frequent contact between patient and PCP. Conclusions: The majority of young cancer survivors in our survey expected their PCP more than their CS to have a significant degree of responsibility for mental, interpersonal, and social issues arising from their cancer or treatment. Early integration of PCP into survivorship care models may augment the work provided by the psychosocial cancer team and ease the transition to survivorship for patients. [Table: see text]