bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical and mental functioning in colorectal cancer (CRC) survivors by work status.
Authors: Denlinger Crystal Shereen , Hegarty Sarah , Shapiro Pamela Joyce , Fang Carolyn Y , Barsevick Andrea Marie
Published: February 2017

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Background: Comorbidities and treatment-related symptoms (sx) affect overall function and may impact return to work. We evaluated SF-12 physical and mental functioning in CRC working (W) and non-working (NW) survivors. Methods: 300 Stage I-III CRC survivors age 25-70 years identified by PA Cancer Registry who completed curative therapy 3-5 years prior to study and were employed at diagnosis were surveyed with validated measures via mail-survey procedures. Current work status (working/not working), demographics, and medical factors (diagnosis, treatment, comorbidities) were assessed, as was fatigue, insomnia, distress, cognitive sx, neuropathy, bowel sx, and urinary sx. Study approved by PA Department of Health; participants (pts) provided informed consent. Results: Pts average age 57 yrs (80% < 65 yrs), 56% male, 87% white, 67% educated beyond high school, 73% married. 56% had rectal cancer, 51% had chemotherapy, 39% had radiation therapy, 16% had an ostomy. Work status at survey: 226 pts (75%) W; 74 pts (25%) NW. Higher comorbidity number was associated with lower physical (PCS) component scores in both W and NW groups (p = 0.004 and 0.013), and with lower mental (MCS) component scores in the NW group (p = 0.004). Among W pts, predictors of lower PCS were fatigue (p = 0.001), bowel problems (p < 0.001), neuropathy (p = 0.009), and being male (p = 0.03). Predictors of lower MCS were fatigue (p = 0.003), cognitive issues (p < 0.001), and distress (p < 0.001). Among NW pts, predictors of lower PCS were fatigue (p = 0.02), neuropathy (p = 0.007), ostomy presence (p = 0.015), and being unmarried (p = 0.007). Predictors of lower MCS were distress (p < 0.001) and younger age (p = 0.007). Conclusions: Both W and NW CRC survivors have significant comorbidity and sx burden associated with poorer physical and mental functioning. Fatigue, neuropathy, and distress were predictors in both groups, while cognitive and bowel sx predicted poorer function among W survivors. Intervening on these modifiable sx may increase survivors’ return to work and improve functioning for those who do. Next steps will focus on intensive management of modifiable sx to determine the effect on physical and mental functioning and potential for returning to work after treatment.
Cardiovascular disease (CVD) risk factors and health behaviors following cisplatin-based chemotherapy (CHEM): A multi-institutional study of testicular cancer survivors (TCS).
Authors: Abu Zaid Mohammad Issam , Fung Chunkit , Williams AnnaLynn , Sesso Howard D. , Kerns Sarah L , Feldman Darren R. , Hamilton Robert James , Vaughn David J. , Beard Clair , Liu Hai , Fossa Sophie D. , Einhorn Lawrence H. , Travis Lois B. ,   The Platinum Study Group
Published: February 2017

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Background: TCS are at increased risk of CVD, but few clinical studies have comprehensively evaluated CVD risk factors through physical exams, lipid panels, and health behaviors in North American patients. Methods: Eligible TCS were < 50 y at diagnosis and treated with only first line CHEM. TCS underwent physical exams, had fasting lipid panels, and completed questionnaires regarding co-morbidities and health behaviors. Age, race, and educational status-matched controls (1:1) were chosen from the general population using the 2011-2012 National Health and Nutrition Examination Survey. Odds ratios (OR) of outcomes among TCS versus matched controls were estimated using logistic regression models. Results: We evaluated 680 consecutively enrolled TCS. Median age at diagnosis was 31 y (range, 15-49) and at clinical evaluation 38 y (range, 19-68). Median time since CHEM was 4.3 y (range, 1-30). Compared to normative controls, TCS were more likely to be overweight (OR = 1.65; 95% CI 1.26-2.16), have total cholesterol ≥ 240 mg/dL (OR = 2.19; 95% CI 1.12-4.28) and LDL ≥ 160 mg/dL (OR = 3.05; 95% CI 1.03-9.00), and report alcohol use > 2 days/week (OR = 2.13; 95% CI 1.64-2.77). In contrast, they were more likely to have a waist circumference < 40 inches (OR = 1.32; 95% CI 1.04-1.66); engage in vigorous (OR = 2.64; 95% CI 2.11-3.29) or moderate (OR = 1.62; 95% CI 1.30-2.03) physical activity, and not smoke (OR = 2.95; 95% CI 2.14-4.08). TCS were about 3 times more likely overall to report excellent, very good, or good health compared to controls (P < 0.05). No significant differences were found comparing HDL, triglycerides, or self-reported hypertension (P > 0.05). Conclusions: Although North American TCS appear more likely to exercise and abstain from smoking compared to normative controls, a greater proportion are overweight and have higher fasting total cholesterol and LDL levels. Health care providers should screen TCS for CVD risk factors, and encourage practices consistent with a healthy lifestyle. Future research should elucidate mechanisms of increased CVD risk and ultimately develop customized prevention and intervention strategies.
Bioimpedance spectroscopy for lymphedema assessment: Clinical practice guidelines.
Authors: Shah Chirag , Vicini Frank A. , Arthur Douglas W.
Published: February 2017

146

Background: Breast cancer related lymphedema (BCRL) is an increasingly diagnosed complication of breast cancer treatment with incidence rates of 5% with lumpectomy alone to more than 40% with mastectomy, axillary dissection, and radiation therapy. Increasing data supports the role of early detection and treatment with one diagnostic modality being bioimpedance spectroscopy (BIS) with L-Dex measurements. Methods: A systematic review of the National Library of Medicine’s PubMed search was performed for articles applicable to BIS and BCRL. Clinical guidelines were created by the authors based on published data and consensus agreement. Results: At this time, multiple randomized and prospective trials have been performed evaluating early detection for BCRL and have demonstrated reduced rates of BCRL with such an approach. BIS with L-Dex represents a technique with published literature supporting increased sensitivity, ability to detect subclinical BCRL and standardized clinical decision points, an improvement from traditional BCRL diagnostics. BCRL surveillance programs should focus on high-risk patients including those undergoing mastectomy, axillary lymph node dissection, sentinel node biopsy with greater than 6 nodes sampled, regional nodal irradiation, and those requiring taxane based chemotherapy. Patients should undergo assessment prior to locoregional therapy and then every 3 months for the first 3 years with additional measurements made based on clinical assessment. A change in L-Dex of 10 has been utilized has a consistent trigger to initiate BCRL treatment. Conclusions: With increasing data supporting early diagnosis and treatment of BCRL, these guidelines offer clinicians a tool to help develop BCRL surveillance programs as part of routine breast cancer care.
Moderators of acupuncture effectiveness in breast cancer survivors: Randomized clinical trial (RCT).
Authors: Palesh Oxana , Haddad Nadia , Schnyer Rosa , Neri Eric , Packer M. Melissa , Zeitzer Jamie M. , Manber Rachel
Published: February 2017

162

Background: The popularity of acupuncture among cancer patients highlights the need for studying its effectiveness for mitigating side effects of cancer treatments. Insomnia is prevalent among cancer patients and is associated with fatigue and reduced quality of life (QOL). It is also closely linked with depression, sleep apnea, and circadian disruption. Using data form an RCT of acupuncture for insomnia among breast cancer survivors, we examined depression, apnea and circadian factors as moderators of acupuncture effectiveness. Methods: 68 breast cancer survivors (54 years, SD = 9) experiencing insomnia symptoms were randomized to receive 12 sessions of acupuncture (N = 34) or sham (N = 34; using placebo needles). Measures included the Insomnia Severity Index, Brief Fatigue Inventory, and FACT—G, obtained at baseline, mid-treatment (3 weeks), end of treatment (6 weeks), and follow-up (10 weeks). Results: Although acupuncture produced significant improvements from baseline to follow-up in insomnia symptoms, fatigue, and QOL, these improvements did not differ from sham. Compared to sham, the acupuncture produced significantly greater improvements in: 1) insomnia severity (p = 0.03) and QOL (p = 0.02) among those with greater tendency for morning chronotype; 2) fatigue (p = 0.01) among those with lower apnea risk; and 3) QOL (p < 0.001) among those with lower depression scores at baseline. Conclusions: These findings suggest that acupuncture might be more effective among certain subgroups of patients. Moderators of insomnia, fatigue, and QOL include morningness tendency, lower risk for sleep apnea and lower depression scores, respectively. Our findings on depression are in line with prior research that has found that patients with less severe depression may have a greater capacity for acupuncture response perhaps due to higher availability of serotonin. Additional research is needed to test whether acupuncture is a viable treatment option for subgroups of cancer survivors with insomnia. Clinical trial information: NCT01162018.
Utilizing design theory to create a patient-centered palliative care model in cancer survisorship care.
Authors: Tribett Erika Lauren , Chavez Jordan , Morris Alison
Published: February 2017

164

Background: Palliative medicine (PM) is an essential component of survivorship care from point of diagnosis. While PM is philosophically committed to supporting patient and family survivorship goals, very few programs incorporate patient and family input into the formation of a patient-centered model of care for symptom management and quality of life. We utilized design theory to develop novel interventions for primary and specialist PM delivery. Methods: Baseline data collected in Fall 2014 revealed a need for assistance navigating support services as well as barriers to PM integration including branding, lack of primary palliative skills, and poor understanding of outcomes of PM integration. In February 2015, we convened a multidisciplinary group of 25 patients, family members, oncology clinicians and experts in patient experience and health services research, to evaluate current state data and formulate ideas for optimizing PM to support symptom management and quality of life. During a 1-day workshop, the group generated interventions for primary and specialist PM. Small teams were assigned to pilot projects based on these recommendations. Proposed solutions are being tested from July - October 2015. Results: The design team generated five focus areas for meeting patient needs and overcoming barriers: standard processes for access to PM, education on primary PM, rapid reporting of outcomes, relationship-building with referring clinicians, and improved access to primary and specialist palliative resources. Three interventions are being developed to address these: 1. A subspecialist “hub” that allows single referrals and streamlined access to supportive care, 2. a novel two-question probe about goals conducted by the oncologist, and 3. a peer support system between PM social work and nursing staff to proactively manage patients with complex needs. Conclusions: Patient and family-centered PM mandates a novel approach. Design theory allows for clear delineation of problem areas, generation of multiple solution sets, and rapid testing and refinement prior to large-scale adoption. A participatory design approach emphasizes user values and limitations and creates values-based solutions.
Integrative medicine modality utilization and impact on quality of life in cancer patients: A single academic cancer center experience.
Authors: Millstine Denise , Gowin Krisstina L. , Chon Tony
Published: February 2017

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Background: The majority of patients with cancer incorporate integrative medicine strategies into their cancer experience however; patient reported preferences and impact on quality of life is limited. We present cancer patient utilization for specific integrative medicine modalities within the Mayo Clinic Arizona Comprehensive Cancer center and describe the patient perceived impact on quality of life. Methods: Patients and family members attending the 2015 Living with Cancer Symposium at Mayo Clinic Arizona completed a survey indicating whether specific integrative medicine modalities were utilized during cancer treatment and whether utilization had an impact on the patients perceived quality of life. Patient diagnoses and stage were collected. A total of 119 patient surveys were completed and analyzed. Results: The patient diagnoses included hematologic malignancies (27%), breast (25%), prostate (18%), and other (30%). Disease stage was nearly evenly distributed with stage I (21%), stage II (20%), stage III (16%), stage IV (15%), and unknown (28%). The most commonly utilized integrative modalities included nutrition (54%), natural product supplementation (34%), massage (33%), exercise (31%) including yoga (23%) and tai chi (1%), breathing and meditation interventions (26-28%), support groups (23%), and pet therapy (17%). The majority of patients (64%) reported integrative intervention utilization led to an enhanced quality of life during cancer therapy. Conclusions: At a single academic cancer center, in a cancer type and stage diverse population, the majority of patients (64%) reported improved quality of life during cancer therapy with integrative medicine intervention utilization. Nutrition, natural product supplementation, massage, exercise, and meditative modalities were most commonly utilized. Interestingly, a large proportion of patients analyzed in this questionnaire-based study were afflicted with hematologic disease, a population underrepresented in the current integrative medicine intervention research. More studies exploring the feasibility and impact of integrative therapies in the hematologic patient population are needed.
Examining the relationship between social cognitive processing and depressive symptoms in long-term breast cancer survivors and their partners.
Authors: Cohee Andrea A , Champion Victoria
Published: February 2017

191

Background: Breast cancer survivors (BCS) and their partners frequently report distress, including depressive symptoms after diagnosis and treatment for breast cancer. The Social Cognitive Processing Theory (SCPT) has been useful in identifying predictors of both BCS and partner distress, although most studies have occurred early in survivorship. Relationships between SCPT variables and depressive symptoms in long-term BCS and their partners have not been well explored. The purpose of this study is to test relationships between SCPT variables and depressive symptoms in long-term BCS and their partners. Methods: In a large cross-sectional study, BCS (N = 222), who were 3-8 years from diagnosis, and their partners completed a survey assessing demographic characteristics, social constraints, cognitive processing (intrusive thoughts and cognitive avoidance), and depressive symptoms. Mediation analyses were conducted for survivors and partners separately to determine if cognitive processing would mediate the relationship between social constraints and depressive symptoms. Results: Cognitive processing mediated the relationship between social constraints and depressive symptoms both for BCS [F(5,209) = 16.373, R2= .281, p < .001] and partners [F(4, 216) = 8.281, R2= .133, p < .001), controlling for age, education, and survivors’ time since diagnosis. Although included in the model, demographic variables did not significantly predict depressive symptoms. Conclusions: Relationships in the SCPT were confirmed; cognitive processing mediated the relationship between social constraints and depressive symptoms for both long-term BCS and their partners. Results expand the utility of the SCPT in long-term survivors and their partners by supporting its use in intervention design.
Cognitive function in cancer survivors: Analysis of the 1999-2002 National Health and Nutrition Examination Survey.
Authors: Williams AnnaLynn , Janelsins Michelle Christine , van Wijngaarden Edwin
Published: February 2017

193

Background: Cancer and its treatment may affect cognitive function in up to 35% of survivors months after treatment. While short-term treatment-related cognitive changes are well recognized, only limited research is available in older, long-term survivors of cancer. Methods: Using NHANES data from 1999 through 2002, 408 cancer survivors and 2,639 non-cancer participants age 60 and above were identified. Cognitive function of these groups were compared on self-reported problems with memory or confusion and using the Digit Symbol Substitution Test (DSST), a test of processing speed, attention, and learning and working memory involving executive functions domains. Results: Cancer survivors were on average 72.8 years old and 11.5 years from diagnosis. After adjustment for covariates, cancer survivors scored, on average, 1.99 points lower on the DSST compared to non-cancer survivors (ß=-1.99, 95%CI -3.94, -0.05). Cancer survivors also had 17% higher odds of self-reporting problems with memory or confusion (OR 1.17, 95%CI 0.89, 1.53). Similar results were observed among survivors ≥ 5 years from diagnosis (ß =-2.38, 95%CI -4.57, -0.18, OR1.41, 95%CI 0.99, 2.02). Results suggest that age modifies the association between cancer diagnosis and DSST score (p=0.11) with a larger effect size in the younger group (between 60 and 75 years). Among those younger than 75, cancer survivors performed 3.25 points lower on the DSST compared to non-cancer survivors (ß =-3.25; 95%CI -5.88, -0.62). However, this difference was only 0.18 points lower among those 75 or older (ß =-0.18; 95%CI -2.94, 2.57). Conclusions: This is the only study to examine domain specific cognitive deficits in a large, nationally representative, older population of long-term cancer survivors and the first to report deficits in processing speed, attention, and learning and working memory domains. These domains are thought to be important for social and executive functioning and quality of life. Characterizing affected domains and subpopulations will help to develop and test effective interventions and may influence treatment practices in older cancer patients.
Psychosocial distress screening in community oncology: A feasibility study.
Authors: Solti Magdolna , Webb Tracy , Koerber Joyce , Mcdermott Rosemary , Hill Virginia
Published: February 2017

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Background: Screening for psychosocial distress is an unmet need for cancer survivors. The oncology team has a critical role caring for the whole patient. We designed a comprehensive screening for newly referred patients in a community oncology setting. The purpose of our screening is early detection of moderate to severe distress and early intervention through social workers. Methods: This feasibility study included 292 newly diagnosed cancer and hematology patients entering our center between May 1 and July 31, 2015. Each participant completed the NCCN Distress Thermometer with checklist and PHQ-2 survey as part of the New Patient Questionnaire. The psychosocial team designed the triage process and contacted each patient if either the distress score or the PHQ-2 scores were ≥ 4. The screened patients underwent counseling by social work and were provided educational materials by nurse navigators and referred to community counselors as needed. Results: 67 % of the 292 newly diagnosed patients completed the screening tool. The average distress score was 4.31, and the average PHQ-2 score was 1.48. Based on the predefined criteria, 63% of all new patients reported significant distress. One-third of these patients had a distress score of 4, and were managed by nurse navigators. 63 patients with higher score were seen by social worker, 23 (37%) were referred to community counseling and 16 (25%) received ongoing follow-up. The documented need of psychosocial counseling increased by 28% during the program. By the end of the project period the early detection rate of severe depression (PHQ-2 ≥ 4) increased from 33% to 80%. The majority of the patients appreciated the distress screening, and the suggested coping strategies and support. Conclusions: Distress screening for newly diagnosed hematology and oncology patients is feasible in the community oncology setting. A large number of previously undetected patients with distress and depression were identified. The distress tool aided in early intervention and providing follow-up. The screening was also effective in identifying patients with high distress and in need to mitigate a crisis. Providing appropriate resources and referrals is essential to manage the extra workload on the psychosocial team.
Importance of surgical role on anxiety of patients with breast cancer: Twelve-month follow-up prospective study.
Authors: Park Sungmin , Lee Sekyung , Bae Soo Youn , Lee Jeong Eon , Kim Seok Won , Nam Seok Jin , Cho Juhee
Published: February 2017

195

Background: Breast cancer diagnosis and treatment often produce stress in patients.Anxiety is one of the most prevalent psychological symptoms perceived by breast cancer patients. This study aims to evaluate the temporal patterns of anxiety and find factors associated with persistent anxiety during breast cancer treatment. Methods: This is prospective cohort study. Between July 2010 and July 2011, we recruited patients with non-metastatic breast cancer who were expected to receive adjuvant chemotherapy (N = 411) from two cancer hospitals in Seoul, Korea. Trained researchers interviewed participants and the patients also completed questionnaires on quality of life at enrollment (before surgery), 2 weeks, 3 months, 6 months and 12 months post-surgery. Anxiety was measured using the Hospital Anxiety and Depression Scale (HADS). Borderline and abnormal levels of HADS scores were classified into the abnormal group for comparison purposes. Results: The mean age of the participants was 46.4 (±7.9) years. Preoperatively, 44.5 % (183/411) of the patients showed abnormal anxiety. The proportion of the subnormal anxiety group significantly decreased after surgery (P < .01) and this phenomenon continued until the 12 month follow-up point. Patients experienced renewed anxiety at 12 months when the main adjuvant therapies were finished. Socioeconomic factors were not associated with persistent anxiety. Pain, breast, and arm symptoms were significantly higher in the persistently abnormal group, especially at postoperative 6months and 12months. Conclusions: Anxiety disorder was common in patients who were diagnosed with breast cancer (44.5%). Surgery was a major relieving factor of anxiety, and patients who finished their main adjuvant treatment experienced renewed anxiety. Surgeons should be the main detectors and care-givers with respect to psychological distress in breast cancer patients. To reduce persistent anxiety, caring for the patient’s physical symptoms is important.
Neurocognitive function and psychological distress in young adults (YA) with cancer.
Authors: Edelstein Kim , D'Agostino Norma Mammone , Pond Gregory Russell , Aubin Sylvie , Matthew Andrew , Gupta Abha A. , Kavan Petr , Crump Michael , Bedard Philippe L. , Schuh Andre C. , Hodgson David C. , Wahl Kate , Simpson Rebecca , Vuong Te , Muanza Thierry , Batist Gerald , Bernstein Lori J.
Published: February 2017

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Background: Cancer treatment is associated with neurocognitive sequelae and changes in structural and functional brain imaging in older adults, even if they do not receive central nervous system directed therapy. Because the brain continues to develop into the 3rd decade of life, YA (age 18-39 yrs) may also be vulnerable to neurocognitive dysfunction. In YA, cancer disrupts acquisition of developmental milestones and is associated with psychological distress. This study aims to characterize neurocognitive functions and its relation to psychological distress in YA. Here we present baseline results of our longitudinal study. Methods: In this prospective, inception-cohort study, we recruited 3 groups of YA from ambulatory oncology clinics: YA with cancers (YAC; lymphoma, breast, gynecology, gastrointestinal, genitourinary, sarcoma) who required chemotherapy (YAC+, n = 55), YAC who do not require it (YAC-, n = 31), and healthy YA (HYA, n = 54). Participants completed a 2-hr battery of standardized neurocognitive tests and validated self-report questionnaires. YAC were assessed within 3 months of diagnosis, and YAC+prior to chemotherapy. Test scores were converted to age-corrected scaled scores and transformed to z-scores (mean 0, SD 1). A global neurocognitive function score and 6 domain scores were evaluated. Results: There were no group differences in neurocognitive domains (ANOVA, all p-values > .1), or in the number of impaired test scores (defined as z < -1). YAC+ reported greater symptoms of somatic distress (p = .001) and anxiety (p = .004) than both HYA and YAC-. Symptoms were unrelated to neurocognitive performance (ρ < .16 for all). However, each group had poorer memory compared to population norms (1-sample t-tests: YAC+ p = .007; YAC- p = .047; HYA p = .023). Conclusions: Prior to treatment, neurocognitive functions of YAC were not different from HYA, suggesting that cancer itself is not a neurocognitive risk factor in YA. It is important to use appropriate control groups, rather than relying on normative data for comparison. We continue to follow this cohort to document neurocognitive function and distress over time, and to identify risk factors that contribute to outcomes in YA.
Feasibility and preliminary efficacy of an interactive portal for lung cancer patients.
Authors: Groen Wim G , Kuijpers Wilma , Oldenburg Hester SA , Wouters Michel W.J.M. , Aaronson Neil K , van Harten Wim H
Published: February 2017

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Background: “MijnAVL” is an interactive portal for cancer patients that includes patient education, an overview of appointments, access to the electronic medical record, patient-reported outcomes and related feedback, and tailored physical activity support. The aim of this study was to evaluate MijnAVL’s feasibility and preliminary efficacy among lung cancer patients. Methods: We included individuals currently or recently treated for lung cancer with curative intent (surgery or radiotherapy). At baseline, they completed a questionnaire on sociodemographics, expectations of MijnAVL and three effect measures: patient activation (PAM), quality of life (SF-36), and physical activity (IPAQ). MijnAVL could be used noncommittally for 4 months. After this period, log data were collected retrospectively and participants completed questions on satisfaction and the effect measures. Results: We included 37 patients (mean age 59.6 years). The mean number of logins was 11.2 with a mean duration of 12.9 minutes. Eighty-nine percent of patients indicated that MijnAVL was easy to use and 82% was positive about using it. Many patients (69%) indicated that MijnAVL was a valuable addition to the care they received and 56% indicated that it helped them to have more control over their health. All features were frequently used and rated 7 or higher on a 10 point scale. Website user satisfaction was rated, on average, 3.9 on a 5 point scale. Patient activation decreased over time from 64.8 to 59.4 (p= 0.049), meaning patients felt less activated. For the SF-36, we found no significant changes over time. In general, levels of physical activity did not change, although vigorous physical activity tended to increase over time (from median of 0 to 360 MET-minutes per week (p= .053)). Conclusions: These results indicate that using MijnAVL is feasible in lung cancer patients. Most users indicated that MijnAVL was useful and easy to use. The efficacy of the patient portal could not be substantiated, which could be due to small sample size, the intervention itself, the (insensitivity of) outcome measures, or a combination of these. Further research is needed to find effective ways to improve and adequately measure patient empowerment in lung cancer survivors.
Understanding patient distress on day +100 of allogeneic stem cell transplant.
Authors: Padrnos Leslie Jane , Kosiorek Heidi , Slack James L. , Khera Nandita
Published: February 2017

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Background: Allogeneic hematopoietic cell transplantation (HCT) is a medically complicated treatment modality used for various hematologic malignancies. Patterns and predictors of distress in post- transplant setting in a contemporary cohort of patients are not well-understood. Methods: 67 patients transplanted between 12/5/12- 4/21/15 completed National Comprehensive Cancer Network Distress Thermometer as part of their long term follow up clinic evaluation on day+100 after HCT. Demographic, socioeconomic and clinical outcome data were analyzed. A score ≥ 4 was considered distressed. Results: Mean age of patients was 50.8 years (range 20-72). Most patients were married or living with their significant other (83%), half were college graduates (58%), and half were employed full time (50%). 21 patients (31%) reported a distress score ≥ 4. Distressed patients reported increased problems with treatment decisions (15% vs 2%, p<0.05) and ability to have children (16% vs 0%, p<0.05). Physically, distressed patients were more likely to report fatigue (85% vs 44%, p <0.05), pain (60% vs 24%, p<0.05) and difficulty getting around (25% vs 7% p<0.05) Distressed patients were likely to report at least 1 emotional problem (N=16, 76%), and nearly a quarter reported ≥ 4 emotional problems (N=5, 24%). Specifically, sadness (25% vs 7%, p<0.05) and worry (64% vs 26%, p <0.01) were more common in distressed patients. Distressed patients had a longer length of hospitalization for transplant (30.8 days vs 24.9 p<0.001) and more hospitalized days during the first 100 days (34.9 vs 28.7 p<0.01). Conclusions: Approximately 30% of allogeneic HCT patients suffer significant distress at Day100 post-transplant. Distressed patients report problems with a variety of factors, including emotional, physical, family and practical issues that may impact function, compliance and quality of life. Higher number of hospitalized days is associated with increased distress and could be used to identify patients who may benefit from stress monitoring. Periodic screening of distress in HCT patients can help identify interventions to help improve patient reported outcomes.
Bridging the gap in psychosocial care in cancer survivorship: A pilot project evaluating psychosocial interventions through telemedicine.
Authors: Bomar Kaitlin , Willingham Elizabeth , Dillard Terra , Dingman Chad M , Humphries Crystal , Kindall Stacey , Hegedus Patricia D. , Bearden James D. , Crosswell Hal E.
Published: February 2017

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Background: Psychosocial distress is a well‐recognized consequence of cancer therapy, but psychosocial care for cancer survivors remains fragmented. Through the use of telemedicine, establishing an integrated, information technology‐based infrastructure between community‐based cancer programs may enhance coordination of survivorship care and increase psychosocial distress screening and intervention. We describe a one year pilot program intended to bridge institutional and geographic gaps in psychosocial intervention for cancer survivors through the use of telemedicine. Methods: There are 17 Commission on Cancer-accredited sites in South Carolina-only 31% of sites routinely conduct distress screening. This SC Cancer Alliance-supported pilot was designed as a quality care improvement project between two community-based cancer programs. The development and execution of the telemedicine project will be described. A survey-based, qualitative assessment of patient satisfaction with psychosocial intervention with between both physical and virtual counselling was performed and scored. Results: All patients seen in survivorship clinics at both institutions received psychosocial distress screening. By the end of the pilot project, 9 cancer survivors from the Spartanburg area were identified as having significant psychosocial distress, participated in counselling and reported on their experiences. Patients were seen either via face-to-face and/or virtual encounters. Counselling sessions performed via telemedicine were well accepted and that there was no difference in patient satisfaction as compared to face-to-face sessions. Anecdotal experiences and comments will be highlighted. Conclusions: Our pilot project demonstrates that psychosocial screening and intervention via telemedicine is feasible and may be effective at reducing psychosocial distress in cancer survivors. Psychosocial intervention via telemedicine may serve as a viable method of providing counselling services to resource poor areas, but significant barriers exist, including reimbursement, institutional variations in screening and care and information technology.
Health care utilization among long-term cancer survivors.
Authors: Rajotte Emily Jo , Heron Leslie , Syrjala Karen Leslie , Baker Kevin Scott
Published: February 2017

22

Background: Survivors of adult cancer face lifetime health risks that are dependent on their cancer, cancer treatment exposures, comorbid health conditions, and lifestyle behaviors. A shared care model, including planned and formal transition of the cancer survivor from the oncologist to the primary care physician needs to be established to ensure appropriate care. Methods: As a LIVESTRONG Survivorship Center of Excellence Network member, the Survivorship Program at the Fred Hutchinson Cancer Research Center has established an outpatient clinic at the Seattle Cancer Care Alliance to meet the clinical needs of cancer survivors. Before their survivorship-focused clinic appointment, adult cancer survivors are asked to complete a comprehensive survey that includes questions on health care utilization. Results: Between August 2013 to December 2014, 142 clinic patients completed the survey. They were 70.4% female, mean age 48 years (SD 16.3, range 22-83) and 21.1% breast cancer, 30.2% leukemia/lymphoma, and 17.6% reproductive cancer survivors. Patients were a mean of 7.8 years (SD 9.5, range 0-43) from their cancer diagnosis at the time of clinic appointment. 70.4% reported receiving oncology care and 87.3% primary care within the 12 months before their survivorship visit. Forty percent reported more than 12 clinic visits in the past year in which they saw a physician, nurse practitioner or physician assistant compared with 6.5 clinic visits in the general population based on CDC, National Health Care Survey reference data. 41.5% had one or more visits to a hospital emergency or urgent care facility within the last year, compared with 39.4% in the CDC NHCS survey. Conclusions: Cancer survivors seen in a Survivorship Clinic utilize healthcare at a much higher rate than the general population. A shared-care model for cancer survivors, including a delineation of roles and specific points of communication, between the oncologist and the primary care physician may help address issues surrounding over-utilization. A cancer treatment summary and a survivorship care plan may be valuable tools to facilitate this shared care approach.
The TRUMPET registry: Assessing clinical outcomes and quality of life in patients with castration-resistant prostate cancer and their caregivers.
Authors: Flanders Scott C , Lin Daniel W. , Karsh Lawrence Ivan , Shevrin Daniel H. , Shore Neal D. , Symanowski James Thomas , Quinn David I. , Otermat Gretchen , Starzyk Kathryn , Brown Bruce , Francis Peter St. John , Wong Elaine Karol , Wu Jun , Wilson Samuel D , Penson David F.
Published: February 2017

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Background: Patient care in castration-resistant prostate cancer (CRPC) is complex, with varying treatment patterns due to differences in therapies, patient characteristics, and physician practices. The impact of such patterns on clinical outcomes and quality of life (QoL) represent a contemporary medical issue. This study aims to improve the understanding of clinical outcomes and QoL of patients with CRPC and their caregivers. Methods: TRUMPET is a prospective, observational, multi-center study of patients with CRPC in the United States. Approximately 2000 patients and their caregivers (if eligible) will be enrolled over 24 months from IRB-approved urology and oncology sites. Eligible patients with CRPC include those with life expectancy of ≥ 6 months initiating the first active course of anti-cancer treatment for M0 or M1. A 48-month observation period will follow the last patient enrolled. Primary objectives are to describe longitudinal patterns of care, disease assessment methods, treatment decisions, treatment settings, physician referral patterns, and CRPC patient characteristics associated with these. Patient-reported health-related QoL (HRQoL) instruments will assess the effects of CRPC and its management on patient perception of key aspects of HRQoL. The following will be administered at baseline and follow-up: SF-12v2 Health Survey, Functional Assessment of Cancer Therapy–Prostate, Brief Pain Inventory-Short Form, and Memorial Anxiety Scale for Prostate Cancer (prostate-specific antigen anxiety subscale). In a patient sub-study, work productivity and treatment satisfaction will be described using the Work Productivity and Activity Impairment (WPAI) Questionnaire: Specific Health Problem and Service Satisfaction Scale for Cancer Care. Caregiver QoL and productivity will be captured with the Caregiver Quality of Life Index–Cancer and the Caregiver-modified WPAI Questionnaire. Results: As of August 21, 2015, 60 sites were active, with 63 patients and 39 caregivers enrolled. Conclusions: Outcomes from the TRUMPET study will describe treatment patterns, QoL, and health care resources associated with patient management in CRPC. Clinical trial information: NCT02380274.
Association of anxiety and depressive symptoms with differing needs among recent breast cancer (BC) survivors.
Authors: Palmer Steven C , DeMichele Angela , Schapira Marilyn M. , Glanz Karen , Blauch Abigail , Pucci Donna A. , Jacobs Linda A.
Published: February 2017

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Background: Although unmet needs are associated with general distress in long term BC survivors, it is unclear is different needs are associated with specific outcomes such as anxiety and depression among recent BC survivors. Such work may provide insight into the interventions needed to improve outcomes early in survivorship for patients. Methods: Eligibility included non-metastatic BC treated < 1 year prior. Prior to an initial survivorship visit, participants completed a PRO symptom measure and reported unmet need for assistance for symptoms experienced. Overall unmet need and unmet need domains (physical, psychosocial, sexual, hormonal) were examined. Anxiety and depressive symptoms were assessed using the HADS. Results: Participants (N = 137) were primarily white (72%), middle-aged (M = 55 yr), and treated for Stage I (47%) or II (38%) BC. Anxiety (M = 5.57, SD = 4.08) and depression (M = 3.21, SD = 3.33) were in the normal range, on average. 29% and 13% met “caseness” (i.e., above criteria for significant elevation) for anxiety and depression, respectively. Caseness for anxiety and depression were not significantly related to demographic variables, time from end of treatment, disease characteristics or treatment exposures (all p > 0.05). Meeting criteria for depression was associated with greater overall unmet need (M = 6.11 vs. M = 2.11, p < 0.001) and need in the physical (M = 2.66 vs. M = 0.83; p < 0.001) and psychosocial (M = 2.56 vs. M = 0.49; p < 0.001) domains, but unrelated to unmet sexual or hormonal needs (all p > 0.05). Meeting criteria for anxiety was associated with greater unmet need in the hormonal (M = .47 vs. M = 0.17; p < 0.05) and psychosocial (M = 1.33 vs. M = 0.55; p < 0.002) domains, but unrelated to unmet overall, physical or sexual needs (all p > 0.05). Conclusions: Unmet needs relate differentially to anxiety and depression in recent BC survivors. In particular, depression is associated with more than 3 times the number of unmet physical needs, while anxiety is associated with more than 2.5 times the number of unmet hormonal needs. Assessing psychosocial outcomes in the absence of unmet needs may represent a missed opportunity for intervention to improve outcomes for specific groups of survivors.
Life satisfaction regarding the ability to have children among female cancer survivors.
Authors: Howards Penelope P , Fothergill Amy , Spencer Jessica B , Mertens Ann
Published: February 2017

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Background: Some cancer treatments can cause sub-fertility in female cancer survivors, which has led to recommendations that all reproductive-aged cancer patients receive fertility counseling at the time of cancer diagnosis. However, little is known about how reproductive-aged cancer survivors feel about their quality of life with respect to their ability to have children. Methods: The FUCHSIA Women’s Study recruited reproductive-aged (22-45 years) female cancer survivors diagnosed with cancer between the ages of 20-35 years, who were at least 2 years post-diagnosis (median 7). All reportable malignant cancers and in situ breast cancer diagnosed from 1990 to 2009 in Georgia were eligible. Participants (n = 1,282) completed a detailed interview about their reproductive history including questions about their feelings about their ability to get pregnant and to have more children as well as their comfort with assisted reproductive technology (ART). Women were classified as premenopausal or menopausal, which included surgical and non-surgical menopause. Results: At the time of the interview, 31% of the study participants did not have a child. Overall, childless women were less likely to feel that having a biologic child was important (46%) than women who had a child (89%). However, 61% of childless, premenopausal women wanted to have a biologic child in the future, and 89% of menopausal women without children reported that they would have liked to have a child if they could. Menopausal women without children were more likely to report being comfortable with the idea of using ART to become pregnant (67% vs. 38% of menopausal women with children). A quarter of premenopausal women without children indicated that they would be dissatisfied with life if they were unable to have a child, and 10% of menopausal women without children indicated they were dissatisfied with life because they could not have children. Conclusions: In general, women without children were more likely to report a poorer quality of life with respect to their reproductive potential. However, our results suggest there is a complex relation between women’s reproductive desires and their feelings about their actual situation.
The “little big things”: A qualitative study of ovarian cancer survivors and their experiences with the health care system.
Authors: Tergas Ana Isabel , Angarita Ana , Cristello Angelica , Lippitt Melissa , Nickles Fader Amanda , Long Kara
Published: February 2017

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Background: Navigating a complex and ever-changing health care system can be stressful and detrimental to psychosocial well-being for patients with serious illness. This study explored women’s experiences navigating the health care system during treatment of ovarian cancer. Methods: Focus groups moderated by trained investigators were conducted with ovarian cancer survivors at an academic cancer center. Personal experiences with cancer treatment, provider relationships, barriers to care, and the health care system were explored. Sessions were audiotaped, transcribed, and coded using grounded theory. Subsequent one-on-one interviews were conducted to further evaluate common themes. Results: Sixteen ovarian cancer survivors with a median age of 59 years participated in the focus group study.Provider consistency, personal touch, and patient advocacy positively impacted care experience.Treatment with a known provider, who was well acquainted with the individual’s medical history, was deemed an invaluable aspect of care. Negative experiences that burdened patients, referred to as the “Little Big Things”, included systems-based challenges: scheduling, wait times, pharmacy, transportation, parking, financial, insurance and discharge. Consistency, a “care-team” approach, effective communication, and efficient connection to resources were suggested as ways to improve patients’ experiences. Conclusions: Systems-based challenges were perceived as burdens to ovarian cancer survivors. The role of a consistent, accessible care team and efficient delivery of resources in the care of women with ovarian cancer should be explored further.
Breast cancer: Does where you get treated affect survival?
Authors: Bickell Nina A. , Lin Jenny J , Franco Rebeca , Egorova Natalia
Published: February 2017

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Background: Under the ACA, more women are insured with Medicaid which should improve access to cancer care. However, Disproportionate Share Hospitals (DSH) are due to receive reduced subsidies thereby threatening resource stressed facilities and poorer hospitals are experiencing greater financial penalties due to higher readmission rates. In NYS, 83% of Medicaid breast cancer patients got their cancer surgery at DSH hospitals. As women gain more choice and access, they will require information about hospitals’ quality and outcomes of cancer care. We sought to determine whether there are survival advantages among breast cancer patients treated at hospitals with varying proportions of Medicaid patients. Methods: We used non-obstetric delivery Medicaid discharges from NYS hospitals in 2005-13 to create quintiles of hospitalized patients with Medicaid. Women treated for breast cancer were identified with a diagnostic and procedure code for breast cancer. Based on NYS hospital discharge database linked with vital statistics death records, we calculated hazard ratios using marginal Cox model with a robust sandwich variance estimator controlling for clustering of patients within the hospital, age and comorbidity. Results: Quintiles of Medicaid hospitals ranged from low (0-15%), to low medium (15-22%), medium (22-29%), medium-high (29-50%), to high ( > 50%). 26% of breast cancer patients were treated at the low; 22% at the low medium; 20% at the medium; 21% at the medium-high and 11% at high quintile hospitals. Patients treated in hospitals with > 50% Medicaid patients had a higher long-term mortality (HR = 1.51; 95%CI: 1.19-1.93) compared to those treated at the lowest quintile hospitals. Sensitivity analyses to adjust for stage are underway. Conclusions: While the ACA may improve access to breast cancer treatment, the long term impact on survival remains questionable as women with breast cancer treated at hospitals with high proportions of Medicaid patients may have worse survival. Analyses to control for stage are underway. Pending these results, hospitals with high proportions of Medicaid patients may need to target cancer quality improvement efforts to assure equitable outcomes.