bluuebunny/crossref_metadata_2025 huggingface dataset:
Divergent Paths of Protestantism and Asian Nationalism: A Comparison of Two Social Movements in Korea and China in 1919
Authors: Ma Li , Li Jin
Published: May 2018

In Korea, the March First Movement in 1919 fused Christian identity with nationalistic rituals, making Korean Protestants respectable patriots in the eyes of their countrymen. In China, however, the fledgling nationalism nurtured by the May Fourth Movement in the same year soon gave rise to strong anti-Christian sentiments, culminating in major waves of anti-Christian movements in the 1920s. How do we explain these different outcomes? We argue that the encounters between two different types of Protestantism and two variant forms of nationalism led Korea and China on divergent paths.
Role of magnetic field on mixed convective flow between two concentric microtubes with heat generation/absorption: An exact solution
Authors: Jha Basant K , Oni Michael O
Published: May 2018

This study examines the role of magnetic field on fully developed mixed convection flow of heat generating/absorbing fluid in a vertical micro-concentric annulus with velocity slip and temperature jump at the surfaces of the cylinders. Exact solution of momentum and energy equations are obtained separately in terms of Bessel’s function and modified Bessel’s function of first and second kind. The solutions obtained are graphically represented and the effects of pertinent parameters on flow formation and skin-friction are investigated in details. Results show that the role of magnetic field is to decrease fluid velocity as well as skin-friction at the outer surface of inner cylinder. In addition, reverse flow formation can be controlled by increasing magnetic field strength.
USP22 deficiency leads to myeloid leukemia upon oncogenic Kras activation through a PU.1-dependent mechanism
Authors: Melo-Cardenas Johanna , Xu Yuanming , Wei Juncheng , Tan Can , Kong Sinyi , Gao Beixue , Montauti Elena , Kirsammer Gina , Licht Jonathan D. , Yu Jindan , Ji Peng , Crispino John D. , Fang Deyu
Published: May 2018

Key Points

USP22 deficiency in Ras-driven myeloproliferative neoplasm blocks myeloid differentiation promoting acute myeloid leukemia. USP22 is a PU.1 deubiquitylase that positively regulates PU.1 stability and the expression of myeloid-differentiation genes.
Metatarsophalangeal joint extension changes ultrasound measurements for plantar fascia thickness
Authors: Granado Michael J. , Lohman Everett B. , Gordon Keith E. , Daher Noha S.
Published: May 2018

Background

Ultrasound is an inexpensive method for quantifying plantar fascia thickness, especially in those with plantar fasciitis. Ultrasound has also been used to assess the effectiveness of various treatments for plantar fasciitis by comparing plantar fascia thickness before and after an intervention period. While a plantar fascia thickness over 4 mm via ultrasound has been proposed to be consistent with plantar fasciitis, some researchers believe the 4 mm plantar fascia thickness level to be a dubious guideline for diagnosing plantar fasciitis due to the lack of standardization of the measurement process for plantar fascia thickness. In particular, no universal guidelines exist on the positioning of the metatarsophalangeal (MTP) joints during the procedure and the literature also has inconsistent protocols. The purpose of this study is to investigate and compare the influence of MTP joint extension on plantar fascia thickness in healthy participants and those with unilateral plantar fasciitis.

Methods

The plantar fascia thickness of forty participants (20 with unilateral plantar fasciitis and 20 control) was measured via ultrasound three times at three different MTP joint positions: 1) at rest, 2) 30° of extension from the plantar surface, and 3) maximal extension possible.

Results

The plantar fascia became significantly thinner as MTP joint extension increased in both the plantar fasciitis group (p < 0.001) and the control group (p < 0.001). In the plantar fasciitis group, the involved plantar fascia was 1.2 to 1.3 mm thicker (p < 0.001) than the uninvolved side depending on the MTP joint position. In the control group, the difference in plantar fascia thickness between the two sides was less than 0.1 mm (p < 0.92) at any MTP joint position.

Conclusions

MTP joint position can influence the ultrasound measurement of plantar fascia thickness. It is recommended that plantar fascia thickness measurements be performed with the toes at rest. If MTP joints must be extended, then the toes should be extended maximally and then noted to ensure subsequent ultrasound procedures are repeated. Standardizing the position of the MTP joints is not only important for attaining the most accurate thickness measurement of the plantar fascia, but is also important to researchers who use plantar fascia thickness to determine the effectiveness of various plantar fasciitis interventions.
Is there a survival benefit from adjuvant chemotherapy for patients with liver oligometastases from colorectal cancer after curative resection?
Authors: Pan Zhizhong , Peng Jianhong , Lin Junzhong , Chen Gong , Wu Xiaojun , Lu Zhenhai , Deng Yuxiang , Zhao Yujie , Sui Qiaoqi , Wan Desen
Published: May 2018

Background

Although colorectal oligometastases to the liver can potentially be cured with aggressive local ablation, the efficacy of adjuvant chemotherapy (ACT) for such metastasis remains unclear. The present study explored the effects of ACT on patients with colorectal liver oligometastases (CLO) after curative resections and aimed to identify patients who could benefit from ACT.

Methods

We retrospectively analyzed 264 eligible patients with CLO who underwent curative resection between September 1999 and June 2015. Recurrence‐free survival (RFS) and overall survival (OS) were analyzed using the Kaplan–Meier method and log‐rank test; prognostic factors were a by Cox regression modeling.

Results

Among 264 patients, 200 (75.8%) patients received ACT and 64 (24.2%) did not receive ACT. These two groups did not significantly differ in clinicopathologic characteristics, and had comparable 3‐year OS and RFS rates (RFS: 42.1% vs. 45.7%, P = 0.588; OS: 69.7% vs. 62.7%, P = 0.446) over a median follow‐up duration of 35.5 months, irrespective of preoperative chemotherapy. ACT markedly improved 3‐year OS in high‐risk patients with Memorial Sloan‐Kettering Cancer Center clinical risk scores (MSKCC‐CRS) of 3–5 (68.2% vs. 33.8%, P = 0.015), but presented no additional benefit in patients with MSKCC‐CRS of 0–2 (72.2% vs. 78.6%, P = 0.834). In multivariate analysis, ACT was independently associated with improved OS in patients with MSKCC‐CRS of 3–5.

Conclusions

ACT might offer a prognostic benefit in high‐risk patients with CLOs after curative liver resection, but not in low‐risk patients. Therefore, patients’ risk status should be determined before ACT administration to optimize postoperative therapeutic strategies.
Peripheral Neuropathy, Sensory Processing, and Balance in Survivors of Acute Lymphoblastic Leukemia
Authors: Varedi Mitra , Lu Lu , Howell Carrie R. , Partin Robyn E. , Hudson Melissa M. , Pui Ching-Hon , Krull Kevin R. , Robison Leslie L. , Ness Kirsten K. , McKenna Raymond F.
Published: May 2018

Purpose

To compare peripheral nervous system function and balance between adult survivors of childhood acute lymphoblastic leukemia (ALL) and matched controls and to determine associations between peripheral neuropathy (PN) and limitations in static balance, mobility, walking endurance, and quality of life (QoL) among survivors.

Patients and Methods

Three hundred sixty-five adult survivors of childhood ALL and 365 controls with no cancer history completed assessments of PN (modified Total Neuropathy Score [mTNS]), static balance (Sensory Organization Test [SOT]), mobility (Timed Up and Go), walking endurance (6-minute walk test), QoL (Medical Outcomes Study 36-Item Short Form Survey), and visual-motor processing speed (Wechsler Adult Intelligence Scale).

Results

PN, but not impairments, in performance on SOT was more common in survivors than controls (41.4% v 9.5%, respectively; P < .001). In multivariable models, higher mTNS scores were associated with longer time to complete the Timed Up and Go (β = 0.15; 95% CI, 0.06 to 0.23; P < .001), shorter distance walked in 6 minutes (β = −4.39; 95% CI, −8.63 to −0.14; P = .04), and reduced QoL (β = −1.33; 95% CI, −1.79 to −0.87; P < .001 for physical functioning; β = −1.16; 95% CI, −1.64 to −0.67; P < .001 for role physical; and β = −0.88; 95% CI, −1.34 to −0.42; P < .001 for general health). Processing speed (β = 1.69; 95% CI, 0.98 to 2.40; P < .001), but not mTNS score, was associated with anterior-posterior sway on the SOT.

Conclusion

PN in long-term ALL survivors is associated with movement, including mobility and walking endurance, but not with static standing balance. The association between processing speed and sway suggests that static balance impairment in ALL survivors may be influenced by problems with CNS function, including the processing of sensory information.
Assessing the feasibility of developing and implementing a web-based patient education application.
Authors: Mosesso Kara , Walters Chasity , Supan Christianne , Jakubowski Ann Alice
Published: May 2018

101

Background: Metabolic Syndrome (MetS) is common following allogeneic stem cell transplant (allo-SCT). Lifestyle counseling in the early post-transplant period is crucial for reducing morbidity and mortality related to MetS. The purpose of this study is to assess the feasibility of developing and implementing a video web-based patient education application that educates patients about Metabolic Syndrome (MetS) and provides preventative lifestyle recommendations following allo-SCT. Methods: We created and animated four video storyboards using evidence based research and recommended guidelines (from nationally recognized organizations). There is one video for each component of MetS including abdominal obesity, hypertension, hyperglycemia and dyslipidemia. The videos and a printable PDF overview of MetS were launched on a landing page on our patient education website (available to MSKCC and non-MSKCC patients) in August 2017. MSKCC patients are introduced to the website ( https://www.mskcc.org/cancer-care/patient-education/managing-metabolic-syndrome-after-allogeneic-stem-cell-transplant ) by the nurse practitioner at their Survivorship Visit. After approximately 10 weeks live, feasibility was assessed according to measured MSKCC and non-MSKCC patient use of the education application. Results: To date there have been 121 pageviews on the landing page, 89 of which are unique IP addresses. Video use statistics are noted in the table below. Conclusions: Developing a video web-based patient application is a feasible adjunct to support and expand upon face-to-face education. Future directions include determining patient satisfaction, change in knowledge and behavior as a result of the videos and perceived usability of the web-based program by integrating a Likert-type patient self-report questionnaire into a module on the landing page. [Table: see text]
Randomized web-based physical activity intervention in adolescent survivors of childhood cancer.
Authors: Howell Carrie R , Krull Kevin R. , Partin, MS Robyn , Kadan-Lottick Nina S. , Robison Leslie L. , Hudson Melissa M. , Ness Kirsten K.
Published: May 2018

102

Background: This study of adolescent survivors of childhood cancer evaluated the initial efficacy of a web-delivered, interactive, rewards-based physical activity intervention that aimed to increase moderate to vigorous physical activity (MVPA) and improve fitness, neurocognitive and health-related quality of life (HRQoL) outcomes over 24 weeks. Methods: Survivors (aged ≥ 11 to < 15 years) who were not undergoing active cancer treatment, were physically active < 60 minutes/day and were treated at a single institution were randomized (2:1) to a rewards-based physical activity intervention delivered via the internet or a control group. The intervention group received educational materials, an activity monitor, and access to an interactive website designed to motivate increased physical activity via rewards (e.g. t-shirts, stickers, gift cards) and the control group received only the activity monitor and educational materials. Physical activity, fitness, neurocognitive and HRQoL outcomes were assessed at baseline and 24-weeks. Mean changes in outcomes were compared between groups using paired t-tests. Results: Of 97 survivors enrolled, 78 completed the study (53 in the intervention group, 25 in the control group), the mean age was 12.7 (SD 1.1), 80% were white, and 55.1% were female. The intervention group increased their MVPA over time (mean change in weekly MVPA: 4.7 minutes [SD 119.9]), while the control group steadily decreased their weekly MVPA (-24.3 minutes [SD 89.7]) (p = 0.30). In the intervention group, mean change in hand grip strength (p = 0.01), number of sit-ups (p < 0.01) and push-ups (p < 0.01), neurocognitive measures (e.g. verbal executive function, p < 0.01), and HRQoL outcomes (e.g. overall HRQoL, p = 0.01; physical function, p = 0.01) improved over time; no change was observed in the control group. Conclusions: These preliminary findings indicate that increasing MVPA via an intervention designed to increase motivation to exercise may have positive effects on fitness, neurocognitive and HRQoL outcomes in adolescent survivors of childhood cancer. Clinical trial information: NCT01778127.
Increasing physical activity in cancer survivors using eHealth: A focus group study.
Authors: Haberlin Ciaran , Moran Jonathan , Broderick Julie M , O'Donnell Dearbhaile M.
Published: May 2018

107

Background: Physical activity (PA) is beneficial in reducing disease and treatment related side‐effects of cancer. However, insufficient PA levels are common among cancer survivors. eHealth may offer an innovative delivery platform to support cancer survivors to increase PA. Few qualitative studies have explored the views of cancer survivors towards eHealth based PA interventions. Our aim was to use cancer survivors’ input to inform the design of a feasibility study of eHealth for PA promotion. Methods: A ten-item scoping questionnaire-based cross-sectional study was administered to 102 cancer survivors. It evaluated their knowledge of PA guidelines, their access to smartphones and interest in eHealth interventions designed to increase PA levels. Questions were refined and evaluated in a follow-up focus group study (7 groups, n=23). Focus groups were audio recorded and transcribed. Transcripts were coded using NVivo software and themes identified by thematic content analysis. Results: In the questionnaire study, only 17.6% (n=18) of participants correctly identified PA guidelines. Sixty-two (60.8%) participants reported having access to a smartphone. Interest in participating in an eHealth intervention was expressed by 56.9% of all participants (n=58) and by 75.8% (n=47) of those with access to a smartphone. Emergent themes from the focus groups included: the physical barriers to PA, the need for PA goals, the importance of both information from healthcare professionals about PA and of a support network (e.g. peer support), the need for technological support and a motivation to improve general health. Conclusions: Very few cancer survivors were aware of the correct PA guidelines. However, over half of our sample was interested in participating in an eHealth intervention for PA, demonstrating that the cancer survivor population is responsive to a PA program delivered using technology. The focus groups have given us insights about the key elements of an effective PA intervention for cancer survivors using eHealth. We are conducting a feasibility study (The IMPETUS study; NCT03036436) of an eHealth intervention targeting PA in cancer survivors; its design was informed by those insights.
Cancer patient attitudes and preferences towards smoking status assessment.
Authors: Eng Lawson , Liu Sophia Yijia , Zhang Qihuang , Farzanfar Delaram , Milne Robin , Yeung Sabrina , Brown M Catherine , Howell Doris , Xu Wei , Goldstein David Paul , Jones Jennifer M. , Selby Peter , Evans William K. , Giuliani Meredith Elana , Liu Geoffrey
Published: May 2018

110

Background: Continued smoking after a cancer diagnosis is associated with poorer outcomes. As smoking cessation is an important part of cancer care, understanding pt attitudes towards smoking status assessment will help with integrating smoking cessation programs into survivorship care. Methods: Cancer pts were surveyed on their smoking history, assessment rates and attitudes/preferences towards smoking status assessment. Multivariate logistic regression models assessed for factors associated with screening preferences. Results: Among 501 pts, 115 smoked at diagnosis, 60% quit after; 53% had a tobacco related (lung/head and neck) cancer (TRC); 40% reported that their smoking status was assessed only on their first clinic visit, while 32% were assessed at a few visits and 12% all visits. Most felt smoking status should be assessed at the first visit (95%), while half (58%) felt it should be assessed each visit. Most felt comfortable with being assessed (96%), felt it was important for clinicians to be aware of smoking status (98%) and that smoking cessation discussions should occur at the first visit (87%). Most preferred being assessed by their oncologist (88%); less than half preferred being asked by another healthcare provider (44%), on paper (29%) or e-surveys (32%). Compared to ex/never smokers, current smokers were assessed more often at every/most visits (36% vs 20% P= 0.001) and were less comfortable with being assessed (88% vs 98% P< 0.001). Among current smokers, lung cancer pts were more agreeable (58%) to being assessed each visit compared to head/neck (aOR 2.48 95% CI [0.9-6.5] P= 0.06) and non TRCs (aOR 2.63 [1.0-6.8] P= 0.05). Among all, pts who are older (aOR 1.03 [1.0-1.1]), curative (aOR 1.92 [1.1-3.2]) and smoked less (aOR 0.98 per pkyr [0.97-0.99]) were more agreeable to assessment at each visit. Most pts also felt oncologists should screen for second hand smoke exposure (92%), felt its assessment was important (93%) and should help others who smoke to quit (68%). Conclusions: Most cancer pts felt that assessment of smoking status was important, were comfortable being assessed and preferred being assessed directly by their oncologist. Routine screening of those currently smoking is recommended to help with cessation.
Long-term risk of cardiovascular disease among colorectal cancer survivors in a population-based cohort study.
Authors: Baraghoshi David , Hawkins Makenzie L. , Abdelaziz Sarah , Park Jihye , Wan Yuan , Fraser Alison M , Smith Ken R , Deshmukh Vikrant , Newman Michael , Rowe Kerry G. , Snyder John , Lloyd Shane , Samadder Niloy Jewel , Hashibe Mia
Published: May 2018

113

Background: In the United States, colorectal cancer is the fourth most common cancer and one of the leading causes of cancer death. Few studies have examined the relationship between colorectal cancer survivorship and long-term cardiovascular disease (CVD) risk. Methods: Individuals diagnosed with colorectal cancer were identified using the Utah Population Database. For a comparison group, up to 5 cancer-free individuals were matched by birth year, birth state, follow-up time and sex to each cancer case. For individuals with > 10 years of follow-up, we estimated CVD risk > 10 years after cancer diagnosis. Cox regression models were used to estimate hazard ratios (HR) and 95% Confidence Intervals. Results: Among 1,749 colorectal cancer survivors who had survived for at least 10 years, 1,001 (57.2%) were diagnosed with CVD > 10 years after cancer diagnosis. Compared to the general population, colorectal cancer survivors had an increased risk of CVD > 10 years after cancer diagnosis: HR = 2.84 (95% CI = 2.59, 3.11) for hypertension; HR = 2.66 (95% CI 2.37, 2.98) for diseases of the heart; HR = 3.91 (95% CI = 3.33, 4.58) for diseases of the arteries, arterioles and capillaries; HR = 2.58 (95% CI = 2.46, 2.99) for diseases of the veins and lymphatics; HR = 2.98 (95% CI = 2.36, 3.76) for cerebrovascular disease. Colorectal cancer survivors with ≥1 comorbidity had an increased risk of CVD > 10 years after cancer diagnosis compared to survivors with no comorbidities (HR = 1.7, 95% CI = 1.49, 1.95). Colorectal cancer survivors who were ≥65 years had an increased risk of CVD > 10 years after cancer diagnosis. Colorectal cancer survivors who were obese at the time of diagnosis had an increased risk of CVD > 10 years after cancer diagnosis when compared to survivors with normal BMIs (HR = 1.25; 95% CI = 1.06, 1.49). Conclusions: Compared to the general population, colorectal cancer survivors had an increased risk of CVD during the > 10 year follow-up period. Within colorectal cancer survivors, there was an increased risk of CVD for those that were older, had ≥1 comorbidity and were obese. The increased risk of CVD among survivors may be attributable to the lifestyle risk factors shared by colorectal cancer and CVD.
Cardiovascular disease risk after treatment-induced primary ovarian insufficiency in female survivors of Hodgkin lymphoma.
Authors: Van Leeuwen Flora , Krul Inge , Opstal-Van Winden Annemieke , Janus Cecile P.M. , Daniels Laurien , Maas Angela , Van Nimwegen Rianne , de Vries Simone , Hauptmann Michael , Józwiak Katarzyna , Aleman Berthe M.P.
Published: May 2018

114

Background: Female survivors of Hodgkin lymphoma (HL) treated with alkylating chemotherapy (CT) and/or pelvic radiotherapy (RT) have an increased risk of primary ovarian insufficiency (POI). Among women with a natural menopause, POI has been associated with increased risk of cardiovascular disease (CVD). We examined whether treatment-induced POI increases long-term CVD risk in HL survivors. Methods: From a large Dutch cohort of 5-year HL survivors, we selected 918 women who were treated before 41 years of age between 1965 and 2000. Data on HL treatment, menopausal status and cardiovascular events (ischemic heart disease (IHD), heart failure (HF) and valvular heart disease (VHD)) were obtained from medical records, general practitioners and patient questionnaires. CVD risks were estimated with Cox regression models using time-dependent covariates and attained age as the time scale. Results: After a median follow-up of 24 years, 299 out of 918 women (33%) had developed POI (median menopausal age, 34 years). We identified 463 cardiovascular events in 300 women, of whom 85 developed CVD after POI. POI was not associated with subsequent CVD risk (HR:0.85, 95% CI 0.62-1.16) compared with a menopausal age of ≥40 years. Compared with women who reached menopause at ages ≥50 years, the HRs for menopausal ages of < 30 years, 30-39 and 40-49 years were 0.90 (95% CI 0.52-1.56), 0.87 (95% CI 0.57-1.33) and 0.96 (95% CI 0.64-1.44), respectively. Furthermore, a short duration of intact ovarian function after HL treatment ( < 5 years) did not increase CVD risk compared to a long duration (≥25 years) (HR:0.72, 95% CI 0.44-1.20). 177 women had used HRT, of whom 115 (65%) with POI (median duration of HRT use, 8.3 years). Women who used HRT for ≥5 years did not have a higher CVD risk than non-HRT users (HR 1.02, 95% CI 0.64-1.62). Similar results were found in analyses with IHD, HF and VHD as separate outcomes. Conclusions: POI and duration of post-treatment intact ovarian function did not affect CVD risk in HL survivors, suggesting that an early artificial menopause does not increase CVD risk.
Fertility preservation use and outcomes among young adult cancer survivors.
Authors: Rosenberg Shoshana M. , Partridge Ann H. , Poorvu Philip Daniel , Casillas Jacqueline N. , Ganz Patricia A. , Jacobs Linda A. , McCabe Mary S. , Overholser Linda , Palmer Steven C , Rajotte Emily Jo , Risendal Betsy C , Rosenstein Donald , Syrjala Karen Leslie , Baker K. Scott
Published: May 2018

115

Background: Fertility is a critical survivorship issue for young adults (YA) with cancer. Data regarding use of fertility preservation (FP) and fertility outcomes in this population are limited. Methods: In 2013-2014, 868 patients, aged 18-39, 1-5 years post diagnosis (dx) of an invasive cancer completed a survey about the impacts of cancer and treatment including fertility. Descriptive statistics were used to characterize FP options pursued, reasons for not undergoing FP, and pregnancy outcomes. Logistic regression was used to identify factors associated with pre- treatment FP. Results: Median age at dx was 32. Most respondents were female (73%), married (61%), with a college degree (71%). Breast (28%), thyroid (15%), and lymphoma (13%) were the most common dx. 13% (77/614) of women and 36% (82/231) of men reported FP attempts prior to treatment, including 57% of testicular, 39% of lymphoma, 27% of leukemia, and 18% of breast cancer survivors. In men, sperm banking (96%) was the most common approach; in women, embryo (47%) and oocyte (23%) cryopreservation. Of those who did not pursue FP (N=686), 19% reported lack of information on risks/options as the reason. In multivariable analyses, FP was associated (p<0.05) with male gender, younger age, chemotherapy, being married, and having a college degree; survivors who had children prior to dx were less likely to pursue FP (Table). Of 60 men who tried to father a pregnancy, 42 (70%) were successful and 37 (88%) conceived naturally. Of 114 women who attempted pregnancy, 83 (73%) were successful, 76 (92%) conceived naturally. Conclusions: Some YA patients are not aware of treatment risks and FP options, indicating that fertility may be under-addressed. In our sample, nearly all patients who reported attempting pregnancy within 5 years of dx conceived naturally, suggesting that a risk stratified approach may help optimize use of FP services. [Table: see text]
Patient-reported survivorship care practices and late effects after treatment of Hodgkin (HL) and non-Hodgkin lymphoma (NHL).
Authors: Frick Melissa , Vachani Carolyn , Hampshire Margaret K. , Bach Christina , Arnold-Korzeniowski Karen , Metz James M. , Hill-Kayser Christine E.
Published: May 2018

119

Background: Multimodal treatment of HL and NHL yields excellent outcomes, however, survivors are at risk for developing myriad late- and long-term effects (LLTEs). We describe survivorship care practices and LLTEs reported by HL/ NHL survivors. Methods: From a convenience sample of 964 HL (37%) and NHL (63%) cancer survivors using a publicly available Internet-based survivorship care plan (SCP) tool between 2011-2016, we examined cancer care and toxicity profile data. Results: Of all survivors, 67% were female and 84% were Caucasian; median age of diagnosis was 28y for HL and 49y for NHL survivors with median fu of 5y and 2y, respectively. 88% were free of cancer, 9% with recurrent or secondary malignancy, and 3% with metastatic disease. Chemotherapy was delivered to 89% of HL and 94% of NHL survivors, and radiation (RT) to 64% and 28%, respectively. Of those receiving RT, 96% (n = 217) HL and 61% (n = 106) NHL survivors received chest/mantle RT. Few reported receipt of previous SCP (13%) or treatment summary (4%). Most reported continued care from an oncologist (49%) or in combination with a PCP (19%). A shift to PCP management alone was observed, increasing from 2% of survivors if < 2y fu to 30% once ≥2y fu. Survivors who received chest RT reported: hyper- or hypothyroidism (35%), thyroid nodules (8%), speaking/swallowing changes (20%), heart disease (14%), pulmonary fibrosis/pneumonitis (12%), and skin cancers within the RT field (9%). 6 of 321 (2%) who received chest RT reported secondary breast cancers, compared to zero in the group not receiving chest RT with median time to breast cancer 20.5y (R 6-32 years). Receipt of chemotherapy was associated with: chronic fatigue (56%), cognitive change (56%), peripheral neuropathy (35%), sexual changes (15% of males, 35% of females), and heart disease (10%). Conclusions: While this population achieves excellent disease outcomes, survivors report a substantial burden of LLTEs, suboptimal delivery of survivorship information, and transitions of care in follow-up. Multiple opportunities thus exist through which SCPs may be used to improve awareness regarding survivorship/ LLTEs and communicate follow-up care plans between survivors and treatment teams.
Availability of therapeutic sexual aids for cancer survivors: A survey of major cancer centers.
Authors: Bober Sharon , Michaud Alexis L , Recklitis Christopher J.
Published: May 2018

134

Background: Treatment-related sexual dysfunction is a distressing problem for many cancer survivors. Cancer treatment guidelines recommend therapeutic aids for sexual health rehabilitation (e.g., vaginal dilators, moisturizers, vacuum erection device). However, survivors often don't know how or where to access sexual aids or may be uncomfortable procuring them. 25 NCI-designated Cancer Centers/NCCN-member institutions were surveyed about availability of sexual aids and resources for survivors. Methods: Using phone and internet, potential sources of aids/resources at each center (e.g, custom boutiques, specialty retail shops) were identified. Relevant retail staff at each center were approached by phone and using a structured script, study staff queried about the availability of aids/resources. Separate calls were made regarding aids for men and women. Additional inquiry included access to aids elsewhere at the cancer center and recommendations for accessing resources if none were available. Results: Of the 25 cancer centers contacted, 23 responded about men and 22 responded about women. Two centers never responded to multiple attempts. Of the centers contacted, 87% reported having no sexual aids for men and 72% had no aids for women. One center carried a vacuum device and two had penile support rings. Six centers had some aids for women, most commonly reported were personal lubricants, moisturizers and dilators. One center stood out, having several types of aids for men and women. Additional recommendations were limited to suggesting a local pharmacy or doing an internet search. Conclusions: In contrast to other widely available cancer care products, e.g., wigs and prosthetics, availability of sexual aids and resources at major cancer centers is very low. The stark absence of sexual aids underscores the cultural taboos around cancer-related sexual dysfunction. Efforts to improve availability of sexual aids for survivors would likely promote sexual health rehabilitation and validate this under addressed aspect of cancer survivorship.
Psychosexual functioning in sexually active female survivors of childhood cancer.
Authors: Bjornard Kari L. , Howell Carrie R , Klosky James L. , Chemaitilly Wassim , Srivastava Deo Kumar , Brinkman Tara M. , Green Daniel M. , Willard Victoria W , Jacola Lisa M , Krasin Matthew J. , Hudson Melissa M. , Robison Leslie L. , Ness Kirsten K.
Published: May 2018

136

Background: Childhood cancer survivors (CCS) may be at risk for low psychosexual function. We estimated the prevalence of low psychosexual function among female CCS, and evaluated associations with treatment exposures. Methods: 712 female CCS (mean age at assessment 31.2±7.71 years, at diagnosis 7.00±5.58 years; 31.3% acute lymphoblastic leukemia, 12.5% Hodgkin lymphoma) and 122 non-cancer controls enrolled in the St. Jude Lifetime Cohort Study completed a clinical assessment, reported sexual activity with or without a partner in the preceding month, and filled out the Sexual Functioning Questionnaire (SFQ) (25 items averaged to create overall and subscale scores ranging 0-5; lower is worse). CCS with SFQ scores < 10th percentile of controls were classified as low function. Linear models, adjusted for age, were used to compare SFQ scores. Associations between CCS characteristics and psychosexual function were evaluated using logistic regression. Results: 19.9% of CCS had low psychosexual function with a lower mean overall SFQ score than controls (3.19 vs. 3.47, effect size 0.4; p < 0.01). The most common impairments among CCS were performance problems (27.4%), orgasm (24.2%), satisfaction (17.6%), interest (17.2%), desire (15.4%), and arousal (12.5%). Survivors with low function reported poor quality of life in both physical (21.1% vs. 12.7%, p = 0.01) and mental health (36.5% vs. 18.2%, p < 0.01) domains compared to those without. Untreated hypogonadism was associated with low function (OR 3.20, 95% CI 1.69-6.42) for the performance problems subscale. Compared to controls, CCS with germ cell tumors (OR 8.82, 95% CI 3.17-24.50), renal tumors (OR 4.49, 95% CI 1.89-10.67) and leukemia (OR 3.09, 95% CI 1.50-6.38) were at greatest risk for low function. Though 40.7% of CCS perceived a higher risk for low psychosexual function compared to other women their age, only 2.9% reported receiving an intervention. Conclusions: Low psychosexual function is prevalent among female CCS. CCS with low psychosexual function also report poorer quality of life and more psychological symptoms. Research is necessary to identify additional risk factors that characterize high-risk survivors who would benefit from targeted screening and intervention.
Utilization of the sexual health service from the prostate cancer supportive care program: A chart review.
Authors: Bossio Jennifer , Zarowski Christine , Elliott Stacy , Hedden Lindsay , Pollock Phil , Spillane Maria , Wu Eugenia , Nunez Natalie , Branch Anna , Goldenberg Larry , Higano Celestia S.
Published: May 2018

137

Background: Sexual dysfunction and psychological distress are two of the most important unmet supportive care needs of prostate cancer (PC) patients (pts). The Sexual Health Service (SHS) from the Prostate Cancer Supportive Care Program at the Vancouver Prostate Centre addresses the sexual recovery needs of PC pts and their partners via education and clinical service. This study explores patient characteristics and needs to better understand SHS utilization. Methods: Data was obtained from patient charts, semi-structured interviews, and patient-reported outcome measures from July 2013-June 2017. Analyses include descriptive statistics and pre-post comparisons via parametric (paired t-tests) or non-parametric (Wilcoxon) tests. Results: Data from 667 pts was analysed. Average age was 65yrs ( SD= 7.3, 43-88yrs) and most were in a relationship (79.6%; mean length = 30.5 yrs, SD= 15.2yrs, 9 mos–68yrs). Appointments were attended with partners (42.3%) or alone (56%) and most pts had undergone surgery for their PC (81.8%). Other treatments included radiation (18.2%), androgen deprivation therapy (13.3%), chemotherapy (1.0%), some had multiple treatments. Average time since end of PC treatment to first SHS appointment was 18 mos ( SD= 25.7mos; range, 0-17yrs). At the first SHS appointment, mean self-reported erectile functioning indicated severe dysfunction (IIEF scores: M =6.39, SD= 5.22). Pts reported significant decreases following PC treatment in: quality of erections, orgasm intensity, sexual desire, partner’s sexual desire, men’s sexual self-view, sexual body image and overall sexual satisfaction ( p’s < .01). Patients also reported lower levels of partner intimacy ( p= .003). At first SHS appointment, 34.5% of patients reported one significant ongoing life stressor, and 23.8% reported more than one. Most common life stressors were health (29.4%), family (23.8%), work (15.3%), relationship (8.8%) and financial (6.9%). Conclusions: Analyses support the need for the SHS, as pts report declines in all realms of sexual wellbeing and ongoing life stressors. Findings improve our understanding of the long-term impacts of PC treatment and guide future treatment offerings.
Designing a survivorship and supportive care center at a comprehensive cancer center.
Authors: Amato Katharine , Glaser Kathryn M. , Beaupin Lynda M. , Rokitka Denise A. , Reid Mary E.
Published: May 2018

159

Background: Unmet physical, psychosocial, and other support needs of cancer survivors may lead to increased distress, anxiety, and decreased quality of life. Survivorship Clinics may be tailored for specific issues identified through a needs assessment. Methods: An invitation to complete a web-based survey was mailed to 35,420 active patients at a comprehensive cancer center in November 2015. The survey domains included demographics, cancer history, comorbidities, lifestyle, cancer prevention, spiritual and emotional support, symptom management, and interest in specific services. Results: 1,054 surveys were completed. The majority of respondents were female (55.2%; n = 582/1054), had Stage I cancer at diagnosis (43.9%; n = 360/820), and had completed treatment (69.0%; n = 727/1054). Genitourinary (23.0%; n = 238/1034) and breast (20.5%; n = 212/1034) were the most common cancer types among the respondents. Participants identified an average of 4.60 side effects experienced during or after treatment (n = 804); the most common were fatigue (64.5%), pain (37.3%), weight change (33.4%), sleep disturbance (30.2%), and gastrointestinal problems (29.4%). One third of participants reported having a physical side effect that caused anxiety and emotional distress (33.3%; n = 331/995), in particular, sexual function (69.7%; n = 136/195) and cognitive dysfunction (43.6%; n = 85/195). A total of 23.9% of participants had financial concerns due to costs of cancer treatment (n = 238/955). Participants were interested in integrative therapies, most notably yoga (75.1%; n = 289/385), acupuncture (72.4%; n = 155/214), aerobics (62.3%; n = 240/385), Swedish massage (60.5%; n = 225/372), aromatherapy (60.2%; n = 224/372), and homeopathy (55.1%; n = 118/214). Most respondents endorsed wanting information on nutrition (81.5%; n = 380/466). Conclusions: Cancer survivors report vast physical and psychosocial needs during and after cancer treatment, and they have a high interest in nutrition education and integrative therapies. Improved care coordination from a dedicated cancer survivorship and supportive care clinic at a comprehensive cancer center may specifically address survivors’ issues.
Elucidating the endocrine therapy experience of South Carolina breast cancer survivors.
Authors: Bedi Julie Summey , Charron Elizabeth , Franco Regina A. , Olinger Matt , Dickes Lori , Mayo Rachel
Published: May 2018

186

Background: Literature consistently shows high discontinuation and non-adherence rates for patients taking endocrine therapy (ET) for breast cancer treatment. The aim of this study is to understand from the breast cancer survivor perspective which modifiable aspects have the greatest impact on the likelihood of ET continuation. Methods: Twenty-two hormone receptor-positive breast cancer survivors under age 64 who had been prescribed ET since 2000 were recruited for participation in focus groups conducted in four South Carolina locations. Qualitative data analysis was completed by a three-member team using an inductive narrative approach. Themes were examined by participant decision to continue or discontinue ET. Results: Participants’ conversations centered around a quality of life cost-benefit analysis that they felt was unique to the individual and could not be generalized by providers. Main themes included the significance of the patient/provider relationship, the desire for a more holistic approach to care, and the need for affirmation in the decision to take ET (i.e. through breast cancer social network, family, faith, research). There was clear support for the utility of multidisciplinary cancer care teams. The roles of nurse navigator and rural pharmacist were specifically highlighted. Participants expressed concerns regarding ET’s damage to their bodies, and participants discussed the dilemma of not having enough time to spend caring for self. Conclusions: The few studies that have addressed currently used interventions to improve adherence showed little to no improvement over usual care. It is imperative that research be conducted that employs a patient-centered perspective. Knowledge gained through further study exploring patient concerns, multidisciplinary teams, and holistic care are needed. There is also a need for novel patient-centered interventions in research to improve compliance and enhance the ET experience for breast cancer survivors.
Serial concept mapping: A tool to assess the evolution of medical student learning about cancer survivorship.
Authors: Fogarasi Miklos C. , Eichengreen Roy P
Published: May 2018

21

Background: Concept mapping (CM) fosters meaningful learning yet its use in cancer education is rare. Serial CM as a learning tool may offer novel ways to promote critical thinking about complex medical issues. We introduced CM in our Cancer Survivorship (CS) elective to study the evolution of students’ conceptual learning, to offer feed-back and as a tool for inter-professional and team-based education. Methods: The study was funded by an institutional grant and received IRB exemption. Eleven 2nd year medical students and 2 pre-med students enrolled. Oncologist-lead classes were co-facilitated by a primary care physician, a survivor, caregivers or other health care professionals. Students were trained using cMAPTools on week 1 and applied domains of the Quality of Life (QoL)-CS tool by City of Hope to their CMs. Feedback given after each round of mapping assessed adequate use of CS concepts and creation of meaningful linkages. Results: Map #1 (week 1) tested baseline perceptions. These maps displayed a wide-range of complexity, a largely non-hierarchical structure with rare connections and a sense of overload by the scope of CS issues. Map #2 (week 4) explored physical and spiritual challenges of CS from a primary care physician and a cancer survivor. Here improved maps presented concepts more clearly but linear thinking with limited crosslinks was still observed. Map #3 (week 8) about social aspects of CS followed lively sessions with a social worker and family caregivers. Emerging cross-links reflected a deeper understanding of survivor issues. Final CMs will be based on interviewing a panel of survivors and should aid students in creating a thorough Survivorship Care Plan. Team-based and inter-professional maps were well received. Conclusions: Serial concept mapping exposes progressive understanding of Survivorship issues during a one-semester elective. CM facilitates the learning of relationships among complex survivorship topics. Inter-professional and team-based CM is feasible. By mapping issues to QoL domains, students practice patient-centered critical thinking. Challenges include low reproducibility due to changing concepts, and limited practicality once concepts grow too large.
A social ecological study of access to breast cancer survivorship services.
Authors: Lefkowitz Deborah
Published: May 2018

31

Background: Survivorship research has largely focused on the survivorship care plan and the transition back to primary care. Long-term survivor service needs remain understudied, particularly in the fragmented healthcare systems where many Americans receive their care. While numerous services support breast cancer patients through treatment, there is a sharp drop-off once treatment has been completed. This study investigated survivors’ post-treatment service access and use in a geographically dispersed, medically underserved population. Methods: Using a social ecological framework to analyze the interplay of individuals, healthcare facilities, and community resources, this study combined in-depth, semi-structured interviews with survey data from 75 breast cancer survivors across 27 cities in a two-county Affordable Care Act rating area. Interviews focused on challenges of access, available resources, and how resources were used. Surveys recorded service use, referral sources, and unmet needs across 27 services (e.g., psychosocial, financial, lymphedema) and information sources (e.g., online, support group, print materials). Results: Survivors ranged in age from 25 to 87, and 0 years of survivorship (still in active treatment) to 41 years (54% at 5+ years, 27% at 10+ years, and 12% at 20+ years). Access to survivorship services was accomplished in community settings (e.g., breast cancer nonprofits) more often than in medical facilities. In-person support groups were the most widely used resource, even by long-term survivors (over 40% were survivors of 5+ years), and played a key role in providing access to other services and information (e.g., nutrition, yoga). Many survivors addressed the lack of services through resourceful do-it-yourself solutions. Nevertheless unmet needs remained across the service spectrum. Conclusions: Community-based resources were pivotal in enabling access for a dispersed, underserved population and may serve as high-leverage points for interventions in healthcare systems. Research was supported by the National Cancer Institute of the National Institutes of Health under Award # F31CA192478.
Overcoming suvivorship care planning implementation challenges through decentralization.
Authors: Rosenberg Carol A. , Hensing Thomas A. , Brockstein Bruce , Green Linda , Patel Anisha , Still Nadia , Wujcik Debra , DiGiovanni Laura , Tilley Carrie , Stricker Carrie Tompkins
Published: May 2018

38

Background: To meet Commission on Cancer accreditation requirements, cancer programs must implement processes to monitor the dissemination of survivorship care plans (SCP) for patients with Stages I-III cancers who were treated with curative intent and completed active therapy. Challenges of SCP delivery across disease sites include lack of designated/trained staff, time burden, knowledge of current evidence-based guidelines, and sustainability. We describe the challenges NorthShore University HealthSystem Kellogg Cancer Center (NKCC) and their Living in the Future (LIFE) Cancer Survivorship Program faced in meeting this standard and how evolving the SCP delivery process has resulted in a sustainable model. Methods: LIFE implemented a technology-based SCP tool using a centralized consultative model led by a nurse practitioner (NP) with specialized survivorship training. Physicians referred eligible patients to the survivorship clinic for an education visit where they received a SCP from the NP. Since the centralized model was dependent on one person for delivery, a more sustainable model was needed. NKCC transitioned to a decentralized process, moving SCP creation and delivery responsibility to all oncology care providers (OCPs). Although not all OCPs had specialized survivorship training, care quality was supported by automated SCP creation based on evidence-based care recommendations embedded in the technology. Results: To date, 143 evidence-based SCPs have been delivered since tool implementation in April 2017. During the centralized model (April 25– June 30) 67 SCPs were created by the lead LIFE NP; 76 were created during the decentralized process while the lead NP was on leave (July 3 – Oct 1). By using a technology-based SCP, OCPs incorporated SCP delivery into their workflow and no longer had to refer patients to a separate clinic. Conclusions: This project demonstrates the feasibility of a sustainable, decentralized process using a technology-based SCP as an option for augmenting centralized SCP delivery. A comparable number of patients received a SCP during both processes with an equivalent number of SCPs being delivered via the decentralized model by OCPs supported by evidence-based technology.