bluuebunny/crossref_metadata_2025 huggingface dataset:
Total and cancer-attributable phase-based costs for adolescent cancer care: A population–based study in British Columbia, Canada.
Authors: McBride Mary L , Duncan Ross , Bremner Karen , De Oliveira Claire , Liu Ning , Nathan Paul C. , Rogers Paul C. , Peacock Stuart , Krahn Murray Dale
Published: March 2017

12

Background: Cancer among adolescents presents unique issues regarding diagnosis, treatment, late effects, and survival; but little is known about their healthcare costs, which are useful for economic evaluations and planning care. This study estimates total and cancer-attributable (net) medical costs for a population-based adolescent cancer cohort in British Columbia, Canada, by phase of care. Methods: Patients diagnosed with cancer aged 15 to 19 years from 1995 to 2009 were identified from the British Columbia Cancer Registry, and followed to December 31st2010. Data were linked with clinical and provincial administrative healthcare databases covering all medically-necessary costs. Total resource-specific costs (Canadian $ 2012) by phase of care were estimated for all patients and specific common cancers. Net costs were calculated by subtracting healthcare costs for propensity-score-matched provincial samples of adolescents without cancer from cancer patient costs. Results: Of the 750 cases, approximately 26% had lymphoma, 17% germ cell, 14% bone and soft tissue sarcomas, 12% central nervous system (CNS), and 11% leukemia; 94% survived > = 1 year. Total mean pre-diagnosis costs per patient were $3657, of which $3554 was attributable to the cancer. First-year mean costs were $60,531 ($59,826). Continuing phase mean costs were $8,413 ($7,708). Final year of life mean costs were $224,243 ($221,018). Cancer types with highest costs were CNS (pre-diagnosis), leukemia (first-year); bone and soft tissue (continuing), and leukemia (end-of-life). Virtually all inpatient hospitalizations were cancer-related, representing ~40% of pre-diagnosis, ~62% of first-year, ~56%of continuing, and ~72%of end-of-life costs respectively. Conclusions: Management of adolescent cancer is costly, but is lower than for childhood cancer in all phases of care. Total costs, cancer-attributable costs, and inpatient activity were highest in the end-of-life period. Hospitalizations were the largest driver of costs in all post-diagnosis phases of care. Costs in the continuing phase, including surveillance and care for late effects, were 14% of first-year phase costs.
Visual functioning in adult survivors of retinoblastoma.
Authors: Friedman Danielle Novetsky , Chou Joanne F. , Ford Jennifer , Francis Jasmine , Sklar Charles A. , Li Yuelin , McCabe Mary S. , Robison Leslie L. , Kleinerman Ruth , Marr Brian , Abramson David H. , Oeffinger Kevin C. , Dunkel Ira J.
Published: March 2017

122

Background: Retinoblastoma (Rb) survivors are at risk for adverse oculo-visual outcomes. Limited data are available regarding long-term visual functioning among adult Rb survivors. Methods: Rb survivors, diagnosed from 1932–1994 and treated in New York, completed a comprehensive questionnaire that included the National Eye Institute Visual Function Questionnaire (VFQ-25), which measures self-reported vision-targeted health in individuals with chronic eye diseases. Items are scored from 0–100 with 100 representing the best possible score. Results: 470 adult Rb survivors participated (53.6% with bilateral disease; mean age at study 43.3 yrs, standard deviation [SD] 11); 86% had at least one eye removed (one eye: 74.5%; both eyes: 11.5%) and 53.4% were treated with radiotherapy. 61.3% rated their eyesight as excellent/good while 16.5% reported complete blindness. Among Rb survivors with some vision, 4% described staying home “most of the time” due to their eyesight and 12% reported often feeling frustrated due to their visual status. The overall VFQ composite score for all Rb survivors was 89.2 (SD 10.1) [unilateral Rb survivors: 92.2 (SD 6.3); bilateral Rb survivors: 84.1 (SD 13.0); p < 0.001).Survivors with bilateral disease were significantly more likely to report inferior visual functioning in all domains when compared to those with unilateral disease (Table 1). Conclusions: Rb-related ocular problems continue to impact survivors’ functional status into adulthood, particularly among those with bilateral disease. [Table: see text]
The effect of cerebellar tumor resection on pain perception in pediatric patients.
Authors: Silva Katie E. , Rosner Julia , Ullrich Nicole A. , Chordas Christine , Becerra Lino , Manley Peter E. , Moulton Eric A.
Published: March 2017

126

Background: Acute cerebellar infarctions have been shown to lead to affective and cognitive deficits in pediatric patients. However, the consequences of cerebellar insult on pain processing are unknown. Recent evidence not only suggests that the cerebellum plays a role in affective processing, but it also demonstrates increased activity in this area when individuals experience experimental or clinical pain, particularly in the posterior cerebellum. The goal of this study is to evaluate the effect of cerebellar resection of low-grade astrocytomas in children on pain perception. Describing the impact of this treatment may be of particular importance in children, as it may alter sensory development into adulthood. Methods: Twelve pediatric patients treated with surgery only for non-malignant astrocytomas (mean age = 13.78 ± 5.64) and ten age-, gender-, race- and handedness-matched healthy controls (mean age = 14.52 ± 5.96) were evaluated using quantitative sensory testing and magnetic resonance imaging, comprising diffusion tensor imaging, resting state and event-related functional MRI scans. Five of these patients had tumors localized to the posterior cerebellar hemispheres. The psychophysical measures assessed included heat and cold detection thresholds (HDT, CDT), heat and cold pain thresholds (HPT, CPT), and cold pain tolerance using a cold pressor task. Results: Patients with lesions in the posterior cerebellum (n = 5) were shown to have a significantly lower tolerance to the cold pressor test than controls (n = 10). No significant differences were detected for the threshold measures. This suggests increased pain sensitivity in these patients to suprathreshold noxious stimuli compared to controls. Patients with lesions that did not include the posterior cerebellar hemispheres (n = 7) did not show significant differences with controls in terms of cold pain tolerance or thresholds. Conclusions: The differences in cold pain tolerance between patients and controls are presumed to result from damage to the posterior cerebellar hemispheres, potentially interfering with the modulation of pain pathways. Analysis of the preliminary imaging data is underway and recruitment is ongoing. Support: NIH/R21CA185870(EM)
A novel strategy to build research capacity in survivorship science.
Authors: Rodriguez Maria Alma , Suarez-Almazor Maria E. , Lewis-Patterson Paula A. , Palos Guadalupe R.
Published: March 2017

13

Background: The steady increase in cancer survivors supports the need for robust clinical and translational survivorship research. Yet, supportive environments and infrastructures to accelerate progress in survivorship research remains relatively limited. This abstract describes the implementation and initial outcomes of an institution’s unique approach to enhance their research capacity in survivorship science. Methods: An executive leadership team championed the formation of a research infrastructure based on the survivorship translational science model. Initial funding from a philanthropic foundation supported a doctoral prepared researcher and staff to provide administrative support. A 30-member Faculty Advisory Workgroup comprised of experts from different disciplines developed a conceptual and sustainability plan. Key components focused on seed money awards, trainee and professional education, and faculty development. Outcomes were measured in 5 groups: 1) seed money - number of $50,000 seed money grants awarded, external funding obtained, publications in peer-reviewed journals, and poster presentations, 2) professional and trainee educational events, i.e. number of symposia, grand rounds, trainees, participants, 3) number and type of faculty development events, and 5) infrastructure sustainability. Descriptive statistics summarize data. Results: Accomplishments achieved from 2011 – 2016 included a return on investment of a 16:1 ratio, 16 awards granted to new investigators totaling $953, 000, funding for 9 external awards resulting in a total of $15, 437, 441, 31 peer-reviewed publications, and 54 podium/oral presentations. Professional events included 8 professional symposia (784 and 325 posters), 6 institutional grand rounds, and 25 undergraduate trainees completed a research internship. Funding to sustain this program was recently awarded. Conclusions: This approach designed to build research capacity appears effective in supporting researchers in generating new evidence which can improve survivors’ outcomes.
Cardiovascular late effects among endometrial cancer survivors in a cohort study.
Authors: Soisson Sean Patrick , Ganz Patricia A. , Rowe Kerry G. , Wan Yuan , Deshmukh Vikrant , Newman Michael , Fraser Alison M , Smith Ken R , Hanson Heidi , Stanford Joseph B , Werner Theresa Louise , Setiawan Veronica , Hashibe Mia
Published: March 2017

131

Background: Endometrial cancer is the second most common cancer among female cancer survivors in the US, with an estimated 757,000 endometrial cancer survivors in 2016. Cardiovascular disease is the leading cause of death among endometrial cancer survivors. Cardiovascular disease risk may be increased among endometrial cancer survivors due to shared risk factors such as obesity or because of cancer treatment. Because of the high overall survival rate and the large number of endometrial cancer survivors, studies that examine late effects among endometrial cancer survivors are critical. Methods: Cohorts of 3,337 endometrial cancer survivors diagnosed between 1997 and 2012, and 19,420 age-matched cancer-free women were identified using the Utah Population Database. All ICD-9 diagnosis codes were collected from the state’s two largest healthcare systems and statewide ambulatory surgery and inpatient visits. Diagnoses were collapsed into cardiovascular system disorders according to the Healthcare Cost and Utilization Project’s Clinical Classification Software. Cox regression models were used to estimate hazard ratios (HR) at 1-5 years and 5-10 years after cancer diagnosis. Models were adjusted for race/ethnicity, baseline BMI, and baseline Charlson Comorbidity Index. Results: Approximately 89.4% of cancer cases were diagnosed with stage I or stage II disease. At 1-5 years after diagnosis, the highest risks among endometrial cancer survivors were observed for phlebitis and thrombophlebitis (HR: 3.36, 99% CI: 1.96-5.77), lymphatic diseases (HR: 1.89, 99% CI: 1.64-2.19), pulmonary heart disease (HR: 1.82, 99% CI: 1.36-2.43), hypotension (HR: 1.64, 99% CI: 1.18-2.29), and atrial fibrillation (HR: 1.61, 99% CI: 1.25-2.06). At 5-10 years, elevated risk persisted for these and 17 out of 66 additional outcomes among the endometrial cancer survivors. Conclusions: Endometrial cancer survivors in this population are at higher risk for various long term cardiovascular outcomes compared to cancer-free women. This study presents sufficient evidence to suggest that increased monitoring is necessary for women diagnosed with endometrial cancer in the first several years after diagnosis, and out to ten years as well.
Cancer rehabilitation outpatient consultation: Patient characteristics, symptom burden and quality of life.
Authors: Gutierrez Carolina
Published: March 2017

136

Background: Cancer rehabilitation focuses on the functional and psychological needs of cancer survivors. Patient-reported outcomes have been increasingly used as part of the standard of care during clinical encounters. We review characteristics that patients present to their outpatient cancer rehabilitation consultation at a large academic hospital. Methods: Patients presenting for their first outpatient cancer rehabilitation consultation completed a paper copy of the PROMIS-10 (Patient Reported Outcomes Measurement Information System) instrument immediately prior to meeting with the physician. It includes 10 items evaluating quality of life, social life, functional activity, mental health, pain, and fatigue. A caregiver or health care provider could provide assistance in completing the form. Patient-reported outcomes were analyzed as part of an IRB-approved protocol. Data were analyzed using descriptive statistics and the “PROMIS Scoring Global Short Form v1.0 and v1.1” (12/16/2010). T-Score distributions are standardized such that a 50 represents the average (mean) for the US general population, and the standard deviation around that mean is 10 points. Results: Twenty-seven patients presented for consultation (63% women, 37% men) from 3/2014 through 6/2015 with an average age of 54.5 (44-76 range). Disease types included 52% brain tumors, 33% breast, 5% prostate, and 1% of each of the following: melanoma, myelofibrosis, and multiple myeloma. For our population, the physical health subscale score was 11.51 with a T-Score 38.6, standard error 4.1, a T-Score more than one standard deviation below the population mean. The mental health subscale was 11.92 with a T-Score 43.5, standard error 3.6, representing less than one standard deviation below the mean. The global health score was 28.55, which fell 2 standard deviations below the population mean. Conclusions: Compared to the US population mean, cancer survivors presenting for a cancer rehabilitation consultation had lower physical health than mental health. Our findings suggest the importance of screening cancer survivors for physical impairments and providing interventions focused on functional recovery.
Late effects among head and neck cancer survivors in Utah cancer survivorship study.
Authors: Kawakita Daisuke , Abdelaziz Sarah , Chen Yuji , Rowe Kerry G. , Wan Yuan , Deshmukh Vikrant , Newman Michael , Fraser Alison M , Smith Ken R , Monroe Marcus , Hashibe Mia
Published: March 2017

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Background: Sites of head and neck are associated with chewing, swallowing and speaking. As for treatment of head and neck cancer (HNC), we have to consider organ preservation as well as clinical outcomes. Although non-surgical treatments have been preferred in recent years, complications after treatment have been a concern. The aim of this study was to evaluate the late effects in a cohort of HNC survivors in Utah compared to a matched cohort of cancer free individuals. Methods: Up to 5 cancer free individuals were matched to each HNC survivor on birth year, sex, birth state, and follow up time. Electronic medical records and statewide ambulatory and inpatient surgery data were used to identify late effects over two time periods: 1-5 and 5-10 years after cancer diagnosis. Cox proportional hazards models were used to estimate the risks of late effects. We adjusted for matching factors, race and number of hospital visit. Results: In this study, 2,432 HNC survivors and 12,149 matched controls were enrolled. More than 80% cases had loco-regional disease and a histological type of squamous cell carcinoma. Hazard ratio (HR) for second primary HNC was notably increased among HNC survivors for both 1-5 years (HR: 1498.46; 95% confidence interval (CI), 158.58-14159.69) and 5-10 years (HR: 1509.62; 95% CI, 147.94-15404.15) post cancer diagnosis. And, HRs for respiratory disease, including respiratory system, lung cancer and pneumoniae, were also increased among HNC survivors for both 1-5 years and 5-10 years post cancer diagnosis. As for hearing loss, HNC survivors had a increased HR for 1-5 years post cancer diagnosis (HR: 5.90; 95% CI, 2.67-13.01) and this association was consistent for 5-10 years post cancer diagnosis (HR: 5.01; 95% CI, 2.06-12.18). Conclusions: In this study, we found HNC survivors have notable associations with second primary HNC, smoking related respiratory disease, and hearing loss which might be associated with chemotherapy when compared to cancer free subjects.
Prevalence of vitamin D insufficiency and falls in older cancer patients.
Authors: Zhang Xiaotao , Sun Ming , Shah Jay Bakul , Dinney Colin P.N. , Popat Uday R. , Champlin Richard E. , Valero Vicente , Tripathy Debu , Hedberg Ann-Marie , Edwards Beatrice Jara-Almonte
Published: March 2017

138

Background: More than 60% of cancer patients are older adults. Such patients undergo age and cancer therapy related changes. Older adults also have geriatric risk factors for falls such as frailty, cognitive impairment (mild cognitive impairment [MCI] and dementia), and malnutrition-including vitamin D deficiency. Objective: To assess the prevalence of vitamin D insuffiency and risk factors for falls in older cancer patients. Retrospective cohort study. Methods: Patients underwent prospective data collection and retrospective analysis. Patients underwent a comprehensive geriatric assessments, including cognitive, functional, nutritional, physical, and comorbidity assessment. Vitamin D was assayed. Bone densitometry was performed. Analysis: Descriptive statistics, and multivariable logistic regression. Results: We enrolled 318 patients and 305 patients with complete data were included for final analysis. Patients were undergoing active cancer care. Patients had gastrointestinal, urologic, breast, lung and gynecologic cancers. The mean age was 78.4 ± 6.9 years. Low bone mass and osteoporosis were very common (80%) in this cohort. Twenty-six percent had one or more falls in the preceding six months. Dementia and mild cognitive impairment were seen in 33% and 37% of patients, and 53% presented frailty. In 256 patients, 48.8% (n = 125) had Vitamin D insufficiency ( < 30 ng/ml). In univariate analysis, co-morbidity (p = 0.05), frailty (p < 0.01), and cognitive impairment (0 = 0.02) were significantly associated with falls, while in multivariate analysis, frailty remained significantly associated with falls (OR = 3.51, 95%CI = 1.88, 6.52). Conclusions: Older cancer patients have a high prevalence of falls, osteoporosis and vitamin D insufficiency, raising the possibility of injurious falls (fractures). Frailty was found to be the most prominent risk factor for falls in this cohort. Greater awareness and targeted interventions such as vitamin D replacement, physical therapy, nutrition interventions, and therapy for low bone mass/osteoporosis will be effective preventing injurious falls.
Patient screening tool as input to the survivorship summary of care plan appointment.
Authors: Robinson Patricia A. , Trosman Julia Rachel , Khosla Pam , Perez Claudia B. , Shrestha Shakuntala , Garcia Sofia F. , Rosenberg Carol A. , Boecher Stephanie , Macias Javier , Berardi Rosa , Penedo Frank J. , Kircher Sheetal Mehta , Slocum Megan , Weldon Christine B.
Published: March 2017

140

Background: A review of the literature failed to identify a screening tool specific to the unique needs of cancer survivors. The Coleman Supportive Oncology Collaborative (CSOC) developed a tool to evaluate psychosocial, physical and practical concerns, and emotional distress for concurrent use during the cancer survivorship visit. Based on pilot results of the tool, minor modifications were made and tested. Methods: The CSOC (v.3) survivorship tool was used in patients (n = 49) who had completed their adjuvant therapy at one of two safety net hospitals in Chicago, IL. The CSOC v.3 screening tool items (n = 44) include: PHQ4, fear of another cancer or recurrence, financial, social and religious concerns, nutritional concerns, physical concerns, lifestyle risk factors, and treatment/care concerns. Results: The most common patient concerns included: fear of another cancer 53% (26/49), tingling in my hands/feet 53% (26/49), concerns about diet 51% (25/49), pain 51% (25/49), sleep 51% (25/49), dry skin 47% (23/49); endorsement of these concerns were not significantly associated. Of the 44 items, 16 were reported by at least 30% of patients, and 3 items were reported by less than 10% of patients. There was an average of 15 items/concerns noted by patients with a maximum of 27 items and a minimum of 5 items. Clinicians (n = 7) reported the use of the screening tool results aided the survivorship appointment discussion, directing the focus to reported patient’s concerns. Conclusions: Survivors continue to experience multiple concerns and distress, thus they may benefit from a comprehensive tool that is tailored to capture their unique survivorship needs. Administration of the tool at the beginning of the survivorship appointment provided the framework for the patient’s appointment narrative. An additional study is planned to compare use of the tool versus current practice at a large academic center.
Heart rate variability (HRV) training for symptom control in cancer survivors.
Authors: O'Rourke Mark Allen , Stokes Sherry , Regina Franco , Susko Kerri , Hendry William , Anderson Annie , Sofge Jameson , Ginsberg Jay , Burch James
Published: March 2017

148

Background: Late effects of cancer and its treatment include pain, fatigue, stress, and depression, all mediated by autonomic dysfunction. Heart Rate Variability (HRV) coherence is an established measure of optimal autonomic function. HRV coherence is achieved when the heart beat-to-beat intervals increase and decrease with respiration in a smooth rhythm. High coherence is associated with improved mood, cognition, executive function, and optimal pulmonary gas exchange. Cancer survivors have lower HRV than controls. Low HRV has been associated with early mortality, inflammation, and other adverse intermediary outcomes. HRV biofeedback (HRV-B) training improves HRV coherence, restores autonomic health, and reduces the above symptoms. HRV-B is non-pharmacologic, inexpensive, and self-maintained. This report describes a feasibility study of HRV-B in symptomatic cancer survivors. Methods: In a randomized, waitlist-controlled clinical trial, 179 were screened, 35 enrolled and 31 completed the protocol. Participants in the intervention arm received weekly HRV-B training up to six weeks. Outcome measures assessed at baseline (pre) and after week six (post) included HRV coherence plus the Brief Pain Inventory (BPI), Multi-Dimensional Fatigue Inventory (MFI), Perceived Stress Scale (PSS) and Beck Depression Inventory II (BDI-II). Data analyzed using linear-mixed models for repeated measures (SAS Proc Mixed). Results: Conclusions: Delivering HRV Biofeedback training to cancer survivors is feasible in a clinical setting. This study provides preliminary evidence that HRV-B training for cancer survivors improves HRV and reduces pain, fatigue, stress, and depression. HRV-B training has potential for symptom control in cancer survivors. Controlled, multisite studies are indicated.[Table: see text]
Subgroups of survivors with distinct aggravating factors associated with chemotherapy-induced neuropathy (CIN) in the feet.
Authors: Mastick Judy , Mausisa Grace , Mazor Melissa , Paul Steven M. , Cooper Bruce A. , Smoot Betty , Topp Kimberly , Abrams Gary , Chen Lee-may , Chesney Margaret , Kober Kord , Conley Yvette , Levine Jon , Miaskowski Christine
Published: March 2017

151

Background: CIN is the most prevalent neurologic complication of cancer treatment. Inter-individual variability exists in survivors’ reports of the factors that aggravate CIN in their feet. The purpose of this study was to identify groups of survivors with CIN in their feet based on distinct aggravating factors and evaluate for differences in demographic, clinical, symptom characteristics and quality of life (QOL) based on group membership. Methods: Cancer survivors (n = 403) who received a platinum and/or a taxane and rated their altered sensation/pain in their feet at > 3 on 0-10 scale were enrolled and completed study questionnaires, including a list of 22 factors that could make pain worse. Medical records were reviewed and sensory and motor tests were done. Latent class analysis was used to identify groups of survivors based on the occurrence rates for aggravating factors. Differences among the groups were evaluated using parametric and nonparametric statistics. Results: Three groups were identified based on occurrence rates for aggravating factors in the feet (i.e., Activity and Temperature (40.2%), Activity (25.8%), Few Factors (34.0%)). No differences were found among the groups in demographic characteristics, or sensory (light touch, temperature, pain, vibration) and motor (Timed Up and Go, Fullerton Assessment of Balance) tests. Compared to the Few Factors group, the other two groups had higher BMI, worse foot pain, poorer functional status and sleep, more depressive symptoms, and lower QOL. Survivors who received a platinum compound were more likely to be in the Activity and Temperature group. Those that received a taxane compound were more likely to be in the Few Factors or Activity groups. Conclusions: Survivors who reported a higher occurrence of aggravating factors had a higher symptom burden and poorer QOL. Objective measures did not differ among the groups. Aggravating factors associated with the CTX received supports previous work in that the survivors who received platinum drugs noted cold temperatures aggravated their CIN. Findings suggest that subgroups of survivors can be identified based on their reports of CIN aggravating factors.
Comparing diets for weight loss and improvement in biomarkers in men with prostate cancer on surveillance: A pilot study.
Authors: Benson Sharon
Published: March 2017

159

Background: Weight loss is recommended for treatment of prostate cancer, yet the most efficacious diet is not clear. The diet should improve biomarkers for prostate cancer, not increase risk of other chronic diseases, and be acceptable for long term use. Ascertaining appropriate dietary treatment for men on surveillance is crucial in preventing future cardiovascular disease, which is the leading cause of death in these men. Methods: Men with prostate cancer on surveillance and/or with untreated biochemical relapse followed 2 diets for 8 weeks of weight loss with random assignment to the order: (1) the diet recommended by the Prostate Cancer Foundation (PCF); (2) a plant-based, olive oil diet (PBOO), which included 3 tablespoons of extra virgin olive oil/ daily. After completing both diets, participants selected one of the diets for 6 months of follow-up (FU). Results: 30 started the protocol; 12 dropped out, 11 due to diet compliance (n = 3 PBOO; n = 8 PCF); 18 completed the 8 weeks of both diets and are reported here. Mean age: 66.6 + 5.9; baseline BMI: 30.9 + 2.7 kg/m2. Thirteen of the 18 have chosen the PBOO for FU. Conclusions: These results suggest a benefit with the PBOO diet in lowering insulin and glucose, and improving insulin function compared to the PCF diet. Despite similar weight loss, energy intake was higher on the PBOO diet. In addition, the PBOO diet was preferred over the PCF diet for long-term use. [Table: see text]
Training a survivorship care workforce with a novel web-based training curriculum.
Authors: Weldon Christine B. , Trosman Julia Rachel , Roggenkamp Betty , Boecher Stephanie , Robinson Patricia A. , Penedo Frank J. , Garcia Sofia F. , Lillis Teresa , Berardi Rosa , Macias Javier , Gerhart James , Shrestha Shakuntala , Khosla Pam , Lo Shelly S. , Dale William , Kircher Sheetal Mehta , Rosenberg Carol A.
Published: March 2017

16

Background: The Commission on Cancer (CoC) standard 3.3 requires survivorship care plan (SCP) delivery to patients who complete treatment with curative intent. The Coleman Supportive Oncology Collaborative (CSOC) is focused on improving supportive and survivorship care through tools, processes and training of health professionals. Methods: A collaborative of 30+ clinicians (faculty) from 25 institutions (academic, community and safety net), funded by The Coleman Foundation, reviewed existing supportive oncology and survivorship care training for content, availability, and cost. They developed a unique fundamental survivorship care training curriculum. Results: Although SCP dissemination training is available, it lacks 1+ attributes: <15 minutes to complete; online access; and CME/CEU credit at no cost. Utilizing existing guidelines and literature, the CSOC identified survivorship (9), palliative (11) and distress (6) modules supporting CoC requirements developed by 2+ expert faculty. Standardized modules include references and a slide presentation with links to additional training, guidelines and literature. Modules were reviewed by The National Comprehensive Cancer Network (NCCN) scientists, and edited. Audio was recorded by faculty. Tech assistance aligned video, graphics and narrated audio into a MP4 (movie) format. Survivorship modules include: Cancer Survivorship Defined, Patient Needs at Survivorship Visit and Coc Requirements for SCPs; Cancer Survivor Care; Survivorship Factors (Lifestyle & Behavior, Psychosocial Challenges and Late and Long Term Effects); Cancer Survivors’ Screening and Prevention Strategies; and Genetic Testing for Patients, Families and Survivors. The NCCN Education Portal published the training (https://education.nccn.org/supportive-oncology-care) available publicly (w CME/CEU) for no charge. Conclusions: Various forms of survivorship training for health professionals exist, but they lack needed attributes. The CSOC developed 9 concise survivorship training modules for NCCN’s education portal, with CME/CEU credit available at no cost to participants. CSOC will collect feedback from training enrollees to determine effectiveness and future training needs.
Self-monitoring and reminder texts to increase physical activity after colorectal cancer (Smart Pace): A pilot trial.
Authors: Van Blarigan Erin , Van Loon Katherine , Kenfield Stacey A. , Chan June M , Fukuoka Yoshimi , Laffan Angela , Mitchell Emily , Chan Hilary , Rodriguez-Jaquez Daniela , Meyerhardt Jeffrey A. , Venook Alan P.
Published: March 2017

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Background: Colorectal cancer (CRC) survivors can improve their quality-of-life (QOL), and potentially survival, by engaging in physical activity. The aim of this pilot randomized controlled trial (RCT) is to determine the feasibility of a technology-based physical activity intervention for CRC survivors. Methods: 40 CRC survivors will be randomized (1:1) to a 12-week physical activity intervention (Fitbit Flex, daily text messages) or usual care. Eligible individuals must: 1) have stage I-III colon or rectal adenocarcinoma; 2) have completed therapy; 3) be considered cancer-free; 4) be English speaking; 5) have no contraindications to moderate physical activity; 6) engage in < 150 min/week of moderate physical activity; and 7) have Internet and a phone that can receive text messages. Our primary outcomes are adherence (e.g., Fitbit wear time, text response rate) and acceptability assessed via survey. Secondary outcomes include change in physical activity via 7-days of ActiGraph GT3X+ accelerometers and QOL. Results: We have screened 350 individuals with stage I-III CRC at the University of California, San Francisco (UCSF) for eligibility. Of these, 181 (52%) were not eligible [non-English speaking (46%), ≥ 150 min/week of physical activity (22%), contraindications to physical activity (22%), not cancer-free (7%), did not own a mobile phone (2%)]. We invited the remaining 169 eligible CRC survivors to participate by mail, e-mail, phone, or in clinic; 76 (45%) actively declined and 59 (35%) did not respond after up to 3 contact efforts. As of October 2016, 34 CRC survivors have been randomized to intervention (n = 16) or control (n = 18). These individuals are: 55% female; 64% Non-Hispanic White; 73% have a 4-y college degree; and 64% work full-time. The median (IQR) age and BMI are: 56 (50, 65) y and 26.4 (23.2, 32.4) kg/m2, respectively. Conclusions: The results of this pilot study will inform a definitive RCT to determine whether a technology-based physical activity intervention improves QOL and survival after CRC diagnosis. Funding: This research was supported by the NIH (K07CA197077, KL2TR000143), Mt. Zion Health Fund and UCSF Helen Diller Family Comprehensive Cancer Center.
Implementation of an exercise behavior change clinic for men with prostate cancer: Baseline results.
Authors: Weller Sarah , Spillane Maria , Pollock Phil , Sundar Monita , Goldenberg Larry , Hedden Lindsay , Higano Celestia S.
Published: March 2017

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Background: Regular physical activity (PA) and resistance training (RT) has been shown to improve the health of prostate cancer survivors (PCS), however participation rates are low. To address survivorship needs and support behaviour change, the Prostate Cancer Supportive Care (PCSC) program implemented an Exercise Physiology (EP) clinic using one-on-one exercise counselling. Our objective was to understand the PA and RT characteristics of PCS and examine the effect of an EP clinic on behaviour change. Methods: After enrolment in the PCSC program, PCS were offered a consultation with an Exercise Physiologist. Subsequent consultations occurred at 3, 6 and 12 months. Clinical data collected at each consultation included physical measures, stage of change (TTM), current exercise (GLTEQ and exercise summary), fatigue (FACIT Fatigue and SIFIR), barriers and facilitators to exercise and a safety screening (PAR-Q+). Information was used during the EP clinic to set PA goals and create an action plan for behaviour change, reviewed each visit. Results: 71 PCS, median age 67 (range 50-86) attended the EP clinic between July 2015 and August 2016. 76% had received primary treatment and 24% were on active surveillance. At first consultation, 63% had an at-risk health profile, with an average BMI of 27kg/m2 (overweight), average waist circumference of 102.6cm (high) and insufficient PA, with only 15% meeting both PA and RT guidelines (150 mins moderate-to-vigorous PA and 2 RT sessions weekly). Average reported fatigue was moderate (4/10 on SIFIR). Stage of change (TTM) showed 44% of PCS at pre-contemplation, contemplation or preparation stages and 54% at action or maintenance stages. Self-reported barriers to exercise included lack of time (24%), laziness (19.7%) and fatigue (18%), while exercising with a spouse/friend/team was the main facilitator to exercise (16.9%). Conclusions: The baseline PA and RT levels of EP clinic PCS is similar to population norms in that the majority of PCS are not meeting current guidelines. Our results demonstrate that the implementation of an EP clinic is feasible. Future follow-up of this cohort will evaluate whether the program creates sustainable PA behaviour change in PCS.
A prospective study on contraceptives used by reproductive-aged patients with breast cancer and the assessment of information.
Authors: Lakhdissi Asmaa , Berrada Narjiss , Bellahammou Khadija , Akkar Othman , Mustapha El Kabous , Akla Sarra , Ougellit Sihame , Mrabti Hind , Errihani Hassan
Published: March 2017

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Background: For reproductive-aged breast cancer (BC) patients, contraception is needed during and after treatment. Few data are available concerning the methods used in the real life and the comprehension of patients. The main objective of our study was to describe the contraceptive practice and to identify the need of information for these patients. Methods: We conducted a survey in young BC patients treated at the National Institute of Oncology Rabat–Morocco. We analyzed the contraceptive methods used. Then, we assessed the level of information and counseling about contraception for this population. The SPSS 10.0 software was used for statistical analysis. Results: 72 patients respond to the survey. The mean age was 41.4 ± 6.3 years. 79.2% had localized disease. 97.2 % were under treatment. The sexual activity was maintained in 69.4%. The contraceptive methods used before the diagnosis and after the announcement are summarized in the Table. 52 pts were informed that the hormonal contraception were not recommended. 86.5% had this information from doctors. 67.3% were informed at the moment of announcement of diagnosis, 17.6% at the consultation of surgery, 29.4% before starting chemotherapy, 35.3% during chemotherapy and 17.6% at the end of treatment. After information about the contraceptive methods, 50 % used a masculine condom, 15.7% had a copper IUD, 18.6% used external ejaculation, 14.3% on patient had a tubal ligation and 14.3% didn’t use a contraception method. 66% patients of patients had not asked about contraceptive methods. The reasons: abstinence: 31.3%, the disease is more important than the contraception: 14.6%. Conclusions: Our study found that there is a lack of information concerning contraception for young BC patients. A contraceptive counseling is highly needed to decrease the risk of pregnancy during treatment. [Table: see text]
Magnesium oxide supplements for the treatment of post-chemotherapy sleep disturbance.
Authors: Carson Cindy Alberts
Published: March 2017

175

Background: While every cancer patient suffers from anxiety and sleep disturbance during cancer treatment, many physicians do not recognize that these problems can continue long after treatment has ended. Many cancer patients feel increased anxiety immediately after treatment ends when they find themselves “on their own,” without the protection of the medical armamentarium. The fear of recurrence, uncertainty about the future, a sense of vulnerability, awareness of mortality, and grief for the loss of a disease-free life all contribute to anxiety and sleep disturbance long term. Magnesium has been used for sleep induction and relaxation for centuries. The primary mechanism by which sleep is enhanced is by muscle relaxation. Magnesium induces muscle relaxation by preventing calcium from binding to troponin, parvalbumin, myosin, and calmodulin, thereby blocking muscle contraction. High levels of free magnesium competitively bind these proteins, and the slow dissociation of bound magnesium provides prolonged relaxation. It is for this reason that magnesium has a long history of use as a tocolytic in labor, as an adjunct to asthma treatment, and as a powerful laxative. Methods: 23 patients in a primary care practice reported continued anxiety and difficulty with sleep initiation following chemotherapy and/or radiation for various forms of cancer. Rather than use SSRIs, benzodiazepines, or sleep medications, all patients were started on an over the counter 1,000 mg magnesium oxide supplement, taken 1 hour before bedtime for 2 weeks. Results: Four patients dropped out before the end of the study period due to magnesium-induced diarrhea. 19 patients completed the 2-week study. Of these, 14 reported a noticeable reduction of sleep latency and an improvement in sleep quality. 11 also reported a subjective sense of reduced anxiety overall. 5 reported an improvement in nocturnal leg cramps, which had been interfering with sleep quality. Conclusions: Overall, magnesium proved to be a well-tolerated treatment for sleep disturbance and anxiety in the majority of the patients studied.
Growing Healing Touch as supportive cancer care in western New York.
Authors: Hess Suzanne M , Beaupin Lynda M.
Published: March 2017

176

Background: Healing Touch (HT) is a specific energy medicine modality that incorporates several techniques to balance the human energy field to help promote healing. It is a safe and non-invasive therapy that complements traditional, standard care and is recognized by NIH’s National Center for Complementary and Integrative Health. HT was first introduced to cancer survivors at our NCI-designated Comprehensive Cancer Center in 2013. We demonstrate HT is well-received and easy to integrate into traditional cancer care. Methods: A Certified Healing Touch Practitioner taught pediatric survivors and families HT techniques, as well as trained staff and volunteers to participate in the pilot program and to offer HT sessions throughout the year. Results: See Table. Qualitative analysis of participant’s feedback indicate benefits in the following themes: 1. Physical Symptom Relief 2. Emotional Issue Relief 3. Spiritual/Grief Support 4. Recommendation to Other Patients. Conclusions: Healing Touch is an energy medicine modality that is easy to teach, simple to integrate into routine cancer care, and beneficial for caregivers and survivors alike. [Table: see text]
Prospective study of work limitations in cancer patients (pts) undergoing curative chemotherapy (CT).
Authors: Tevaarwerk Amye , Buhr Kevin A , Conkright William A. , Onitilo Adedayo A. , Robinson Emily G. , Hegeman Robert B. , Ahuja Harish G. , Kwong Roger W. , Nanad Ranveer , Dennee Alexandra , Burkard Mark E. , Wiegmann Douglas , Wisinski Kari Braun , Sesto Mary E
Published: March 2017

18

Background: Impaired work performance that when significant leads to decreased productivity (work limitations) contribute to the “financial toxicity” of cancer treatment. Factors influencing work limitations and employment outcomes are poorly understood for cancer pts. We prospectively examined the proportion of cancer pts with significant increases in work limitations during curative treatment (co-primary endpoint). Methods: Eligible pts were ≥ 18 years, employed, intended to work during or after end of treatment (EOT), and had received ≤ 1 CT cycle. The Work Limitations Questionnaire (WLQ) survey was administered (baseline [BL], EOT, 3 and 6-months post EOT) to determine change in work limitations (WLQ index scale: 0 = no limitations to 28.6 = limited all of the time). “Significantly affected” pts had > 5-point increase in WLQ - an increase associated with decreased work productivity. Descriptive statistics (estimates with 95% confidence intervals [CI]; means with standard deviations [SD]) were calculated. A two-factor ANOVA (pt, timepoint) was used for analysis of WLQ changes over time. Results: 120 pts enrolled 5/2013 - 10/2015 at 8 sites (85 breast, 16 colon, 19 other). 110 took 1+ surveys: median age 50 (range 24-69), 92 (84%) female, 105 (96%) White; 93 (85%) had surgery, 110 (100%) CT, 57 (52%) RT. The mean increase in WLQ index from BL to EOT was +4.4 (95% CI [+2.1,+6.8], p < 0.001). A total of 44% were “significantly affected” by treatment (37/85, 95% CI [33%,55%]). WLQ index decreased at 3 and 6-mos (as compared to BL or EOT, see table). Conclusions: Among largely White pts getting CT, 44% experienced a significant increase in work limitations from BL to EOT. An improvement in group WLQ scores was noted after EOT. Analysis of factors (e.g., job type, education, symptoms) most associated with work limitations is underway to assist in prospectively identifying at-risk pts. [Table: see text]
Is cancer information exchanged on social media scientifically accurate?
Authors: Warunek Molli , Gage-Bouchard Elizabeth
Published: March 2017

186

Background: Cancer patients and their caregivers are increasingly using social media as a platform to share cancer experiences, connect with support, and exchange cancer-related information. Yet, little is known about the nature and scientific accuracy of cancer-related information exchanged on social media. Methods: We conducted a content analysis of 12 months of data from 18 publically available Facebook pages hosted by parents of children with Acute Lymphoblastic Leukemia (n = 15,852 posts), and extracted all exchanges of medically-oriented cancer information. We systematically coded for themes in the nature of cancer-related information exchanged on personal Facebook pages, and two oncology experts independently evaluated the scientific accuracy of each post. Results: Of the 15,852 total posts, 171 posts contained medically-oriented cancer information. The most frequent type of cancer information exchanged was information related to treatment protocols and health services use (35%) followed by information related to side effects and late effects (26%), medication (16%), medical care-giving strategies (13%), alternative and complementary therapies (8%), and other (2%). Overall, 67% of all cancer information exchanged was deemed medically/scientifically accurate, 19% was not medically/scientifically accurate, and 14% described unproven treatment modalities. Conclusions: These findings highlight the potential utility of social media as a cancer-related resource, but also indicate that providers should focus on recommending reliable, evidence-based sources to patients and caregivers.
Final Journey: A reference booklet for families of dying patients.
Authors: Zachariah Finly , Mooney Stefanie , Banerjee Chandana , Buga Sorin , Freeman Bonnie
Published: March 2017

189

Background: Family members will carry the memory of the death of their loved-one with them for the rest of their lives. If they perceive their loved-one suffered as they died there is a risk they will develop Post Traumatic Stress Disorder or other psychological dysfunctions. It is crucial the family be educated and holistically supported during the dying process. Health care providers and care givers require information that will enable them to act as patient advocates and work effectively with families toward the common goal of a peaceful death. Resources that provide basic explanations, suggestions for care, open communication, and prepare families and care givers about the dying process are essential. Methods: Final Journey is a patient and family centric booklet developed based on the CARES tool, which is a guide to help medical teams better care for the dying and their family. CARES stands for comfort, airway, restlessness and delirium, emotional and spiritual support, and self-care. Final Journey details in each section what patients and families may experience, helps families understand what constitutes suffering, and suggests what families can do to help their loved ones. Results: There is a need for education tools that are easily understood, pertinent, and made accessible to help improve the dying experience for all parties involved. Final Journey helps assure families are informed and more emotionally prepared. Furthermore, the booklet expands the available resources available to medical providers, allowing them to more effectively address the challenges of caring for the dying. Final Journey will be available as a free download from the Department of Supportive Care Medicine website. Conclusions: We anticipate utilization of the Final Journey booklet will improve knowledge and understanding for health care providers, care givers, and families regarding a normal dying process and how to distinguish this from suffering, provide them suggestions on how to offer support and comfort during the dying process, promote communication between health care providers, care givers, and families of dying patients and supply resources and information on the importance of self-care when working with a dying patient.