bluuebunny/crossref_metadata_2025 huggingface dataset:
Survivorship care delivery: From a consultative clinic to an integrative program based on patient outcome and resource analyses.
Authors: Schreffler Kevin , DelCampo Carol , Hayes Dawn , Meyer Donna L. , Miller Bryan , Sickles Amy , Jones Mildred , Tamim Hiba
Published: May 2018

37

Background: Delivery of survivorship care plan (SCP) using a multidisciplinary approach is optimal (Hewitt et al., 2006). However, many institutions experience implementation barriers (Dulko et al., 2013). The pilot study aim compared the effectiveness of two SCP delivery methods (extended vs. brief) on self-reported confidence in disease management (breast cancer). Secondary aim evaluated timeliness and patient/provider burden. Methods: Quasi-experimental pre- and post-survey design with control group (brief explanation/ delivery of SCP) and treatment group (comprehensive consultative visit). Pretesting included distress screening and self-efficacy survey. Post-testing included self-efficacy survey, tracking of referral activity, and patient satisfaction. Time study data and process mapping were included. Descriptive data analyses and Mixed ANOVA; significance set p < .05. Results: 73 eligible patients identified (age 61.93 ±11.6 years), 36 completing pre/post testing, and 62% declined consultative visit. At pre-testing, 45% rated distress > 3 [emotional (58%), physical (50%), nutritional (30%)]. Post-testing showed 94% compliance with support service referral(s). 89% felt understanding improved, 66% found SCP helpful, 59% said SCP prepared them for transition, and 77% were satisfied. Time main effect was significant for self-efficacy, Wilks Lambda = .89, F (1,34) = 4.2, p = .048. Follow-up paired-samples t-test showed significant improvement in consultative group, t (21) = -2.56, p = .018. Group differences not significant, but both groups demonstrated positive change (7% consultative; 4% control). Time study data revealed overall time spent per patient was 3.7 hours for consultative group vs. 2.2 hours for control group. New process change to integrative model reduced time by 65%. Conclusions: Both SCP delivery methods demonstrated improved patient confidence in managing disease and positive satisfaction. However, the extended visit did not yield outcomes justifying the increased program cost and resource. The pilot fostered a multidisciplinary approach to SCP delivery and yielded a process for improved timeliness and optimal delivery model.
Cardiovascular disease-related chronic conditions among Veterans Affairs colorectal cancer survivors: A matched case-control analysis.
Authors: Zullig Leah L. , Smith Valerie , Lindquist Jennifer , Williams Christina D. , Weinberger Morris , Provenzale Dawn , Jackson George L. , Kelley Michael J. , Danus Susanne , Bosworth Hayden B
Published: May 2018

4

Background: The growing number of colorectal cancer (CRC) survivors often have multiple chronic conditions. Comparing CRC survivors and matched non-cancer controls, our objectives were to determine the odds of CRC survivors being diagnosed with CVD-related chronic conditions and their likelihood of control during the year after CRC diagnosis. Methods: We retrospectively identified patients diagnosed with non-metastatic CRC in the Veterans Affairs (VA) healthcare system from fiscal years 2009-2012 and matched each with up to 3 non-cancer control patients. We used logistic regression to assess differences in the likelihood of being diagnosed with CVD-related chronic conditions and control between CRC survivors and non-cancer controls. Results: We identified 9,758 CRC patients and matched them to 29,066 non-cancer controls. At baseline, 69.4% of CRC survivors and their matched controls were diagnosed with hypertension, 52.4% with hyperlipidemia, and 36.7% with diabetes. Compared to matched non-cancer controls, CRC survivors had 57% higher odds of being diagnosed with hypertension (OR = 1.57, 95% CI = 1.49-1.64) and 12% higher odds of poor blood pressure control (OR = 1.12, 95% CI 1.06-1.18) in the subsequent year. Compared to matched non-cancer control patients, CRC survivors had half the odds of being diagnosed with hyperlipidemia (OR = 0.50, 95% CI = 0.48-0.52) and higher odds of LDL control (OR 1.14, 95% CI 1.06-1.23). There were no significant differences between groups for diabetes diagnoses or control. Conclusions: Compared to non-cancer controls, CRC survivors have: 1) greater likelihood of being diagnosed with hypertension and worse blood pressure control in the year following diagnosis; 2) lower likelihood of being diagnosed with hyperlipidemia or LDL control; and 3) comparable diabetes diagnoses and control. There may be a need for hypertension control interventions targeting cancer survivors.
Meeting requirements for survivorship visits: Interventions for patient identification.
Authors: Termer Nancy K. , Richardson Margie , Adams M Jacob , Alongi Alexander , Bellohusen Patricia , Bruckner Lauren B. , Cowen Richard , Fritsch Susan , Hettler Dwight , Kerns Sarah L. , Pandya Chintan , Williams AnnaLynn , Constine Louis S.
Published: May 2018

59

Background: A major challenge in providing quality survivorship care to cancer patients is efficiently and effectively identifying and scheduling patients who need a Survivorship Visit (SV). While the Commission on Cancer (CoC) Standard 3.3 defines which patients require a Survivorship Care Plan (SCP), staff need to operationalize the definition and search the clinic’s patient records on a regular basis to accurately identify eligible patients. This is a challenge for a busy cancer center. Methods: In July 2017 the Judy DiMarzo Cancer Survivorship Program instituted a full time Data Analyst (DA) to assist in identifying survivors using the OncoLog Cancer Registry and the Electronic Medical Record (EMR). Previously the identification process was limited to the EMR, and the Survivorship Program Nurse Coordinator (NC) was a combined role overseeing metrics, identifying patients and assisting with SVs. Currently the DA has piloted a method extracting data monthly from OncoLog and the EMR to assess eligibility of Standard 3.3. The data is compiled and sent to the NC who assists the cancer-specific service lines responsible for the patients identified to ensure SVs occur in a timely manner. Results: Our pilot intervention resulted in a 283% increase in SVs per month, from an average of 30 SVs to 115 SVs per month. The overall achievement for the CoC SV delivery requirement increased from 16% prior to the intervention to 33% in just 3 months. GI increased from 5% to 20%. Lung increased from 16% to 39%. The average SV was 3 months after the end of treatment. Approximately 60 hours was dedicated to establishing this method and 35 hours per month in the eligibility, identification process. Conclusions: By adding a DA role, extracting data from Oncolog and the EMR, as well as increasing accountability at the service line level to improve identification and scheduling of eligible patients, the delivery of SCPs to eligible patients substantially increased. Nevertheless this process is time consuming and will likely not be sufficient to ensure that all eligible survivors receive appropriate care. Consequently, additional, systematic improvements in this process should be explored such as EMR methodologies to automate patient identification.
Using electronic medical records system to advance cancer survivorship programs.
Authors: Lanigan Megan , Lee Theresa M. , Torp Lisa , Rudge Beth , Lu Kit Yu ,   UPMC Pinnacle Breast Care Center
Published: May 2018

65

Background: Survivorship care is now being increasingly recognized as an important part of cancer care. The Commission on Cancer (CoC) Standard 3.3 now recommends 100% compliance in the delivery of Survivorship Care Plans (SCP) by 2019 to eligible survivors. However, there are no systematic ways of ensuring compliance of Care Plan delivery and assessing patient eligibility. There are also no standardized methods for documentation or data collection to ensure appropriate consolidation of information from the electronic medical record (EMR) to a SCP, to assess for patient eligibility for survivorship follow up, or to appropriately report on timely delivery and follow-up with Survivorship Programs. Methods: Our survivorship team worked closely with the Cancer Registry Program, nurse navigators, and Information Technology team to optimize our institution owned EPIC electronic medical records system to populate and consolidate information automatically into patient specific care plans. By having electronic care plans, we are able to deliver plans to all members of the care team and to the patients. We also created discrete methods of flagging eligible survivors and automated data reporting and collection to ensure compliance and timeliness of care plan delivery. Results: By optimizing our electronic medical records system and our workflow process for Care Plan delivery, we were able to increase our delivery compliance rate to 100%. We are able to track patients through their care delivery and appropriately refer to our survivorship program and track care plan delivery. Conclusions: The CoC has implemented new standards to encourage appropriate survivorship care delivery and proper communication for ongoing survivorship care and follow up. With these new standards comes the challenge of developing and implementing a system for creating, delivering and evaluating the delivery of SCP. For our team to provide quality survivorship care that is measurable, we have developed data analysis and reports through our EMR with assistance from our IT department. These improvements utilizing our IT and EMR more efficiently has provided us with the ability to achieve 100% care plan delivery compliance.
Piloting a screening tool in a breast cancer survivorship clinic.
Authors: Kircher Sheetal Mehta , Garcia Sofia F. , Slocum Megan , Rutsohn Joshua P , Fisher Allison , Weldon Christine B. , Penedo Frank J.
Published: May 2018

66

Background: Breast cancer survivors experience physical, psychosocial, and practical concerns. Our Adult Survivorship Clinic provides patients a comprehensive survivorship visit following curative intent therapy to identify and address these needs. This study assessed patient and staff feasibility, usefulness, and burden of a screening tool. Methods: Patients seen in the Robert H. Lurie Breast Cancer Survivorship Clinic were randomly assigned to receive a screener (Coleman Supportive Oncology Tool including a concerns checklist & the 4-item Patient Health Questionnaire [PHQ-4]) versus no screener prior to their survivorship clinic appointment. All patients were asked to complete the FACIT-TS-PS to assess treatment satisfaction following the appointment. The screener group also completed an additional set of screener acceptability questions. The survivorship clinician completed a questionnaire after each patient visit. Results: Patients with breast cancer (n = 100) were randomized. Twenty-six (52%) of the participants not given a screener and 26 (52%) of the participants given a screener completed the FACIT TS-PS. 48% of participants were age 55 years or older and 54% received chemotherapy. While there were no statistically significant differences between the groups, both groups scored high on the FACIT TS-PS. Screener patients provided high ratings for the satisfaction survey with 100% of the respondents reporting the screener was “probably” or “definitely” clear and relevant. 85% reported that the questions provided little or no distress. The median time to complete the tool was 4 to 5 minutes. The survivorship provider reported that in 47% of patients (23/49) the screener uncovered an additional significant concern. In 35% of screened patients (17/49), the provider felt the screener prompted an additional referral to supportive oncology services or a medical specialist. Conclusions: A comprehensive and brief screener for patient concerns was feasible and acceptable for both patients and provider. Even in the context of a comprehensive survivorship visit, a screening tool uncovered additional concerns that led to supportive care referrals.
Shared medical appointment for early stage melanoma survivorship.
Authors: Funchain Pauline , Song Jung Min , Stanek Carolyn , McNamara Michael J. , Tarhini Ahmad A. , Gastman Brian , Marcus Joel Daniel
Published: May 2018

69

Background: Shared medical appointments (SMA) are a newer patient care format that involve both education and creation of individualized medical plans for multiple patients in a group setting. SMAs have been found to be cost-effective with high patient satisfaction scores. Methods: We describe an SMA model for early stage melanoma surveillance. The development of our SMA required multidisciplinary input from oncology, psychology, social work, schedulers, business, nursing and cancer center administration. We emphasized creation of a nonjudgmental environment to educate and promote healthy behavior. Results: Our early stage melanoma SMA involves 4-6 patients with an APP as group leader, RN as facilitator, and PsyD to provide psychosocial support. The 90-minute visit starts with a private physical exam followed by group education, activities, and formation of an individualized surveillance plan. An integral component of our SMA is the use of a self-assessment Melanoma Risk tool that has been found to be an efficient method to promote sun protective behaviors. Patients self-identify behavioral risks and personalize strategies to combat long-term effects of unhealthy behaviors. Psychosocial aspects are monitored with the NCCN distress management tool to identify areas of distress. The primary goals of care are to diminish isolation, enhance self-management, and provide professional expertise in combination with first-hand information from peers. Long-term goals are to decrease anxiety and increase survival with prevention. Conclusions: The first project to our knowledge utilizing an SMA format for cancer surveillance, this effort identifies a population at risk and provides education and psychosocial support to change high-risk behaviors. Future areas of research include quantifying outcomes of SMA-based surveillance and the addition of significant others to enhance surveillance.
Assessing perceptions of transition readiness in the adolescent and young adult oncology population.
Authors: Agrawal Vaibhav , Blessing Kristina K. , Berger Andrea , Schleicher Amanda , Styer Mike , Seel Vicki , Khan Sharif S. , Miller Michal A.
Published: May 2018

73

Background: Childhood cancer patients have distinct health-related needs as they transition from patient to survivor and from pediatric to adult-based care. This study used the Transition Readiness Assessment Questionnaire (TRAQ) to assess transition readiness and compare variation in readiness perceptions between patients, parents, and physicians. Methods: The TRAQ was completed by patients between ages 12 to 26 and their parent and oncologist at Geisinger Medical Center from Sept. 2015 to Dec. 2016. Surveys were scored according to validated methods (min. 1, max. 5). Statistical analysis was completed using SAS 9.4. Results: The study enrolled 49 patients, including 6 patients (12.2%) and 43 survivors (87.8%). There were 29 males (59.2%). The patient’s mean age at the time of survey was 18.4 years. Cancer types included: acute lymphoblastic leukemia (n = 17), lymphoma (n = 12), and sarcoma (n = 7). There were no significant differences in overall TRAQ scores between parents, patients, and physicians (mean 3.2, 3.5, and 3.7, respectively). The highest interobserver agreement was seen between patients and parents; the lowest was seen between physicians and patients. The greatest competency was assessed in the activity of talking with providers, and the lowest was measured in appointment keeping. In the domain of tracking health issues, providers assigned higher scores than patients (p = 0.003) and parents (p = 0.001). In the skill of talking with providers, patients ranked themselves higher than providers (p = 0.003). There was no significant variation in scores based on disease type, length of therapy, or insurance type. Patient age at diagnosis, patient age at therapy completion, and patient age at survey were correlated with higher patient (p = 0.004, p = 0.002, p = 0.0001, respectively), parent (p = 0.017, p = 0.019, p = 0.0001, respectively), and physician (p = 0.027, p = 0.03, p = 0.0001, respectively) scores. Conclusions: This study demonstrated that the overall assessment of transition readiness in the adolescent and young adult oncology population was similar between patients, parents, and physicians. The TRAQ is a tool that can be effectively used to guide healthcare transition in this population.
Identifying challenges to breast cancer care coordination at urban community-based primary care clinics.
Authors: Hamlish Tamara , Moton Zakiya N , Zhang Zuoli , Sohmer Dana , Olopade Olufunmilayo I. , Johnson Daniel , Hong Susan
Published: May 2018

83

Background: Primary care providers (PCPs) are well positioned to play a significant role in improving cancer care in the U.S. and achieving the Institute of Medicine (IOM) recommendation for patient-centered, coordinated, comprehensive cancer care across the care continuum. This is particularly important in underserved communities where fragmented care contributes to widening disparities in cancer mortality. However, PCPs can face considerable challenges delivering cancer care. This research examines challenges to breast cancer survivorship (BCS) care coordination at federally qualified health centers (FQHCs). Methods: We conducted a chart review at five Chicago FQHCs to assess BCS-related follow-up care provided by PCPs. We reviewed patient electronic medical records for documentation of breast cancer-related health information by the PCP and for documentation from cancer specialists, including consultant notes, pathology reports, and treatment histories. Based on BC ICD -9 codes we identified 109 patients who had a BC diagnosis within five years and a primary care visit at one of the five FQHCS within 2 years. Results: The patient population was primarily comprised of African Americans (81%), with 16% Hispanic, and 4% Asian or non-Hispanic White. Mean age at diagnosis was 55 years with 30% diagnosed < 50 years. Medicaid (59%) was the most common health insurance. More than half of the patients had ≥1 chronic disease. Critical clinical BC information was missing from patient medical records, including BC pathology (65%), mammogram (60%), last clinical breast examination (49%), and cancer specialist notes (45%). Documentation of family history and genetic counseling were missing from 76% and 98% of the records, respectively. Conclusions: Our data indicate that PCPs at FQHCs currently have a limited role in delivering IOM recommended patient-centered, coordinated, comprehensive cancer care across the care continuum. The research results underscore a need for improvement in two key areas: 1) support for PCPs to build capacity in BCS care and 2) enhanced communication and care coordination between cancer specialists and PCPS in order to make PCPs an active part of the BCS care team.
Evaluation of coordination of cancer care between designated cancer hospitals and primary care providers: Results from a nationwide survey in Japan.
Authors: Tomizuka Taro , Watanabe Tomone , Kamitani Satoru , Higashi Takahiro
Published: May 2018

84

Background: To improve coordination of cancer care between cancer specialist hospitals and primary care providers (PCPs), the Japanese government accredited cancer specialist hospitals, so called “designated cancer care hospitals (DCCHs)” and introduced “Cancer care coordination instruction fee” which PCPs can receive if they share a cancer critical path (Japanese version of Survivorship Care Plans) of each cancer patient with DCCHs. We sought to assess the current status of coordination of cancer care in Japan and communication between DCCHs and PCPs from PCPs’ point of view. Methods: A cross-sectional mail survey was administered to randomly selected clinic-based PCPs (4,000 clinics) from a nation-wide database of medical institutions authorized by Ministry of Health, Labour and Welfare Japan to treat patients with health insurance (87,869 clinics). The survey evaluated how much PCPs provided cancer follow-up care and how well DCCHs coordinated care and communicated with PCPs in cancer survivorship. Results: 1,873 PCPs returned the questionnaire (response rate: 46.8%). 1,223 (65.3%) answered to provide cancer follow-up care in outpatient setting. Most of the PCPs which provided cancer follow-up care evaluated the care coordination and support by DCCHs were satisfactory (946, 77.4%) but the degree of good evaluation varied by region (highest: 91.3%, lowest: 45.8%). In regression analysis, provision of palliative care by PCPs (OR 1.52 95%CI 1.05-2.17) and use of cancer critical path (OR 2.10 95%CI 1.63-2.71) were significantly correlated with better evaluation of communication and care coordination. Conclusions: DCCHs communicated well with PCPs and PCPs were satisfied with the communication and care coordination by DCCHs. Provision of palliative care by PCPs and use of cancer critical path are likely to lead good care coordination in cancer care.
Effects of oral vitamin B12 for the treatment of aromatase inhibitors (AI)-related musculoskeletal symptoms in women with early stage breast cancer.
Authors: Nahleh Zeina A. , Campbell Aleli , Heydarian Rosalinda , Dwivedi Alok Kumar
Published: May 2018

86

Background: Breast cancer patients receiving Aromatase Inhibitor (AI) therapy experience many side effects including arthralgias, myalgias and stiffness of joints. The objective of this study was to evaluate the effect of vitamin B12 supplements on pain related symptoms. Methods: In this study, patients taking AIs and experiencing pain at baseline were given 2500 mcg of vitamin B12 sublingually daily for 90 days. The validated Brief Pain Inventory-Short Form (BPI-SF) questionnaire using a 10 scale rating was evaluated prior and post- intervention. The BPI-SF asseses pain level and its interference with other daily life events on a scale from one to ten, one meaning pain does not interfere. Item 9 from the BPI assesses 7 important dimensions that are reported here. Results: 36 patients were recruited and scores were evaluated at baseline and at 90 days after taking vitamin B12 for general activity, mood, walking ability, normal work, relations with people, and for enjoyment of life post interventions as shown in the table. Conclusions: This study suggests that by taking a high dose of vitamin B12, significant improvement was observed in several dimensions related to pain scales in patients with AI -related musculoskeletal symptoms. Preliminary data confirms that vitamin B12 not only help improve pain, but it also aids in improving patient’s mood, well-being and relations with others. Larger randomized studies are warranted to confirm these promising findings. Clinical trial information: NCT03069313. [Table: see text]
Piloting a supportive oncology screener with adult survivors of childhood cancers.
Authors: Garcia Sofia F. , Kircher Sheetal Mehta , Wortman Katy , Kinahan Karen , Fisher Allison , Slocum Megan , Weldon Christine B. , Didwania Aarati , Penedo Frank J.
Published: May 2018

9

Background: Adult survivors of childhood cancers experience a host of late effects. Our Survivors Taking Action and Responsibility (STAR) clinic treats those needs. Methods: We piloted the Coleman Supportive Oncology Tool (CSOT, which includes a concerns checklist & the 4-item Patient Health Questionnaire [PHQ-4]) that patients completed before STAR visits. We used chi-square, T-tests, and logistic regression to identify differences in CSOT scores associated with patient characteristics. Results: Patients (n = 115) completed the CSOT: 54% women; 81% White; 34% leukemias, 30% lymphomas, 10% brain tumors, 8% sarcomas, and 18% other cancers. Mean years: current age = 33.48 (SD = 7.71) and age at diagnosis = 9.8 (SD = 5.84). The majority had chemotherapy (95%) and radiation (74%). A minority underwent surgery (38%) and transplant (22%); experienced a cancer recurrence or second malignancy (each 20%). We assessed 21 potential late effects; the mean number per patient was 1.92 (range = 0-9); most frequent were cardiologic (23%), endocrine (17%), musculoskeletal (17%) and infertility (16%). Controlling for current age, each 13 years (a) since diagnosis was associated with roughly 1 more long term effect (β = 1.02, p < 0.01) and (b) at age of diagnosis was associated with 1 less (β = -1.02, p < 0.01). Receiving > = 300 mg anthracycline was associated with a nearly 8-fold increase in cardiologic late effects (OR = 7.94, p < .01). Recurrence, second malignancy, and age < 10 years at diagnosis were associated with significantly more late effects (p = < .001, 01, < .01, and .02 respectively); those variables were not associated with greater CSOT concerns. We assessed 32 CSOT supportive care concerns; the mean number per patient was 3.23 (range = 0-18); the most frequent were difficulties with body weight (34%), sleep (19%), work / school (18%), concentration and health insurance (each 17%). On an item assessing fear of recurrence (FoR) frequency, most (74%) endorsed “not at all” but any FoR was associated with endorsing a greater number of CSOT concerns (p < .0001). Conclusions: Using a brief screener was feasible in a clinic providing follow-up care to adult survivors of childhood cancers to identify patients’ current medical and supportive care needs.
Yoga as a survivorship tool in cancer patients and caregivers.
Authors: Tan Winston , Ailawadhi Meghna
Published: May 2018

90

Background: Preliminary data suggest that yoga is one of the most popular complementary and alternative therapies and most likely to improve quality of life. In spite of the methodologic limits,studies suggest an improvement in a range of symptoms of patients with cancer among those who did yoga. The absence of side effects and the excellent cost-benefit ratio make it a very interesting symptom management tool. Methods: We advertised to our cancer patients the availability of a free yoga class twice a week. (August 2016-present). This was run by one trained instructor. All patients with different cancers were allowed to participate including caregivers. A post session survey was done at one time point to evaluate the benefits of the class. Results: Usually between 8-15 individuals attend the class. In one session a written survey was conducted, 13 patients/caregiver agreed to fill up the survey. 9 were patients (breast , sarcoma, lymphoma, brain tumor melanoma and spine tumor) and 5 were caregivers.4 never had any prior yoga class before, the reasons for attending the class included stress relief, improve balance, help pain, support spouse, suggestion by MD and exercise. Among those who answered the question 7 were new to yoga 0-3 month, they mainly did restorative and gentle yoga. The perceived benefits among attendees included being more relaxed, calm down, peaceful, increase strength, more mindful and better health. 8/13 perceived that it did improve quality of life very much, 3/13 quite a bit 1 a little. All were very satisfied with the yoga sessions. Conclusions: In an undifferentiated group of cancer patients, yoga classes participants have positive perceived benefits in majority of the individuals who did restorative/gentle yoga. This led to symptom control and also had significant participant satisfaction.
Text messaging and activity tracker motivation program to increase physical activity in cancer survivors.
Authors: Koontz Bridget F. , Levine Erica , McSherry Frances , Dale Tykeytra , Streicher Martin , Chino Junzo P. , Kelsey Christopher Ryan , Ward Kim , Little Katie , Owen Lynda , Bennett Gary , Kraus William , Peterson Bercedis , Pollak Kathryn I. , Sutton Linda ,   Duke Cancer Network Physicians
Published: May 2018

92

Background: Cancer survivors have high rates of sedentary behavior leading to obesity and cardiovascular disease. Physical activity improves quality of life (QOL) and reduces morbidity and mortality. However, cancer survivors commonly cite motivation as a barrier to increasing physical activity. We hypothesized that a motivational text-messaging feedback system linked to a Fitbit Flex activity tracker would increase the activity level of survivors and those undergoing cancer treatment. Methods: 29 participants were enrolled in an IRB-approved single-institution study. Eligibility allowed any cancer/stage, ≤2 days of exercise per week, life expectancy of 12+ months, and smartphone access. After baseline fitness/QOL testing, participants were provided a Fitbit Flex activity tracker. A text-messaging program automatically uploaded data from the tracker via an application programming interface and provided personalized text message feedback to subject’s smartphone daily for 3 months. Primary endpoint was change in step count from baseline to 3 months, with additional endpoints of change in 6 minute walk/QOL measures at 3 months, and continued exercise/use of tracker at 6 months. Results: To date, 24 have completed the 3 month program. Both academic and community sites participated, including areas with limited internet access. Most participants were female (71%) and white (63%). Eight cancer types and all stages were represented. Three participants withdrew – one because of lost tracker, one cancer death, and one “disappointed” with tracker function. Median daily steps at baseline were 3773 (IQR 2928) and 4365 at 3 months (IQR 4864). 42% had at least a 20% increase in median step count at 3 months. Improvement was noted in 45% of survivors and 38% of active treatment participants. Participants frequently used research nurses for guidance on use of wearable tracker (e.g. syncing, charging, features). Conclusions: Activity tracker with personalized daily feedback via text message successfully motivates cancer patients to increase daily activity. Patients are interested in health technology, but require technical support and coaching to maintain use. Clinical trial information: NCT02627079.
Increasing physical activity in cancer survivors at cardiovascular risk using Fitbits: Randomized controlled trial.
Authors: Maxwell-Smith Chloe Marie , Cohen Paul Andrew , Platell Cameron , Tan Patrick , Tan Jason , Salama Paul , Levitt Michael , Makin Gregory Bryan , Salfinger Stuart , Kader Ali Mohan Ganendra Raj , Kane Robert , Hince Dana , Hardcastle Sarah Jane
Published: May 2018

93

Background: Efforts to increase physical activity in cancer survivors have typically been facility-based, and results have generally not been durable. Home-based interventions provide a more feasible option, and are likely to produce longer-lasting benefits. Wearable trackers present a novel opportunity for monitoring physical activity in a practical way. The Health Action Process Approach model suggests that strategies such as action-planning and overcoming barriers may be effective for transitioning individuals from intention to behavioural change. This trial aims to increase physical activity in cancer survivors at cardiovascular risk, by implementing a 24-week self-monitoring and action-planning intervention using Fitbits. Methods: Sixty-eight cancer survivors were recruited to participate in the trial. Eligibility criteria included: insufficiently physically active, presence of cardiovascular risk factors, and completion of active cancer treatment in the five years prior to recruitment. Trial assessments are performed at baseline, 12-weeks, and 24-weeks, and measure physical activity (using 7-day accelerometer data), BMI, blood pressure, physical activity attitudes, barriers and perceived outcomes. Participants were randomly allocated to treatment and control groups, following the baseline assessment. Each participant in the treatment group was given a Fitbit Alta to monitor activity for the 24-week trial, attended two 2-hour group sessions involving goal-setting and action-planning activities, and a follow-up phone call to ensure program adherence. Results: Data collection is currently underway. Data analysis will use the Group x Time interaction from a General Linear Mixed Model analysis. Conclusions: As the population of cancer survivors is largely inactive and at cardiovascular risk, interventions are warranted. Specifically, physical activity interventions that are feasible, have robust theoretical underpinnings, and suit the preferences of cancer survivors post-treatment, show promise as a long-term solution. Clinical trial information: 2617000131358.
Perceived facilitators and barriers to physical exercise adherence in esophageal cancer patients after surgery.
Authors: van Vulpen Jonna , Witlox Lenja , Methorst - de Haan Alida , Peeters Petra H.M. , van Hillegersberg Richard , Nieuwenhuijzen Grard A. P. , Kouwenhoven Ewout , Siersema Peter , May Anne Maria
Published: May 2018

94

Background: To achieve optimal effects of exercise interventions in esophageal cancer patients, high adherence is needed. Knowledge on facilitators and barriers can help improving exercise adherence. Hence, the aim of this study is to evaluate perceived facilitators and barriers to physical exercise adherence in esophageal cancer patients in the first year after surgery. Methods: Semi-structured interviews were conducted with patients (n = 16) who were randomised to the exercise group of the Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT) Study. Patients participated in a 12-week supervised combined aerobic and resistance exercise program twice weekly, and were advised to be physically active at least 30 minutes each day. Physiotherapists registered attendance at the supervised sessions and compliance (i.e., performing the exercises according to protocol). Transcribed interviews were analysed using a thematic content approach. Results: Median attendance was 97.9%, interquartile range (IQR): 91.7 – 100%. Median compliance to both components of the exercise program was high: 89.6% (IQR 75.5 – 95.8%) for aerobic exercise and 88.0% (IQR 73.8 – 93.6%) for resistance exercise. The most important perceived facilitators were patients’ own attitudes towards exercise (i.e. motivation, commitment and personal goals) and supervision by a physiotherapist. There were only few perceived barriers, of which the most frequently mentioned were logistic factors (i.e. holidays, conflicting activities and weather circumstances) and impaired physical condition due to regular endoscopic esophageal dilation therapy or general physical complaints, such as fatigue. Conclusions: Esophageal cancer patients after surgery are well capable to perform physical exercise with moderate-to-high intensity. The most important perceived facilitators for the high adherence rates are patients’ own attitudes towards exercise and supervision by a physiotherapist. Completion of the exercise program was only minimally affected by perceived barriers as logistic factors and physical complaints. This information can help in designing future exercise programs for clinical practice.
A 9-year summary of a mentor-based 5K training program for childhood cancer survivors.
Authors: Lone Diana , Agrawal Caitlin , Rivard Linda , Stepenske Julia , Boland Lisa
Published: May 2018

96

Background: 5-year survival rate for childhood cancers significantly improved leading to increased awareness to long-term effects associated with these diseases. Many childhood cancer survivors have significantly lower exercise capacity. The POST (Pediatric Oncology Survivorship in Transition) team at Advocate Children’s Hospital created a 5k Program to encourage survivors to return to physical activity. Participants were childhood cancer survivors who had been off therapy or cleared by their oncologist to participate, and who were greater than 9 years old. The Program had weekly 1 hour supervised training sessions and home physical activity assignments over 8-12 weeks in preparation for the 5K. Each participant invited a friend/family member to partner in training and on race day. Methods: The purpose of this study is to evaluate the strengths and weaknesses of the 5K Program in promoting physical activity and to validate its continuation and expansion. All participants who finished the 5K (n = 68) from 2009-2017 were included in our retrospective chart review. Data collected from the medical records included diagnoses and number of times of participation. An online Qualtrics survey inquired about barriers encountered, subjective experience of having a personal coach and training partner, and additional personal comments. The IRB approved this study. Results: The survey was distributed in October 2017 and complete data collection is anticipated in November 2017. The primary outcome will reflect the effectiveness of the Program in promoting return to physical activity, measured by descriptive survey responses. Secondary outcomes include data collected by retrospective chart review. 44 of 68 (65%) participants completed the 5K multiple times. The majority of these were survivors of leukemia (31) followed by lymphoma (13), solid tumors (9), bone marrow transplant (9), brain tumors (5) and histiocytosis (1). Conclusions: While the 8-12 week program is likely too short to measure physical changes, the high percentage of participants completing multiple 5Ks demonstrates its effectiveness in improving physical endurance. Additional conclusions with full data analysis will be completed by February 2018.
Body mass index (BMI), health behaviors, and perceptions in cancer survivors.
Authors: Eng Lawson , Liu Sophia Yijia , Su Jie , Pringle Dan , Mahler Mary , Niu Chongya , Naik Hiten , Mohan Rahul , Tiessen Kyoko , Hon Henrique , Brown M Catherine , Jones Jennifer M. , Howell Doris , Selby Peter , Alibhai Shabbir M.H. , Xu Wei , Liu Geoffrey
Published: May 2018

97

Background: Obesity is associated with poorer outcomes across multiple cancer types. Health behaviour change (smoking cessation, physical activity (PA) and alcohol moderation) can improve both obesity and outcomes among cancer survivors. Methods: Cancer patients (pts) were cross-sectionally surveyed on their smoking, PA and alcohol use before and after diagnosis and their perceptions of these behaviours on quality of life (QoL), fatigue, survival (OS) and safety. Multivariable logistic regression models evaluated the association of BMI 1 year prior to diagnosis with behaviour changes and perceptions. Results: Of 1269 pts, 204 smoked at diagnosis and 58% quit afterwards; 350 met PA guidelines at diagnosis and 238 at follow-up; 661 drank alcohol at diagnosis and 50% reduced consumption afterwards. Median BMI was 25.8 (22% obese). Most pts perceived PA ( > 75%) as improving outcomes, smoking ( > 70%) as worsening outcomes and half (41-49%) felt alcohol worsened outcomes. At diagnosis, increased BMI was associated with being an ex-smoker (vs current smoker; P= 0.003), never using alcohol (vs former use; P= 0.05) and not meeting PA guidelines ( P= 0.01). Among smokers at diagnosis, increased BMI was associated with smoking cessation (aOR 1.08 per 1 unit BMI increase, P= 0.03) and perceiving that smoking worsens OS (aOR 1.10, P= 0.04) and fatigue (aOR 1.08, P= 0.08). Among pts not meeting PA guidelines at diagnosis, increased BMI was associated with perceiving that PA worsens fatigue (OR 1.02, P= 0.06) and is unsafe (OR 1.04, P= 0.06). Among drinkers at diagnosis, increasing BMI was associated with perceiving alcohol to be less harmful (aOR 0.93, P= 0.002), less likely to worsen OS (aOR 0.96, P= 0.04) and fatigue (aOR 0.97, P= 0.09). BMI was not associated with changes in alcohol or PA after diagnosis. BMI was not associated with counselling rates; however, 66% of current smokers received cessation counselling while only 14% of current drinkers and 13% of pts not meeting PA guidelines received counselling on their respective behaviours. Conclusions: Obese pts were more likely to quit smoking and perceive it to be harmful but less likely to perceive alcohol as harmful. Survivorship programs should consider focusing on PA and alcohol counselling in obese pts.
Cancer patient interest and perceptions of health behavior change programs.
Authors: Eng Lawson , Liu Sophia Yijia , Zhang Qihuang , Farzanfar Delaram , Yeung Sabrina , Brown M Catherine , Xu Wei , Howell Doris , Goldstein David Paul , Jones Jennifer M. , Selby Peter , Giuliani Meredith Elana , Liu Geoffrey
Published: May 2018

98

Background: Health behavior change including smoking cessation, physical activity (PA) and alcohol moderation are important aspects of cancer survivorship. We assessed cancer pt interest and perceptions of programs for these behaviours. Methods: 501 cancer pts were surveyed on their smoking, PA and alcohol use along with their interest and perceptions for programs for these behaviors. Multivariate logistic regression models identified factors associated with pt interest and perceptions. Results: At diagnosis, 115 pts smoked; 184 were exposed to second hand smoke (SHS); 313 did not meet PA guidelines; 238 were drinking alcohol. At risk pts’ (e.g, smokers for smoking cessation, SHS exposed for household smoking cessation) survey results are shown in the table. Most pts perceived smoking (90%), SHS (83%) and alcohol (56%) to be harmful on quality of life, survival and fatigue while PA (77%) was felt to improve these outcomes. These perceptions were not associated with program interest ( P> 0.05). However, pts perceiving that alcohol worsened and PA improved these outcomes were more to likely believe associated programs are beneficial (alcohol aORs = 2.1-2.2 P< 0.03; PA aORs = 1.9-3.2 P< 0.02) and should be routine care (alcohol aORs = 1.9-3.5 P< 0.03; PA aORs = 1.7-2.4 P< 0.1). Pts with more pack-yrs smoked less likely perceived a benefit in a household smoking cessation program (aOR = 1.02 P< 0.007). Pts preferred discussing programs with doctors ( > 35%) or counsellors ( > 42%). Conclusions: About half of pts feel that health behavior change programs would be beneficial and should be part of routine care. These factors were more important than perception of the behaviors on outcomes in influencing pt interest. Initial discussions with pts should focus on discussing benefits of these programs. [Table: see text]
The Linnaean names in Statice (Plumbaginaceae)
Authors: Guacchio Emanuele Del , Erben Matthias , Iamonico Duilio
Published: May 2018

The Linnaean names Statice aurea, S. cordata, S. flexuosa, S. incana, S. pruinosa, and S. speciosa (Plumbaginaceae) are investigated. Specimens from the Linnaean Herbarium (LINN) are designated as lectotypes of S. aurea, S. flexuosa, S. pruinosa and S. speciosa, and an illustration is designated as lectotype for S. cordata. Finally, the typification of the remaining Linnaean names in Statice is briefly reviewed and discussed.
Correct type designation of the endemic Canary pine Pinus canariensis (Pinaceae)
Authors: Prado Jefferson , Lendemer James , Tripp Erin , Ferrer-Gallego P. Pablo , Boisset Fernando
Published: May 2018

The typification of the name Pinus canariensis (Pinaceae) is revised. This name was initially “lectotypified” from a specimen collected by Christen Smith and kept in the herbarium of the University of Copenhagen (C). However, this designation is ineffective, and should be rejected, because two specimens (syntypes) are cited in the protologue by Candolle, collected by Broussonet. Accordingly, the name is lectotypified using a Broussonet’s specimen collected in Tenerife (Canary Islands, Spain) and preserved in the Candolle Herbarium (G­DC).
Strategic Performance Management for Egyptian public libraries as a portal for national sustainable development: Greater Cairo library as a model
Authors: Aldosoky Ayman
Published: May 2018

The interest of public libraries, a symbol of civilization in developed countries, because of their prominent and active role in upgrading the cultural, social and creative side of individuals and communities, and takes interest in manage of the Egyptian public libraries manage and develop a vision, mission and objectives of each library, which calls for action at the Strategic Performance Management of public libraries management as a cognitive and cultural capable of shaping the spirit and thought and conscience of society and culture, so as to strategic performance management advantages and aspects of positive may provide Egyptian public libraries in an effort to develop the performance to cope with regional and international developments, and in line with the public beneficiaries, to help the formation of personality conscious inhabitants and the times in which we live, as well as to contribute to the provision of knowledge and systematic organization a high degree of precision and clarity, as a serious step national sustainable development in accordance with the Egyptian strategic vision 2030.
Living with an implantable cardioverter defibrillator: partners' experiences
Authors: Humphreys Nina K , Lowe Rob , Rance Jaynie , Bennett Paul D
Published: May 2018

This study explored the experiences of partners of recipients of implantable cardioverter defibrillators (ICDs). Eighteen partners (11 female and 7 male) were interviewed using semi-structured interviews between 3 and 24 months following their partner's ICD implantation. Analysis focused on the emotional consequences of their partner having an ICD, and how they coped with these. Many of their emotions were negative; these included feeling traumatised by the initial cardiac event; anxiety and fear in relation to their partner's health, and the threat of the ICD firing; and frustration and anger, particularly in relation to the healthcare system. Coping strategies included: active problem-solving, which involved becoming informed about relevant issues and monitoring their partner's health; and engaging in protective behaviour, such as reassessing their role identity, avoidance and concealing worries from their partner. The clinical implications of these findings are discussed.
Hormone imbalance a cause of treatment-resistant hypertension
Authors: Palmer Sarah Jane
Published: May 2018

In this monthly feature, Sarah Jane Palmer delves into topical news, the latest research and what the experts are saying on subjects related to cardiology and cardiac nursing practice.
Continuing Professional Development: Pulmonary embolism in pre-hospital care
Authors: Hodkinson Mark , Ambulance Devon Air
Published: May 2018

Overview

Pulmonary embolism (PE) is a potentially life-threatening disease, which presents with non-specific signs and symptoms. Evidence suggests that diagnosis is often made on post-mortem examination and misdiagnosis is likely. There are a number of pathophysiological processes that occur in acute PE, which have several systemic effects on the body and the compensatory mechanisms. A thorough understanding of these physiological processes and how these manifest, will afford the attending clinician a greater knowledge base on which to develop clinical reasoning skills, therefore initiating timely management and transportation to definitive care. Clinicians should also have an awareness of adjunctive therapies available in the management of PE, which include inotropic support for profound shock and thrombolytic therapy in cardiac arrest. This article explores the pathophysiology of the disease process, the identification and pre-hospital management of PE.
Stoma care: choosing the right appliances and accessories
Authors: White Maddie
Published: May 2018

Living with a stoma can be challenging, both for the ostomate and the nurses looking after them. Maddie White discusses stoma care, which accessories are available and how to decide which products to order in which quantities
Under pressure: relieving ulcers with mattresses
Authors: Payne Drew
Published: May 2018

Pressure ulcers are a common occurence in the care home population, but much can be done to prevent and treat these. Drew Payne discusses the most efficient ways of selecting and using pressure-relieving mattresses and cushions
Friend or foe? Social media's legal pitfalls
Authors: Stevens Mark
Published: May 2018

Social media platforms are a double-edged sword: they are very useful for promoting a business or gaining influence, but they can cause great harm to a business' reputation when used incorrectly. Mark Stevens helps to find a balance in social media policies