bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient- versus physician-reported toxicities among survivors of head and neck cancer after chemoradiation: Prospective evaluation of screening methodologies.
Authors: Chen Allen M. , Felix Carol , Hsu Sophia
Published: February 2017

150

Background: This study sought to compare the incidence of late toxicities among survivors of head and neck cancer treated by definitive chemoradiation using patient-reported versus physician-reported methodologies. Methods: Two validated quality of life instruments, the University of Washington Quality of Life questionnaire (UW-QOL) and the Functional Assessment of Cancer Therapy for Head and Neck questionnaire (FACT-H&N) were administered to patients returning for follow-up after chemoradiation for head and neck cancer. Only patients who had been clinically without evidence of disease for greater than 6 months were sampled. Scores were compared to physician-reported toxicities, which were recorded blindly and independently after each patient visit, using the National Cancer Institute’s Common Toxicity Criteria (version 4.0). Two by two contingency tables were constructed to assess differences between patient- and physician-reported responses using Fisher’s exact test. Results: Fifty patients (35 male; 15 females) completed both instruments. While 78% of patients reported an inability “to swallow certain solid foods” and 70% reported difficulty to “swallow naturally and easily” using the self-reported UW-QOL and FACT-H&N surveys, respectively, the incidence of grade 2+ esophageal dysfunction as reported by physicians was only 48% (p < 0.001). While 60% of patients reported “too little saliva” and 50% acknowledged having problems with "voice quality and strength" using the UW-QOL and FACT-H&N surveys, only 20% and 30%, respectively, were scored as having grade 2+ xerostomia and laryngeal toxicity. Significant discordance was also observed between patient- and physician-reported toxicities with respect to the domains of appearance (p = 0.02), pain (p = 0.01), activity/energy (p < 0.001), and mood (p = 0.001). Conclusions: Late toxicities are frequently under-reported by physicians after chemoradiation for head and neck cancer. The true incidence and severity of these treatment-related toxicities, with respect to both functional and psychosocial impairment, among survivors may be better evaluated by patient-reported methods.
Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management.
Authors: Samuel Cleo A. , Turner Kea , Donovan Heidi AS , Van Londen G J.
Published: February 2017

155

Background: Adjuvant endocrine therapy (AET)-related symptom management (SM) among breast cancer survivors (BCS) typically involves a multidisciplinary team of health care providers; yet few studies have examined provider perspectives on AET-related SM. The purpose of this study was to examine provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. Methods: We conducted 3 focus groups (FGs) with a multidisciplinary group of health care providers (n = [6] physician; n = [7] non-physician) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM and its barriers and facilitators as well as recommendations for improvement. All FGs were held at the University of Pittsburgh, audiotaped, and transcribed. We analyzed FG transcripts using qualitative software to identify key themes. Results: Providers described patient-, provider-, and system- level facilitators and barriers to AET-related SM. At the patient-level, facilitators included social support and provider communication about symptoms while cancer-related distress, misinformation and misinterpretation of online information were identified as barriers. Provider-level facilitators included strong relationships with other providers and ongoing communication with patients; however, lack of time, insufficient resources, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Finally, at the system-level, electronic health records were described as both a facilitator and barrier to SM. Moreover, poor care coordination among different providers and lack of clear guidelines on which provider “owns” AET-related SM emerged as key system-level barriers. Conclusions: Findings suggest that efforts to improve AET-related SM should span multiple levels, in order to address patient-, provider-, and system-level barriers to SM. Recommendations include increased education for patients, greater access to clinical decision support tools for providers, and improved coordination of survivorship resources within hospitals.
Management of aromatase inhibitor-associated musculoskeletal symptoms: A systematic review.
Authors: Roberts Kate , Rickett Kirsty , Woodward Natasha E.
Published: February 2017

157

Background: Aromatase inhibitor-associated musculoskeletal symptoms (AIMSS) are experienced by a significant number of women on adjuvant aromatase inhibitors for breast cancer. These symptoms can result in therapy noncompliance and there is no accepted standardised treatment. We believe that this is the first systematic review to consider the evidence for all pharmacological and non-pharmacological interventions in the treatment of AIMSS. Methods: We conducted a systematic search in PubMed, EMBASE, CINAHL and CENTRAL. Clinical trials and observational studies for all potential pharmacological and non-pharmacological interventions were included. Two reviewers screened the results and extracted the relevant data. Risk of bias for the full papers were assessed using JADAD or a modified Newcastle Ottawa score, with conference abstracts and letters to the editor excluded from this process. Results: Of 1260 records being identified, 887 unique citations were screened with 93 full text papers retrieved for assessment, and 37 selected for inclusion. We identified 9 pharmacological interventions (RCT = 3, pre-post = 4, cohort = 2) and 28 non-pharmacological interventions (RCT/CCT = 16, pre-post = 8, cohort = 3). The largest number of studies were for various exercise interventions (n = 7) with the largest trial showing a 29% decrease in worst joint pain scores compared to the control (2%, p < 0.001). The highest number of RCTs was for acupuncture (n = 5), the majority of which showed a significant benefit with both real and sham acupuncture. Other single RCTs showing benefit include the use of testosterone, calcitonin and etoricoxib. No study adequately controlled for contamination bias from extraneous variables of both pharmacological and non-pharmacological interventions. Conclusions: Given that pharmacological treatment is often recommended for AIMSS, it is surprising that there is limited published evidence for its use. Although the interventions being used appear tolerable with minimal adverse effects, the current level of evidence is low, and additional large RCTs with more rigorous controlling for contamination from other interventions are required to confirm some of the reported promising results.
Crossover from one aromatase inhibitor (AI) to another in the Exemestane and Letrozole Pharmacogenetics (ELPh) trial.
Authors: Kadakia Kunal C. , Kidwell Kelley M , Seewald Nicholas J. , Snyder Claire Frances , Flockhart David A. , Carpenter Janet S , Otte Julie L. , Hayes Daniel F. , Storniolo Anna Maria , Stearns Vered , Henry Norah Lynn
Published: February 2017

158

Background: Tolerance of AI therapy can be poor due to treatment-emergent toxicities and can lead to early discontinuation (non-persistence). Patients often switch from one AI to another when toxicities develop; however, limited prospective data exist on patients who switch AI. Here we describe the effect of switching from E to L or L to E on tolerance of and persistence with therapy. Methods: Postmenopausal women initiating AI therapy were enrolled on the ELPh trial and randomized to E or L. Those that stopped their AI for self-reported intolerance were offered crossover to alternate AI after a 2-6 week washout. Kaplan-Meier estimates of proportions on AI after 1, 3, and 6 months were assessed during 1st and 2nd AI. Associations between time on 2ndAI and clinicopathologic factors were analyzed using univariable Cox proportional hazards model. To evaluate effect of crossover on patient-reported outcomes, multiple questionnaires, including a pain visual analog scale (VAS), were assessed serially. Results: 83 women, mean age 60 years, 45% prior chemotherapy, and 31% with prior tamoxifen use, participated in the crossover protocol. 71% reported improvement in symptoms a mean 4.72 weeks after discontinuing 1st AI therapy. Median time on 1st AI was 6.8 months (95% CI 5.8-9 months), and on 2nd AI was 11.5 months (6.9-24.2). The probability of persistence at 1, 3, and 6 months for the 1st AI was 94%, 76%, and 55% and for the 2nd AI was 89%, 73%, and 62%, respectively. There was no significant association between duration on 2nd AI and 1st AI (L vs. E), duration on 1st AI, age, body mass index, or prior therapies. The change in pain VAS from baseline to 1 or 3 months was not significantly different during treatment with the 1st or 2ndAI. Conclusions: Although all AI medications have similar mechanisms of activity, nearly two-thirds of patients who are intolerant of one AI are able to maintain therapy for at least 6 months following switch to 2nd AI. Switching is a reasonable approach for women who cannot tolerate 1st AI that may improve persistence with therapy. The mechanisms for intrapatient variation in tolerance warrant further study. Clinical trial information: NCT00228956.
Physical activity communication between oncology providers and patients with early stage breast, colon or prostate cancer.
Authors: Nyrop Kirsten A , Deal Allison Mary , Williams Grant Richard , Guerard Emily Jean , Pergolotti Mackenzi , Muss Hyman B.
Published: February 2017

171

Background: National guidelines recommend that patients with a cancer diagnosis engage in regular physical activity (PA) to reduce cancer-related fatigue, maintain quality of life and physical function, and improve overall prognosis and survival. This study investigates oncology provider communications about PA during routine clinic visits with early stage breast, colon or prostate cancer patients. Methods: Retrospective chart review for documentation of communications (inquiries or recommendations) pertaining to PA in clinician notes and after visit patient summaries. Mixed methods analysis. Results: In a 1-month period, 55 oncology providers had 361 encounters (clinic visits) with early stage cancer patients. Of these encounters, 35% included a provider communication about “physical activity”, “exercise” or “activity”. Encounters with a medical oncologist resulted in a PA communication 55% of the time as compared to 20% of encounters with other clinician specialties (p < 0.0001). Older patients were more likely than younger patients to have a PA communication (p < 0.001). When the encounter was with a patient who was being seen for surveillance, chemotherapy or endocrine treatment, the rate of PA communications was significantly higher (46%, 37%, 58% respectively) as compared to when the visit was during radiation treatment or surgery (6%, 19% respectively) (p < 0.0001). Four PA themes emerged from our analysis of provider communications: (1) level and types of engagement in PA, (2) restrictions on PA either by the provider or perceived by patients, (3) encouragement or recommendations, or (4) relationships between PA and weight, nutrition, pain, and fatigue. There were no significant differences in PA communication rates by clinician gender, clinician training, patient gender, patient race, or disease site. Conclusions: This study shows it is feasible for oncology providers to have PA communications during routine clinic visits; however, the frequency of PA communications varies among providers. Interventions are needed to remind all oncology providers to encourage of their patients with early stage cancer to be physically active.
Weight control strategies in breast cancer patients: A systematic review.
Authors: LeVasseur Nathalie , Clemons Mark J. , Mazzarello Sasha , Vandermeer Lisa , Jones Lee , Joy Anil Abraham , Smith Stephanie , Hutton Brian , Hilton John Frederick
Published: February 2017

179

Background: Obesity remains an underestimated contributor to global cancer incidence and cancer-related mortality. Accumulating evidence suggests excessive energy intake and suboptimal levels of physical activity may be important after the diagnosis of cancer and may influence recurrence and overall survival(OS). Objective: Conduct a systematic review to evaluate data from randomized trials of weight control strategies used in breast cancer patients. Methods: A systematic search of Medline, Embase and the Cochrane Register of Controlled Trials through April 2015 was performed. Randomized trials of weight management strategies in breast cancer patients were sought. Outcomes studied included; change in weight, BMI and waist circumference, disease-free survival, recurrence-free survival and OS survival. Random effects meta-analyses were planned provided that included studies were considered to be clinically and methodologically homogenous. Results: Of 2876 abstracts, 312 were retained for review of the full texts. Overall 43 publications describing 40 studies met inclusion criteria. Of 12,801 enrolled patients, 11,597 had breast cancer. Fifteen studies consisted of dietary interventions, 17 consisted of exercise interventions and 8 consisted of both dietary and exercise interventions. Endpoints included: changes in weight (32 studies, 7,861 pts), BMI (12 studies, 1,886 pts), waist circumference (10 studies, 702 pts), recurrence-free survival (4 studies, 6105 pts) and overall survival (2 studies, 3,330 pts). Network meta-analyses of available data are in progress. Study results suggest that weight control strategies including dietary and exercise interventions were effective at reducing weight, BMI and waist circumference. Two large studies showed statistically significant recurrence-free survival benefits with weight control strategies and one showed OS benefit with an exercise intervention. Conclusions: Data from included trials suggest benefits of weight control strategies to decrease weight, BMI and waist circumference. Few trials have been designed to detect PFS or OS benefits. Larger trials are warranted to better define the role of weight control strategies in the management of breast cancer patients.
Changes in biomarkers and DNA methylation in breast cancer survivors enrolled in the ENERGY weight loss trial: A pilot study.
Authors: Demark-Wahnefried Wendy , Rock Cheryl L , Sedjo Rebecca L. , Toriola Adetunji , Liu Jingxia , Byers Tim , Ganz Patricia A. , Cui Xiangqin , Tiwari Hemant , Absher Devin , Colditz Graham A.
Published: February 2017

181

Background: In 2014, an ASPO position statement was released calling for action regarding cancer survivors’ needs for weight management. Reduction of body weight is hypothesized to affect several cancer-related biological pathways. Methods: The Exercise and Nutrition to Enhance Recovery and Good health for You (ENERGY) trial is the largest weight loss trial completed to date among breast cancer survivors. In it, 692 stage Ic-IIIc breast cancer survivors were randomized to an intensive, group-based weight loss intervention with 26 contacts over one year or to a non-intensive intervention with two contacts over the same time period. Results recently reported in JCO showed significantly greater weight loss in the intensive intervention arm compared to the non-intensive arm. A pilot study exploring baseline to 6-month changes in gene methylation and expressed biomarkers was undertaken in 30 chemo-naïve, post-menopausal, non-Hispanic white women who participated in this study. Results: Several significant differences in mean change scores (standard error) between the intensive vs. non-intensive groups were noted, i.e., insulin: -4.19(0.80) vs. 0.42 (1.01)/p = 0.0016; c-peptide: -0.49(0.14) vs. 0.40(0.19)/p = 0.0009; leptin: -15.73(1.79) vs. 2.53(1.78)/p < 0.0001; adiponectin:leptin ratio: 0.67(0.15) vs. 0.010(0.064)/p = 0.0007; homeostasis model of insulin resistance (HOMA-IR): 20.00(4.65) vs. 9.57(5.00)/p = 0.0003; sex hormone binding globulin 20.45(4.61) vs. 8.65(8.00)/p = 0.023; and Follistatin-Related Protein-3 (FSTL3): 0.48(0.19) vs. -0.88(0.55)/p = 0.0497. While effects were in the direction hypothesized for c-reactive protein, interleukin-6, vascular endothelial growth factor, and tumor necrosis factor no significant differences were noted. Significant differences in DNA methylation also were noted for genes encoding for Follistatin Related Protein (corresponds to FSTL3), and those on hormonal/growth pathways (e.g., AMOTL1, ESR, EGR3), inflammatory pathways (e.g., TNFRS10A/TRAIL-R1, C14orf106), and metabolic pathways (e.g., ZBED3, GABRA). Conclusions: While results are based on a small sample and not corrected for multiple testing, they provide evidence that weight loss affects several biomarkers and pathways that impact cancer and which warrant further investigation. Clinical trial information: NCT01112839.
Depression and smoking patterns among head and neck cancer patients in an inner city minority population.
Authors: Poola Harsha Vardhan , Thekkekara Romy , Udayagiri Venkata Sravani , Patel Urjeet , Goldberg David , Rosen Fred R.
Published: February 2017

184

Background: Continued smoking among head and neck cancer patients(HNCP) is associated with poor prognosis. These patients (pts) experience highest rates of depressive symptoms of all oncology patients. Smoking and depression are among factors that influence long term quality of life in these pts. Methods: HNCP were evaluated for patterns of smoking and depression at our Hospital. Survey using a standardized questionnaire about smoking patterns and depression using PHQ9 was employed. Pts were stratified as nonsmokers, ex-smokers (quit > 6 mo), recent smokers ( < 6 mo), and current smokers ( < 7 days). EMR was reviewed for sociodemographic variables, stage (stg), diagnosis (Dx) date, treatment(Rx) modality. The cohort was followed till 7/31/2015 to assess disease recurrence and survival. Results: 39 pts were interviewed. Mean age at Dx was 56 +/-7 yrs. 82% were men. 46% were African American, 36% Caucasians(cau) and 8% Hispanics. 74% had stg IV disease at Dx. 76.9% were recent/current smokers at Dx. At 280 days from Dx, 41% continued smoking; decrease in smoking was statistically significant (p value: .000). 52% of smokers with stg III/IV cancer quit smoking while pts with stg I/II continued to smoke. Continued smoking was higher in Cau (p = 0.038). Mild to severe depression was seen in 56% of pts. Higher rates of depression were noted among smokers (62%) with stage III/IV disease; though it was not statistically significant. Complete response to Rx was seen in 82% and recurrence in 20.5%. No difference in outcomes based on smoking patterns was noted. Conclusions: Although smoking rates at Dx were comparable to literature, our pts had higher rates of continued smoking and depression. Dx and stg appear to be important factors in smoking cessation. SSRIs have been prophylactically used to reduce rates of depression in these pts. Studies are needed to determine if they can be used with the same success in minority population. Larger studies are also needed to assess the role of smoking cessation as a strategy to prevent depression among minority population.
Exploring correlates of quality of life in older family caregivers to cancer patients.
Authors: Cuthbert Colleen Ann , King-Shier Kathryn , Ruether Joseph D. , Tapp Dianne , Culos-Reed S. Nicole
Published: February 2017

186

Background: Family caregivers (FCs) have negative impacts to their physical and emotional health, and poorer quality of life (QoL) compared to non-caregivers. Most research on FCs has included heterogeneous samples, therefore little is known about specific groups such as older (age 60+) FCs. Older persons are at increased risk for health problems, may have co-morbidities, and be socially isolated. Understanding factors related to QoL may lead to interventions targeted to older FCs. The purpose of this study was to examine factors associated with QoL in older FCs to cancer patients. Methods: The data for this study are from a larger survey of FCs aged 60+, recruited from a hospital-based cancer facility. FCs were included if their care recipient had breast, prostate or colorectal cancer. QoL was measured using the MOSF-36. Analyses using descriptive statistics and Pearson’s correlations were conducted. Results: n = 168 participants consented, with n = 129 surveys returned. The majority of participants were female (60.5 %), 70 yrs old (sd 7.4), had at least a college diploma (65.2 %), were spouses of the patient 92.2%, and retired (60.5%). Mean caregiving hours per week was 24.2 (sd 26.3). Mean time as a caregiver was 31 months (45.9). The majority of patients were on treatment (75.2%) and were 71.3 yrs old (sd 7.5). The Physical Component Summary (PCS) of the MOSF-36 was significantly correlated with gender r = -.24, social support r = .25, sleep quality r = -.47, depression r = -.51, state anxiety r = -.40, and trait anxiety r = -.45 (all p’s < .01). There were significant correlations between the Mental Component Summary (MCS) and social support r = .40, sleep quality r = -.40, depression r = -.77, gender r = -.25, state anxiety r = -.72, and trait anxiety r = -.71 (all p’s < .01). The MCS was correlated with caregiving hours, r = -.197 (p < .05), however, not with patient treatment status. The PCS was not correlated with caregiving hours or patient treatment status. Conclusions: Consistent with previous FC research across different diseases, QoL was associated with gender, caregiving hours per week, social support, sleep quality, depression, and anxiety. Interventions for older FCs of cancer patients could be targeted to specific factors of overall QoL.
Quality of life difficulties in partners of young breast cancer survivors.
Authors: Champion Victoria , Cohee Andrea A , Monahan Patrick , Stump Timothy E. , Miller Kathy , Wagner Lynne , Cella David , Sledge George
Published: February 2017

188

Background: Although breast cancer is more commonly diagnosed in post-menopausal women, there are a significant number of survivors diagnosed at age 45 or younger. Compared to older survivors, younger survivors have significantly more problems with depression sexual functioning, marital satisfaction, and overall well-being, but there is little research on the partners of these younger survivors. The purpose of this study is to determine if the partners of young survivors experience more problems with depression, sexual functioning, marital satisfaction, and overall well-being than partners of age-matched controls. Methods: Survivors and partners (n=227) were enrolled in a large cross-sectional study, executed through the ECOG-ACRIN Cancer Research Group. Eligibility for survivors included being 45 or under at diagnosis, 3 to 8 years from treatment without a breast cancer recurrence, and with similar chemotherapy treatment regimens. Survivors identified age-matched acquaintance controls without breast cancer. These age matched controls and their partners (n=170) were also included. All groups completed a survey assessing demographic characteristics, depression, sexual functioning (enjoyment and difficulty), marital satisfaction, and overall well-being. The partners of both young survivors and acquaintance controls were compared on all study variables adjusting for demographic variables. Results: Partners of young survivors reported significantly more depression (effect size [ES] = -0.23, p=.0199), worse sexual functioning as indicated by lower enjoyment (ES= 0.32, p=.0019) and more sexual difficulty (ES= -0.24, p=.0164), lower marital satisfaction (ES=0.24, p=.0189), and lower overall well-being (ES= 0.40, p=.0001). Conclusions: Partners of breast cancer survivors suffer from problems similar to breast cancer survivors. Further research is needed to fully understand the impact of a breast cancer diagnosis on both the partner as well as the survivor, especially when problems exist that are related to the dyadic relationship.
"Hot Girls Pearls" and other coping strategies for women experiencing adverse effects from endocrine therapy in the treatment of breast cancer.
Authors: Halley Meghan , Beryl Louise , Gillespie Katherine , Rendle Katharine , May Suepattra Grace , Frosch Domnick L
Published: February 2017

197

Background: While endocrine therapy can significantly improve outcomes for women with hormone receptor-positive breast cancer, as few as 50% of patients take the medication as prescribed. Studies have shown that physical side effects contribute to non-adherence with hormone therapy. This study draws on prospective, qualitative interviews with patients to identify coping strategies patients employ to manage concerns over current and anticipated side effects, and suggests methods for encouraging adherence. Methods: Interviews were conducted with breast cancer patients (n = 41) at four time points throughout their treatment, resulting in over 150 patient narratives. Using a grounded theory approach, data were coded and analyzed to identify influential factors in decision-making. Here we present data from a subset of our participants (n = 18) focused on the role of side effects in patients' endocrine therapy decision-making. Results: Patients expressed a variety of concerns about current and anticipated side effects associated with endocrine therapy. Our data suggest five categories of coping strategies participants employed to manage these concerns: 1) emphasizing control over their choice to remain adherent; 2) focusing on a future free from side effects and cancer instead of current concerns or discomfort; 3) "familiarizing" side effects to make current and potential treatment risks feel less strange and/or intimidating; 4) making lifestyle changes to mitigate physical discomfort; and 5) seeking help from both medical and social sources. Patients often described using these multiple strategies to help navigate the functional, social and physical responses to side effects, and remain adherent to their treatment regimen. Conclusions: Our data describe the diverse coping strategies employed by women to manage current or anticipated side effects, and maintain adherence to prescribed endocrine therapy. Discussion of these different coping strategies by clinicians with patients may help to improve adherence rates by personalizing approaches to managing side effects.
Survivorship workshop delivery to primary care providers.
Authors: Chaput Genevieve , Hendricks Kristin , D'Souza Vinita , Khan Sarah , Naismith Laura
Published: February 2017

2

Background: There are approximately 15 million cancer survivors (CS) in North America. In addition to higher risk of recurrence, over 50% of CS are afflicted with late effects. CS are burdened with more medical conditions than the general population. CS visit specialists during treatment, and 75% of them also see their primary care provider (PCP) during and after treatments. Despite their integral role in survivorship care, PCP lack survivorship knowledge and have low confidence regarding CS care, supporting the urgent need to educate them about CS issues and surveillance needs. This study aimed to assess the educational benefit of a survivorship workshop targeting PCP in Montreal, Canada. Methods: An accredited workshop based on NCCN’s 8 common survivor issues was developed and delivered to 155 PCP at 5 sites. Matched pre and post surveys were designed using Likert scale and short-answer questions, and were completed on a voluntary basis by PCP. Specific outcome measures were based on the first 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behaviour. Data analysis included an open-coding approach to identify major themes of qualitative data. Ethics approval was granted. Results: Response rate was 64%. 95% indicated high satisfaction and relevancy of content for primary care. Using t-tests to compare pre and post responses, results were statistically significant for both “list 2 standards of survivorship” and “name 2 late-effects of cancer treatment” survey items, indicating an increase in both standards and late effects identified post workshop. 99% expressed behavioural intent to incorporate survivorship information into practice. Conclusions: Much research has focused on identifying PCP barriers to optimal survivorship care delivery such as limited topic proficiency, yet further efforts are warranted to close that knowledge gap. Our findings revealed increased knowledge of CS issues and surveillance needs post workshop. 3 months survey data is being collected to evaluate for actual practice changes and willingness to manage specific CS issues (i.e. treating depression). A second workshop targeting cardiovascular health promotion interventions has been created: delivery is anticipated early 2016.
Examining the relationship between multiple primary cancers and psychological distress: A systematic literature review.
Authors: Belcher Sarah M. , Hausmann Emilie A. , Klem Mary Lou , Cohen Susan M. , Donovan Heidi AS , Schlenk Elizabeth A.
Published: February 2017

214

Background: The incidence of multiple primary cancers (MPC) in cancer survivors is increasing. However, little is known about the psychological effects of MPCs on cancer survivors. The purpose of this systematic review was to synthesize the evidence regarding the impact of MPC on psychological distress in cancer survivors. Methods: Relevant studies were identified in PubMed database (up to June 2015). Non-English articles were excluded. Two independent evaluators reviewed articles for relevancy and data extraction. Data was organized and recorded using a coding log with exclusionary rationale, a PRISMA flow diagram, and a standardized table of evidence. Effect sizes (ES) were calculated using Cohen’s d to measure relationship magnitude and direction. Results: Of the 543 potentially relevant articles identified, four articles met criteria and were retained for analysis. Different quality of life (QOL) measures were used to assess psychological distress across studies, so ES were calculated for individual studies. There were consistently small but significant ES found for the impact of MPC on distress. When compared to survivors of a single cancer: one study found lower global QOL and higher total stress (ES, 0.1430 and 0.3653); one study reported that those with MPC were more likely to experience frequent mental distress and sleep problems (ES, 0.1404 and 0.2235); and one study found that those with MPC had lower global QOL and emotional function and greater anxiety and depressive symptoms (ES range, 0.1026 - 0.3215). Finally, the one study that evaluated suicidal ideation in survivors of childhood cancers did not find a higher incidence among those with MPC. Conclusions: The ES noted in the four studies suggest a small but significant increase in psychological distress in survivors of MPC compared to survivors of a single cancer. Clinicians should be aware of this at-risk population when screening for distress in cancer survivors. Additional studies that control for care transition points known to increase distress are warranted to explore the impact of MPC on psychological distress over time. Additionally, as the science in this area grows, it will be necessary to reevaluate the literature.
Substance use, psychological distress, and quality of life (QOL) in adolescent and young adult (AYA) cancer patients with hematologic malignancies in early survivorship.
Authors: Hlubocky Fay J. , Muffly Lori S. , GOmez Jocelyn , Breitenbach Kate , Lappe Mary , Stock Wendy , Daugherty Christopher
Published: February 2017

219

Background: Prior research identifies both the physical and psychological effects of cancer treatments as significant predictors of substance use among AYA. However, the prevalence of substance use and its effect on QOL and psychological well-being of AYA hematologic survivors has not been described. Methods: AYA patients (15-40 years at diagnosis) of acute leukemia, aggressive non-Hodgkin lymphoma, Hodgkin lymphoma undergoing curative intent therapy (on-treatment cohort) or 2 year completion of therapy and in remission (early survivor cohort) completed following measures: depression (CES-D), state anxiety (STAI-S), PTSD (PCL-C), QOL (FACIT-G). Semi-structured interviews evaluated substance use. Results: 62 AYA (26 on-treatment, 36 early survivors) were interviewed. For total population: median age at dx 26y (15-40); 64% male; 59% Ca; 79% college/post educ; 41% income <$75,000y; 52% and 48% lymphoma/ leukemia dx, respectively. Overall, 52% AYA reported the current use of a substance (ex. alcohol, nicotine, illicit drug). Of these, 49% AYA reported alcohol use; 20% reported nicotine use; 31% reported illicit drug use (ex. marijuana). AYA who used alcohol had poorer QOL (79±15 v 84±18,p=.02). AYA who used nicotine had higher STAI-S anxiety (44±13 v33±10, p=.01) and CES-D depression (30±16 v 15±8,p<.00). Nicotine use was associated with severe illness-related PTSD symptoms (57±26 v 28±10, p<.00). Also, AYA with illicit drugs use had greater CES-D (20±13 v 11±9, p=.03) and moderate PTSD (41±18 v 29±12, p=.01). On-treatment AYA were more likely to deny current use of illicit drugs (58% v 41%, p=.02) than early survivors. Conclusions: AYAs with hematologic malignancies report substance use negatively impacting QOL thus warranting the need for future age-specific psychological interventions.
Patient utilization of supportive care services identified through the Athena Breast Health Questionnaire System.
Authors: Wong Emily Claire , Kaplan Celia , Shumay Dianne , Leykin Yan , Van't Veer Laura , Stover-Fiscalini Allison , Esserman Laura , Melisko Michelle
Published: February 2017

226

Background: Psychological wellbeing and lifestyle changes are important factors in long-term health of cancer survivors. As part of the Athena Breast Health Network, the UCSF Breast Care Center (BCC) incorporated an electronic health questionnaire system (HQS) that collects patient-reported data on physical and psychological symptoms, medical conditions, family history, and lifestyle to identify patients’ supportive care needs. Methods: Through a semi-automated process, patients whose HQS responses meet pre-established thresholds are referred to Psycho-Oncology, social work, genetic counseling, and Onco-Fertility. Referrals generated within the HQS are signed and routed by clinicians at the time of a BCC visit. When patients decline appointments with these services, staff members document reasons within the electronic medical record (EMR). A retrospective chart review identified patients who did not receive supportive care services to which they were referred and a qualitative analysis was performed. Results: From 7/1/14-12/31/14, 525 patients completed an HQS and agreed to have their data used for research. The table summarizes referral information. 45 patients referred to Psycho-Oncology did not complete an appointment. Of these, ten did not respond to phone contact to schedule visits. 35 were reached, but declined an appointment. 25 (71.4%) were not ready to make an appointment; 5 (14.3%) cited distance as a primary barrier; 3 (8.6%) were satisfied with the psychological services they were receiving elsewhere; and 2 (5.7%) did not have insurance coverage. Reasons women disregarded referrals for genetic counseling and fertility are being evaluated. Conclusions: HQS can assist in identifying patient supportive care needs, but despite automation of referrals, many patients do not follow through to use supportive care and clinical resources. Timing and resource accessibility may be key. Through analysis of reasons for non-utilization, we hope to better tailor the delivery of supportive care services, when indicated, to better serve patient needs. [Table: see text]
Using eye-tracking to quantify the impact of prostate cancer treatments on male libido: A pilot study.
Authors: Skead Charlenn , Tsang Vivian , Palmer-Hague Jaime L , Wassersug Richard J , Nasiopoulos Eleni , Kingstone Alan
Published: February 2017

231

Background: Eye-tracking research has demonstrated that heterosexual men with normal testosterone levels attend visually to features of women associated with fertility, notably their breast size and waist to hip ratio. As such, eye-tracking data can serve as an implicit measure of a man’s libido. Many treatments for prostate cancer (PCa)—in particular androgen deprivation therapy (ADT)—depress sexual interest in men, but there is no objective measure of the intensity of this effect. Here we explore whether eye-tracking can be used to quantify the impact of PCa treatments on men’s libido. Methods: We used an IRB-approved deception protocol to explore the validity of eye-tracking technology for assessing the level of sexual interest of PCa patients and normal controls. Three age-matched groups of heterosexual men aged 50 years and older were recruited. They were: PCa patients using ADT, PCa patients not using ADT, and healthy controls. Unaware that their eye movements were being tracked, all were exposed to photographs of female models, either fully clothed (neutral) or minimally clothed (sexy). Number and duration of eye fixations on target areas of the female models’ bodies were recorded. Results: Trends observed in our preliminary data suggest that men on ADT exhibit differential patterns of visual attention to sexual stimuli compared to men in the other two groups. Although confirmation with a larger sample size is required, such shifts in attention may provide an objective measure of the influence of cancer treatments on the libido of PCa patients. Conclusions: Eye-tracking technology may provide a reliable and objective technique for measuring the libido of cancer patients. Such data could help patients be better informed about psychological side effects when making treatment decisions. They could also lead to ways to both study and reduce the impact of PCa treatments on men’s sexual interest.
Racial and ethnic variation in baseline health-related quality of life scores prior to prostate cancer treatment.
Authors: Reading Stephanie R. , Porter Kimberly R. , Slezak Jeffrey M. , Chien Gary W. , Jacobsen Steven J.
Published: February 2017

232

Background: To compare the racial and ethnic variations in baseline health-related quality of life (HRQOL) scores among men newly-diagnosed with prostate cancer prior to their prostate cancer treatment. Methods: Male members of the Kaiser Permanente of Southern California (KPSC) health plan, newly-diagnosed with prostate cancer, completed the five-domain specific Expanded Prostate Index Composite (EPIC-26) health-related quality of life (HRQOL) questionnaire between March 1, 2011 and August 31, 2013 (n=2,225). The five EPIC-26 domain scores (sexual, bowel, hormonal, urinary incontinence and urinary irritation) were compared across racial and ethnic subgroups and multiple logistic regression analyses were used to assess the association, adjusting for socio-demographic and clinical characteristics. Results: Within each racial and ethnic subgroup,higher baseline HRQOL scores were seen on the bowel, hormonal, urinary incontinence and urinary irritation domains (median score range: 87.5 – 100) as compared to the sexual domain (median score range: 49.3 – 62.5). Asian or Pacific Islander men were less likely to be above the sample median on the sexual (OR=0.51; 95% CI [0.36, 0.74]; p<0.001) and urinary incontinence domains (OR=0.65; 95% CI [0.46, 0.92]; p=0.015) as compared to the non-Hispanic white men. No additional statistically significant differences (p<0.05) were identified. Conclusions: These data suggest that few differences exist in baseline HRQOL scores across racial and ethnic subgroups among men newly-diagnosed with prostate cancer in an integrated health care organization. This finding provides important insight into the pre-treatment HRQOL status among these men with which to interpret HRQOL changes during and after prostate cancer treatment.
Impact of chemotherapy on health-related quality of life among ethnically diverse breast cancer survivors treated with breast-conserving therapy.
Authors: Amora Aseel Veronica , Tano Jessika , Conde Francisco A.
Published: February 2017

237

Background: Breast cancer (BC) is the most common cancer among women in the U.S. Public awareness and advances in BC screening have resulted in more women being diagnosed with early stage BC and treated with breast-conserving therapy (BCT) (lumpectomy followed by radiation therapy). Depending on prognostic factors and recurrence risk, systemic chemotherapy may be prescribed. Purpose of this study was to examine the impact of chemotherapy on quality of life (QOL) and needs of BC survivors treated with BCT for early stage BC. Methods: A list of 750 breast cancer survivors, aged 18 or older and who completed breast-conservation therapy for stages 0-II from 2001 - 2010, was obtained from a hospital’s tumor registry. Consent form and questionnaires, including a demographic questionnaire, City of Hope’s quality of life survey, and an investigator-developed questionnaire to assess for needs of cancer survivors, were mailed. T-test was used to compare mean subscales and overall QOL scores between those who received chemotherapy and those who did not. Frequencies and percentages were used to summarize the needs of BC survivors. Results: 119 completed surveys were received. Majority of respondents were Asians (56.3%), Caucasians (21.8%) and mixed ethnicity (13.4%). 55 patients received BCT plus systemic chemotherapy and 64 received BCT alone. Those who received systemic chemotherapy scored significantly lower on psychological subscale (p< 0.01), social subscale (p= 0.04), and overall QOL (p= 0.03) compared to survivors treated with BCT alone. Regarding needs, BC survivors want to learn about nutrition (40.3%), pain management (39.5%), improving memory (37.8%), and physical activity (33.6%). Conclusions: Although chemotherapy may decrease the risk of recurrence for early stage BC, lasting effects of treatment can negatively impact QOL. Understanding the impact of chemotherapy on various domains of QOL can be beneficial to patients and healthcare providers when discussing the risks and benefits of adjuvant systemic therapy. Further interventions are needed to improve QOL and address the needs among BC survivors treated with breast-conserving therapy.
Psychotropic and stimulant medication (PSM) use among testicular cancer survivors (TCS): A multi-institutional clinical study of 680 patients given cisplatin-based chemotherapy (CHEM) (NCI 1R01 CA157823-02).
Authors: Case-Eads Somer , Travis Lois B. , Fung Chunkit , Sesso Howard D. , Feldman Darren R. , Vaughn David J. , Hamilton Robert James , Johnson Eileen , Peterson Derick R , Fossa Sophie D. , Einhorn Lawrence H. , Beard Clair
Published: February 2017

242

Background: Testicular cancer (TC) is the most common cancer in men aged 15-40, with survival rates after diagnosis > 95%. Testicular cancer survivors (TCS) are known to be at increased risk for certain acute and chronic medical conditions, but few studies have examined barometers of their psychological health. The objective is to characterize the prevalence of PSM use and associations with demographics, health behaviors, and treatment-associated toxicities among TCS. Methods: TCS aged < 50 years at first-line CHEM completed a questionnaire regarding co-morbidities and prescription drug use, including PSMs. For co-morbidities, peripheral neuropathy (PN) responses of ‘a little’, “quite a bit”, or “very much” were scored ‘yes.’ Fisher’s exact test was used to examine the significance of various associations. Results: Among the first 680 consecutively enrolled TCS, median age at TC diagnosis was 31y (range, 15-49y) and median time since CHEM completion was 52mo (range 12-360mo). 85 TCS (12.5%) reported PSM use, including antidepressants (N = 65 [76.5%]), anxiolytics (N = 23 [27%]), and stimulants (N = 21 [25%]) with 20 TCS on ≥ 2 PSMs (23%). Compared to non-users, more PSM users were unemployed (11.8% vs. 4.4%%; P < .01), self-rated their health as fair/poor (12.2% vs 4%; P < .01), and had gained > 20lb since CHEM (39.8% vs 23.4%;P < .01). PSM users were more likely to have tinnitus (49.4% vs. 36.4%; P < 0.04), both tinnitus and PN (43.5% vs. 27.2%; P < 0.01), cardiovascular disease (26.2% vs. 15.6%; P < .02), and greater use of prescription medications for pain control (20% vs. 4.7%; P < 0.01), hypertension (16.5% vs. 7.1%; P < 0.01), diabetes (8.3% vs. 2.9%; P < 0.02), and testosterone replacement (10.6% vs. 5.0%; P = 0.048). Conclusions: Future studies should aim for identification of high-risk patients in need of intensified preventive and therapeutic interventions.
Androgen deprivation therapy educational program: A Canadian true nth initiative.
Authors: Wibowo Erik , Walker Lauren M , Wilyman Shawn , Matthew Andrew , McLeod Deborah L , Wassersug Richard J , Robinson John W.
Published: February 2017

243

Background: Androgen deprivation therapy (ADT) is commonly prescribed for advanced prostate cancer (PCa) patients, but ADT has many side effects that can impair patients’ quality of life. In various Canadian cities, we are running an educational program to help PCa patients and their partners deal with the side effects of ADT, and maintain a strong relationship with each other while on ADT. Methods: Patients, who are about to start or have been on ADT, and their partners are invited to attend an educational program. Each patient is given a copy of the book Androgen Deprivation Therapy: An essential guide for men with prostate cancer and their partners (Wassersug et al., 2014) and attends a 1.5 hour educational class, where they learn strategies for managing ADT side effects and how to effectively make healthier lifestyle changes using goal-setting exercises. At the end of the class, participants are given the option to attend a monthly follow-up session. To evaluate the effectiveness of the program, participants are asked to complete questionnaire package before attending the class and again 2-3 months later. Results: As of August 2015, 179 patients and 113 partners have attended the ADT Educational Program at Victoria, Vancouver, and Calgary. About 40% of patients returned for the follow-up session. 62 attendees participated in the research evaluation portion of the program. Uniquely designed for this study, the questionnaire package assesses ADT side effect frequency, bother associated with side effects, use of management strategies, and self-efficacy regarding side effect management. An assessment of physical activity and relationship adjustment, and feedback about the class are also included. Conclusions: Patients and partners appreciate being informed about ADT side effects managements and how to make healthier lifestyle changes while on ADT. It remains to be seen how effective the program is in limiting the bother from ADT side effects and helping couples maintain a strong dyadic relationship in the fact of the challenges brought on by ADT. Good enrollment in the in-person program in the 3 cities has propelled the development of the program in Halifax and Toronto starting in fall 2015, and an online version to be available in early 2016.