bluuebunny/crossref_metadata_2025 huggingface dataset:
Body image disturbances in adolescent and young adult patients with cancer confronting infertility risk and fertility preservation decisions.
Authors: Wytiaz Victoria A , Levin Nina , Tan Chiu Yi Joey , Stelmak Daria , Iannarino Nicholas , Zhang Anao , Ellman Erin , Herrel Lindsey A. , Moravek Molly , Walling Emily Byrnes , Chugh Rashmi , Zebrack Brad J.
Published: June 2023

e24175

Background: Body image is a major psychosocial concern for all cancer patients but can affect the adolescent and young adult (AYA) population in distinct ways. Similarly, the prospect of infertility and the fertility preservation process can create additional stress during cancer treatment. Discussions regarding infertility inherently implicate the body and its reproductive function, but downstream effects on self-perception have not been previously described. The aim of this study was to better elucidate the relationship between oncofertility discussions and body image disturbances in the AYA cancer population. Methods: AYA cancer patients (n = 27) aged 12-25 years whose cancer treatment conferred the risk of infertility were recruited through electronic health record query at an NCI-Designated Comprehensive Cancer Center. Participants completed semi-structured interviews which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to body image were identified. Results: Body image concerns, including those related to both physical appearance and body functioning, emerged as common themes. Specific concerns included 1) anticipating and coping with body changes, 2) discomfort in experiencing and discussing one’s own body, 3) fear of judgement, and 4) failing to meet both internal and external expectations of the body. Some participants expressed a sense of loss when learning about infertility risk and the emotional challenges associated with accepting this risk. Several respondents worried that they would be negatively judged by their peers for a perceived defect of the body. Still others struggled with facing the unknown regarding fertility preservation and the difficulty in sharing this information with loved ones and future romantic partners. Conclusions: AYA cancer patients experience a multitude of body image related disturbances when faced with the possibility of infertility and decisions regarding fertility preservation. In identifying and exploring these themes, future opportunities, and novel interventions for improving oncofertility practice and discussions among AYAs with a focus on body image positivity emerge. These include the dual involvement of multidisciplinary teams (oncology and reproductive medicine) at initial clinical consultation and frequent follow-up contact; AYA and oncofertility-specific peer support programs, both in-person and virtual; and early, frequent involvement of social workers and mental health providers experienced in both cancer care and reproductive medicine.
Information and decisional needs of patients (pts) with newly diagnosed advanced cancer in the hospital: A multi-level, mixed-methods study.
Authors: Reyes Kevin R , Wong Paul , Petrofsky Mary , Dai Annie , Pelayo Alyson , Brondfield Sam , Kwon Daniel H
Published: June 2023

e24177

Background: Pt informed decision-making (IDM) is crucial in cancer care. Little is known about the informational and decisional needs of pts with newly diagnosed advanced cancer in the hospital, for whom unique IDM challenges may exist. Methods: A single-center, mixed-methods study of hospitalized pts with a newly diagnosed, treatment-naïve advanced solid malignancy; their caregivers; and outpatient medical oncologists was conducted from June to November 2022. At discharge, pts were surveyed for cancer type/stage knowledge, treatment knowledge & decisional conflict using the informed subscale & total Decisional Conflict Scale (DCS; scored 0-100, higher = more conflict) respectively, and information timing preferences. Post-discharge semi-structured interviews exploring information/decisional needs were conducted with pts or pt-caregiver dyads. Oncologists were surveyed about the knowledge of the most recent pt they saw who met aforementioned criteria. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. Results: Of 25 pts approached, 20 (80%) completed the survey. Interviews were halted after 12 pts and 4 caregivers due to saturation. Fifteen (75%) pts knew their cancer type and 10 (50%) their stage. For the DCS, 13 (65%) scored > 37.5, which is linked with decision delay/regret; median informed subscale score was 66.7. Pts reported wanting to be informed as soon as possible (vs. later) about cancer type (90%), stage (85%), treatment options (80%) and prognosis (70%). Interview themes were cancer knowledge, cancer decisions, information needs/uncertainty, barriers/facilitators to information gathering during/post-hospitalization, decision-making barriers/facilitators, locus of control in decision-making, and goals. Of 46 oncologists approached, 32 (70%) completed the survey. Twenty-four (75%) reported that the pt was somewhat/very well-informed about cancer type, 15 (47%) stage, 18 (57%) treatment options and 9 (28%) prognosis. Themes from open-ended questions were inpatient information processing, outpatient care navigation/expectations, and low expectations of pt cancer knowledge. Oncologists recommended pt education, supportive care referrals, and inpatient-outpatient communication at discharge. Conclusions: Pts with an inpatient diagnosis of advanced cancer experience high decisional conflict and are not well-informed about cancer treatment and prognosis. Pts, caregivers, and oncologists identified numerous information/decisional needs and barriers/facilitators. Though some needs were due to barriers unique to hospitalization, pts did not perceive hospitalization as a barrier to IDM. Further studies should explore transitional interventions such as enhanced pt education, supportive care, and standardized, tailored handoffs to the outpatient team.
The impact of COVID-19 on anxiety among breast cancer survivors before, during and after the pandemic.
Authors: Tsui Edison , Reeves Katherine , Caruso Isabella , Makari-Judson Grace
Published: June 2023

e24178

Background: The COVID-19 pandemic has caused unprecedented stressors on the mental health of patients with cancer as well as with cancer survivors. Little is known regarding anxiety among breast cancer survivors during and following the pandemic. Methods: We performed a cross-sectional study evaluating the mental health impacts of the COVID-19 pandemic on a cohort of breast cancer survivors (n = 1333). Between January and March 2022, participants enrolled in the Rays of Hope Breast Cancer Research Registry were invited to complete an online study questionnaire. We analyzed the data collected from a series of questions regarding outcomes and perspectives representing three distinct time periods: before (prior to March 2020), during (March 2020-June 2021) and after the COVID-19 pandemic (January-March 2022), based on the dates of the Massachusetts State of Emergency declaration. The COVID-19 Anxiety Scale (CAS) was used to measure anxiety specific to COVID-19. Generalized anxiety symptoms were measured using the Generalized Anxiety Disorder 7-item (GAD-7) scale. Multinomial logistic regression was used to identify factors related to increased or decreased anxiety symptoms. Results: A total of 272 independent participants (21.5%) completed the survey. Of these, 230 respondents with a confirmed history of breast cancer were included in the final analysis. While 26.2% met GAD-7 criteria for moderate to severe anxiety after the pandemic, only 13% self-reported a prior diagnosis of any mental health condition. Approximately 17% reported experiencing more anxiety symptoms after the pandemic compared to before. A history of smoking was associated with a higher likelihood of experiencing increased symptoms of generalized anxiety (OR = 1.97, 95% CI 0.93-4.14); whereas exercise frequency of at least three times per week was associated with experiencing a decrease in anxiety symptoms over this period (OR = 7.00, 95% CI 1.39-35.14). The CAS and reporting that the pandemic had a negative impact on cancer care were associated with a higher likelihood of increased generalized anxiety after the pandemic (OR = 2.21, 95% CI 1.19-4.09; OR = 3.05, 95% CI 1.06-8.83, respectively). Conclusions: Increased symptoms of anxiety were prevalent among breast cancer survivors during the pandemic and, in some, have not returned to pre-pandemic levels. Less than half of participants with symptoms meeting criteria for moderate to severe anxiety reported having a formal medical diagnosis, suggesting that clinically significant anxiety may be underrecognized in breast cancer survivors following the pandemic.
The voice of the breast cancer survivor: Implementation of survivorship needs assessment in an integrated health system.
Authors: Tahir Nayha , Wei Jenny , Zamani Constanza , Kurz Heather , Goler Nancy , DeYoung Claudia , Siegel Samantha , Shiraz Aida , Weldon Christine B. , Trosman Julia R. , Dixit Niharika , Liu Raymond
Published: June 2023

e24180

Background: The population of breast cancer survivors in the US has reached 3.8 million in 2022. In times of standardized and guideline driven oncologic treatment, individual patients continue to have multitude of unique needs that may impact their long-term survival outcomes. To address whether assessment of patient needs is feasible and leads to actionable findings, we implemented a breast cancer survivor needs assessment with standardized documentation of actions taken in the electronic medical record. Methods: An adapted NCCN evaluation tool (Coleman Tool) was used in survivorship visits to assess the feasibility of needs assessment from January 2022 to June 2022 as part of a quality improvement project. The assessment was done either electronically via secure health portal prior to the visit or in person at the time of the visit. Patient, tumor, treatment characteristics as well as needs identified, and actions taken were abstracted from the electronic medical record. Fisher’s exact test used for comparisons. Results: Patients were ethnically diverse (43% White, 39% Asian, 13% Hispanic, African American 4%), English speaking (82%), and employed (50.5%). The median time from cancer diagnosis to needs assessment was 884 days. Most of the patients had Stage 1A (38.2%), were ER (91.7%) and PR (77.8%) positive and HER2 negative (73.7%). The majority underwent lumpectomy (66.4%), had radiation therapy (67.7%) and hormonal therapy (81.6%). Only 32.3% received chemotherapy. Most patients received some form of needs assessment (202 of 217, 94.0%), with 59 (29.2%) receiving pre-appointment electronic assessments with a 42.4% response rate. Major domains of needs reported by patients and actions taken are mentioned below in the table. Both pre and at visit assessments noted a high degree of treatment and physical needs that lead to subsequent actions (p value of 1.00 and 0.04 respectively). Conclusions: An adapted NCCN Needs Assessment Tool (Coleman Tool) is a practical and feasible method of assessing breast cancer survivors’ needs. The assessment can be done pre or at visit and can lead to actions which improve survivorship care. [Table: see text]
Differential efficacy of antidepressants in the treatment of hormone mediated depression in patients with ER+ breast cancer.
Authors: Kato Martha M , Martinez Constanza , Currier Maria , Rubens Muni B.
Published: June 2023

e24181

Background: Tamoxifen (TAM) and aromatase inhibitors (AI) are associated with a high side-effect burden including depression and cognitive deficits which compromise quality of life and adherence to treatment. The aims of the study were to determine the efficacy of antidepressants (AD) with hormone mediated depression in ER+ breast cancer patients and to determine if any clinical variables predicted successful AD treatment response. Methods: A retrospective chart review of consecutive referrals to psycho-oncology of breast cancer patients on TAM or AI with new onset depression was conducted. Demographic variables, cancer stage and treatment, hormonal treatment, psychiatric history and AD treatment were collected. Assessments for depression, anxiety and cognitive disorders included clinical interviews, patient-rated scales [Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI)] and a clinician-rated scale [Montreal Cognitive Assessment (MoCA)]. These measures were done at baseline (before starting an AD) and follow-up to determine AD treatment response. Successful AD treatment is defined as ≥50% reduction in baseline BDI score, while remission of depression is defined as a BDI score < 8. Statistical analysis comparing clinical variables between AD responders and non-responders included Fischer’s exact test or chi-square, one-way ANOVA, t-test, and binary logistic regression to determine which variables predicted successful AD treatment response. Results: A sample of 40 ER+ breast cancer patients (mean age 55 years; 39 females, 1 male; 26 Hispanic, 14 non-Hispanic) included 18 on TAM and 22 on AI. AD included venlafaxine (N = 18), escitalopram (N = 9), bupropion (N = 4), mirtazapine (N = 4), sertraline (N = 3) and duloxetine (N = 2). Over 72% (29/40) of patients successfully responded to AD with a complete depression remission rate of 50% (20/40). Venlafaxine at a mean dose of 150 mg was significantly more effective (p = .013) in treating hormone-mediated depression when compared to selective serotonin reuptake inhibitors (SSRIs) and other AD (bupropion, mirtazapine). Specifically, 94% (17/18) of patients on venlafaxine successfully responded. Other variables such as cancer stage and treatment, demographics, psychiatric history, and specific hormonal therapy did not predict AD treatment response. Conclusions: Venlafaxine 150 mg daily yielded significantly higher rates of AD response and complete remission of depression in ER+ breast cancer patients with TAM-induced and AI-induced major depression. Venlafaxine was significantly more effective than SSRIs and atypical AD. This high rate of response is likely due to dual serotonin and norepinephrine reuptake inhibition achieved at 150 mg dosing. Venlafaxine can be safely administered with TAM.
Patient resilience and distress level prior to chemotherapy based on time estimation.
Authors: Kraleva Petya , Petrova Mila , Popov Teodor , Conev Nikolay Vladimirov , Dimitrova Eleonora , Ruseva Rossitza Krasteva , Changalova Aynura , Iliev Bozhidar , Nedeva Snezhina , Tatarov Tsvetan , Zhbantov Georgi , Hadjiev Rosen , Donev Ivan
Published: June 2023

e24184

Background: Our prospective and multicentric study aimed to determine if the effects of breast cancer patients' resilience on their distress levels are mediated by the assessment of time before initiating neo/adjuvant chemotherapy. Methods: In 104 chemo-naive breast cancer patients, time estimation was evaluated by comparing each subject's prospective estimate of how rapidly one minute passed to the actual time. The Distress Thermometer of the National Comprehensive Cancer Network was used. The range of the scale is from 0 (no distress) to 10 (extreme distress). The Connor-Davidson Resilience Questionnaire (CD-RISC), a self-reported 10-item unidimensional scale, was utilized to measure resilience. Respondents rate statements on a 5-point Likert scale ranging from 0 (not true at all) to 4 (true nearly all the time). A higher score reflects greater resilience. Based on their RISC scores, patients were divided into three groups: low (up to the 33rd percentile), intermediate (between the 33rd and the 66th percentile), and high (over the 66th percentile). Patients' time estimations were similarly divided. Cronbach's α was 0.87 for all 10 items. Results: The mean age of the patients was 53.1±12.4 years. RISC scores correlated positively with time estimation (rho = 0.31, p = 0.002) and negatively with distress levels (rho = -0.445, p < 0.001). A significant negative correlation was observed between time estimation and distress levels (rho = -0.394, p < 0.001). Correspondence analysis revealed a significant association across the three matching groups of RISC score and time estimation (χ2 = 9.8, p = 0.044). The Jonckheere-Terpstra test revealed that patient estimates of time varied significantly between the three groups (p = 0.013). Using Hayes simple regression, we discovered that RISC scores were a significantly positive predictor of time estimation (b = 0.844, s.e. = 0.261, p < 0.0001). Both RISC score (b = -0.136, s.e. = 0.031, p < 0.0001) and time estimation (b = -0.041, s.e. = 0.011, p = 0.0005) were significant negative predictors for higher distress levels in the second regression. Conclusions: Via time estimation, patients' resilience influences distress levels prior to treatment initiation.
Ask Questions (ASQ): Implementation of a question prompt list communication intervention in a network of outpatient medical oncology clinics.
Authors: Hamel Lauren M. , Moore Tanina Foster , Mattei Larissa H. , Jang Hyejeong , Kim Seongho , Keaton-Williams Kimberly , Brown-Miller Voncile M. , Eggly Susan
Published: June 2023

e24185

Background: High-quality, patient-centered communication is not experienced equitably across patient populations, likely contributing to healthcare disparities. Question Prompt Lists (QPL) improve patient active participation and other aspects of patient-physician communication in diverse populations and settings. This descriptive, single-arm study assessed the implementation and patient perceptions of a previously-developed, evidence-based QPL, the ASQ brochure, across a network of oncology clinics providing care in a diverse population across Michigan. Methods: The QPL was revised in collaboration with community and physician stakeholders. Implementation was assessed through the reach, adoption, and efficacy domains of the RE-AIM framework. Eligible patients had a cancer diagnosis and were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before their appointment, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and univariable and multivariable linear mixed-effects models. Results: Reach: A total of 81 patients participated with a consent rate of 68.3%. Self-identified racial/ethnic groups were representative of the population served by the clinic network (72.4% white, 21.0% black, 3.7% American Indian/Native Alaskan, and 1.2% Mexican/Hispanic). Adoption: All eight invited clinics participated and recruited patients. Efficacy: All outcomes improved significantly, with no significant differences by clinic site or patient race. Patient perceptions of the ASQ brochure were overwhelmingly positive. Conclusions: The implementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population. Findings suggest this simple, evidence-based communication intervention should be implemented widely in similar clinical contexts.
Transplant teeter-totter: How hematologists communicate the high risk, high reward nature of allogeneic hematopoietic cell transplant with patients.
Authors: Rodenbach Rachel , Thordardottir Thorunn Halldora , Campbell Toby Christopher
Published: June 2023

e24189

Background: While allogeneic hematopoietic cell transplant (HCT) offers a chance of cure for many patients with aggressive blood cancers, it carries many risks. Little is known about how hematologists communicate this uncertainty with patients. In this secondary analysis from a telemedicine study assessing how transplant hematologists facilitate shared decision making with patients, we evaluated how physicians discuss the high risk, high reward concept of allogeneic HCT. Methods: This is a qualitative analysis of transcribed video-recorded virtual encounters of transplant hematologists with patient actors. We recruited US hematologists who routinely perform allogeneic HCT via email. Participants conducted up to an hour-long video encounter with an actor trained to portray a 67-year-old man recently diagnosed with high-risk myelodysplastic syndrome and referred for specialty hematology consultation for discussion of treatment options. Results: Transcripts from 33 hematologists (mean age 46 +/- 11 years; 61% male) were available at the time of analysis. Hematologists frequently used “teeter-totter” language that oscillated between optimistic encouragement and cautious hesitancy about allogeneic HCT: HCT represented the best and only chance for cure, but it was dangerous, required sacrifice, and did not ensure long term survival. Many hematologists used tentative hedging to describe HCT’s intent for possible (rather than certain) cure, and many detailed the effect of potential undesirable complications on survival and quality of life. They also acknowledged that given HCT’s unpredictability and complexity, prognostication for any individual patient was difficult if not impossible, especially early on. The teeter-totter language frequently occurred within the same sentence or speaker turn (e.g. it may “give[] you a cure, but it comes at a price”) and also played out more gradually throughout the encounter both in exchanges between hematologist and patient and by the hematologist. With respect to decision making, some hematologists expressed their goal for the patient to understand the teeter-totter of transplant in order to make a well-informed decision based upon the patient’s personal risk tolerance/aversion. Others proposed that they share an acceptance of the teeter-totter and together deal with complications one step at a time along the transplant journey. Many reinforced that transplant offered the best chance for long term survival despite the risks and that they would do everything they could to help the patient achieve this. Conclusions: Hematologists use “teeter-totter” language to express uncertainty, hope, and caution about the high risk, high reward nature of allogeneic HCT. This language is used to prepare patients for unpredictable and uncontrollable aspects of the transplant journey and to inform decision making.
Willingness of women at increased genetic and non-genetic risk of breast cancer to participate in intervention trials to prevent cancer.
Authors: Mastrogiacomo Cecilia , Thompson Patricia , Moyer Anne , Preece Christina , Stopeck Alison
Published: June 2023

e24190

Background: The factors that influence willingness to participate (WTP) in breast cancer (BC) prevention trials are not well understood. WTP in BC prevention trials was examined in patients at increased risk of BC considering intervention and participant characteristics. Methods: Women self-identifying as being at increased risk for BC were recruited to a cross-sectional study of WTP in BC prevention trials. 78% (87 of 112) of participants completed ≥50% of a 29 item Likert Scale questionnaire about WTP in BC prevention trials that varied in intervention type and intensity, duration, time commitment, study procedures, and side effects of medications. Responses were dichotomized into “more willing” (“a lot” and “moderately”) versus “less willing” (“some,” “a little,” and “not at all”). A chi-square test was used to determine if responses differed between participants based on intervention and participant characteristics. Results: General WTP in BC ‘prevention’ studies was high at 79% “more willing”, including 67% and 72%, respectively, for unspecified physical activity and diet behavior change interventions. WTP differed significantly for diet-based behavior change interventions by type and duration; WTP was significantly lower for 12- versus 3-month interventions for both eliminating foods (28% versus 53% “more willing”, p = 0.0007) and for engaging in intermittent fasting (30% versus 45% “more willing”, p = 0.042). For physical activity, WTP decreased with duration of the intervention with 28% fewer WTP for one hour of low intensity exercise/day when compared to 30 minutes (p < 0.0001). For medications, less than half of participants (46%) expressed being “more willing” to participate, and WTP decreased significantly when possible side effects were presented (81% “less willing”) with 95% “less willing” for medications with a rare risk of serious side effects. WTP was influenced by BC risk gene mutation status, with higher proportions among gene carriers compared to non-gene carriers (59% versus 21% “more willing,” p = 0.0013), including WTP in medication chemoprevention studies (38% versus 8% “more willing,” p = 0.002). Conclusions: WTP in BC prevention trials of behavior change is high among patients at elevated risk of BC but for all women was found to be significantly negatively influenced by greater time commitment and duration of intervention beyond a few months. WTP in studies of medication is lower compared to behavior change, and very low for medications with any side effects. Overall, WTP is greater in women with known genetic risk. This study suggests that WTP may be influenced by how patients perceive their level of risk. These results also suggest that despite interest in behavior change prevention, patients may not fully recognize the relationship between sustained behavior change and potential for prevention benefit.
How did the COVID-19 pandemic affect the management of patients with cancer? What is the impact of anti-cancer medications on the immune response to the COVID-19 vaccinations?.
Authors: Abdelsalam Mahmoud , Salem Maged , McPherson Alexander , Abdel-Samad Nizar , Obrien Pierre , Ross Laura , Sughayar Rana , Avileli Mrudula
Published: June 2023

e24193

Background: This study had two objectives: To assess the impact of the COVID-19 pandemic on cancer patients’ management. To determine the impact of cancer types and anti-cancer medications on the immune response to COVID-19 vaccinations. Methods: Cancer patients at the Moncton Hospital, Oncology/Hematology Clinic, were invited to voluntarily complete a survey about the date of their cancer diagnosis, treatment, the impact of the COVID-19 pandemic on their health, and to complete a prepared list of possible side effects that they experienced after receiving any of the COVID-19 vaccines. Participants, who had received at least two doses of any COVID-19 vaccine, were given the option to consent to a sub-study to provide a blood sample to check their antibody response to the COVID-19 vaccination. Blood samples were collected at least 4 weeks after the second dose of a primary vaccine series, or at least 2 weeks after any booster dose. Samples were sent to the Dr. Georges-L.-Dumont University Hospital lab to be analyzed. Data was collected regarding the type of treatment (chemotherapy, immunotherapy, targeted therapy, hormonal therapy, radiation therapy, or a combination of these therapies). Analysis of the data was done using SPSS program. Results: 178 patients completed the survey. 117 patients had solid tumors, and 61 had a hematological malignancy. The mean age was 65.75 (range 31-90) years and 45.5% were males. 62.3% either had a high school diploma or a graduate degree. When asked if their anxiety about their health increased due to the pandemic, 57.8% reported that their anxiety level has moderately or somewhat increased. Similarly, around 70% responded that their stress levels moderately or somewhat increased due to the pandemic. Only 7.3% of patients mentioned that they had delays in diagnosis, and only 2.8% had changes in their treatment, however, around 30% had their appointments changed into phone appointments as a result of the pandemic. Only 4% reported a loss of job due to the pandemic, and 11.2% reported financial stress. Cross tabulations were done between type of cancer and results of the COVID-19 antibody test and type of treatment and results of the COVID-19 antibody test. Results showed that the type of treatment that the patient was receiving has no impact on the production of COVID-19 antibodies. However, antibodies after COVID-19 vaccination were not detected in 20.5% (10/49) of patients with hematological malignancies compared to 3.6% (3/82) of patients with solid tumors. This difference was statistically significant (p = 0.001). Conclusions: The pandemic affected Cancer patients in terms of increasing their anxiety and stress levels. The production of antibodies after COVID-19 vaccinations was significantly decreased in patients with hematological malignancies.
Effectiveness of a video-based educational training program to enhance primary care providers confidence and self-efficacy in the management of cancer survivors.
Authors: Gilmore Katherine Ramsey , Nguyen Linh K. , Bortolotti Julie S. , Nguyen-Vu Nancy N. , Reygaerts Hannah , Johnson Lance , Hartman Ronda L. , Murphy Thomas J. , Rodriguez Maria Alma
Published: June 2023

e24194

Background: As of January 2019, there were over 1.1 million cancer survivors residing in Texas. It is well documented that primary care providers (PCPs) currently care for a large number of cancer survivors but may not receive adequate training to offer comprehensive survivorship care. Through training and education, this project aims to increase the confidence and self-efficacy of PCPs providing care to survivors and to improve overall health outcomes based on comprehensive domains of care. Methods: Focus groups and surveys were conducted with PCPs in a community-based family practice to identify potential knowledge gaps and confidence related to survivorship care. We developed and distributed a video-based training curriculum consisting of four domains of survivorship care and the management of four common cancers. We used the Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) to conduct pre- and post-training evaluation. Results: Seventeen (100%) providers completed the pre- and post-training SPARCCS. The survey results showed that 94% of the PCPs have previously provided care for patients diagnosed with cancers. However, prior to training only 6-18% felt very confident in their knowledge of cancer-related follow-up care for breast, colorectal, lung, and prostate cancer survivors and 24-41% felt not at all confident. All participants completed 8 video-based education modules (approximately 6 hours of education). Post-training results indicated 18-29% of providers felt very confident in the domains in questions and only 12% lacked confidence related to the management of long-term and late physical adverse effects (Table 1). Conclusions: Video-based educational training can improve the confidence and self-efficacy of PCPs in the care and management of cancer survivors. Continued evaluations are planned to assess the sustainability of this demonstrated improvement over time. [Table: see text]
Evaluation of the psychological state of patients suspected of Lynch syndrome after the germline genetic testing result.
Authors: Barbosa Oliveira Francisca Fernanda , Sant'Ana Rosane Oliveira , Picanço-Albuquerque Clarissa Gondim , Luciano Maria Claudia dos Santos , Bastos Jose Fernando , Bitencourt Flávio da Silveira , Bezerra Maria Júlia Barbosa , Souza Thuany Pinto Rocha de , Silva Paulo Goberlanio de Barros , Freitas Karisa Lorena , Silva-Fernandes Isabelle Joyce de Lima
Published: June 2023

e24201

Background: Lynch syndrome (LS) also known as Hereditary Non-Polyposis Colorectal Cancer (HNPCC) syndrome, is caused by a deficiency of Mismatch Repair Complex (MMR) enzymes. It is an autosomal dominant syndrome associated with an increased risk of developing colorectal cancer and other neoplasms, which can be confirmed using a germline molecular test. Psychological distress can be triggered regardless of the genetic test result. How the individual reacts emotionally and psychologically to the development can influence the processing of information and guidelines and adherence to preventive strategies. In this context, tracking anxiety symptoms provides opportunities for psychosocial follow-up planning. Objective: to evaluate levels of anxiety and depression in cancer patients suspected of having LS submitted to genetic testing. Methods: 84 patients with clinical criteria for LS were submitted to the germline genetic panel by NGS and immediately after the genetic test result, answered the Hospital Anxiety and Depression Scales (HADS). Data were expressed as mean±SD and compared using the Mann-Whitney, Kruskal-Wallis/Dunn, and Spearman correlation tests (SPSS v20.0, p < 0.05). Results: The mean levels of anxiety (5.59±3.31) were significantly higher than that of depression (4.63±3.58) ( p= 0.007), both domains were positively correlated ( p< 0.001, r= 0.447). Eighteen patients (21.4%) had pathogenic mutations in genes of the MMR complex. A positive diagnosis did not affect levels of anxiety or depression (pathogenic variant p= 0.617 and p= 0.478; Significance Uncertain-VUS p= 0.415 and p= 0.561, respectively). Females had higher levels of depression than males ( p= 0.047, with a relative risk of 1.65 times; CI95% = 1.05-13.19); however, other clinical and therapeutic characteristics did not significantly influence anxiety levels or depression. Conclusions: Colorectal cancer women are most sensitive to depression after germline genetic testing, despite the results. These findings reinforce the need for psychological screening of individuals undergoing genetic testing for LS and continuing psychological follow-up after receiving the genetic test.
Therapy preferences of patients with cancer.
Authors: Dhakal Prajwal , Wichman Christopher S. , Pozehl Bunny J. , Elnair Radowan , Yellala Amulya , Mahato Kalika , Bhatt Vijaya Raj
Published: June 2023

e24205

Background: Clear understanding of patient (pt) preferences is crucial for creating a treatment (tx) plan that aligns with pt's goals and expectations. We developed "Therapy Preference Scale" (TPS), a self-reported questionnaire, to measure tx preferences of pts with cancer. TPS includes 30 questions: 19 questions on pt preferences on safety, efficacy, and other aspects of therapy (on scale of 0-10), 8 questions on importance of different aspects of tx (on 4-item Likert scale with choices of 'strongly disagree,' 'disagree,' 'agree,' and 'strongly agree.'), and 3 questions on intent of therapy, expenses, and life expectancy gain. This report presents results of the 8 questions rated on the 4-item Likert scale from a prospective study using TPS. Methods: 300 pts > 18 yrs with a cancer diagnosis completed TPS. We divided pts into 4 groups: Male < 60 yrs (M < 60), Male ≥60 yrs (M ≥60), Female < 60 yrs (F < 60), and Female ≥60 yrs (F ≥60). We compared responses between M < 60 and M≥60 and between F < 60 and F≥60. The responses were categorized into 2 groups: "disagree" (combining "strongly disagree" and "disagree") and "agree" (combining "strongly agree" and "agree"). Results: Median age was 61 yrs (range 19-89). 62% had solid tumors. 57% indicated cure as their tx goal versus gain in life expectancy without cure (35%) or symptom relief (8%). 4 groups were 20% M < 60, 32% M ≥60, 19% F < 60, and 29% F ≥60. M < 60 were more likely to accept tx with side effects and financial burden, while M ≥60 prioritized avoiding poor quality of life (QoL). F < 60 were more likely to undergo tx causing significant pain, while F ≥60 would avoid permanent cognitive impairment. Table 1 shows percentage of pts who agreed with the 8 questions. Conclusions: Despite similar preferences for a cure, age and gender play role in prioritizing tx options, including those with potential side effects such as life-threatening infection, poor QoL, financial burden, severe pain, and permanent cognitive impairment. TPS can improve the precision medicine approach and aid in choosing the right tx for each pt. [Table: see text]
The semantics of cancer: An experimental study in the meaning and use of cancer-related terms among surgical professionals.
Authors: Raghunathan Rajam , Rett Jessica , Raghunathan Rajam , Eilber Frederick C.
Published: June 2023

e24216

Background: Because cancer does not form a natural kind, there is no list of properties that can exhaustively define it. Consequently, philosophers would expect the meaning of the term “cancer” to be subjective and variable, even across medical specialties. We hypothesized that a semantic difference regarding the understanding of “cancer” leads to diagnostic miscommunication. The goal of this multi-phase project is to better understand, quantify and compare expert and non-expert interpretations of the word “cancer” to help address this discrepancy. Methods: A 26-question online survey was administered to 72 English-speaking medical professionals at surgical grand rounds at the University of California, Los Angeles on October 17, 2022. Respondents were provided with 15-20 minutes to complete the survey questions, consisting of: demographics; level of experience with cancer diagnoses; a one-sentence definition of cancer; three words or phrases to describe cancer; ranking four properties as criteria for defining cancer; a short description of six conditions followed by three questions per condition on whether it qualifies as cancer, should be called “cancer,” and ought to be described as “cancer” in diagnosis delivery; ranking 10 cancers provided in order of how much they qualify as a cancer, from most to least "cancer-y." Results: Sixty-three percent of respondents were from surgical disciplines and 22% were attending surgeons. The majority (55%) reported “quite a lot of experience” with delivering cancer diagnoses. On a 7-point Likert scale from “not a cancer” (1 point) to “definitely a cancer,” no result received a 100% ranking in either category: 54% of respondents described micro-papillary thyroid carcinoma (mPTC) as “not a cancer” ( < 6 points) while 53% of respondents described benign metastasizing leiomyomas as cancer ( > 3 points). This suggests a widespread variation and distribution of “cancer” across subjects. While only 46% of respondents thought mPTC was “definitely a cancer,” 71% felt it should be called “cancer” ( p < 0.0001). Conversely, 47% of respondents felt that benign metastasizing leiomyoma did not qualify as a cancer, but this was less significantly related to feeling that the term “cancer” should be avoided in its diagnosis delivery ( p =0.001). Conclusions: The first-phase our study presents the results obtained among surgical professionals. Variability in usage of the term “cancer” points to a gradient of understanding of what qualifies as "cancer" and in what context the term "cancer" should be used. This gradient in semantic understanding of "cancer" contributes to diagnostic miscommunication and leads to over-treatment. Future studies will focus on how different medical professionals and non-professionals understand "cancer," to mitigate misunderstanding in diagnosis and reduce over-treatment.
The accuracy of the Psychological Distress Inventory – Revised (PDI-R) in identifying distress in oncological outpatients: A pilot study using a machine learning approach.
Authors: Rossi Alessandro Alberto , Marconi Maria , Mannarini Stefania , De Cicco Luigi , Verusio Claudio
Published: June 2023

e24222

Background: Ever greater importance is given to psychological distress in oncological settings. Distress could have a severe adverse effect on adherence and compliance to therapies, medical treatments, and quality of life (NCCN, 2015). Moreover, psychological research is progressively increasing in oncological settings and psychological distress has rapidly gained popularity – leading to the development of scales aimed at its evaluation. In this regard, the revised version of the Psychological Distress Inventory – the PDI-R (Rossi et al., 2022) – has demonstrated excellent psychometric properties but its screening properties were limited to self-report questionnaires. Consequently, to fill this gap, this study aimed to evaluate the accuracy of the PDI-R in identifying the levels of distress of oncological outpatients compared to a diagnostic interview – using a machine learning approach. Methods: Oncological outpatients ( n = 603; mean age = 68.38, SD = 9.31; 316 males) were enrolled at the Presidio Ospedaliero of Saronno, ASST Valle Olona, Italy. Patients were tested with the PDI-R which is composed of 8 items that evaluate internal, external, and general distress. In this study, the PDI-R shows good internal consistency: McDonald’s omega = .922. Then, patients were interviewed by a psycho-oncologist who assessed distress levels of each patient. In accordance with the methodological procedures for the application of machine learning algorithms, patients were randomly divided into two different databases. The first database ( n = 400) was used to train the machine learning algorithm and the second one ( n = 203) was used to test the accuracy of its predictions. The k-nearest neighbors ( k-NN) algorithm was applied. Results: According to the clinical interview, the training database (mean age = 67.78, SD = 9.10; 212 males) shows that 76% of patients were without distress (or mild distress) and 24% had moderate or severe distress. Moreover, according to the clinical interview, the testing database (mean age = 69.58, SD = 9.62; 104 males) shows that 71% of patients were without distress (or mild distress) and 29% had moderate or severe distress. Using the 8 items of the PDI-R, the k-NN algorithm, correctly identified 193 subjects (144 true negatives and 49 true positives). At the same time, only 10 subjects (10 false negatives) were incorrectly classified – thereby showing a machine learning-based accuracy of 95%. Conclusions: These findings suggest that the PDI-R is a reliable self-report questionnaire with strong psychometric properties and high accuracy in identifying psychological distress. Its use in research and clinical practice is therefore recommended to increase the quality of both assessment and treatment of psychological distress in patients with oncological difficulties.
Exploring the unmet needs of Mexican women living with metastatic breast cancer: A patient survey.
Authors: Enriquez Luis Fernando , Reyes-Lizaola Sebastian , Vazquez Juarez Daniela , Platas Alejandra , Platas Ana Laura , Villarreal-Garza Cynthia
Published: June 2023

e24223

Background: Breast cancer is the most prevalent form of cancer among women worldwide and the top cause of cancer-related fatalities. In Mexico, delayed diagnosis and referral contribute to a significant proportion of breast cancer patients being diagnosed with metastatic breast cancer (mBC) or experiencing distant recurrences. Patients with mBC face unique needs and concerns for their illness, which are frequently not attended to or covered. Gaining insight into their diagnostic experiences is crucial for enhancing the standard of care. The aim of this study is to explore the unmet needs of Mexican women living with mBC. Methods: An anonymous and voluntary survey was distributed to women diagnosed with mBC. The instrument employed was drawn from the European "Being There" study and underwent translation into Spanish in accordance with the current best practices for the translation and cultural adaptation of health measurement tools. The survey addressed various subjects including patient’s personal experiences concerning diagnosis and treatment, attitudes of healthcare providers toward cancer services, information available to patients, and patients' views on enhancing future care. Results: A total of 29 responses were received from women ranging in age from 26 - 74 years. Despite generally positive feedback on the care received (42% as excellent/very good, 55% as good/acceptable, and only 3% as bad), these women identified areas for improvement. Regarding their personal experience receiving information about their diagnosis and treatment, 86% reported receiving medical attention that helped them cope with their illness and 80% reported being convinced that the medical team was highly qualified and coordinated. However, only 55% of physicians and 44% of nursing staff displayed interest in the patients' goals and wishes after they received their diagnosis. Regarding the attitudes of healthcare providers in cancer services, 62% of the women believed that they should be more empathetic, 65% would like to see the same doctor/nurse/specialist on every visit, and 69% indicated that they would like them to show more interest in the challenges they face on a day-to-day basis. Table 1 summarizes the information that these women would like to receive about their treatment. Conclusions: In conclusion, this study provides insight into the experiences and unmet needs of women living with mBC in Mexico. While the care received by the women was generally positive, the study highlights the need for improvement in certain areas to address their unmet needs. The findings can be used to enhance the standard of care for women with mBC. [Table: see text]
Evaluation of palbociclib in combination with topotecan and cyclophosphamide in pediatric patients with recurrent or refractory neuroblastoma.
Authors: Laetsch Theodore Willis , Navid Fariba , Weigel Brenda , Fox Elizabeth , Hawkins Douglas S. , Muscal Jodi Ann , Juszczak-Kosela Katarzyna Alicja , Zhang Zhe , Macy Margaret E
Published: June 2023

TPS10069

Background: Palbociclib is an orally administered, highly selective, reversible, small molecule cyclin-dependent kinases 4/6 (CDK4/6) inhibitor. Inhibition of CDK4/6 reduced growth of neuroblastoma cell lines. The phase 1 portion of the study, conducted and funded by Pfizer in collaboration with the Children's Oncology Group, established the recommended phase 2 dose (RP2D) of palbociclib with topotecan and cyclophosphamide (TOPO/CTX) in children with solid tumors. Per study protocol, if 2 or more patients from the phase 1 study show a confirmed objective response (OR) in a specific tumor type, an open-label, non-randomized tumor-specific cohort (TSC) may be opened. Methods: A neuroblastoma TSC has been opened to evaluate the preliminary antitumor activity of palbociclib with TOPO/CTX in the treatment of patients with recurrent/refractory neuroblastoma using a modified Simon’s 2-stage optimal design. Up to 21 patients will be enrolled and receive palbociclib with TOPO/CTX. The primary endpoint is OR, as assessed by investigator using International Neuroblastoma Response Criteria (INRC). Secondary efficacy endpoints include duration of response, progression-free survival, and overall survival. Key eligibility criteria include: recurrent/refractory neuroblastoma, measurable disease as defined by INRC, aged ≥2 and < 21 years at the time of study entry, adequate blood counts organ function, and performance status. Patients may have received prior TOPO and/or CTX, provided their disease did not progress on this regimen. Prior treatment with a CDK4/6 inhibitor is exclusionary. Patients will receive palbociclib at the RP2D of 75 mg/m2 orally once daily on days 1–14 of each 21-day treatment cycle. CTX (250 mg/m2) followed by TOPO (0.75 mg/m2) will be administered intravenously once daily on days 1–5. Concurrent radiotherapy or surgery for local control will be permitted. Treatment will continue until disease progression, patient and/or legal guardian refusal, unacceptable toxicity , or up to 24 months of treatment, whichever occurs first. Enrollment in the neuroblastoma TSC was initiated in December 2022 ( NCT03709680 ). Clinical trial information: NCT03709680 .