bluuebunny/crossref_metadata_2025_split huggingface dataset:
Promoting patient health maintenance with cancer care planning at diagnosis and during treatment: baseline data of the Coleman Supportive Oncology Collaborative (CSOC).
Authors: Weldon Christine B. , Trosman Julia Rachel , Berardi Rosa , Benson Al Bowen , Roggenkamp Betty , Hand Mary Ellen , Stamp Michelle , Bao Jean J , Feldman Lawrence Eric , Pasquinelli Mary , Gradishar William John , Shah Ami N. , Kircher Sheetal Mehta , Foster Kelly Danielle , Nelson Valerie , Wiebe Lauren Allison , Baer Rachel Podrazik , England Gale M , Dalal Neil , Perez Claudia Beth 
Published: May 2020

e24051 Background: CSOC conducts quality improvements (QI) for cancer patients that facilitate delivery of appropriate health maintenance and supportive cancer care at diagnosis and during treatment. CSOC is implementing a care planning QI starting at diagnosis using the 4R oncology model (Right Info / Care / Patient / Time), which provides patients a formal personalized care plan called Patient Care Sequence. Each Care Sequence includes health maintenance, cancer treatments and supportive care. As part of CSOC, we conducted provider surveys as a pre-intervention baseline to inform QI opportunities. Methods: Online survey of cancer providers from 8 cancer centers (4 academic, 4 community) conducted July 2018 - October 2019, prior to 4R implementation. The survey focused on current care planning practices and inclusion of guideline recommended health maintenance in care plans. Results: Survey response rate: 80% (180/225); respondents were 53% physicians, 20% advanced practice, 27% nurses. Only 59% (107/180) of respondents give patients care plans at diagnosis: 61% (65/107) verbally, 22% (24/107) written, 17% (18/107) using a printed form. Providers reported considerable gaps in including guideline-based health maintenance and promotion activities in care plans given to patients (Table). Additionally, 61% of providers reported concerns that it is challenging for their patients to manage their own health maintenance activities. Providers who are concerned about patients’ challenges in managing their own health maintenance are significantly more likely to give their patients a written or printed plan (76%, 32/42) compared to those providing care plans to patients verbally or not at all (56%, 77/138), p = .02. Conclusions: Guideline based health promotion activities are not consistently included in care plans, and care planning is not sufficiently conducted at cancer diagnosis. The CSOC 4R Oncology Model, which implements Patient Care Sequences at diagnosis, will address these gaps and examine the impact of formal care planning on improving utilization of health maintenance and promotion activities. [Table: see text]
Physical activity platform to improve bone health in cancer survivors.
Authors: Skinner Cathy 
Published: May 2020

e24054 Background: Cancer treatment-induced bone loss and the risk of fractures is a significant burden on national health care with the annual cost of osteoporosis at $25.3 billion. Clinical studies report that moderate-intensity resistance exercises prevent a decline in bone health and reduce complications such as fatigue, muscle wasting, and bone loss. Only a small percentage cancer survivors engage in exercise. Several factors account for this low level of engagement such as poor awareness of the benefits, lack of motivation, and access to exercise programs for cancer survivors. Web- and mobile app-based programs that encourage physical activity can potentially address these problems and can be scaled for dissemination. Methods: Thrivors plus Bone Health (Thrivors+BH) is first-of-its-kind, clinically validated platform of bone health exercises that adapts to a cancer survivor's pain and energy levels with several interactive feedback features. The product has physical activity, mindfulness, nutrition, survivorship resources, and bone health education. The platform's back-end tracks and reports module activity. We conducted a single-blind RCT of 142 breast cancer survivors adherence to a 20-week program of resistance and impact exercises. Participants in the control arm accessed Thrivors Basic which lacked interactive feedback. Results: The primary outcome was higher adherence. High adherence equals completion of at least 40 of 60 recommended exercise sessions during the 20-week intervention. The intervention group showed higher measures of platform usage, duration and activity. Intervention group completed the validated jumping protocol after an 8-week program of strength training to prepare for increased intensity exercises. Although some participants discontinued due to various reasons (time constraints or health complications), the supportive modules and feedback from the PI influenced participants to resume exercise after a period of inactivity. The mean scores in the PAM and SF-36v surveys were higher for the intervention group. Conclusions: The study demonstrates breast cancer survivors' willingness to utilize a digital platform with prescribed exercise routines. Feedback suggests that more personalized and interactive features may encourage a higher frequency of engagement in bone-health specific physical activity. A follow-up study will examine the impact of the exercise program on bone health and the role of coaching to impact sustainable behavior change. Clinical trial information: NCT03651037 .
Objective and subjective vulvovaginal symptoms in breast cancer patients.
Authors: Goldfarb Shari Beth , Saban Sally , Arkema Ashley , Patil Sujata , Flynn Jessica , Goldfrank Deborah J. , Norton Larry , Carter Jeanne 
Published: May 2020

e24056 Background: Breast cancer and its treatment adversely impact sexual function and QoL. As more women become survivors, information is needed about vulvovaginal symptoms, sexual concerns and treatment options. Methods: An IRB Limited Waiver of Authorization was obtained to evaluate the medical records of 650 breast cancer patients with initial sexual medicine consults between 7/19/12 & 3/5/19. All women completed the Clinic Assessment form including a pelvic exam checklist, vulvovaginal tissue quality assessment (Vaginal Assessment Scale (VAS)/Vulvar Assessment Scale (VuAS) and sexual function measures (FSFI, PROMIS-SF) at initial visit and 56% (366/650) completed it at follow-up visits. R v3.6.1 was used to perform statistical analysis. Results: Women were categorized at initial consult as either postmenopausal (PM), pre/perimenopausal or menopausal from ovarian suppression (OS). Median age at initial consult was 52 (range 26 to 83) and median endocrine exposure ranged from 12 months on Tamoxifen only to 52 months on Tamoxifen followed by an AI. Of the total sample, 60% reported no confidence in future sexual activity and 68% reported pelvic pain with exam at initial consult. Improvements were seen at the first follow-up in confidence about intimacy and sexual health concerns (p < .001). Vulvovaginal symptoms (VAS/VuAS) and dilator and vulvovaginal moisturizer use (p < .001) also improved from baseline to follow-up 1. The women most likely to attend first follow-up appointments were OS (70%) and PM women on AIs (64%) who also reported worse symptoms at baseline compared to pre/perimenopausal women on Tamoxifen. At initial presentation, PM on AIs and OS had poor exam outcomes respectively: pH > 5 (92%; 83%), poor vaginal elasticity (19%; 13%), vaginal dryness (88%; 68%), decreased rugosity (36%; 30%) and poor vascularity (33%; 21%). At initial consult, exam findings for pH, moisture, vulvar and vestibular irritation each correlated significantly with patient reported vaginal (VAS total score) and vulvar (VuAS total score) symptoms (p≤ .05). Conclusions: Breast cancer patients can benefit from coordinated multidisciplinary care addressing the long-term effects of premature menopause and endocrine therapy. Patient characteristics such as menopausal status and type/duration of endocrine therapy should be considered when assessing sexual health since aromatase inhibitors and ovarian suppression appear to worsen clinical exam and patient reported outcomes. Sexual health counseling and treatment can help women cope with sexual concerns during and after breast cancer therapy.
Cancer's role in chemotherapy-induced neuropathy.
Authors: Housley Stephen Nick , Nardelli Paul , Wang Allison B. , Flores Ann Marie , Perreault Eric J. , Cope Tim 
Published: May 2020

e24064 Background: For the constellation of neurological disorders known as chemotherapy-induced neuropathy, mechanistic understanding, and treatment remain deficient. This might be due to the fact that studies on the effects of chemotherapies on the nervous system have utilized experimental models that exclude cancer perhaps due to the presumption that chemotherapy alone explains the neuropathology. However, the convergence of cancer and chemotherapy on the same biological processes seems likely to yield non-linear interactions. This led us to hypothesize that clinically relevant neuropathy emerges from codependent actions of cancer and chemotherapy. Methods: We established a clinically-relevant animal model of chronic sensory neuropathy in rats with cancer (adenomatous polyposis coli in rat colon: Apc+/Pirc) and age-matched animals without cancer ( ApcWT) that were randomly assigned to receive a human-scaled course of oxaliplatin (OX) or control treatment (4 groups). We quantified behavioral deficits during precision ladder walking, a validated measure of locomotor performance. Neuronal signaling was measured during terminal in vivo experiments to examine the response of sensory neurons to physiologically-relevant stimuli. We defined statistical significance as when 95% of a highest density interval (HDI) of posterior probabilities do not overlap (hierarchical Bayesian modeling). Results: Apc+/Pirc+OX (n = 11) rats exhibited significantly higher error rate (19.2±5.6%, 95%HDI) during precision ladder walking in comparison to ApcWT+control (2.4±2.7%: n = 9) or Apc+/Pirc +control (2.5±2.9%: n = 7) and significantly exceeded the error rate observed in animals treated with OX alone (8.4±3.1%: n = 10). In contrast to the observations in all other groups, we found drastically impaired neuronal signaling in Apc+/Pirc+OX rats which manifested as significantly reduced sensitivity and attenuated static and dynamic firing patterns (95%HDI). Conclusions: We present the first evidence that chronic neuropathy cannot be explained by the effects of chemotherapy alone but instead depend on non-linear interactions between cancer and chemotherapy. This understanding is a prerequisite for developing meaningful treatment or prevention of neuropathy.
Patterns of self-reported symptom distress among survivors of head and neck cancers.
Authors: Palos Guadalupe R. , Gilmore Katherine Ramsey , Hutcheson Kate A. , Pytynia Kristen B , Gruschkus Stephen K. , Chapman Patricia Hansberry , Bi Weiqi , Rodriguez Maria Alma 
Published: May 2020

e24073 Background: Head and neck cancer (HNC) survivors are known to experience debilitating disease-related symptoms and late effects. Patterns of symptoms among HNC survivors who have transitioned care to survivorship clinics could inform supportive care needs. We sought to assess patterns of self-reported symptoms in HNC survivors and to describe the level to which these symptoms interfered with their function. Methods: Symptoms and their interference were assessed using the MD Anderson Symptom Inventory Head and Neck (MDASI–HN). This validated patient-reported outcome (PRO) instrument consists of 28 questions grouped into 3 subscales; 1) 13 “core” or general symptoms, 2) 9 symptoms specific to HN and 3) 6 daily life interference items. Symptom severity is measured using a 0 to 10 scale, 0 = not present, 10 = as bad as can be imagined. Patients completed the MDASI-HN during a visit to the HNC Survivorship Clinic. Three databases a) MDASI HN, b) institutional, and c) the HNC survivorship provided data. We defined the primary outcome, symptom distress, as the combination of severity and interference rated ≥5 (0-10). Descriptive statistics were used to characterize the sample. Results: The sample included 1390 HNC survivors, majority were male (77%), Caucasian (83%) with a median age of 63 years (range 22- 95 years). The median years since diagnosis was five (range 2-37 years). The top disease sites were oropharynx (37%), oral cavity (35%), and larynx/hypopharynx (15%). The table summarizes the patterns of symptom distress. Conclusions: These results highlight the variation in symptom distress reported by long-term HNC survivors. Understanding the clinical implications of these patterns is important to ensure the well-being of those with head and neck cancers. [Table: see text]
Determining the impact of chemotherapy-induced peripheral neuropathy: A survey of cancer survivors.
Authors: Battaglini Eva , Goldstein David , Park Susanna 
Published: May 2020

e24080 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a major yet poorly understood side effect of cancer treatment, leading to symptoms including numbness, tingling and pain. It can lead to cessation of effective treatment, long-term functional disability and reduced quality of life. Despite this, there is currently little understanding of its impact. Methods: The aim of the study was to investigate the impact of neurotoxic chemotherapy side effects on the lives of cancer survivors. Data was collected via an online survey covering demographics, cancer diagnosis and treatment, CIPN and other side effects of chemotherapy, using standardised measures to assess comorbidities, quality of life, physical activity, pain and CIPN symptoms. Results: Data was analysed from 986 respondents who were treated with neurotoxic therapies (83% female, 16% male), with mean age 59 years ( SD 10.7 years). A majority of respondents were treated for breast cancer (59%), 14% for colorectal cancer and 11% for multiple myeloma. Chemotherapy types received included paclitaxel (32%), docetaxel (32%) and oxaliplatin (13%), and respondents completed treatment a mean of 3.6 years ago. The majority of respondents (80%) reported experiencing neuropathic symptoms after finishing chemotherapy, with 77% reporting current CIPN. Those with CIPN reported functional impacts, with 23% reporting moderate to severe problems with hand function and 28% reporting moderate to severe walking difficulties. CIPN was second most commonly rated as the treatment side effect having the greatest impact, following fatigue. Respondents with high levels of current CIPN symptoms had poorer quality of life, more comorbid health conditions, higher BMI and more often received multiple neurotoxic chemotherapies than those with low levels of CIPN symptoms. In addition, respondents who reported meeting government physical activity guidelines had lower CIPN and higher quality of life scores than those who did not meet the guidelines. Regression analyses investigating the association between quality of life and clinical and sociodemographic characteristics resulted in a model with comorbid health conditions, CIPN symptoms, years since treatment, age and physical activity as significant predictors of quality of life. Conclusions: These findings suggest that CIPN has a lasting impact on cancer survivors, leading to decreases in quality of life, often occurring alongside poorer general health. This impact supports the need for further research to improve assessment, prevention and treatment.
Asymptomatic cardiotoxicity in long-term breast cancer survivors.
Authors: Saidi Mohammed Alaeddine , Ghomari Soumeyya 
Published: May 2020

e24084 Background: Multimodal approach in the adjuvant treatment of early breast cancer has led to a significant number of survivors. However, the combination of these treatments may increase the risk of long-term cardiotoxicity, particularly in the presence of cardiovascular risk factors (CVRF). Methods: We examined cardiac function in patients who had previously been treated for early breast cancer. Echocardiograms were performed at least 2 years after therapy. We measured left ventricular ejection fraction (LVEF) and reported pre-treatment LVEF and all CVRF. The initial Framingham Risk Score (FRS) has been calculated. Asymptomatic cardiotoxicity was defined by decrease of 5% or more in the LVEF value without clinical symptoms of CHF. Doxorubicin, Trastuzumab, Radiotherapy, older age, and CVRF (hypertension (HTN), diabetes, dyslipidemia, obesity, Waist circumference) were evaluated as potential risk factors for the development of cardiotoxicity. All statistical analysis was performed using SPSS version 25.0. Results: A total of 143 breast cancer survivors with a median age of 46 ± 10 years (range: 26-72) underwent Echocardiogram imaging after a median follow-up of 9,22 years (range: 2 - 22). 48 women were postmenopausal at diagnostic. 32,2% were obese. HTN was present in 15%, diabetes in 12%, and dyslipidemia in 12% of patients. ARA-II was the most used treatment of HTN (55%). 11,9% of patients were under statin therapy. FRS was low in 69%, moderate in 22% and high in 9% of patients. 4 patients had received endocrine therapy alone, none of whom developed cardiotoxicity. There was only one case of symptomatic cardiotoxicity. In the remaining 138 women who received multimodal treatment (Anthracyclines:100%, Docetaxel:62,9%, Endocrine therapy:72%, Trastuzumab:7%, Radiotherapy:83,2%), a statistical but non-clinically significant decrease was observed in LVEF (67.7 ± 3.6 to 65.4 ± 5.1, p < 0.001). 39 women (28,3%) developed asymptomatic cardiotoxicity. In multivariate analysis, factors that contributed to decreased LVEF were HTN (p = 0,006), diabetes (p = 0,008) and dyslipidemia (p = 0,03). Conclusions: The use of adjuvant therapy in breast cancer may increase long term cardiotoxicity particularly in survivors with CVRF. Long-term cardiac follow-up is essential in order to initiate cardioprotective therapy at the right time.
Incidence of breast pain in breast cancer patients in a multi-ethnic cohort.
Authors: Fukui Jami Aya , Meister Madison , Pagano Ian , Bantum Erin 
Published: May 2020

e24085 Background: Breast cancer is the most common cancer in women. Prevalence rates for persistent pain following breast cancer surgery are reported to be up to 60%. Younger age, radiation, more invasive surgery, and acute post-operative pain have been identified as predictors of chronic pain after surgery. Several studies have looked at factors predicting breast pain, but to our knowledge none of these studies have reported on perceived pain among ethnic groups beyond white and non-white comparisons. Methods: Participants were asked to complete an anonymous breast pain questionnaire based on the McGill pain questionnaire, either online or face-to-face in a clinical setting. Incidence and type of breast pain, common risk factors (age, type of surgery, treatment: chemotherapy, radiation and endocrine therapy), and race/ethnicity was collected and analyzed through descriptive and multivariate analysis. Results: 238 responses were collected and analyzed. About 36% of participants reported breast pain, where 82% reported these symptoms for more than a year. More than 71% identified as non-white, with the majority identifying as Asian (50%) followed by White (11%), Multi-ethnic (9%) and Native Hawaiian (8%). The majority of participants were older than 60 years of age (57%), with 30% being older than 70. Japanese, Filipino and Native Hawaiian participants reported significantly more pain compared to White participants (p < .0001). The majority of participants reported a 3/10 pain level on a pain scale and described overall breast pain as mild. The most common descriptor of mild pain was aching and represents the dullness pain characteristic. The most common descriptor of moderate pain was sharp characterizing an incisive pressure, and the most common descriptors of severe pain were heavy, tender, shooting and throbbing, representing various pain characteristics. Participants who were undergoing radiation (p < .0001) or chemotherapy (p < .05) reported statistically higher breast pain, although there were no differences in breast pain according to the type of surgery (mastectomy vs lumpectomy). Participants who completed the survey online also reported more pain (p < .0001) than participants who completed the survey face-to-face. Conclusions: Breast pain is a significant problem in our breast cancer community. This questionnaire has informed our understanding of the type of pain our multi-ethnic breast cancer patients are experiencing and in turn we are developing culturally appropriate pain management strategies to treat this challenging symptom for breast cancer survivors.
Determining the unmet survivorship needs in patients with head and neck cancer: A prospective, longitudinal study.
Authors: Giuliani Meredith Elana , Weiss Jessica , Jones Jennifer M. , Toulany Alexander , Quartey NaaKwarley , Papadakos Janet , Ringash Jolie 
Published: May 2020

e24088 Background: Head and neck cancer patients commonly have unmet needs. Our purpose was to determine the number, type, and predictors of unmet survivorship needs in patients with head and neck cancer over their cancer journey. Methods: Patients with primary, non-metastatic head and neck cancer were prospectively enrolled prior to curative intent treatment (surgery, radiation and or systemic therapy in any combination). Patients completed baseline demographics, the Cancer Survivors' Unmet Needs Measure (CaSUN) and the FACT-HN and then again 3, and 6 months post-treatment. Mean unmet needs at each time point were calculated. Univariable and stepwise multivariable analyses of predictors for number of unmet needs were performed at each time point. Results: Among 187 participants, median age was 64 (31-88) and 148 (79%) were male. Education was beyond high school in 117 (63%) and 63 (41%) were working at diagnosis. Most patients had oropharynx (n = 84; 46%), hypopharynx/larynx (n = 40; 22%) or oral cavity (n = 28;15%) cancers. At least one unmet need was reported by 68%, 52%, and 56% at baseline, 3 and 6 months. The mean number of unmet needs was 7.5 ± 9.1 at baseline, 3.8 ± 6 at 3 months and 5.4 ± 8.5 at 6 months. Higher education level [3.24 (0.24,6.24); p = 0.035] and worse QOL [-0.14 (-0.22,-0.06); p < 0.01] were associated with increased survivorship unmet needs on multivariable analysis at baseline. Worse QOL was associated with increased survivorship unmet needs on multivariable analysis at 3 [-0.21 (-0.31,-0.12); p < 0.01] and 6 months [-0.27 (-0.49,-0.06); p < 0.01]. Table describes the top unmet needs. Conclusions: A high proportion of patients with head and neck cancer have unmet needs, more commonly in patients with poorer quality of life. Post-treatment, unmet needs were more often related to treatment toxicities and their impact on quality of life. [Table: see text]