bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using health-related quality of life and treatment measures to predict 10-year mortality in older survivors of early stage breast cancer.
Authors: DuMontier Clark , Clough-Gorr Kerri , Silliman Rebecca A , Stuck Andreas , Moser André 
Published: September 2018

e21548 Background: Older women make up the growing majority of breast cancer (BC) survivors. Guideline BC treatments are known contributors to long-term survival, and health-related quality of life (HRQOL) is emerging as not only an important outcome in survivorship care but also as a factor thought to influence mortality. However, prognostic models that include HRQOL alongside BC treatment measures are lacking. We aimed to develop a 10-year mortality risk score based on a priori chosen treatment and HRQOL variables. Methods: We studied 660 women ≥65-years old diagnosed with stage I-IIIA primary breast cancer in years 1997-1999. Data from medical and psychosocial domains were collected over 10 years from interviews, medical records, and death indexes. BC treatment variables included receipt of definitive locoregional surgery +/- radiation, chemotherapy, and tamoxifen. HRQOL variables included physical function [10-item Physical Function Index (PFI-10) from the Medical Outcomes Study Short Form-36 (MOS SF-36)]; mental health [5-item Mental Health Index (MHI-5) from the MOS SF-36]; and social support [8-item modified MOS Social Support Scale (mMOS-SSS)]. We used penalized logistic regression models to develop a 10-year mortality risk score, and investigated its discrimination (c-statistic) and calibration (observed versus predicted mortality using the Hosmer-Lemeshow (HL) test). Results: Mortality though 10-years of follow-up was 34.8% (230 of 660 women). The c-statistic of a risk score using only age, number of comorbidities, stage of BC, and BC treatment was 0.71. The c-statistic increased to 0.74 with the addition of HRQOL measures and showed good calibration (p = 0.72 from HL test). Physical function and mental health had strong independent associations with mortality (women with high PFI-10: OR 0.63, 95% CI 0.43, 0.92; women with high MHI-5: OR 0.57, 95% CI 0.39, 0.85). Conclusions: In older early stage breast cancer survivors, our risk score combining HRQOL with treatment measures showed good discrimination and calibration. HRQOL is independently associated with 10-year mortality and adds predictive ability to age, comorbidity, stage of BC, and BC treatment.
Efficacy and safety of isolated limb perfusion for melanoma in elderly patients.
Authors: Madu Max Fullah , Deken Marion M. , Van Der Hage Jos A. , Józwiak Katarzyna , Wouters Michel W.J.M. , Van Akkooi Alexander Christopher Jonathan 
Published: September 2018

e21549 Background: Data on isolated limb perfusion (ILP) in elderly melanoma patients is scarce. We aimed to evaluate the efficacy and safety of ILP in our institutional cohort of melanoma patients. Methods: Retrospective analysis of AJCC stage IIIB/C melanoma patients who underwent ILP for locally advanced (unresectable) melanoma in-transit metastases of the limb between 2000 and 2016. Normothermic ILP (37-38 °C) was performed with either Melphalan or Melphalan and Tumor Necrosis Factor (TNF). Baseline characteristics, local toxicity (Wieberdink) and systemic toxicity, locoregional progression-free survival (PFS) and melanoma-specific survival (MSS) were assessed and prognostic factors for response to ILP, melanoma recurrence and survival were analyzed using univariable and multivariable analysis. Results: 88 patients were included. The overall response rate to ILP was 81%, with a complete response (CR) rate of 47%. Median overall locoregional PFS was 6 months, while patients with a CR had a median PFS of 16 months. Median overall MSS was 38 months. Two patients (2.3%) suffered Wieberdink IV toxicity (compartment syndrome), while no patients required amputation because of severe toxicity. Based on the median age of 70, we split patients into younger and elderly groups. Toxicity rates, response rates and locoregional PFS did not differ significantly between younger and elderly patients. CR was prognostic for improved locoregional PFS and MSS. Moreover, patients > 70 and patients with stage IIIC disease had a higher risk of melanoma-specific death. Conclusions: ILP has good and potential durable responses, but also less frequent and less severe toxicity than recently developed targeted or immune therapies, which can be reserved for progression to stage IV. This study showed that ILP is an effective and safe procedure for elderly patients ( > 70) with locally advanced melanoma of the limb.
Body image, self-esteem and quality of life during oncology treatment in breast cancer, cervical cancer, and prostate cancer in comparison to the healthy population.
Authors: Kieszkowska-Grudny Anna , Rucinska Monika , Ciesak Robert , Wisniewska Marta 
Published: September 2018

e21550 Background:Cancers are the second most common cause of death. Treatment of cancers is complex and might be aggressive, takes a long time and is usually difficult to accept for patients. As a result of disease and treatment a body image(BI) is impaired and can reduce quality of life(QoL),which has become a very important factor. The objective of the study was to investigate BI and QoL during oncological treatment of breast cancer(BCa), cervical cancer(CeCa) and prostate cancer(PCa) patients and to compare with healthy groups of men(HM) and women(HW). Methods:The analysis included 280 participants: 31 BCa-pts just after oncological surgery (age26-86 years,M = 63,23,Me = 65), 44 BCa-pts during adjuvant radiotherapy (age37-69years, M = 57,23,Me = 60), 21 CeCa-pts during therapy (age30-68years,M = 54,43,Me = 60), 52 PCa-pts with clinical stage T1-T2N0M0 (age57-86;M = 70,65;Me = 70) after standard three-dimensional conformal radiation treatment (3DCRT), 32 PCa-pts (age59-84;M = 74;Me = 75) after stereotactic hypofractionated radiotherapy (HRT), than without any type of cancer 50HM (age47-92years;M = 62,28;Me = 60) and 50HW (age30-84 years,M = 51,46,Me = 50). The subjects filled out the questionnaire EORTC QLQ-C30 (ver3.0.) and a specially designed questionnaire for a body image assessment. Results:All factors associated with BI between groups differed significantly (p < 0,05): general appearance, self-esteem, physical and sexual attractiveness. The highest assessment in all categories were done by HRT-pts and the lowest by BCa-pts during radiotherapy, than BCa-pts after surgery. HM and HW perceived BI on a similar level, however lower than HRT-pts. Overall QoL was significantly lowest in BCa-pts after surgery (p < 0,05), but physical, role, emotional, and general functioning were the worst in BCa-pts during radiotherapy (p < 0,05). The lowest social QoL was assessed by CeCa-pts (p < 0,05). Conclusions:It seems that oncological treatment influences significantly BI of cancer patients and worsens QoL especially in breast cancer women just after surgery and adjuvant radiotherapy. HTR-pts assesses BI and general QoL even better than healthy groups.
Implementing and analyzing a distress screening tool (DST) in a community oncology setting: Breaking down barriers to comprehensive medical and psychosocial (PS) care—The Kaiser Permanente Lone Tree, CO (KP-LT) experience.
Authors: Kono Scott Arthur , Reichel Jammie , Menter Alex R. , Mayer Stephen Armond , Klancar Lillian , Sturtz Keren , Narayanan Vignesh , Crank Rebecca , Elliot Brenda , Grimes William G , Barden Jeromie , Virdi Kylee 
Published: September 2018

e21553 Background: PS distress (D) in cancer patients is an underestimated barrier to optimal care. The NCCN recommends D screening and intervention for D scores (DS) ≥4. KP is an ideal environment for large-scale screening. We sought to identify barriers in DST compliance, find a successful standardized workflow (SWF), and understand sources of D to elevate the standard of PS care. Methods: The DST was administered by the physician at completion of initial encounter to all new patients. Compliance recorded before and after implementing a SWF in 2/2016. Our DST utilizes 4 Major Categories of Distress (MCD) [Practical (P), Social (S), Health (H), Emotional (E)] to identify specific areas of D, and stratify DS by diagnosis [Benign (BH)-, Malignant- (MH) Hematology, Solid Tumor (ST)]. Clinic outreached any patient with a 4+ DS. DST was modified (mDST) 9/2016 to provide a DS for each MCD rather than 1 overall DS to improve practicality. Results: 936 DSTs completed from 6/2015-1/2017 (304/632 were mDST). DST compliance increased from 51% to 78% after the SWF. 289/632 (46%) scored 4+ (avg. DS 6.15). 153/304 (54%) mDSTs scored 4+ in ³ 1category. The avg. DS was 3.9 (n=936). Avg. DS for: BH= 3.67 (50% scored 4+, avg. 6.0), MH=3.79 (49% score 4+, avg. 6.14), and ST=4.02 (54% score 4+, avg. 6.18). The 3 most common concerns in each MCD are reported in Table 1. Most frequent outreach requests: Dietitian (n=88, 9%), LCSW (n=70, 7%), and Financial Counselor (n=50, 5%). Conclusions: Sources of D are a patient reported metric, not provider-assumed. DST use is feasible and essential to comprehensive cancer care. A SWF is crucial for success and led to a 27% increase in compliance. 4+ DS is frequent and was higher than expected in BH. Identifying specific stressors allows early intervention and improved resource utilization. [Table: see text]
Postponement of death weighed against duration of treatment and toxicity as key components in shared decision making about last line oncologic treatment.
Authors: Jensen Lars Henrik , Trabjerg Natacha D , Hansen Torben , Jakobsen Anders Kristian Moeller , Steffensen Karina Dahl 
Published: September 2018

e21555 Background: Decisions about last-line treatment are challenging in oncology practice. The hope of prolonging life and reducing symptoms should be weighed against the time spend on treatment, side effects and cost. Standard oncology measures of effect such as median survival time and number needed to treat are not easily explained to patients. Postponement of symptoms or death has been shown to be superior to e.g. number needed to treat in communicating the benefit of treatment to patients. The aim of the present study was to develop a tool for shared decision making in last line treatment of patients with colorectal cancer. Methods: A literature review identified pivotal phase III trials about specific antineoplastic agents for metastatic colorectal cancer after standard treatments. Principles for determining the mean survival followed restricted mean survival time analysis. High-resolution survival curves were digitalized. Areas under the curves (AUC) were calculated for the experimental group and the control group. Results: Two drugs are approved for colorectal cancer after exposure to standard treatments; regorafenib and TAS102. AUC at one year for regorafenib was 30.1 weeks compared to 26.6 weeks for placebo resulting in a difference of 3.5 weeks. AUC at one year for TAS102 was 31.4 weeks compared to 25.7 weeks for placebo resulting in a difference of 5.7 weeks. Average time on treatment was 12 weeks for regorafenib and 14 weeks for TAS102. Risk of severe, medical significant or life-threatening (grade 3-4) adverse events increased from 14% to 54% (regorafenib) and from 52% to 69% (TAS102). Conclusions: Data was developed for shared decision making using restricted mean survival time. A patient with colorectal cancer after standard treatment can be advised: »This is a deadly disease irrespective of treatment. On average, taking medicine for about 12 weeks will postpone death for 4 to 6 weeks. Taking the medicine will cause 17 to 40 extra patients out of 100 experiencing severe or life-threatening side effects«. The concept of postponement will be further explored as a key component in patient empowerment for value based care.
An explorative study of the psychological profile of women who access an oncofertility unit.
Authors: Di Mattei Valentina E. , Carnelli Letizia , Mangili Giorgia , Rancoita Paola M.V. , Bernardi Martina , Mazzetti Martina , Taranto Paola , Bergamini Alice , Papaleo Enrico , Candiani Massimo 
Published: September 2018

e21557 Background: Advances in cancer treatment have resulted in an increase in survival rates. Thus, quality of life after disease is being addressed more often; loss of fertility is a crucial aspect, especially in young women. This study aims to investigate the psychological profile of women who access the Oncofertility Unit at the San Raffaele Hospital before gonadotoxic treatment. Psychological consultation is undertaken prior to the medical evaluation as an integrative part of fertility preservation counselling. Our hypothesis is that women who access the Unit present psychologically adaptive characteristics, which facilitate a better adjustment to diagnosis and disease; this involves the decision to cryopreserve their oocytes to avoid possible future infertility. Methods: Seventy-six women were counselled between January 2014-2017; 96% of these (N = 73) decided to undergo cryopreservation. Only these women returned the administered questionnaires and took part in the study. A self-report measure and three validated questionnaires were used: the Beck Depression Inventory (BDI-II), the State Trait Anxiety Inventory Form-Y (STAI-Y), and the Temperament and Character Inventory – Revised (TCI-R). Results: The age range of the sample was 19-42 years (mean = 30.49; SD = 5.42); 21% (N = 15) of patients were older than 35 years. Seventeen women (23%) were single and 12% (N = 9) had children prior to the cancer diagnosis. Regarding the BDI, 89% (N = 65) of patients obtained minimal depression scores [0-13]. On the STAI-Y trait subscale, 70% (N = 51) of patients’ scores fell within the low anxiety range [20-40]; state anxiety scores were higher, but only 18% (N = 13) of women reported high levels [60-80]. The TCI-R highlighted that 95% (N = 69) of patients had medium or high levels of Persistence (perseverance despite fatigue Conclusions: Women who access the Unit report low levels of psychological distress (depression and anxiety) and show adaptive personality traits. This supports our hypothesis. The main study limitation of the study is the lack of data regarding women who decided not to undergo cryopreservation.
Use and usefulness of the “know yourself” tool in outpatient cancer care.
Authors: Berger Zackary , Yesantharao Pooja , Zhou Alice , Blackford Amanda , Smith Thomas J. , Snyder Claire Frances 
Published: September 2018

e21558 Background: Patient-physician communication is important to cancer care. The National Coalition for Cancer Survivorship developed the Know Yourself Tool, a 2-page form, to improve patients’ understanding of goals of care and clinicians’ understanding of patients’ priorities/expectations. We assessed the Tool’s use and usefulness. Methods: This mixed-methods study at an academic cancer center recruited 1 medical, 1 radiation, and 1 surgical oncologist for each of 5 cancer types: breast, lung, gastrointestinal, genitourinary, head & neck. For each clinician (n = 15), we recruited 2 control patients to observe usual care (n = 30) and then 4 intervention patients who were provided the Tool (n = 60); eligible patients were at a decision point in their care. Data were collected for the decision making visit via patient and physician post-visit surveys analyzed descriptively and visit recordings/transcripts to analyze: 1) option presentation 2) patient preference assessment 3) shared decision making elements 4) patient question asking opportunities. Results: Of 90 patients, 39 (43%) were female and 75 (83%) were white. Of the 60 intervention patients, 42 (70%) completed a post-visit survey: 15 (36% of respondents) reported using the Tool and 13 (31%) discussing the Tool. Nearly half (49%) reported the Tool helped them prepare for follow-up visits and know the importance of their perspective in decision making. Patients reported the Tool was easy to use (76%) and would recommend the Tool to others (52%). Clinicians reported on Tool use for 24 visits, finding it most helpful in identifying areas of concern (74%). Based on visit transcripts, physicians were more likely to describe certain options as more appropriate than others with intervention vs control patients. However, physicians were less likely to assess patient preference, engage in shared decision making behaviors, and provide opportunities for patients to ask questions with intervention vs control patients. Conclusions: Use and usefulness of the Know Yourself Tool was limited. Further work should identify barriers to Tool use, determine if there are specific subgroups for whom the Tool would be more useful, and further elucidate how the Tool affects patient-clinician interactions.
Relation of depressive and anxious symptoms to overall distress and mortality in patients undergoing radiation therapy.
Authors: Brett Christopher , Strong Gerald , Hintenlang Lauren L. , Whitaker Dale Alan , Jagadesh Niveditha , Miller Robert Clell 
Published: September 2018

e21567 Background: For patients diagnosed with cancer, depression and anxiety represent a common and significant burden, which has been proposed to not only affect quality of life but to potentially shorten duration of life as well. This study examines the influence of patient reported symptoms of anxiety and depression on overall distress and mortality in patients undergoing radiation therapy. Methods: As part of their intake paperwork, patients undergoing radiation therapy completed distress screening that included 29 questions regarding their level of concern with various factors related to their care as well as their overall distress level. This information and other parameters including demographics, site of primary disease, use of chemotherapy, presence of metastasis, and last known status were recorded for analysis. Answers regarding degree of concern for “feeling down or depressed”, “loss of interest in my usual activities”, and “feeling nervous or anxious” were examined for influence on study endpoints. Results: Results for final analysis were available from 519 patients undergoing therapy from April 2010 to May 2016. The cohort’s average age was 66yrs, 71% were treated curatively, and 29% were treated palliatively. The most common treatment sites were breast (27%), thorax (16%), H&N (12%), GU (12%), GI (10%), and CNS (7%). Significant correlation was found between level of concern with symptoms of anxiety and depression and level of overall distress (P < 0.001, Kruskal-Wallis Rank Sum Test). Significance remained on separate analysis of curative and palliative subgroups. No significant correlation was found for 1 or 2 year survival on either single or multivariate analysis of curative or palliative patients. Conclusions: Depression and anxiety are common conditions among cancer patients, and can contribute significantly to their overall distress. Although no effects on mortality were demonstrated on initial follow-up of this cohort, it remains evident that attention to emotional well-being is critical in the care of such patients. Additional investigations can be pursued regarding ideal interventions for patients identified by such screening.
Family quality of life (FQOL) of patients with cancer and caregivers.
Authors: Goldman Jamie , Dietrich Mary S. , Wells Nancy L. , Murphy Barbara A. 
Published: September 2018

e21568 Background: There are no validated tools assessing FQOL in the cancer population. We developed a 32-item cancer specific tool (CFQOL) comprised of general and cancer specific subscales directed towards the patient and caregiver. Domains included family interactions, roles, communication, and emotional support. Methods: 150 patient-caregiver dyads in a general oncology population completed the CFQOL, SF36, FACT, BC-FQOL, and FACE IV tools. Exploratory factor analysis was used to identify the underlying structure. We compared the CFQOL with validated measures using Spearman's Rho. Results: Characteristics: Patients - median age 59, 57% male, 96% Caucasian, and 65% in treatment. Caregivers - median age 56, 67% spouses/partners and 86% primary caregiver. The analysis revealed a single underlying structure for both the general and cancer-specific domains (Cronbach's α 0.96 and 0.94 respectively). Median scores for patients on both measures were 4.5 out of 5 (IQR: 4-5); caretaker scores were lower (median: 4.2, IQR: 3.5-4.2, p < .05). As expected, convergent validity was supported with those tools focusing on similar themes to those in the CFQOL, and items involving physical aspects demonstrated divergent validity but were not statistically significant (table 1). Conclusions: The CFQOL is a brief, valid tool for assessing multiple constructs relevant to FQOL in the cancer patient population. Patterns of correlations were similar for general and cancer subscales questioning the need for both sub-scales. Further validation and exploration of sensitivity to change is indicated. [Table: see text]
Long-term cancer survivors: Satisfaction with medical care and information received during the diagnosis and treatment of cancer.
Authors: Gallego Alejandro , Martinez Beatriz , Espinosa Enrique , Ghanem Ismael , Ruiz-Gimenez Leticia , Garcia Tania , Gonzalez Teresa , Castelo Beatriz , Zamora Pilar , Redondo Andres , Feliu Jaime 
Published: September 2018

e21573 Background: Long-term survival rates for many types of cancer have substantially improved in past decades. A specific medical office was started up two years ago at our institution for the follow-up and comprehensive care of this population. Long-term cancer survivors were surveyed to know how they perceive medical care and information received during the diagnosis and treatment of cancer. Methods: A 54-item questionnaire was developed based on QLACS (Quality of Life in Adult Cancer Survivors). 286 patients completed the questionnaire from January 2015 to December 2016. All of them were disease-free and without any antitumour therapy for at least two years. The information was collected in a database and processed with SPSS 18. Results: Median age at the time of diagnosis was 56 years. Colorectal and breast carcinomas accounted for 54% of all cases and 61% of patients had been diagnosed in early stages of disease. Median time from cancer diagnosis to questionnaire completion was 104 months (range 29-444 months). Sixty-seven per cent of patients were satisfied with the information received by their oncologist about their cancer, although information provided about other health issues was less satisfactory. Twenty-eight per cent reported that the oncologist never made recommendations about healthy lifestyle. In fact, only 8 patients (2.8%) made dietary modifications, all regular alcohol drinkers (31.1%) maintained their daily intake and 73 patients (25.5%) gained 5 kg over their recommended weight. Anxiety/depression symptoms were reported by 30% of the best informed patients about cancer treatment and 52% of the worst informed. Only 12.4% of long-term cancer survivors of our study consulted their family doctor during the last year, while 75.4% visited their oncologist. Finally, the medical care of the oncologist was satisfactory for 235 patients (83.2%), receiving an overall score of 8.7 on a 0 to 10 scale. Conclusions: Most long-term cancer survivors feel satisfied with the medical care received, but the information provided about other health aspects should be improved. Furthermore, although they rely on their family doctors, most prefer being followed-up by their oncologist.