bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association of hospital visits with executive functioning among childhood cancer survivors.
Authors: Gorsi Hamza , Trask Christine 
Published: May 2018

133 Background: Childhood cancer survivors are at increased risk of executive dysfunction related to treatment. In addition to the direct effect of treatment, hospital visits may also impact development. Children with complicated health issues visit Emergency Departments (ED) multiple times and spend a very high number of days in the hospital, which can interfere with normal development. Methods: Information from 77 childhood cancer survivors, ranging in age from 6-18, was examined. Parents completed several surveys, including the Behavior Rating Inventory of Executive Functioning (BRIEF). Additional information was collected from the medical record and administrative data sets, including total number of days in the hospital and number of ED visits. Multiple linear regressions were used to determine the relationship between total hospital days/number of ED visits and BRIEF scores, as well as potential confounders, such as socioeconomic factors and treatment factors. Results: The survivors were 11 years old, on average, at the time of participation and evenly divided between boys (49.4%) and girls (50.6%). In the sample, 26% had been treated with cranial radiation and 55% had been treated with intrathecal chemotherapy. On average, this group had 47.0 inpatient days in the hospital with 6.8 visits to the ED. There was a positive correlation between both number of ED visits and number of inpatient days with executive functioning (GEC; r = .33, p = .004; r = .23, p = .05, respectively). In multiple linear regressions, after controlling for time since diagnosis, a higher number of ED visits was associated with greater reported executive dysfunction ( R2= .12; F (2, 74) = 5.2, p = .008). Conclusions: An association was found between ED visits and length of hospitalizations on parent-reported executive functioning. ED visits and hospitalization are often related to medical complications, and may reflect severity of illness, but may also influence children’s ability to participate in school and other aspects of normal development. Follow-up prospective studies with a longer duration are needed to understand the course of this relationship in terms of predicting long-term risk.
Perceptions of unintentional weight loss among cancer survivors.
Authors: Zaleta Alexandra Katherine , McManus Shauna , LeBlanc Thomas William , Buzaglo Joanne S 
Published: May 2018

138 Background: Unintentional weight loss (WL) can be a disruptive symptom of cancer, yet its psychosocial impact is not well understood. We examined cancer survivors’ experiences with unintentional WL. Methods: 320 cancer survivors completed an online survey, provided demographic, health, and unintentional WL history, and rated (0 = not at all; 4 = extremely) 19 statements about WL outcomes. We examined bivariate associations between weight status, unintentional WL, and WL outcomes. Results: Participants were 90% White; mean age = 58.8 years, SD= 11; 41% breast cancer, 23% blood cancer, 8% prostate cancer, mean time since diagnosis = 6.0 years, SD= 5; 18% metastatic, 22% current recurrence/relapse, 51% remission. 55 participants (17%) reported unintentional WL in the past 6 months (mean = 16lbs; range = 2-70; mean BMI = 27.6, SD= 6.3). These participants were less likely to be in disease remission ( p< .05). Participants with unintentional WL tended to underestimate their weight category (e.g., of BMI-classified healthy weight participants, 26% believed they were underweight); κ = -.17, p< .01. 51% of participants felt (somewhat to extremely) positive about WL, 49% said their health care team was supportive of WL; these statements were more strongly endorsed by people describing themselves as overweight ( ps < .05). 27% believed WL caused physical weakness, 23% said WL resulted in lost control over nutrition/eating, 16% said WL made them feel like a burden, 14% said WL caused them to lose their identity; these statements were more strongly endorsed by people describing themselves as underweight ( ps < .01). 20% viewed their WL as a sign of approaching end of life, 13% believed WL meant they would not be able to continue treatment; these views did not differ by perceived weight status. Conclusions: Many cancer survivors experience unintentional weight loss and associate their weight loss with negative outcomes. Survivors also often underestimate their weight status, which is notable given that personal views of one’s weight status, not BMI-derived weight status, is associated with beliefs about the impact of unintentional weight loss. Our findings suggest that people believe unintentional WL meaningfully affects their quality of life.
Dietary modifications for bowel dysfunction in rectal cancer survivors: The Altering Intake, Managing Symptoms (AIMS) intervention study.
Authors: Sun Virginia , Crane Tracy E , Slack Samantha D , Yung Angela , Wright Sarah , Sentovich Stephen , Melstrom Kurt , Fakih Marwan , Krouse Robert S. , Thomson Cynthia A. 
Published: May 2018

141 Background: Rectal cancer survivors often experience persistent long-term effects of treatment. Functional deficits, such as bowel dysfunction, are associated with poor quality of life (QOL). There is a lack of evidence-based interventions to address bowel dysfunction symptoms in rectal cancer survivors. The purpose of this abstract is to describe the development and design of the Altering Intake, Managing Symptoms (AIMS) intervention to manage bowel dysfunction in rectal cancer survivors. Methods: Survivors with stage I-III rectosigmoid colon or rectal cancer who are 6 months post-treatment, > 21 years, and English-speaking are eligible to participate. The AIMS intervention is a ten (30-40 minute) session, 4 month, telephone-based intervention delivered by trained health coaches. Outcome measures are assessed at baseline, 4 and 6 months, and include the MSKCC Bowel Function Tool, the COH-QOL-CRC, and adherence to cancer survivorship diet guidelines. Results: Based on the Chronic Care Self-Management Model (CCM), the AIMS intervention applies social cognitive theory to improve self-efficacy and self-management of bowel symptoms by coaching survivors to modify their diets to attenuate symptoms and enhance diet quality. Motivational interviewing-based behavioral approaches are applied, such as goal setting, self-monitoring, identification of barriers, and problem-solving. Monitoring of diet health involves review of 24 hour dietary recalls in conjunction with food and symptom diaries to promote survivor-directed behavior change resulting in improved bowel health. Conclusions: The AIMS intervention is among the first and few to address diet behavior changes for symptom management in rectal cancer survivors. It has the potential to positively impact the quality of long-term rectal cancer survivorship by integrating classic behavior change theories for cancer symptom management. Findings from the study will inform the design and development of future multi-institutional Phase II and III randomized trials. Clinical trial information: NCT03063918.
Integrative therapies for symptom management in cancer survivors: Assessment of an on-site integrative medicine (IM) program.
Authors: Dilawari Asma Ali , Gilboa Leatt , Kakareka Renee , Ratner Emily 
Published: May 2018

142 Background: Up to 89% of oncology patients utilize integrative therapies with reported improvements in quality of life. However, less than half of patients report IM use to providers, potentially impeding optimal care. In September 2016, MedStar Montgomery Medical Center (MMMC), part of the MedStar Georgetown Cancer Network, opened the Center for Integrative Medicine (CIM) with support from MedStar’s Institute for Innovation (MI2). This clinical program offers IM consultation, acupuncture, mindfulness, psychology services, nutrition, and reiki. The purpose of this analysis is to examine oncology patient utilization of the CIM. Methods: Medical records of 174 patients seen September 2016 - October 2017 were reviewed, and 39 patients with a cancer diagnosis identified. Data regarding chief complaints, treatments, number of visits, and outcomes were analyzed. Results: 39 (22%) of 174 patients had a cancer diagnosis. After initial consultation, 29 of these patients received IM treatment; 14 returned for ≥5 treatments. Most common chief complaints were pain, stress/anxiety, fatigue, insomnia, and arthralgias (Table 1). The majority of CIM’s oncology patients was female and referred from in-network clinicians. The CIM referred 7 patients to other medical providers for unexpected medical issues and 2 required same-day appointments arranged by the CIM. Conclusions: These data illustrate oncology patients’ utilization and benefit of IM services within a hospital network. Communication between IM and referring providers may address unexpected clinical situations, potentially avoiding care delays and facilitating transparency with the use of IM services. Unpleasant symptom treatment may improve therapy adherence and quality of life. This review illustrates feasibility for an on-site CIM and the benefit to cancer survivors when IM services are offered collaboratively.[Table: see text]
The caregiver voice: Insights into caring for the young adult colorectal cancer patient.
Authors: Raymond Martha , Simonetta Margaret-Ann 
Published: May 2018

148 Background: According to data from the National Cancer Institute’s Surveillance, Epidemiology & End Results (SEER) Program, since 1994 statistics show a 50% increase in young onset colorectal cancer incidence in the 20-49 age group. Researchers estimate that by 2030, more than 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in young adults under 50 years of age. Based on these alarming statistics and understanding the vital role caregivers play throughout the cancer continuum, our study explores the emotional and psychosocial implications for caregivers of young adult colorectal cancer survivors. Methods: From September 2015 – September 2017, our professional facilitator with over 25 years of cancer advocacy work hosted nationwide caregiver focus groups. Primary goals included reaching caregivers in rural, urban and community oncology settings to gain perspective from diverse populations. During the study period, we spoke with caregivers in 32 states via traditional focus group settings and online via Skype format. Results: 576 caregivers (37% male, 63% female) participated in our national focus groups. When asked to describe in one word their current feelings, the top ten responses were: Stressed, Anxious, Alone, Exhausted, Angry, Needed, Guilty, Burned-Out, Overwhelmed, Frustrated. 55% of the young caregivers reported they were experiencing self-health decline ( Can’t sleep, can’t focus – feel sad all the time). 73% reported they felt lost and totally helpless ( No control over situation or outcome). 89% reported depression ( We hurt because we can’t take their pain away). 76% reported they felt ill-equipped to help their loved one leading to stress and anxiety ( Desperate for whatever might help). Conclusions: New and expanded caregiver support services are needed. Emotional and psychosocial support are essential to the well-being of our caregivers as they provide vital support to patients in need throughout the cancer care continuum. We will continue the conversation with caregivers as we create programs and expand support services.
The humanistic burden of advanced non-small cell lung cancer: What are the key drivers of caregiver burden?
Authors: Wood Robert , Taylor-Stokes Gavin , Smith Fiona , Chirita Oana Christina , Chaib Torralba Carlos 
Published: May 2018

149 Background: Advanced Non-Small Cell Lung Cancer (aNSCLC) impacts the lives of patients and their caregivers. This analysis aimed to provide insight into the clinical, patient and caregiver factors associated with increased caregiver burden. Methods: Data from a cross-sectional study of aNSCLC patients and informal (unpaid) caregivers in France, Germany and Italy, were collected from May 2015 to June 2016, consisting of a chart review and patient and caregiver surveys. Caregiver burden was assessed using the Zarit Burden Interview (ZBI), measured on a 0-88 scale. An ordinary least square regression model was constructed to assess clinical, patient and caregiver factors associated with ZBI. Measured at time of survey completion, covariates included: country, patient age, sex, body mass index, stage of NSCLC, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), disease duration, smoking status, presence of brain metastases, histology, comorbidities, chemotherapy treatment, caregiver age and sex, and the number of formal (paid) and informal caregiver hours provided per week by additional caregivers. A significance level of 0.05 was used. Results: 331 caregivers were analysed. Mean (SD) caregiver age was 53.8 years (12.4), 239 (72.2%) were female. Caregivers provided a mean (SD) of 17.8 (23.4) hours of care per week. Mean (SD) formal / informal caregiver hours provided by other caregivers was 3.9 (13.3) / 3.9 (12.0). Many caregivers did not receive support from additional formal (75.5%) or informal (68.6%) caregivers. Mean (SD) ZBI score was 31.3 (14.8). Significant independent predictors of ZBI were patient’s ECOG-PS and number of additional informal caregiver hours provided. ZBI scores for caregivers of patients with an ECOG-PS of 3-4 were 7.68 units higher compared to those with an ECOG-PS of 0-2 (p = 0.006). Also, ZBI scores increased by 0.16 units per hour of informal caregiver provided by additional caregivers (p = 0.008). Conclusions: The key drivers of caregiver burden found in the study reinforce the need to develop supportive and personalised interventions to maintain patient performance status by delaying progression, and reduce informal caregiver hours supporting the patient.
Does depression affect illness beliefs in cancer survivors?
Authors: Prieto Sarah , Muellers Kimberly A. , Wisnivesky Juan P. , Jenny Lin J. 
Published: May 2018

156 Background: As cancer survivors live longer and many die from their comorbidities rather than from cancer, it is important to understand how a cancer diagnosis may impact survivors’ perception of their other comorbidities. In addition, cancer is associated with increased risk for depression. We aim to assess the relationship between depressive symptoms and illness beliefs in cancer survivors with diabetes (DM). Methods: We recruited 75 patients with DM who were newly diagnosed with early-stage breast, prostate, lung or colon cancer. Depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale; illness beliefs were assessed with the Brief Illness Perception Questionnaire. Illness belief questions were dichotomized at the median, and non-parametric analyses were used to assess the relationship between depressive symptom scores and presence of illness beliefs. Results: Seventy-five patients with DM and a new diagnosis of cancer were enrolled. The average age was 61.8 years, 47% were male, 45% had breast cancer, 42% prostate cancer, 8% colon cancer, and 4% had lung cancer. Patients who perceived having more control over their DM had lower depression scores (median 26 vs. 20, p = 0.01). Furthermore, those who did not feel their health depended on their DM medications at present (median score 21 vs. 26, p = 0.007) had lower depression scores. Regarding beliefs about cancer, those who reported being less concerned about cancer had lower depression scores (median 21 vs. 25, p = 0.01). Additionally, patients who did not feel that cancer affected their lives much (median 19 vs. 26, p = 0.001) or who did not report that cancer affected them emotionally (median 19 vs. 26, p = 0.001) had lower depression scores. Patients’ perception of their control over their cancer was not associated with depression scores. Conclusions: Cancer survivors with higher depression scores report being more affected by cancer and simultaneously feel they have less control over DM. It is important to support survivors emotionally while increasing their self-efficacy over their comorbidity management to improve survivors’ health outcomes.
Analysis of psychosocial distress screening and needs assessment in adult survivors of childhood cancer.
Authors: Lowry Becky N. , Alsman Kyla , Krigel Susan , Hein Wendy , Krebill Hope , Doolittle Gary C. , Mount Rebecca , Shankweiler Caylin , Gibson Cheryl 
Published: May 2018

160 Background: Childhood cancer survivors (CCS) face complex psychological late effects. The need for systematic screening for psychosocial distress has been clearly identified; however, less clarity exists around characterizing factors that might identify patients at higher risk to support targeted treatment. The purpose of this study was to examine the results of psychological screening in a clinic for adult survivors of childhood cancer using the validated NCCN Distress Screening Thermometer and modified Needs Assessment and exploring the results with other patient factors. Methods: Retrospective chart review was completed on 117 CCS seen in our Survivorship Transition Clinic (STC) between 2014 and 2017. The NCCN Distress Thermometer and Needs Assessment were administered to patients attending the STC. Results were then analyzed with a number of additional factors to explore association. These factors included intensity of treatment (by Children’s Hospital of Philadelphia Intensity of Treatment Rating scale or ITR3), gender, and age at diagnosis. Results: Of 117 patients, 54 had low intensity ITR3 scores (1 or2) and 63 had high intensity ITR3 scores (3 or 4). Mean distress score was 2.669 for the group. A weak but statistically significant association existed between ITR3 scores and distress scale scores (r = 0.2, n = 117, p = 0.022). Mean distress scale scores did not differ between men (2.26 +/- 2.09) and women (2.92 +/- 2.6) nor were they significantly related to age at diagnosis (p = 0.242). Needs assessment identified emotional, nutritional, and physical as the most frequent concerns. Care needs mostly commonly identified were feeling anxious/worried/irritable, being concerned with weight control, or problems with pain / fatigue. Conclusions: While we did not identify statistically significant differences in distress based on gender or age at diagnosis, we did find weak statistical association between higher treatment intensity and higher distress scores. Needs assessment helped guide care plan development. As childhood cancer survivor rates increase, we have an obligation to evolve our understanding of not only physical late effects but also psychological late effects.
Effect of physical activity trackers and daily text messages on quality-of-life in colorectal survivors (Smart Pace): A pilot randomized controlled trial.
Authors: Chan Hilary , Van Loon Katherine , Kenfield Stacey A. , Chan June M. , Mitchell Emily , Zhang Li , Paciorek Alan T , Joseph Galen , Laffan Angela , Fukuoka Yoshimi , Miaskowski Christine , Meyerhardt Jeffrey A. , Venook Alan P. , Van Blarigan Erin 
Published: May 2018

168 Background: There are over 1.3 million colorectal cancer (CRC) survivors in the United States, and many of whom suffer from lower health-related quality-of-life (HRQoL) years after diagnosis and treatment. Physical activity may improve survival outcomes and HRQoL for CRC survivors. Feasible interventions to support physical activity after CRC diagnosis are needed. Methods: We conducted a two-arm randomized controlled trial of 41 men and women who had completed treatment for CRC. Participants in the intervention arm were given a Fitbit Flex™ and received daily text messages for 12 weeks. HRQoL was assessed in both arms at baseline and 12 weeks using the RAND Short Form Survey (SF-36) and the Functional Assessment of Cancer Treatment – Colorectal (FACT-C). Survey score changes from baseline to 12 weeks were compared between the two arms using independent t-tests, and scores at baseline and 12 weeks were compared using paired t-tests. SAS was used for analysis, and statistical significance was declared at p < 0.05. Results: We observed a statistically significant increase in the FACT-C functional well-being sub-scale in individuals in the intervention arm pre- and post- intervention (mean ∆ 1.81 ± 2.76; p: 0.02). There was no change in functional well-being in the control arm (mean ∆ -0.35 ± 4.12; p: 0.71). The between-arm comparison of change from baseline to 12 weeks was not statistically significantly ( p: 0.08). There was a statistically significant increase in the FACT-C emotional well-being sub-scale in the control arm (mean ∆ 1.20 ± 2.48; p: 0.04) and in the SF-36 role physical sub-scale in the control arm (mean ∆ 22.5 ± 38.8; p: 0.02). No other measures of HRQoL were statistically significantly different within groups, across time points, or between groups. Conclusions: A 12-week physical activity intervention using a Fitbit Flex and daily text messages may improve functional well-being among CRC survivors. Larger randomized studies are needed to definitively determine if a digital physical activity intervention improves functional well-being among CRC survivors, and if the improvement can be sustained over time. Clinical trial information: NCT02966054.
Multidisciplinary conference to standardize survivorship care.
Authors: Rudge Beth , Lanigan Megan , Lee Theresa M. , Torp Lisa , Lu Kit Yu 
Published: May 2018

17 Background: Survivors of breast cancer can face a multitude of long term and late effects after completing active treatment. Recommendations for side effect management can vary widely based on professional society guidelines, a provider’s clinical experience, and patient preference. When providing survivorship care in a multidisciplinary institution, maintaining consistent recommendations between providers and disciplines can be a daunting challenge. A cohesive approach is extremely important for a satisfying patient-clinician relationship and for patient safety. Our objective is to create standardized management of breast cancer survivorship issues. Methods: A quarterly Survivorship Multidisciplinary Conference (SMC) was initiated for case review and education on side effect management. The multidisciplinary group included medical and radiation oncologists, surgeons, nurse practitioners, nurse navigators, dieticians, physical therapists, social workers, spiritual care, and a genetic counselor. We used an evidence-based approach, including ASCO and NCCN guidelines as well as published peer-reviewed recommendations to create a treatment consensus for side effect management. Clinicians attending SMC were surveyed regarding their approach to late and long term effects of breast cancer pre- and post-SMC and their overall satisfaction with the conference. Results: Prior to involvement in SMC, most providers based their treatment of side effects on their own professional society’s guidelines and their personal clinical experience. After implementing SMC, 60% of providers reported a change in their practice and there was a 37.5% reported increase in the use of ASCO and NCCN survivorship guidelines across disciplines. 94% of providers reported the SMC is effective in providing evidence based guidelines. Providers also reported a high level of satisfaction and that SMC provided opportunity for a more collaborative multidisciplinary approach. Conclusions: Survivorship Multidisciplinary Conference brings multiple specialties together for review of evidence-based approaches to survivorship care, increasing consistency in management of survivors' late and long term effects after completing breast cancer treatment.