bluuebunny/crossref_metadata_2025_split huggingface dataset:
Behavioral treatment of insomnia in cancer survivors: Early results of a stepped-care trial.
Authors: Recklitis Christopher J. , Partridge Ann H. , Michaud Alexis L. , Zhou Eric 
Published: May 2018

140 Background: Insomnia is a burdensome late-effect for up to 30% of long-term survivors. Behavioral insomnia treatments are highly effective, but are not available to most affected survivors. Treatment barriers include lack of trained clinicians and resource demands for standard treatment of 6-8 individual sessions. To address these barriers we investigated the efficacy of delivering insomnia treatment in a stepped-care trial (NCT02756390); low intensity treatment was delivered to all participants, and more intense treatment reserved for non-responders. Methods: 43 survivors (91% female; mean ge = 55 yrs; mean time since diagnosis = 11 yrs) participated. They were primarily breast (63%) and blood cancer (26%) survivors, all with clinically elevated ( > 12) Insomnia Severity Index (ISI) scores at baseline. Participants first received a single education session addressing basic sleep hygiene and were reassessed 4 weeks later. Those with an elevated ISI ( > 12) at 4-week follow-up were offered more intense treatment: a 3-session CBT group program developed for cancer survivors. Participants completed the ISI again prior to CBT and 4-weeks post-treatment. Results: Survivors reported significant reductions in insomnia after a single education session; mean ISI scores fell 5.8 points (p < .001), and 23 of 43 survivors (54%) no longer had clinically elevated ISI scores. Of the 20 survivors with persistent insomnia, 9 have received CBT to date and shown similar improvement; their mean ISI scores fell 6.4 points (p = .006), and 6 (67%) no longer had clinically elevated ISI scores. Both treatments had large effect sizes (d = 1.2). Conclusions: Results support a stepped-care approach to treating survivors’ insomnia. A brief sleep hygiene intervention has important dissemination implications, as it may be delivered by non-specialists or as a mobile intervention. For survivors needing more intensive treatment, a short-duration group CBT intervention is effective while requiring fewer resources than standard CBT insomnia treatment. This ongoing trial will investigate how treatment gains in both groups are maintained over three-month follow-up, and explore what factors may predict response to low-intensity treatment. Clinical trial information: NCT02756390.
Implementation of an electronic patient reported outcome system in a prostate cancer urology clinic.
Authors: Spillane Maria , Pollock Phil , Hedden Lindsay , Wu Eugenia , Goldenberg Larry , Jones Jennifer M. , Matthew Andrew , Truong Tran , Gavrylyuk Yuliya , Higano Celestia S. 
Published: May 2018

143 Background: The Prostate Clinic at Vancouver General Hospital recently implemented electronic Patient Reported Outcomes (ePRO) collection from prostate cancer patients (pts). The ePRO system was adopted from the University Health Network, Toronto. Our objective was to review the successes and challenges related to the implementation of the system during its first 6 months of use. Methods: All newly diagnosed pts, those going for a prostate biopsy, and pts booking surgery are asked to complete ePRO on iPads at their clinic appointment. The ePRO includes the EPIC-26, EQ-5D-5L, WHODAS 2.0 questionnaires and the Distress Thermometer. It takes about 4-5 minutes to complete the questions, and consent to be contacted about future prostate cancer research is also requested. Afterwards, pts complete ePROs at each clinic appointment. They receive a report summarizing that day’s responses in the context of previous responses. Results: Between 4-1-17 and 10-16-17, 360 pts were eligible to complete the ePRO. 311/360 pts (86.4%) filled out the ePRO at least once. Of the 49 who didn’t, 24 were missed by the coordinator and 21 were not referred by clinic staff. Only 4 pts (8.2%) refused to answer the ePRO. 18 of the 311 pts only partially answered the ePRO, most often due to the length of the questionnaires. 396 instances of ePRO were completed by 311 pts. WiFi connectivity issues were encountered 30/396 times, which prolonged ePRO completion time, and on 3 occasions resulted in patients refusing to complete ePRO. Conclusions: Implementation of the ePRO system into our urology clinic is a success based on a high completion and low refusal rate, and was organized mainly by a single individual. Challenges include training clinic staff to refer pts to complete ePROs at appropriate times, technical difficulties with WiFi connectivity, and the need to interact with each pt individually, which can be time consuming and result in lost data. Eventually, all pts will be trained to pick up an iPad and complete ePROs prior to each appointment. We found the system straightforward to use, and have updated our iPads with additional questionnaires. It is clear that systems collecting ePROs will become standard practice as technology improves and costs go down.
"Getting to know you and your child" screening questionnaire: Results from a Chicago-based collaborative.
Authors: Weldon Christine B. , Roggenkamp Betty , Owen Erika D , Reichek Jennifer , Stewart Zayda , Trosman Julia Rachel , Dighe Dipti , Iqbal Asneha , Suh Eugene , Berardi Rosa , Ganesan Rani , Choi Daniel K. , Henderson Tara O. 
Published: May 2018

150 Background: In 2013 the Institute of Medicine recommended that supportive oncology services be initiated at time of cancer diagnosis. Providers of pediatric cancer care in the Chicago metro area, supported by The Coleman Foundation, created and pilot tested a standard psycho-social stressors screening instrument for children with cancer and their families. Methods: The collaborative conducted structured review of tools: Psychosocial Assessment Tool (PAT), Social Work Assessment Tool (SWAT), National Comprehensive Cancer Network (NCCN) Problem List, and √IN; and collected input from social workers and oncology providers on stressors throughout the care continuum. The resulting tool was piloted in English and Spanish at 7 pediatric cancer hospitals. Providers qualitatively reported assessment of its usefulness. Results: Patients/family (n = 57) completed the “getting to know you and your child” instrument which inquired about caregivers, siblings, child’s likes/hobbies, school situation, SSI/SNAP, challenges, and cultural/religious preferences. Providers reported that almost all families found the tool useful “to think about support needs”; one said it was invasive. The tool assessed 12 psychosocial stressors; the mean per patient/family was 2.49 (range 0-11). The most frequent stressors were support from friends, family, community (30%), paying for food (26%), job flexibility (26%), school concerns (25%), emotional support for family (25%), and medical costs (23%). All who reported temporary housing also reported difficulty paying for a place to live (p < 0.0001). Providers reported that the standard tool generated new insight into family structures, challenges and needs informing resolution efforts. Provider recommended adjustments: simplify terms for siblings, hobbies and spiritual, adding question about pets in the home. Conclusions: Pilot testing of a psycho-social screening tool for pediatric and adolescent oncology informed providers of patient/family needs in a standard manner. Four of the seven sites involved in the pilot are now implementing this tool as a standard practice; the remaining sites are performing analyses on how to incorporate the tool into their care processes.
Correlates of anxiety and depression in chronic lymphocytic leukemia (CLL) survivors.
Authors: Williams AnnaLynn , Yarosh Rina , Clark Jackson , Casulo Carla , Barr Paul M. , Kamen Charles Stewart , van Wijngaarden Edwin , Zent Clive , Janelsins Michelle Christine 
Published: May 2018

153 Background: CLL is an indolent lymphoma effecting aging populations. Early stage patients are assigned to active surveillance and only 10% of patients require treatment at diagnosis. Active surveillance for CLL may increase susceptibility to anxiety and depression, resulting in enhanced comorbidities and reduced quality of life. However, little is known about the prevalence and risk factors of anxiety and depression in CLL. Methods: 125 CLL patients that were treatment naïve (n = 86) or previously chemotherapy-treated (n = 39) completed anxiety and depression questionnaires (State Trait Anxiety Index (STAI) and Center for Epidemiologic Studies Depression (CES-D)). Multivariable linear regression was used to examine associations with STAI/CES-D score. Logistic regression was used to examine clinically meaningful anxiety and depression, using validated cut points of 40 for the STAI and 16 (or on antidepressants) for the CES-D. All models included treatment status (treatment naïve vs. treated), age, gender, ECOG grade, time since diagnosis, education, & disease stage. Results: Patients had a median age of 65, were mostly male (60.8%), Caucasian (96%), well educated (55% ≥ college), and had low stage CLL (66% stage 0) and good performance status (67% ECOG 0). 20 and 24% of patients had clinically meaningful anxiety or depression (11% had both). Treatment and time since diagnosis were not associated with anxiety or depression. Older age was associated with better STAI and CES-D scores (STAI β = -0.34 (95%CI -0.52, -0.17) CES-D β = -0.27 (95%CI -0.42, -0.12)), and each 1 year increase in age was associated with a 9% decrease in odds of anxiety and a 7% decrease in odds of depression (OR 0.91(95%CI 0.86, 0.96) OR 0.93 (95%CI 0.88, 0.98) respectively). An ECOG grade of 3 or 4 was a significant predictor of increased depression risk (OR 2.84 (95%CI 1.03, 7.82)) and worse CES-D scores (β = 4.69 (95%CI 8.09, 1.29)) but not of anxiety. Conclusions: Anxiety and depression are common among CLL patients. Poor performance status was associated with more depression while older age was associated with less anxiety and depression. Future studies should investigate potential interventions for anxiety and depression in younger CLL patients.
Development of a digital patient navigation application: Preliminary results from patient interviews.
Authors: LeBlanc Thomas William , Herring Kris , Chilcott Jack , Bletcher Katherine , Osaka Miya , Manassei Hugo , Pendergraft Trudy , Corbett Cheyenne , Zafar Yousuf , Higgins Adam , Patierno Steven R. 
Published: May 2018

161 Background: People living with cancer face challenges too numerous to attend to during brief clinic visits, and thus may benefit from additional help with supportive care needs. While patient navigators offer promise, they are a limited resource. Digital navigation offers a scalable solution, to extend navigators’ reach and connect patients with existing resources, thereby enhancing our ability to address unmet needs. Methods: Utilizing a “design thinking” approach, we developed and tested a digital navigation platform to enhance utilization of support resources in the Duke Cancer Institute (DCI). The alpha version of the application (app) was based upon insights gleaned from interactions with patients, caregivers, advisory board members, and staff. It was then tested among adult patients with advanced cancer at the DCI. Subjects participated in qualitative interviews with design/content experts, to elicit supportive care needs and gauge interest in utilizing the app to improve their care experiences. Detailed notes were taken, and emerging themes compiled. Results: We enrolled 10 patients and caregivers. Subjects reported feeling overwhelmed by information, feeling that “they don’t know where to start when looking for support.” They also expressed uncertainty about what questions to ask, and said they are not always comfortable asking for help. All struggled to define “supportive care;” only one knew it refers to a set of services. Subjects felt a digital navigation app would enable them to explore and access services as needed, to help them “feel less alone,” and to know “someone or something was there for them.” They expressed dislike for being asked lots of questions, wanting to explore options on their own instead of being led somewhere. Digital navigation has the promise to increase their sense of control, with one subject noting: “I like to know what my options are and decide for myself…people try to assume they know what you need all the time.” Conclusions: Digital supportive care navigation may be an effective, scalable, and cost-efficient intervention to support patients and caregivers, and ultimately improve outcomes. Further refinement and testing of this approach is needed.
Psychosocial outcome and health-related quality of life (HRQoL) in advanced melanoma survivors.
Authors: Rogiers Anne , De Cremer Jennifer , Ben Salama Laila , De Ridder Mark , Bernheim Jan Louis , Neyns Bart , Theuns Peter 
Published: May 2018

162 Background: An increasing proportion of advanced melanoma patients (pts), treated with immune checkpoint inhibitors and/or BRAF/MEK-inhibitors, achieve long-term survival. The traumatic experience of melanoma progression, which often involves the brain, puts them at high risk for emotional and neurocognitive function (NCF) disturbances that may negatively impact their HRQoL. Methods: Pts with advanced melanoma (AJCC stages IIIC or IV) who were in remission for at least 1 year after treatment initiation were included in this ongoing single-center therapeutically non-interventional clinical trial. Data on psychosocial outcome and HRQoL were collected using 6 validated questionnaires, a semi-structured psychiatric examination (SSPE) and a computer based neuro-cognitive function (NCF) test. Results: Test results from the first 24 pts (9M/15F; median age 58y (29-87) were analysed. Mean EORTC Global Health Score was significant lower than the European Mean (t[23]=2.713, p= 0.006). The SSPE revealed that all pts reported fear of recurrence; 19 pts (79%) suffered from feelings of insecurity with daily worrying about the disease, associated with a fear of dying. Irritability was a prominent complaint in 18 pts [75%]). Twelve pts (50%) received a message of no hope at diagnosis of metastatic disease which had a persistent major psychological impact. Suicidal ideation occurred in 3 pts (13%), 1 pt (4%) made a suicide attempt (in the absence of depression). Nine pts (38%) reported worrying about their family, 4 pts (17%) had relational problems and 7 pts (29%) had financial problems related to the disease. Despite frequent fatigue complaints, only 4 pts (17%) had mild excessive sleepiness on the Epworth Sleepiness Scale and 9 pts (38%) on the Fatigue Severity Scale. The HADS results indicated a greater occurrence of anxiety compared to depression (NA=10, ND=6). Twenty pts (83%) reported memory complaints, but only 7 pts (29%) had elevated scores on the Cognitive Failure Questionnaire (CFQ). Conclusions: Advanced melanoma survivors are at risk of emotional and neurocognitive disturbances impacting on their HRQoL. Timely detection of psychosocial and neurocognitive problems and adapted care are indicated.
Distress screening, intervention, and follow-up outcomes among Hispanic and Caucasian women with newly diagnosed breast cancer.
Authors: Shay Rebecca C. , Britt Gregory Joseph 
Published: May 2018

163 Background: We describe acceptance and impact of mental health (MH) interventions provided to an English speaking Caucasian and Spanish speaking Hispanic female breast cancer (BC) population reporting symptoms of depression and anxiety. Methods: Records of 170 women with newly diagnosed BC at Cancer Centers of Colorado at SCL Health/Saint Joseph Hospital in 2015 were retrospectively assessed for record of a distress screening questionnaire (DSQ), administered in each patients’ native language. Among patients who reported psychosocial distress (PD), records were reviewed for an outreach phone call and visit with social work (SW) or MH, new antidepressant or anxiolytic prescription, and completion of a second DSQ. SCL Health IRB approval obtained. Results: Of 170 subjects, 94 (68% (n = 64) Caucasian, 19% (n = 18) Hispanic, 13% (n = 12) other) completed an initial DSQ. Scores reflecting PD were seen in 57 DSQs; 15 were high-grade PD (HPD). Nearly half (49%; n = 28) of those with PD had been called by MH or SW; 93% (n = 14) with HPD were called. Anxiety scores (AS) improved in 78% (n = 18) and depression scores (DS) in 74% (n = 17) of subjects called. AS and DS improved in 67% (n = 8) and 75% (n = 9), respectively, of Caucasian patients and in 89% (n = 8) and 67% (n = 6) of Hispanic patients called. Of 35 patients who completed follow-up DSQ, 17 visited with MH or SW. AS and DS improved in 65% (n = 11) of these. Improved AS and DS were seen in 38% (n = 3) and 63% (n = 5) of Caucasian patients, respectively, and 88% (n = 7) and 63% (n = 5) of Hispanic patients who had a visit. An antidepressant or anxiolytic was prescribed for 7 patients; AS and DS improved for 33% (n = 1) of Caucasian patients and 67% (n = 2) of Hispanic patients given prescriptions. Conclusions: Outreach to patients with PD and HPD correlated with improved AS and DS. Hispanics were more likely than Caucasians to accept a visit from MH or SW and were more likely to improve AS and DS following a visit with these services or antidepressant or anxiolytic prescription, demonstrating the importance of intervention in this group. This study does not account for patients’ initial staging, progression or regression, therapy pursued, nor presence of other psychosocial concern.
Pathway to support and growth: Feasibility of formalized peer mentoring in gynecologic cancer survivorship.
Authors: Lee Nita Karnik , Anderson Diane , Hlubocky Fay J. 
Published: May 2018

164 Background: Peer support among cancer patients is understudied. Formal peer mentoring programs matching patients with survivor peers provides emotional and social support. Gynecological cancer patients are: underserved in the survivorship community, stigmatized due to disease, suffer elevated distress. Little is known on how to design and implement a formal peer support program for gynecologic cancer. Methods: To study the effect of peer support, a novel outpatient pilot peer support program for gynecologic cancer patients was implemented. Peer mentors had prior gynecologic cancers, completed treatment 1 year prior, and had formal 6 hour training. Newly diagnosed patients were matched with a peer at: 1) initial diagnosis 2) post-surgery 3) chemotherapy/radiation initiation 4) post treatment. Patients and Peers were matched based upon demographics. Qualitative individual and group interviews were used for program evaluation. Results: To date, 38 participants are enrolled: 17 peer mentors underwent training and 21 new patients were matched with mentors. Mentor demographics include: Mean age 61.8 (range 48-80), median 62. Ethnicity 65% CA, 30% AA, 5% Latina. Diagnoses were 47% endometrial, 12% cervical and 41% ovarian cancers. 65% of mentors have been matched with patients. Majority of pairs communicated via phone followed by face-to-face encounters. Qualitative program evaluation by mentors revealed barriers including: new patient resistance, readiness, distress. Matched mentors reported themes associated with advocacy, positive patient interactions, personal growth and satisfaction, greater sense of purpose due to their mentor role. Mentors expressed desire for future programs in inpatient/ infusion settings and group education. Programmatic challenges identified included inconsistent provider referrals, matching to disease site/stage, patient readiness to participate as mentees, and management of disease recurrence in mentors. Conclusions: Formalized peer mentoring program is feasible, offers a novel approach to providing psychosocial support for newly diagnosed patients and provides mentors a pathway for positive growth as survivors.
Bringing a creative writing intervention for young adult cancer survivors online.
Authors: Casperson Mallory C , Peckham Jennifer 
Published: May 2018

166 Background: Studies show the importance of age-specific, young adult cancer (YAC) psychosocial interventions. They demonstrate psychological interventions “reduce emotional stress and increase coping skills needed to adjust to life after a cancer diagnosis."(Peckham JL, et al. JAYAO. 2017;6:50-52.) With YAC survivors spread around the country, many lack access to such interventions. This feasibility study considered online delivery of a structured, long term writing intervention in YAC survivors and the perceived participant benefit. Methods: Lacuna Loft held three structured, creative writing workshops over 10 weeks, 10 weeks, and 8 weeks. An online video chat platform delivered the workshops, allowing participant connection via video and voice. The workshop followed the methods used in Unspoken Ink.(Peckham JL, et al. JAYAO. 2017;6:50-52.) Each week used a different cancer topic and several prompts were given. Participants completed questionnaires at the start and end of each workshop. Results: Over three writing workshops, twenty-one people completed a workshop, five participated in multiple, and ninety expressed interest in future workshops. People from nine states and three countries participated. The online platform allowed writers to join from any location including the hospital. Participants expressed a decrease in feelings of isolation at the completion of a workshop as well as an increase in feelings of connection to other YAC survivors. All participants stated they would refer another YAC survivor to the workshop. The online nature of the program proved inconsequential. Conclusions: Research shows that structured writing workshops for YAC survivors “to explore their cancer experiences may be an effective psychosocial intervention.”(Peckham JL, et al. JAYAO. 2017;6:50-52.) This study used online video chat platform to deliver the workshop and connect participants. All participants expressed decreased feelings of isolation and increased feelings of connection to their YAC survivor peers at the conclusion. Most had never participated in an online group previous to this online workshop. Online delivery of structured writing interventions thus allows for more wide-spread accessibility of psychosocial interventions for YAC survivors.