bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility pilot implementation of a low-dose CT screening program.
Authors: Yoon Joo Hyung , Lofters Aisha , Liu Geoffrey 
Published: May 2018

109 Background: The National Lung Cancer Screening Trial showed 20% reduction in lung cancer mortality with low dose CT (LDCT) screening. The highest risk populations for developing lung cancer are commonly found among lower socioeconomic groups. 30% of patients enrolled with St. Michael’s Hospital Academic Family Health Team (SMHAFHT) are below the low-income cut-off. This study aims to implement LDCT screening at SMHAFHT using the Knowledge-to-Action framework. Methods: Stakeholders were engaged to adapt an existing Princess Margaret Cancer Centre (PMCC) LDCT program with focus groups, interviews, and patient post-LDCT interviews to assess barriers and facilitators. Patients were referred from SMHAFHT to PMCC for LDCT. PLCO2012 scores stratified patient risk, and those at highest risk were chosen. Results: 12 patients were assessed for eligibility; 7 (56%) qualified and 5 (42%) completed LDCT at PMCC. 11 (92%) patients assessed were from two Smoking Cessation Clinics (SCC) within SMHAFHT. Those at SCC (vs LDCT) group were younger (51±12 vs 69±7, p = 0.001), had lower Charlson comorbidity index scores (2.1±1.8 vs 3.4±1.7, p = 0.15) and had fewer pack years (37±24 vs 56±16, p = 0.06). The SCC (vs LDCT) group had comparable prevalence of males (64% vs 66%), COPD (30% vs 33%), personal cancer history (5% vs 0%), family history of lung cancer (17% vs 20%), and proportion of patients reporting the lowest quartile of household income (95% vs 80%), all p > 0.05. Thematic analysis yielded the following barriers among practitioners: limited study awareness, difficulty providing consent forms and lack of time. Top patient reported barriers included fear: of positive results, LDCT and follow up procedures. Practitioner facilitating factors included greater research coordinator involvement, while patients reported clear communication of LDCT risks and benefits and accessibility of PMCC. Conclusions: Implementation predominantly took place within SMHAFHT SCCs. Barriers for future intervention were identified. Differences between participants of SCC and LDCT screening can be attributed to selection of the highest-risk group with PLCO2012 scores. Implementing LDCT screening at SCCs allowed for the recruitment of those below the low-income cut-off.
Barriers of EQ5D-5L implementation into routine clinical practice: A multisite evaluation.
Authors: Baek Justine , Tse Tiffany , Brown M Catherine , Skitch Amy , Chen Judy , Liang Mindy , Naik Hiten , Eng Lawson , Howell Doris , Xu Wei , Shultz David , Brezden Christine B. , Liu Geoffrey 
Published: May 2018

11 Background: As numbers of cancer survivors increase, health-related quality of life and healthcare service utilization warrant closer attention, which requires routine valuations such as health utility scores (e.g. EQ5D-5L). EQ5D-5L implementation into routine clinical practice requires systematic evaluation to assess project scalability with goals of eventual roll-out across all 15 Ontario cancer centres in all disease sites. Methods: We used the Canadian Institutes of Health Research’s Knowledge-to-Action (KTA) framework as a guide to assess implementation of EQ5D-5L in two outpatient cancer populations; St. Michael’s Hospital’s general breast cancer clinic (GBR) and Princess Margaret Cancer Centre’s multidisciplinary brain metastases clinic (MBM), chosen to represent two very different organizational structures and patient populations. KTA steps from landscape assessment and engagement of stakeholders through to pilot implementation using paper surveys are reported. Results: After assessing 270 patients (GBR = 137; MBM = 117) across 57 days, implementation issues at the two sites were noted. GBR clinic’s larger and more general patient base was associated with a lower average socioeconomic status than MBM clinic, which targets a specialized patient population. More barriers to implementation at GBR were systemic and organizational in nature, whereas barriers at MBM were associated with patient management, where patients’ functional disabilities or neglect to return completed questionnaires hindered data collection. For both sites, successful EQ5D-5L implementation was contingent on senior management support and engagement of multiple stakeholders throughout the implementation process, leading to site-specific suggestions. Conclusions: Differing implementation strategies at both sites is reflective of target sites’ distinctive systemic and organizational characteristics and findings can be used to inform the translation of EQ5D-5L to other sites. We present recommendations to aid scalability and implementation efforts, including future transition to electronic routine assessments.
Implementation of an electronic referral smoking cessation tool into clinical practice across cancer clinics of different disease sites and institutions.
Authors: Afzaal Tamoor , Chen Lina , Baek Justine , Tse Tiffany , Chan Kelvin K. , Brown M. Catherine , Howell Doris , Selby Peter , Giuliani Meredith Elana , Jones Jennifer M. , Skitch Amy , Brezden Christine B. , Eng Lawson , Eisen Andrea , Liu Geoffrey 
Published: May 2018

112 Background: Cancer Care Ontario, the government's cancer management agency, mandated routine collection of smoking data province wide (catchment of > 13 million individuals), but did not mandate specifics of a smoking cessation program for cancer patients, despite known benefits. Referral rates to smoking cessation clinics for cancer patients are low. In 2014, Princess Margaret Cancer Centre developed an electronic, patient-driven e-referral tool shown to improve referral rates, known as the smoking Cessation E-referrAl SystEm (CEASE). The objective of this study is to assess the feasibility for expanding this program through adoption and implementation of the CEASE tool to 5 additional clinics across 3 different Cancer Centres. Methods: The Canadian Institute of Health Research’s Knowledge-to- Action (CHIR KTA) framework guided the assessment. Feasibility was addressed through situational assessments, pilot implementation, and clinic/patient feedback in at least two cycles, with procedural changes made at the conclusion of each cycle. Clinics were selected to cover a wide range of hospital, clinic styles, and disease sites. Results: Pilot implementation occurred over 21 clinic days (Jun 2017- Aug 2017); 123 patients were enrolled in the pilot studies in breast, gastrointestinal, head and neck, and thoracic sites. Feasibility assessment in each clinic identified similarities and differences in resource availability, access to authority figures, and patient flow patterns. After the feasibility assessment, a pilot implementation identified English as a second language and the lack of patient's tablet/technological experience as the main barriers for implementation in 4 of 5 clinics. The use of volunteers assisting patients with the survey helped address these barriers. Strong internet connection, short survey length and staff engagement were seen as universal common facilitators to implementation in all 5 clinics. Conclusions: Despite different outpatient environments, common barriers and potential solutions were identified, which will help with scalable future widespread implementation of CEASE across the province of Ontario.
Assessment of pulmonary function test abnormalities in adult survivors of childhood cancer.
Authors: Bassal Mylene , Story Eden , Chang Lynn , Nair Vimoj , Reisman Joseph , Voduc Nha , Radhakrishnan Dhenuka 
Published: May 2018

117 Background: As childhood cancer survival approaches 85%, it is increasingly recognized that childhood cancer survivors (CCS) are at risk for long-term therapy-related complications. Data suggest that pulmonary function test (PFT) abnormalities occur in as many as 84.1% of CCS. Our aim was to assess the prevalence and nature of respiratory abnormalities in adult CCS and to correlate these abnormalities with therapeutic exposures and health behaviors. Methods: Patients who received pulmonary toxic therapy routinely undergo PFTs at their first visit to the POGO AfterCare clinic in Ottawa, Canada. We conducted a retrospective review of all patients seen in clinic from August 2015 until December 2016. PFT results, treatment exposures and health habits were documented. We used NHANES-III prediction equations for PFT interpretation, with expiratory flows and lung volumes of ≥80% predicted as cutoffs for normal. Results: Of a total of 200 patients, 48 received pulmonary toxic therapy and 38 underwent PFTs. Mean age at the time of PFT was 28.8 years (18.5-57.5 years) and the mean time from diagnosis was 17.4 years (3.4-47.5 years). Although no patients reported respiratory symptoms, 42% (16/38) demonstrated a mild restrictive ventilatory defect, 11% (4/38) had mild airflow obstruction, 18% (7/38) had an isolated reduction in diffusion capacity and 1 patient had a moderate mixed obstructive/restrictive abnormality. Only 26% (10/38) had normal lung function. Of those with restrictive defects, all received radiation and 50% were also exposed to pulmonary toxic chemotherapy. All patients with obstructive defects received radiation therapy in combination with bleomycin. Tobacco or marijuana use was reported in 26% (10/38) of the cohort, and in 29% (8/28) of those with PFT abnormalities. Conclusions: PFT abnormalities are common among adult CCS who received pulmonary toxic therapy. Studies evaluating the change in pulmonary function abnormalities over time and their correlation to cardiopulmonary exercise testing and lung imaging are required to inform the health impact on these survivors.
Risk prediction model for heart disease among endometrial cancer survivors.
Authors: Hashibe Mia , Blackburn Brenna , Park Jihye , Rowe Kerry G. , Snyder John , Wan Yuan , Deshmukh Vikrant , Newman Michael , Fraser Alison M , Smith Ken R , Herget Kim , Werner Theresa Louise , Setiawan Veronica Wendy , Hu Nan , Ganz Patricia A. , Gaffney David K. , Lee Yuan-Chin Amy 
Published: May 2018

120 Background: There are an estimated 760,000 endometrial cancer survivors alive in the US today. We previously reported on increased heart disease (HD) risk among endometrial cancer survivors from our population-based cohort study. Although there are many risk prediction models for the risk of endometrial cancer, there are none to our knowledge for endometrial cancer survivors. Methods: We identified 2,994 endometrial cancer patients in the Utah Population Database, which links data from multiple statewide sources. We estimated hazard ratios with the Cox proportional hazards model for predictors of five-, ten- and fifteen-year risks. The Harrell’s C statistic was used to evaluate the model performance. We used 70% of the data randomly selected to develop the model and the rest of the data to validate the model. Results: A total of 1,591 patients were diagnosed with HD. Increased risks of HD among endometrial cancer patients were observed for older age, obesity at baseline, family history of HD, previous disease diagnosis (hypertension, diabetes, high cholesterol, COPD), distant stage, grade, histology, chemotherapy, and radiation therapy. The C-statistics for the risk prediction model were 0.69 for the hypothesized risk factors for HD, 0.56 for clinical factors, and 0.71 when statistically significant risk factors were included. With the final model selected, as one example, the absolute risks of HD were 17.6% at 5-years, 24.0% at 10-years and 32.0% at 15 years for a woman diagnosed with regional stage, grade I endometrial cancer in her fifties, was white, was obese at cancer diagnosis, had a family history of HD but no previous history of HD herself, had hypertension, but no history of diabetes or high cholesterol or COPD, and had radiation therapy treatment but no chemotherapy. The AUCs were 0.79 for the 5-year, 0.78 for the 10-year and 0.78 for the 15-year predictions. Conclusions: We developed the first risk prediction model for HD among endometrial cancer survivors within a population-based cohort study. Risk prediction models for cancer survivors are important in understanding long-term disease risks after cancer treatment is complete. Such models may contribute to management plans for treatment and individualized prevention efforts.
Impact of quality of life on employment and marital status in long-term cancer survivors treated in a referral center in Mexico.
Authors: Remolina Bonilla Yuly Andrea , Armengol Alonso Alejandra , Trejo rosales Raul Rogelio 
Published: May 2018

122 Background: Worldwide there is an increasing number of cancer survivors (CS); in the United States in 2016 there were more than 15 million CS and are predicted to increase to 20 million in 2026. In Mexico (GLOBOCAN 2012), new cancer cases were 148.000 and at least 69.000 will survive. Therefore, it is necessary to focus on cancer survivor’s quality of life (QOL) and its effects in social aspects. Methods: A cross-sectional study was performed including 205 CS with history of non-metastatic cancer (aged ≤65 years, ≥ 2 years from diagnosis and off chemo- or radiotherapy). The QOL-CS questionnaire developed by City of Hope Medical Center was used to measure QOL. Participants reported employment and marital status changes during or after cancer treatment. The aim of this study was to evaluate QOL in CS and its association with employment and marital status. A multivariate logistic regression analysis was conducted to estimate odds ratios (OR). Results: Of the 205 CS 70.2% were women and 29.8% men. Median age at the time of the study was 56 years. Median survival time from diagnosis was 83.6 months. 37.1% had history of invasive breast, 18% colorectal and 8.8% testicular cancers. Disease-related marital status changes presented in 15.6%, 26.8% lost or changed work and 36.6% decreased their work hours. Distress about initial diagnosis, cancer treatment, family and financial burden had the worst score in the QOL-CS. We found no differences in QOL between gender, income, age at diagnosis or type of tumor, but having received chemotherapy was associated with worst QOL (OR 7.33 CI 95% 1.99-26.96 p = 0.003) as well as self-reported neuropathy (OR 2.34 CI 95% 1.06-5.19 p = 0.032). Those with low QOL-CS scores (≤6) were more likely to have a disease-related change in employment (OR 2.34 CI 95% 1.19-4.61 p = 0.014). Disease-related marital status changes were higher in who experienced work status variations (OR 3.87 CI 95% 1.21-12.4 p = 0.023). Conclusions: this is one of the first studies in Mexican CS that associate QOL with relevant social roles. In this cohort having received chemotherapy has the greatest impact in QOL. CS with low QOL were more likely to have changes in employment and therefore, in the marital status.
Effect of immunotherapy and stereotactic radiosurgery on cognitive function and quality of life in long term survivors of metastatic brain malignancies.
Authors: Reddy Naveen Kumar , Brown Franklin , Hess Judith , Fogarasi Miklos C. , Chiang Veronica 
Published: May 2018

125 Background: Use of whole brain radiation, radiosurgery, targeted therapies, and more recently, immunotherapies have resulted in improved survival for patients with brain metastases. As patients live longer, it is becoming increasingly important to understand the long-term cognitive function (CF) and quality of life (QOL) changes associated with these therapies. Methods: The Yale Gamma Knife Database was searched for patients surviving greater than 2 years after brain metastasis diagnosis. Of 79 patients identified, 19 were willing to participate in study. All participants underwent a single assessment session of cognitive tests that evaluated executive function (TMTa and TMTb), processing speed (COWA), memory (HVLT), and quality of life (FACT-Br). Results: Within the whole group, mean age was 65.5 years (range 50-88), median time from brain metastasis diagnosis to testing was 60 months (range 25.6-120.6). Mean number of lesions treated was 3.8 (range 1-10). Mean total lesion volume treated was 14.1 mm3 (range 0.6 - 39). Only 2 patients were treated with whole brain radiation therapy. Patient scores were compared to validated normative data for their age group. Patients performed worse than normal for their age on TMTb (p < 0.0001), total word recall (p < 0.0001) and discriminative ability (p = 0.0004). Patients performed as expected for age on TMTa, animal naming, FAS, and % retention. A negative correlation was seen between executive function results and QOL (TMTa: r = -0.569, p ≤ 0.05, TMTb: r = -0.484, p ≤ 0.05) and a positive correlation was seen between processing speed results and QOL (r = 0.672, p ≤ 0.001). Conclusions: In patients surviving more than 2 years after diagnosis and successful treatment of brain metastases, this study shows that portions of executive function and memory are worse than expected for their age, while cognitive processing speed is similar to norms. Cognitive function was correlated with QOL; patients with lowered cognitive function reported a lower quality of life. Given this preliminary data, a further study in a larger population is needed to determine if certain treatments preferentially predispose patients to declines in CF and QOL.
Developing and evaluating a training intervention to address fear of cancer recurrence.
Authors: Berrett-Abebe Julie , Maramaldi Peter , Cadet Tamara 
Published: May 2018

13 Background: Growing numbers of cancer survivors are increasingly receiving care from primary care providers (PCPs), who often lack cancer-specific expertise. In addition to long-term effects from cancer, survivors tend to be older with multiple chronic conditions, often leaving psychosocial concerns such as fear of cancer recurrence (FCR) unaddressed. This study reports the development and testing of a continuing education intervention to train PCPs to identify and address FCR. Methods: The training was developed through key-informant interviews with 42 health care professionals, researchers, and cancer survivors. The 30-minute training was then delivered and pilot-tested with a total of 46 participants, including physicians, PAs, NPs, nurses, and social workers in six discrete primary care practices. A one group pre-test, post-test design was used to evaluate the effectiveness of the training. Participants completed self-report surveys consisting of 5 domains developed from Social Cognitive Theory and Kirkpatrick’s Evaluation of Training Programs. Data were analyzed using descriptive statistics, paired-sample t-tests, and ANOVAs. Results: ± 10.9. Participants reported high levels of confidence that the training would change their practice, although they also identified barriers to action. Results of t-tests indicated that the training significantly increased participants’ knowledge and self-efficacy. With the except of 1 knowledge domain, no significant differences were found in multivariate analyses. Conclusions: This study demonstrated that a brief, on-site interprofessional training is feasible in a range of primary care practices, well-received by participants, and achieved goals of improved knowledge, self-efficacy and confidence to implement anticipated practice behavior changes. Such training efforts are important, as quality healthcare for increasing numbers of cancer survivors can be improved through continuing education efforts for their PCPs.
Non-melanoma skin cancer in childhood cancer survivors previously treated with radiotherapy: Clinical findings, histology, and management.
Authors: Thorsness Stefanie , Freites-Martinez Azael , Lacouture Mario E. , Marchetti Michael A. , Navarrete-Dechent Christian P. , Tonorezos Emily S. 
Published: May 2018

131 Background: Radiotherapy is a well-known risk factor for non-melanoma skin cancer (NMSC), but whether diagnosis, histologic features, or natural history of NMSC after radiotherapy resemble those observed in the general population is unknown. This study aims to describe clinical findings, histology, and management of NMSC on the skin of childhood cancer survivors previously treated with radiotherapy. Methods: A retrospective chart review (2000-2017) was performed including adult survivors of childhood cancer referred to the Adult Long-Term Follow-Up Program or the dermatology service at Memorial Sloan Kettering Cancer Center. Data was obtained from electronic medical records, including demographics, histologic subtype and treatment received for NMSC (basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)). Clinical features were assessed with clinical images. Results: 960 (mean age 40 years, SD ± 13) patients were assessed for the diagnosis of BCC/SCC after radiotherapy for cancer. The mean age of cancer diagnosis was 15 years (range: birth-39 years). The most common primary diagnosis was Hodgkin lymphoma. 82 patients developed NMSC; 67 of these developed NMSC in the field of prior radiotherapy. 283 in-field lesions were counted, of which 275 were BCC and 8 were SCC. Of the 275 BCC, 261 (95%) were primary lesions and 14 (5%) were recurrent lesions. All SCC were primary lesions. Based on clinical images, 30% of BCC were clinically pigmented; the most common presentation was macule (46%). The mean intervals for BCC and SCC from time of radiotherapy to diagnosis of the first in-field lesion were 24 years (range, 2-44 years) and 32 years (range, 14-46 years), respectively. Histologically, superficial subtype was most prevalent in the BCC subgroup, comprising 47% of all cases. Mohs surgery was the most common therapy (43% of BCC cases; 37% of SCC cases). Conclusions: Among survivors of childhood and young adult cancer, BCC was the most prevalent NMSC. Most of BCC arising in sites of prior radiotherapy for cancer treatment were of low-risk histologic subtype and had low rates of recurrence. An expanded role for topical therapy may be appropriate, but further research is needed.