bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fear of cancer recurrence and associations with mental health status and individual characteristics among cancer survivors: Findings from a nationally representative sample.
Authors: Reed Sarah C. , Bell Janice , Nekhlyudov Larissa , Fairman Nathan , Joseph Jill G. , Miglioretti Diana L 
Published: May 2018

147 Background: Fear of cancer recurrence (FCR) and related constructs are experienced by many cancer survivors and are consistently identified as important areas of need. This study adds to sparse literature on this topic by describing the prevalence of FCR and testing its associations with mental health status measures in a US sample of cancer survivors. Methods: Using the Medical Expenditure Panel Survey (MEPS) Experiences with Cancer Survivorship Supplement (n = 1,032), we examined socio-demographic, health and mental health characteristics of cancer survivors by their level of fear of cancer recurrence (none, low, high). Survey-weighted population-based estimates describe the prevalence of key variables. Multinomial logistic regression was used to test associations between validated measures of mental health status and individual characteristics, and levels of FCR in models unadjusted and controlling for socio-demographic and health characteristics. MEPS survey weights were applied in all analyses to account for the survey design. Results: Overall, 34% of cancer survivors reported no FCR, 54% reported low FCR, and 11% reported high FCR. Cancer survivors were at increased risk of reporting high FCR relative to no FCR if they had a low 12-item Short Form Health Survey (SF-12) Mental Component Summary (MCS) score (≤48) compared to high scores (odds ratio = 2.89; 95% confidence interval (CI) = 1.58, 5.32). Reporting depressive symptoms or psychological distress did not significantly increase the risk of reporting high or low FCR relative to no FCR. Conclusions: This study is the first to provide US population-based estimates of associations between FCR and individual, health and mental characteristics. Our results also provide valuable information on which survivors are most at-risk for FCR, and add to a new and growing literature supporting FCR as a multidimensional construct distinct from depression and distress. Future research is needed to more clearly differentiate FCR from other constructs, specifically anxiety disorders, and to identify clinically significant levels of FCR to better target survivors with the highest needs.
Supporting survivorship care through comprehensive cancer control technical assistance.
Authors: Harvey Allison , Khalaf Mohammad , Villalobos Aubrey , Chapman Mandi 
Published: May 2018

15 Background: In 2010, the Centers for Disease Control and Prevention (CDC) issued six priorities for Comprehensive Cancer Control (CCC) programs, including addressing needs of cancer survivors (Seeff, 2010). CCC programs identified need for technical assistance (TA), tools and resources in this area. George Washington University (GW) Cancer Center provides TA on survivorship through a 5-year agreement from CDC and contracts from 5 states. Methods: Since 2013, GW developed three online trainings for health care providers with a focus on survivorship. From 2016-2017, GW delivered four tailored in-person workshops to health care professionals (N = 137). GW also produced a survivorship report and a roadmap to implement the patient navigation standard from the Commission on Cancer: both include background information, sample metrics and implementation resources. Results: Across online trainings for oncology and primary care provider (PCP) learners, a majority of participants (N = 1,983) agreed or strongly agreed their knowledge was enhanced (94.6%) and planned to implement strategies/skills/information learned (79.6%). While content varied for workshops, patient-provider communication, survivorship care plans and patient navigation were common topics presented. The majority (n = 74) agreed or strongly agreed their knowledge was enhanced (82.4%) and planned to implement strategies/skills/information learned (86.4%). The survivorship report has been downloaded 11,000+ times in one year and the roadmap nearly 5,000 times in one month. Conclusions: Based on uptake of TA, GW is meeting a need for CCC programs. However, stakeholder feedback indicates programs continue to desire TA support to meet patient navigation and survivorship care standards. Notably, most PCPs are not familiar with survivorship care, and uptake of trainings aimed at PCPs remains low. Opportunities for further TA to troubleshoot challenges in patient navigation and survivorship care remain.
Investigating Hispanic disparities in supportive medication use among Medicare beneficiaries with breast cancer.
Authors: Pinheiro Laura C , Check Devon , Rosenstein Donald , Reeder-Hayes Katherine Elizabeth , Dusetzina Stacie 
Published: May 2018

154 Background: Compared to their White counterparts, Hispanic women with breast cancer are more likely to report pain, depression, and other mental health concerns. As such, this group may benefit from supportive medication use following diagnosis. However, little is known about their uptake of supportive medication, relative to White patients. In particular, it is unknown if this varies by nativity. This study’s objectives were to assess supportive medication use and investigate potential disparities in use by ethnicity/nativity. Methods: We used the Surveillance, Epidemiology and End Results data linked with Medicare claims to identify women 65+ years diagnosed with incident breast cancer between July 1, 2007 and December 31, 2011. Use of supportive medications (defined as opioid pain and non-opioid psychotropic medications) within 90 days of diagnosis was the primary outcome. We categorized ethnicity/nativity as U.S-Born Non-Hispanic, U.S-Born Hispanic, Foreign-Born Non-Hispanic, and Foreign-Born Hispanic. Poisson models were used to examine associations between ethnicity/nativity and supportive medication use, adjusting for tumor, treatment, and demographic characteristics. We estimated adjusted risk ratios and 95% confidence intervals for all estimates. Results: This study included 23,091 women, of whom 88% were U.S-Born Non-Hispanics, 4% U.S-Born Hispanics, 6% Foreign-Born Non-Hispanics, and 2% Foreign-Born Hispanics. We observed significant adjusted differences in supportive medication use by ethnicity/nativity. Compared to US-Born Non-Hispanics, Foreign-Born Hispanics and Non-Hispanics were 5% (95% CI 0.92-0.98, p = 0.005) and 10% (95% CI 0.85-0.96, p = 0.0005) less likely to receive supportive medications, respectively. U.S-Born Hispanics were 5% (95% CI 1.02-1.09) more likely to receive supportive medications. Conclusions: This work highlights potential disparities in supportive care, and the need to address the psychosocial needs of Foreign-Born women to improve the equity of breast cancer care. Future studies should explore if differences observed in this study are reflective of true health disparities or differential patient preferences.
Facial processing abilities and social functioning in pediatric brain tumor survivors, children with autism spectrum disorder, and typically developing children.
Authors: Brodsky Cole , Shabason Emily Kauvar , Minturn Jane E. , Blum Nathan , Schultz Robert , Herrington John D , Hocking Matthew 
Published: May 2018

157 Background: Pediatric brain tumor survivors (PBTS) often experience late effects in social functioning that mirror those seen in children with autism spectrum disorder (ASD). This study evaluated group differences in facial processing abilities and social functioning between school-aged PBTS, children with ASD, and typically developing children (TDC). Methods: PBTS(n=40;65% male; mean age=13.9 years; mean age at diagnosis=5.8 years)were at least 5 years from tumor diagnosis,2 years from end of tumor-directed therapy and absent a multi-system genetic disorder or developmental delay before tumor diagnosis. Participants completed measures of IQ, facial affect/identity recognition(Victoria/Yale Face Processing Battery), and social functioning(Children’s Communication Checklist-2, Vineland Adaptive Behavior Scales,2nd Ed. and Social Responsiveness Scale, 2nd Ed.).PBTS data were compared to a previously collected sample of age, gender, and IQ-matched children with ASD(n=41)and TDC (n=39).One-way ANOVA evaluated differences between groups with Tukey post-hoc tests.Results: IQ for PBTS(m=100.9; SD=16.27),ASD(m=100.17; SD=17.09),and TDC(m=104.72; SD=14.0)were all in the average range.One-way ANOVA revealed group differences for facial identity recognition[ F (2,114)=4.8 η²=.09 , p=.01],facial affect recognition[ F (2, 114)=3.8 , η²=.07, p=.024],and all social functioning measures[ p=.000].Tukey tests revealed PBTS facial affect recognition to be significantly worse than TDC(p < .05)and more comparable to youth with ASD for both facial affect and identity recognition.PBTS also showed worse social functioning than TDC and better than ASD youth across social measures( p’s < .01).Conclusions: Findings suggest PBTS demonstrate impairments in facial affect and identity recognition and social functioning compared to TDC.PBTS facial processing abilities appear similar to those of youth with ASD.PBTS may benefit from multi-disciplinary interventions similar to those used in ASD to improve social functioning. Screening facial processing abilities may identify those at higher risk for social functioning deficits.
Exercise capacity and quality of life in cancer survivors after completion of a survivorship focused exercise program.
Authors: Jones Rebecca , Harrison Trish , Mesara Doug 
Published: May 2018

169 Background: Exercise is a key component in addressing the concerns of cancer survivors. Only a third of survivors meet physical activity recommendations, and 70% of survivors are overweight/obese. For survivors, inactivity and obesity increase risks of recurrence, development of a second primary cancer, and higher mortality overall. Benefits of exercise include weight loss and improved quality of life. Survivorcise, a 12 week exercise program for survivors, was developed with the goal of improving exercise capacity and quality of life. Methods: Survivorcise is a small group exercise program meeting for 60 minutes, twice a week, for 12 weeks. Pre and post testing of strength, balance, and aerobic capacity and pre and post quality of life surveys were completed. Results: Forty-four participants completed Survivorcise between 2015 and 2017. Paired t-test analysis of pre and post testing revealed significant improvements in upper body strength (p = 0.0001), lower body strength (p = 0.0001), and balance (p = 0.0071). Aerobic capacity (p = 0.1583) improved, but not significantly. Paired t-test analysis of pre and post quality of life surveys revealed significant improvements in patient perception of strength (p = 0.0001), stress (p = 0.0002), weight gain (p = 0.0002), adjusting to the new normal (p = 0.0031), depression (p = 0.0034), fatigue (p = 0.0089), change in mood/behavior (p = 0.0094), pain (p = 0.0118), and lymphedema (p = 0.0290). Patient perception of memory (p = 0.1002), balance, walking, and mobility (p = 0.1104), sleep disturbance (p = 0.1361), neuropathy (p = 0.1455), anxiety (p = 0.1537), nausea/vomiting (p = 0.1597), hot flashes (p = 0.2247), poor appetite (p = 0.4560), osteoporosis (p = 0.5748), falls, tripping, and stumbling (p = 0.6574), and weight loss (p = 0.7890) showed no significant change. Conclusions: Our data demonstrated that Survivorcise is an effective tool for cancer survivors. The program significantly improved upper and lower body strength and balance. Participants self-reported significant improvement in perceived strength, stress, weight gain, adjusting to new normal, depression, fatigue, change in mood and behavior, pain, and lymphedema.
Identifying vulnerable populations among breast cancer survivors.
Authors: Lu Kit Yu , Lee Theresa M. , Lanigan Megan , Rudge Beth , Wert Yijin , Torp Lisa 
Published: May 2018

176 Background: Long term survival is common after breast cancer treatment with 5-year survival rate reaching almost 90%. Many breast cancer survivors (BCS) face varying degrees of quality of life (QOL) issues depending on their age of diagnosis, severity of their disease, and treatment course. This is a retrospective analysis to describe demographics, QOL concerns, and to identify vulnerable populations among the BCS. Methods: This is a retrospective analysis of BCS seen at our Breast Cancer Survivorship Program from Oct 2016 to Oct 2017. Patients were given a comprehensive survey to assess self-reported symptoms and concerns following their treatment. Chi-square test was used to analyze group differences. The Fisher exact test was employed when any of the expected frequencies was five or less. Results: 252 patients (age 26-93; median 60) were seen. Characteristics are listed in the Table. Most common self-reported concerns affecting BCS were: fatigue (40%), insomnia (38%), hot flashes (29%), night sweats (26%), pain (26%), trouble concentrating (26%), and neuropathy (25%). Majority(87%) reported having a happy outlook and felt that they have a sense of purpose (85%), but about 12% of BCS felt isolated at least 50% of their time. Young cancer survivors (age ≤45) (p<0.0001), higher stage BCS (Stage 2-3) (p=0.0023), and those who had chemotherapy either alone or as part of their multi-modality treatment (p=0.0061) were significantly more likely to worry about their cancer post treatment. The same populations were significantly less likely to return back to at least 50% of their pre-treatment baseline (young cancer survivors p=0.0049; higher stage p=0.0011; chemo+/-other treatments p=0.0012). Conclusions: Majority of BCS report a happy and optimistic outlook post treatment, but some may experience significant QOL issues. Identifying common concerns after treatments and vulnerable populations are especially important to deliver quality care and to optimize interventions. [Table: see text]
The impact of a breast cancer diagnosis on women’s work status.
Authors: Barry Lucinda , Storer Leanne , Pitcher Meron 
Published: May 2018

23 Background: The diagnosis and treatment of cancer often causes financial stress, partly by impacting on the ability to continue in paid employment. Our aim was to identify changes in work status 12 months after a diagnosis of breast cancer. Methods: An audit of the medical records of women who presented to the Western Health (Victoria, Australia) nurse led breast cancer Survivorship Clinic (SC) between October 2015 and October 2016 was performed to identify employment status at diagnosis and at their review at SC 12 months later. Results: 111 records were reviewed. The mean age was 55 (range 28-82yrs). 84 of these women (76%) were 65 years of younger at the time of diagnosis. 46 of the 84 women ≤65 years were in paid employment at diagnosis (55%), and 38 (83%) were still working in some capacity at review in the SC. Of the 38 still working, 28 were working in the same capacity, 8 were working reduced hours, and 2 were working increased hours. Women who had axillary dissections were most likely to have changed work status. Financial stress was reported by 8/19 of women who stopped working or had changed work hours, including 9 no longer in paid employment and 10 with changed hours. 2/28 women working in the same capacity reported financial stress. 65% of those who reported financial stress (11/17) had chemotherapy as part of their treatment. Conclusions: A breast cancer diagnosis has the ability to influence a woman's work status one year after diagnosis. Health professionals should appreciate the potential work concerns and financial stresses continuing to affect their patients.
Patterns of concordance with clinical algorithms for survivors of head and neck cancers.
Authors: Gilmore Katherine Ramsey , Palos Guadalupe R. , Chapman Patricia , Lewis-Patterson Paula A. , Bi Weiqi , Rodriguez Maria Alma 
Published: May 2018

26 Background: Research indicates survivors of head and neck cancers (HNC) are at greater risk for recurrences and adverse late effects. HNC survivorship algorithms are available to provide consistent and optimal care to this at-risk group. Here, we describe practitioners’ concordance with algorithms aimed at survivors diagnosed with cancers of the oral cavity (OC) oropharynx (OP), and larynx/hypopharynx (LH). Methods: We reviewed medical records, treatment summaries, and survivorship care plans of patients seen in the HNC Survivorship Clinic from 09/01/2011 to 08/31/2014. The primary outcome was providers’ rate of concordance (> 90%) with 3 HNC algorithms. Concordance rates (CRs) were measured and compared within and between groups. Results: 145 patients met the eligibility criteria. Demographics varied by cancer sub-type: 19.3% OC, 58.6% OP, and 22.1% LH. Most were white males with the mean age of 62.7 years at first visit during the study period. Table 1 indicates clinicians’ CRs ranged from 9.2% to 99.7%. Overall, CRs were highly consistent and met or exceeded the benchmark for H & P, chest x-ray, and dysphagia and lymphedema assessment. Body image assessment had the lowest CRS. Wide variation in CRs existed within and between sites for: T4/TSH, head/neck CTs, xerostomia assessments. Conclusions: Our findings indicate providers’ practice did deviate from recommendations listed in the HNC algorithms. Increasing clinicians' awareness and education may help achieve optimal adherence to survivorship algorithms. [Table: see text]
Come back: Identifying targets to engage young adult survivors who have been lost to follow-up.
Authors: Beaupin Lynda M. , Boldt Anne , Amato Katharine 
Published: May 2018

29 Background: Despite national survivorship guidelines, follow-up care after treatment has ended is generally lacking for AYA survivors. Our previous pilot study involving 27 AYA in a focus group found that the major barriers to follow-up included loss of health insurance, poor communication with their oncologist, and on-going adjustment challenges. The current study aimed to determine the proportion of young adult survivors who no longer continued with follow-up care at our institution and examine which factors contributed to the lack of follow-up. Our objectives were: 1. Evaluate how many AYAs who completed treatment may be lost to follow up over time; 2. Determine which AYAs are most at risk of being lost to follow-up. Methods: Data Analysis: 1. AYA Survivorship Dataset – Tumor Registry used to include the following: Current age, age at diagnosis (captured those 18 and 39 years of age), gender, date of diagnosis, date of most recent visit, disease type and histology. 2. Compare follow-up appointments and insurance status between two sets of survivors: Cohort A - 852 patients diagnosed between 2010-2014; Cohort B - 783 patients diagnosed between 2005-2009. Results: 2367 AYAs were diagnosed between 2000-2015; 37% did not have a follow-up visit since 2015 and no significant variation across disease types Regardless of insurance coverage, 33% of Cohort A and 48% of Cohort B survivors were not seen in 2016. Follow-up status was not related to disease type or insurance status. Conclusions: Many AYAs do not continue with survivorship care. Health insurance status did not predict follow-up adherence, nor did disease type. The longer survivors are from the end of their treatment, the less likely they are to have follow-up care at a cancer center. Further research is needed to determine other implicating factors, such as age at diagnosis and type and intensity of cancer treatment received. [Table: see text]
Seeing results: Outcomes from offering breast cancer survivorship care for more than 10 years.
Authors: Ward Andrew Joseph , Lloyd Jillian , Pospiech Emily , Wheelon Cystal , Orucevic Amila , Bell John Lawrence 
Published: May 2018

32 Background: The University of Tennessee Medical Center (UTMCK), Knoxville Tennessee is the region’s sole academic medical center. Annually, 3000 new patients are seen within the Cancer Institute (CI) of UTMCK, and over 13% are breast cancer patients. Under the leadership of our director, Surgical Oncologist Dr. John L. Bell, survivorship care has been offered to these patients for almost twenty years. This combination has created a unique opportunity for us to look at long term results of offering disease-specific survivorship care, and what effect it has made upon detection of recurrence. Methods: Tumor registry data was utilized to examine the influence of survivorship care upon detection of recurrence. All patients treated from 1999 – 2015 with a diagnosis of recurrent breast cancer were selected out of the tumor registry. These patients were then stratified by time to recurrence, and mean, median, and range were calculated in time to recurrence (TR) by month. Results: A total of 223 patients with recurrent breast cancer were identified in our tumor registry out of 4422 total breast cancer patients treated by UTMCK from 1999 – 2015, recurrence rate of 5.04%. The mean TR for this cohort was 43.9 months. The median TR was 33 months, and the range of TR varied from 4 months to 166 months. All patients were followed for a minimum of five years following their diagnosis, and by 60 months, 73.99% of all recurrences were identified. Conclusions: Offering disease specific survivorship care to breast cancer patients is beneficial to both patients and our institution. When recurrence is diagnosed, survivorship care is valuable by helping to identify these cases as early as possible, to get patients back into active treatment sooner in the disease process. We have demonstrated that this is not a recent phenomenon reflective of current practice changes and accreditation requirements, and have validated this with our institution’s long history of providing survivorship care services for breast cancer patients dating back to the last century.
Primary and subspecialty care trends for adults with a history of childhood cancer.
Authors: Lowry Becky N. , Alsman Kyla , Hein Wendy , Shankweiler Caylin , Krebill Hope , Gibson Cheryl , Mount Rebecca , Doolittle Gary C. 
Published: May 2018

33 Background: With growing numbers of childhood cancer survivors (CCS), having systems for survivorship care coordination is imperative. While studies have compared the comfort and knowledge between primary care and oncology physicians in providing CCS care, few have analyzed primary and subspecialty care rates. Referral trends can be informative for institutions developing systems of care. Correlative measures with referral needs may help institutions prioritize process development for patients. Methods: Retrospective chart reviews were completed on 117 adult CCS from Survivorship Transition Clinic (STC) between 2014-2017. Upon arrival, STC patient self-reports were recorded regarding existing PCP status. Patients with PCPs were enrolled in survivorship consultation care, those without enrolled in survivorship and PCP care. Referrals were tracked by electronic medical record. Two oncology providers performed blinded independent reviews treatment summaries and scored treatments using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Final scores were matched with data on subspecialty referral patterns. Results: Of 117 patients, 65 (57%) needed both PCP and survivorship care while 50 (43%) had established PCPs. ITR3 scores were low intensity (1 or2) for 54 patients and high intensity (3 or 4) for 63 patients. The low intensity group had 157 total referrals (3 per patient) compared to 391 total referrals (6 per patient) in the high intensity group. The top 5 subspecialty referrals (by patients referred) were psychological services (46), dermatology (44), fertility (29), hematology / oncology / BMT (22), cardiology (20). Conclusions: Our care coordination trends suggest many CCS do not have established PCPs despite their complex care needs. Not surprisingly, higher intensity treatment correlates with higher subspecialty care needs. Psychological care remains the most prevalent need in our patient population. [Table: see text]