bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare utilization and quality among survivors of adolescent and young adult cancer.
Authors: Kirchhoff Anne C. , Kaul Sapna , Fluchel Mark , Parmeter Christopher F , Spraker Holly Lynn 
Published: February 2017

21 Background: To evaluate perceived health care quality among a national sample of survivors of adolescent and young adult (AYA) cancer relative to individuals from the general population. Methods: Using the Medical Expenditure Panel Surveys from 2008-2012, we identified 1,163 survivors diagnosed with cancer ages 15-39 who were at least five years from diagnosis and currently ages of 20-64. A comparison group with no history of cancer was created via propensity score matching on sex, age at study, race/ethnicity, census-region, and survey year. Participants with one or more health care visit in the past 12 months were asked to rate health care quality from all providers (0 = worst to 10 = best), which we categorized as low (0-4), moderate (5-7) and high (8-10). Among survivors, we identified factors such insurance and health status associated with health care quality using ordinal logistic regression. Results: Mean time since diagnosis was 18.3 years. A total of 18% of survivors of AYA cancer reported no health care visits in the previous 12 months compared to 25% of the comparison group (p < 0.001). Survivors rated their health care quality lower than the comparison group (low/moderate: 30.8% vs. 22.5%, respectively, p = 0.003). Among survivors, those who were publicly insured (odds ratio (OR) = 0.62, 95% confidence interval (CI): 0.39-0.97, p = 0.04) and uninsured (OR = 0.25, 95% CI: 0.13-0.48, p < 0.001) were more likely to provide lower health care quality ratings than privately insured survivors. Survivors in fair/poor health also reported poorer quality compared to those in excellent/very good/good health (OR = 0.43, 95% CI, p < 0.001). Conclusions: Survivors of AYA cancer reported greater health care use and poorer health care quality compared to individuals without cancer. Our results call for targeted interventions to meet AYA cancer survivors’ health care needs and expectations.
Predicting patterns of distress in adult survivors of childhood cancer: A latent profile analysis from the Childhood Cancer Survivor Study.
Authors: D'Agostino Norma Mammone , Edelstein Kim , Zhang Nan , Recklitis Christopher J. , Brinkman Tara M. , Srivastava Deokumar , Leisenring Wendy M. , Robison Leslie L. , Armstrong Gregory T. , Krull Kevin R. 
Published: February 2017

210 Background: Although most survivors are emotionally healthy, subgroups report elevated or increasing distress over time. Distress often involves comorbid symptoms, which are difficult to treat. Predictors of comorbidity have not been examined in survivors. This study identifies patterns of distress and examines disease, treatment and demographic predictors in long-term survivors diagnosed between 1970-99. Methods: Latent profile analyses were used to identify clusters of survivors (N = 16079) and siblings (N = 3085) based on symptoms of somatization, anxiety, and depression from the Brief Symptom Inventory – 18. Bayesian information criterion & Lo-Mendell-Rubin adjusted likelihood ratio test were used to select cluster number. Multinomial logistic regression was used to identify predictors of cluster membership stratified by sex. Results: Four clusters were identified: low distress on all subscales (asymptomatic); high distress on all subscales (global distress); primary somatization (somatic distress); primary depression (affective distress). Compared to siblings, fewer survivors were asymptomatic (62% v. 74%) and more had global distress (11% v. 5%), p’s < 0.0001. More male (66%) than female (58%) survivors were asymptomatic, and more females reported somatic (17% vs 10%) and global (12% vs 9%) distress, all p’s < 0.0001. Among females, fair/poor perceived health (OR 30.9, 95% CI 19.4-49.1); pain (OR 3.4, 95% CI 2.4-4.8), divorced/separated (OR 2.3, 95% CI 1.7-3), less than college education (OR 1.9, 95% CI 1.5-2.3), and antimetabolite therapy (OR 1.3, 95% CI 1.1-1.6) were associated with global distress. Fair/poor perceived health (OR 26.2, 95% CI 17.6-38.9), pain (OR 5.1, 95% CI 3.8- 6.8), divorced/separated (OR 3.0, 95% CI 2.2-4), and anthracycline therapy (OR 1.2, 95% CI 1.0-1.4) were associated with global distress in males. Diagnosis, age at or time since diagnosis, and radiation were not significant predictors. Conclusions: Results support the conceptual distinction between somatic versus affective symptoms of distress and highlight sex differences and health-related predictors of distress, all which have implications for treatment approaches.
Oncofertility and quality of life among adolescent and young adult survivors of childhood cancer.
Authors: Tercyak Kenneth , Mays Darren , Johnson Andrea , Murphy Sarah , Shad Aziza T. 
Published: February 2017

222 Background: Although infertility risks due to childhood cancer treatment are well-documented, research on the psychosocial impact of treatment-associated infertility risks among adolescent and young adult (AYA) cancer survivors is limited. This study examined AYA pediatric cancer survivors’ perceptions of oncofertility and cancer treatment-associated infertility risks and associations with patient-reported quality of life (QoL). Methods: Patients ages 12 to 25 (n= 70, M age 19.4, 74% white, 57% female, a majority leukemia/lymphoma survivors) were recruited from a pediatric hematology/oncology clinic and local pediatric cancer survivor support organizations. Patients reported knowledge and beliefs about treatment-related fertility risks and reproductive health, and oncofertility information and support needs, and completed the Pediatric Oncology Quality of Life (QoL) scale. Results: Patients’ knowledge about infertility risks and fertility preservation options was low (M 13.5, SD 8.6, range 0-42): patients’ attitudes indicated treatment-related infertility risks was important (M 21.7, SD 7.0, range 0-40), they perceived they were at-risk for infertility (M 3.8, SD 1.0 range 1-5), and expressed unmet needs for supportive resources on reproductive health (M 13.6, SD 4.8, range 1-24). Greater perceived risks of infertility (r = .34, p = .004) and importance of fertility risks (r = .34, p = .004) were associated with lower QoL. In a multivariable model adjusting for patient age and gender, beliefs that reproductive health was important was associated with lower QoL (B = .68, p = .041). Conclusions: Population data demonstrate few AYA cancer survivors have opportunities to discuss fertility preservation with providers. Our findings indicate AYA cancer survivors perceive treatment-related infertility risks as important, associated with QoL, and with needs for more information about reproductive health and fertility preservation. Care models addressing AYA survivors’ infertility risks are needed as part of the diagnosis, treatment, and long-term follow-up of these patients.
Engaging a statewide network to expand survivorship care to rural and urban cancer survivors.
Authors: Klemp Jennifer R. , Bush Carol , Spaulding Ashley , Krebill Hope , Doolittle Gary C. 
Published: February 2017

23 Background: Advances have been made in elevating cancer survivorship as a public health priority and defining elements needed to deliver high-quality follow-up care to survivors. However, a lack of research on how best to care for survivors and the most effective and efficient strategies for delivering survivorship care in the community setting still exists. We report our assessment of the current state of practice, knowledge and professional development, and plan to increase access to care of urban and rural practices across the state of Kansas. Methods: In 2014, the Midwest Cancer Alliance (MCA), a membership-based outreach arm of The University of Kansas Cancer Center, convened an educational summit and survey to assess the survivorship landscape in Kansas. Post-summit, individual interviews were conducted. Survey and interviews included questions regarding health records, treatment summaries, survivorship care plans (SCP), availability of survivorship programs and resources, access to primary care and specialists, distress screening, community support, and educational needs. Results: Ten MCA member health systems were invited to participate and 7 indicated interest in participating in the project. Only one organization provided an SCP to survivors. Barriers included lack of an integrated approach and knowledge. A majority of survivorship care could be delivered close to home, however, services including fertility preservation, genetic counseling, oncology rehab, sexual health, and second opinions, required travel of more than 50 miles. Identified educational needs focused on comprehensive survivorship care across the health care team. Conclusions: Survivorship care remains fragmented across the state of Kansas. Based on this project, we have secured a CDC survivorship grant that will facilitate clinical and technical assistance related to process improvement and electronic health record integration focused on survivorship care and delivery of an SCP. Next steps include engaging primary care providers and survivors to assure the SCP meets the needs of stakeholders. This work will focus on a translational process to meet the growing needs of the survivors and complex health care organizations.
Discrimination and quality of life among breast cancer survivors.
Authors: Gomez Scarlett Lin , Gonzales Felisa A , Shariff-Marco Salma , Dwyer Laura A , Nuru-Jeter Amani 
Published: February 2017

250 Background: We examined the role of race/ethnicity, education, and medical discrimination on global and breast cancer-specific (BCS) quality of life (QoL). Methods: Telephone interviews were administered to 536 Asian, Black, Hispanic and White women identified through the Greater Bay Area Cancer Registry who were aged 20+ when diagnosed with a first invasive primary breast cancer between 2006 and 2009. Women reported perceptions of discriminatory experiences while receiving breast cancer care. QoL was assessed with a single item asking about global QoL over the past 4 weeks ( “excellent” vs “less than excellent”) and a summary score for the 6-item breast cancer subscale of the FACT-B (higher scores indicated more concerns (or worse QoL)). Race/ethnicity and education were combined into an 8-category variable (4 race/ethnic groups x 2 education groups). Psychometric analyses was used to create a summed medical discrimination score using 7 items that comprised a single factor, and split into tertiles to indicate no, low, and moderate/high levels of discrimination. Main effects for race/ethnicity x education and medical discrimination were identified using logistic and linear regression models. Adjusted analyses controlled for age, marital status, health insurance, stage, histology, and tumor size. Results: In adjusted analyses, disparities across combined race/ethnicity x education groups were observed for global QoL (Wald χ2(7) = 23.32, p < 0.01) but not for BCS QoL (F= 0.78, p= 0.60). Black and Asian women reported lower global QoL than college-educated White women. Medical discrimination was related to global (Wald χ2(2) = 6.98, p= 0.03) and BCS QoL (F= 6.14, p< 0.01). Women reporting moderate/high levels of medical discrimination had significantly lower odds of excellent QoL (OR= 0.416, p< 0.01) and more breast cancer concerns (β= 1.19, t= 3.50, p< 0.001) than women reporting no discrimination. Conclusions: Medical discrimination was associated with lower global and BCS QoL. More research is needed to identify specific factors at the individual, provider, and organizational levels that contribute to perceptions of medical discrimination so that they can be addressed and QoL can be improved for breast cancer patients.
Integrating health insurance assessments into oncology care.
Authors: Morales Joanna , Bryant Monica 
Published: February 2017

253 Background: Nearly 10% of the U.S. population lacks health insurance coverage. Healthcare professionals are often asked by their patients about health insurance options. The Patient Protection and Affordable Care Act (ACA) has brought new health care options and consumer protections for people coping with cancer. Unfortunately, there is a plethora of misinformation about these changes. Healthcare professionals are uniquely positioned to provide patients with accurate, quality information, improving patient quality of life. Methods: The presentation will cover the implementation of the ACA at the federal and state levels and the impact of the ACA on the cancer community. Attendees will learn about new consumer protections and health insurance options, and receive concrete tools to conduct clinical assessments that address access to health insurance coverage and the subsequent impact on psychosocial needs. Results: Our surveys have found that 75% of oncology healthcare professional respondents were asked for guidance on how healthcare reform might affect their patients. However, only 7% of those surveyed felt “very comfortable” answering questions about the ACA. Therefore, there is an obvious gap between the knowledge level of healthcare professionals and what they are being asked by their patients. Oncology healthcare provider attendees will gain a better understanding of health insurance options available to their patients. Attendees will receive practical tools to answer questions and provide appropriate resources, thereby alleviating anxiety, and improving quality of life for patients. Conclusions: In order to effectively navigate patients through the cancer care continuum, oncology healthcare providers must be armed with up-to-date knowledge about health insurance options and protections, and given concrete tools for conducting clinical assessments that address a broad spectrum of psychosocial needs.
Development of second primary cancers in breast cancer survivors.
Authors: Jung Hong Kyu , Lee Jihyoun , Kim Zisun , Lee Min Hyuk , Lee Ilkyun 
Published: February 2017

257 Background: Breast cancer survivors have slightly increased risk of second primary cancers. Importance of screening for second cancers has been raised due to increased survival in those populations. Not only having genetic risk such as BRCA mutation, but also treatment-related risk presents. The most common second primary cancer is breast cancer. Colon cancer, uterine cancer, and ovarian cancer showed increased cumulative incidence. In this study, we assessed development second primary cancers in breast cancer survivors. Methods: Medical record of breast cancer patients was reviewed retrospectively in three tertiary medical institutions. Available data of ICD-9 record after breast cancer diagnosis was evaluated. Diagnosis of second primary breast cancer was excluded in evaluation. Results: Since Jan 1989 to Jan 2014, available medical records were reviewed in breast cancer patients(N = 5880) in three institutions(one urban and the other two rural institutions). Cumulative incidence of overall second primary cancers was 4.57%. Among 269 second primary cancers, thyroid cancer(44.2%) was most common second primary cancer, followed by gastric cancer(10.0%). Gastric cancers were more common in rural institution than urban area(14.2 % vs 5.5%), while incidence of thyroid cancer is elevated in urban institution(57.8% vs 31.9%). Among 9 patients who has been diagnosed endometrial cancer, 7 patients had history of selective estrogen receptor modulator(tamoxifen or toremifen) treatment. Development of lung cancer was not related to breast cancer radiation treatment(4 of 15 patients). Leukemia after breast cancer treatment was diagnosed in 5 patients (8.5% of second primary cancers), three of them were adult T cell leukemia and two of them were acute myeloid leukemia. Conclusions: Incidence of cancer in general population was reflected to development of second primary cancer in breast cancer survivors. Endocrine treatment was related increased incidence of endometrial cancer, respectively. Application of personalized cancer screening plan would be important in this patient group.
Use of telemedicine to expand access to survivorship care.
Authors: Cole-Vadjic Kelli Kristine , Crews Jennie Robertson 
Published: February 2017

26 Background: PeaceHealth St Joseph Cancer Center (PHSJCC) provides medical and radiation oncology services in northwest Washington. PeaceIsland Medical Center (PIMC) is an affiliated medical center that provides medical oncology services in the nearby San Juan islands. Survivorship appointments for Survivorship Care Plan (SCP) delivery are available at PHSJCC but have not been available at PIMC. Telemedicine services were previously established for medical oncology appointments for patients at PIMC with a provider at PHSJCC. Methods: Since January of 2015, patients who are eligible for survivorship services are identified by their medical oncologist or nurse upon completion of chemotherapy at PIMC. They are scheduled for a 1 hour survivorship telemedicine appointment with the survivorship physician assistant (PA). The patients attend the appointment at PIMC with a nurse present there to assist with logistics and deliver survivorship appointment materials. The PA is at PHSJCC and conducts the appointment through visual and audio telemedicine equipment. During the telemedicine appointment the SCP is reviewed and delivered, educational materials are provided and discussed, and referrals are initiated as needed based on a standardized patient distress screening questionnaire. Patients who complete radiation therapy at PHSJCC but live in the San Juan islands are now also being identified and scheduled for survivorship telemedicine appointments at PIMC. Results: Patients who live in a small island community where survivorship services were not available are now able to receive a survivorship appointment with SCP delivery through telemedicine. Between January and July of 2015, 6 patients were identified for survivorship appointment eligibility upon completion of chemotherapy at PIMC. 3 of these patients have completed a survivorship telemedicine appointment, 2 are currently scheduled, and 1 declined to schedule. Although qualitative surveys have not yet been conducted, the patients who completed survivorship telemedicine appointments offered generally positive feedback about the experience. Conclusions: Telemedicine is an effective way to deliver SCPs in geographic areas where patients do not otherwise have access to survivorship care.
Factors affecting survival in women with ductal carcinoma in situ (DCIS): Race and the delivery of adjuvant radiotherapy.
Authors: Arrojo Elisabeth E. , Martinez Alvaro , Fernandez Eduardo , Forman Jeffrey D. , Ghilezan Michael , Vicini Frank A. 
Published: February 2017

29 Background: Recent publications questioned the survival impact of adjuvant radiotherapy (A-RT) in the treatment of DCIS. These reports had in common a short follow up. We wanted to know, in a disease where long term follow up is required, the magnitude of improvement in survival and assess any correlation with race and income. Methods: Search in the Surveillance, Epidemiology and End Results database, of patients diagnosed with DCIS between 1988 and 2012, younger than 70 years old. Analyses of age, race, hormonal receptors (HR), tumor size, surgery, ART and household income. Survival analyses with Kaplan-Meier and multifactorial with Cox proportional-hazard regression. Results: 125,805 patients. Mean follow-up 7.9 years. Patients treated with A-RT resulted in a mortality by breast cancer (DBC) significantly lower (-1.10%; HR: 0.54 [IC95%:0.48-0.59]; p < 0.0001). Based on the type of surgery, mastectomy resulted on a DBC significantly higher than those treated with tumorectomy and A-RT (+1.15%; HR: 2.08 [IC95%:1.84-2.36]; p < 0.0001). Patients with HR+ presented a significantly lower DBC. Black race was the one with the lowest household income (43% < 53900$) opposite to the Asian which was the one with the highest (47% > 71520$). Black race, also presented a DBC significantly higher than the other ones. In the multifactorial analyses (see table), the only variables which presented a significantly influence in DBC were -ART (it decreases DBC) and race (black race increases DBC). Conclusions: These results show blacks, which are the ones with lowest household income, have a significantly increase in cancer mortality than the other races, and that A-RT cuts mortality rates quite drastically in women with DCIS. [Table: see text]
Prevalence of low bone mass and osteoporosis in patients with cancer: Program for healthy aging.
Authors: Edwards Beatrice Jara-Almonte , Sun Ming , Holmes Holly Michelle , Valladarez Heather , Nguyen Vu , Khalil Peter , Song Juhee 
Published: February 2017

30 Background: Older adults, 65 years of age and older, with cancer may be at higher risk for low bone mass or osteoporosis, however, the exact magnitude of this condition is unknown. It is postulated that the etiology of low bone mass and osteoporosis in cancer may be a combination of age-related and cancer therapy related bone loss. Methods: We conducted a retrospective cohort analysis, of older adult cancer patients evaluated at the Program for Healthy Aging at MD Anderson from January 1, 2013 through March 31, 2015. Bone mineral density (BMD) was assessed with a Hologic W densitometer, with a CV% of 1%. Information on prior fractures and falls were also collected. Results: One hundred and nine patients with Bone density tests were included in the analysis, with males (n = 57) constituting 52% of cases, the mean age was 77 years, range 65 – 93 years. Race: white (n = 79, 74.5%), African- American (n = 23, 21.2%), Asian (n = 4, 3.8%). Ethnicity: Latino (n = 8, 11.4%). Cases included hematologic cancers (n = 41, 37.6%), breast cancer (n = 19, 17.4%), prostate cancer (n = 15, 13.8%), gastrointestinal cancers (n = 10, 9.2%), and bladder and lung cancer each (n = 6, 5.5%). Low bone mass and osteoporosis was identified in 87 cases (80%). Only 26 cases reported falls in the preceding 6 months, while 11 cases had a prior fracture after the age of 50 years. Additional risk factors for falls and fractures included cognitive impairment, malnutrition, and polypharmacy. Conclusions: Low bone mass and osteoporosis are highly prevalent conditions in older patients with hematologic and solid malignancies. A greater awareness of such, should allow for effective interventions in order to prevent fractures and their negative impact on quality of life.