bluuebunny/crossref_metadata_2025_split huggingface dataset:
PTSD and lymphoma: Two very different psychological trajectories following a common diagnosis.
Authors: Jacob Regina , Robbins Laura , Leonard John , Peterson Janey C 
Published: March 2017

195 Background: Long-term chronic lymphoma survivors report lower quality of life compared to those who are cured of lymphoma, despite an equal prevalence of PTSD symptoms in both groups. Posttraumatic Growth (PTG), or positive psychological change following a traumatic event, has been associated with greater acceptance of the disease and greater quality of life, particularly because PTG has been shown to diminish the negative effects of PTSD symptoms. Methods: Semi-structured, in-person qualitative interviews were conducted among a convenience sample of lymphoma survivors. Participants answered questions about their emotional reactions after diagnosis, during treatment, and symptoms of PTSD and positive changes—if any—that developed during the cancer experience. Interviews were audiotaped, transcribed, and analyzed using Grounded Theory methodology. Results: 77 lymphoma survivors - 75% chronic lymphoma, 25% curable lymphoma completed interviews. Themes included 1) disease: perception of health; 2) support system: physician support, social support, and healthcare system support; 3) internal processing: acquiring knowledge, and coping mechanisms; 4) fear: stigma of cancer; 5) growth: relationship with others, and appreciation of life; and 5) acceptance: preparation, and death & dying. Most participants, regardless of chronic or curable diagnoses, reported distress during diagnosis and treatment within the categories: perception of health, healthcare system support, social support, and acquiring knowledge. Chronic lymphoma participants reported less fear and subsequently less growth than their curable counterparts. Participants further viewed their cancer as carrying a different stigma, which then resulted in these blunted reactions. Conclusions: Chronic lymphoma patients do not follow the same psychological trajectory as their curable counterparts with regards to long-term adjustment. They, instead, emulate patients with other chronic disease. The blunted psychological experience of both PTSD symptoms and PTG could potentially explain the lower reports of quality of life in the long term cancer survivor with indolent disease.
Will Chinese oncologists refer cancer survivors to psychological support for survivorship care? A cross-sectional survey.
Authors: Sun Lingyun , Yang Yufei , Wang Xia , Chen Dongmei , Mao Jun J. 
Published: March 2017

196 Background: Cancer survivors often experience substantial psychological distress, such as anxiety and depression, due to cancer diagnosis and treatment. As psychological support is still not a standard part of survivorship care in China, little is known about Chinese oncologists’ attitudes towards referring cancer survivors to this service. Methods: We conducted a cross-sectional survey among oncologists who were attending the 18th annual meeting of Chinese Society of Clinical Oncology (CSCO, September 16th - 20th 2015) in Xiamen, China. Participants voluntarily completed a questionnaire measuring their demographics and occupational information. The outcome variable was willingness to refer cancer survivors to psychological support. We used a multivariate logistic regression model to evaluate the factors associated with such willingness. Results: Among 351 responders, 53% were male, with a mean age of 38±9 years. Half of the oncologists were senior attendings, 34% were junior attendings, and 17% were residents. More than half of the physicians (58%) had an additional Masters or PhD degree. The majority of oncologists (263, 79%) were willing to refer their patients to psychological support as part of survivorship care. Physicians over 40 years old were more likely to recommend psychological support than their younger colleagues (85% versus 76%, p = 0.048). In multi-variable logistic regression model, controlled by gender and education level, physicians > 40 years were associated with more willingness to refer their patients to psychological support than physicians ≤ 40 years (odds ratio [OR] 2.9, 95% confidential interval [C.I.]1.4-6.1, p= 0.01); compared to residents, junior attendings were more likely to recommend psychological support (OR 2.8, 95% C.I. 1.1-7.1, p= 0.03). Conclusions: The majority of Chinese oncologists were willing to refer cancer survivors for psychological support; age and position appeared to impact such willingness. By further educating young Chinese oncologists about the importance of psychological care during survivorship, we can help develop a health care delivery system that better meets Chinese cancer survivors’ psychosocial needs.
Institutional racism, segregation, and breast cancer outcomes.
Authors: Beyer Kirsten M. M. , Bemanian Amin , McGinley Emily L , Nattinger Ann B 
Published: March 2017

199 Background: Racial breast cancer mortality disparities are significant vary in magnitude across the US, indicating that place-specific factors may influence mortality. Racism and segregation are widely considered to contribute to health disparities, and may influence breast cancer outcomes. Several pathways linking racism, segregation and health care outcomes have been proposed, including (1) stressors in the local environment, (2) social resources and opportunities, and (3) knowledge and information. Given these hypothesized pathways, it is possible that racism and segregation may also influence elements of the breast cancer diagnosis, such as stage at diagnosis and tumor characteristics. Methods: We examined the influence of measures of institutional racism (racial bias in mortgage lending) and segregation (the Location Quotient) on 4-year mortality after breast cancer diagnosis, stage at diagnosis, and hormone receptor status among a cohort of women diagnosed with breast cancer between 2007 and 2009, included in the SEER-Medicare linked database. Analyses focused on three metropolitan areas: Detroit (MI), Atlanta (GA), and Seattle (WA). Logistic regression analyses were used to predict the odds of each outcome, while controlling for a number of covariates: age, race and ethnicity, ER-/PR- status, diagnosis stage, enrollment in Medicaid, metropolitan area, marital status, diagnosis year, tumor size, histological type, and tumor grade. Results: Results indicate that institutional racism is associated with an increased odds of being diagnosed with an ER-/PR- tumor. No associations were detected for 4-year mortality or diagnosis stage, nor for the Location Quotient and any outcome. Conclusions: Researchers are currently exploring whether social conditions may influence tumor characteristics through pathways such as inflammation and comorbidities. Our results contribute to this growing body of work. Our results can also be interpreted in light of recent studies that identified an association between a different measure of segregation and ER-/PR- tumor type, and no association between census tract level SES and tumor type. Additional study of institutional racism, segregation and breast cancer outcomes is warranted.
Five-year overall survival among patients with metastatic renal cell carcinoma: Results of Russian population-based study RENSUR5.
Authors: Tsimafeyeu Ilya , Zolotareva Tatiana , Varlamov Sergey , Zukov Ruslan , Vladimirova Liubov Yu , Petkau Vladislav , Mazhbich Mikhail , Statsenko Galina , Safina Sufia , Zaitsev Igor , Sakaeva Dina , Popov Alexander , Borisov Pavel 
Published: March 2017

20 Background: The results of the 5-year overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) has been reported rarely. The aim of the RENSUR5 registry study was to obtain real-world data on the use of therapies in mRCC and assess 5-year OS in Russian population. Methods: Patients were retrospectively identified at 11 cancer centers in different regions of Russia (Astrakhan, Barnaul, Ekaterinburg, Kazan, Krasnoyarsk, Obninsk, Omsk, Rostov-on-Don, Samara, St.Petersburg, Ufa). Patients were included if mRCC was diagnosed from January 2010 to January 2011. Anonymised data were collected through an online registry covering demographics, treatments and outcomes. Results: 439 adult mRCC patients were included in the study for analysis. Mean age at diagnosis of mRCC was 60.9 (33-90) years (with 9% of patients aged 375 years). Patients were predominantly male (70.2%), 67.7% had nephrectomy; clear-cell and non-clear cell tumors were detected in 61.1% and 7.7% of patients, respectively. 271 (62%) patients received systemic therapy. Median duration of therapy was 11 months (95% CI 9.5-12.5). The majority of treatment was with interferon only (n=145). 105 (23.9%) patients were treated with targeted therapy. 69 (15.7%) patients received 3 2 treatment lines. Survival outcomes are listed in Table. Conclusions: RENSUR5 is a large 'real-world' database assessing mRCC treatment patterns and 5-year OS in Russia. Based on results of this study, we assume that 5-year OS is poor and should be improved on novel therapies. [Table: see text]
Social network, social support and unplanned hospital admission in older patients with cancer.
Authors: Edwards Beatrice Jara-Almonte , Sun Ming , Fu Shuangshuang , Zhang Xiaotao , Markham Christine 
Published: March 2017

201 Background: Cancer incidence is rising as the number of older adults increases. Lack of social support has been found to predict mortality among cancer patients. Emotional support has been reported to be the most desirable type of social support. Methods: The data was collected prospectively, and analysis conducted in a retrospective manner, in a cohort of older adults seen at the Program for Healthy Aging at the MD Anderson Cancer Center between Jan 2013 and December 2015. Demographics, cancer diagnosis, and other geriatric conditions were diagnosed and collected during comprehensive geriatric assessments. Social supports were measured through self-report RAND’s Medical Outcomes study (MOS) questionnaires. Overall social support and sub domains (emotional, informational, tangible, affectionate, and positive interaction) were scored. Outcomes including unplanned hospital admission were collected through reviewing of medical records. Pearson chi-square or the Fisher exact tests were used to compare groups on admission. Logistic regressions were used to investigate the relative contribution of social network and social supports for unplanned hospital admission. Results: Among 132 patients who were included in the analysis, 49(37%) patients had unplanned hospital admissions, and the overall social support score was 86%. Cancer type -hematologic versus solid tumors- demonstrated a stronger association with hospitalizations than social support. The subdomains of tangible support, positive interaction, and affection support were different between two groups. Tangible support had an odd ratio of 10.6 (p = 0.026) in unplanned hospital admission, after adjusting for cancer type, cancer stage, and cognitive status. In our study population, patients who receive more social support were more likely to be hospitalized. Conclusions: Among older cancer patients, those who receive more social support are more likely to be hospitalized. Further studies that correlate with health outcomes may be meaningful to develop strategies or interventions to improve clinical practices, to enhance quality of life and meaningful survival in elderly cancer patients.
Patient perspectives and treatment regret after de-escalated chemoradiotherapy for HPV-positive head and neck cancer: Findings from a phase II trial.
Authors: Shaverdian Narek , Hegde John , Felix Carol , Hsu Sophia , Garst Jordan , Basehart Vincent , Steinberg Michael L. , Chen Allen M. 
Published: March 2017

212 Background: We present the first data evaluating overall treatment priorities, priorities specific to de-escalated therapy, treatment regret, and original expectations versus actual experiences among patients treated with de-escalated chemoradiation for human papillomavirus (HPV)-positive head and neck cancer (HNSCC). Methods: Participants were treated on a prospective phase II trial of induction chemotherapy followed by attenuated chemoradiotherapy for HPV-positive HNSCC. Eligible patients presented with stage III or IV squamous cell carcinoma of the oropharynx, p16-positivity, age ≥ 18 years, and Zubrod score 0-1. A total tumor dose of 60 Gy or 54 Gy was delivered depending on the response to induction chemotherapy. Participants were surveyed with validated measures evaluating their treatment experience. Results: Twenty-four out of 26 (92%) study patients participated with a median post-treatment follow-up of 20 months. 96% (n = 23) of participants selected ‘being cured’ or ‘living as long as possible’ to be their top priority. The highest-ranked priority with respect to treatment de-escalation was ‘to be able to swallow all foods and drinks’. No patient professed to any regret about the decision to enroll and be treated on a de-escalation protocol. 67% (n = 16) of participants reported long-term swallowing function to be either better than or as originally expected. 71% (n = 17) found long-term salivary function to be worse than expected. Overall, 63% (n = 15) of respondents found the severity of short-term side effects to be greater than expected, however, 63% (n = 15) of respondents found overall long-term toxicities to be less than originally expected. Conclusions: Among HPV-positive patients with HNSCC who had completed de-escalated therapy on a phase II protocol, cancer cure was the top overall priority, and preserving swallowing function was the highest priority for de-escalated therapy. No patient endorsed treatment regret, and the majority of patients found long-term swallowing outcomes to be better than or as originally expected. These data support ongoing studies aiming to establish the role of de-escalated therapies for HPV-positive HNSCC.
Association of spiritual well-being pre- and post-radiotherapy for prostate cancer with health-related quality of life and psychological state.
Authors: Walker Sara J , Chen Yiyi , Leatherwood Amy Eiko , Paik Kyungjeen , Mirly Brandy , Thomas Charles R. , Hung Arthur 
Published: March 2017

214 Background: Cancer survivors often experience psychological stress, with impact on quality of life (QOL) and mortality. Religious/spiritual identity and well-being (WB) can also significantly relate to QOL among individuals with cancer. The specific aim of the current study investigates correlates of spiritual (WB), QOL, and psychological state before and after radiotherapy for prostate cancer (PC). We hypothesized that 1) positive correlations between pre-treatment spiritual WB and health-related QOL will be seen both time points and that 2) negative correlations between spiritual WB and depression and anxiety will be seen at both points. Methods: The PHQ-9 and GAD-7 assessed depression and anxiety, respectively. The FACT-P assessed physical, social, emotional, and functional WB. The FACIT-Sp-Ex assessed spiritual WB. Our sample ( N= 65) had mean age of 68 (range 52-81) and education of 16 years (range 10-20). Most participants (82%) identified as European-American. Associations were assessed by Pearson’s correlation coefficients. Results: Pre-treatment spiritual WB positively correlated with social, emotional, and functional well-being (all p < .001). Spiritual and physical WB were not significantly related. Spiritual WB negatively correlated with depression and anxiety (both p < .001). Among a smaller subsample ( N = 39) with pre-, mid-, and post-treatment assessment, spiritual WB significantly increased over time, p < .001. Post-treatment spiritual WB again correlated with social, emotional, and functional WB (all p < .001) and did not correlate with physical WB. Spiritual WB was again negatively correlated with anxiety ( p < 0.05), but it was no longer associated with depression. Conclusions: Assessing and addressing spiritual WB can be helpful in itself, as well as in better understanding QOL and psychological state. Future directions include more fine-grained assessment of pre- and post-treatment spiritual WB in order to better understand which aspects of religious/spiritual identity relate more or less closely to post-treatment QOL for different stages of PC.
Uncertainty about the future for patients with advanced cancer and their informal caregivers: A qualitative view.
Authors: Shilling Valerie M , Starkings Rachel , Jenkins Valerie A. , Fallowfield Lesley 
Published: March 2017

218 Background: In the PROACT study, we developed two scales measuring wide-ranging life impacts of cancer and treatment for patients (pts) and caregivers (cgs). Qualitative work in the development phase produced rich data on the concerns of both groups. Here we explore one specific topic, uncertainty, and contrast pts' and cgs' experience. Methods: In-depth qualitative interviews with pts with advanced cancer and their informal cgs about the impact of extended cancer survival on broader aspects of life and well-being. Interviews were transcribed verbatim. A thematic framework was developed from an initial process of open coding and tested iteratively as new data were collected. Results: We interviewed 24 pt-cg dyads with advanced ovarian (9) melanoma (9) or lung cancer (6). Pts were aged 39-84 (median 62 years), cgs 19-85 (median 54 years). Cgs were pts’ partners/spouses (15), children (5), siblings (2), and friends (2). 20 major themes and 33 sub-themes were identified. One concerned the uncertainty when planning for the future and encompassed issues such as providing for one’s family, employment and finances. For both groups uncertainties were related to the timescale and trajectory of the disease and lack of control or ability to make plans, resulting in a life lived day-by-day. Some felt it would be easier to have a definite timeframe (about death) and struggled with accepting that no one could predict what was going to happen and when. There were marked age effects. Differences existed between the groups: pts were concerned with their family’s emotional and financial wellbeing while cgs expressed a lack of control over their own futures and a sense of life "being on hold." These thoughts were often accompanied by guilt. Accounts from within the same dyad often differed and pts and cgs rarely discussed concerns with each other. Conclusions: Both pts and their informal cgs are challenged about coping with death but equally about coping with life and the lack of a defined trajectory. This impacted many areas including employment and general planning for the future. Dyads seldom discussed these concerns so might benefit from professional help aimed at facilitating open discussion together.
A preliminary evaluation of the TrueNTH androgen deprivation therapy educational program.
Authors: Wibowo Erik , Wassersug Richard J , Robinson John W , Matthew Andrew , McLeod Deborah L , Wilyman Shawn , Walker Lauren M 
Published: March 2017

219 Background: Androgen deprivation therapy (ADT) is the most common systemic treatment for prostate cancer (PCa), but has many adverse effects that reduce patients’ quality of life and that of their partners. In 5 Canadian cities, we offer an educational program designed to help PCa patients and their partners manage ADT side effects as well as maintain a strong dyadic relationship despite changes that accompany ADT. Methods: Patients on or about to start ADT and their partners participate in a 1.5 hour educational session. Patients receive a copy of the 2014 book, Androgen Deprivation Therapy: An essential guide for men with prostate cancer and their partners (DEMOS Health, NY) which discusses how to manage ADT side effects and how to make effective lifestyle changes to maintain a good quality of life. To date, 358 patients and 220 partners have attended the ADT class. A subset (32%) of participants elected to complete questionnaires at baseline and again 2 to 3 months later to assess the program efficacy. Results: At the time of the ADT class, patients who have been on ADT for ≥ 2 months had more frequent side effects (e.g., hot flashes and breast tenderness), and were more bothered by hot flashes. They also reported worse self-efficacy for managing weight gain and diabetes than those who have been on ADT for < 2 months. However, at 2 to 3 months after the class, patients’ self-efficacy for managing ADT side effects improved, despite experiencing more side effects and more bother associated with those side effects. Notably, patients who were on ADT for a shorter duration (< 2 months), who have attended the class, had less bother associated with hot flashes and better self-efficacy for managing weight gain than those who had been on ADT longer before attending the class. Conclusions: The TrueNTH ADT Educational Program potentially dampens side effect bother and improves self-efficacy for two of the most troublesome adverse effects of ADT, hot flashes and weight gain respectively. The program is most beneficial when offered to patients just starting on ADT. Future analyses will focus on exercise behaviour and dyadic relationship to assess the program’s effectiveness in encouraging a healthy lifestyle and maintain strong dyadic bonds in the face of ADT.
Clinical trial enrollment and follow-up visit rates among survivors of childhood cancer.
Authors: Hutchins Kelley Kennedy , Savasan Sureyya , Thomas Ronald , Strathdee Laura , Taub Jeffrey Warren 
Published: March 2017

22 Background: Childhood cancer treatment outcomes have improved substantially with five-year overall survival rates reaching greater than 80%. However, survivors are at increased risk of long-term complications, and long-term follow-up (LTFU) is critical. Distance from a cancer treatment center and increased time from completion of therapy have been associated with decreased LTFU rates. We studied whether lack of enrollment in a therapeutic clinical trial may be an additional barrier to receiving LTFU care. Methods: We conducted a retrospective review of 353 patient records at the Children’s Hospital of Michigan enrolled in our Children’s Oncology Group (COG) registry between 1/1/05-12/31/10. All patients were ≤ 25 years of age at diagnosis.Sixty-seven patients were excluded (died prior to follow-up, n = 61; still on therapy, n = 5; insufficient information, n = 1). A total of 286 patient charts were available for analysis after exclusion. One hundred sixty-two (57%) patients were enrolled in a therapeutic clinical trial, and 124 (43%) were enrolled in a biology study alone due to lack of an open therapeutic clinical trial at the time of diagnosis. One hundred eighty-six (65%) patients were < 10 years of age at diagnosis. Results: Follow-up rates at one-, two- and five-years following completion of therapy for patients enrolled in a therapeutic clinical trial were 94.5%, 91.9% and 74%, respectively, compared to 82.9% (p = 0.002), 74% (p < 0.001) and 66% (p = 0.029) for patients not enrolled. The follow-up rate at five-years for patients who were < 10 years of age was 77.5% compared to 70.7% (p = 0.007) for patients > 10 years. There was no significant difference at one- or two-years based on age at diagnosis. Conclusions: Our findings demonstrate that patients enrolled in a therapeutic clinical trial have significantly superior LTFU rates compared to patients enrolled in biology studies alone. Younger age at diagnosis demonstrated a superior rate at five-years of follow-up. Our findings suggest that additional resources/strategies must be utilized to ensure better LTFU for patients not enrolled in therapeutic clinical trials.