bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of multidisciplinary rehabilitation on physical well-being and quality of life of breast cancer survivors.
Authors: Adriaenssens Nele , Fontaine Christel , Vanhoeij Marian , Lamote Jan , De Greve Jacques 
Published: February 2017

143 Background: Breast cancer treatment has adverse effects. The aim of this study was to examine the effects of a multidisciplinary oncologic rehabilitation program on health related quality of life (HRQoL), cancer related fatigue (CRF), muscle strength, physical fitness and anthropometrics in breast cancer survivors. Methods: This quasi-experimental study included 30 early breast cancer patients in the first year following treatment. Patients completed a 12-week exercise program for 4 hours a week combined with lifestyle guidance for 2 hours a week. The supervised training sessions consisted of aerobic exercises combined with muscular strengthening exercises. Measurements were carried out at baseline (T0), at the end of the intervention (T1) and at 12-weeks follow-up (T2). HRQoL (EORTC QLQ-C30 questionnaire) and CRF (FACIT-Fatigue questionnaire), were measured at T0, T1 and T2. Muscle strength (handgrip dynamometer) was measured at T0 and T1. Physical fitness and anthropometrics were assessed at T0 and T1 using spiro ergometrics, bioimpedance and waist- and hip circumference. Results: Significant positive changes in HRQoL were found, especially for physical functioning (p = 0.004) and dyspnea (p = 0,003) at T1, but HRQoL decreased at T2. Weight, BMI, waist - and hip circumference and fat free mass decreased significantly (respectively p = 0,030; p = 0,047; p = 0,020; p = 0,041 and p = 0,003). Body impedance increased significantly over time (p = 0,034). There was a significant improvement in CRF at T1 (p = 0.03), that was no longer significant at T2. No significant improvements were found in muscle strength at the affected side (p = 0.16) and the non-affected side (p = 0.95). Physical fitness increased significantly for VO2max at the maximal progressive cycle test (p = 0.005). Conclusions: This study reports significant improvements in HRQoL, anthropometric characteristics, CRF and physical fitness after a 12-week rehabilitation program. The declines between T1 and T2 may be explained by discontinuation of physical activity. Further research should use randomized clinical trials to examine the effectiveness of rehabilitation programs with different contents, duration and initiation.
Variation among follow-up survivorship guidelines for adolescent and young adults (AYA).
Authors: Barthel Erin Marie , Kiernan Elizabeth , Banco Darcy , Spencer Katherine , Parsons Susan K. 
Published: February 2017

147 Background: The AYA population is a growing group of survivors, exceeding more than 600,000 who are at high risk for late effects of cancer-directed therapy. While many guidelines exist for cancer survivorship care, choosing which to use for an AYA cancer survivor is challenging, yet essential, to ensure comprehensive follow-up care. Methods: Survivorship care plans, including treatment summaries and follow-up care plans, were created for three clinical vignettes (acute lymphoblastic leukemia, osteosarcoma, and Hodgkin Lymphoma). Four sets of guidelines were used including the Children’s Oncology Group Long-Term Follow-Up Guidelines (COG LTFU), National Comprehensive Cancer Network (NCCN) Guidelines for Age- Related Recommendations: AYA Oncology (NCCN-AYA), NCCN Guidelines for Treatment of Cancer by Site (NCCN-Site), and NCCN Guidelines for Supportive Care: Survivorship (NCCN-Survivor) and NCCN supplemental cancer screening guidelines. The follow-up care plans were compared across guidelines to determine the extent and nature of the similarities and differences concerning AYA survivorship care. Results: The guidelines differ widely on surveillance recommendations based on risk, test, and frequency. The COG LTFU recommends screening all individuals with a specific treatment exposure, whereas the NCCN-AYA recommends screening based on risk and the NCCN-Survivor recommends testing individuals with a positive review of systems and other health risk factors. To illustrate this, in the follow-up care plan for our Hodgkin Lymphoma case, recommended monitoring for cardiac toxicity varied from annual screening (COG LTFU) to ten year intervals (NCCN-Survivor), based on which guideline was used. Conclusions: The guidelines disagree on the link between treatment exposures and late effects, on the population to be screened, on the screening test to be used, and on the time interval of testing. This has significant implications for the long-term follow-up care an AYA survivor will receive. We highlight differences across the guidelines and offer solutions to harmonize guidelines to ensure comprehensive, quality survivorship care for this population.
Predictors of trajectories of cognitive change in women with breast cancer.
Authors: Bender Catherine M , Merriman John , Gentry Amanda , Ahrendt Gretchen M. , Brufsky Adam , Sereika Susan M. 
Published: February 2017

149 Background: Subgroups of women with breast cancer may be vulnerable to cognitive changes with systemic therapy. Given our previous findings of changes in concentration and working memory (WM), we sought to identify subgroups of women with distinct trajectories of concentration and WM and determine predictors of subgroup membership. Methods: Cognitive function was assessed before systemic therapy and semi-annually to 18 months post-therapy initiation in 181 postmenopausal women with breast cancer who received the AI, anastrozole, or chemotherapy+anastrozole and at matched time points for 110 healthy controls. Group-based trajectory modeling identified subgroups of women with distinct trajectories of concentration and WM (as measured by composites of mean z-scores for neuropsychological tests). Multinomial logistic regression identified predictors of subgroup membership. Results: A 3-group model was found for concentration: low and constant (25%; b0 = -0.84), normal but declining (65%; b0 = 0.05, b1 = -0.04), and high and constant (10%; b0 = 1.29). At baseline, the low subgroup was older (p = .009) and had lower psychomotor speed (p = .035) than the normal subgroup. Controlling for baseline concentration z-scores, membership in the low concentration subgroup was associated with greater age (p < .001), more fatigue (p < .001), and poorer self-reported cognitive function (p = .001). For WM, a 2-group model was identified: low and increasing (35%; b0 = -0.67, b1 = 0.11) and high and increasing (65%; b0 = 0.32, b1 = 0.07). At baseline, the low WM subgroup was older (p = .008), had less education (p < .001), and scored lower on the NART verbal IQ test (p < .001). Controlling for baseline WM z-scores, membership in the low WM subgroup was associated with poorer executive function (p < .001), receipt of anastrozole alone (p = .011), and worse pain (p = .002) and anxiety (p = .008). Conclusions: Subgroups of women are more vulnerable to poorer concentration and WM during adjuvant therapy for breast cancer. Advancing age, less education, and co-occurring symptoms are associated with membership in these vulnerable subgroups.
Oncologists' perception of residual cancer recurrence risk and recommended follow-up care.
Authors: Basu Arnab , Miller Kenneth David 
Published: February 2017

151 Background: Many medical oncologists avoid using the word "cure" even at 20 years post-diagnosis. Little data has been reported on oncologists' perceptions of patients’ residual risk of recurrence and their recommendations for follow-up care. Methods: E-mail requests were sent to oncologists to review four brief case scenarios and to indicate their perception of the patients’ residual risk of recurrence (Essentially Zero, 1-10%, 11-25%, 26-50%, 51-75%, 76-100%) and their recommended follow-up care. We also conducted a literature review to estimate actual recurrence risks for these stated scenarios. Results: 130 medical oncologists responded. The percentage who perceived a zero or essentially zero risk of recurrence steadily increased at the 5,10, 15, and 20+ year post-diagnosis time points in patients with Stage II triple negative breast, Stage II colon, Stage II lung, and Diffuse Large B-cell Lymphoma. Follow-up for 20+ years was recommended by 43%, 27%, 32%, and 38% of respondents respectively. Among respondents who recommended this long-term follow-up 37%, 63%, 57%, and 58% perceived no residual risk of recurrence after 20 years. There was no statistically significant relationship between recommending follow-up at > 20 years and the perception of the patient having a non-zero risk of recurrence. Even at twenty years post-diagnosis a > 10% risk of recurrence was expected by 14%, 8%, 10%, and 11% of respondents.However,a literature review indicated recurrence risks of < 5% after 10 years of disease free survival for patients with each described scenario. At 10 and 15 years, participants indicated the two most common reasons for follow up were screening for late and long-term effects followed by screening for new cancer Conclusions: The risk of cancer recurrence is typically greatest in the initial years after diagnosis and then decreases, especially after 10 years. In this study, many medical oncologists still perceived a > 10% residual risk of recurrence at 10, 15, and 20 years post-diagnosis and recommended follow-up visits.
Tart cherry juice as a treatment for chemotherapy-induced peripheral neuropathy.
Authors: Carson Cindy Alberts 
Published: February 2017

153 Background: CIPN is believed to affect up to 30% of cancer patients, particularly recipients of platinum compounds, plant alkaloids, and taxanes. Conventional treatments, such as antiepileptics, antidepressants, NSAIDs, and narcotics, usually provide only partial relief, and may have significant adverse effects. Tart cherries have a long history as a treatment for arthritides. It is believed that acanthocyanin pigments found in tart cherries modulate cytokines, decrease capillary permeability, and inhibit cyclooxygenase, which would be expected to reduce inflammation and pain. Methods: The study group consisted of 17 primary care patient volunteers with painful CIPN. This is a subset of a larger ongoing study of tart cherry juice as a treatment for PN generally. All study patients had carried a diagnosis of PN for 1-5 years, and had no symptoms of PN prior to cancer treatment. All patients described 7-10/10 pain more than 50% of the time. All study patients were allowed to remain on their prescribed doses of AEDs and antidepressants during the study. The patients agreed not to use NSAIDs, steroids, lidocaine, and narcotics during the study. There were no other restrictions. 12 patients had received platinum compounds and/or taxanes, 4 had received plant alkaloids, and 1 bortezomib. All patients drank 4 oz. of tart cherry juice BID for 14 days. The juice was a combination of 4 species imported from the Caucasus and sold commercially as “100% Cherry Juice from Concentrate.” Results: After 14 days of treatment, the patients were questioned regarding pain level. Three patients (carboplatin+taxol) reported no improvement. Seven patients (platinum, taxanes, alkaloids, and bortezomib) reported a decrease of maximum pain to 5-6/10. Five patients (alkaloids, platinum) reported a decrease of maximum pain to 3-4/10. Two patients (alkaloids) reported a decrease of maximum pain to 0-2/10. Overall, greater than 70% of the patients reported a greater than 25% reduction in maximum pain. Conclusions: While there are significant limitations to this study, a 14 day course of tart cherry juice appeared to improve CIPN in the majority of patients, with no reported adverse effects.
Late effects of pelvic radiation treatment (EAGLE study).
Authors: Taylor Sophia Emily , Muls Ann , Andreyev Jervoise , Green John , Farnell Damian , Smith Lesely , Ahmedzai SAM H. , Pickett Sara , Ferguson Catherine , Fitzsimmons Deborah , Cambell Susan , O'Shea Raymond , Nelson Annmarie , Staffurth John 
Published: February 2017

159 Background: Radiotherapy treatment for prostate cancer can cause severe long –term bowel problems, including limiting travel, work or socialising. Around half of patients suffer from late effects, appearing more than six months after radiotherapy. These symptoms often remain unmonitored in follow up care, despite the existence of effective treatment if referred to gastroenterology departments. This study focuses on the early identification and treatment of neglected late effect symptoms. Methods: Novel healthcare interventions are often difficult to embed in local clinical settings. Implementation research methodology will be used to evaluate experiences of a multi-component intervention aimed at prompting referrals to an enhanced gastroenterology service, making real time adjustments as needed, with the ultimate aim of successfully embedding the intervention into practice across the UK. The intervention, introduced in three UK centres, comprises a brief, standardised clinical assessment of relevant symptoms and rapid referral to a gastroenterological service, with staff trained to use a validated investigation and treatment algorithm. Evaluation of the intervention and its acceptability within local practices will be conducted using longitudinal mixed methods research. All prostate cancer patients attending follow up clinics, meeting the eligibility criteria will be invited to be screened (n = 300) and offered a referral to gastroenterology if appropriate. A cost effectiveness analysis of health-related quality of life and resource utilisation data will be undertaken and contrasts made between participants and a comparison group. Results: Interim results will focus on interview data from healthcare professionals and how they are working locally to embed practice, sharing learning points with other locations whilst working towards a sustainable service. Conclusions: This study evaluates the effectiveness of an enhanced assessment and treatment service spanning oncology and gastroenterology services in improving the outcome of men with prostate cancer after radiotherapy. Successful implementation will act as examples of best practice for a network of centres of excellence in this area.
Utilization of sexual health and pelvic floor physiotherapy services in Vancouver’s Prostate Cancer Supportive Care (PCSC) Program.
Authors: Higano Celestia S. , Zarowski Christine , Dayan Marcy , Pollock Phil , Elliott Stacy , Mahovlich Sarah , Sundar Monita , Goldenberg Larry 
Published: February 2017

163 Background: The Vancouver Prostate Centre established PCSC in January 2013 to provide education and clinical services to men with prostate cancer (pts) and their partners. The program includes a dedicated sexual health (SH) clinician and physiotherapist (PT) with expertise in male pelvic floor anatomy and physiology. Educational and clinical services are available to pts without charge. We examined the use of the SH and PT services in PCSC to better understand how the services are utilized. Methods: Pts who are pre-treatment or within 6 months of surgery or radiation are offered a group educational (ED) session regarding sexual rehabilitation with the option of visits to the SH clinic. Those who were > 6 months from surgery or radiation were offered evaluation in the SH clinic. Pts who are about to undergo surgery or who have postoperative incontinence are offered attendance at a group ED session and/or 3 visits with the PT clinician. We gathered data from PCSC logs, clinic schedules, and patient records to assess utilization of SH and PT services. Results: SH and PT ED sessions and clinics (CLIN) were initiated in July and October 2013 respectively. Of 802 pts oriented to PCSC, 400 pts, median age 64 (42-92), participated in the SH module and 229, median age 66 (range 42-88) in the PT module. 90% of patients in each module had been treated with surgery; 10% were on ADT. Details of utilization of the ED and CLIN components by pts for both modules are shown in the table below. There was a total of 781 SH clinic visits: 141 pts had one visit, the remainder had a median of 3 visits (range 2-8). For PT, there were 334 visits, with a median of 2 (range 1-4) per pt. 37% of pts who were seen by SH were also seen by PT and 65% of those seen in PT were seen in SH. Conclusions: Sexual dysfunction and urinary incontinence can be significant problems, and often occur together. The PCSC Program offers both educational and clinical services to address these issues, and continues to modify its programs to best serve patient and partner needs at various time points after therapy. [Table: see text]
Associations between peripheral neuropathy and nausea/vomiting in survivors of ovarian cancer: Evidence of persistent vagal neuropathies?
Authors: Donovan Heidi AS , Horn Charles , Campbell Grace , Hagan Teresa , Bovbjerg Dana H. 
Published: February 2017

165 Background: Persistent numbness and tingling in extremities are reported by many ovarian cancer survivors and are widely recognized symptoms of chemotherapy-induced peripheral neuropathy. Minimal research has addressed the possibility that chemotherapy may also result in vagal neuropathy, with associated adverse effects on somatosensory input to the brain. We hypothesize that ovarian cancer survivors with persistent numbness and tingling, hallmark symptoms of peripheral neuropathy, will report higher levels of nausea and vomiting, consistent with vagal neuropathy. Methods: A secondary analysis was conducted with data from 713 respondents to a survey of randomly selected members of the National Ovarian Cancer Coalition with a history of ovarian cancer. A validated questionnaire was used to assess symptom severity (0-10) at it worst over the past week for 22 commonly reported symptoms. For the present study, analyses were limited to women reporting no evidence of disease following chemotherapy (n = 362) at a mean of 50.3 months post-treatment. The mean age of the sample was 53.1y; 71.7% were married; 54.5% were college graduates. The symptom experiences of women with persistent numbness and tingling , N/T, (n = 206) were statistically compared to those without numbness and tingling (n = 156) with age and time since treatment included as covariates. Results: Ovarian cancer survivors with N/T had significantly higher levels of nausea (p < 0.001) and vomiting (p < 0.001), as well as several other symptoms consistent with vagal neuropathy, compared to women without N/T. Sensitivity analysis indicated that among women with the highest N/T severity (7-10), nausea severity was nearly three times higher than among women with the lowest levels of N/T severity (1-3), p < 0.002. Conclusions: Consistent with the study hypothesis, ovarian cancer survivors with persistent numbness and tingling also reported higher levels of nausea and vomiting. These results suggest the importance of new research efforts to examine vagal neuropathy in ovarian cancer survivors.
A randomized trial of a clinic-based weight loss intervention in cancer survivors.
Authors: Yung Rachel Lynn , Giobbie-Hurder Anita , Shockro Laura , O'Connor Keelin , Campbell Nancy , Kasper Jocelyn , Overmoyer Beth , Mayer Erica L. , Tolaney Sara M. , Partridge Ann H. , Ligibel Jennifer A. 
Published: February 2017

167 Background: Evidence increasingly links obesity to increased risk of cancer recurrence and mortality in breast and other cancers, but few studies have evaluated weight loss interventions in cancer patients. We evaluated the impact of a group-based weight loss intervention implemented through an oncology clinic on weight and other outcomes in a mixed population of cancer survivors. Methods: Overweight and obese cancer survivors were randomized 1:1 to immediate or delayed participation in a 15-week group-based weight loss program focused on calorie restriction and increased physical activity. Weight, body composition, physical activity, fitness and quality of life were assessed at baseline and 15 weeks. Changes in measurements between baseline and 15 weeks were compared using Wilcoxon rank sum tests. The primary outcome was change in weight between baseline and 15 weeks between groups. Results: 60 participants were randomized; 30 to intervention and 30 to control. Median age was 52, average BMI was 31.8 kg/m2, 97% of participants were women, and 80% had breast cancer. Intervention participants lost 5.3% of baseline weight at 15 weeks vs 0.2% weight gain in controls (P < 0.001) (Table). Improvements in fitness (6-minute walk test) and physical functioning (EORTC QLQ C30) were also observed in the intervention group vs. controls. Conclusions: We found thatparticipation in a 15-week group-based intervention resulted in weight loss and improvements in fitness and physical functioning in overweight and obese cancer survivors. More work is needed to evaluate the feasibility and sustainability of weight loss programs implemented through oncology practices. Clinical trial information: NCT01978899. [Table: see text]
Implementation of an integrative wellness program for pediatric cancer survivors at risk for cardiac late-effects.
Authors: DiSipio Theresa C , Zappalla Frances , Quillen Joanne 
Published: February 2017

168 Background: Many adult childhood cancer survivors are at risk of developing adverse health outcomes as a result of their previous diagnosis and treatments. Cardiac events are the most common cause of non-malignant mortality among pediatric cancer survivors; one in eight will develop severe cardiac disease (Lipshultz et al, 2012). The use of integrative therapies in the survivorship setting has the potential to reduce risk of developing late effects and assist with positive coping mechanisms (Kelly, 2009). Early exposure to anti-inflammatory nutrition, yoga and relaxation techniques in combination with thorough cardiac monitoring has the potential to reduce feelings of anxiety and fear of recurrence while catalyzing positive lifestyle modifications and improving overall wellness. Methods: In partnership with the Department of Cardiology at AIDHC, childhood cancer survivors at moderate-to-high risk were identified and referred for integrative cardiology consults (ICC) with a goal of providing an introduction to integrative medicine approaches, and a long-term emphasis on decreasing the incidence of future adverse cardiac events. Patients were approached during their routine post-therapy follow-up appointments. Cardiology consult orders were placed by the oncology provider through the electronic medical record (EPIC) via smart phrasing. Results: A total of 15 patients and families were approached. All 15 complied to ICC in conjunction with their routine ECHO/EKG testing. 47% of the referred patients were exposed to both anthracycline chemotherapy and radiation. 17% presented with significant cardiac related family medical history and 40% had existing comorbidities or lifestyles that may affect future cardiac health. Conclusions: Implementing an ICC standard for childhood cancer survivors at moderate-to-high risk for cardiac late-effects has been successful for AIDHC’s Cancer Survivorship Clinic and shows promise as a preventative intervention. Efficacy will be assessed by measuring patient and family knowledge pre and post ICC in the future.