bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-reported outcomes (PROs), unmet need, and psychosocial adaptation among recent breast cancer (BC) survivors.
Authors: Palmer Steven C , DeMichele Angela , Schapira Marilyn M. , Glanz Karen , Blauch Abigail , Pucci Donna A. , Jacobs Linda A. 
Published: February 2017

212 Background: BC survivors have physical and psychosocial symptoms which, if unaddressed, result in unmet need. Unmet need has been examined primarily in long term survivors, and understanding the characteristics associated with unmet need is under-studied among recent patients. Methods: Eligibility included non-metastatic BC treated < 1 year prior. Participants completed a PRO symptom measure and reported unmet need for assistance for symptoms. Concerns about recurrence risk, late effects, health maintenance, family needs, and hereditary risks were assessed. Anxiety and depressive symptoms were assessed using the HADS; quality of life (QoL),using the SF-12. Results: Participants (N = 137) were primarily white (72%), middle-aged (M = 55 yrs), and treated for Stage I (47%) or II (38%) BC. Participants reported an average of 10.7 symptoms (R = 0-18), while unmet need was less common (M = 2.6, R = 0-15). Physical and mental health QoL were similar to norm values (M = 48.0; M = 53.5). 13% and 29% met “caseness” (i.e., criteria for significant elevation) for depression or anxiety on the HADS, respectively. Unmet need was trichotomized into no (0), low (1-3), and elevated (4-15) groups. Level of unmet need was not predicted by demographic variables, time from end of treatment, treatment exposure, staging, or physical QoL. Groups differed significantly with respect to level of patient concern, mental health QoL, anxiety and depression, and meeting caseness for depression on the HADS (all p < 0.03) with elevated needs being associated with worse outcomes. In multivariate analysis, overall unmet need was independently predicted by depression and level of survivorship concerns (R2 = .28, p < .001). Conclusions: In the year after treatment, patient reported symptoms are common, but unmet need is less common. QoL is similar to national norms. Higher unmet need is associated with worse psychosocial adaptation, including QoL, patient concerns, anxiety, and depression. In particular, depression and survivorship concerns independently predict unmet need. Addressing unmet needs among recent BC survivors may be one means of improving the psychological functioning of these survivors.
Patient-reported outcome driven case management system for hematology and oncology patients.
Authors: Warsame Rahma M. , Dispenzieri Angela , Croghan Katrina , Hubbard Joleen Marie , Thompson Carrie A. , Sloan Jeffrey 
Published: February 2017

229 Background: Modern clinical practice places time restrictions on the amount of information and processing that can be done in a typical office visit. Meeting patient needs within the healthcare system is often inefficient and ineffective, contributing to patient and clinician dissatisfaction and suboptimal outcomes. We developed a point-of-care case management system for oncology clinical practices adapted from an algorithm initially designed for patients with diabetes. The system’s goal is to obtain patient-reported quality of life (QOL) outcomes and provide clinicians with information regarding QOL issues to address. Methods: Literature review and focus groups of oncology patients were used to identify key patient concerns. The program was adapted for cancer patients to collect the identified patient concern including QOL, fatigue, pain and other cancer-specific issues scored on a scale of 0-10. Suggested actions and available resources were identified for the patient/clinician based on the issue selected. We performed a pilot study involving 20 cancer patients to assess feasibility, and administered a “was it worth it survey” (WIWI). Results: The resultant hematology/oncology electronic system includes a set of eight primary “buttons”: Personal Relationships, Emotional health, Physical healthy, Cancer diagnosis and treatment, Health behaviors, Money, Care planning and Something else. Every “button” was selected, most commonly Cancer diagnosis and treatment 6/20 (30%). The median (range) reported QOL, fatigue and pain were 7 (1-10), 4 (0-8), 2 (0-8), respectively. The average completion of the tool took 4 minutes. One hundred percent of patients who took the survey thought it was worth it, would participate again and recommend it to others. Conclusions: The system was quick and easy to utilize in a small pilot of patients. All of the identified categories were chosen and relevant to our patient population. This tool has the potential to improve patient well-being and clinical outcomes, reduce the burden on clinicians and distribute case management activities to the most appropriate providers. Next steps include initiating a larger prospective protocol to assess if this tool improves QOL over time.
Emerging from the haze: A psycho-educational series to combat cognitive complaints after cancer treatment.
Authors: Bailey Charlotte , Asher Arash , Jo Mi-Yeoung 
Published: February 2017

230 Background: Cognitive dysfunction after cancer treatment can be distressing and may profoundly impact quality of life, feasibility of returning to work, and social reintegration. Meaningful, evidence-based options for cancer-related cognitive changes are limited and urgently needed. A standardized rehabilitation program targeting common cognitive problems faced by cancer survivors may represent a safe, low-cost, effective treatment that can be easily disseminated. Emerging from the Haze (Haze) is a 6 week multi-disciplinary clinical program that provides a psycho-educational series to patients who are experiencing changes in cognition or having difficult adjustment after cancer diagnosis or treatment. The Haze course covers topics including: mood and stress management, mindfulness meditation, countering negative automatic thoughts, compensatory strategies for attention, memory, and executive functioning/problem solving, pacing and balance in addition to wellness issues related to cognition such as sleep hygiene, nutrition, social isolation, and exercise. The purpose of this research was to assess changes in the Functional Assessment of Cancer Therapy Cognitive Scale (FACT-Cog) scores immediately after the intervention and at regular intervals until the 1 year mark. Methods: Patients were given questionnaires including the FACT-Cog on the first day of the Haze series. The FACT-Cog includes the following domains: Perceived Cognitive Impairment (PCI), Perceived Cognitive Abilities (PCA), and Impact on Quality of Life (QOL). The survey battery was repeated on the last day of the series, 3 months, 6 months and 1 year after the series. Results: Based on the first 110 patients with various cancer types that have completed Haze, highly statistically significant improvements have been found in PCI (p < 0.001; Mean Δ = 8.71), QOL (p < 0.001; Mean Δ = 2.09), and PCA ( p < 0.001; Mean Δ= 2.83) based on a before and after comparison of the FACT-Cog. Conclusions: It appears that a multi-disciplinary psycho-educational clinical program to address cognitive changes and adjustment difficulties after treatment can have a positive effect on patients’ perceived cognitive functioning as measured by FACT-Cog.
Impact of yoga on quality of life for young adult noncurative cancer patients: A pilot study.
Authors: Keats Melanie , Woodside Hillary , Culos-Reed S. Nicole 
Published: February 2017

249 Background: A growing body of evidence is emerging to suggest that the practice of yoga can improve disease and treatment-related side effects in the non-curative cancer patient by addressing their physical, psychological, and spiritual needs. Regrettably, the literature regarding the positive benefits of yoga for the young adult (YA) non-curative cancer patient is limited. Accordingly, the purpose of this ongoing exploratory study is to examine the feasibility and safety of a 7-week home/hospice based instructive Hatha yoga intervention (Yoga Thrive - available on DVD) in non-curative, YA cancer patients. Secondary outcomes include the examination of the efficacy of yoga in mitigating cancer and treatment-related side effects through ratings of self-reported quality of life (QOL). Methods: A single-arm, non-randomized, pre and post-test, pilot investigation of a 7-week instructive home/hospice-based Hatha yoga program is currently ongoing. Pre/post program data include measures of QOL, specific to palliative disease and spiritual domains as well as open-ended measures of perceived program value. Feasibility data (e.g., recruitment, adherence, safety) are also collected. Results: To date, four YA non-curative cancer patients have participated in the 7-week yoga program. Preliminary data show a significant difference in both functional well-being (p= .047, ηp2= 0.78) and spirituality (FACIT-Sp) scores (p= 0.04, ηp2= 0.77). Although not statistically significant, a large effect in physical well-being (ηp2= 0.38); general cancer outcomes (FACT-G) (ηp2= 0.42); and palliative specific scores (ηp2= 0.62) have also emerged. Early responses to the post-program exit questions suggest that participants find the program as an opportunity for self-care, separate from traditional cancer therapies. Subjective improvements in flexibility and mindfulness (e.g., body awareness, relaxation, and calmness) have also been reported. Additionally, participants have complemented the program for its ease and flexibility of use. Conclusions: Early findings of this study provide support for the feasibility and efficacy of a home/hospice-based yoga program for YA non-curative cancer patients.
Systematic development of a a breast cancer survivorship program at a small independent oncology practice.
Authors: Rogers Cynthia , Satpute Shailesh R. 
Published: February 2017

52 Background: It is widely accepted that providing survivorship care plans leads to improvements in outcomes for cancer survivors. Treatment summaries are now part of ASCO and NCCN survivorship guidelines. We faced a unique challenge of implementing the survivorship care plan at the Jones Clinic as a small independent practice. The Jones Clinic consists of three full time physicians and two full time nurse practitioners. We see approximately 850 new patients per year. Methods: As a part of ASCO’s quality training program, we focused on the stage I – III (early stage) breast cancer patients who completed their initial therapy. We formed a team, identified the barriers, created a flow diagram of the process, assigned roles for each individual member and finally implemented the process. Results: The major issues identified were lack of provision in the electronic medical record (EMR) system for survivorship and lack of standardized data entry process. We created a system in the EMR for survivorship data entry and extraction of such data in a document. Since July 2015, one hundred percent of breast cancer patients completing adjuvant therapy at the Jones Clinic have received a survivorship treatment summary and a plan of care. The care plan is also shared with their primary care provider. Importantly, creating a survivorship document required less than 10 minutes of the provider’s time. Conclusions: We are now able to provide our patients with a survivorship care plan and address survivorship issues within thirty days of completion of therapy. Creating the care plan requires minimal time from the providers. Our new process meets ASCO guidelines for survivorship care plans and no additional staffing was needed. We now plan to provide a survivorship care plan to all oncology patients treated with curative intent.
Disease-free survival of women 70 years or older with stage I-II BC treated with BCS and RT.
Authors: Gopi Mounika , Hager Steven Jeffrey , Kimball Beth , Monson Jedidiah Mercer 
Published: February 2017

e268 Background: Breast RT is the standard of care for women undergoing BCS. Recent trends suggest omitting RT for women > 70 years of age. Our retrospective study evaluated the DFS and failure pattern of women > 70 treated with BCS and RT compared with their younger cohorts. Methods: Between 2009-2011, 101 women with Stage I-II BC were treated with BCS and RT at a physician-owned, community-based cancer center. Clinical, pathologic and treatment characteristics were extracted from patients’ medical records. Results: Of the 101 patients, 71 comprised the < 70 cohort and 30 comprised the > 70 cohort. Patients in the older cohort were more likely to have Stage I tumors (80% vs 64%), but the cohorts were otherwise balanced in terms of T-size, grade, ER/PR and Her2 status. RT was typically delivered in a first course of 50.4 Gy to the whole breast followed by a 10 Gy boost. Median DFS for the older cohort was 36 months (range, 1-66) and 41 months for the younger cohort (range, 1-74). There was only one event in the older cohort, a patient who developed DM at 40 months. In the younger cohort one patient developed LR at 54 months, and 4 developed DM at 18, 33, 51 and 54 months. Conclusions: In our community-based study, women > 70 who received BCS and RT experienced excellent DFS and local control. The three-year median DFS observed in the older women in our study suggests that a long-term view should be taken when treating older patients and that biological age rather than chronological age is a better determinant of when cancer therapies should be withheld.
Prognostic factors affecting severity of radiation-induced fibrosis.
Authors: Maklad Ahmed M , Assaf Hanan Abdel-Rady , Nada Essameldin Abdelaziz , Elyamany Ashraf , Badran Asmaa A 
Published: February 2017

e280 Background: Evaluation of prognostic factors affecting Radiation Induced Fibrosis (RIF) to help for decreasing its incidence and to improve quality of life for cancer survivors. Methods: Thirty patients were included in this study .It was carried out at faculty of medicine, Sohag University Hospital, Egypt during the period between July 2012 and July 2013 after approval of university ethical committee. We included all patients with (RIF) which is persistent or appeared after 6 months of completion of radiation therapy. Detailed medical history and clinical examination were done for all patients included in the study. We categorized the patients according to severity of RIF into four grades according RTO 2010. Assessment of pain was done according to 0–10 Numeric Pain Rating Scale. Results: Thirty patients with RIF were included in the study. The age of the studied patients ranged from 21- 65 years with a Mean 48,33 ± SD of 10,88. 56.7% of the cases were more than 50 years old. Female patients were 73.3%. BMI of the studied patients ranged from 19-40 kg/cm2 with a Mean 28.03 ± SD of 6.98. 26.7%patients were smokers.43.3% patientshadprevious history of acute radio dermatitis.60% had breast tumor. Chest was affected in 19 (60%) patients, back in 3 (10%) patients, neck in 4 (13%) patients, lower limbs in 2 (7%) patients, and face in 2 (7%) patients.T1 represented in 30%, T2 in 36.7%, T3 in 13.3% while T4 in 20% of the included patients. Twenty four (80%) patientsreceived chemotherapy before radiation. We documented a significant relation between BMI and severity of RIF (p = 0.007).Severity of RIF was significantly associated with higher BMI (p = 0.007), higher radiation doses (p = 0.02), higher number of radiotherapy treatment fraction (p = 0.03), higher radiation field sizes (p = 0.003), and patients with duration of more than one year of RIF (p < 0.001). Patients from rural areas documented higher degree of RIF (p = 0.03). Conclusions: It is important to give more attention to RIF as a one of late toxicity of radiation therapy. It can be minimized by avoiding its predisposing factors to improve quality of life of cancer survivors.
Statistical analysis on the behavior and recurrence of breast phyllodes tumors.
Authors: Ye John Shangming 
Published: February 2017

e294 Background: Statistical analysis on the behavior, diagnosis accuracy, treatment, and recurrence of breast phyllodes tumors. Methods: Thousands of phyllodes tumor cases have been analyzed by mathematical statistics in order to assess the behavior, diagnosis, classification, treatment, recurrence, and five-year survival rates. Results: The age of breast phyllodes tumor patients generally ranges from ten years old to over eighty years old, and the disease most frequently occurs between ages of forty and fifty among various ethnicities. For clinic-pathological features, over 70% of the patients' tumors may be classified as benign, about 20% borderline, and less than 10% malignant. Patients who had ages over 40, larger tumor sizes, permeative borders, atypia, high stromal hypercellularity, and especially high mitotic activity were observed to develop borderline and malignant phyllodes tumor more frequently. Recurrences were noted in about 13% for all patients, but the ratio of recurrence rate of benign : borderline : malignant tumor is approximately 1: 1.5 : 3. A five-year survival rate was observed in almost 100% of patients with benign tumors, 98% with borderline, and about 88% with malignant. Accurate diagnosis at an early stage plays a vital role for effective treatment. Conclusions: Early stage accurate diagnosis, post-excision pathology analysis on the fibroepithelial tumor tissue for confirming the clinicopathological features, and wide excision (with negative margins) may reduce the risk of tumor recurrence and improve the respective survival rates of the breast phyllodes tumor patients.
Prospective randomized phase II study of FOLFIRI versus FOLFOX7 in advanced gastric adenocarcinoma: A Chinese Western Cooperative Gastrointestinal Oncology Group study.
Authors: Bi Feng , Li Qiu , Wen Feng , Zhou Chengya , Qiu Meng , Liu Jiyan , Chen Jing , Yi Cheng , Li Zhiping , Luo Deyun , Xu Feng , Cai Xiaohong ,   Chinese Western Cooperative Gastrointestinal Oncology Group
Published: February 2017

1 Background: The purpose was to compare mFOLFIRI (arm A) with mFOLFOX7 (arm B) as first-line treatments in patients (pts) with locally advanced gastric adenocarcinoma in an open, randomized, phase II study. Methods: Previously untreated metastatic or recurrent gastric adenocarcinoma pts with measurable disease received mFOLFIRI (arm A) or mFOLFOX7 (arm B) every 2 weeks. The second-line treatment was mFOLFOX7 for arm A and mFOLFIRI for arm B. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were overall survival (OS), disease control rate (DCR) and toxicity. Results: In total, 200 pts were included. The evaluable population consisted of 128 pts (54 in arm A; 74 in arm B). The median PFS of arm A was 2.9 months (m) (1.9 to 4.1 m) versus 4.1 m (3.2 to 4.8 m) for arm B(p0.109). The median OS was 9.9 months (6.0 to 13.5 m) for arm A versus 12.0 m for arm B (10.3 to 13.7m; p= 0.431). The DCRs for arm A and arm B were 59.3% and 66.3%, respectively (p = 0.850). In subgroup analysis of the pts who completed both treatment lines per protocol, the median OS was 11.0 m (5.1 to 16.9 m) for the mFOLFIRI/mFOLFOX7 group and 20.2 m (13.4 to 26.6 m) for the mFOLFOX7/mFOLFIRI group ( p= 0.030). Both regimens were well-tolerated with acceptable and manageable toxicities. Grade ¾ adverse events were 53.2% and 55.4% in arm A and arm B, respectively. Conclusions: There was no significant difference in the PFS or DCR. However, mFOLFOX7 followed by mFOLFIRI might have a better OS. Clinical trial information: ChiCTR-TRC-08000167. [Table: see text]
On-trial radiotherapy quality assurance in NeoSCOPE: A randomised phase II trial of chemoradiotherapy in oesophageal cancer.
Authors: Evans Elin , Jones Gareth , Radhakrishna Ganesh , Hawkins Maria A , Mukherjee Somnath , Maggs Rhydian , Ray Ruby , Crosby Tom David Lewis , Gwynne Sarah 
Published: February 2017

119 Background: Failure to adhere to trial protocols for target volume delineation (TVD) within radiotherapy (RT) trials may have an adverse effect on, and potentially invalidate trial outcomes. NeoSCOPE, a UK phase II study RCT of two neo-adjuvant CRT regimens in oesophageal cancer, undertook prospective individual case-reviews (ICR) to identify and correct such variations. Methods: All participating centres had passed a pre-accrual outlining benchmark case with detailed feedback provided. Prospective ICR was undertaken for all patients. Real time review (feedback to centres within 3 working days) was performed on the first 20 patients recruited and the first case submitted from each participating centre. Subsequent cases were subject to ‘timely retrospective review’, with review within 2 weeks of the start of RT. Target volumes (including organ at risk), along with diagnostic information, were submitted in DICOM format to the RTQA centre. Each case was reviewed by an upper gastrointestinal radiation oncologist, against pre-determined acceptable and unacceptable variations, using a standardised proforma. Unacceptable variation required re-submission. The outlining reviews were complimented by prospective review of planning. Results: 83 cases were reviewed in total, 39 (47%) of which were real-time and 44 (53%) timely- retrospective. 9(11%) cases required re-submission, of which 6 were real-time reviews and 3 timely-retrospective. Delineation of the tumour (GTV) and elective nodal areas (CTVB) were the most common unacceptable variations. 29 (74%) of real time reviews were returned within 3 working days and 100% of retrospective returned by 3rdfraction. The review process did not result in any delay in starting treatment. Conclusions: Prospective review of outlining in the NeoSCOPE trial has enabled identification and correction of unacceptable variations from the protocol without introducing treatment delays. The reduction in the re-submission rate for timely-retrospective review cases suggests an educational benefit from the pre-trial RTQA and the real-time review process. Clinical trial information: NCT01843829.