bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing of the survivorship visit and symptom prevalence in breast cancer survivors.
Authors: Moore Halle C. F. , Mustafa Ali Moaath Khader , Moeller Machelle , Rybicki Lisa A. 
Published: February 2017

125 Background: Since 2009, breast cancer patients at the Cleveland Clinic have been offered Survivorship Visits during which treatment summaries and follow-up care plans are provided following a detailed assessment of patient reported concerns. Timing of the initial Survivorship Visit varied from within 6 months of to more than 5 years from completing initial therapy. It is hypothesized that survivorship needs will differ between early, middle and late survivorship periods. Methods: Through an IRB approved data base, we evaluated symptom prevalence among women treated for stage 0 to III breast cancer according to treatment received and by time interval between completion of initial treatment and the first formal Survivorship Visit. Time intervals were divided into early (within 6 months), middle (more than 6 months but less than 5 years) or late (5 years or more) survivorship periods with respect to completion date of local therapy and any chemotherapy. Symptom prevalence was compared among the three time intervals using the Chi-square test. Results: Between April 2009 and August 2015, 1257 patients received formal initial Survivorship Visits with completion of a survivorship questionnaire. Detailed results of patient reported rates of fatigue, pain, numbness, concentration difficulty, anxiety, depression, hot flashes, insomnia and sexual problems will be described during the three different survivorship periods (early, middle , and late). Conclusions: Understanding of patient reported concerns at various time points during cancer survivorship should allow for better tailoring of survivorship needs and services.
Physical and mental functioning in colorectal cancer (CRC) survivors by work status.
Authors: Denlinger Crystal Shereen , Hegarty Sarah , Shapiro Pamela Joyce , Fang Carolyn Y , Barsevick Andrea Marie 
Published: February 2017

126 Background: Comorbidities and treatment-related symptoms (sx) affect overall function and may impact return to work. We evaluated SF-12 physical and mental functioning in CRC working (W) and non-working (NW) survivors. Methods: 300 Stage I-III CRC survivors age 25-70 years identified by PA Cancer Registry who completed curative therapy 3-5 years prior to study and were employed at diagnosis were surveyed with validated measures via mail-survey procedures. Current work status (working/not working), demographics, and medical factors (diagnosis, treatment, comorbidities) were assessed, as was fatigue, insomnia, distress, cognitive sx, neuropathy, bowel sx, and urinary sx. Study approved by PA Department of Health; participants (pts) provided informed consent. Results: Pts average age 57 yrs (80% < 65 yrs), 56% male, 87% white, 67% educated beyond high school, 73% married. 56% had rectal cancer, 51% had chemotherapy, 39% had radiation therapy, 16% had an ostomy. Work status at survey: 226 pts (75%) W; 74 pts (25%) NW. Higher comorbidity number was associated with lower physical (PCS) component scores in both W and NW groups (p = 0.004 and 0.013), and with lower mental (MCS) component scores in the NW group (p = 0.004). Among W pts, predictors of lower PCS were fatigue (p = 0.001), bowel problems (p < 0.001), neuropathy (p = 0.009), and being male (p = 0.03). Predictors of lower MCS were fatigue (p = 0.003), cognitive issues (p < 0.001), and distress (p < 0.001). Among NW pts, predictors of lower PCS were fatigue (p = 0.02), neuropathy (p = 0.007), ostomy presence (p = 0.015), and being unmarried (p = 0.007). Predictors of lower MCS were distress (p < 0.001) and younger age (p = 0.007). Conclusions: Both W and NW CRC survivors have significant comorbidity and sx burden associated with poorer physical and mental functioning. Fatigue, neuropathy, and distress were predictors in both groups, while cognitive and bowel sx predicted poorer function among W survivors. Intervening on these modifiable sx may increase survivors’ return to work and improve functioning for those who do. Next steps will focus on intensive management of modifiable sx to determine the effect on physical and mental functioning and potential for returning to work after treatment.
Cardiovascular disease (CVD) risk factors and health behaviors following cisplatin-based chemotherapy (CHEM): A multi-institutional study of testicular cancer survivors (TCS).
Authors: Abu Zaid Mohammad Issam , Fung Chunkit , Williams AnnaLynn , Sesso Howard D. , Kerns Sarah L , Feldman Darren R. , Hamilton Robert James , Vaughn David J. , Beard Clair , Liu Hai , Fossa Sophie D. , Einhorn Lawrence H. , Travis Lois B. ,   The Platinum Study Group
Published: February 2017

129 Background: TCS are at increased risk of CVD, but few clinical studies have comprehensively evaluated CVD risk factors through physical exams, lipid panels, and health behaviors in North American patients. Methods: Eligible TCS were < 50 y at diagnosis and treated with only first line CHEM. TCS underwent physical exams, had fasting lipid panels, and completed questionnaires regarding co-morbidities and health behaviors. Age, race, and educational status-matched controls (1:1) were chosen from the general population using the 2011-2012 National Health and Nutrition Examination Survey. Odds ratios (OR) of outcomes among TCS versus matched controls were estimated using logistic regression models. Results: We evaluated 680 consecutively enrolled TCS. Median age at diagnosis was 31 y (range, 15-49) and at clinical evaluation 38 y (range, 19-68). Median time since CHEM was 4.3 y (range, 1-30). Compared to normative controls, TCS were more likely to be overweight (OR = 1.65; 95% CI 1.26-2.16), have total cholesterol ≥ 240 mg/dL (OR = 2.19; 95% CI 1.12-4.28) and LDL ≥ 160 mg/dL (OR = 3.05; 95% CI 1.03-9.00), and report alcohol use > 2 days/week (OR = 2.13; 95% CI 1.64-2.77). In contrast, they were more likely to have a waist circumference < 40 inches (OR = 1.32; 95% CI 1.04-1.66); engage in vigorous (OR = 2.64; 95% CI 2.11-3.29) or moderate (OR = 1.62; 95% CI 1.30-2.03) physical activity, and not smoke (OR = 2.95; 95% CI 2.14-4.08). TCS were about 3 times more likely overall to report excellent, very good, or good health compared to controls (P < 0.05). No significant differences were found comparing HDL, triglycerides, or self-reported hypertension (P > 0.05). Conclusions: Although North American TCS appear more likely to exercise and abstain from smoking compared to normative controls, a greater proportion are overweight and have higher fasting total cholesterol and LDL levels. Health care providers should screen TCS for CVD risk factors, and encourage practices consistent with a healthy lifestyle. Future research should elucidate mechanisms of increased CVD risk and ultimately develop customized prevention and intervention strategies.
Bioimpedance spectroscopy for lymphedema assessment: Clinical practice guidelines.
Authors: Shah Chirag , Vicini Frank A. , Arthur Douglas W. 
Published: February 2017

146 Background: Breast cancer related lymphedema (BCRL) is an increasingly diagnosed complication of breast cancer treatment with incidence rates of 5% with lumpectomy alone to more than 40% with mastectomy, axillary dissection, and radiation therapy. Increasing data supports the role of early detection and treatment with one diagnostic modality being bioimpedance spectroscopy (BIS) with L-Dex measurements. Methods: A systematic review of the National Library of Medicine’s PubMed search was performed for articles applicable to BIS and BCRL. Clinical guidelines were created by the authors based on published data and consensus agreement. Results: At this time, multiple randomized and prospective trials have been performed evaluating early detection for BCRL and have demonstrated reduced rates of BCRL with such an approach. BIS with L-Dex represents a technique with published literature supporting increased sensitivity, ability to detect subclinical BCRL and standardized clinical decision points, an improvement from traditional BCRL diagnostics. BCRL surveillance programs should focus on high-risk patients including those undergoing mastectomy, axillary lymph node dissection, sentinel node biopsy with greater than 6 nodes sampled, regional nodal irradiation, and those requiring taxane based chemotherapy. Patients should undergo assessment prior to locoregional therapy and then every 3 months for the first 3 years with additional measurements made based on clinical assessment. A change in L-Dex of 10 has been utilized has a consistent trigger to initiate BCRL treatment. Conclusions: With increasing data supporting early diagnosis and treatment of BCRL, these guidelines offer clinicians a tool to help develop BCRL surveillance programs as part of routine breast cancer care.
Moderators of acupuncture effectiveness in breast cancer survivors: Randomized clinical trial (RCT).
Authors: Palesh Oxana , Haddad Nadia , Schnyer Rosa , Neri Eric , Packer M. Melissa , Zeitzer Jamie M. , Manber Rachel 
Published: February 2017

162 Background: The popularity of acupuncture among cancer patients highlights the need for studying its effectiveness for mitigating side effects of cancer treatments. Insomnia is prevalent among cancer patients and is associated with fatigue and reduced quality of life (QOL). It is also closely linked with depression, sleep apnea, and circadian disruption. Using data form an RCT of acupuncture for insomnia among breast cancer survivors, we examined depression, apnea and circadian factors as moderators of acupuncture effectiveness. Methods: 68 breast cancer survivors (54 years, SD = 9) experiencing insomnia symptoms were randomized to receive 12 sessions of acupuncture (N = 34) or sham (N = 34; using placebo needles). Measures included the Insomnia Severity Index, Brief Fatigue Inventory, and FACT—G, obtained at baseline, mid-treatment (3 weeks), end of treatment (6 weeks), and follow-up (10 weeks). Results: Although acupuncture produced significant improvements from baseline to follow-up in insomnia symptoms, fatigue, and QOL, these improvements did not differ from sham. Compared to sham, the acupuncture produced significantly greater improvements in: 1) insomnia severity (p = 0.03) and QOL (p = 0.02) among those with greater tendency for morning chronotype; 2) fatigue (p = 0.01) among those with lower apnea risk; and 3) QOL (p < 0.001) among those with lower depression scores at baseline. Conclusions: These findings suggest that acupuncture might be more effective among certain subgroups of patients. Moderators of insomnia, fatigue, and QOL include morningness tendency, lower risk for sleep apnea and lower depression scores, respectively. Our findings on depression are in line with prior research that has found that patients with less severe depression may have a greater capacity for acupuncture response perhaps due to higher availability of serotonin. Additional research is needed to test whether acupuncture is a viable treatment option for subgroups of cancer survivors with insomnia. Clinical trial information: NCT01162018.
Utilizing design theory to create a patient-centered palliative care model in cancer survisorship care.
Authors: Tribett Erika Lauren , Chavez Jordan , Morris Alison 
Published: February 2017

164 Background: Palliative medicine (PM) is an essential component of survivorship care from point of diagnosis. While PM is philosophically committed to supporting patient and family survivorship goals, very few programs incorporate patient and family input into the formation of a patient-centered model of care for symptom management and quality of life. We utilized design theory to develop novel interventions for primary and specialist PM delivery. Methods: Baseline data collected in Fall 2014 revealed a need for assistance navigating support services as well as barriers to PM integration including branding, lack of primary palliative skills, and poor understanding of outcomes of PM integration. In February 2015, we convened a multidisciplinary group of 25 patients, family members, oncology clinicians and experts in patient experience and health services research, to evaluate current state data and formulate ideas for optimizing PM to support symptom management and quality of life. During a 1-day workshop, the group generated interventions for primary and specialist PM. Small teams were assigned to pilot projects based on these recommendations. Proposed solutions are being tested from July - October 2015. Results: The design team generated five focus areas for meeting patient needs and overcoming barriers: standard processes for access to PM, education on primary PM, rapid reporting of outcomes, relationship-building with referring clinicians, and improved access to primary and specialist palliative resources. Three interventions are being developed to address these: 1. A subspecialist “hub” that allows single referrals and streamlined access to supportive care, 2. a novel two-question probe about goals conducted by the oncologist, and 3. a peer support system between PM social work and nursing staff to proactively manage patients with complex needs. Conclusions: Patient and family-centered PM mandates a novel approach. Design theory allows for clear delineation of problem areas, generation of multiple solution sets, and rapid testing and refinement prior to large-scale adoption. A participatory design approach emphasizes user values and limitations and creates values-based solutions.
Integrative medicine modality utilization and impact on quality of life in cancer patients: A single academic cancer center experience.
Authors: Millstine Denise , Gowin Krisstina L. , Chon Tony 
Published: February 2017

169 Background: The majority of patients with cancer incorporate integrative medicine strategies into their cancer experience however; patient reported preferences and impact on quality of life is limited. We present cancer patient utilization for specific integrative medicine modalities within the Mayo Clinic Arizona Comprehensive Cancer center and describe the patient perceived impact on quality of life. Methods: Patients and family members attending the 2015 Living with Cancer Symposium at Mayo Clinic Arizona completed a survey indicating whether specific integrative medicine modalities were utilized during cancer treatment and whether utilization had an impact on the patients perceived quality of life. Patient diagnoses and stage were collected. A total of 119 patient surveys were completed and analyzed. Results: The patient diagnoses included hematologic malignancies (27%), breast (25%), prostate (18%), and other (30%). Disease stage was nearly evenly distributed with stage I (21%), stage II (20%), stage III (16%), stage IV (15%), and unknown (28%). The most commonly utilized integrative modalities included nutrition (54%), natural product supplementation (34%), massage (33%), exercise (31%) including yoga (23%) and tai chi (1%), breathing and meditation interventions (26-28%), support groups (23%), and pet therapy (17%). The majority of patients (64%) reported integrative intervention utilization led to an enhanced quality of life during cancer therapy. Conclusions: At a single academic cancer center, in a cancer type and stage diverse population, the majority of patients (64%) reported improved quality of life during cancer therapy with integrative medicine intervention utilization. Nutrition, natural product supplementation, massage, exercise, and meditative modalities were most commonly utilized. Interestingly, a large proportion of patients analyzed in this questionnaire-based study were afflicted with hematologic disease, a population underrepresented in the current integrative medicine intervention research. More studies exploring the feasibility and impact of integrative therapies in the hematologic patient population are needed.
Examining the relationship between social cognitive processing and depressive symptoms in long-term breast cancer survivors and their partners.
Authors: Cohee Andrea A , Champion Victoria 
Published: February 2017

191 Background: Breast cancer survivors (BCS) and their partners frequently report distress, including depressive symptoms after diagnosis and treatment for breast cancer. The Social Cognitive Processing Theory (SCPT) has been useful in identifying predictors of both BCS and partner distress, although most studies have occurred early in survivorship. Relationships between SCPT variables and depressive symptoms in long-term BCS and their partners have not been well explored. The purpose of this study is to test relationships between SCPT variables and depressive symptoms in long-term BCS and their partners. Methods: In a large cross-sectional study, BCS (N = 222), who were 3-8 years from diagnosis, and their partners completed a survey assessing demographic characteristics, social constraints, cognitive processing (intrusive thoughts and cognitive avoidance), and depressive symptoms. Mediation analyses were conducted for survivors and partners separately to determine if cognitive processing would mediate the relationship between social constraints and depressive symptoms. Results: Cognitive processing mediated the relationship between social constraints and depressive symptoms both for BCS [F(5,209) = 16.373, R2= .281, p < .001] and partners [F(4, 216) = 8.281, R2= .133, p < .001), controlling for age, education, and survivors’ time since diagnosis. Although included in the model, demographic variables did not significantly predict depressive symptoms. Conclusions: Relationships in the SCPT were confirmed; cognitive processing mediated the relationship between social constraints and depressive symptoms for both long-term BCS and their partners. Results expand the utility of the SCPT in long-term survivors and their partners by supporting its use in intervention design.
Cognitive function in cancer survivors: Analysis of the 1999-2002 National Health and Nutrition Examination Survey.
Authors: Williams AnnaLynn , Janelsins Michelle Christine , van Wijngaarden Edwin 
Published: February 2017

193 Background: Cancer and its treatment may affect cognitive function in up to 35% of survivors months after treatment. While short-term treatment-related cognitive changes are well recognized, only limited research is available in older, long-term survivors of cancer. Methods: Using NHANES data from 1999 through 2002, 408 cancer survivors and 2,639 non-cancer participants age 60 and above were identified. Cognitive function of these groups were compared on self-reported problems with memory or confusion and using the Digit Symbol Substitution Test (DSST), a test of processing speed, attention, and learning and working memory involving executive functions domains. Results: Cancer survivors were on average 72.8 years old and 11.5 years from diagnosis. After adjustment for covariates, cancer survivors scored, on average, 1.99 points lower on the DSST compared to non-cancer survivors (ß=-1.99, 95%CI -3.94, -0.05). Cancer survivors also had 17% higher odds of self-reporting problems with memory or confusion (OR 1.17, 95%CI 0.89, 1.53). Similar results were observed among survivors ≥ 5 years from diagnosis (ß =-2.38, 95%CI -4.57, -0.18, OR1.41, 95%CI 0.99, 2.02). Results suggest that age modifies the association between cancer diagnosis and DSST score (p=0.11) with a larger effect size in the younger group (between 60 and 75 years). Among those younger than 75, cancer survivors performed 3.25 points lower on the DSST compared to non-cancer survivors (ß =-3.25; 95%CI -5.88, -0.62). However, this difference was only 0.18 points lower among those 75 or older (ß =-0.18; 95%CI -2.94, 2.57). Conclusions: This is the only study to examine domain specific cognitive deficits in a large, nationally representative, older population of long-term cancer survivors and the first to report deficits in processing speed, attention, and learning and working memory domains. These domains are thought to be important for social and executive functioning and quality of life. Characterizing affected domains and subpopulations will help to develop and test effective interventions and may influence treatment practices in older cancer patients.
Psychosocial distress screening in community oncology: A feasibility study.
Authors: Solti Magdolna , Webb Tracy , Koerber Joyce , Mcdermott Rosemary , Hill Virginia 
Published: February 2017

194 Background: Screening for psychosocial distress is an unmet need for cancer survivors. The oncology team has a critical role caring for the whole patient. We designed a comprehensive screening for newly referred patients in a community oncology setting. The purpose of our screening is early detection of moderate to severe distress and early intervention through social workers. Methods: This feasibility study included 292 newly diagnosed cancer and hematology patients entering our center between May 1 and July 31, 2015. Each participant completed the NCCN Distress Thermometer with checklist and PHQ-2 survey as part of the New Patient Questionnaire. The psychosocial team designed the triage process and contacted each patient if either the distress score or the PHQ-2 scores were ≥ 4. The screened patients underwent counseling by social work and were provided educational materials by nurse navigators and referred to community counselors as needed. Results: 67 % of the 292 newly diagnosed patients completed the screening tool. The average distress score was 4.31, and the average PHQ-2 score was 1.48. Based on the predefined criteria, 63% of all new patients reported significant distress. One-third of these patients had a distress score of 4, and were managed by nurse navigators. 63 patients with higher score were seen by social worker, 23 (37%) were referred to community counseling and 16 (25%) received ongoing follow-up. The documented need of psychosocial counseling increased by 28% during the program. By the end of the project period the early detection rate of severe depression (PHQ-2 ≥ 4) increased from 33% to 80%. The majority of the patients appreciated the distress screening, and the suggested coping strategies and support. Conclusions: Distress screening for newly diagnosed hematology and oncology patients is feasible in the community oncology setting. A large number of previously undetected patients with distress and depression were identified. The distress tool aided in early intervention and providing follow-up. The screening was also effective in identifying patients with high distress and in need to mitigate a crisis. Providing appropriate resources and referrals is essential to manage the extra workload on the psychosocial team.