bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recovery challenges faced by bladder cancer survivors after recent cystectomy and urinary diversion.
Authors: McMullen Carmit K. , Danforth Kim N. , Kwan Marilyn L , Bulkley Joanna E , O'Keeffe-Rosetti Maureen Cecelia , Weinmann Sheila , Krouse Robert S. , Hornbrook Mark C. , Grant Marcia , Leo Michael C , Gilbert Scott Michael 
Published: February 2017

90 Background: Bladder cancer patients who are treated with cystectomy (bladder removal) and urinary diversion (bladder replacement) experience high rates of complications and hospital readmissions, and have substantial supportive care needs. Patient-reported priorities for improving early-phase survivorship care are lacking. Methods: On the basis of focus groups and in-depth interviews with 32 bladder cancer survivors about post-operative challenges, we developed a structured question listing 16 early survivorship challenges. We asked respondents to indicate which challenges had been difficult to manage at home. The item was part of a survey mailed to members of three Kaiser Permanente regions who had undergone cystectomy and urinary diversion for bladder cancer approximately 6 months previously (N = 197). Eligible patients were identified through health plan databases and chart review. Results: The response rate to the survey was 65%. Respondents reported an average of 3 challenges. The most commonly reported challenges pertained to coordination of medical care (69%), such as confusion about follow-up care, problems obtaining medical and ostomy supplies, knowing what complications to look for and who to notify if they occur, receiving home health care, or obtaining prompt medical advice. Other problems were caring for the urinary diversion (53%); dealing with urine leaks and incontinence (49%); problems with balance, vision, and dexterity (32%); difficulty managing emotions (23%); and management of lymphedema (11%) or incisional or parastomal hernias (7%). Conclusions: More than two thirds of bladder cancer survivors who had recently undergone cystectomy and urinary diversion struggled with medical care coordination. Managing self-care, complications, and emotional well-being after this major surgery can be difficult for patients, who must also navigate a variety of supportive services, such as medical follow-up with multiple departments and providers, home health services, and wound or ostomy care. A more formal approach to discharge and better communication among patients and providers will help improve early survivorship care for this group.
Understanding the impact of primary care providers on treatment decisions for men with localized prostate cancer.
Authors: Radhakrishnan Archana , Grande David , Crossette Linda , Bekelman Justin E. , Pollack Craig Evan 
Published: February 2017

91 Background: Primary care providers (PCPs) play important roles for cancer patients across the care continuum and may help patients make treatment decisions in line with patients’ preferences. However, the extent of PCP involvement is poorly understood. We evaluated how frequently men with localized prostate cancer discuss treatment with their PCP and whether PCP involvement decreased use of definitive treatment, including among those eligible for surveillance according to clinical guidelines. Methods: We mailed surveys to men diagnosed with localized prostate cancer between 2012 and 2013 in the greater Philadelphia area. Patients reporting having a PCP at the time of diagnosis were asked whether their PCP helped decide how to treat their cancer. Definitive treatment was defined as having radical prostatectomy or radiation therapy. Unadjusted and multivariate logistic regression analyses were used to compare sociodemographic and clinical characteristics of patients who did and did not discuss treatment with their PCP. Similar analyses were used to determine effect of PCP involvement on definitive treatment, both overall and in subgroups of men eligible for surveillance (men > 70 years, with limited life expectancy and with low-risk prostate cancer). Results: 3743 men were mailed a survey, 1757 responded, and 1139 were eligible for analyses. Overall, 438 (38.5%) discussed treatment with their PCP. In adjusted analyses, black men were more likely than white men (Odds Ratio 1.89; 95% Confidence Interval 1.22-2.91) and men with Medicare were more likely than men with private insurance (OR 1.61; 95% CI 1.03-2.51) to discuss treatment with their PCP. However, men who had treatment discussions with their PCP were not less likely to receive definitive treatment (p = 0.11), both overall and among those eligible for surveillance. Conclusions: Though a large proportion of men engaged in treatment discussions with their PCP, these discussions were not associated with differences in the receipt of definitive treatment among men with localized prostate cancer. Understanding the content of these discussions can inform interventions that can help patients make preference concordant treatment decisions.
What is the role of comorbidity, frailty, and functional status in the decision-making process for older adults with cancer and their family members, oncologists, and family physician?
Authors: Puts Martine , Sattar Schroder , McWatters Kara , Lee Katharine , Kulik Michael , Macdonald Mary Ellen , Jang Raymond Woo-Jun , Amir Eitan , Krzyzanowska Monika K. , Leighl Natasha B. , Fitch Margaret , Joshua Anthony M. , Warde Padraig Richard , Tourangeau Ann , Alibhai Shabbir M.H. 
Published: February 2017

92 Background: Little is known about the treatment decision making process (TDMP) in older adults (OA) with cancer. The objective of this study is to develop a theoretical framework with the aim to improve the TDMP for this population. Methods: This is a mixed methods multi-perspective longitudinal study. OAs aged > 70 years with advanced prostate, breast, colorectal, or lung cancer, their family members, oncologists and family physicians are invited to participate in individual, semi-structured interviews. Each OA also completes a short survey to characterize their health, functional status, frailty level, decision-making preferences, and satisfaction with the TDMP. The sample is stratified on age (70-79 and 80+) to obtain data saturation for the oldest old. All interviews will be analyzed using the grounded-theory approach. Results: To date, 32 first interviews and 15 second interviews have been completed with 32 older adults, 21 family members and 12 family physicians and 7 cancer specialists. Interviews lasted between 10-60 minutes. Most older adults felt that they should have the final say in the treatment decision, but strongly valued their physician’s opinion. Most participants felt they received enough information, time and support from the oncologist to make their decision. About half the participants went to see their family physician to talk about the diagnosis and plan. Comorbidity and potential side-effects did not play a major role in the decision-making processes for patients and families but it did for oncologists. Family physicians reported they were not involved in treatment decisions, and they preferred more timely information about the patient. Conclusions: This study-in-progress is examining the TDMP from four different perspectives and examining changes over time in the TDMP. Patients and family members were generally satisfied with the treatment decision making process. Final results will be presented at the conference.
The female self-advocacy in cancer survivorship scale: Validating a new measure to support patient voice and engagement.
Authors: Hagan Teresa , Cohen Susan M. , Rosenzweig Margaret Quinn , Zorn Kristin Kelley , Stone Clement , Donovan Heidi AS 
Published: February 2017

96 Background: The Female Self-Advocacy in Cancer Survivorship (FSACS) Scale is a new measurement tool designed to address the increasing need for cancer survivors to lead their care in face of barriers. Based on previous input from female cancer survivors and other stakeholders, the purpose of this study is to evaluate the construct validity of the FSACS Scale. Construct validity is supported by evidence from: (I) Internal structure consistent with the underlying model of self-advocacy; (II) Sensitivity to differences between known groups; (III) Relationships between self-advocacy and key predictors (openness and conscientiousness; information engagement; social support) and outcomes (symptom distress and healthcare utilization); (IV) Relationships between self-advocacy and related concepts (patient activation; self-advocacy within the HIV/AIDS population); and (V) Relationships between self-advocacy and criterion measures. Methods: A mixed-mode cross-sectional survey design was used. Women with a history of an adult diagnosis of invasive cancer were recruited from two patient registries and seven advocacy organizations. Analyses included an exploratory factor analysis, t-tests, and bivariate correlations. Results: 315 adult female cancer survivors completed the survey. Evidence from all five construct validity hypotheses supports the construct validity of the FSACS Scale. The factor analysis confirmed the three underlying dimensions of self-advocacy resulting in a 20-item measure explaining 45.87% of the variance in responses with subscales’ Cronbach’s alphas between 0.791 and 0.850. Conclusions: Results support that the FSACS Scale is a theoretically-grounded measure of self-advocacy that can be used by clinicians and researchers to identify women at-risk for poor outcomes associated with low self-advocacy.
Are we meeting the standards for cancer survivor care?
Authors: Crabbe Wendy W. , Karnad Anand B. , Kaklamani Virginia 
Published: February 2017

98 Background: The Institute of Medicine (IOM), American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network (r) (NCCN (r)) have issued standards of care for cancer survivors including development of a cancer treatment summary and coordination with the patient’s primary care provider (PCP) and other providers for follow up care. The author’s NCI-designated cancer center recently developed a survivor program for women with breast cancer and the plan is to expand the program to all cancers. Methods: To find out what physicians or providers are doing at baseline with cancer survivor care, a short 9 question survey was developed with questions based on the NCCN guidelines (r) and standards for survivorship care. These questions were sent to providers in all the disease specific clinics. The survey was sent to a total of 51 providers via email using SurveyMonkey.com and given 2.5 weeks to complete the survey. Results: A total of 51 providers were sent the survey by email and 21 responded (41%). Ten different disease subspecialties within oncology were represented with an average of 15 years of experience with providers seeing an average of 42 survivors per month. Seventy-one percent felt prepared to discuss survivorship care. Greater than 66% discussed prevention and all the providers who responded screened for recurrence or development of second cancers (100%). Greater than 47% screened for late physical and psychosocial effects of treatment. Most of the providers (61%) had interventions for physical but not psychosocial late effects of treatment. The majority of respondents felt that communication was poor between the oncology specialty provider and the patient’s PCP regarding survivorship care. Conclusions: Based on the responses to the survey based on NCCN standards for survivor care, at our institution most of the providers feel capable of discussing survivor care and 100% of those that responded screen for recurrence or second cancers. Providers need more help with interventions for late effects of treatment especially for psychosocial issues. The area that needs the most improvement is communication between specialty provider and PCP about survivorship care.
Patient-reported outcomes in patients enrolled at Pain Control Center Hospice of Solofra (Italy): A management model.
Authors: Genua Geppino , Fasano Mela , Rizzo Luisa M , Genua Lucia , Landolfi Vincenzo , Strollo AnnaMaria , De Vinco Elena , Fina P. Lino , Canzanella Sergio , Ferrante Mario Nicola Vittorio , Servillo Giuseppe 
Published: February 2017

e266 Background: The Pain Control Center of Solofra (Italy) is managed with a mixed public / private using the funds provided by Law 39/1999 of the Italian Republic for the establishment of the hospice. The daily rate for each resident is € 281.09 and is paid entirely by the national health system. We have evaluated the treatment procedures and the clinical outcome on 282 consecutive patients enrolled from December 2012 to May 2015 at “Pain Control Center” of the Hospice. Methods: The following characteristics have been evaluated: patient gender, mean hospitalization time, differentiation between patients (pts) with and without cancer , tumor type, medical weapon use, venous access type, parenteral feeding, transfer in intensive care units, pain killer use. Results: 282/164 pt males 282/118 females, mean age 72.04 yr (range 18-92 yr, mean hospitalization time 38 days), 205/282 pt (72.69%) had tumor diseases and 77/282 pt (27.31%) non cancer diseases. % Types of cancer: lung 20, colorectal 13.6, breast 7.7, ovarian 3.1, bladder 4, gastric 6.8, prostate 4.5, hepatocellular and biliary tract 7.7, pancreas 2, head and neck 8.6, kidney 2.7, other tumors 19. The central venous accesses were already present at the time of hospitalization in 77/282 pt (27.30%); the central venous access were made on 65/282 (29.44%). 131/282 pt received either parenteral feeding while 39/282 pt enteral feeding. 11/282 pt were transferred to ICU and 189/273 pt (69.23%) deceased at hospice. Analgesic therapy with opiates was administered at 216/282 pt (76.59%). The most intensively treated pt were those with tracheostomy(4.96%) and followed by uretero and colostomy(11.34%). About 30% of pt required central venous access procedures. Conclusions: The present study shows the underestimation of the parenteral feeding and analgesic requirements by pts with chronic diseases. The results lead us to continue the experience of public / private collaboration to achieve greater effectiveness of care and improve the overall management of patients so peculiar.
Colorectal cancer survivorship statistics: A Veterans Affairs Central Cancer Registry analysis.
Authors: Zullig Leah L. , Smith Valerie , Danus Susanne , Schnell Merritt , Lindquist Jennifer , Provenzale Dawn T. , Jackson George L. , Weinberger Morris , Kelley Michael J. , Bosworth Hayden B 
Published: February 2017

e267 Background: Our objective was to evaluate VA CRC incidence and survival and compare with the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data. Methods: Data were obtained from VACCR for veterans diagnosed/treated in VA for incident CRC during fiscal years (FY) 2009-2012. Using VHA Support Service Center information about the distribution of VA healthcare system enrollees for corresponding years, we adjusted incidence rates for age and gender to the underlying VA population. Survival data were available through January 2015; thus, patients in the analysis had 3-6 years of follow-up data and were censored accordingly. CRC incidence and survival among VA patients was compared to projected national 2014 CRC-specific SEER and supporting data sources. Results: From FY 2009-2012, 12,551 patients (2.6% women; 97.4% men) were in the analytic cohort. Among VACCR patients, the most common tumor location was proximal colon (38%), followed by rectum (31%), distal colon (26%), and other colon (5%). This is comparable to SEER, in which proximal colon and rectum are most common. Among patients in the VACCR, SEER summary stage distribution was: 44% local, 36% regional, 17% distant and 4% unknown. This also aligns with SEER, in which approximately 40% of CRC cases are diagnosed locally. Mirroring SEER, overall VA CRC incidence rate decreased from 0.22 to 0.16 cases per 1,000 veterans in FYs 2009 and 2012. Evaluating survival, median follow-up time was 3.3 years among veterans. The 3-year survival rate for VA patients was 65.9%. Overall 3-year survival is slightly higher for rectal (66.4%) than for colon (65.6%). This is comparable to 5-year SEER survival rates (66.5% and 64.2% for rectal and colon, respectively). Also consistent with SEER, VA CRC patients < 65 have higher rates of 3-year survival than patients > 65 years (74.6% vs. 58.5%, respectively). Conclusions: VACCR data indicate that CRC incidence and survival in FY 2009-2012 approximated SEER projections during a similar timeframe. This suggests that, although VA patients are more complex than the general population, they are diagnosed with comparable CRC locations and stages.
Cognitive impairment and dementia in older cancer patients.
Authors: Edwards Beatrice Jara-Almonte , Khalil Peter , Holmes Holly Michelle , Sun Ming , Song Juhee , Valladarez Heather 
Published: February 2017

e269 Background: Chemotherapy effect on cognitive function has also been described in women with breast cancer. Our objective was to define the prevalence of cognitive impairment and dementia in older patients with cancer. Methods: This is a retrospective study at the Program for Healthy Aging at MD Anderson Cancer Center between January 1, 2013 and March 31, 2015. Patients with cancer, 65 years of age and older underwent functional and cognitive testing through personal interview, using IADLs, ADLs, and the Montreal cognitive assessment (MOCA). Screening for depression used PHQ-9. Risk factors for dementia assessed, included depression, concussions, alcohol abuse, and family history of dementia. Level of education was determined. Cognitive impairment was diagnosed with an abnormal MOCA ( < 26) without functional impairment, dementia was diagnosed with an abnormal MOCA with functional impairment. Imaging and assessment for reversible factors of memory loss was conducted. SAS 9.4 (SAS Institute INC, Cary, NC) was used for data analysis. Results: 192 patients were evaluated, male gender (n = 93, 48.4%), female (n = 99, 51.6%), mean age 78 years old (SD, 7) range 65 to 94 years. Sixty-two patients (32.3%) with a hematological malignancy; 26 (13.5%) with breast cancer; 22 (11.5%) with GI cancer; 19 (9.9%) with prostate malignancy; 16 (8.3%) with lung cancer; 14 (7.3%) with bladder cancer; and 33 (17.2%) with other malignancies. Cognitive impairment and/or dementia was identified in 118 (61.5%) patients. Mild cognitive impairment was evidenced in 27 cases (18.2%). Types of dementia included Alzheimer’s disease (n = 11, 7.4%), vascular dementia (n = 21, 14.2%), and mixed dementia (n = 59, 39.9%). The majority of cases of dementia were early stage dementia (n = 45, 56.3%), moderate stage dementia (n = 29, 36.3%), and advanced or severe dementia (n = 6, 7.5%). No significant thyroid abnormalities, B12 deficiency or other reversible causes were identified. Conclusions: Cognitive impairment and/or dementia are commonly seen in patients with cancer in a comprehensive cancer center. Further research in this area is necessary.
Perioperative evaluation of medical comorbidities at a comprehensive cancer center.
Authors: Sahai Sunil Kumar , Nekkalapudi Divya K. , Foreman Jessica T. , Lin Heather Y. , Voss Rachel , Andrabi Tayab A. , Aloia Thomas A. , Hwang Jessica 
Published: February 2017

e271 Background: The Internal Medicine Perioperative Assessment Center (IMPAC), the first and only dedicated perioperative cancer medicine service at a comprehensive cancer center, provides medical risk assessment and optimization of patients undergoing surgery at The University of Texas MD Anderson Cancer Center. We examined the demographic and clinical characteristics of patients seen in the IMPAC program over the last decade. Methods: Retrospective cohort study of patients who were referred to the IMPAC program from November 2004 through January 2015. We identified patient demographics as well as type of cancer at presentation and frequency of comorbidities. Our analysis was based on review of billing data using institutional administrative and clinical databases. Comorbidities were determined based on ICD-9 billing diagnosis at time of initial consultation in the IMPAC program. Results: During the study period, 29,732 patients between the ages of 9 to 105 years old were evaluated for perioperative risk assessment, and 50% were female. The patients were referred to IMPAC program from a primary cancer center. The top referring centers were Head & Neck (7353 patients), Gastrointestinal (4939), Genitourinary (4759), Breast (3565), Gynecology (3175), Melanoma/Skin (1355), Leukemia/Lymphoma (1056), Sarcoma (975), Endocrine (913), Thoracic (779), and Brain and Spine (714). The most frequent comorbidities among all patients seen in the IMPAC program were hypertension (57%), dyslipidemia (35%), diabetes (22%), and coronary artery disease and heart failure (16%). Conclusions: Cardiovascular diseases and diabetes were common comorbidities among patients with cancer awaiting surgery. The identification and optimization of comorbid medical conditions such as diabetes and cardiovascular disease are important because they are known to predict clinical outcomes. Future work should focus on optimal perioperative management strategies to reduce risk of complications in patient with cancer and comorbidities.
Cancer survivorship: Is there a role for cancer survivor clinics?
Authors: Tirelli Umberto , Zanet Ernesto , Spina Michele , Michieli Mariagrazia 
Published: February 2017

e272 Background: The population of survivors of cancer is increasing worldwide. In Italy, 2,243,953 patients (4% of the Italian population) survived after a cancer diagnosis in 2006. The drafting of survivorship care plans (SCPs), consisting of a written treatment summary and a follow-up care plan, is regarded by both the Institute of Medicine and the American Society of Clinical Oncology as an essential step in the care of survivors of cancer. However, Salz et al. in 2013 reported in Cancer that although oncology providers have positive feelings regarding SCPs, only 52% of them ever provided any component of an SCP to their patients. Ultimately, the lack of integration of SCPs into clinical practice is due to the absence of definite guidance regarding what constitutes standards of care for survivors of cancer. Methods: We propose the establishment of cancer survivor clinics (CSCs), which consist of health professionals (i.e., medical oncologists; radiation therapists; psychologists; nurses; and other physicians such as cardiologists, gynecologists, and urologists) dedicated to the care of survivors of cancer who we have previously defined as disease and treatment free for at least 5 years and that is established within our Institution since 2013. Results: The number of these CSCs should be planned in relation to the estimated number of survivors of cancer in each country and designed within the medical oncology departments. Conclusions: CSCs should assess: 1) the occurrence of any known side effects from cancer or its treatment (i.e., neurocognitive problems, premature menopause, infertility, cardiorespiratory system dysfunctions, and chronic fatigue); 2) the concomitant presence of comorbidities and their influence on the patient’s general health status; 3) psychological disturbances (i.e., fear of cancer recurrence, anxiety, depression, and body image perception disorders); and 4) problems regarding social and employment reintegration. Moreover, CSCs should provide screening guidelines for cancer recurrence and second primary tumors, design proper clinical follow-up pathways, promote behavioral changes (i.e., smoking cessation and alcohol intake reduction), and improve screening and prevention programs for the relatives of cancer survivors.