bluuebunny/crossref_metadata_2025_split huggingface dataset:
The SMILE scale: A pilot study among patients with cancer.
Authors: Vater Laura , Ajrouch Ali , Monahan Patrick O. , Jennewein Laura , Han Yan , Karkash Ahmad , Hanna Nasser H. 
Published: June 2023

e24036 Background: In the US, it is projected that more than 22 million people will be living with cancer by 2030. As survivorship increases, there is a need for simple, convenient tools to quantify patient quality of life and encourage healthy behaviors. To fill this gap, a new psychometric tool named the SMILE Scale was created. The SMILE Scale is a brief self-administered questionnaire assessing the frequency of behaviors intended to improve wellness in five domains: Sleep, physical activity (Move), stress management (Inhale and Exhale), social interactions (Love and connect), and nutrition (Eat to nourish). In this study, we aimed to determine the feasibility of collecting daily self-reported SMILE Scale data and weekly quality of life data, via electronic surveys in patients with cancer. We also aimed to measure the association between SMILE Scale responses and validated health-related quality of life (HRQOL) tools (PROMIS-29+2 and SymTrak-8) as a pilot test of the hypothesis that increased wellness behaviors may impact quality of life. Methods: We surveyed 100 patients with cancer at the IU Simon Comprehensive Cancer Center. Participants were asked to complete daily SMILE Scale assessments over a two-week period, as well as weekly PROMIS-29+2 and SymTrak-8 surveys. The primary endpoint was the SMILE Scale completion rate. Secondary endpoints in this single-arm pilot study included correlations between SMILE Scale results and the other HRQOL tools. Results: Daily completion rate of the SMILE Scale ranged from 57% to 65% of participants over a 14-day period. Among the 61% of participants who completed SMILE on day 1, 87% completed SMILE on 10 of 14 days. Further, 77% completed SMILE at least 1 of the 14 days. By end of study, participants who self-reported more wellness behaviors (i.e., higher daily SMILE scores) demonstrated significantly higher PROMIS physical health (p = .003), higher PROMIS mental health (p = .008), and lower (better) SymTrak total symptom burden (p = .006). Further, among those who completed at least 1 of 14 daily SMILE assessments, quality of life significantly improved over the two-week period for PROMIS mental health (p = .018) and SymTrak total symptom burden (p = .014). Conclusions: The SMILE Scale completion rate on any given day did not satisfy our pre-planned ≥70% threshold for feasibility; however, the rate for completing SMILE at least once during the 14 days (77%) met this threshold. There is growing recognition that interventions with modest uptake may benefit interested patients. The SMILE completion rate across 14 days among those who completed at least one day indicates benefit for providing a daily or on-demand option for those interested. Further, significant correlative results between SMILE scores and secondary QOL endpoints suggest a potential benefit for delivering SMILE in clinical practice and warrants testing the SMILE Scale’s causal impact in a future randomized trial.
Exploring the benefits of therapeutic horticulture in patients in gynecologic oncology: A pilot study.
Authors: Jhaveri Vasanti , Diehl Leah , Jennings-Coulibaly Alexis , Li Derek , Durning Patricia , Bashir Shazia , Markham Merry Jennifer , Rhoton-Vlasak Alice 
Published: June 2023

e24038 Background: Women who are diagnosed with gynecologic cancer experience a significant level of distress and symptoms that impact their quality of life. Recently, there has been an emphasis on quality of life for oncology patients. Non-pharmacological interventions such as therapeutic horticulture (TH) have been linked with enriching individual lives. TH is defined as the engagement of a person in gardening and plant-based activities, facilitated by a professionally registered horticultural therapist, to achieve specific treatment goals. The purpose this study is two-fold: 1) to determine the impact of TH on quality of life and anxiety for gynecologic oncology patients and 2) to test the feasibility and acceptability of implementing a pilot TH program for this specific patient population. Methods: This was an IRB approved study. Individuals were recruited from the oncology clinic. Inclusion criteria included adult women, age 18 and over, who were diagnosed with gynecologic cancer. They were included in the study independent of what stage they were in their cancer treatment. The intervention included attending eight 1-hour group-based gardening sessions that were led by a professionally registered horticultural therapist at Wilmot Botanical Gardens. Self-report psychometric assessments were administered to assess anxiety and quality of life before and after the intervention. Results: Over one month, ten patients were interested in the study. Due to limitations in funding, only seven were able to partake in the study. Three participants were able to complete the study in its entirety by attending eight out of the twelve sessions. Four participants were unable to complete at least eight sessions due to scheduling conflicts: one completed seven sessions and three completed less than five sessions. Given that only three patients completed the intervention, quantitative measures are not included. In the focus group at the end of the study, the three participants described the TH as engaging and felt that they were more physically active and mentally at peace. They felt that the sessions brought camaraderie amongst each other regardless of the number of sessions attended. Conclusions: While our participant accrual was limited, the study was noted to be feasible and acceptable with the sessions being overall helpful for well-being. Given the results from this study, more funding has been established for recruiting a larger cohort in Fall of 2023.
First integrative oncology clinic in the Veteran Affairs (VA) Pittsburgh healthcare system.
Authors: Tan Jocelyn L , Rai Hema , Passero Vida Almario , Green Jeanne , Herman James G. , Genovese Dana , Harrold Lauri , Denk Lisa 
Published: June 2023

e24041 Background: Integrative oncology (IO) is PROACTIVE and combines complementary with conventional care. The VA's comprehensive collection of integrative services is already in place. However, providers are often unaware of these, therefore veteran cancer patients don’t benefit from them. Prostate cancer is the most common cancer within the VA (31.8%), Aside from radiation/chemotherapy side effects (dry mouth, stomatitis, fatigue, neuropathy, gastrointestinal ) prostate cancer patients also have hormonal issues (hot flashes, low bone density, sexual dysfunction). Conventional treatments focus on symptoms (REACTIVE). Complementary and IO approaches are evidence-based toward specific treatment-related side effects. By educating and offering integrative approaches, we empower veterans to take charge of their health and well-being. Shifting our focus from treating only the disease to treating the entire patient, will improve health outcomes. Methods: Recruit 40 prostate cancer patients with fatigue, radiation-induced diarrhea, neuropathy, nausea, vomiting, anorexia, constipation, sexual dysfunction, and emotional issues(depression, anxiety, poor sleep, lack of energy). Identify/train providers to focus on concerning areas. Develop VA Personal Health Plans (PHP) to identify patients mission, aspiration, and purpose (MAP). Offer acupuncture, yoga, Reiki, TaiChi, meditation, biofeedback for headaches - Video Support group. Assessment tools. In late 2022, we reached our goal of 40 prostate cancer patients and opened clinic enrollment to patients of all cancer types. Results: The pilot IO clinic began in 2020, with 40 patients. In 2022, we expanded services to patients with other cancer types. Integrative options improved surgical outcomes, minimize chemotherapy /radiation side effects, boost morale, and optimize clinical outcomes. There is a high-interest level among oncology staff and patients. Resources are abundant but need organization and refinement to effectively present IO to our patients. Conclusions: There is huge potential for integrative oncology to improve the clinical, laboratory, and quality-of-life outcomes of cancer patients. We were able to construct a program within the Veteran Affairs, using existing integrative resources with high patient engagement. Currently, we plan to expand services to other VA sites nationwide.
Role of ketogenic diet in the management of cancer: A systematic review.
Authors: Chelikam Nikhila , Patel Urvish , Akella Sai Anusha , Ali Abdirazak , Lakhanpal Manisha Rakesh , Singh Aryak , Toor Varneet , Shivashankar Prashanth Gumpu , Shah Shlok Vimal , Lahori Simmy , Manjani Lokesh , Gujarathi Rahul , Manjani Divesh , Adiga Avinash , Kukreja Geetika 
Published: June 2023

e24042 Background: Cancer is 2nd leading cause of death (1 in every 5) in the United States followed by heart disease. Use of ketogenic diet (KD)- high-fat & low-carbohydrate diet, allows fatty acids to become the obligatory source of cellular energy which can help in decreasing the tumor cell growth. Aim of this study was to evaluate role of KD in different types of cancer. Methods: We performed a systematic review using PRISMA protocol to identify articles describing the role of the ketogenic diet in cancer patients in PubMed. Keywords like cancer, neoplasm, tumor, KD, and intermittent fasting (IF) were used & filters like full text, English, human, observational studies, & clinical trials (CTs) were applied between 2018-2022. Results: Of the 362 studies after using filters only 22 studies were CTs. Of these 22, 12 studies were excluded & 10 studies were included in this study. [Table 1] We found CTs describing role of KD, IF or standard diet (SD) in brain cancer, non-metastasized rectal cancer, high-grade glioma, head and neck squamous cell carcinoma, locally advanced and metastatic breast cancer, ovarian and endometrial cancer. KD was describes as an accompanying measure for patients undergoing standard-of-care therapy that helps to improve the quality of life, survival & acceptable safety and tolerability. KD may augment the antitumor effects of classic chemotherapy and radiotherapy. Conclusions: Role of KD is described in depth, but majority RCT results were heterogeneous in nature to provide quantitative measures of survival timeline, outcomes, & recovery. Thus, more human prospective studies are warranted to evaluate the therapeutic effectiveness & safety of KD.[Table: see text]
A new model of cancer survivorship: Feasibility and findings of a survivorship-based primary care clinic led by a medical oncologist.
Authors: Yurkiewicz Ilana , Steele Natasha 
Published: June 2023

e24043 Background: Since the Institute of Medicine published “From Cancer Patient to Cancer Survivor: Lost in Transition,” there has been widespread recognition of the role of primary care in providing long-term care for cancer survivors. However, many gaps remain as patients transition from oncology to primary care. We report on the findings of an innovative practice model in which a medical oncologist opened a primary care clinic to address survivorship-specific needs and ongoing primary care in one place. Methods: The clinic was housed in the primary care division of a large academic medical center. The physician is board certified in internal medicine, oncology, and hematology. Data were collected from when the clinic opened November 1, 2021 through January 31, 2023 via electronic chart review. Results: A total of 209 patients established care. Seventy-four percent were women, with a mean age 54, age range 19 to 89, and 24% adolescents and young adults aged 39 or younger. The most common cancer was breast (44%), followed by leukemia (12%) and lymphoma (10%). Thirty-two patients (15%) had undergone an allogeneic or autologous bone marrow transplant (BMT). Thirty-three patients (16%) had a hereditary cancer syndrome, including 11 with a BRCA mutation and 10 with a TP53 mutation. A majority (74%) were post treatment; 22% had active disease; and 3% were “previvors” with a genetic syndrome without a cancer diagnosis. Twenty-seven (13%) had more than one cancer. Most referrals came from medical oncology (36%), followed by self-referrals (29%) and hematology or BMT (11%). Most (74%) returned for at least one follow-up visit. Long-term and late effects were addressed in 87% and at least one other primary care problem was managed in 96%. These included cardiovascular risk (92%, with a new cardiovascular medication started in 31 patients), mental health (76%), bone health (47%), sexual health (22%), and fertility (19%). Secondary cancer screening was addressed in 93%, and four secondary cancers were diagnosed. Surveillance for the primary cancer was addressed in 86%, and seven recurrences were diagnosed. Conclusions: Given a growing need to care for cancer survivors and known challenges in the oncology to primary care pipeline, new models of comprehensive survivorship care are greatly needed. This study demonstrates the feasibility and high demand for a novel survivorship-based primary care clinic in which both ongoing survivorship needs and routine primary care are managed concurrently.[Table: see text]
Clinical use of quality of life data for treatment and survivorship in oncology.
Authors: Beutter Chantal N.L. , Vladimirova Dilyana , Martens Uwe Marc , Fegeler Christian 
Published: June 2023

e24044 Background: Since cancer treatment and disease itself may cause chronic limitations, the challenge of reducing symptom burden during therapy and achieving good Quality of Life (QoL) for longevity with cancer becomes increasingly important. Research already shows that including QoL during treatment increases compliance, survivorship and outcome, but the transition of these concepts into regular care are mostly not implemented. Nevertheless, do regular measurements give a good insight to personal deviations and may enable a harmonious transition from clinical - to post treatment and into everyday life. Methods: For this research assessment of QoL was carried out within a registry study of gastrointestinal patients at the SLK Clinics Heilbronn (DRKS00018788). As a registry study, research is not bound to a fixed deadline, therefore we're still recruiting. First, we deployed a process for a continuous, digital measurement of QoL at clinical visits through the QLQ-C30. Parallel, a separate project implemented an app to measure QoL independently from home. Both ways, data is then structured to visualize the course of events for the identification of deviations or trends. Results: Up to now we included almost 100 patients with over 600 assessment points in our study. It could be shown that our process is applicable in the real world setting of clinical routine and accepted by patients. The study has been running for about 36 months and we were able to visualize QoL charts over several data collection points per patient. Trends within data indicate a relation of the clinical course to changes in QoL. Thus, a possible correlation of the decrease in tumor markers with an increase in QoL is shown. Also, progressions usually result in a significant decrease of QoL. Nevertheless, data also showed that one should be careful to relate the course exclusively to therapy or disease, since environmental influences such as injuries, infections or multimorbidity’s did also result in declines. Here, not only the interpretation of the overall QoL is important, but also the consideration of individual dimensions. Thereby specific limitations of how the patient experiences therapy or possible long-term consequences for survivors get more tangible. To better assess these factors, monitoring of QoL is necessary, not only at visits, but also at home. The developed app for assessing QoL independently was able to show that such a survey can be implemented and applied. Uniform data structure via HL7 FHIR ensures interoperability of the data for both systems. Conclusions: It could be shown that a standardized survey of QoL is possible both in clinical use and independently through patients at home. To close information gaps between clinical visits, both concepts should be merged next to enable an independent survey with a continuous measurement across all therapy stages. With that, adjustments or transitions in therapy could be tailored by limitations in a patients’ QoL.
Healthy lifestyle behaviors among a diverse population of early posttreatment adolescent and young adult (AYA) survivors participating in a virtual stress management program.
Authors: Venkataraman Vinayak , Markwart Michaela , Finkelstein-Fox Lucy , Temel Jennifer S. , Park Elyse R. , Perez Giselle Katiria 
Published: June 2023

e24048 Background: Adolescent and young adults (AYA) cancer survivors have worse long-term physical health than survivors of adult cancers. Healthy lifestyle behaviors can maximize physical health and enhance quality of life. The National Comprehensive Cancer Network (NCCN) publishes survivorship guidelines for healthy behaviors; however, it is unclear if AYA survivors follow these recommendations. Methods: This is a secondary analysis of a waitlist-controlled trial of an adapted mind body stress management group program for AYA survivors recruited between 03/2019-09/2020. Participants completed self-report questionnaires assessing tobacco use, e-cigarette use, alcohol use, physical activity, and sleep quality both before and after completing the 8-week group program. Descriptive statistics were used to characterize the proportions of survivors meeting NCCN guidelines at time of enrollment. Results: Seventy-two AYA survivors participated in this study (mean age 24, 74% female, 60% Non-Hispanic White, 21% Hispanic, 4% Black, 53% hematologic malignancy, mean 1.6 years post-treatment).Table 1 summarizes NCCN guidelines and concordant behavior at enrollment. Most participants met guidelines for tobacco and e-cigarette use at study entry, with the majority reporting they abstained from using tobacco (85%) and e-cigarettes (90%). Only 28% reported abstaining from any alcohol use. Of those who consumed alcohol, most reported consuming < 3 drinks per day (83%), but 65% endorsed at least occasional binge drinking behavior ( > 5 drinks). Only 52% met guidelines for vigorous- or moderate- intensity activity (i.e. 75 and 150 minutes weekly, respectively). Specifically, participants reported a median of 47.5 minutes/week (IQR 0-120 min/week) of vigorous-intensity activity and 60 minutes/week (IQR 30-140) of moderate-intensity activity. Many experienced sleep concerns, with only 30% reporting good or very good sleep (i.e. > 4 on a 1 (very poor)-5 (very good) Likert scale). Conclusions: In a racially/ethnically diverse sample of AYA survivors, NCCN survivorship guideline concordance for healthy lifestyle was mixed. Of concern was that AYA survivors’ use of tobacco and e-cigs was similar to the general population. Furthermore, alcohol and physical activity recommendations were mostly not followed, and reported sleep quality was poor. These results highlight the need to better understand barriers and promote healthy lifestyles to optimize post-treatment outcomes. [Table: see text]
Perspectives about healthy eating and exercise among patients and providers at the safety-net Lyndon B. Johnson (LBJ) hospital oncology clinic.
Authors: Kizub Darya Aleksandrovna , Ramsey Margaret , Baum Miranda , Ma Hilary Y. , Patel Tejal Amar , Basen-Engquist Karen 
Published: June 2023

e24055 Background: Previous studies have described barriers and facilitators of healthy eating and exercise among cancer patients, but none have done so in a primarily low-income minority population. Understanding the perspectives of patients and providers from safety net hospitals has important implications for optimizing diet and exercise counseling and referral strategies to bridge disparities in cancer care and outcomes. Methods: The population at LBJ hospital is majority Hispanic and Black that are uninsured or underinsured. We conducted semi-structured interviews with patients who were either undergoing or completed cancer treatment at LBJ, as well as with clinic providers, to compare perceived barriers and facilitators of healthy eating and exercise. Interviews were audio-recorded, transcribed, and analyzed via hybrid analysis. Results: Thirty-one patients were interviewed, including 20 (65%) survivors and 11 (35%) who were on active treatment. Twenty-one (68%) were female, 22 (71%) Black, 5 (16%) Hispanic, and 4 (13%) other. Twenty-one healthcare providers were interviewed, including 5 (24%) physicians, 5 (24%) nursing professionals, 4 (19%) dietitians, and 7 (33%) ancillary staff. Barriers to healthy diet and exercise for patients as perceived by providers included lack of knowledge (100%), low access (80%) due to financial difficulties, transportation issues, work and family responsibilities, and low motivation (76%). This resulted in reluctance to counsel patients about healthy living, in part due to anticipated low adherence to recommendations (33%). Most patients could name components of and thought they had a healthy diet (65%), but did not exercise enough (75%) due to cancer-related physical and mental health symptoms (68%). Patients recognized benefits of healthy eating and exercise during and after cancer treatment (32% each) and recalled recommendations from providers about healthy living (48%). Patients voiced high motivation to participate in healthy eating and exercise programming (84%) and follow their medical team’s recommendations (84%), so long as programming was convenient (29%) and included flexibility of multiple options (56%). Patients acknowledged resource-related barriers to healthy living but cited proximity to grocery stores and exercise facilities (84%), help from family in cooking meals (52%), and ability to walk outside or exercise with friends (13%). Conclusions: Despite multiple barriers of capacity, opportunity, and motivation to healthy eating and exercise, cancer patients in a safety-net hospital recognized the importance of healthy living, wanted to participate in such programs, and to get additional information or referrals from their medical team. Based on these results, ongoing studies are evaluating the implementation of referral pathways to healthy living programs for cancer patients at LBJ.