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Demedis J, Reedy J, Miller K, Hu J, Klosky JL, Holliman BD, Peterson PN, Chow EJ, Studts C. Testing effectiveness and implementation of a standardized approach to sexual dysfunction screening among adolescent and young adult-aged survivors of childhood cancer: A type I hybrid, mixed methods trial protocol. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.05.24308510. [PMID: 38883789 PMCID: PMC11178009 DOI: 10.1101/2024.06.05.24308510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Approximately 20-50% of adolescent and young adult-aged childhood cancer survivors (AYA-CCS) experience sexual dysfunction (SD), although this healthcare need is widely underrecognized. Previous research from both AYA-CCS patients and their providers report that SD needs are unaddressed despite patient desires for SD discussions to be incorporated as part of their care. Patients and providers agree that standardized use of a patient-reported outcome measure may facilitate SD discussions; an SD screening approach was developed with patient and provider input. This study will measure the effectiveness of a standardized SD screening intervention and assess implementation outcomes and multilevel barriers and facilitators to guide future research. Methods This multi-site, mixed methods, type 1 effectiveness-implementation hybrid trial will be evaluated using a pre-post design ( NCT05524610 ). The trial will enroll 86 AYA-CCS (ages 15-39) from two cancer centers in the United States. The SD intervention consists of core fundamental functions with a "menu" of intervention options to allow for flexibility in delivery and tailoring in variable contexts. Effectiveness of the intervention on facilitating SD communication will be measured through patient surveys and clinical data; multivariable logistic regression will be used for the binary outcome of self-reported SD screening, controlling for patient-level predictors. Implementation outcomes will be assessed using mixed methods (electronic health record abstraction, patient and provider surveys, and provider interviews. Quantitative and qualitative findings will be merged using a joint display to understand factors affecting intervention success. Implications Identification and treatment of SD in AYA-CCS is an important and challenging quality of life concern. The type 1 hybrid design will facilitate rapid translation from research to practice by testing the effects of the intervention while simultaneously identifying multilevel barriers and facilitators to real-world implementation. This approach will inform future testing and dissemination of the SD screening intervention.
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Sun K, Thao Dinh N, Lewin J, Grzeskowiak L, Mariano C, Bailey E, Lazarakis S, Hussainy SY. A Scoping Review of Oncosexology Policy and Practice Tools Focused on Adolescents and Young Adults. J Adolesc Young Adult Oncol 2024. [PMID: 38563827 DOI: 10.1089/jayao.2023.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background: Despite being considered a key component of quality-of-life, sexual health concerns in adolescents and young adults (AYA) patients with cancer (aged 15-39 years old) are often unmet due to barriers from both patients and health care professionals (HCPs). Investigation into policy and practice tools in this scope of practice is also limited. Aim: To review the literature on policy and practice tools in AYA oncosexology. Method: A scoping review was conducted using four databases: Medline, EMCARE, EMBASE, and PsycINFO, based on the Joanna Briggs Institute Scoping Review methodology. Retrieved articles were extracted into Covidence, followed by two screening rounds. Descriptive and basic content analyses were performed for evidence synthesis. Results: Seventy-four articles were included after screening rounds and citation searches. Overall, oncosexology policy and practice tools were categorized into screening tools (11 articles), guidelines (38 articles), training programs (15 articles), service delivery initiatives (5 articles), and the evaluation of their feasibility/challenges to implementation (5 articles). Among these, only ten articles were specifically about the AYA population. They helped identify and resolve sexual health concerns in AYA patients with cancer by providing strategies to overcome communication barriers, treatment options, and information resources for patients, and by advocating for more HCP education on this topic. Conclusion: The results warrant the need for more research, implementation and expansion of policy and practice tools for sexual health issues in AYA patients with cancer.
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Affiliation(s)
- Kexin Sun
- The University of Melbourne, Melbourne, Australia
| | - Nhu Thao Dinh
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Jeremy Lewin
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Australia
- ONTrac at Peter Mac, Victorian Adolescent & Young Adult Cancer Service, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Luke Grzeskowiak
- Flinders University and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Chiara Mariano
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Eliza Bailey
- Radiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne Hospital, Parkville, Australia
| | - Safeera Y Hussainy
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of General Practice, School of Public Health and Preventative Medicine, Monash University, Parkville, Australia
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Demedis J, Reedy J, Chow EJ, Dorsey Holliman B, Peterson PN, Studts CR. Provider perspectives and recommendations on standardized sexual function screening intervention in adolescent/young adult oncology patients. Pediatr Blood Cancer 2024; 71:e30872. [PMID: 38233999 DOI: 10.1002/pbc.30872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Sexual function (SF) concerns are common among adolescent and young adult (AYA) cancer survivors, are underrecognized and undertreated. This study sought AYA oncology provider input on the implementation of an SF screening tool to address this unmet need. PROCEDURE Semi-structured interviews were completed with oncology providers (n = 25) who care for AYAs at a single institution. Interviews sought to understand barriers to addressing SF, elicit perspectives on use of an established screening tool, and obtain recommendations for SF screening intervention development and implementation. Interviews were developed using the Consolidated Framework for Implementation Research (CFIR); thematic analysis-guided interpretation. RESULTS AYA oncology providers were in favor of using an SF screening tool, but confirmed previously identified barriers and implementation considerations within multiple CFIR domains, including concerns about privacy, patient comfort, provider buy-in, provider knowledge, resource needs, and workflow/capacity constraints. They identified numerous strategies to address barriers through screening intervention design and implementation approaches. For example, provider buy-in could be optimized through education, availability of clinical resources, creation of a dedicated sexual healthcare team, provider engagement in intervention development, and leadership involvement. CONCLUSIONS Development and implementation of an effective SF screening intervention is necessary to improve diagnosis and treatment of sexual dysfunction, with the ultimate goal of improving sexual health-related quality of life in AYA cancer survivors. AYA oncology providers identified numerous intervention and implementation design strategies for the development and implementation of an SF screening intervention, which must be integrated with patient recommendations.
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Affiliation(s)
- Jenna Demedis
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julia Reedy
- Center for Cancer and Blood Disorders at Children's Hospital Colorado, Aurora, Colorado, USA
| | - Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Washington, USA
| | - Brooke Dorsey Holliman
- Center for Cancer and Blood Disorders at Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pamela N Peterson
- Center for Cancer and Blood Disorders at Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Denver Health Medical Center, Denver, Colorado, USA
| | - Christina R Studts
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Cancer and Blood Disorders at Children's Hospital Colorado, Aurora, Colorado, USA
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Blaes AH, Abu-Khalaf MM, Bender CM, Dent SF, Fung C, Smith SK, Watson S, Katta S, Merrill JK, Hudson SV. Coverage for evidence-based cancer survivorship care services. Support Care Cancer 2024; 32:165. [PMID: 38368466 PMCID: PMC10874319 DOI: 10.1007/s00520-024-08359-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE The American Society of Clinical Oncology Cancer Survivorship Committee established a task force to determine which survivorship care services were being denied by public and private payers for coverage and reimbursement. METHODS A quantitative survey instrument was developed to determine the clinical practice-reported rates of coverage denials for evidence-based cancer survivorship care services. Additionally, qualitative interviews were conducted to understand whether coverage denials were based on payer policies, cost-sharing, or prior authorization. RESULTS Of 122 respondents from 50 states, respondents reported that coverage denials were common ("always," "most of the time," or "some of the time") for maintenance therapies, screening for new primary cancers or cancer recurrence. Respondents reported that denials in coverage for maintenance therapies were highest for immunotherapy (41.74%) and maintenance chemotherapy (40.17%). Coverage denials for new primary cancer screenings were highest for Hodgkin lymphoma survivors needing a PET/CT scan (49.04%) and breast cancer survivors at a high risk of recurrence who needed an MRI (63.46%), respectively. More than half of survey respondents reported denials for symptom management and supportive care services. Fertility services, dental services when indicated, and mental health services were denied "always" or "most of the time" 23.1%, 22.5%, and 12.8%, respectively. Respondents reported they often had a process in place to automatically appeal denials for evidence-based services. The denial process, however, resulted in greater stress for the patient and provider. CONCLUSION Our study demonstrates that additional advocacy with payers is needed to ensure that reimbursement policies are consistent with evidence-based survivorship care services.
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Affiliation(s)
| | | | | | | | | | | | | | - Sweatha Katta
- American Society of Clinical Oncology, Alexandria, VA, USA
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Hamad M, Mehana RA, Abd-Al haseeb MM, Houssen M. Potential antitumour effect of all-trans retinoic acid on regorafenib-treated human colon cancer cell lines. Contemp Oncol (Pozn) 2023; 27:198-210. [PMID: 38239861 PMCID: PMC10793621 DOI: 10.5114/wo.2023.133742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/12/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Colorectal cancer (CRC) is a significant contributor to cancer-related mortality worldwide, ranking as the second leading cause of such deaths. Central to the progression of this malignancy is angiogenesis - a complex process orchestrated by vascular endothelial growth factor (VEGF). Regorafenib, a potent multikinase inhibitor, acts as a critical antagonist of multiple kinases involved in angiogenesis, proliferation, and metastasis. Conversely, all-trans retinoic acid (ATRA) has demonstrated compelling antitumour effects across various cancer types. This study aims to comprehensively evaluate the combined antitumour potential of ATRA and regorafenib in human colon cancer cell lines while elucidating the intricate molecular mechanisms that underlie their action. Material and methods Our investigative approach involved an enzyme-linked immunosorbent assay to meticulously analyse the levels of key players in the VEGF signalling pathway, including VEGF itself, activated protein kinase (AMPK), extracellular signal-regulated protein kinase 1 (ERK1), and nuclear factor kappa B (NF-κB). Additionally, we assessed caspase-3 activity as a fundamental marker of apoptosis. Results The combined use of ATRA and regorafenib exhibited a remarkable augmentation in both AMPK and caspase-3 activities. This was accompanied by a significant reduction in VEGF, ERK1, and NF-κB levels within human colon cancer cell lines subjected to regorafenib treatment. Conclusions Our findings underscore the remarkable antiproliferative, antiangiogenic, and proapoptotic effects resulting from the combined use of ATRA and regorafenib in the context of CRC. This modulation of tumourigenic processes is predominantly mediated through the VEGF signalling axis.
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Affiliation(s)
- Mariam Hamad
- Biochemistry Department Faculty, Pharmacy Damanhour University, Egypt
| | - Radwa Ali Mehana
- Medical Physiology Department, Faculty of Medicine, Alexandria University, Egypt
| | | | - Maha Houssen
- Biochemistry Department Faculty, Pharmacy Damanhour University, Egypt
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Lee YJ, Kim JS, Jo JC, Kim Y, Im HS, Kim H, Koh S, Min YJ, Park SH, Ahn JW, Choi Y. Risk factors of menopause after allogeneic hematopoietic cell transplantation in premenopausal adult women. Eur J Haematol 2023. [PMID: 37308461 DOI: 10.1111/ejh.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Allogeneic hematopoietic stem-cell transplantation (HCT) is the only curative option for most hematologic malignancies. However, HSCT can cause early menopause and various complications in premenopausal women. Therefore, we aimed to investigate risk factors predicting early menopause and its clinical implications among survivors post HCT. METHODS We retrospectively analyzed 30 adult women who had received HCT at premenopausal status between 2015 and 2018. We excluded patients who had received autologous stem cell transplantation, had relapsed, or died of any cause within 2 years of HCT. RESULTS The median age at HCT was 41.6 years (range, 22-53). Post-HCT menopause was identified in 90% of myeloablative conditioning (MAC) HCT and 55% of reduced-intensity conditioning (RIC) HCT (p = .101). In the multivariate analysis, the post-HCT menopausal risk was 21 times higher in a MAC regimen containing 4 days of busulfan (p = .016) and 9.3 times higher in RIC regimens containing 2-3 days of busulfan (p = .033) than that of non-busulfan-based conditioning regimens. CONCLUSIONS Higher busulfan dose in conditioning regimens is the most significant risk factor affecting post-HCT early menopause. Considering our data, we need to decide on conditioning regimens and individualized fertility counseling before HCT for premenopausal women.
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Affiliation(s)
- Yoo Jin Lee
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Jeong Sook Kim
- Department of Obstetrics, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Youjin Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Hyeon-Soo Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Hyeyeong Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - SuJin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Young Joo Min
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Sang-Hyuk Park
- Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Jun Woo Ahn
- Department of Obstetrics, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Yunsuk Choi
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Turhal E, Koç Z. Sexual Function and Quality of Life Among Turkish Oncology Patients Receiving Chemotherapy. Semin Oncol Nurs 2023; 39:151401. [PMID: 36898936 DOI: 10.1016/j.soncn.2023.151401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/12/2022] [Accepted: 02/08/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Sexual health and sexual function in oncology patients are inseparable elements of general quality of life and important indicators of emotional well-being. The aim of this study was to determine the relationship between the quality of life and sexual function of oncology patients receiving chemotherapy. DATA SOURCES This cross-sectional and correlational study was conducted within the chemotherapy unit of a university hospital between June 25, 2017, and June 21, 2018. A total of 410 oncology outpatients participated in this study. Data were collected using the FACT-G Quality of Life Evaluation Scale, the Arizona Sexual Experiences Scale, and the Edmonton Symptom Assessment Scale. CONCLUSION A negative and weak statistically significant relationship between the Arizona Sexual Experiences Scale total score and the FACT-G Quality of Life Evaluation Scale total score was found (r = -0.224, P < .01). The regression model where the FACT-G Quality of Life Evaluation Scale total scores (F = 3.263; P < .001) and Arizona Sexual Experiences Scale total scores (F = 8.937; P < .001) of the patients were taken as dependent variables and their sociodemographic and clinical characteristics were taken as independent variables was found to be statistically significant. IMPLICATION FOR NURSING PRACTICE Psychosocial and medical evaluation should be performed when a concern or problem regarding the sexual life of an oncology patient is detected. The sexual quality of life of oncology patients should be improved through sexual counseling and education. Patients and their families should be encouraged to participate in family support programs.
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Affiliation(s)
- Ebru Turhal
- Lecturer, Medical Simulation Center, Karadeniz Teknik University, Trabzon, Turkey
| | - Zeliha Koç
- Professor, Health Science Faculty, Ondokuz Mayıs University, Samsun, Turkey.
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Gerstl B, Signorelli C, Wakefield CE, Deans R, Vaishnav T, Johnston K, Neville K, Cohn RJ, Anazodo A. Sexual and reproductive complications and concerns of survivors of childhood, adolescent and adult cancer. J Cancer Surviv 2023:10.1007/s11764-023-01349-6. [PMID: 36991269 DOI: 10.1007/s11764-023-01349-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/10/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Cancer survivors may experience infertility and sexual dysfunction following cancer treatment. Survivors report significant gaps in oncofertility care and consider these issues important, yet they are rarely discussed. The aims of this study were to evaluate survivors' sexual and reproductive complications across age groups and to identify specific groups of survivors at risk for sexual and reproductive complications. METHOD We report data collected from survivors of cancers diagnosed in childhood, adolescence and adulthood following the development and piloting of a reproductive survivorship patient reported outcome measure (RS-PROM). RESULTS One hundred and fifty survivors participated in the study (mean age at cancer diagnosis was 23.2 years [SD, 10.3 years]). About 68% of participants expressed concerns about their sexual health and function. Survivors (50%) expressed at least one body image concern, with the female gender the most common risk factor for all subgroups. A total of 36% of participants reported at least one concern regarding their fertility, with more male than female survivors reporting fertility preservation prior to treatment. Females compared with male participants were more likely to feel less physically attractive after treatment (OR = 3.83, 95% CI = 1.84-7.95, p < 0.001). More females than males were also more likely to feel dissatisfied with the appearance of a scar(s) after treatment (OR = 2.36, 95% CI = 1.13-4.91, p = 0.02). CONCLUSION The RS-PROM identified multiple reproductive complications and concerns for cancer survivors in the survivorship period. IMPLICATIONS FOR CANCER SURVIVORS Utilising the RS-PROM in conjunction with a clinic appointment could help identify and address cancer patients' concerns and symptoms.
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Affiliation(s)
- Brigitte Gerstl
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Childrens Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Childrens Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia
- Department of Gynaecology, The Royal Hospital for Women, Sydney, NSW, Australia
- Fertility Research Centre, The Royal Hospital for Women, Sydney, NSW, Australia
| | - Tejnei Vaishnav
- Fertility Research Centre, The Royal Hospital for Women, Sydney, NSW, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia
| | - Kristen Neville
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia
- Department of Endocrinology, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Childrens Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia.
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia.
- Fertility Research Centre, The Royal Hospital for Women, Sydney, NSW, Australia.
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia.
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Peifer HG, Raker C, Pesek S, Edmonson D, Stuckey A, Gass JS. Breast-Specific Sensuality in Breast Cancer Survivors: Sexually Active or Not. Ann Surg Oncol 2022; 29:6225-6233. [PMID: 35951135 DOI: 10.1245/s10434-022-12196-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND We sought to better understand breast-specific sensuality (BSS) in sexually inactive breast cancer survivors. METHODS We conducted an anonymous cross-sectional survey of breast cancer survivors during surveillance appointments from 2014 to 2016. Sexual inactivity was defined as no sexual activity within 4 weeks prior. Categorical data were analyzed using Fisher's exact test. Multiple logistic regression adjusted for age and menopausal status, and Firth's bias correction accommodated sparse data. RESULTS Of 585 respondents, 546 (93.3%) were between the ages of 40 and 79 years, of whom 285 (48.7%) were sexually inactive. Favorable post-treatment appearance satisfaction was reported by 413 (71.0%) respondents. Sexually inactive respondents were more likely to score discomfort with their partner seeing their chest after surgery compared with sexually active respondents (41 [20.4%] vs. 34 [11.4%]; p = 0.002). Both sexually inactive and active respondents reported that their chest was important in intimacy after surgery but at significantly different rates (117 [44.3%] vs. 217 [72.6%]; p < 0.001). Post-surgical appearance satisfaction for sexually inactive respondents was positively associated with level of comfort with partner seeing their chest after surgery (p < 0.001) and with rating of a pleasurable caress of the treated breast (p < 0.001). CONCLUSIONS Over 40% of sexually inactive respondents reported their chest was important in intimacy after surgery, suggesting that BSS may be a route to intimacy for sexually inactive breast cancer survivors. Post-surgical breast appearance satisfaction significantly correlated with comfort being seen by one's partner and appreciation of a pleasurable breast caress. Optimizing breast cancer surgical aesthetic outcomes may improve survivorship.
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Affiliation(s)
- Hannah G Peifer
- Alpert Medical School of Brown University, Providence, RI, USA.
| | - Christina Raker
- Division of Research, Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | - Sara Pesek
- St. Peter's Hospital, St. Peter's Health Partners Medical Associates, Albany, NY, USA
| | - David Edmonson
- Breast Health Center, Women and Infants Hospital, Providence, RI, USA.,Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ashley Stuckey
- Breast Health Center, Women and Infants Hospital, Providence, RI, USA.,Gynecologic Oncology, Women and Infants Hospital, Providence, RI, USA
| | - Jennifer S Gass
- Breast Health Center, Women and Infants Hospital, Providence, RI, USA.,Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
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Top, bottom or vers? Creating a more equitable health system for sexual and gender minority patients with prostate cancer. Nat Rev Urol 2022; 19:321-322. [PMID: 35478032 DOI: 10.1038/s41585-022-00600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Mintz R, Wang M, Xu S, Colditz GA, Markovic C, Toriola AT. Hormone and receptor activator of NF-κB (RANK) pathway gene expression in plasma and mammographic breast density in postmenopausal women. Breast Cancer Res 2022; 24:28. [PMID: 35422057 PMCID: PMC9008951 DOI: 10.1186/s13058-022-01522-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/27/2022] [Indexed: 12/22/2022] Open
Abstract
Background Hormones impact breast tissue proliferation. Studies investigating the associations of circulating hormone levels with mammographic breast density have reported conflicting results. Due to the limited number of studies, we investigated the associations of hormone gene expression as well as their downstream mediators within the plasma with mammographic breast density in postmenopausal women. Methods We recruited postmenopausal women at their annual screening mammogram at Washington University School of Medicine, St. Louis. We used the NanoString nCounter platform to quantify gene expression of hormones (prolactin, progesterone receptor (PGR), estrogen receptor 1 (ESR1), signal transducer and activator of transcription (STAT1 and STAT5), and receptor activator of nuclear factor-kB (RANK) pathway markers (RANK, RANKL, osteoprotegerin, TNFRSF18, and TNFRSF13B) in plasma. We used Volpara to measure volumetric percent density, dense volume, and non-dense volume. Linear regression models, adjusted for confounders, were used to evaluate associations between gene expression (linear fold change) and mammographic breast density. Results One unit increase in ESR1, RANK, and TNFRSF18 gene expression was associated with 8% (95% CI 0–15%, p value = 0.05), 10% (95% CI 0–20%, p value = 0.04) and % (95% CI 0–9%, p value = 0.04) higher volumetric percent density, respectively. There were no associations between gene expression of other markers and volumetric percent density. One unit increase in osteoprotegerin and PGR gene expression was associated with 12% (95% CI 4–19%, p value = 0.003) and 7% (95% CI 0–13%, p value = 0.04) lower non-dense volume, respectively. Conclusion These findings provide new insight on the associations of plasma hormonal and RANK pathway gene expression with mammographic breast density in postmenopausal women and require confirmation in other studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-022-01522-2.
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Affiliation(s)
- Rachel Mintz
- Biomedical Engineering Department, Washington University, St. Louis, MO, 63110, USA
| | - Mei Wang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Campus Box 8100, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Shuai Xu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Campus Box 8100, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Campus Box 8100, 660 South Euclid Ave, St. Louis, MO, 63110, USA.,Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Chris Markovic
- McDonnell Genome Institute at Washington University, St. Louis, MO, 63018, USA
| | - Adetunji T Toriola
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Campus Box 8100, 660 South Euclid Ave, St. Louis, MO, 63110, USA. .,Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA.
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12
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The Sexual and Emotional Life Experiences Reported by Brazilian Men with Head and Neck Cancer at a Public University Hospital: A Qualitative Study. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractThis study explored the sexual and emotional experiences of male patients with head and neck cancer. This study utilized a clinical-qualitative method. Twelve patients with head and neck cancer were recruited to participate in the research through in-depth semi-directed interviews with open-ended questions recorded. Data was collected at the radiotherapy of a Brazilian hospital. All patients demonstrated negative impacts on the dynamics of affective and sexual relationships caused by a serious disease. Data revealed that impacts mainly affect “The felt/lived body”, and “The affective-sexual body”. Requiring, then, an “Elaboration of the grief of the bodily and sexual changes”. Considering, evaluating and proposing care for a sexual and emotional aspects of patients with head and neck cancer is essential for the creation and implementation of comprehensive health measures, especially in terms of quality of life for patients.
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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Hall DL, Yeh GY, O'Cleirigh C, Peppercorn J, Wagner LI, Denninger J, Bullock AJ, Mizrach HR, Goshe B, Cheung T, Li R, Markowitz A, Park ER. A Multi-step Approach to Adapting a Mind-Body Resiliency Intervention for Fear of Cancer Recurrence and Uncertainty in Survivorship (IN FOCUS). Glob Adv Health Med 2022; 11:21649561221074690. [PMID: 35237466 PMCID: PMC8883302 DOI: 10.1177/21649561221074690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/08/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For cancer survivors, there is a paucity of fear of recurrence (FOR) interventions that integrate empirically supported mind-body and psychological skills for managing FOR and are delivered in scalable formats. OBJECTIVE To adapt an evidence-based resiliency intervention to address FOR among cancer survivors. METHODS A multidisciplinary team of researchers, clinicians, and patient stakeholders followed an iterative intervention adaptation process (ORBIT). In Step 1, we sought to define key FOR management skills through a literature review and feedback from stakeholders. In Step 2, we integrated findings into a treatment manual and refined procedures for in-person delivery to groups of cancer survivors, defined as adults who had completed primary cancer treatment for non-metastatic cancer. In Step 3, we conducted a single arm trial to assess initial acceptability and change in FOR severity with 23 cancer survivors (N=4 intervention groups). In Step 4, we conducted additional qualitative interviews with 28 cancer survivors (N=6 focus groups stratified by FOR severity, N=15 individual interviews) to define adaptive and maladaptive strategies for coping with FOR and to identify preferences for delivery. In Step 5, we refined the treatment manual and procedures for testing in a future pilot randomized feasibility trial. RESULTS We identified critical feedback using a combination of qualitative and quantitative methods. The single arm trial suggested preliminary feasibility and sustained reductions in FOR severity, yet need for refinement (i.e., eligibility, delivery modality), prompting additional qualitative interviews for further targeting. The resulting intervention (IN FOCUS) is comprised of virtual, synchronous, group-delivered sessions that offer an integrated approach to FOR management by teaching cognitive-behavioral techniques, meditation, relaxation training, adaptive health behaviors, and positive psychology skills. Sessions are targeted by applying skills to FOR and associated healthcare engagement. CONCLUSIONS IN FOCUS is a targeted intervention for teaching mind-body resiliency skills to groups of cancer survivors with elevated FOR. Next steps are testing feasibility in a pilot randomized trial.
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Affiliation(s)
- Daniel L. Hall
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,Daniel L. Hall, PhD, Massachusetts General Hospital/Harvard Medical School, 100 Cambridge Street, 16th floor, Boston, MA 02114, USA.
| | - Gloria Y. Yeh
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Conall O'Cleirigh
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Lynne I. Wagner
- Wake Forest University and the Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - John Denninger
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Andrea J. Bullock
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Helen R. Mizrach
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Brett Goshe
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Tina Cheung
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Raissa Li
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Elyse R. Park
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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15
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Xu J, Xue B, Li L, Qiao J, Redding SR, Ouyang YQ. Psychological interventions for sexual function and satisfaction of women with breast cancer: A systematic review and meta-analysis. J Clin Nurs 2022; 32:2282-2297. [PMID: 34985158 DOI: 10.1111/jocn.16194] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To systematically evaluate the effectiveness of psychological interventions for women with breast cancer on sexual function, sexual satisfaction, sexual relationships, sexual distress and sexual quality of life. BACKGROUND Sexual dysfunction is common in women with breast cancer and seriously affects their quality of life and marital harmony. Several studies have explored the effects of psychological interventions related to sexual function of women with breast cancer, but results were inconclusive. DESIGN A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHOD A search of PubMed, EMBASE, PsycINFO, Web of Science, the Cochrane Library, Scopus, CINAHL, ProQuest Dissertations and Theses Global, ClinicalTrials.gov. and Open Grey was conducted from inception to 9 May 2021. Two reviewers independently screened studies, extracted data and conducted a quality appraisal of included studies using the Joanna Briggs Institute critical appraisal checklists. RESULTS Fifteen studies involving 1307 participants were included. The current study showed that psychological interventions made statistically significant improvements in sexual function (SMD = 0.82; 95% CI = [0.43, 1.20]; p < .001), sexual satisfaction (SMD = 0.95; 95% CI = [0.19, 1.72]; p = .01), sexual relationships (SMD = 0.37; 95% CI = [0.15, 0.60]; p = .001) and sexual distress (MD = -5.05; 95% CI = [-7.88, -2.22]; p = .0005) of women with breast cancer. A subgroup analysis regarding the types of psychological interventions indicated that cognitive behavioural therapy and psychoeducational therapy were beneficial to sexual function and satisfaction, and psychosexual counselling could also improve sexual function. CONCLUSION Psychological interventions, especially psychoeducational therapy and cognitive behavioural therapy, are effective for improving the sexual health of women with breast cancer. RELEVANCE TO CLINICAL PRACTICE This current study provides evidence for the application of psychosexual interventions in women with breast cancer. REGISTRATION The study has been registered on the PROSPERO on 6 June 2021, with the registration number CRD42021253493.
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Affiliation(s)
- Jing Xu
- School of Nursing, Wuhan University, Wuhan, China
| | - Bing Xue
- School of Nursing, Wuhan University, Wuhan, China
| | - Lu Li
- School of Nursing, Wuhan University, Wuhan, China
| | - Jia Qiao
- School of Nursing, Wuhan University, Wuhan, China
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Crouch A, Champion VL, Unverzagt FW, Pressler SJ, Huber L, Moser LR, Cella D, Von Ah D. Cognitive dysfunction prevalence and associated factors in older breast cancer survivors. J Geriatr Oncol 2022; 13:33-39. [PMID: 34246583 PMCID: PMC8688207 DOI: 10.1016/j.jgo.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/03/2021] [Accepted: 07/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the prevalence and factors associated with objective and subjective cognitive dysfunction in older breast cancer survivors (BCS). MATERIALS AND METHODS This cross-sectional descriptive study leveraged previously collected data from older BCS (n = 335). Separate linear regression models were used to determine relationships between demographic factors (age, education), medical factors (comorbidities), disease factors (time since diagnosis, cancer stage), cancer-related symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and cognitive dysfunction measures, including objective learning, delayed recall, attention, executive function-working memory, verbal fluency and subjective attentional function. RESULTS Cognitive dysfunction was prevalent with up to 18.6% of older BCS experiencing mild-moderate dysfunction (1.5 standard deviations below mean of non-cancer controls) in at least one cognitive domain. Poor to moderate subjective attentional function was reported by 26% of older BCS. More depressive symptoms were significantly related to poorer cognitive function including learning (p < .01), delayed recall (p < .05), verbal fluency (p < .001), and subjective attentional function (p < .001) but not attention and executive function-working memory. Age, education, anxiety, and fatigue were also negatively associated with cognitive function in some models (p < .05-0.001). CONCLUSION Cognitive dysfunction is common among older BCS and depressive symptoms, anxiety, and fatigue are related factors. Importantly, depressive symptoms were not only related to self-report, but also to cognitive performance. Healthcare providers should be aware of and assess for related factors and cognitive dysfunction itself in older BCS even years after diagnosis and treatment thorough geriatric assessment. Future longitudinal research is needed to discern these relationships.
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Affiliation(s)
- Adele Crouch
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, USA 46202
| | - Victoria L. Champion
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, USA 46202
| | | | - Susan J. Pressler
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, USA 46202
| | - Lesa Huber
- Indiana University School of Public Health, 1025 E. 7 Street Bloomington, IN USA 47405
| | - Lyndsi R. Moser
- Indiana University School of Medicine, 355 W. 16th Street Indianapolis, IN, USA 46202
| | - David Cella
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave – 21 Floor Chicago, IL USA 60611
| | - Diane Von Ah
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, USA 46202
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Böwe R, Beuth J. Einfluss von Bewegungstherapie auf sexuelle Dysfunktionen bei Patienten mit Prostatakarzinom als Begleitung (oder nach) medizinischer Tumorbehandlung – Ein systematisches Review. PHYSIOSCIENCE 2021. [DOI: 10.1055/a-1546-2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Hintergrund Sexuelle Dysfunktionen sind Lebensqualität mindernde Nebenwirkungen von Standardtherapien bei Prostatakarzinom.
Ziel Diese Untersuchung erfasst den aktuellen wissenschaftlichen Kenntnisstand bezüglich Effektivität von Bewegungstherapie zur Kompensation sexueller Dysfunktionen in Folge von Standardtherapien bei Prostatakarzinom.
Methode Systematisches Review in Anlehnung an „Preferred Reporting Items for Systematic Reviews and Meta-Analyses“ (PRISMA). Die Literaturrecherche wurde von 2 unabhängigen Gutachter*innen in den Datenbanken Pubmed und PEDro durchgeführt. Eingeschlossen wurden Randomized Controlled Trials (RCT) mit dem American Society of Clinical Oncology (ASCO) Evidenzlevel I, die sexuelle Funktionen von Patienten mit standardtherapierten Prostatakarzinom unter Bewegungstherapie evaluieren.
Ergebnisse 17 Publikationen mit 1175 Patienten mit Prostatakarzinom erfüllten die Einschlusskriterien. 11 Studien berichten signifikante Verbesserungen der sexuellen Funktionen durch Bewegungstherapie.
Schlussfolgerung Da die Mehrzahl der Studien nicht vergleichbar war, ist keine generalisierte Aussage bezüglich der Wirksamkeit von Bewegungstherapie möglich. Weitere kontrollierte Studien sind unabdingbar, um den Einfluss von Bewegungstherapie auf sexuelle Dysfunktion bei Patienten mit Prostatakarzinom unter Standardtherapien aufzuzeigen.
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Affiliation(s)
- Rebecca Böwe
- Hochschule Fresenius, University of Applied Sciences, Fachbereich Gesundheit & Soziales, Köln, Deutschland
| | - Josef Beuth
- Institut zur wissenschaftlichen Evaluation naturheilkundlicher Verfahren an der Universität zu Köln, Köln, Deutschland
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18
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Abstract
Sexual dysfunction is extremely common in cancer survivors. Cancer survivors are living longer, and survivorship issues like sexual functioning are now a part of routine cancer care. Oncology providers need to be as comfortable assessing and addressing these issues as they would any other aspect relating to cancer care. Providers should know how to perform an evaluation for sexual dysfunction, understand basic treatment options, and have appropriate referrals available to ensure that the patient's needs are met. This review provides an overview of sexual dysfunction pertaining to women who are survivors of cancer and articulates areas needing further research.
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Affiliation(s)
- Mindy Goldman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 2356 Sutter Street, San Francisco, CA 94143, USA.
| | - Mary Kathryn Abel
- University of California, San Francisco School of Medicine, 2356 Sutter Street, San Francisco, CA 94143, USA
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Gerstl B, Signorelli C, Wakefield CE, D'Souza C, Deans R, Vaishnav T, Johnston K, Neville KA, Cohn RJ, Anazodo A. Feasibility, acceptability and appropriateness of a reproductive patient reported outcome measure for cancer survivors. PLoS One 2021; 16:e0256497. [PMID: 34449779 PMCID: PMC8396734 DOI: 10.1371/journal.pone.0256497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Cancer patients can experience a number of reproductive complications as a result of cancer treatment and may benefit from reproductive preventative health strategies. A Reproductive Survivorship Patient Reported Outcome Measure (RS-PROM) is not currently available but could assist patients address reproductive concerns. Purpose To develop and test the acceptability, feasibility and appropriateness of a RS-PROM tool to be used to assess reproductive needs of cancer survivors aged 18–45 years. Methods We reviewed the outcomes of a recently published audit of reproductive care provided in our cancer survivorship clinic to identify gaps in current service provided and used this along with available validated reproductive measures, to develop this pilot RS-PROM. Survivors aged 18–45 years either attending the SCH survivorship clinic over a 1-year period or participants on the Australasian Oncofertility Registry (AOFR) who had agreed to be contacted for future research studies were asked to complete the RS-PROM and a questionnaire on the acceptability, feasibility and appropriateness of content included. Results One-hundred and fifty patients participated (61.3% females). Median age at cancer diagnosis was 24.5 years (range: 2–45 years). Eighty percent of participants reported the length of the RS-PROM was “just right”, 92% agreed they would not mind completing the RS-PROM and 92.7% were willing to answer all questions, with 97% agreeing that the RS-PROM would be an important tool in addressing difficult sexual/reproductive topics concerning with healthcare professionals. Conclusion The large majority of survivors participating in our pilot study found the RS-PROM to be an acceptable, feasible and useful tool to assist discussions of their sexual and reproductive health concerns and experiences with their clinical team.
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Affiliation(s)
- Brigitte Gerstl
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Chantelle D'Souza
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Department of Gynaecology, the Royal Hospital for Women, Sydney, NSW, Australia.,Fertility Research Centre, the Royal Hospital for Women, Sydney, NSW, Australia
| | - Tejnei Vaishnav
- Fertility Research Centre, the Royal Hospital for Women, Sydney, NSW, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Kristen A Neville
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Department of Endocrinology, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
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20
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Fong AJ, Sabiston CM, Nadler MB, Sussman J, Langley H, Holden R, Stokes-Noonan M, Tomasone JR. Development of an evidence-informed recommendation guide to facilitate physical activity counseling between oncology care providers and patients in Canada. Transl Behav Med 2021; 11:930-940. [PMID: 33590874 DOI: 10.1093/tbm/ibaa127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Decision support aids help reduce decision conflict and are reported as acceptable by patients. Currently, an aid from the American College of Sports Medicine exists to help oncology care providers advise, assess, and refer patients to physical activity (PA). However, some limitations include the lack of specific resources and programs for referral, detailed PA, and physical function assessments and not being designed following an international gold standard (Appraisal of Guidelines for Research and Evaluation [AGREE] II). This study aimed to develop a recommendation guide to facilitate PA counseling by assessing the risk for PA-related adverse events and offering a referral to an appropriate recommendation. Recommendation guide development followed AGREE II, and an AGREE methodologist was consulted. Specifically, a stakeholder group of oncology care providers and cancer survivors were engaged to develop the assessment criteria for comorbidities, PA levels, and physical function. Assessment criteria were developed from published PA interventions, consultations with content experts, and targeted web-based searches for cancer-specific PA programs. Feedback on the recommendation guide was solicited from stakeholders and external reviewers with relevant knowledge and clinical experience. Independent AGREE methodologists appraised the development process. The recommendation guide is a five-page document, including a preamble, assessment criteria for absolute contraindications to PA, comorbidities, and PA/functional capacity with a list of appropriate resources. Independent AGREE methodologists rated the development process as strong and recommended the guide for use. The recommendation guide has the potential to facilitate PA counseling between oncology care providers and cancer survivors, thus, potentially impacting PA behavior.
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Affiliation(s)
- Angela J Fong
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada.,Section of Behavioral Sciences, Rutgers Cancer Institute New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Michelle B Nadler
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | | | - Hugh Langley
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Rachel Holden
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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21
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Relationship of perceived everyday cognitive function and work engagement in breast cancer survivors. Support Care Cancer 2021; 29:4303-4309. [PMID: 33415361 DOI: 10.1007/s00520-020-05950-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Breast cancer survivors (BCS) who represent approximately 3.5 million survivors in the USA frequently report ongoing cognitive dysfunction that may impact work outcomes. However, little is known about how perceived everyday cognitive function may affect work engagement (a measure of work efficacy and work well-being) in BCS who have completed treatment. OBJECTIVES The purpose of this study was to examine the relationship between perceived everyday cognitive function and work engagement in BCS. METHODS A convenience sample of 68 employed BCS seen at a Midwest NCI-Cancer Center who were at least 1-year post-treatment, completed a cross-sectional questionnaire assessing demographic and medical characteristics, and perceived everyday cognitive function (Everyday Cognition Scale) and work engagement (Utrecht Work Engagement Scale). Descriptive statistics, Pearson's r, and separate regression models controlling for age and education were used to analyze the data. RESULTS BCS who were on average 52 (SD = 8.6) years old, 5 (SD = 3.8) years post-treatment, and primarily employed full-time (79%) participated. A subset of BCS (12%) identified poorer everyday cognitive function after BC diagnosis and treatment. Everyday cognition, including subscales vigor and dedication, were correlated with work engagement (p˂0.01), controlling for age and education. CONCLUSIONS Findings indicate the important role of perceived everyday cognitive function in work engagement well into survivorship. Reducing cognitive dysfunction may be an important area for future intervention research to support BCS who return to work. IMPLICATIONS TO PRACTICE Healthcare providers need to assess and address perceived cognitive dysfunction to promote work-related outcomes in BCS well into survivorship.
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22
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Reese JB, Sorice KA, Pollard W, Handorf E, Beach MC, Daly MB, Porter LS, Tulsky JA, Lepore SJ. Efficacy of a multimedia intervention in facilitating breast cancer patients' clinical communication about sexual health: Results of a randomized controlled trial. Psychooncology 2020; 30:681-690. [PMID: 33305520 DOI: 10.1002/pon.5613] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Many women with breast cancer (BC) hesitate to raise sexual concerns clinically. We evaluated a multimedia intervention to facilitate BC patients' communication about sexual/menopausal health, called Starting the Conversation (STC). METHODS Female BC patients (N = 144) were randomly assigned to either STC (20-min video, workbook, and resource guide) or control (resource guide only). Audio-recorded dialogue from patients' next oncology clinic encounter was coded for patients' sexual health communication. Self-report surveys assessed patients' beliefs about sexual health communication, self-efficacy for clinical interactions, sexual function/activity, anxiety/depression symptoms, and quality of life at baseline, post-intervention, and 2-month follow-up. T-tests or mixed-effects logistic regression compared study arms. RESULTS Women in the STC arm were more likely to raise the topic of sexual health (51%; OR = 2.62 [1.02, 6.69], p = 0.04) and ask a sexual health question (40%; OR = 2.85 [1.27, 6.38], p = 0.01) during their clinic encounter than those in the control arm (30% and 19% for raise and ask, respectively). At follow-up, women in the STC arm showed greater improvements in sexual health communication self-efficacy (p = 0.009) and in anxiety symptoms (p = 0.03), and more women were sexually active at follow-up, compared to the control arm (OR = 1.5, 70% vs. 46%, p = 0.04). CONCLUSIONS The STC intervention facilitated women's clinical communication about sexual health and reduced women's anxiety, possibly due to increased confidence in expressing their medical needs. Helpful information gained from clinical discussions could have improved women's willingness or ability to engage in sexual activity. Future studies should identify aspects of the clinical encounter most critical to improving women's sexual outcomes.
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Affiliation(s)
- Jennifer B Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Whitney Pollard
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Elizabeth Handorf
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Mary C Beach
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mary B Daly
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Stephen J Lepore
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.,Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
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Feasibility and preliminary efficacy of a hypopressive exercise program on postmenopausal cancer survivors: A pilot study. J Bodyw Mov Ther 2020; 24:484-489. [PMID: 33218551 DOI: 10.1016/j.jbmt.2020.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 02/01/2020] [Accepted: 02/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is a common symptom during and after cancer treatment that negatively affects the patient's quality of life. Exercise is one of the most effective non-pharmacological treatments for CRF. Multimodal exercise therapy programs that include hypopressive exercises, relaxation and myofascial release may be beneficial for CRF. The aim of this pilot study was to evaluate the feasibility and efficacy of a multimodal program on CRF and lower limb functional strength in postmenopausal women diagnosed with cancer. METHODS 7 postmenopausal women (age = 55.28 years; BMI = 26.05 kg/m2) who had a cancer diagnosis participated in a supervised and progressive 55-min class once per week for 12-weeks. CRF was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer Related Fatigue 12 and lower limb strength was assessed with the sit and stand test. RESULTS No adverse events were reported during the training period and all participants completed the exercise protocol. There was a significant increase (p = 0.01) in lower limb functional strength (pre: 19.60 (SD = 2.19) vs post: 24.60(SD = 2.19)) with an effect size of d = 2.28 and a decrease in CRF (p = 0.245) (pre: 29.36 ± 24.42; post: 17.85 ± 14.23) with a trivial effect size (d < 0.5). CONCLUSIONS These preliminary findings indicate that a supervised once per week multimodal program that includes hypopressive exercises for postmenopausal cancer survivors increased lower limb functional strength without exacerbating their CRF. These findings support further randomized trials of hypopressive training programs on patients with cancer.
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The Self-management Smartphone Application for Cancer Survivors, ReLive: Development and Usability Testing. Comput Inform Nurs 2020; 39:312-320. [PMID: 33214389 DOI: 10.1097/cin.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ReLive is a nursing theory-driven and evidence-based smartphone application that aims to promote self-management among cancer survivors. It has been designed to display symptom measurement results in different traffic light colors, depending on the severity of a user's symptoms (eg, severe symptoms are presented in red). Therefore, it is easy for users to draw inferences about changes in their symptoms. Further, users can simultaneously set several physical activity goals and monitor their performance. Social support, self-efficacy, and quality of life of a user can also be monitored regularly. This study investigated the usability of this application. An iterative formative test, including a cognitive walkthrough and face-to-face interviews, was conducted. Participants were seven individuals with a diagnosis of chronic myeloid leukemia. The ease of use and understanding, acceptability, and usefulness of the application were evaluated. The results revealed that the participants had evaluated ReLive positively. This program could be used as an intervention to deliver health information and manage their performance. Further research is needed to assess the application's effects on self-management among survivors of various types of cancers.
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25
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Ernst A, Flynn KE, Weil EM, Crotty BH, Kamaraju S, Fergestrom N, Neuner J. Aromatase Inhibitor Symptom Management Practices: A Retrospective Study. Clin Breast Cancer 2020; 21:e38-e47. [PMID: 33183969 DOI: 10.1016/j.clbc.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/24/2020] [Accepted: 07/17/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Aromatase inhibitor (AI)-associated symptoms contribute to early therapy discontinuation. Although guidelines exist for management of these symptoms, little is known about the degree to which physicians address symptoms and adhere to the guidelines for treatment. PATIENTS AND METHODS In this retrospective chart review, women with hormone receptor-positive breast cancer who were prescribed an AI between October 15, 2012, and September 14, 2017, were randomly selected from the institution's cancer registry. Patient medical records were reviewed to identify the prevalence of symptom documentation and management. Documented symptoms were categorized into musculoskeletal, vasomotor, and urogenital. Symptom treatment guidelines were compiled from the National Comprehensive Cancer Network (NCCN) and the American Cancer Society/American Society of Clinical Oncology (ACS/ASCO). Treatments were categorized as either meeting or not meeting the guidelines. Among patients with symptoms recorded, chi-square tests and time-to-event models were used to examine factors associated with treatment and factors associated with guideline-based treatment. RESULTS Among 179 women prescribed an AI, 82% had at least one symptom and 46% had multiple symptoms. Of the 147 women with any documented symptom, 97 (66%) received some form of symptom-palliating treatment. Seventy-seven patients (52%) received guideline-based treatments or guideline-based treatments in combination with non-guideline-based treatments. There were no differences in receipt of treatment overall (ie, guideline based or non-guideline based) for either vasomotor or musculoskeletal symptoms by age, race, or stage. CONCLUSION Although 82% of patients had symptoms documented in their medical records, just over half of those patients received guideline-based treatment.
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Affiliation(s)
- Andrew Ernst
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Elizabeth M Weil
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - Bradley H Crotty
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Sailaja Kamaraju
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Nicole Fergestrom
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Joan Neuner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI.
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Anazodo AC, Choi S, Signorelli C, Ellis S, Johnston K, Wakefield CE, Deans R, Neville KA, Cohn RJ. Reproductive Care of Childhood and Adolescent Cancer Survivors: A 12-Year Evaluation. J Adolesc Young Adult Oncol 2020; 10:131-141. [PMID: 33180653 DOI: 10.1089/jayao.2020.0157] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Reproductive complications for cancer survivors are identified as one of the top unmet needs in the survivorship period. However, current models of cancer care do not routinely incorporate reproductive follow-up for pediatric or adolescent cancer patients. The Kids Cancer Centre has had a one-stop survivorship clinic that includes the attendance of a gynecologist and fertility specialist for the last 12 years. Methodology: To inform the future development of our reproductive survivorship care, we reviewed the reproductive care our survivorship clinic has provided over a 12-year period, specifically reviewing the electronic and patient records to collect information on the demographics of the patients who used the service and their gonadotoxic risk and associated fertility treatment, their documented reproductive needs and concerns, and information provided on preventative reproductive advice and screening. Main Results: Two hundred seventy-eight patients were seen (397 consultations) for advice and management of reproductive issues, including 189 female patients (68.0%). Survivors' median age at follow-up was 25.0 years (range = 6-50), on average 19.2 years from their primary diagnosis (range = 3-46). The reviewed data had five overarching themes (fertility care, hormone dysfunction, sexual dysfunction, fertility-related psychological distress due to reproductive concerns, and preventative health care), although each theme had a number of components. Patients had on average 2.5 reproductive concerns documented per consultation (range 1-5). The three most commonly documented symptoms or concerns at the initial consultation related to fertility status (43.9%), endocrine dysfunction (35.3%), and contraception advice (32.4%). In patients younger than 25 years, documented discussions were predominately about endocrine dysfunction, fertility status, and contraception, while dominant themes for 26-35-year olds were fertility status, reproductive-related health prevention strategies, contraception, and endocrine dysfunction. Survivors 36-45 years of age prioritized fertility status, pregnancy, and contraception. Fertility preservation (FP) (p = 0.05), preventative health strategies (p = 0.001), and contraception advice (p < 0.001) were more commonly discussed by females than males. Conclusion: Young cancer survivors have multiple ongoing reproductive concerns that change over time. Assessing survivors' reproductive potential following cancer treatment is important as it gives patients who have not completed their family planning an opportunity to explore a possible window to FP or Assisted Reproductive Treatment. Our data can assist in informing the model of care for a reproductive survivorship clinic.
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Affiliation(s)
- Antoinette Catherine Anazodo
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospitals, Sydney, Australia
| | - Sumin Choi
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia
| | - Christina Signorelli
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Sarah Ellis
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Claire E Wakefield
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Rebecca Deans
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Royal Hospital for Women, Sydney, Australia
| | - Kristen A Neville
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Department of Endocrinology, Sydney Children's Hospital, Sydney, Australia
| | - Richard J Cohn
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
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Muhsen IN, Bar M, Savani BN, Estey EH, Hashmi SK. Follow-up issues in survivors of hematologic malignancies – Current stance and future perspectives. Blood Rev 2020; 44:100674. [DOI: 10.1016/j.blre.2020.100674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/12/2020] [Accepted: 02/24/2020] [Indexed: 12/28/2022]
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Ramey SJ, Silver B, Diaz DA, Munjal A, Mehta S, Rich B, Yechieli R, Takita C. Smoking Cessation at a Safety-Net Hospital: A Radiation Oncology Resident-Led Quality Improvement Initiative. Adv Radiat Oncol 2020; 5:1061-1065. [PMID: 33083667 PMCID: PMC7557130 DOI: 10.1016/j.adro.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/22/2020] [Accepted: 05/31/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose Continued smoking among patients with cancer has been associated with increased toxicities, resistance to treatment, and recurrence. This resident-led quality improvement study attempted to increase smoking cessation by providing free smoking cessation medications in the radiation oncology clinic. Methods and Materials Twenty currently smoking patients with nonmetastatic cancer were prospectively enrolled. First line treatment was protocol-standardized combined nicotine replacement therapy (patches and lozenges). Therapy was initiated before radiation therapy and given for 12 weeks. Patient self-reported tobacco use was assessed at midtreatment, end of 12-week treatment, 3-month follow-up, 6-month follow-up, and 12-month follow-up. Results Within the initial cohort of 20 patients, average years smoked was 36.3 years (median = 37.5). In addition, 85% had attempted to quit previously. Among patients initially enrolled, 3 did not initiate radiation therapy, and 4 were removed from the study by midtreatment due to noncompliance. Midway through treatment, patients had cut self-reported cigarette use to 31% of baseline. However, 75% or more of patients had smoked within the last week at all timepoints assessed. With further follow-up, the number of cigarettes smoked daily continued to rise, reaching 61% of baseline by the 12-month follow-up. Conclusions Patients reduced cigarette consumption, but all patients eventually resumed smoking during the 12-month follow-up. Although it is unfortunate that this study did not result in long-term smoking cessation, the results demonstrate the difficulties faced in helping patients with cancer quit, particularly patients seen at a safety-net hospital. Future efforts could be directed at intensified smoking cessation programs, likely incorporating a more standardized counseling component.
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Affiliation(s)
- Stephen J Ramey
- Department of Radiation Oncology, Jackson Memorial Hospital and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.,Department of Radiation Oncology, Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Benjamin Silver
- Department of Radiation Oncology, Jackson Memorial Hospital and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.,University of Miami Miller School of Medicine
| | - Dayssy A Diaz
- Department of Radiation Oncology, Jackson Memorial Hospital and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.,Department of Radiation Oncology, Ohio State University, Columbus, Ohio
| | - Akul Munjal
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Shahil Mehta
- University of Miami Miller School of Medicine.,JFK Medical Center, Atlantis, Florida
| | - Benjamin Rich
- Department of Radiation Oncology, Jackson Memorial Hospital and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.,University of Miami Miller School of Medicine
| | - Raphael Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Cristiane Takita
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
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Donohoe KJ, Aloff J, Avram AM, Bennet KG, Giovanella L, Greenspan B, Gulec S, Hassan A, Kloos RT, Solórzano CC, Stack BC, Tulchinsky M, Tuttle RM, Van Nostrand D, Wexler JA. Appropriate Use Criteria for Nuclear Medicine in the Evaluation and Treatment of Differentiated Thyroid Cancer. J Nucl Med 2020; 61:375-396. [PMID: 32123131 DOI: 10.2967/jnumed.119.240945] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Kevin J Donohoe
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | - Anca M Avram
- American College of Nuclear Medicine, Reston, Virginia
| | - K G Bennet
- American College of Nuclear Medicine, Reston, Virginia
| | | | | | - Seza Gulec
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Aamna Hassan
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | | | | | - Mark Tulchinsky
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
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30
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Reese JB, Sorice KA, Zimmaro LA, Lepore SJ, Beach MC. Communication about Sexual Health in Breast Cancer: What Can We Learn from Patients' Self-Report and Clinic Dialogue? PATIENT EDUCATION AND COUNSELING 2020; 103:1821-1829. [PMID: 32349896 PMCID: PMC7423724 DOI: 10.1016/j.pec.2020.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 03/13/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Research assessing clinical communication about sexual health is limited. We compared clinical communication about sexual health across patients' self-reports and coded dialogue in breast cancer outpatients. METHODS 134 patients had clinic visits audio-recorded and coded for sexual health communication and completed self-report questionnaires immediately after the visit. Associations between the self-report and dialogue were assessed using Phi coefficient. Agreements (present/absent) and discrepancies (omissions, commissions) about discussed topics were classified and discrepancies analyzed for themes. RESULTS Sexual health was discussed in 61 of 134 patient visits (46%). Associations were significant (p < .01) but differed by topic (φ = .27-.76). 37 women (23%) had ≥ 1 self-report error. Discrepancies were common (19 omissions, 29 commissions). Patients often omitted communication about sexual concerns when such concerns were not problematic, and interpreted non-specific discussions as including specific topics of concern, even when not explicitly stated. Omissions were more common for women with lower education. CONCLUSIONS Patients' reports of whether sexual health communication occurs does not always align with observed dialogue, and may vary by personal relevance of the topic. PRACTICE IMPLICATIONS There are limitations in determining the prevalence of clinical communication about sexual health through patient self-report. Explaining sexual health terms might enhance shared understanding.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA; Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, USA.
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Lauren A Zimmaro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stephen J Lepore
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA; Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, USA
| | - Mary Catherine Beach
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Hall DL, Park ER, Cheung T, Davis RB, Yeh GY. A Pilot Mind-Body Resiliency Intervention Targeting Fear of Recurrence among Cancer Survivors. J Psychosom Res 2020; 137:110215. [PMID: 32818720 PMCID: PMC7873146 DOI: 10.1016/j.jpsychores.2020.110215] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/13/2020] [Accepted: 08/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Interventions for fear of recurrence (FOR) of cancer have nominal effects, perhaps due to limited integration of empirically supported skills. This pilot trial tested the acceptability and feasibility of a multimodal, mind-body resiliency intervention targeting FOR among survivors of various cancers. METHODS Early stage cancer survivors 3-30 months post-treatment were recruited to participate in an eight-session in-person mind-body resiliency group intervention that taught relaxation skills, cognitive-behavioral techniques, healthy lifestyle behaviors, mindfulness meditation, and positive psychology skills all targeted for FOR. Primary outcomes were feasibility (enrollment rate, session attendance, survey completion, skills practice) and acceptability (enjoyableness, convenience, helpfulness, relevance). Patient-reported outcomes (FOR, uncertainty intolerance, cancer-related uncertainty, perceived stress, resiliency, positive affect, and coping skills) were collected at baseline, post-intervention, +1 month, and +3 months. Exit interviews assessed survivors' reported benefits. RESULTS Participants (N = 4 groups, 23 survivors, enrollment response rate = 58%) included survivors of seven common cancer types who were on average 12 months post-treatment. Attendance was high (M = 6.1 sessions), and 96% of survivors completed all surveys. Sustained increases in relaxation skills practice 3+ days/week were reported (baseline = 16%, post-intervention = 76%, +3 months = 71%). Most sessions (87%) were rated as highly or very highly acceptable. Moderate-to-large (d = 0.87) improvements in FOR severity were observed post-intervention (p < .01) and across assessments (p < .01), with similar changes observed in other patient-reported outcomes. Exit interviews revealed behavioral, cognitive, emotional, and existential benefits. CONCLUSIONS The targeted mind-body resiliency intervention shows promising acceptability, feasibility, and favorable changes in FOR and coping skills practice. Further adaptation and testing in a randomized trial are warranted. ClinicalTrials.govRegistration Number: NCT03695406.
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Affiliation(s)
- Daniel L Hall
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America.
| | - Elyse R Park
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America
| | - Tina Cheung
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America
| | - Roger B Davis
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America; Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Gloria Y Yeh
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States of America
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Schaffer K, Panneerselvam N, Loh KP, Herrmann R, Kleckner IR, Dunne RF, Lin PJ, Heckler CE, Gerbino N, Bruckner LB, Storozynsky E, Ky B, Baran A, Mohile SG, Mustian KM, Fung C. Systematic Review of Randomized Controlled Trials of Exercise Interventions Using Digital Activity Trackers in Patients With Cancer. J Natl Compr Canc Netw 2020; 17:57-63. [PMID: 30659130 DOI: 10.6004/jnccn.2018.7082] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Background: Exercise can ameliorate cancer- and treatment-related toxicities, but poor adherence to exercise regimens is a barrier. Exercise interventions using digital activity trackers (E-DATs) may improve exercise adherence, but data are limited for patients with cancer. We conducted a systematic review examining the feasibility of E-DATs in cancer survivors and effects on activity level, body composition, objective fitness outcomes, health-related quality of life (HRQoL), self-reported symptoms, and biomarkers. Methods: We identified randomized controlled trials (RCTs) of E-DATs in adult cancer survivors published in English between January 1, 2008, and July 27, 2017. Two authors independently reviewed article titles (n=160), removed duplicates (n=50), and reviewed the remaining 110 articles for eligibility. Results: A total of 12 RCTs met eligibility criteria, including 1,450 patients (mean age, 50-70 years) with the following cancers: breast (n=5), colon or breast (n=2), prostate (n=1), acute leukemia (n=1), or others (n=3). Duration of E-DATs ranged from 4 to 24 weeks, and the follow-up period ranged from 4 to 52 weeks, with retention rates of 54% to 95%. The technology component of E-DATs included pedometers (n=8); pedometers with smartphone application (n=1), Wii Fit (n=1), heart rate monitor (n=1); and a wireless sensor with accelerometer, gyroscope, and magnetometer (n=1). Adherence by at least one measure to E-DATs was >70% in 8 of 8 RCTs. Compared with controls, E-DATs significantly improved patients' step count in 3 of 5 RCTs, activity level in 6 of 9 RCTs, and HRQoL in 7 of 9 RCTs (all P≤05), with no significant changes in biomarkers (eg, interleukin 6, tumor necrosis factor α, C-reactive protein, c-peptide, lipid panel) in 3 RCTs. Duration of E-DAT was not significantly correlated with adherence or study retention. Conclusions: This systematic review shows that E-DATs are feasible to implement in cancer survivors. Future research should examine the optimal type, dose, and schedule of E-DATs for cancer survivors.
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Schover LR, Strollo S, Stein K, Fallon E, Smith T. Effectiveness trial of an online self-help intervention for sexual problems after cancer. JOURNAL OF SEX & MARITAL THERAPY 2020; 46:576-588. [PMID: 32400321 DOI: 10.1080/0092623x.2020.1762813] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual dysfunction affects over 60% of cancer survivors. Internet interventions have improved sexual function, but with considerable clinician guidance, restricting scalability. This pragmatic trial evaluated an online, self-help intervention. As with many unguided digital interventions, attrition was high. Given low numbers in other groups, this paper focuses on 30% of female patient participants who completed 3-month questionnaires and visited the intervention site (N = 60). Benefits included increased sexually active individuals at follow-up (p < 0.001, Effect size = 0.54), improved sexual function (p < 0.001, Effect size = -0.76, N = 41), and increased use of sexual aids (p = 0.01, Effect size=-0.14, N = 58). The intervention has been revised to improve patient engagement.
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Affiliation(s)
| | - Sara Strollo
- Behavioral and Epidemiology Research Group, American Cancer Society, Inc., Atlanta, USA
| | - Kevin Stein
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Elizabeth Fallon
- Behavioral and Epidemiology Research Group, American Cancer Society, Inc., Atlanta, USA
| | - Tenbroeck Smith
- Behavioral and Epidemiology Research Group, American Cancer Society, Inc., Atlanta, USA
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Sopfe J, Gupta A, Appiah LC, Chow EJ, Peterson PN. Sexual Dysfunction in Adolescent and Young Adult Survivors of Childhood Cancer: Presentation, Risk Factors, and Evaluation of an Underdiagnosed Late Effect: A Narrative Review. J Adolesc Young Adult Oncol 2020; 9:549-560. [PMID: 32380878 DOI: 10.1089/jayao.2020.0025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
An area of concern affecting the quality of life of childhood cancer survivors (CCS) is that of sexual dysfunction (SD), which may be a result of both physical and psychosexual challenges associated with cancer and its treatment. This is especially pertinent as CCS are known to experience diminished quality of life compared to peers. Relevant to SD, cancer and its associated treatment are associated with negative effects on body image and romantic relationships, as well as overall physical and mental health. Although CCS have been shown to have SD at higher rates than the general population, this is often under-recognized and CCS commonly report that it is not addressed by their health care providers. To guide future research and improve clinical screening and treatment practices for SD, we performed a narrative review of this understudied topic to summarize existing knowledge of the incidence, risk factors, pathophysiology, and rates of screening for SD in CCS. We also outline current gaps in knowledge and directions for future research.
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Affiliation(s)
- Jenna Sopfe
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Abha Gupta
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.,Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Leslie C Appiah
- Department of Obstetrics/Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Pamela N Peterson
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Denver Health Medical Center, Denver, Colorado, USA
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Relationship of menopausal symptoms and ovarian reserve in reproductive-aged cancer survivors. J Cancer Surviv 2020; 14:607-613. [PMID: 32323140 DOI: 10.1007/s11764-020-00857-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study sought to evaluate the prevalence of menopausal symptoms in a population of reproductive-aged women remote from cancer therapy compared with a group of healthy similar-aged controls and with a cohort of late reproductive-aged (LR) controls. METHODS Participants were assessed for symptoms of menopause, early follicular phase hormones, and ultrasound examinations. Menopausal symptoms were analyzed in exposed participants and controls using χ2 analyses, Wilcoxon-Mann Whitney tests, and multivariable logistic regression models. RESULTS One hundred seventy cancer survivors, 135 similar-aged controls, and 71 LR controls were followed prospectively for an average of 38 months. Compared with similar-aged controls, a greater proportion of survivors reported vasomotor symptoms at some point over the study period (35% vs 19%, p < 0.01), and this proportion was similar to LR controls (44%, p = 0.22). Survivors were more likely to be bothered by vaginal dryness (27%) than similar-aged controls (16%, p = 0.02) or LR controls (14%, p = 0.02). FSH levels were 38.4% higher in those with vasomotor symptoms compared with those without symptoms (p = 0.021). CONCLUSIONS Reproductive-aged cancer survivors have a higher prevalence of vasomotor symptoms and vaginal dryness than their similar-aged peers. IMPLICATIONS FOR CANCER SURVIVORS Providers should be attuned to the high prevalence of menopausal symptoms in cancer survivors.
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Scott JM, Thomas SM, Peppercorn JM, Herndon JE, Douglas PS, Khouri MG, Dang CT, Yu AF, Catalina D, Ciolino C, Capaci C, Michalski MG, Eves ND, Jones LW. Effects of Exercise Therapy Dosing Schedule on Impaired Cardiorespiratory Fitness in Patients With Primary Breast Cancer: A Randomized Controlled Trial. Circulation 2020; 141:560-570. [PMID: 32065769 DOI: 10.1161/circulationaha.119.043483] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Current exercise guidelines for clinical populations recommend an exercise therapy (ET) prescription of fixed intensity (moderate), duration (40-50 minutes per session), and volume (120-160 min/wk). A critical overarching element of exercise programming that has received minimal attention is dose scheduling. We investigated the tolerability and efficacy of 2 exercise training dose regimens on cardiorespiratory fitness and patient-reported outcomes in patients with posttreatment primary breast cancer. METHODS Using a parallel-group randomized trial, we randomly allocated 174 postmenopausal patients (2.8 years after adjuvant therapy) with impaired peak oxygen consumption (VO2peak) to 1 of 2 supervised exercise training interventions delivered with a standard linear (LET) (fixed dose intensity per session for 160 min/wk) or nonlinear (NLET) (variable dose intensity per session for ≈120 min/wk) schedule compared with a stretching attention control group for 16 consecutive weeks. Stretching was matched to exercise dosing arms on the basis of location, frequency, duration, and treatment length. The primary end point was change in VO2peak (mL O2·kg-1·min-1) from baseline to after intervention. Secondary end points were patient-reported outcomes, tolerability, and safety. RESULTS No serious adverse events were observed. Mean attendance was 64%, 75%, and 80% for attention control, LET, and NLET, respectively. In intention-to-treat analysis, VO2peak increased 0.6±1.7 mL O2·kg-1·min-1 (P=0.05) and 0.8±1.8 mL O2·kg-1·min-1 (P=0.07) in LET and NLET, respectively, compared with attention control. Change in VO2peak ranged from -2.7 to 4.1 mL O2·kg-1·min-1 and from -3.6 to 5.1 mL O2·kg-1·min-1 in LET and NLET, respectively. Approximately 40% of patients in both exercise dosing regimens were classified as VO2peak responders (ie, Δ ≥1.32 mL O2·kg-1·min-1). NLET improved all patient-reported outcomes compared with attention control. CONCLUSIONS Short-term exercise training, independently of dosing schedule, is associated with modest improvements in cardiorespiratory fitness in patients previously treated for early-stage breast cancer. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01186367.
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Affiliation(s)
- Jessica M Scott
- Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., C.T.D., A.F.Y., D.C., C.C., C.C., M.G.M., L.W.J.)
| | - Samantha M Thomas
- Duke University Medical Center, Durham, NC (S.M.T., J.E.H., P.S.D., M.G.K.)
| | - Jeffrey M Peppercorn
- Weill Cornell Medical College, New York, NY (J.M.S., C.T.D., L.W.J.).,Massachusetts General Hospital Cancer Center, Boston (J.M.P.)
| | - James E Herndon
- Duke University Medical Center, Durham, NC (S.M.T., J.E.H., P.S.D., M.G.K.)
| | - Pamela S Douglas
- Duke University Medical Center, Durham, NC (S.M.T., J.E.H., P.S.D., M.G.K.)
| | - Michel G Khouri
- Duke University Medical Center, Durham, NC (S.M.T., J.E.H., P.S.D., M.G.K.)
| | - Chau T Dang
- Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., C.T.D., A.F.Y., D.C., C.C., C.C., M.G.M., L.W.J.).,Weill Cornell Medical College, New York, NY (J.M.S., C.T.D., L.W.J.)
| | - Anthony F Yu
- Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., C.T.D., A.F.Y., D.C., C.C., C.C., M.G.M., L.W.J.)
| | - Diane Catalina
- Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., C.T.D., A.F.Y., D.C., C.C., C.C., M.G.M., L.W.J.)
| | - Cristi Ciolino
- Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., C.T.D., A.F.Y., D.C., C.C., C.C., M.G.M., L.W.J.)
| | - Catherine Capaci
- Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., C.T.D., A.F.Y., D.C., C.C., C.C., M.G.M., L.W.J.)
| | - Meghan G Michalski
- Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., C.T.D., A.F.Y., D.C., C.C., C.C., M.G.M., L.W.J.)
| | - Neil D Eves
- University of British Columbia, Kelowna, British Columbia, Canada (N.D.E.)
| | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., C.T.D., A.F.Y., D.C., C.C., C.C., M.G.M., L.W.J.).,Weill Cornell Medical College, New York, NY (J.M.S., C.T.D., L.W.J.)
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Shimizu Y, Tsuji K, Ochi E, Arai H, Okubo R, Kuchiba A, Shimazu T, Sakurai N, Narisawa T, Ueno T, Iwata H, Matsuoka Y. Study protocol for a nationwide questionnaire survey of physical activity among breast cancer survivors in Japan. BMJ Open 2020; 10:e032871. [PMID: 31964669 PMCID: PMC7044853 DOI: 10.1136/bmjopen-2019-032871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/15/2019] [Accepted: 12/16/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION A major concern is that few cancer survivors meet the guidelines for recommended levels of physical activity. No studies have investigated physical activity among breast cancer survivors nationwide in Japan. Therefore, the aims of this study are to identify the levels of physical activity among breast cancer survivors, to examine factors-related physical activity among breast cancer survivors and to identify breast cancer survivors' preferences for and interest in exercise programmes in order to inform the future programme development. METHODS AND ANALYSIS We will administer a cross-sectional survey using a self-report questionnaire to breast cancer survivors. At each of 50 facilities selected to include a variety of institutional backgrounds according to the population distribution of different regions throughout Japan, we will consecutively distribute the questionnaire to 30 outpatients who have completed initial treatments, except for hormone therapy. The target sample size is 1500 survivors. We will calculate descriptive statistics for each measurement item and perform univariate and multivariate analyses using outcome measures (eg, physical activity and quality of life) related to physical, psychological, social and environmental factors. DISCUSSION This is the first nationwide survey of physical activity levels among breast cancer survivors in Japan. Identifying the factors associated with physical activity will help us to develop, disseminate and implement programmes that encourage more survivors to adhere to physical activity guidelines. ETHICS AND DISSEMINATION The protocol was approved by the Institutional Review Board (IRB) of the National Cancer Center on 11 January 2019 (ID: 2018-295). In addition, many of the participating facilities required ethical approval from their local IRBs, while others did not. Accordingly, approval from the local IRBs of individual facilities was obtained when required. The findings will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Yoichi Shimizu
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Katsunori Tsuji
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Eisuke Ochi
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Faculty of Bioscience and Applied Chemistry, Hosei University, Koganei, Tokyo, Japan
| | - Hirokazu Arai
- Department of Psychology, Faculty of Letters, Hosei University, Chiyoda-ku, Tokyo, Japan
| | - Ryo Okubo
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Aya Kuchiba
- Division of Biostatistical Research, Center for Public Health Sciences, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center Hospital, Tokyo, Chuo-ku, Japan
| | - Taichi Shimazu
- Division of Prevention, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Chuo-ku, Japan
| | | | - Tomomi Narisawa
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | | | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yutaka Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Lifestyle Medicine, Cooperative Graduate Program, The Jikei University Graduate School of Medicine, Tokyo, Japan
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Campia U, Moslehi JJ, Amiri-Kordestani L, Barac A, Beckman JA, Chism DD, Cohen P, Groarke JD, Herrmann J, Reilly CM, Weintraub NL. Cardio-Oncology: Vascular and Metabolic Perspectives: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e579-e602. [PMID: 30786722 DOI: 10.1161/cir.0000000000000641] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardio-oncology has organically developed as a new discipline within cardiovascular medicine as a result of the cardiac and vascular adverse sequelae of the major advances in cancer treatment. Patients with cancer and cancer survivors are at increased risk of vascular disease for a number of reasons. First, many new cancer therapies, including several targeted therapies, are associated with vascular and metabolic complications. Second, cancer itself serves as a risk factor for vascular disease, especially by increasing the risk for thromboembolic events. Finally, recent data suggest that common modifiable and genetic risk factors predispose to both malignancies and cardiovascular disease. Vascular complications in patients with cancer represent a new challenge for the clinician and a new frontier for research and investigation. Indeed, vascular sequelae of novel targeted therapies may provide insights into vascular signaling in humans. Clinically, emerging challenges are best addressed by a multidisciplinary approach in which cardiovascular medicine specialists and vascular biologists work closely with oncologists in the care of patients with cancer and cancer survivors. This novel approach realizes the goal of providing superior care through the creation of cardio-oncology consultative services and the training of a new generation of cardiovascular specialists with a broad understanding of cancer treatments.
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Feng X, Higa GM, Safarudin F, Sambamoorthi U, Chang J. Prevalence and factors associated with potentially inappropriate medication use in older medicare beneficiaries with cancer. Res Social Adm Pharm 2019; 16:1459-1471. [PMID: 31926877 DOI: 10.1016/j.sapharm.2019.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/29/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the factors related to potentially inappropriate medication (PIM) use in elderly patients with cancer, as well as to compare the PIM prevalence in older adults with and without cancer. METHODS Data from the Surveillance, Epidemiology, and End Results-Medicare-linked base (2009-2011) were accessed to conduct a retrospective study comparing patients with cancers of the breast, colon/rectum, and prostate against a matched population of subjects without cancer. PIM use was defined based on the 2015 Beers Criteria and was quantified using prescription claims. Multivariable logistic regression models were used to assess the associations between the patients' characteristics, clinical factors, and PIM use in patients with cancer based on Beers criteria. Propensity score matching was applied to compare use of PIM in patients with versus without cancer. RESULTS PIM usage rates in patients with colorectal and breast cancers were significantly higher than non-cancer-bearing adults; the difference in PIM usage rate was not significantly different in the prostate cancer-matched cohort. The prevalence of inappropriate medication use in the three types of cancers evaluated was directly correlated with number of medications prescribed, treatment with chemotherapy, and co-morbid medical problems. CONCLUSION Patients diagnosed with cancer were more likely to use PIM compared with their non-cancer counterparts. The updated Beers criteria has the potential to serve as an important tool in geriatric oncology practice but it may still need to take into consideration different cancer types and their respective treatments.
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Affiliation(s)
- Xue Feng
- Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, WV, USA
| | - Gerald M Higa
- Department of Clinical Pharmacy, West Virginia University, School of Pharmacy, WV, USA.
| | - Fnu Safarudin
- Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, WV, USA; Department of Pharmacy, School of Mathematics and Natural Sciences, Tadulako University-Palu, Central Sulawesi, Indonesia
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, WV, USA
| | - Jongwha Chang
- Department of Pharmacy Practice, The University of Texas, School of Pharmacy, El Paso, TX, USA
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Okubo R, Wada S, Shimizu Y, Tsuji K, Hanai A, Imai K, Uchitomi Y, Fujiwara Y, Tsugane S, Matsuoka YJ. Expectations of and recommendations for a cancer survivorship guideline in Japan: a literature review of guidelines for cancer survivorship. Jpn J Clin Oncol 2019; 49:812-822. [PMID: 31095338 DOI: 10.1093/jjco/hyz070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/24/2019] [Accepted: 04/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Optimal cancer survivorship care needs its comprehensive guidelines. We aimed to identify English and Japanese guidelines that include cancer survivorship in their title, the issues highlighted in such guidelines, and any existing oncology practice guidelines in Japan that address these issues. METHODS This literature review was performed in three stages. First, guidelines published in English or Japanese that included cancer survivorship in the title were identified. Then, the issues that each cancer survivorship guideline addressed were defined. Lastly, Japanese guidelines that include survivorship issues were sought. RESULTS Six guidelines published in English addressed 31 cancer survivorship issues. No specific cancer survivorship guideline was available in Japanese. Thirty-four Japanese guidelines mentioned cancer survivorship issues. These guidelines addressed screening/surveillance for detecting recurrence or secondary cancer but did not address coordination of care, implications for practice, or inclusion of family. At present, Japanese guidelines poorly address the issue of promotion of a healthy lifestyle in cancer survivors. Also, poorly addressed were long-term and late effects such as pain, psychological distress, fatigue, cognitive dysfunction, cardiovascular effects (including anthracycline-induced cardiac toxicity), sleep disorders, and sexual dysfunction in cancer survivors. CONCLUSION There is a need for guidelines on optimal coordination of care between oncologists and other health care providers to support patients along the cancer care continuum and specifically to encourage a healthy lifestyle as part of cancer survivorship. The development of a comprehensive Japanese guideline that addresses these issues would help to improve the clinical outcome for cancer survivors in Japan.
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Affiliation(s)
- Ryo Okubo
- Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Saho Wada
- Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yoichi Shimizu
- Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Katsunori Tsuji
- Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Akiko Hanai
- Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Kenjiro Imai
- Division of Health Services Research, Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Yosuke Uchitomi
- Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yasuhiro Fujiwara
- Strategic Planning Bureau, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Shoichiro Tsugane
- Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yutaka J Matsuoka
- Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
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Matsuoka YJ, Okubo R, Shimizu Y, Tsuji K, Narisawa T, Sasaki J, Sasai H, Akashi-Tanaka S, Hamaguchi T, Iwasa T, Iwata S, Kato T, Kurotani K, Maruyama D, Mori A, Ogawa A, Sakurai N, Shimazu T, Shimizu C, Tabuchi T, Takahashi M, Takano T, Tatematsu N, Uchitomi Y, Watanabe C, Fukui T. Developing the structure of Japan's cancer survivorship guidelines using an expert panel and modified Delphi method. J Cancer Surviv 2019; 14:273-283. [PMID: 31811478 DOI: 10.1007/s11764-019-00840-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/23/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop consensus-based components used in the first evidence-based cancer survivorship guidelines in Japan. METHODS Purposive sampling was used to recruit a panel of experts in oncology clinical practice, nursing, health science, epidemiology, and patient advocacy. The panel engaged in a modified Delphi process to (1) generate consensus related to the definition of survivorship, (2) determine the aim and target users of the guideline, and (3) identify clinical issues for inclusion. A Web-based survey and panel meeting were conducted to obtain the panelists' feedback on the initial draft proposed by the secretariat. Multiple online votes were then completed until all elements of the proposed guidelines reached an approval rate of 80% or higher. Following each round, iterative refinements were made based on all panelists' feedback. RESULTS Twenty-two experts were enrolled in the panel and participated in four rounds of online voting and two face-to-face meetings. Ultimately, the panel reached consensus on the definition of survivorship, the aim of the guidelines, and target users. Moreover, 11 of the original 17 clinical issues were retained. Finally, the panel selected two priority areas to implement immediately. CONCLUSION The panel's consensus on the definition of survivorship, aim and target users of the guideline, and 11 clinical issues will serve as a compass for the development of comprehensive cancer survivorship guidelines in Japan. IMPLICATIONS FOR CANCER SURVIVORS A culturally sensitive consensus approach was developed to improve the long term health and well- being of cancer survivors in Japan.
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Affiliation(s)
- Yutaka J Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan.
| | - Ryo Okubo
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
| | - Yoichi Shimizu
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
- Department of Nursing, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Katsunori Tsuji
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
| | - Tomomi Narisawa
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hiroyuki Sasai
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 153-8902, Japan
| | - Sadako Akashi-Tanaka
- Department of Breast Surgery Oncology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, Comprehensive Cancer Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Takeshi Iwasa
- Department of General Internal Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
| | - Satoshi Iwata
- Department of Infectious Disease, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kayo Kurotani
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Ayako Mori
- Department of Nursing, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Asao Ogawa
- Department of Psycho-Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan
| | - Naomi Sakurai
- Cancer Solutions Co., Ltd., 2-9-401 Kandanishikicho Chiyoda-ku, Tokyo, 101-0054, Japan
| | - Taichi Shimazu
- Division of Prevention, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Chikako Shimizu
- Department of Breast and Medical Oncology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Takahiro Tabuchi
- Osaka International Cancer Institute, Cancer Control Center, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Miyako Takahashi
- Division of Cancer Survivorship Research, Center for Cancer Control and Information Services, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Tokyo, 105-8470, Japan
| | - Noriatsu Tatematsu
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Chie Watanabe
- Department of Nursing, Faculty of Human Sciences, Sophia University, 7-1 Kioi-cho Chiyoda-ku, Tokyo, 102-8554, Japan
| | - Tsuguya Fukui
- St. Luke's International Hospital, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
- St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
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Integration of the National Comprehensive Cancer Network (NCCN) Distress Screening Tool as a Guidepost for Telephonic Oncology Case Management. Prof Case Manag 2019; 24:148-154. [PMID: 30946253 DOI: 10.1097/ncm.0000000000000336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF STUDY Cigna's oncology case management programs identified the opportunity for case managers to integrate distress screening as recommended by the National Comprehensive Cancer Network (NCCN) in oncology populations. Our purpose in conducting this study was to quantify oncology case management program improvements as a result of using the NCCN Distress Screening Tool to guide telephonic case management. The program improvements we measured comprised more efficient identification of biopsychosocial problems and appropriate resource referrals. PRIMARY PRACTICE SETTING Case managers in a large commercial health plan piloted integration of distress screening into telephonic case management among U.S. oncology customers experiencing a new diagnosis or care transition from September 2016 to April 2017. METHODOLOGY AND SAMPLE A retrospective, matched case-control study was conducted among Cigna customers eligible for oncology case management. The pilot group of 317 received distress screening early in the oncology case management assessment. Outcomes included distress severity ranging from 0 to 10 (where 0 = no distress, 1-3 = mild, 4-7 = moderate, and 8-10 = severe), identification and number of biopsychosocial health problems, and percentage of direct resource referrals by case managers to supportive services. RESULTS More than half (54%) of the screened customers reported mild or greater distress, and there was a strong correlation between degree of distress and average numbers of biopsychosocial health problems or direct resource referrals. Screened customers were 16% more likely to be referred to internal and external resources than customers not screened with the tool (66% vs. 50%, χp < .001). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE This study advances evidence-based oncology case management practice during care transitions by providing quantitative evidence for the utility of integrating the NCCN Distress Screening Tool into telephonic oncology case management. Using the tool (thermometer and problem list) to guide telephonic oncology case management and care coordination facilitated more tailored referrals to individuals with cancer enrolled in a large commercial health plan. On the basis of our findings, we integrated distress screening to address unmet biopsychosocial needs in patients with cancer.
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Tsuji K, Ochi E, Okubo R, Shimizu Y, Kuchiba A, Ueno T, Shimazu T, Kinoshita T, Sakurai N, Matsuoka Y. Effect of home-based high-intensity interval training and behavioural modification using information and communication technology on cardiorespiratory fitness and exercise habits among sedentary breast cancer survivors: habit-B study protocol for a randomised controlled trial. BMJ Open 2019; 9:e030911. [PMID: 31444192 PMCID: PMC6707761 DOI: 10.1136/bmjopen-2019-030911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Maintaining high levels of physical activity helps to maintain and improve physical health and quality of life, and plays a role in reducing adverse effects due to cancer treatments. Moreover, a greater degree of cardiorespiratory fitness is associated with reduced risk of all-cause mortality. However, there are no home-based programme for improving cardiorespiratory fitness using body weight exercises for breast cancer survivors. This study will assess the efficacy of the newly developed habit-B programme on maximum oxygen uptake compared with treatment as usual with wearable device. The effects of this programme on exercise habits, level of physical activity, physical fitness and subjective indices will also be investigated. METHODS AND ANALYSIS This is a 12-week, parallel-group, single-blind, randomised controlled trial. Allocation will be managed by a central server using a computer-generated random allocation sequence provided by an independent data centre. Participants will be assigned to the habit-B programme (high-intensity interval training, exercise counselling + guidance, home-based exercise support using information and communication technology, and a wearable device) or treatment as usual with a wearable device. Subjects will be sedentary women aged 20-59 years who have received breast surgery in the past 2-13 months after the diagnosis of invasive breast cancer (stages I-IIa) and have never received chemotherapy except for hormone therapy. The primary endpoint is the change in peak oxygen uptake (VO2peak; mL/kg/min) between the groups after 12 weeks of intervention. ETHICS AND DISSEMINATION The study protocol was approved by the Institutional Review Board of the National Cancer Center Japan on 28 February 2019 (ID: 2018-347). The findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER UMIN000036400.
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Affiliation(s)
- Katsunori Tsuji
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Eisuke Ochi
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Faculty of Bioscience and Applied Chemistry, Hosei University, Koganei, Tokyo, Japan
| | - Ryo Okubo
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Yoichi Shimizu
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Aya Kuchiba
- Division of Biostatistical Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center Japan, Tokyo, Japan
| | | | - Taichi Shimazu
- Division of Prevention, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yutaka Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Lifestyle Medicine, Cooperative Graduate Program, The Jikei University Graduate School of Medicine, Tokyo, Japan
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45
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Abstract
Introduction: Breast cancer is heterogeneous with distinct clinical outcomes. Diverse types of markers are available on the market for breast cancer prognosis, diagnosis, and therapeutics, with distinct assay approaches. These, though they enlarge our selection pool for characterizing breast cancer patients and help improve the precision on the therapeutics, they can complicate our understanding and choice of marker panels. Areas covered: This review aims at classifying the commonly used marker panels according to their functionalities and detection approaches, comparing their advantages and disadvantages, and identifying their shared features to gain a comprehensive understanding of the diversified molecular profiles that drive breast cancer heterogeneity. Expert opinion: Our effort will contribute as a guidebook for clinicians on the use of breast cancer signature panels for disease management, and for researchers on the establishment of novel marker panels with improved precision and reduced complexity. We propose that collectively analyzing all available marker panels is equally important as investigating on entirely novel marker panels. Advances in technologies capturing signals from multiple levels are of practical importance in breaking through limitations on translating markers into clinical use.
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Affiliation(s)
- Zhen Wang
- Wuxi School of Medicine, Jiangnan University , Wuxi , China
| | - Xuanhao Zhang
- School of Biotechnology, Jiangnan University , Wuxi , China
| | - Shuo Zhang
- School of Biotechnology, Jiangnan University , Wuxi , China
| | - Xiaofeng Dai
- Wuxi School of Medicine, Jiangnan University , Wuxi , China
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46
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Hall DL, Jimenez RB, Perez GK, Rabin J, Quain K, Yeh GY, Park ER, Peppercorn JM. Fear of Cancer Recurrence: A Model Examination of Physical Symptoms, Emotional Distress, and Health Behavior Change. J Oncol Pract 2019; 15:e787-e797. [PMID: 31298966 DOI: 10.1200/jop.18.00787] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Fear of cancer recurrence is highly prevalent among adult survivors of cancer. The role of fear of recurrence in the emotional distress of survivors of cancer, as well as health behaviors that may directly affect their health, remains unclear. To advance oncology practice, this study sought to examine the extent to which fear of recurrence stemming from physical symptoms accounts for emotional distress in a large sample of adult survivors of cancer and to extend the model to explain postdiagnosis self-reported health behavior change. METHODS In 2016, 258 survivors of cancer at an academic hospital completed a survey of psychosocial needs. Items assessed physical symptoms (checklist), fear of cancer recurrence (Assessment of Survivor Concerns), emotional distress (anxiety and depressed mood), and health behaviors (current alcohol use, physical activity, diet, and sunscreen use, as well as changes after cancer diagnosis) informed by National Comprehensive Cancer Network survivorship guidelines. Indirect effects regression models accounting for relevant covariates (age and treatment history) used 5,000-iteration bootstrapping. RESULTS Higher fear of cancer recurrence was associated with greater number of physical symptoms (P < .001), greater emotional distress (P < .05), lower moderate or vigorous physical activity (P < .05), higher sunscreen use (P < .05), and postdiagnosis increases in alcohol use (P < .01) and reductions in physical activity (P < .01). Fear of cancer recurrence models accounted for almost half of the variance in distress of survivors of cancer (R2 = 0.44, P < .001) and, to a lesser yet significant extent, changes in alcohol consumption (R2 = 0.09, P < .001) and physical activity (R2 = 0.06, P = .003). CONCLUSION Fear of cancer recurrence plays a central role in the emotional distress and key health behaviors of survivors of cancer. These findings support fear of cancer recurrence as a potential target for emotional health and health behavior change interventions.
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Affiliation(s)
- Daniel L Hall
- Harvard Medical School/Massachusetts General Hospital, Boston, MA.,Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA
| | - Rachel B Jimenez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
| | - Giselle K Perez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA.,Mongan Health Policy Research Center, Massachusetts General Hospital, Boston, MA
| | - Julia Rabin
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
| | - Katharine Quain
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
| | - Gloria Y Yeh
- Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA
| | - Elyse R Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA.,Mongan Health Policy Research Center, Massachusetts General Hospital, Boston, MA
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47
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Santa Mina D, Au D, Auger LE, Alibhai SMH, Matthew AG, Sabiston CM, Oh P, Ritvo PG, Chang EB, Jones JM. Development, implementation, and effects of a cancer center's exercise‐oncology program. Cancer 2019; 125:3437-3447. [DOI: 10.1002/cncr.32297] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 05/13/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Daniel Santa Mina
- Faculty of Kinesiology and Physical Education University of Toronto Toronto Ontario Canada
- Department of Supportive Care Princess Margaret Cancer Centre Toronto Ontario Canada
- Faculty of Medicine University of Toronto Toronto Ontario Canada
| | - Darren Au
- Faculty of Kinesiology and Physical Education University of Toronto Toronto Ontario Canada
- Department of Supportive Care Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Leslie E. Auger
- Kinesiology Program University of Guelph‐Humber Toronto Ontario Canada
| | - Shabbir M. H. Alibhai
- Faculty of Medicine University of Toronto Toronto Ontario Canada
- Toronto General Research Institute Toronto General Hospital Toronto Ontario Canada
| | - Andrew G. Matthew
- Department of Supportive Care Princess Margaret Cancer Centre Toronto Ontario Canada
- Faculty of Medicine University of Toronto Toronto Ontario Canada
- Department of Surgery, Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Catherine M. Sabiston
- Faculty of Kinesiology and Physical Education University of Toronto Toronto Ontario Canada
| | - Paul Oh
- Faculty of Medicine University of Toronto Toronto Ontario Canada
- Cardiovascular Prevention and Rehabilitation Program Toronto Rehabilitation Institute Toronto Ontario Canada
| | - Paul G. Ritvo
- School of Kinesiology and Health Sciences York University Toronto Ontario Canada
| | - Eugene B. Chang
- Department of Supportive Care Princess Margaret Cancer Centre Toronto Ontario Canada
- Faculty of Medicine University of Toronto Toronto Ontario Canada
| | - Jennifer M. Jones
- Department of Supportive Care Princess Margaret Cancer Centre Toronto Ontario Canada
- Faculty of Medicine University of Toronto Toronto Ontario Canada
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48
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Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review. Endocr Rev 2019; 40:711-767. [PMID: 30476004 DOI: 10.1210/er.2018-00092] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
The number of patients surviving ≥5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.
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Affiliation(s)
- Judith Gebauer
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Thorsten Langer
- Division of Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christian Denzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Ulm University Medical Center, Ulm, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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49
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Chrischilles EA, Riley D, Letuchy E, Koehler L, Neuner J, Jernigan C, Gryzlak B, Segal N, McDowell B, Smith B, Sugg SL, Armer JM, Lizarraga IM. Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network. Breast Cancer Res Treat 2019; 175:675-689. [PMID: 30852760 PMCID: PMC6534523 DOI: 10.1007/s10549-019-05184-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of breast cancer patients and examines its relationship with personal and treatment factors and QoL. METHODS Eight hundred and thirty-three women diagnosed at eight medical institutions during 2013-2014 with microscopically confirmed ductal carcinoma in situ or invasive stage I-III breast cancer were surveyed an average of 22 months after diagnosis. UED was measured with a modified QuickDASH and QoL with the FACT-B. The questionnaire also collected treatments, sociodemographic information, comorbidity, body mass index, and a 3-item health literacy screener. RESULTS Women who received post-mastectomy radiation and chemotherapy experienced significantly worse UED and QoL. Women who had lower income, lower health literacy and prior diabetes, arthritis or shoulder diagnoses had worse UED. Patients with worse UED reported significantly worse QoL. Income and health literacy were independently associated with QoL after adjustment for UED but treatment and prior conditions were not, indicating mediation by UED. UED mediated 52-79% of the effect of mastectomy-based treatments on QoL as compared with unilateral mastectomy without radiation. UED and QoL did not differ by type of axillary surgery or post-mastectomy reconstruction. CONCLUSIONS A large portion of treatment effect on QoL is mediated by UED. Rehabilitation practices that prevent and alleviate UED are likely to improve QoL for breast cancer survivors.
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Affiliation(s)
- Elizabeth A Chrischilles
- University of Iowa College of Public Health, Iowa City, IA, USA.
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA.
- College of Public Health, University of Iowa, S424 CPHB, 145 N. Riverside Dr., Iowa City, IA, 52242-2007, USA.
| | - Danielle Riley
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Elena Letuchy
- University of Iowa College of Public Health, Iowa City, IA, USA
| | | | - Joan Neuner
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Brian Gryzlak
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Neil Segal
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Bradley McDowell
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Brian Smith
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Sonia L Sugg
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jane M Armer
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA
| | - Ingrid M Lizarraga
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
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50
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Reese JB, Lepore SJ, Daly MB, Handorf E, Sorice KA, Porter LS, Tulsky JA, Beach MC. A brief intervention to enhance breast cancer clinicians' communication about sexual health: Feasibility, acceptability, and preliminary outcomes. Psychooncology 2019; 28:872-879. [PMID: 30811732 DOI: 10.1002/pon.5036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Sexual concerns are often unaddressed for breast cancer patients; one reason is inadequate clinician training. We examined the feasibility, acceptability, and potential benefits of a novel intervention, improving Sexual Health and Augmenting Relationships through Education (iSHARE) for breast cancer clinicians. METHODS Clinicians received training in communicating about sexual concerns with breast cancer patients. Intervention feasibility and acceptability were measured through enrollment/participation and postintervention program evaluations, respectively. Intervention effects were assessed through (1) clinician self-reported beliefs about sexual health communication, assessed at baseline, post-intervention, and 1- or 6-month follow-up, (2) clinical communication coded from audio recorded, transcribed clinic encounters at preintervention or postintervention, and (3) patient satisfaction with clinical care, reported immediately after the clinic visit. Patients also reported sociodemographic characteristics and level of sexual concerns. RESULTS Seven breast cancer clinicians enrolled (88% participation), completed the intervention, and were audio recorded in clinic encounters with 134 breast cancer outpatients (67 each at preintervention or postintervention). Program evaluations supported intervention acceptability. Effect sizes suggest iSHARE increased clinicians' self-efficacy (d = 0.27) and outcome expectancies for communicating about sexual concerns (d = 0.69) and reduced communication barriers (d = -0.14). Clinicians' sexual health communication behaviors increased from baseline to postintervention, including for raising the topic (28% vs 48%), asking questions (33% vs 45%), and offering information (18% vs 24%). Neither patient satisfaction nor duration of sexual health communication changed (mean duration less than 1 minute at both time points). CONCLUSIONS The iSHARE intervention was feasible and well received by clinicians and may change breast cancer clinicians' beliefs and communication behaviors regarding sexual health.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Stephen J Lepore
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth Handorf
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mary Catherine Beach
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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