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Santos P, Chakraborty N, Salz T, Curry M, Vicioso NL, Mathis NJ, Caron M, Ostroff J, Guttman D, Salner AL, Panoff JE, McIntosh AF, Pfister DG, Yang JT, Snyderman AL, Gillespie EF. Implementation Outcomes of Strategies to Promote Short-Course Radiation for Nonspine Bone Metastases in an Academic-Community Partnership: Survey Results from the ALIGNMENT Trial. Int J Radiat Oncol Biol Phys 2023; 117:S124-S125. [PMID: 37784321 DOI: 10.1016/j.ijrobp.2023.06.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Local treatment of nonspine bone metastases has become increasingly complex, resulting in physician practice variability nationwide. The purpose of this study was to assess physician perceptions of 3 implementation strategies to promote adoption of short course radiotherapy (RT) for nonspine bone metastases. MATERIALS/METHODS ALIGNMENT ("Alliance Group for Bone Metastasis") was a multi-institutional stepped wedge cluster randomized implementation trial testing strategies to increase use of ≤5 fractions for nonspine bone metastases conducted across 3 clinical sites in an academic-community partnership. Strategies included a) multidisciplinary consensus guidelines, b) e-Consults, an email-based consultation platform, and c) personalized audit and feedback (A&F) reports with peer comparison. Using the Proctor et al. framework and validated questions from Weiner et al., physician surveys were used to assess each strategy's usefulness, acceptability (i.e., "I welcome [strategy]"), appropriateness (i.e., "[strategy] seems like a good match"), and feasibility (i.e., "[strategy] seems implementable" or "easy to use"). Survey responses were anonymized, so Fisher's Exact test was used to compare proportions with significance set at p<0.05. RESULTS Overall, 29 of 38 and 30 of 38 physicians participated in the pre- and post-implementation surveys, respectively, with 80% completing both. Pre-implementation, guidelines was most often ranked 1st in terms of usefulness (61%), followed by eConsults (38%) and A&F (3%). Post-implementation, guidelines and eConsults had the most and least favorable acceptability, appropriateness, and feasibility scores, respectively (Table), with 77% of physicians being likely to recommend the guidelines to other oncologists. In contrast, while 43% of physicians reported having at least 1 difficult clinical question regarding bone metastases during the study, only 33% of physicians preferred eConsults, while 50% preferred reaching out to a friend/colleague. Lastly, although A&F had the lowest perceived usefulness pre-implementation, A&F had the greatest increase in acceptability (72%→90%; p = 0.10), appropriateness (66%→90%; p = 0.03) feasibility ("implementable": 59%→93%, p = 0.002; "easy to use": 45%→93%, p<0.001). CONCLUSION In this multicenter trial, all strategies were acceptable, appropriate, and feasible, with guidelines and A&F showing the most favorable outcomes post-implementation. While guidelines were assessed as the most useful, A&F had significant increases in appropriateness and feasibility.
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Affiliation(s)
- P Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Harvard T.H. Chan School of Public Health, Boston, MA
| | - N Chakraborty
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Curry
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Ledesma Vicioso
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - N J Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Caron
- Strategic Partnerships, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Guttman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A L Salner
- Hartford HealthCare Cancer Institute, Hartford, CT
| | - J E Panoff
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - A F McIntosh
- Allentown Radiation Oncology Associates, Allentown, PA, United States
| | - D G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J T Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiation Oncology, University of Washington, Seattle, WA
| | - A Lipitz Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - E F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiation Oncology, University of Washington, Seattle, WA
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Mitchell AP, Persaud S, Chimonas S, Salner AL, Palyca P, Farooki A, Ostroff JS, Morris MJ. Barriers to guideline-concordant use of bone modifying agents for prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
68 Background: NCCN Guidelines recommend the use of bone-modifying agents (BMAs) to prevent skeletal-related events (SRE) for patients with castrate-resistant prostate cancer (CRPC) and bone metastasis, but not for castrate-sensitive prostate cancer (CSPC). Prior studies have identified both underuse of BMAs for CRPC and overuse for CSPC, but the clinical circumstances underlying these apparent gaps in care are unknown. Methods: Qualitative interview study, with physicians who treat prostate cancer within an academic cancer center and an affiliated network of community-based practices. Using a semi-structured interview guide, an experienced moderator probed participants’ experiences and perceptions around NCCN Guidelines recommendations, guideline adherence and non-adherence, and barriers to adherence. Interviews also probed participants’ views of potential interventions to promote guideline-concordant BMA use. Participants used Likert-scale items to rate the likely effectiveness of each intervention in influencing BMA practice patterns. They also identified the 3 most helpful interventions for reducing BMA underuse and overuse separately. Results: 19 physicians were invited, of whom 15 agreed to participate; 1 physician did not respond to some questions as outside scope of practice. All were aware of the recommendation for use of BMAs in CRPC. 14% (2/14) were unaware of the recommendation against BMA use for CSPC; an additional 29% (4/14) believed that BMA use could be appropriate for CSPC depending on the burden of bony metastatic disease. 36% (5/14) were unaware of recommendations for baseline DEXA scan and BMA for patients with low bone mineral density. The most commonly reported barriers (occurring “often” or “sometimes”) to BMA use for CRPC were obtaining dental clearance (11/15) and insufficient time in clinic (6/15). The interventions perceived as most helpful to reduce underuse for CRPC were dental navigation (11/15) and EMR-based guidance (9/15). The interventions identified as most helpful to reduce overuse for CSPC were peer-to-peer education (14/15) and EMR-based guidance (13/15). Conclusions: Among physicians treating prostate cancer in our study, there was incomplete awareness of guideline recommendations for screening and treatment of low bone mineral density, and against BMA use for SRE prevention in CSPC. Dental navigation, peer-to-peer education, and EMR-based guidance were preferred implementation strategies to reduce underuse and overuse of BMAs.
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Affiliation(s)
| | - Sonia Persaud
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Paul Palyca
- Lehigh Valley Topper Cancer Institute, Bethlehem, PA
| | - Azeez Farooki
- Memorial Sloan Kettering Cancer Center, New York, NY
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Ozcan G, Braish J, Mohammed TJ, Hong C, Mott N, Eanniello M, Shahrokni A, Salner AL, Yu PP, Nipp RD, Elias R. Home-based geriatric oncology care: A feasibility study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
62 Background: The Comprehensive Geriatric Assessment (CGA) improves the outcomes of older patients with cancer, and by identifying of geriatric impairments the CGA can guide the development of supportive interventions. However, the implementation of these interventions in a real-world setting can be burdensome for patients, particularly when additional visits are required in an often frail population. Therefore, our team developed a collaborative model for home-based delivery of CGA-guided interventions. Methods: We performed a retrospective review of community-dwelling patients aged ≥ 70 years with an active cancer diagnosis who were deemed to be frail by a CGA and who received home-based CGA-guided supportive interventions under a collaborative care model established by the geriatric oncology and the palliative home care teams at Hartford HealthCare Cancer Institute between October 2020 and April 2022. The collaboration is based on multidisciplinary discussion of the CGA results / interventions and weekly rounds to discuss patient’s progress and emerging needs. Results: A total of 182 patients received a CGA during the study period, 54% (n = 99) were determined to be frail based on impairment in ≥ 7 geriatric domains. Among all eligible patients, 19 patients (19%) were included in the collaborative model. The median age of enrolled patients was 84 years (74-90), 12/19 (63%) had metastatic cancer, 7/19 (37%) received systemic treatment, and 8/19 (42%) received radiation. The average number of geriatric impairments per patients was 9.5 (7-12). Geriatric impairments addressed at home were skilled nursing (19/19), physical therapy (18/19), occupational therapy (12/19), speech-language-pathology (2/19), nutrition (5/19), or social worker (11/19) support at home. The average number of unplanned hospitalizations was 1.16 per patient (range 0-4), and the average unplanned emergency room visit was 0.89 per person (range 0-4) during study time. Transition to hospice occurred in 8/19 patients (42%), the median time to transition to hospice was 33.5 days (15-167). Conclusions: This study demonstrates the feasibility of a collaborative model for home-based geriatric oncology care in a real-world setting to help reduce the burden of care on patients and ensure patient-centered delivery of CGA-guided interventions. Findings underscore the need for future work to evaluate the impact of this novel geriatric oncology care model on patient outcomes.
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Affiliation(s)
| | - Julie Braish
- University of Connecticut Health Center, Farmington, CT
| | | | - Catriona Hong
- University of Connecticut School of Medicine, Farmington, CT
| | | | | | | | | | | | | | - Rawad Elias
- Hartford HealthCare Cancer Institute, Hartford, CT
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4
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Ledesma Vicioso N, Lin D, Gomez DR, Yang JT, Lee NY, Rimner A, Yamada Y, Zelefsky MJ, Kalman NS, Rutter CE, Kotecha RR, Mehta MP, Panoff JE, Chuong MD, Salner AL, Ostroff JS, Diamond LC, Mathis NJ, Cahlon O, Pfister DG, Zhang Z, Chino F, Tsai J, Gillespie EF. Implementation Strategies to Increase Clinical Trial Enrollment in a Community-Academic Partnership and Impact on Hispanic Representation: An Interrupted Time Series Analysis. JCO Oncol Pract 2022; 18:e780-e785. [PMID: 35544650 PMCID: PMC10166438 DOI: 10.1200/op.22.00037] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Community-academic partnerships have the potential to improve access to clinical trials for under-represented minority patients who more often receive cancer treatment in community settings. In 2017, the Memorial Sloan Kettering (MSK) Cancer Center began opening investigator-initiated clinical trials in radiation oncology in targeted community-based partner sites with a high potential to improve diverse population accrual. This study evaluates the effectiveness of a set of implementation strategies for increasing overall community-based enrollment and the resulting proportional enrollment of Hispanic patients on trials on the basis of availability in community-based partner sites. METHODS An interrupted time series analysis evaluating implementation strategies was conducted from April 2018 to September 2021. Descriptive analysis ofHispanic enrollment on investigator-initiated randomized therapeutic radiation trials open at community-based sites was compared with those open only at themain academic center. RESULTS Overall, 84 patients were enrolled in clinical trials in the MSK Alliance, of which 48 (56%) identified as Hispanic. The quarterly patient enrollment pre- vs postimplementation increased from 1.39 (95% CI, -3.67 to 6.46) to 9.42 (95% CI, 2.05 to 16.78; P5 .017). In the investigator-initiated randomized therapeutic radiation trials open in the MSK Alliance, Hispanic representation was 11.5% and 35.9% in twometastatic trials and 14.2% in a proton versus photon trial. Inmatched trials open only at the main academic center, Hispanic representation was 5.6%, 6.0%, and 4.0%, respectively. CONCLUSION A combination of practice-level and physician-level strategies implemented at community-based partner sites was associated with increased clinical trial enrollment, which translated to improved Hispanic representation. This supports the role Q:2 of strategic community-academic partnerships in addressing disparities in clinical trial enrollment.
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Affiliation(s)
| | - Diana Lin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan T Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Noah S Kalman
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | | | - Rupesh R Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - Joseph E Panoff
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | | | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lisa C Diamond
- Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Noah J Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David G Pfister
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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5
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Anderson AJ, Starkweather A, Cong X, Xu W, Judge MP, Schulman-Green D, Zhang Y, Salner AL, Dornelas EA. A Descriptive Survey Study of Patient Needs and Preferences for Cancer Pain Self-Management Support. Oncol Nurs Forum 2022; 49:46-57. [PMID: 34914676 DOI: 10.1188/22.onf.46-57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To characterize the needs and preferences for pain self-management support (SMS) among patients with cancer during the transition of cancer care from the hospital to the home setting. SAMPLE & SETTING 38 participants with cancer pain at a research-intensive cancer center in New England. METHODS & VARIABLES A descriptive, cross-sectional survey study was conducted to investigate relationships among preferred and received support, extent and management of transitional change, and pain outcomes. Pain intensity and interference were measured using the Brief Pain Inventory-Short Form, transitional change was measured using the Measurement of Transitions in Cancer Scale, and SMS was measured using dichotomous questions. RESULTS About half of participants reported concordance between preferred and received cancer pain SMS in the hospital and at home. The extent of transitional change in cancer care was found to be a significant predictor of average pain intensity in the hospital and pain interference at home. Satisfaction with cancer pain SMS was a significant predictor of pain intensity at home. IMPLICATIONS FOR NURSING The extent of change during care transitions should be considered when fulfilling patient needs and preferences for cancer pain SMS to optimize outcomes.
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Salz T, Ostroff JS, Nightingale CL, Atkinson TM, Davidson EC, Jinna SR, Kriplani A, Lesser GJ, Lynch KA, Mayer DK, Oeffinger KC, Patil S, Salner AL, Weaver KE. The Head and Neck Survivorship Tool (HN-STAR) Trial (WF-1805CD): A protocol for a cluster-randomized, hybrid effectiveness-implementation, pragmatic trial to improve the follow-up care of head and neck cancer survivors. Contemp Clin Trials 2021; 107:106448. [PMID: 34023515 DOI: 10.1016/j.cct.2021.106448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
Survivors of head and neck cancer (HNC) can have multiple health concerns. To facilitate their care, we developed and pilot-tested a clinical informatics intervention, HN-STAR. HN-STAR elicits concerns online from HNC survivors prior to a routine oncology clinic visit. HN-STAR then presents tailored evidence-based clinical recommendations as a clinical decision support tool to be used during the visit where the oncology clinician and survivor select symptom management strategies and other actions. This generates a survivorship care plan (SCP). Online elicitation of health concerns occurs 3, 6, and 9 months after the clinic visit, generating an updated SCP each time. HN-STAR encompasses important methods of improving survivorship care (e.g., needs assessment, tailored interventions, dissemination of guidelines) and will be evaluated in a pragmatic trial to maximize external validity. This hybrid type 1 implementation-effectiveness trial tests HN-STAR effectiveness while studying barriers and facilitators to implementation in community oncology practices within the National Cancer Institute Community Oncology Research Program. Effectiveness will be measured as differences in key survivorship outcomes between HNC participants who do and do not use HN-STAR over one year after the clinic visit. The primary endpoint is HNC-specific quality of life; other outcomes include patient-centered measures and receipt of guideline-concordant care. Implementation outcomes will be assessed of survivors, providers, and clinic stakeholders. The hybrid design will provide insight into a dose-response relationship between the extent of implementation fidelity and effectiveness outcomes, as well as how to incorporate HN-STAR into standard practice outside the research setting.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA.
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Chandylen L Nightingale
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Thomas M Atkinson
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Eleanor C Davidson
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Sankeerth R Jinna
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Glenn J Lesser
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Kathleen A Lynch
- Memorial Sloan Kettering Cancer Center, 1275 York Street, New York, NY 10065, USA
| | - Deborah K Mayer
- University of North Carolina Lineberger Comprehensive Cancer Center, 450 West Dr, Chapel Hill, NC 27599, USA
| | - Kevin C Oeffinger
- Duke Cancer Institute, 2424 Erwin Dr, Suite 601, Durham, NC 27705, USA
| | - Sujata Patil
- The Cleveland Clinic Foundation, 9500 Euclid Avenue, CA6-160, Cleveland, OH 44195, USA
| | - Andrew L Salner
- Hartford HealthCare Cancer Institute at Hartford Hospital, 79 Retreat Ave, Hartford, CT 06106, USA
| | - Kathryn E Weaver
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Mathis NJ, Yang JT, Vaynrub M, Santos Martin E, Kotecha R, Panoff J, Salner AL, McIntosh AF, Gupta R, Gulati A, Yerramilli D, Xu A, Bartelstein M, Guttmann D, Yamada Y, Pfister DG, Lin D, Lapen K, Lipitz-Snyderman A, Gillespie EF. Multidisciplinary consensus recommendations for the management of non-spine bone metastases: Results of a modified Delphi process in a community-academic partnership. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e24092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24092 Background: Local therapy for bone metastases is becoming increasingly complex, but national guidelines remain limited. We leveraged a community-academic partnership to develop consensus recommendations for multidisciplinary treatment of non-spine bone metastases which are generalizable to diverse practice settings. Methods: We convened a group of 15 physicians (9 radiation oncologists, 2 orthopaedic surgeons, 2 medical oncologists, 1 interventional radiologist, 1 interventional pain specialist) treating bone metastases across 4 institutions from Apr 2020-Feb 2021. We distributed a survey to identify questions warranting consensus development in the treatment of non-spine bone metastases. A literature review was conducted to inform answer statements, and evidence was rated using the Strength of Recommendation Taxonomy. A modified Delphi process was employed to reach consensus defined (a priori) as ³75% of respondents indicating “agree” or “strongly agree”. Results: A total of 16 questions were identified, including indications for multidisciplinary discussion or referral (n=4), appropriate use and duration of RT (n=4), and handling of systemic therapies during RT (n=5). After 2 rounds of modified Delphi process, consensus has been reached on 9 questions (see Table). Strength of Recommendation was rated A (1/9, 11%), B (5/9, 56%), or C (3/9, 33%). Conclusions: Our consensus process provides guidance for management of non-spine bone metastases that expands upon current guidelines. We also highlight areas where prospective trials are needed, including the role of RT prior to stabilization surgery and the selection of patients for ablative treatment. [Table: see text]
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Affiliation(s)
- Noah J Mathis
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Diana Lin
- Penn State College of Medicine, Hershey, PA
| | - Kaitlyn Lapen
- Memorial Sloan Kettering Cancer Center, New York, NY
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Dugan AG, Decker RE, Namazi S, Cavallari JM, Bellizzi KM, Blank TO, Dornelas EA, Tannenbaum SH, Shaw WS, Swede H, Salner AL. Perceptions of clinical support for employed breast cancer survivors managing work and health challenges. J Cancer Surviv 2021; 15:890-905. [PMID: 33405056 DOI: 10.1007/s11764-020-00982-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/12/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE A substantial portion of breast cancer survivors are active in the workforce, yet factors that allow survivors to balance work with cancer management and to return to work are poorly understood. We examined breast cancer survivors' most valued/desired types of support in early survivorship. METHODS Seventy-six employed breast cancer survivors answered an open-ended survey question assessing the most valued/desired support to receive from healthcare providers during early survivorship to manage work and health. Cutrona's (Journal of Social and Clinical Psychology 9:3-14, 1990) optimal matching theory and House's (1981) conceptualization of social support types informed our analyses. Data were content-analyzed to identify themes related to support, whether needed support was received or not, and the types of healthcare providers who provided support. RESULTS We identified six themes related to types of support. Informational support was valued and mostly received by survivors, but they expected more guidance related to work. Emotional support was valued but lacking, attributed mainly to providers' lack of personal connection and mental health support. Instrumental (practical) support was valued but received by a small number of participants. Quality of life support to promote well-being and functionality was valued and often received. Other themes included non-specific support and non-support. CONCLUSIONS This study expands our understanding of how breast cancer survivors perceive work-related support from healthcare professionals. Findings will inform targeted interventions designed to improve the support provided by healthcare professionals. IMPLICATIONS FOR CANCER SURVIVORS Breast cancer survivors managing work and health challenges may benefit by having their unmet support needs fulfilled.
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Affiliation(s)
- Alicia G Dugan
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Ragan E Decker
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Sara Namazi
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Jennifer M Cavallari
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Keith M Bellizzi
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT, 06269, USA
| | - Thomas O Blank
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT, 06269, USA
| | - Ellen A Dornelas
- Hartford Hospital, Hartford HealthCare Cancer Institute, 80 Seymour St, Hartford, CT, 06102, USA
| | - Susan H Tannenbaum
- Neag Comprehensive Cancer Center, UConn Health, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - William S Shaw
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Helen Swede
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Andrew L Salner
- Hartford Hospital, Hartford HealthCare Cancer Institute, 80 Seymour St, Hartford, CT, 06102, USA
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Hong BY, Hoare A, Cardenas A, Dupuy AK, Choquette L, Salner AL, Schauer PK, Hegde U, Peterson DE, Dongari-Bagtzoglou A, Strausbaugh LD, Diaz PI. The Salivary Mycobiome Contains 2 Ecologically Distinct Mycotypes. J Dent Res 2020; 99:730-738. [PMID: 32315566 DOI: 10.1177/0022034520915879] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A broad range of fungi has been detected in molecular surveys of the oral mycobiome. However, knowledge is still lacking on interindividual variability of these communities and the ecologic and clinical significance of oral fungal commensals. In this cross-sectional study, we use internal transcribed spacer 1 amplicon sequencing to evaluate the salivary mycobiome in 59 subjects, 36 of whom were scheduled to receive cancer chemotherapy. Analysis of the broad population structure of fungal communities in the whole cohort identified 2 well-demarcated genus-level community types (mycotypes), with Candida and Malassezia as the main taxa driving cluster partitioning. The Candida mycotype had lower diversity than the Malassezia mycotype and was positively correlated with cancer and steroid use in these subjects, smoking, caries, utilizing a removable prosthesis, and plaque index. Mycotypes were also associated with metabolically distinct bacteria indicative of divergent oral environments, with aciduric species enriched in the Candida mycotype and inflammophilic bacteria increased in the Malassezia mycotype. Similar to their fungal counterparts, coexisting bacterial communities associated with the Candida mycotype showed lower diversity than those associated with the Malassezia mycotype, suggesting that common environmental pressures affected bacteria and fungi. Mycotypes were also seen in an independent cohort of 24 subjects, in which cultivation revealed Malassezia as viable oral mycobiome members, although the low-abundance Malassezia sympodialis was the only Malassezia species recovered. There was a high degree of concordance between the molecular detection and cultivability of Candida, while cultivation showed low sensitivity for detection of the Malassezia mycotype. Overall, our work provides insights into the oral mycobiome landscape, revealing 2 community classes with apparently distinct ecologic constraints and specific associations with coexisting bacteria and clinical parameters. The utility of mycotypes as biomarkers for oral diseases warrants further study.
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Affiliation(s)
- B Y Hong
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA.,The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - A Hoare
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA.,Laboratorio de Microbiología Oral, Facultad de Odontología, Universidad de Chile, Santiago, Chile
| | - A Cardenas
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA
| | - A K Dupuy
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, USA
| | - L Choquette
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA.,The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - A L Salner
- Hartford Healthcare Cancer Institute at Hartford Hospital, Hartford, CT, USA
| | - P K Schauer
- Hartford Healthcare Cancer Institute at Hartford Hospital, Hartford, CT, USA
| | - U Hegde
- Department of Medicine, UConn Health, Farmington, CT, USA
| | - D E Peterson
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA
| | - A Dongari-Bagtzoglou
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA
| | - L D Strausbaugh
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - P I Diaz
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA
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10
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Salz T, Schnall RB, McCabe MS, Oeffinger KC, Corcoran S, Vickers AJ, Salner AL, Dornelas E, Raghunathan NJ, Fortier E, McKiernan J, Finitsis DJ, Chimonas S, Baxi S. Incorporating Multiple Perspectives Into the Development of an Electronic Survivorship Platform for Head and Neck Cancer. JCO Clin Cancer Inform 2019; 2:1-15. [PMID: 30652547 DOI: 10.1200/cci.17.00105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To improve the care of survivors of head and neck cancer, we developed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR). HN-STAR is an electronic platform that incorporates patient-reported outcomes into a clinical decision support tool for use at a survivorship visit. Selections in the clinical decision support tool automatically populate a survivorship care plan (SCP). We aimed to refine HN-STAR by eliciting and incorporating feedback on its ease of use and usefulness. METHODS Human-computer interaction (HCI) experts reviewed HN-STAR using think-aloud testing and the Nielsen Heuristic Checklist. Nurse practitioners (NPs) thought aloud while reviewing the clinical decision support tool and SCP and responded to an interview. Survivors used HN-STAR as part of a routine visit and were interviewed afterward. We analyzed themes from the feedback. We described how we addressed each theme to improve the usability of HN-STAR. RESULTS Five HCI experts, 10 NPs, and 10 cancer survivors provided complementary usability insight that we categorized into themes of improvements. For ease of use, themes included technical design considerations to enhance user interface, ease of completion of a self-assessment, streamlining text, disruption of the clinic visit, and threshold for symptoms to appear on the SCP. The theme addressing usefulness was efficiency and comprehensiveness of the clinic visit. For each theme, we report revisions to HN-STAR in response to the feedback. CONCLUSION HCI experts provided key technical design insights into HN-STAR, whereas NPs and survivors provided usability feedback and clinical perspectives. We incorporated the feedback into the preparation for additional testing of HN-STAR. This method can inform and improve the ease of use and usefulness of the survivorship applications.
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Affiliation(s)
- Talya Salz
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Rebecca B Schnall
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Mary S McCabe
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Kevin C Oeffinger
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Stacie Corcoran
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Andrew J Vickers
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Andrew L Salner
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Ellen Dornelas
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Nirupa J Raghunathan
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Elizabeth Fortier
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Janet McKiernan
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - David J Finitsis
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Susan Chimonas
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Shrujal Baxi
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
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11
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Diaz PI, Hong BY, Dupuy AK, Choquette L, Thompson A, Salner AL, Schauer PK, Hegde U, Burleson JA, Strausbaugh LD, Peterson DE, Dongari-Bagtzoglou A. Integrated Analysis of Clinical and Microbiome Risk Factors Associated with the Development of Oral Candidiasis during Cancer Chemotherapy. J Fungi (Basel) 2019; 5:jof5020049. [PMID: 31200520 PMCID: PMC6617088 DOI: 10.3390/jof5020049] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/15/2022] Open
Abstract
Oral candidiasis is a common side effect of cancer chemotherapy. To better understand predisposing factors, we followed forty-five subjects who received 5-fluorouracil- or doxorubicin-based treatment, during one chemotherapy cycle. Subjects were evaluated at baseline, prior to the first infusion, and at three additional visits within a two-week window. We assessed the demographic, medical and oral health parameters, neutrophil surveillance, and characterized the salivary bacteriome and mycobiome communities through amplicon high throughput sequencing. Twenty percent of all subjects developed oral candidiasis. Using multivariate statistics, we identified smoking, amount of dental plaque, low bacteriome and mycobiome alpha-diversity, and the proportions of specific bacterial and fungal taxa as baseline predictors of oral candidiasis development during the treatment cycle. All subjects who developed oral candidiasis had baseline microbiome communities dominated by Candida and enriched in aciduric bacteria. Longitudinally, oral candidiasis was associated with a decrease in salivary flow prior to lesion development, and occurred simultaneously or before oral mucositis. Candidiasis was also longitudinally associated with a decrease in peripheral neutrophils but increased the neutrophil killing capacity of Candida albicans. Oral candidiasis was not found to be associated with mycobiome structure shifts during the cycle but was the result of an increase in Candida load, with C. albicans and Candida dubliniensis being the most abundant species comprising the salivary mycobiome of the affected subjects. In conclusion, we identified a set of clinical and microbiome baseline factors associated with susceptibility to oral candidiasis, which might be useful tools in identifying at risk individuals, prior to chemotherapy.
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Affiliation(s)
- Patricia I Diaz
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT 06030, USA.
| | - Bo-Young Hong
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT 06030, USA.
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA.
| | - Amanda K Dupuy
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT 06269, USA.
| | - Linda Choquette
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT 06030, USA.
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA.
| | - Angela Thompson
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT 06030, USA.
| | - Andrew L Salner
- Department of Medical Oncology, Hartford Healthcare, Hartford, CT 06106, USA.
| | - Peter K Schauer
- Department of Medical Oncology, Hartford Healthcare, Hartford, CT 06106, USA.
| | - Upendra Hegde
- Department of Medicine, UConn Health, Farmington, CT 06030, USA.
| | - Joseph A Burleson
- Department of Community Medicine and Health Care, UConn Health, Farmington, CT 06032, USA.
| | - Linda D Strausbaugh
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT 06269, USA.
| | - Douglas E Peterson
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT 06030, USA.
| | - Anna Dongari-Bagtzoglou
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT 06030, USA.
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12
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Hong BY, Sobue T, Choquette L, Dupuy AK, Thompson A, Burleson JA, Salner AL, Schauer PK, Joshi P, Fox E, Shin DG, Weinstock GM, Strausbaugh LD, Dongari-Bagtzoglou A, Peterson DE, Diaz PI. Chemotherapy-induced oral mucositis is associated with detrimental bacterial dysbiosis. Microbiome 2019; 7:66. [PMID: 31018870 PMCID: PMC6482518 DOI: 10.1186/s40168-019-0679-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/02/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Gastrointestinal mucosal injury (mucositis), commonly affecting the oral cavity, is a clinically significant yet incompletely understood complication of cancer chemotherapy. Although antineoplastic cytotoxicity constitutes the primary injury trigger, the interaction of oral microbial commensals with mucosal tissues could modify the response. It is not clear, however, whether chemotherapy and its associated treatments affect oral microbial communities disrupting the homeostatic balance between resident microorganisms and the adjacent mucosa and if such alterations are associated with mucositis. To gain knowledge on the pathophysiology of oral mucositis, 49 subjects receiving 5-fluorouracil (5-FU) or doxorubicin-based chemotherapy were evaluated longitudinally during one cycle, assessing clinical outcomes, bacterial and fungal oral microbiome changes, and epithelial transcriptome responses. As a control for microbiome stability, 30 non-cancer subjects were longitudinally assessed. Through complementary in vitro assays, we also evaluated the antibacterial potential of 5-FU on oral microorganisms and the interaction of commensals with oral epithelial tissues. RESULTS Oral mucositis severity was associated with 5-FU, increased salivary flow, and higher oral granulocyte counts. The oral bacteriome was disrupted during chemotherapy and while antibiotic and acid inhibitor intake contributed to these changes, bacteriome disruptions were also correlated with antineoplastics and independently and strongly associated with oral mucositis severity. Mucositis-associated bacteriome shifts included depletion of common health-associated commensals from the genera Streptococcus, Actinomyces, Gemella, Granulicatella, and Veillonella and enrichment of Gram-negative bacteria such as Fusobacterium nucleatum and Prevotella oris. Shifts could not be explained by a direct antibacterial effect of 5-FU, but rather resembled the inflammation-associated dysbiotic shifts seen in other oral conditions. Epithelial transcriptional responses during chemotherapy included upregulation of genes involved in innate immunity and apoptosis. Using a multilayer epithelial construct, we show mucositis-associated dysbiotic shifts may contribute to aggravate mucosal damage since the mucositis-depleted Streptococcus salivarius was tolerated as a commensal, while the mucositis-enriched F. nucleatum displayed pro-inflammatory and pro-apoptotic capacity. CONCLUSIONS Altogether, our work reveals that chemotherapy-induced oral mucositis is associated with bacterial dysbiosis and demonstrates the potential for dysbiotic shifts to aggravate antineoplastic-induced epithelial injury. These findings suggest that control of oral bacterial dysbiosis could represent a novel preventive approach to ameliorate oral mucositis.
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Affiliation(s)
- Bo-Young Hong
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, 263 Farmington Ave, Farmington, CT, 06030-1710, USA
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Takanori Sobue
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, 263 Farmington Ave, Farmington, CT, 06030-1710, USA
| | - Linda Choquette
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, 263 Farmington Ave, Farmington, CT, 06030-1710, USA
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Amanda K Dupuy
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, USA
| | - Angela Thompson
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, 263 Farmington Ave, Farmington, CT, 06030-1710, USA
| | - Joseph A Burleson
- Department of Community Medicine and Health Care, UConn Health, Farmington, CT, USA
| | | | | | - Pujan Joshi
- Department of Computer Science, University of Connecticut, Storrs, CT, USA
| | - Evan Fox
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, 263 Farmington Ave, Farmington, CT, 06030-1710, USA
| | - Dong-Guk Shin
- Department of Computer Science, University of Connecticut, Storrs, CT, USA
| | | | - Linda D Strausbaugh
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, USA
| | - Anna Dongari-Bagtzoglou
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, 263 Farmington Ave, Farmington, CT, 06030-1710, USA
| | - Douglas E Peterson
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, 263 Farmington Ave, Farmington, CT, 06030-1710, USA
| | - Patricia I Diaz
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, UConn Health, 263 Farmington Ave, Farmington, CT, 06030-1710, USA.
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13
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Hoag JR, Andemariam B, Wang X, Gregorio DI, Jones BA, Sporn J, Salner AL, Swede H. Serious adverse events in African-American cancer patients with sickle cell trait and inherited haemoglobinopathies in a SEER-Medicare claims cohort. Br J Cancer 2019; 120:861-863. [PMID: 30890774 PMCID: PMC6474269 DOI: 10.1038/s41416-019-0416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 01/19/2023] Open
Abstract
African–American (AA) cancer patients have long-experienced worse outcomes compared to non-Hispanic whites (NHW). No studies to date have evaluated the prognostic impact of sickle cell trait (SCT) and other inherited haemoglobinopathies, of which several are disproportionately high in the AA population. In a cohort analysis of treated patients diagnosed with breast or prostate cancer in the linked SEER-Medicare database, the relative risk (RR) for ≥1 serious adverse events (AEs), defined as hospitalisations or emergency department visits, was estimated for 371 AA patients with a haemoglobinopathy (AA+) compared to patients without haemoglobinopathies (17,303 AA−; 144,863 NHW−). AA+ patients had significantly increased risk for ≥1 AEs compared to AA− (RR = 1.19; 95% CI 1.11–1.27) and NHW− (RR = 1.23; 95% CI 1.15–1.31) patients. The magnitude of effect was similar by cancer type, and in analyses of AA+ with SCT only. Our findings suggest a novel hypothesis for disparities in cancer outcomes.
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Affiliation(s)
- Jessica R Hoag
- Department of Internal Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University School of Medicine, New Haven, CT, USA
| | - Biree Andemariam
- New England Sickle Cell Institute, Division of Hematology/Oncology, Neag Comprehensive Cancer Center, UConn Health, Farmington, CT, USA
| | - Xiaoyan Wang
- Center for Quantitative Medicine, UConn School of Medicine, Farmington, CT, USA
| | - David I Gregorio
- Department of Community Medicine and Health Care, UConn School of Medicine, Farmington, CT, USA
| | - Beth A Jones
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Jonathan Sporn
- Department of Hematology-Oncology, St. Francis Hospital and Medical Center, Hartford, CT, USA
| | - Andrew L Salner
- Hartford Health Care Cancer Institute, Hartford Hospital, Hartford, CT, USA
| | - Helen Swede
- Department of Community Medicine and Health Care, UConn School of Medicine, Farmington, CT, USA.
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14
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Finitsis DJ, Vose BA, Mahalak JG, Salner AL. Interventions to promote adherence to endocrine therapy among breast cancer survivors: A meta‐analysis. Psychooncology 2018; 28:255-263. [PMID: 30511789 DOI: 10.1002/pon.4959] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/26/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022]
Affiliation(s)
- David J. Finitsis
- Hartford HealthCare Cancer InstituteHartford Hospital Hartford Connecticut
- Department of PsychiatryYale University School of Medicine New Haven Connecticut
| | - Brittany A. Vose
- Hartford HealthCare Cancer InstituteHartford Hospital Hartford Connecticut
| | - Justin G. Mahalak
- Hartford HealthCare Cancer InstituteHartford Hospital Hartford Connecticut
| | - Andrew L. Salner
- Hartford HealthCare Cancer InstituteHartford Hospital Hartford Connecticut
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15
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Finitsis DJ, Vose BA, Mahalak JG, Salner AL. Interventions to promote adherence to endocrine therapy among breast cancer survivors: A meta-analysis. Psychooncology 2018. [PMID: 30511789 DOI: 10.1002/pon.4959.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Adjuvant endocrine therapy (AET) significantly reduces risk of breast cancer recurrence in those patients whose tumor tests hormone (estrogen and/or progesterone) receptor positive. Many who are prescribed AET do not adhere adequately. Studies have sought to examine the effects of interventions to enhance patients' AET adherence, with strikingly mixed results. In order to reconcile a disparate literature, this paper aims to (1) quantitatively review the aggregate effect of interventions designed to optimize AET adherence within the current literature and (2) meta-analyze these effects across studies' by intervention design. METHODS Duplicate searches were conducted using multiple electronic databases as well as hand searches of recent year conference abstracts. Studies were included that (1) tested an intervention to promote AET adherence; (2) reported at least one measure of medication adherence; and (3) reported (or provided upon request) data sufficient to calculate effect size. Effect sizes were calculated using random effects models. RESULTS Seven studies representing eight unique interventions were included. We observed an overall null effect across all interventions (k = 8; d [95% CI] = 0.28 [-0.05, 0.61]); however, sensitivity analyses showed that interventions that used bi-directional communication showed statistically significant effects relative to control groups within each study (k = 4; d [95% CI] = 0.59 [0.23, 0.95]) while those relying only on providing information to the patient (one-way communication) did not (k = 4; d [95% CI] = -0.03 [-0.27, 0.20]). CONCLUSIONS Interventions that promote patient self-report may improve AET adherence through enhancing patient engagement. Investigators and clinicians who wish to optimize medication adherence in this population can consider this approach.
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Affiliation(s)
- David J Finitsis
- Hartford HealthCare Cancer Institute, Hartford Hospital, Hartford, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Brittany A Vose
- Hartford HealthCare Cancer Institute, Hartford Hospital, Hartford, Connecticut
| | - Justin G Mahalak
- Hartford HealthCare Cancer Institute, Hartford Hospital, Hartford, Connecticut
| | - Andrew L Salner
- Hartford HealthCare Cancer Institute, Hartford Hospital, Hartford, Connecticut
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16
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Salner AL, Smith S, Yu PP. Timing of adjuvant chemotherapy administration for early breast cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
62 Background: Adjuvant chemotherapy treatment has contributed to the reduction in cause-specific mortality from early stage breast cancer by reducing the risk of recurrence and metastasis. The initiation of adjuvant chemotherapy is typically started within 4-8 weeks following surgery. Although earlier treatment does not necessarily render a better prognosis, treatment delayed beyond 12 weeks may result in an unfavorable decrease in disease-free survival. In order to explore quality data for each of our 5 cancer centers and their breast surgeons, we conducted a quality outcomes project to examine our data and factors which could result in delay. Methods: We conducted a retrospective review evaluating all cases of patients diagnosed with stage 1 and 2 breast cancer at all of our cancer centers during the 2015 and 2016 calendar years, utilizing patient lists obtained from our cancer registries. Patients who received neoadjuvant chemotherapy or who had inadequate data were excluded. Variables included stage at diagnosis, percent of nodal positivity, age at diagnosis, race and ethnicity, attending surgeon, type of surgery (breast conservation vs. mastectomy +/- reconstruction), and number of days from final breast surgery to initiation of adjuvant chemotherapy treatment. Results: 757 and 319 patients with Stage I and II breast cancer respectively were identified in our 5 cancer centers. 16% had nodal positivity, and 25.6% received adjuvant chemotherapy. Average age at diagnosis was 62.5, and average age for node positive and adjuvant chemotherapy were 58.5 and 56.8. Days to chemotherapy ranged from 3-208, with 94% of patients treated in less than 12 weeks and ranges of mean days to begin chemotherapy 35.6 to 55.4 in our cancer centers. No significant differences were noted by age, race, ethnicity, stage, surgery type, surgeon, or hospital. Conclusions: This study reveals outcomes suggesting that our breast cancer teams at our cancer centers are meeting the current standard of care for initiation of adjuvant chemotherapy, and points to the value of quality studies in assuring standards of care.
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Smilowitz HM, Meyers A, Rahman K, Dyment NA, Sasso D, Xue C, Oliver DL, Lichtler A, Deng X, Ridwan SM, Tarmu LJ, Wu Q, Salner AL, Bulsara KR, Slatkin DN, Hainfeld JF. Intravenously-injected gold nanoparticles (AuNPs) access intracerebral F98 rat gliomas better than AuNPs infused directly into the tumor site by convection enhanced delivery. Int J Nanomedicine 2018; 13:3937-3948. [PMID: 30013346 PMCID: PMC6038872 DOI: 10.2147/ijn.s154555] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Intravenously (IV)-injected gold nanoparticles (AuNPs) powerfully enhance the efficacy of X-ray therapy of tumors including advanced gliomas. However, pharmacokinetic issues, such as slow tissue clearance and skin discoloration, may impede clinical translation. The direct infusion of AuNPs into the tumor might be an alternative mode of delivery. MATERIALS AND METHODS Using the advanced, invasive, and difficult-to-treat F98 rat glioma model, we have studied the biodistribution of the AuNPs in the tumor and surrounding brain after either IV injection or direct intratumoral infusion by convection-enhanced delivery using light microscopy immunofluorescence and direct gold visualization. RESULTS IV-injected AuNPs localize more specifically to intracerebral tumor cells, both in the main tumor mass and in the migrated tumor cells as well as the tumor edema, than do the directly infused AuNPs. Although some of the directly infused AuNPs do access the main tumor region, such access is largely restricted. CONCLUSION These data suggest that IV-injected AuNPs are likely to have a greater therapeutic benefit when combined with radiation therapy than after the direct infusion of AuNPs.
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Affiliation(s)
- Henry M Smilowitz
- Department of Cell Biology, University of Connecticut Health Center, Farmington, CT,
| | - Alexandria Meyers
- Department of Cell Biology, University of Connecticut Health Center, Farmington, CT,
| | - Khalil Rahman
- Department of Cell Biology, University of Connecticut Health Center, Farmington, CT,
| | - Nathaniel A Dyment
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Dan Sasso
- Department of Cell Biology, University of Connecticut Health Center, Farmington, CT,
| | - Crystal Xue
- George Washington University School of Medicine, Washington, DC
| | - Douglas L Oliver
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT
| | - Alexander Lichtler
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT
| | - Xiaomeng Deng
- David Geffen School of Medicine at UCLA, Student Affairs Office, Los Angeles, CA
| | - Sharif M Ridwan
- Department of Cell Biology, University of Connecticut Health Center, Farmington, CT,
| | - Lauren J Tarmu
- Department of Human Behavior, College of Southern Nevada
- Department of Anthropology, University of Nevada, Las Vegas, NV
| | - Qian Wu
- Department of Anatomic Pathology, University of Connecticut Health Center, Farmington
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Salz T, Salner AL, Raghunathan NJ, McCabe MS, Dornelas E, Finitsis D, Corcoran S, Fortier E, Weber R, Tin A, Vickers AJ, Oeffinger KC, Baxi SS. Using patient-reported outcomes measures to tailor care for complex cancer survivors: A feasibility study of HN-STAR. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | - Ryan Weber
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amy Tin
- Memorial Sloan Kettering Cancer Center, New York, NY
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Salner AL, Baxi SS, Fortier E, Salz T. Tailored survivorship care plans for head and neck cancer patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
51 Background: Survivorship care plans SCPs typically include generic advice for cancer surveillance, management of late effects (LEs), wellness recommendations (WRs), and cancer screening. We developed a platform called HN-STAR that uses electronic patient-reported outcomes (ePROs) and evidence-based management guidelines to generate tailored SCPs for head and neck cancer survivors (HNCSs), a population particularly vulnerable to various LEs. We surveyed HNCSs and their primary care providers (PCPs) regarding the SCP to assess its acceptability and usefulness. Methods: HNCSs at 2 cancer hospitals used HN-STAR. Prior to a routine clinic visit, HNCSs used a validated ePRO measure (PRO-CTCAE) to report 22 physical LEs and other measures to assess wellness. Based on the visit discussion, HN-STAR generated an SCP that included a treatment summary, WRs, and LE management plans. HNCSs indicated their perceptions of the SCP and intentions to adhere to WR and LE management recommendations. PCPs reported on the SCP utility and their comfort in managing WRs and LEs. Results: 47 HNCSs completed surveys (mean 5.4 yrs. from treatment completion). Most were white (89%), male (85%), had an oropharynx tumor (58%), and received multimodality therapy (81%). 51% experienced at least 9 of the 22 LEs in the last month (mean 8.2/person). 91% of HNCSs felt the SCP was easy to follow. 98% intended to follow recommendations for LEs management and 98% reported they would refer back to the SCP. 87% said they plan to share the SCP with a PCP. 23 PCPs completed the survey. 95% were satisfied with the SCP and 95% reported they would like to have one for every cancer patient. PCPs expressed varying levels of comfort in managing specific LEs of head and neck cancer (30-80%). Conclusions: Among HNCSs, an automatically generated SCP that was tailored to their WRs and LEs was acceptable, was trusted, and provided recommendations they intended to follow. PCPs found the SCP useful, and SCPs may help improve their comfort with LE management. Patient-centered SCPs that focus on existing LEs hold promise as a means to help survivors and PCPs manage survivorship issues.
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Affiliation(s)
| | | | | | - Talya Salz
- Memorial Sloan Kettering Cancer Center, New York, NY
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Salz T, McCabe MS, Oeffinger KC, Schnall RB, Corcoran S, Vickers AJ, Salner AL, Dornelas EA, Raghunathan NJ, Fortier E, Finitsis D, Baxi SS. Survivor feedback on a late effects-oriented survivorship care plan for head and neck cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21596 Background: Survivorship care plans (SCPs) typically include generic advice for the management of late effects (LEs) that can occur, rather than addressing LEs that the survivor actually has. We developed a platform called HN-STAR that uses electronic patient-reported outcomes (ePROs) and evidence-based LE management to generate a personalized SCP for survivors of head and neck cancer (HNC), a population vulnerable to various LEs. We assessed HNC survivors’ experiences with HN-STAR to ensure its acceptability and usefulness. Methods: Disease-free HNC survivors at two cancer hospitals used HN-STAR in conjunction with a routine survivorship visit. Prior to the visit, survivors used a validated ePRO measure (PRO-CTCAE) to report up to 22 physical LEs. Based on clinic visit discussions, HN-STAR generated an SCP that included a treatment summary and LE management plans. Survivors indicated their level of agreement to statements regarding the ease of use of the ePROs, content of the SCP, and intentions to adhere to LE management recommendations. Results: 47 survivors completed surveys (mean 5.4 years from treatment completion). Most were white (89%), male (85%), had an oropharynx tumor (58%), and received multimodality therapy (81%). More than half (51%) experienced at least 9 of the 22 LEs in the last 30 days (mean 8.2 per person). Most survivors reported that completing ePROs improved the discussions with their provider (98%), the quality of their care (96%), and their communication with their provider (98%). 91% agreed the SCP was the right length, and 98% agreed it was easy to follow. 98% intended to follow at least some of the recommendations for LEs management, and 98% reported feeling confident that they could follow the recommendations. The majority agreed that the SCP accurately summarized the clinic visit (98%), they would refer back to the SCP (98%), they trust the SCP (100%), and they plan to share the SCP with a primary care provider (87%). Conclusions: Among HNC survivors, an automatically generated SCP that was tailored to their LEs was acceptable, was trusted, and provided recommendations they intended to follow. Patient-centered SCPs that focus on existing LEs hold promise as a means to help survivors manage LEs.
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Affiliation(s)
- Talya Salz
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Shimanovsky A, Cartun R, Fiel-Gan M, Mandich D, Earle J, Salner AL, Collins K, Otterson GA, Chu BF. Immunohistochemical staining for programmed cell-death ligand 1 (PD-L1) in malignant thymoma and thymic carcinoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20003 Background: Recent development of anti-PD-1/L1 antibodies has demonstrated activity in various neoplasms. Thymic malignancies (TMS) are rare and treatment in advanced disease is limited. To evaluate the potential impact of anti-PD-1/L1 therapy in TMS, we examined the expression of PD-L1 in previously resected thymoma (TM) and thymic carcinoma (TC). Methods: We examined resected specimens from patients at Hartford Hospital with TM and TC between 2000 and 2014. Expression of PD-L1 was evaluated on formalin-fixed paraffin-embedded tissue. Immunohistochemical testing was done using four different clones of PD-L1 antibodies on the Leica Bond Max automated platform. The four clones include: E1L3N (Cell Signaling Technology), 28-8 (Epitomics) and SP142 (Spring Bioscience), and CAL10 (BioCare). PD-L1 expression was evaluated based on the percentage of tumor cells positive and their intensity graded as negative, weak (1+), moderate (2+), and strong (+3). The scoring was performed by three pathologists and was blinded for clinicopathologic data and antibody clones. Results: We evaluated a total of 29 patients, including 26 patients with TM and 3 with TC. Among the 29 available specimens, 12 had completed PD-L1 expression assessment at the time of submission. PD-L1 expression is present in 75-100% of the evaluated patients. All had positive PD-L1 staining by SP142 and CAL10. Three patients showed strong intensity by CAL10, and one by SP142. E1L3N and 28-8 had positive PD-L1 expression in 9 and 8 patients respectively with weak/moderate intensity. SP142 and CLA10 demonstrated the strongest concordance (R2 = 0.91) but there was significant variation between antibodies (R2 = 0.31-0.91). No correlation was detected between tumor grade and PD-L1 expression. There were focal areas that lacked expression in all of the evaluated specimens. Conclusions: There is increased expression of PD-L1 in TMS. The level of PD-L1 expression varies between the four PD-L1 antibodies. Increased PD-L1 expression provides evidence for the use of PD-L1 inhibitors in TMS. The variable staining highlights the heterogeneity of TMS and challenges in developing predictive biomarker in this cancer.
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Salner AL, Sekerak R, Yu PP. Identification of Lynch syndrome cohort in a hospital system. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
91 Background: Lynch Syndrome (LS) is a genetically inherited autosomal dominant disease that is the result of germline mutations in mismatch repair (MMR) genes. LS is the most common cause of inherited colorectal cancer (CRC), causes cancer at a younger age, and increases other cancer risk (pancreas, endometrium). Thus, it is important to identify patients who have LS so that patients and affected family members can receive the proper surveillance and care. Hartford HealthCare Cancer Institute (HHCCI) has developed a standard of care to screen patients who may have LS by testing CRC specimens for loss of expression of MMR genes, as well as to refer all patients under 50 for counseling. The aim of this research project is to determine how well each of our healthcare system's five hospitals is meeting the standard. Methods: This retrospective study explored all cases of CRC at each of the five HHCCI hospitals from 2014-2015. Patients were identified from the Cancer Registry and data was extracted from patient charts, pathology and genetics reports. The study analyzed: age, gender, stage, presence of MMR testing, and genetics counseling and testing for MMR positive patients and patients under 50. Results: 423 CRC patients were diagnosed at HHC cancer centers, 45% male, 55% female, average age of 68.2. In total, HHCCI tested 81.3% of patients diagnosed with CRC in 2014-2015, ranging from 30.8 to 94.5% among the hospitals. 7.6% of patients had abnormal MMR results. Of patients with MMR+ results, 57.7% had genetic consult and 10 of the 15 consulted had a germline test. Seven patients (70%) tested positive for LS. Patients with LS were younger (average age 47.6), and the majority were male. Ten of 45 patients under 50 were referred for genetics consult (22%), with a range of 0-67% amongst the hospitals. Three were LS positive on testing. Conclusions: Clinicians on our GI cancer team assumed that the agreed upon standard of MMR testing in CRC and referral of younger patients for genetics counseling would result in 100% compliance. The study outcomes suggest a need for improved implementation strategies for CRC testing at HHCCI hospitals. Overall, the study demonstrates the importance and need of quality improvement measures to inform and improve patient care.
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Nekhlyudov L, Lacchetti C, Davis NB, Garvey TQ, Goldstein DP, Nunnink JC, Ninfea JIR, Salner AL, Salz T, Siu LL. Head and Neck Cancer Survivorship Care Guideline: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Cancer Society Guideline. J Clin Oncol 2017; 35:1606-1621. [PMID: 28240970 DOI: 10.1200/jco.2016.71.8478] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose This guideline provides recommendations on the management of adults after head and neck cancer (HNC) treatment, focusing on surveillance and screening for recurrence or second primary cancers, assessment and management of long-term and late effects, health promotion, care coordination, and practice implications. Methods ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. The American Cancer Society (ACS) HNC Survivorship Care Guideline was reviewed for developmental rigor by methodologists. An ASCO Expert Panel reviewed the content and recommendations, offering modifications and/or qualifying statements when deemed necessary. Results The ASCO Expert Panel determined that the ACS HNC Survivorship Care Guideline, published in 2016, is clear, thorough, clinically practical, and helpful, despite the limited availability of high-quality evidence to support many of the recommendations. ASCO endorsed the ACS HNC Survivorship Care Guideline, adding qualifying statements aimed at promoting team-based, multispecialty, multidisciplinary, collaborative head and neck survivorship care. Recommendations The ASCO Expert Panel emphasized that caring for HNC survivors requires a team-based approach that includes primary care clinicians, oncology specialists, otolaryngologists, dentists, and other allied professionals. The HNC treatment team should educate the primary care clinicians and patients about the type(s) of treatment received, the likelihood of potential recurrence, and the potential late and long-term complications. Primary care clinicians should recognize symptoms of recurrence and coordinate a prompt evaluation. They should also be prepared to manage late effects either directly or by referral to appropriate specialists. Health promotion is critical, particularly regarding tobacco cessation and dental care. Additional information is available at www.asco.org/HNC-Survivorship-endorsement and www.asco.org/guidelineswiki .
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Affiliation(s)
- Larissa Nekhlyudov
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Lacchetti
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy B Davis
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thomas Q Garvey
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David P Goldstein
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Chris Nunnink
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jose I Ruades Ninfea
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew L Salner
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Talya Salz
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lillian L Siu
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
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Harris D, Stricker CT, Walker D, Katzman A, Still N, Digiovanni L, Finitsis D, Salner AL, Dornelas EA. Survivorship care plans: Strategies to enhance patient utility and value. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.5_suppl.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
75 Background: A decade ago the Institute of Medicine (IOM) recommended that every survivor receive a survivor care plan (SCP), yet despite endorsements of clinical merit, evidence of their effectiveness is inconsistent, and patient satisfaction with, use of, and perceived utility of SCP’s remains unclear. Methods: This ongoing multicenter pilot enrolls breast cancer (BC) patients who have recently completed active treatment. Patients complete an electronic patient reported outcomes (ePRO) survey via the Carevive Care Planning System (CPS), which is combined with clinical data to electronically generate tailored care plans with survivorship and symptom-specific recommendations (i.e. follow-up care, self-management, supportive care referrals) in real-time. Patients receive their care plan at a consultative survivorship visit. Approximately 6-weeks following SCP receipt, patients complete a survey to evaluate satisfaction Results: Over 200 patients have received SCPs to date; 101 have completed follow-up surveys. Patients are on average 59 years old (Range: (33-84 yo), female (100%), and with 0-III stage BC. Study outcomes include patient-reported use and helpfulness of, as well as satisfaction (1-5 Likert scale items) with, their SCP. On average, patients were “very satisfied” with their SCP overall (M = 4.08), and 90% (n=90) would, “recommend other women receive a similar care plan after cancer treatment”. In addition to majority of patients (99%) having read or planning to read the SCP carefully, the three most frequently cited ways for use/planned use of the SCP include to: inform about symptoms (90%); speak with healthcare professionals about concerns (88%); and help identify information online (86%). Seventy-two (78%) patients and 68 (74%) reported that SCP’s were most useful to helping them make changes in what they ate and types of exercises, respectively. Conversely, 51 (58%) of patients and 47 (59%) of patients reported that the SCP was most useful to helping them find support resources and talking about personal cancer experience with family members. When asked to recall what recommendations their SCPs endorsed, patients most commonly recalled surveillance recommendations (e.g. follow up visits (83%), mammograms (80%), compared to recommendations specific to reported concerns and symptoms (e.g, management of sexual concerns (31%), evaluation and management of lymphedema (27%)). Conclusions: n/a
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Swede H, Sarwar A, Magge A, Braithwaite D, Cook LS, Gregorio DI, Jones BA, R Hoag J, Gonsalves L, L Salner A, Zarfos K, Andemariam B, Stevens RG, G Dugan A, Pensa M, A Brockmeyer J. Mortality risk from comorbidities independent of triple-negative breast cancer status: NCI-SEER-based cohort analysis. Cancer Causes Control 2016; 27:627-36. [PMID: 27000206 PMCID: PMC5591028 DOI: 10.1007/s10552-016-0736-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 03/03/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE A comparatively high prevalence of comorbidities among African-American/Blacks (AA/B) has been implicated in disparate survival in breast cancer. There is a scarcity of data, however, if this effect persists when accounting for the adverse triple-negative breast cancer (TNBC) subtype which occurs at threefold the rate in AA/B compared to white breast cancer patients. METHODS We reviewed charts of 214 white and 202 AA/B breast cancer patients in the NCI-SEER Connecticut Tumor Registry who were diagnosed in 2000-2007. We employed the Charlson Co-Morbidity Index (CCI), a weighted 17-item tool to predict risk of death in cancer populations. Cox survival analyses estimated hazard ratios (HRs) for all-cause mortality in relation to TNBC and CCI adjusting for clinicopathological factors. RESULTS Among patients with SEER local stage, TNBC increased the risk of death (HR 2.18, 95 % CI 1.14-4.16), which was attenuated when the CCI score was added to the model (Adj. HR 1.50, 95 % CI 0.74-3.01). Conversely, the adverse impact of the CCI score persisted when controlling for TNBC (Adj. HR 1.49, 95 % CI 1.29-1.71; per one point increase). Similar patterns were observed in SEER regional stage, but estimated HRs were lower. AA/B patients with a CCI score of ≥3 had a significantly higher risk of death compared to AA/B patients without comorbidities (Adj. HR 5.65, 95 % CI 2.90-11.02). A lower and nonsignificant effect was observed for whites with a CCI of ≥3 (Adj. HR 1.90, 95 % CI 0.68-5.29). CONCLUSIONS comorbidities at diagnosis increase risk of death independent of TNBC, and AA/B patients may be disproportionately at risk.
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Affiliation(s)
- Helen Swede
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
| | - Amna Sarwar
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Anil Magge
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Dejana Braithwaite
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Linda S Cook
- Department of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, NM, USA
| | - David I Gregorio
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Beth A Jones
- Yale School of Public Health, New Haven, CT, USA
| | - Jessica R Hoag
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Lou Gonsalves
- Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, CT, USA
| | - Andrew L Salner
- Helen & Harry Gray Cancer Center, Hartford Hospital, Hartford HealthCare System, Hartford, CT, USA
| | - Kristen Zarfos
- The Hospital of Central Connecticut, Hartford HealthCare System, Hartford, CT, USA
| | - Biree Andemariam
- New England Sickle Cell Institute, Department of Medicine and Neag Cancer Center, University of Connecticut Health, Farmington, CT, USA
| | - Richard G Stevens
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Alicia G Dugan
- New England Sickle Cell Institute, Department of Medicine and Neag Cancer Center, University of Connecticut Health, Farmington, CT, USA
| | - Mellisa Pensa
- Department of Occupational and Environmental Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jessica A Brockmeyer
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
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Park CL, Cho D, Salner AL, Dornelas E. A randomized controlled trial of two mail-based lifestyle interventions for breast cancer survivors. Support Care Cancer 2016; 24:3037-46. [PMID: 26887585 DOI: 10.1007/s00520-016-3129-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/09/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Although breast cancer survivors' lifestyle choices affect their subsequent health, a majority do not engage in healthy behaviors. Because treatment end is a "teachable moment" for potentially altering lifestyle change for breast cancer survivors, we developed and tested two mail-based interventions for women who recently completed primary treatment. METHODS One hundred seventy-three survivors were randomly assigned to (1) Targeting the Teachable Moment (TTMI, n = 57), (2) Standard Lifestyle Management (SLM, n = 58), or (3) usual care (UC, n = 58) control group. Participants who were assigned to TTMI and SLM received relevant treatment materials biweekly for 4 months. Participants were assessed at baseline (T1, before randomization), post-treatment (T2, 4 months), and follow-up (T3, 7 months). Fruit and vegetable (F/V) intake, fat intake, and moderate-to-vigorous physical activity (MVPA) were assessed. RESULTS Results showed promise for these mail-based interventions for changes in health behaviors: Survivors in TTMI (+.47) and SLM (+.45) reported increased F/V intake, whereas those in UC (-.1) reported decreased F/V intake from T1 to T2. Changes in minutes of MVPA from T1 to T2 were higher in SLM than UC and marginally higher in TTMI than UC. However, these differences were due to decreased MVPA in UC rather than increased MVPA in the intervention groups. There were no group differences regarding fat intake. Survivors reported high satisfaction and preference for mail-based interventions, supporting feasibility. CONCLUSIONS Mail-based lifestyle interventions for breast cancer survivors may benefit F/V intake and physical activity. Further testing and optimizing of these interventions is warranted.
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Affiliation(s)
- Crystal L Park
- Department of Psychology, University of Connecticut, 406 Babbidge Rd, Unit 1020, Storrs, CT, 06269-1020, USA.
| | - Dalnim Cho
- Department of Psychology, University of Connecticut, 406 Babbidge Rd, Unit 1020, Storrs, CT, 06269-1020, USA
| | - Andrew L Salner
- Helen & Harry Gray Cancer Center, Hartford Hospital, 85 Retreat Ave, Hartford, CT, 06106, USA
| | - Ellen Dornelas
- Helen & Harry Gray Cancer Center, Hartford Hospital, 85 Retreat Ave, Hartford, CT, 06106, USA
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Salner AL, Walker D, Seltzer A, Panzer S, Stricker C, Dornelas EA. Recall and uptake of survivorship care plan recommendations. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
67 Background: Despite the growing delivery of survivorship care plans (SCPs), little research has examined survivors’ recall and adoption of SCP recommendations, including those based on patient-reported symptoms and concerns. Methods: 65 stage 0-III breast cancer survivors participated in this pilot project. Patients completed an electronic patient-reported outcomes (ePRO) survey prior to a visit with a nurse practitioner, who delivered a tailored SCP generated by the Carevive Care Planning System (CPS) using evidence-based algorithms driven by ePRO and diagnosis/treatment data. Approximately 6 weeks later, patients completed a survey to evaluate their recall and any corresponding action taken. Actual SCP recommendations were extracted from the Carevive CPS database and matched to follow-up surveys to determine recall accuracy. Results: Data were analyzed for 35 patients completing follow-up surveys to date. SCPs contained an average of 22.2 recommendations per patient, almost half (n = 10.7) for active symptoms/supportive care issues. Recommendations were broken down into 3 groups 1) Surveillance, 2) Prevention, and 3) Intervention; see table below for select results. Of note, lymphedema-related recommendations were recalled accurately more often (p = 0.005) by those with symptoms vs. those advised on prevention. Conclusions: Incorporating an ePRO survey into SCP delivery enables tailoring to patient needs and concerns, which may in turn enhance recall and follow through given saliency. Patients tended to recall more accurately SCP recommendations for active or more severe symptoms. Additional research is needed to maximize retention and follow through on SCP recommendations. [Table: see text]
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Abstract
102 Background: After a diagnosis of breast cancer, it can be difficult for patients to understand the role their primary care physician (PCP) should play in their follow up care. Methods: 65 women (mean age 60 years, SD = 10) with breast cancer (stage 0-III) were seen by a nurse practitioner for a 60-90 minute consultative survivorship visit and received a treatment summary and personalized survivorship care plan (SCP) utilizing Carevive Care Planning Systems software. The Carevive system incorporates patient-reported and clinical data to create tailored care plans with personalized recommendations for follow up care and supportive referrals, including direction to follow up with primary care for specific care and health maintenance activities. Approximately 6 weeks following their survivorship care visit, patients completed a survey assessing their use of and satisfaction with the SCP. Patients were advised that the SCP would be mailed to their referring oncologist and primary care physician. Results: Out of 65 sent, 35 surveys have been completed to date. Survivors were diagnosed approximately 10 months prior, and all were within 6 months following completion of treatment. All patients (100%) reported that they read, or planned to read, their survivorship care plan packet carefully. While all care plans included a recommendation to follow up with their PCP, only (71%) of survivors remembered receiving this recommendation. Of those who did, most (74%) had either seen or scheduled an appointment with their PCP. Patients who reported higher anxiety at the time of the survivorship visit were more likely to report that the follow up care plan helped them take action about seeing their PCP (p = .03). Conclusions: Coordination between primary and oncology care providers has previously been shown to improve the quality of care for cancer survivors. SCPs that emphasize the importance of and activities to be undertaken in primary care may help to improve this coordination. Continuation of this research will help to better understand how to integrate the primary care physician into cancer follow up care. Updated data will be shared at time of presentation.
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Linehan WM, Spellman PT, Ricketts CJ, Creighton CJ, Fei SS, Davis C, Wheeler DA, Murray BA, Schmidt L, Vocke CD, Peto M, Al Mamun AAM, Shinbrot E, Sethi A, Brooks S, Rathmell WK, Brooks AN, Hoadley KA, Robertson AG, Brooks D, Bowlby R, Sadeghi S, Shen H, Weisenberger DJ, Bootwalla M, Baylin SB, Laird PW, Cherniack AD, Saksena G, Haake S, Li J, Liang H, Lu Y, Mills GB, Akbani R, Leiserson MD, Raphael BJ, Anur P, Bottaro D, Albiges L, Barnabas N, Choueiri TK, Czerniak B, Godwin AK, Hakimi AA, Ho T, Hsieh J, Ittmann M, Kim WY, Krishnan B, Merino MJ, Mills Shaw KR, Reuter VE, Reznik E, Shelley CS, Shuch B, Signoretti S, Srinivasan R, Tamboli P, Thomas G, Tickoo S, Burnett K, Crain D, Gardner J, Lau K, Mallery D, Morris S, Paulauskis JD, Penny RJ, Shelton C, Shelton WT, Sherman M, Thompson E, Yena P, Avedon MT, Bowen J, Gastier-Foster JM, Gerken M, Leraas KM, Lichtenberg TM, Ramirez NC, Santos T, Wise L, Zmuda E, Demchok JA, Felau I, Hutter CM, Sheth M, Sofia HJ, Tarnuzzer R, Wang Z, Yang L, Zenklusen JC, Zhang J(J, Ayala B, Baboud J, Chudamani S, Liu J, Lolla L, Naresh R, Pihl T, Sun Q, Wan Y, Wu Y, Ally A, Balasundaram M, Balu S, Beroukhim R, Bodenheimer T, Buhay C, Butterfield YS, Carlsen R, Carter SL, Chao H, Chuah E, Clarke A, Covington KR, Dahdouli M, Dewal N, Dhalla N, Doddapaneni H, Drummond J, Gabriel SB, Gibbs RA, Guin R, Hale W, Hawes A, Hayes DN, Holt RA, Hoyle AP, Jefferys SR, Jones SJ, Jones CD, Kalra D, Kovar C, Lewis L, Li J, Ma Y, Marra MA, Mayo M, Meng S, Meyerson M, Mieczkowski PA, Moore RA, Morton D, Mose LE, Mungall AJ, Muzny D, Parker JS, Perou CM, Roach J, Schein JE, Schumacher SE, Shi Y, Simons JV, Sipahimalani P, Skelly T, Soloway MG, Sougnez C, Tam A, Tan D, Thiessen N, Veluvolu U, Wang M, Wilkerson MD, Wong T, Wu J, Xi L, Zhou J, Bedford J, Chen F, Fu Y, Gerstein M, Haussler D, Kasaian K, Lai P, Ling S, Radenbaugh A, Van Den Berg D, Weinstein JN, Zhu J, Albert M, Alexopoulou I, Andersen JJ, Auman JT, Bartlett J, Bastacky S, Bergsten J, Blute ML, Boice L, Bollag RJ, Boyd J, Castle E, Chen YB, Cheville JC, Curley E, Davies B, DeVolk A, Dhir R, Dike L, Eckman J, Engel J, Harr J, Hrebinko R, Huang M, Huelsenbeck-Dill L, Iacocca M, Jacobs B, Lobis M, Maranchie JK, McMeekin S, Myers J, Nelson J, Parfitt J, Parwani A, Petrelli N, Rabeno B, Roy S, Salner AL, Slaton J, Stanton M, Thompson RH, Thorne L, Tucker K, Weinberger PM, Winemiller C, Zach LA, Zuna R. Comprehensive Molecular Characterization of Papillary Renal-Cell Carcinoma. N Engl J Med 2016; 374:135-45. [PMID: 26536169 PMCID: PMC4775252 DOI: 10.1056/nejmoa1505917] [Citation(s) in RCA: 887] [Impact Index Per Article: 110.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Papillary renal-cell carcinoma, which accounts for 15 to 20% of renal-cell carcinomas, is a heterogeneous disease that consists of various types of renal cancer, including tumors with indolent, multifocal presentation and solitary tumors with an aggressive, highly lethal phenotype. Little is known about the genetic basis of sporadic papillary renal-cell carcinoma, and no effective forms of therapy for advanced disease exist. METHODS We performed comprehensive molecular characterization of 161 primary papillary renal-cell carcinomas, using whole-exome sequencing, copy-number analysis, messenger RNA and microRNA sequencing, DNA-methylation analysis, and proteomic analysis. RESULTS Type 1 and type 2 papillary renal-cell carcinomas were shown to be different types of renal cancer characterized by specific genetic alterations, with type 2 further classified into three individual subgroups on the basis of molecular differences associated with patient survival. Type 1 tumors were associated with MET alterations, whereas type 2 tumors were characterized by CDKN2A silencing, SETD2 mutations, TFE3 fusions, and increased expression of the NRF2-antioxidant response element (ARE) pathway. A CpG island methylator phenotype (CIMP) was observed in a distinct subgroup of type 2 papillary renal-cell carcinomas that was characterized by poor survival and mutation of the gene encoding fumarate hydratase (FH). CONCLUSIONS Type 1 and type 2 papillary renal-cell carcinomas were shown to be clinically and biologically distinct. Alterations in the MET pathway were associated with type 1, and activation of the NRF2-ARE pathway was associated with type 2; CDKN2A loss and CIMP in type 2 conveyed a poor prognosis. Furthermore, type 2 papillary renal-cell carcinoma consisted of at least three subtypes based on molecular and phenotypic features. (Funded by the National Institutes of Health.).
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Affiliation(s)
- W. Marston Linehan
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD
- Corresponding Author: W. Marston Linehan, M.D., Urologic Oncology Branch, National Cancer Institute, Building 10 CRC Room 1-5940, Bethesda, MD 20892-1107 USA, Tel: 301-496-6353, Fax: 301-402-0922,
| | - Paul T. Spellman
- Oregon Health & Science University, Portland, OR
- Corresponding Author: W. Marston Linehan, M.D., Urologic Oncology Branch, National Cancer Institute, Building 10 CRC Room 1-5940, Bethesda, MD 20892-1107 USA, Tel: 301-496-6353, Fax: 301-402-0922,
| | | | | | | | | | | | - Bradley A. Murray
- The Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University Cambridge, MA
| | - Laura Schmidt
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD
| | - Cathy D. Vocke
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD
| | - Myron Peto
- Oregon Health & Science University, Portland, OR
| | | | | | | | - Samira Brooks
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Angela N. Brooks
- The Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University Cambridge, MA
| | | | - A. Gordon Robertson
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Denise Brooks
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Reanne Bowlby
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Sara Sadeghi
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Hui Shen
- Van Andel Research Institute, Grand Rapids, MI
| | | | | | | | | | - Andrew D. Cherniack
- The Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University Cambridge, MA
| | - Gordon Saksena
- The Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University Cambridge, MA
| | - Scott Haake
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Jun Li
- Univ. of Texas MD Anderson Cancer Center, Houston, TX
| | - Han Liang
- Univ. of Texas MD Anderson Cancer Center, Houston, TX
| | - Yiling Lu
- Univ. of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Rehan Akbani
- Univ. of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Pavana Anur
- Oregon Health & Science University, Portland, OR
| | - Donald Bottaro
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD
| | | | | | | | | | | | - A. Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - James Hsieh
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - William Y. Kim
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Maria J. Merino
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD
| | | | | | - Ed Reznik
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | - Satish Tickoo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Daniel Crain
- The International Genomics Consortium, Phoenix, AZ
| | | | - Kevin Lau
- The International Genomics Consortium, Phoenix, AZ
| | | | - Scott Morris
- The International Genomics Consortium, Phoenix, AZ
| | | | | | | | | | - Mark Sherman
- The International Genomics Consortium, Phoenix, AZ
| | | | - Peggy Yena
- The International Genomics Consortium, Phoenix, AZ
| | - Melissa T. Avedon
- The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Jay Bowen
- The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | | | - Mark Gerken
- The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Kristen M. Leraas
- The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | | | - Nilsa C. Ramirez
- The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Tracie Santos
- The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Lisa Wise
- The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Erik Zmuda
- The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - John A. Demchok
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Ina Felau
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Carolyn M. Hutter
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Margi Sheth
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Heidi J. Sofia
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Roy Tarnuzzer
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Zhining Wang
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Liming Yang
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jean C. Zenklusen
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Brenda Ayala
- SRA International, Inc., 4300 Fair Lakes Court, Fairfax, VA
| | - Julien Baboud
- SRA International, Inc., 4300 Fair Lakes Court, Fairfax, VA
| | - Sudha Chudamani
- Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Rockville MD
| | - Jia Liu
- Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Rockville MD
| | - Laxmi Lolla
- Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Rockville MD
| | - Rashi Naresh
- SRA International, Inc., 4300 Fair Lakes Court, Fairfax, VA
| | - Todd Pihl
- SRA International, Inc., 4300 Fair Lakes Court, Fairfax, VA
| | - Qiang Sun
- SRA International, Inc., 4300 Fair Lakes Court, Fairfax, VA
| | - Yunhu Wan
- SRA International, Inc., 4300 Fair Lakes Court, Fairfax, VA
| | - Ye Wu
- Leidos Biomedical Research, Inc. Frederick National Laboratory for Cancer Research, Rockville MD
| | - Adrian Ally
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Miruna Balasundaram
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Saianand Balu
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rameen Beroukhim
- The Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University Cambridge, MA
| | - Tom Bodenheimer
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Rebecca Carlsen
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Scott L. Carter
- The Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University Cambridge, MA
| | - Hsu Chao
- Baylor College of Medicine, Houston, TX
| | - Eric Chuah
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Amanda Clarke
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | | | | | | | - Noreen Dhalla
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | | | | | - Stacey B. Gabriel
- The Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University Cambridge, MA
| | | | - Ranabir Guin
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | | | | | - D. Neil Hayes
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert A. Holt
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Alan P. Hoyle
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Steven J.M. Jones
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Corbin D. Jones
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Jie Li
- Baylor College of Medicine, Houston, TX
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Marco A. Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Michael Mayo
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Shaowu Meng
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew Meyerson
- The Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University Cambridge, MA
| | | | - Richard A. Moore
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | | | - Lisle E. Mose
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew J. Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | | | - Joel S. Parker
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jeffrey Roach
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Steven E. Schumacher
- The Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University Cambridge, MA
| | - Yan Shi
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Janae V. Simons
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Payal Sipahimalani
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Tara Skelly
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Carrie Sougnez
- The Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University Cambridge, MA
| | - Angela Tam
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Donghui Tan
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nina Thiessen
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | | | - Min Wang
- Baylor College of Medicine, Houston, TX
| | | | - Tina Wong
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Junyuan Wu
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Liu Xi
- Baylor College of Medicine, Houston, TX
| | - Jane Zhou
- Baylor College of Medicine, Houston, TX
| | | | | | - Yao Fu
- Yale University, New Haven, CT
| | | | - David Haussler
- University of California Santa Cruz Genomics Institute, Santa Cruz, CA
| | - Katayoon Kasaian
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC
| | - Phillip Lai
- University of Southern California, Los Angeles, CA
| | - Shiyun Ling
- Univ. of Texas MD Anderson Cancer Center, Houston, TX
| | - Amie Radenbaugh
- University of California Santa Cruz Genomics Institute, Santa Cruz, CA
| | | | | | - Jingchun Zhu
- University of California Santa Cruz Genomics Institute, Santa Cruz, CA
| | - Monique Albert
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | | | - J. Todd Auman
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John Bartlett
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Sheldon Bastacky
- University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, PA
| | - Julie Bergsten
- Penrose-St. Francis Health Services, Colorado Springs, CO
| | | | - Lori Boice
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jeff Boyd
- Fox Chase Cancer Center, Philadelphia, PA
| | | | - Ying-Bei Chen
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Erin Curley
- The International Genomics Consortium, Phoenix, AZ
| | - Benjamin Davies
- University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, PA
| | - April DeVolk
- Penrose-St. Francis Health Services, Colorado Springs, CO
| | - Rajiv Dhir
- University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, PA
| | | | - John Eckman
- Penrose-St. Francis Health Services, Colorado Springs, CO
| | - Jay Engel
- Kingston General Hospital, Kingston, Ontario, Canada
| | - Jodi Harr
- Penrose-St. Francis Health Services, Colorado Springs, CO
| | - Ronald Hrebinko
- University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, PA
| | - Mei Huang
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Mary Iacocca
- Helen F Graham Cancer Center at Christiana Care Health Systems, Newark, DE
| | - Bruce Jacobs
- University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, PA
| | - Michael Lobis
- Helen F Graham Cancer Center at Christiana Care Health Systems, Newark, DE
| | - Jodi K. Maranchie
- University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, PA
| | - Scott McMeekin
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jerome Myers
- Penrose-St. Francis Health Services, Colorado Springs, CO
| | - Joel Nelson
- University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, PA
| | | | - Anil Parwani
- University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, PA
| | - Nicholas Petrelli
- Helen F Graham Cancer Center at Christiana Care Health Systems, Newark, DE
| | - Brenda Rabeno
- Helen F Graham Cancer Center at Christiana Care Health Systems, Newark, DE
| | - Somak Roy
- University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, PA
| | | | - Joel Slaton
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | - Leigh Thorne
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kelinda Tucker
- Penrose-St. Francis Health Services, Colorado Springs, CO
| | | | | | | | - Rosemary Zuna
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Onukwugha E, Petrelli NJ, Castro KM, Gardner JF, Jayasekera J, Goloubeva O, Tan MT, McNamara EJ, Zaren HA, Asfeldt T, Bearden JD, Salner AL, Krasna MJ, Das IP, Clauser SB, Onukwugha E, Petrelli NJ, Castro KM, Gardner JF, Jayasekera J, Goloubeva O, Tan MT, McNamara EJ, Zaren HA, Asfeldt T, Bearden JD, Salner AL, Krasna MJ, Prabhu Das I, Clauser SB. ReCAP: Impact of Multidisciplinary Care on Processes of Cancer Care: A Multi-Institutional Study. J Oncol Pract 2015; 12:155-6; e157-68. [PMID: 26464497 DOI: 10.1200/jop.2015.004200] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The role of multidisciplinary care (MDC) on cancer care processes is not fully understood. We investigated the impact of MDC on the processes of care at cancer centers within the National Cancer Institute Community Cancer Centers Program (NCCCP). METHODS The study used data from patients diagnosed with stage IIB to III rectal cancer, stage III colon cancer, and stage III non–small-cell lung cancer at 14 NCCCP cancer centers from 2007 to 2012. We used an MDC development assessment tool—with levels ranging from evolving MDC (low) to achieving excellence (high)—to measure the level of MDC implementation in seven MDC areas, such as case planning and physician engagement. Descriptive statistics and cluster-adjusted regression models quantified the association between MDC implementation and processes of care, including time from diagnosis to treatment receipt. RESULTS A total of 1,079 patients were examined. Compared with patients with colon cancer treated at cancer centers reporting low MDC scores, time to treatment receipt was shorter for patients with colon cancer treated at cancer centers reporting high or moderate MDC scores for physician engagement (hazard ratio [HR] for high physician engagement, 2.66; 95% CI, 1.70 to 4.17; HR for moderate physician engagement, 1.50; 95% CI, 1.19 to 1.89) and longer for patients with colon cancer treated at cancer centers reporting high 2MDC scores for case planning (HR, 0.65; 95% CI, 0.49 to 0.85). Results for patients with rectal cancer were qualitatively similar, and there was no statistically significant difference among patients with lung cancer. CONCLUSION MDC implementation level was associated with processes of care, and direction of association varied across MDC assessment areas.
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Affiliation(s)
- Eberechukwu Onukwugha
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Nicholas J Petrelli
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Kathleen M Castro
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - James F Gardner
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Jinani Jayasekera
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Olga Goloubeva
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Ming T Tan
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Erica J McNamara
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Howard A Zaren
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Thomas Asfeldt
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - James D Bearden
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Andrew L Salner
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Mark J Krasna
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Irene Prabhu Das
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Steve B Clauser
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Eberechukwu Onukwugha
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Nicholas J Petrelli
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Kathleen M Castro
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - James F Gardner
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Jinani Jayasekera
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Olga Goloubeva
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Ming T Tan
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Erica J McNamara
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Howard A Zaren
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Thomas Asfeldt
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - James D Bearden
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Andrew L Salner
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Mark J Krasna
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Irene Prabhu Das
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Steve B Clauser
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
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Skolarus TA, Wolf AMD, Erb NL, Brooks DD, Rivers BM, Underwood W, Salner AL, Zelefsky MJ, Aragon-Ching JB, Slovin SF, Wittmann DA, Hoyt MA, Sinibaldi VJ, Chodak G, Pratt-Chapman ML, Cowens-Alvarado RL. American Cancer Society prostate cancer survivorship care guidelines. CA Cancer J Clin 2014; 64:225-49. [PMID: 24916760 DOI: 10.3322/caac.21234] [Citation(s) in RCA: 289] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer survivors approach 2.8 million in number and represent 1 in 5 of all cancer survivors in the United States. While guidelines exist for timely treatment and surveillance for recurrent disease, there is limited availability of guidelines that facilitate the provision of posttreatment clinical follow-up care to address the myriad of long-term and late effects that survivors may face. Based on recommendations set forth by a National Cancer Survivorship Resource Center expert panel, the American Cancer Society developed clinical follow-up care guidelines to facilitate the provision of posttreatment care by primary care clinicians. These guidelines were developed using a combined approach of evidence synthesis and expert consensus. Existing guidelines for health promotion, surveillance, and screening for second primary cancers were referenced when available. To promote comprehensive follow-up care and optimal health and quality of life for the posttreatment survivor, the guidelines address health promotion, surveillance for prostate cancer recurrence, screening for second primary cancers, long-term and late effects assessment and management, psychosocial issues, and care coordination among the oncology team, primary care clinicians, and nononcology specialists. A key challenge to the development of these guidelines was the limited availability of published evidence for management of prostate cancer survivors after treatment. Much of the evidence relies on studies with small sample sizes and retrospective analyses of facility-specific and population databases.
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Affiliation(s)
- Ted A Skolarus
- Assistant Professor of Urology, Department of Urology, University of Michigan, Research Investigator, HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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Salz T, McCabe MS, Onstad EE, Baxi SS, Deming RL, Franco RA, Glenn LA, Harper GR, Jumonville AJ, Payne RM, Peters EA, Salner AL, Schallenkamp JM, Williams SR, Yiee K, Oeffinger KC. Survivorship care plans: is there buy-in from community oncology providers? Cancer 2013; 120:722-30. [PMID: 24327371 DOI: 10.1002/cncr.28472] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/16/2013] [Accepted: 09/13/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Institute of Medicine recommended that survivors of cancer and their primary care providers receive survivorship care plans (SCPs) to summarize cancer treatment and plan ongoing care. However, the use of SCPs remains limited. METHODS Oncology providers at 14 National Cancer Institute Community Cancer Centers Program hospitals completed a survey regarding their perceptions of SCPs, including barriers to implementation, strategies for implementation, the role of oncology providers, and the importance of topics in SCPs (diagnosis, treatment, recommended ongoing care, and the aspects of ongoing care that the oncology practice will provide). RESULTS Among 245 providers (response rate of 70%), 52% reported ever providing any component of an SCP to patients. The most widely reported barriers were lack of personnel and time to create SCPs (69% and 64% of respondents, respectively). The most widely endorsed strategy among those using SCPs was the use of a template with prespecified fields; 94% of those who used templates found them helpful. For each topic of an SCP, although 87% to 89% of oncology providers believed it was very important for primary care providers to receive the information, only 58% to 65% of respondents believed it was very important for patients to receive the information. Furthermore, 33% to 38% of respondents reported mixed feelings regarding whether it was the responsibility of oncology providers to provide SCPs. CONCLUSIONS Practices need additional resources to overcome barriers to implementing SCPs. We found resistance toward SCPs, particularly the perceived value for the survivor and the idea that oncology providers are responsible for SCP dissemination.
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Affiliation(s)
- Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
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Murray BC, Hogarty LH, Latney D, Salner AL. Partnering to build a statewide cancer disparities program. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.31_suppl.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
216 Background: People of color die from cancer in disproportionately higher rates than Caucasians. As an NCI Community Cancer Centers Program (NCCCP) network member, we utilized American Recovery and Reinvestment Act (ARRA) funding to develop a unique partnership. Hartford Hospital’s Helen and Harry Gray Cancer Center (GCC) has worked closely with our statewide comprehensive cancer control coalition, the Connecticut Cancer Partnership (CCP), to address racial and ethnic health disparities across the state of Connecticut. Methods: We provided a Disparities Project Coordinator (DPC) to work for the CCP as a loaned executive. In this role, the DPC leveraged GCC resources, shared best practices, convened and coordinated statewide activities, and provided oversight for statewide implementation of evidence-based disparities- related cancer projects. This project has been funded in whole or in part with Federal Funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. Results: The DPC worked within the CCP structure to inform decision-making, initiate educational activities, and spearhead innovative projects such as a disparities internship with local universities and the evidence-based Body and Soul program in churches. Beyond CCP integration, the DPC represents CCP and the GCC on key statewide bodies to influence and inform policy affecting racial and ethnic minorities. Conclusions: This unique partnership is an example of a successful private-public partnership that has resulted in increased minority involvement in the state coalition and creation of multiple key partnerships with private, non-profit and state agencies. The accomplishments of the DPC have resulted in sustainability for this position and the establishment of an effective partnership model to address cancer disparities in the state.
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Morrill S, Mandich D, Cartun R, Salner AL. Implementation of a high-quality biospecimen program to support molecular medicine. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.31_suppl.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
200 Background: The successful implementation of a tumor genomics program relies heavily upon the collection of high quality tumor tissue samples. Although there has been an evolution towards utilizing formalin-fixed paraffin embedded (FFPE) tissue, many research centers continue to rely upon frozen fresh tissue for these types of analyses. A comprehensive effort is required to supply high-volume and high-quality tissue for research. Most community hospitals, even with superb pathology departments, are not well suited to deliver consistent tissue samples without a concerted programmatic effort. As part of the NCI Community Cancer Centers Program (NCCCP), we undertook the development of such capability at our hospital. In addition, as a member of H. Lee Moffitt Cancer Center’s Total Cancer Care program, we received grant funding to help support this comprehensive effort. Our patients and clinicians expressed a strong desire to participate in this type of translational research. This project has been funded in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. Methods: We developed a comprehensive staffing model to implement this program, including a program coordinator, consenters, pathology assistant, lab aide, and data manager. We developed superb relationships with surgeons, interventional radiologists, pathologists and staffs to assure appropriate referrals and processes, and implemented quality checks as a standard. We developed relationships with Moffitt, The Cancer Genome Atlas, and other research efforts, which help provide funding. Results: We successfully implemented a program which resulted in high levels of patient and provider satisfaction, high numbers of fresh frozen and FFPE tissues (nearly 3,000 over 3 years), high quality pass rates, low ischemia time, and high satisfaction on the part of our research partners. We have incorporated best practices in our tissue handling protocols. Conclusions: We successfully implemented a comprehensive cancer genomics bio-specimen program utilizing dedicated staff, working with patients and clinicians closely, and assuring careful coordination of all efforts.
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Salz T, Onstad E, McCabe MS, Baxi SS, Deming RL, Franco RA, Glenn LA, Harper GR, Jumonville A, Payne RM, Peters EA, Salner AL, Schallenkamp JM, Williams SR, Yiee K, Oeffinger KC. Survivorship care plans: Is there buy-in from oncology providers? J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.31_suppl.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8 Background: The Institute of Medicine advised that cancer survivors and their primary care providers receive survivorship care plans (SCPs) to summarize cancer treatment and plan ongoing care. However, the use of SCPs remains limited. Methods: Oncology providers at 14 National Cancer Institute Community Cancer Centers Program (NCCCP) hospitals completed a survey regarding their perceptions of SCPs, including barriers to implementation, strategies for implementation, the role of oncology providers, and the importance of topics in SCPs (diagnosis, treatment, recommended ongoing care, and the aspects of ongoing care that the oncology practice will provide). Results: Among 245 providers (70% response rate), a minority reported ever providing an SCP or any of its components to patients. The most widely reported barriers were personnel to creating SCPs and time (69% and 64% of respondents, respectively). The most widely endorsed strategy among those using SCPs was the use of a template with pre-specified fields; 94% of those who used templates found them helpful. For each topic of an SCP, while 87%-89% of oncology providers felt it was very important for primary care providers to receive the information, only 58%-65% of respondents felt it was very important for patients to receive the information. Further, 33%-38% of respondents had mixed feelings about whether it was oncology providers’ responsibility to provide SCPs. Conclusions: Practices need additional resources to overcome barriers to implementing SCPs. We found resistance toward SCPs, particularly the perceived value for the survivor and the idea that oncology providers are responsible for SCP dissemination.
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Affiliation(s)
- Talya Salz
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Erin Onstad
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | - Regina A Franco
- Cancer Institute at Greenville Health System, Greenville, SC
| | - Lyn A. Glenn
- Providence Portland Medical Center, Portland, OR
| | | | | | | | | | | | | | | | - Kevin Yiee
- St. Elizabeth Regional Medical Center, Lincoln, NE
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Salner AL, Walker D, Dornelas E. Development of a cancer survivorship patient navigator program. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.31_suppl.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
206 Background: Survivorship and navigation are component concepts within the continuum of integrated comprehensive cancer care. The focus of survivorship navigation is to provide strategies for a seamless transition for patients/family from acute cancer treatment to optimal post-treatment recovery, and to communicate those strategies with the patient’s health care providers. In addition, this visit may target a “teachable moment” where patients view health and lifestyle modifications as prioritized strategies for remaining cancer free. We developed a survivorship patient navigator program utilizing an APRN model, and performed pilot studies on its feasibility and effectiveness. This project has been funded in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. Methods: Our study, funded in part by a grant from the Livestrong Foundation and also through our collaborative work as an NCI Community Cancer Centers Program (NCCCP) site, examines whether the cancer treatment summary and survivorship care plan provided to the patient by a Survivorship Nurse Practitioner Navigator (SPN) will improve health and wellness from the patient’s perspective. The study obtained self-report data after a post treatment initial SPN visit and again 6 months later. It also explored enablers and barriers to successful program development. Results: Data analysis indicates that patients perceive they are receiving personalized and beneficial cancer care and are highly satisfied with the care plan provided. Barriers to establishing the program include: lack of MD understanding and acceptance, difficulty in obtaining treatment data from outside offices, limited staff resources, equipment costs, patient concern and buy-in for additional visit. Enablers include: MD champions, excellent communications to all team members, satisfied patients, CoC standards new in 2015 and ASCO QOPI measures, automation, sustainability, grant funding, philanthropy, and APRN visit charge. Conclusions: Survivorship is a key component of comprehensive cancer care. We have developed a sustainable model for program delivery, and our preliminary data supports enhancement of the patient experience.
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Lalla RV, Choquette LE, Curley KF, Dowsett RJ, Feinn RS, Hegde UP, Pilbeam CC, Salner AL, Sonis ST, Peterson DE. Randomized double-blind placebo-controlled trial of celecoxib for radiation-induced oral mucositis. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9620 Background: Oral mucositis (OM) is a painful complication of radiation therapy (RT) for head and neck (H&N) cancer. OM can compromise nutrition, require opioid analgesics and hospitalization for pain control, and lead to treatment interruptions. Due to the role of inflammatory pathways in the pathogenesis of OM, this study investigated the effect of inhibition of cyclooxygenase-2 (COX-2) on severity and morbidity of OM. Methods: In this randomized double-blind placebo-controlled trial,40 H&N cancer patients were randomized to daily use of 200 mg celecoxib or matched placebo, for the duration of RT. Eligibility criteria included planned RT dose of ≥ 5000 cGy to 2+ areas of the mouth and no contraindication for celecoxib use. The planned sample size of 20 per arm provided 80% power to detect a 1 point difference in mean Oral Mucositis Assessment Scale (OMAS) score (range 0-5) at 5000 cGy RT (primary endpoint), applying a two-tailed, two-sample t-test at the 5% level of significance. Clinical OM, normalcy of diet, pain scores and analgesic use were assessed 2-3 times a week by blinded investigators during the 6-7 week period of RT, using validated scales. Results: Twenty subjects were randomized to each arm, which were similar with respect to tumor location, radiation dose, and concomitant chemotherapy. In both arms, mucositis and pain scores increased over the course of RT. Intent-to-treat analyses demonstrated no significant difference in mean (SD) OMAS scores at 5000 cGy [celecoxib 1.32 (0.71), placebo 1.27 (0.86), p = 0.83, two sample t-test]. There was also no difference between the celecoxib and placebo arms respectively, in mean OMAS scores over the period of RT (SD) [0.98(0.77) & 0.97 (0.86), p = 0.84], mean worst pain scores [3.38 (3.07) & 3.31 (3.32), p = 0.83], mean normalcy of diet scores [5.43 (3.86) & 5.11(3.94), p = 0.65], or mean daily opioid medication use in IV morphine equivalents [19.08 (16.57) & 20.48 (19.07), p = 0.48], all by linear mixed model fixed effects regression analysis. There were no SAEs attributed to celecoxib use. Conclusions: Daily use of a selective COX-2 inhibitor, during the period of RT for H&N cancer, did not reduce the severity of clinical OM, pain, dietary compromise or use of opioid analgesics. Clinical trial information: NCT00698204.
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Affiliation(s)
| | | | | | | | - Richard S. Feinn
- Frank Netter MD School of Medicine at Quinnipiac University, Hamden, CT
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Patel VB, Nahar R, Murray B, Salner AL. Exploring implications of Medicaid participation and wait times for colorectal screening on early detection efforts in Connecticut--a secret-shopper survey. Conn Med 2013; 77:197-203. [PMID: 23691732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Routine colorectal screening, decreases in incidence, and advances in treatment have lowered colorectal cancer mortality rates over the past three decades. Nevertheless, it remains the second most common cause of cancer death amongst men and women combined in U.S. Most cases of colon cancer are diagnosed at a late stage leading to poor survival outcomes for patients. After extensive research of publically available data, it would appear that the state of Connecticut does not have available state-wide data on patient wait times for routine colonoscopy screening. Furthermore, there are no publicly available, or Connecticut-specific, reports on Medicaid participation rates for colorectal screening amongst gastroenterologists (GI) in Connecticut. In 2012, the American Cancer Society report on Colorectal Cancer Screening Rates confirmed barriers to health-care access and disparities in health outcomes and survival rates for colon cancer patients based on race, ethnicity, and low socioeconomic status. Given this information, one could conjecture that low Medicaid participation rates among GIs could potentially have a more severe impact on health-care access and outcomes for underserved populations. At present, funding and human resources are being employed across the state of Connecticut to address bottlenecks in colorectal cancer screening. More specifically, patient navigation and outreach programs are emerging and expanding to address the gaps in services for hard-to-reach populations and the medically underserved. Low Medicaid participation rates and increased wait times for colonoscopy screening may impair the efficacy of colorectal cancer patient navigation and outreach efforts and potentially funding for future interventions. In this study, we report the results of our secret-shopper telephone survey comprising of 93 group and independent gastroenterologist (GI) practices in different counties of Connecticut. METHODS Reviewing online resources and yellow pages, researchers compiled a county-specific list of GI practices throughout Connecticut and conducted a secret-shopper survey by telephone. A standard script and set of questions was formulated and used for each telephone call to GI practices. Data was analyzed in context of statistics available to the public at large from the U.S. Census Bureau. RESULTS Overall, 46% of all 93 practices and 62% of individual GIs from all 93 practices state-wide reported Medicaid participation. About 35% of surveyed practices were independent practices; 41% of these reported Medicaid participation. About 65% of surveyed practices were group practices; 49% of these reported Medicaid participation. Approximately, 85% of all practices are in Fairfield, Hartford, orNew Haven counties. Of all three counties, New Haven reported the highest Medicaid participation rate by practices; 62% of all practices in New Haven reported participation. Fairfield reported the lowest Medicaid participation rate by practices; 29% of all practices in Fairfield reported participation. When Medicaid participation rates were calculated for total number of gastroenterologists from all practices in a given county (as opposed to participation rates by number of practices), Medicaid participation rates were 80% and 44% for New Haven and Fairfield, respectively. Of all practices in Hartford, only 50% reported Medicaid participation, whereas 67% of the total number of gastroenterologists (as opposed to practices) reported Medicaid participation. According to a recent national survey, 47% of gastroenterologists reported stopping accepting new Medicaid patients. Overall minimum and maximum wait times were reported to be the highest for Hartford, but wait times were long even for smaller counties, reflecting a possible imbalance in supply and demand or inefficiency in allocating the available resources. CONCLUSIONS Only a limited number of gastroenterology practices in Connecticut accept Medicaid patients, notably in selected counties, but in all counties, and this may add to access barriers. It is yet unclear whether these disparities are significant enough to create a supply-demand imbalance and thus, have a significantly negative impact on health outcomes for the underserved. Nevertheless, with the high unemployment rates and impending implementation of mandated state-wide health-care reform as outlined in the Affordable Care Act, the Medicaid population in the state of Connecticut will increase, increasing future demand for services. In addition, based on the survey findings, longer wait times for colonoscopy screening are reported for the many of GI practices in Connecticut for Medicaid-insured as well as non-Medicaid patients. Longer wait times may have an impact on patient compliance, especially for the underserved populations that are hard to reach and ensure follow-up, contributing to potential delayed diagnosis. A Medicaid-associated disparity in this area will serve to exacerbate the problem for the underserved compared to those relatively well served. Those currently not seeking screening are at even higher risk of contributing to the higher mortality rate, and we need to find out how best to ensure that we can more uniformly apply screening and have the capacity to do so.
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Affiliation(s)
- Vatsal B Patel
- University of Connecticut School of Medicine, Farmington, USA
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Salner AL. Connecticut Cancer Partnership: the development of a statewide comprehensive control program. Conn Med 2012; 76:327-330. [PMID: 22856017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Salner AL, Silber ALM. Comprehensive cancer control--impacting every physician. Conn Med 2012; 76:325-326. [PMID: 22856016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Alexander GA, Swartz HM, Amundson SA, Blakely WF, Buddemeier B, Gallez B, Dainiak N, Goans RE, Hayes RB, Lowry PC, Noska MA, Okunieff P, Salner AL, Schauer DA, Trompier F, Turteltaub KW, Voisin P, Wiley AL, Wilkins R. BiodosEPR-2006 Meeting: Acute dosimetry consensus committee recommendations on biodosimetry applications in events involving uses of radiation by terrorists and radiation accidents. RADIAT MEAS 2007. [DOI: 10.1016/j.radmeas.2007.05.035] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Dainiak N, Delli Carpini D, Bohan M, Werdmann M, Wilds E, Barlow A, Beck C, Cheng D, Daly N, Glazer P, Mas P, Nath R, Piontek G, Price K, Albanese J, Roberts K, Salner AL, Rockwell S. Development of a statewide hospital plan for radiologic emergencies. Int J Radiat Oncol Biol Phys 2006; 65:16-24. [PMID: 16618574 DOI: 10.1016/j.ijrobp.2005.12.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2005] [Revised: 12/21/2005] [Accepted: 12/21/2005] [Indexed: 10/24/2022]
Abstract
Although general guidelines have been developed for triage of victims in the field and for hospitals to plan for a radiologic event, specific information for clinicians and administrators is not available for guidance in efficient management of radiation victims during their early encounter in the hospital. A consensus document was developed by staff members of four Connecticut hospitals, two institutions of higher learning, and the State of Connecticut Department of Environmental Protection and Office of Emergency Preparedness, with assistance of the American Society for Therapeutic Radiology and Oncology. The objective was to write a practical manual for clinicians (including radiation oncologists, emergency room physicians, and nursing staff), hospital administrators, radiation safety officers, and other individuals knowledgeable in radiation monitoring that would be useful for evaluation and management of radiation injury. The rationale for and process by which the radiation response plan was developed and implemented in the State of Connecticut are reviewed. Hospital admission pathways are described, based on classification of victims as exposed, contaminated, and/or physically injured. This manual will be of value to those involved in planning the health care response to a radiologic event.
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Affiliation(s)
- Nicholas Dainiak
- Department of Medicine, Bridgeport Hospital, Bridgeport, CT 06610, USA.
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Distasio SA, Salner AL, Brant JM, Fischberg D, Manfredi P. Brachial plexopathy after treatment for breast cancer. Cancer Pract 2000; 8:110-3. [PMID: 11898134 DOI: 10.1046/j.1523-5394.2000.83003.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- S A Distasio
- Northwest CT Oncology-Hematology Assoc. Litchfield County, Connecticut, USA
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Saleh J, Silberstein HJ, Salner AL, Uphoff DF. Meningioma: the role of a foreign body and irradiation in tumor formation. Neurosurgery 1991; 29:113-8; discussion 118-9. [PMID: 1870671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A case of meningioma is reported. At the age of 18 years, the patient had undergone insertion of a Torkildsen shunt through a posteroparietal burr hole for obstructive hydrocephalus secondary to a tumor of the pineal region, of which no biopsy had been made. After the hydrocephalus was relieved, he underwent irradiation of the tumor. Thirty years later, he was treated for an intracranial meningioma wrapped around the shunt. The tumor followed the shunt in all of its intracranial course. Microscopy disclosed pieces of the shunt tube within the meningioma. The role of a foreign body and irradiation in the induction of meningiomas is discussed, and a comprehensive review of the literature is presented.
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Affiliation(s)
- J Saleh
- Department of Neurosurgery, Hartford Hospital, Connecticut
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Abstract
Abstract
A case of meningioma is reported. At the age of 18 years, the patient had undergone insertion of a Torkildsen shunt through a posteroparietal burr hole for obstructive hydrocephalus secondary to a tumor of the pineal region, of which no biopsy had been made. After the hydrocephalus was relieved, he underwent irradiation of the tumor. Thirty years later, he was treated for an intracranial meningioma wrapped around the shunt. The tumor followed the shunt in all of its intracranial course. Microscopy disclosed pieces of the shunt tube within the meningioma. The role of a foreign body and irradiation in the induction of meningiomas is discussed, and a comprehensive review of the literature is presented. (Neurosurgery 29:113-119, 1991)
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Affiliation(s)
- Jamshid Saleh
- Departments of Neurosurgery, Hartford Hospital, Hartford, Connecticut
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Salner AL, Obbagy JE, Hellman S. Differing stem cell self-renewal of lectin-separated murine bone marrow fractions. J Natl Cancer Inst 1982; 68:639-41. [PMID: 7040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The success of bone marrow transplantation depends not only on the engraftment of adequate numbers of hematopoietic stem cells but also on their self-renewal capacity, which must be sufficient to provide lifetime hematopoiesis. The lectin peanut agglutinin (PNA), when exposed to bone marrow, causes separation into two distinct fractions. The agglutinated fraction not only is enriched with colony-forming units--spleen but also is devoid of graft-versus-host (GVH) activity when injected into allogeneic lethally irradiated recipients, and therefore, it is considered to be an ideal source for bone marrow transplantation. The absence of GVH activity is presumably due to the separation of mature thymocytes into the nonagglutinated fraction and functionally immature thymocytes into the agglutinated fraction. Although there has been speculation that immature hematopoietic stem cells also selectively bind to PNA, other evidence suggests that the relationship of lectin binding specificity to level of maturity varies in different tissues. This study was performed to assess the self-renewal capacity of lectin-separated bone marrow stem cells. Results indicate that the self-renewal of the agglutinated fraction is significantly lower than that of the unfractionated bone marrow; such self-renewal of the nonagglutinated fraction is higher. This is further evidence for the heterogeneity of the stem cell pool. Stem cell enrichment should not be the goal in bone marrow transplantation; rather, the goal should be utilization of stem cells with the greatest self-renewal potential.
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Salner AL, Botnick LE, Herzog AG, Goldstein MA, Harris JR, Levene MB, Hellman S. Reversible brachial plexopathy following primary radiation therapy for breast cancer. Cancer Treat Rep 1981; 65:797-802. [PMID: 6791820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Reversible brachial plexopathy has occurred in very low incidence in patients with breast carcinoma treated definitively with radiation therapy. Of 565 patients treated between January 1968 and December 1979 with moderate doses of supervoltage radiation therapy (average axillary dose of 5000 rad in 5 weeks), eight patients (1.4%) developed the characteristic symptoms at a median time of 4.5 months after radiation therapy. This syndrome consists of paresthesias in all patients, with weakness and pain less commonly seen. The symptom complex differs from other previously described brachial plexus syndromes, including paralytic brachial neuritis, radiation-induced injury, and carcinoma. A possible relationship to adjuvant chemotherapy exists, though the etiology is not well-understood. The cases described demonstrate temporal clustering. Resolution is always seen.
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Salner AL, Mullany LD, Cole SR. Methysergide induced mitral valvular insufficiency. Conn Med 1980; 44:6-8. [PMID: 7353368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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