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Gonzalez BD, Choo S, Janssen JJ, Hazelton J, Latifi K, Leach CR, Bailey S, Jim HS, Oswald LB, Woolverton M, Murphy M, Schilowitz EL, Frakes JM, Robinson EJ, Hoffe S. Novel Virtual Reality App for Training Patients on MRI-guided Radiation Therapy. Adv Radiat Oncol 2024; 9:101477. [PMID: 38681889 PMCID: PMC11043805 DOI: 10.1016/j.adro.2024.101477] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/09/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Patients receiving respiratory gated magnetic resonance imaging-guided radiation therapy (MRIgRT) for abdominal targets must hold their breath for ≥25 seconds at a time. Virtual reality (VR) has shown promise for improving patient education and experience for diagnostic MRI scan acquisition. We aimed to develop and pilot-test the first VR app to educate, train, and reduce anxiety and discomfort in patients preparing to receive MRIgRT. Methods and Materials A multidisciplinary team iteratively developed a new VR app with patient input. The app begins with minigames to help orient patients to using the VR device and to train patients on breath-holding. Next, app users are introduced to the MRI linear accelerator vault and practice breath-holding during MRIgRT. In this quality improvement project, clinic personnel and MRIgRT-eligible patients with pancreatic cancer tested the VR app for feasibility, acceptability, and potential efficacy for training patients on using breath-holding during MRIgRT. Results The new VR app experience was tested by 19 patients and 67 clinic personnel. The experience was completed on average in 18.6 minutes (SD = 5.4) by patients and in 14.9 (SD = 3.5) minutes by clinic personnel. Patients reported the app was "extremely helpful" (58%) or "very helpful" (32%) for learning breath-holding used in MRIgRT and "extremely helpful" (28%) or "very helpful (50%) for reducing anxiety. Patients and clinic personnel also provided qualitative feedback on improving future versions of the VR app. Conclusion The VR app was feasible and acceptable for training patients on breath-holding for MRIgRT. Patients eligible for MRIgRT for pancreatic cancer and clinic personnel reported on future improvements to the app to enhance its usability and efficacy.
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Affiliation(s)
- Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Sylvia Choo
- Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | | | - Kujtim Latifi
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | | | - Shannon Bailey
- Morsani College of Medicine, University of South Florida, Tampa, FL
- Center for Advanced Medical Learning and Simulation, University of South Florida, Tampa, FL
| | - Heather S.L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | | | | | | | | | | | - Sarah Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
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Rees-Punia E, Masters M, Teras LR, Leach CR, Williams GR, Newton CC, Diver WR, Patel AV, Parsons HM. Long-term multimorbidity trajectories in older adults: The role of cancer, demographics, and health behaviors. Cancer 2024; 130:312-321. [PMID: 37837241 DOI: 10.1002/cncr.35047] [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: 03/09/2023] [Revised: 08/18/2023] [Accepted: 09/06/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Multimorbidity is associated with premature mortality and excess health care costs. The burden of multimorbidity is highest among patients with cancer, yet trends and determinants of multimorbidity over time are poorly understood. METHODS Via Medicare claims linked to Cancer Prevention Study II data, group-based trajectory modeling was used to compare National Cancer Institute comorbidity index score trends for cancer survivors and older adults without a cancer history. Among cancer survivors, multinomial logistic regression analyses evaluated associations between demographics, health behaviors, and comorbidity trajectories. RESULTS In 82,754 participants (mean age, 71.6 years [SD, 5.1 years]; 56.9% female), cancer survivors (n = 11,265) were more likely than older adults without a cancer history to experience the riskiest comorbidity trajectories: (1) steady, high comorbidity scores (remain high; odds ratio [OR], 1.36; 95% CI, 1.29-1.45), and (2) high scores that increased over time (start high and increase; OR, 1.51; 95% CI, 1.38-1.65). Cancer survivors who were physically active postdiagnosis were less likely to fall into these two trajectories (OR, 0.73; 95% CI, 0.64-0.84, remain high; OR, 0.42; 95% CI, 0.33-0.53, start high and increase) compared to inactive survivors. Cancer survivors with obesity were more likely to have a trajectory that started high and increased (OR, 2.83; 95% CI, 2.32-3.45 vs. normal weight), although being physically active offset some obesity-related risk. Cancer survivors who smoked postdiagnosis were also six times more likely to have trajectories that started high and increased (OR, 6.86; 95% CI, 4.41-10.66 vs. never smokers). CONCLUSIONS Older cancer survivors are more likely to have multiple comorbidities accumulated at a faster pace than older adults without a history of cancer. Weight management, physical activity, and smoking avoidance postdiagnosis may attenuate that trend.
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Affiliation(s)
- Erika Rees-Punia
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Matthew Masters
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Lauren R Teras
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Corinne R Leach
- Center for Digital Health, Moffitt Cancer Center, Tampa, Florida, USA
| | - Grant R Williams
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina C Newton
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - W Ryan Diver
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Helen M Parsons
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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Canada AL, Murphy PE, Stein K, Alcaraz KI, Leach CR, Fitchett G. Assessing the impact of religious resources and struggle on well-being: a report from the American Cancer Society's Study of Cancer Survivors-I. J Cancer Surviv 2023; 17:360-369. [PMID: 35726114 PMCID: PMC10084782 DOI: 10.1007/s11764-022-01226-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/14/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The current study examined the relationships between religious resources (i.e., certainty of belief in God and attendance at religious services), religious struggle (e.g., belief that cancer is evidence of God's punishment or abandonment), and physical and mental health-related quality of life (HRQoL), including fear of cancer recurrence (FCR), in a large, geographically and clinically diverse sample of long-term survivors of cancer. METHODS Participants were 2021 9-year survivors of cancer from the American Cancer Society's Study of Cancer Survivors - I. Religious resources included belief in God and attendance at religious services. Items from the Brief RCOPE and the PROMIS Psychosocial Impact of Illness were combined to assess religious struggle. Survivors also completed the Fear of Cancer Recurrence Inventory, SF-12, and Meaning and Peace subscales of the FACIT-Sp. Regression models were used to predict HRQoL and FCR from religious resources and struggle. RESULTS In multivariable models, certain belief in God predicted greater mental HRQoL (B = 1.99, p < .01), and attendance at religious services was associated with greater FCR (B = .80, p < .05) as well as better mental (B = .34, p < .01) and physical (B = .29, p < .05) HRQoL. In addition, religious struggle predicted greater FCR (B = 1.32, p < .001) and poorer mental (B = - .59, p < .001) and physical (B = - .29, p < .001) HRQoL. Many of these relationships were mediated through Meaning. CONCLUSIONS With the exception of FCR, religious resources predicted better HRQoL outcomes in these long-term survivors of cancer. Conversely, religious struggle consistently predicted poorer HRQoL, including greater FCR. IMPLICATIONS FOR CANCER SURVIVORS Given the documented importance of its role in coping with the cancer experience, religion/spirituality should be a consideration in every survivorship care plan. Multidisciplinary assessment and support of religious resources and identification of and referral for religious struggle are needed to ensure the well-being of most long-term survivors of cancer.
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Affiliation(s)
- Andrea L Canada
- Rosemead School of Psychology, Biola University, 13800 Biola Ave, La Mirada, CA, 90639, USA.
| | - Patricia E Murphy
- Religion, Health, and Human Values, Rush University Medical Center, Chicago, USA
| | - Kevin Stein
- Rollins School of Public Health, Emory University, Atlanta, USA
| | | | | | - George Fitchett
- Religion, Health, and Human Values, Rush University Medical Center, Chicago, USA
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Rees-Punia E, Leach CR, Westmaas JL, Dempsey LF, Roberts AM, Nocera JR, Patel AV. Author Correction to: Pilot Randomized Controlled Trial of Feasibility, Acceptability, and Preliminary Efficacy of a Web-based Physical Activity and Sedentary Time Intervention for Survivors of Physical Inactivity-related Cancers. Int J Behav Med 2023; 30:304. [PMID: 36781575 DOI: 10.1007/s12529-023-10158-1] [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] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Erika Rees-Punia
- Department of Population Science, American Cancer Society, Atlanta, GA, USA.
| | - Corinne R Leach
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - J Lee Westmaas
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Lauren F Dempsey
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Amelia M Roberts
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Joe R Nocera
- Departments of Neurology and Rehabilitation Medicine, Emory University, Atlanta, GA, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA
- Cancer Prevention and Control Program, Winship Cancer Institute, Atlanta, GA, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
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Rees-Punia E, Newton CC, Parsons HM, Leach CR, Diver WR, Grant AC, Masters M, Patel AV, Teras LR. Fracture Risk Among Older Cancer Survivors Compared With Older Adults Without a History of Cancer. JAMA Oncol 2023; 9:79-87. [PMID: 36326746 PMCID: PMC9634602 DOI: 10.1001/jamaoncol.2022.5153] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
Importance The number of cancer survivors living in the US is projected to be 26.1 million by 2040. Cancer survivors may be at increased risk of bone fractures, but research is limited in several important ways. Objective To investigate the associations of cancer diagnoses, including time since diagnosis and stage at diagnosis, with risks of pelvic, radial, and vertebral fractures (separately and combined) among older cancer survivors and compared with fracture risk among older adults without a history of cancer. Secondarily, to examine differences in risk of fracture stratified by modifiable behaviors, treatment, and cancer type. Design, Setting, and Participants This longitudinal cohort study used data from 92 431 older adults in the US Cancer Prevention Study II Nutrition Cohort linked with 1999 to 2017 Medicare claims. Data were analyzed from July 15, 2021, to May 3, 2022. Exposures Cancer history, time since cancer diagnosis, and stage at cancer diagnosis. Main Outcomes and Measures Hazard ratios (HRs) and 95% CIs for the risk of pelvic, radial, vertebral, and total frailty-related fractures were estimated using multivariate Cox proportional hazards regression. Stratification was used for secondary aims. Results Among 92 431 participants (mean [SD] age, was 69.4 [6.0] years, 51 820 [56%] women, and 90 458 [97.9%] White], 12 943 participants experienced a frailty-related bone fracture. Compared with participants without a history of cancer, cancer survivors who were diagnosed 1 to less than 5 years earlier with advanced stage cancer had higher risk of fracture (HR, 2.12; 95% CI, 1.75-2.58). The higher fracture risk in cancer survivors with recent advanced stage diagnosis (vs no cancer) was driven largely by vertebral (HR, 2.46; 95% CI, 1.93-3.13) and pelvic (HR, 2.46; 95% CI, 1.84-3.29) fracture sites. Compared with cancer survivors who did not receive chemotherapy, survivors who received chemotherapy were more likely to have a fracture; this association was stronger within 5 years of diagnosis (HR, 1.31; 95% CI, 1.09-1.57) than 5 or more years after diagnosis (HR, 1.22; 95% CI, 0.99-1.51). Although the HR for risk of fracture was lower among physically active cancer survivors 5 or more years after diagnosis (HR, 0.76; 95% CI, 0.54-1.07), this result was not statistically significant, whereas current smoking was significantly associated with higher risk of fracture (HR, 2.27; 95% CI, 1.55-3.33). Conclusions and Relevance Findings from this cohort study suggest that older adults with a history of cancer may benefit from clinical guidance on prevention of frailty-related fractures. If study findings are replicated, fracture prevention programs for survivors might include referrals for physical activity with cancer exercise professionals and smoking cessation programs.
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Affiliation(s)
- Erika Rees-Punia
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Christina C. Newton
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Helen M. Parsons
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Corinne R. Leach
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - W. Ryan Diver
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Amber C. Grant
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Matthew Masters
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Alpa V. Patel
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Lauren R. Teras
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
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Rees-Punia E, Newton CC, Parsons H, Leach CR, Grant AC, Masters M, Diver WR, Patel AV, Teras LR. Does Physical Activity Mitigate The Risk Of Frailty-related Bone Fractures Among Cancer Survivors? Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000876076.83962.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McCullough ML, Chantaprasopsuk S, Islami F, Rees-Punia E, Um CY, Wang Y, Leach CR, Sullivan KR, Patel AV. Association of Socioeconomic and Geographic Factors With Diet Quality in US Adults. JAMA Netw Open 2022; 5:e2216406. [PMID: 35679041 PMCID: PMC9185183 DOI: 10.1001/jamanetworkopen.2022.16406] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE Poor diet quality is a key factor associated with obesity and chronic disease. Understanding associations of socioeconomic and geographic factors with diet quality can inform public health and policy efforts for advancing health equity. OBJECTIVE To identify socioeconomic and geographic factors associated with diet quality in a large US cohort study. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included adult men and women who enrolled in the Cancer Prevention Study-3 at American Cancer Society community events in 35 US states, the District of Columbia, and Puerto Rico between 2006 and 2013. Participants completed a validated food frequency questionnaire between 2015 and 2017. Data were analyzed from February to November 2021. EXPOSURES The main exposures included self-reported race and ethnicity, education, and household income. Geocoded addresses were used to classify urbanization level using Rural-Urban Commuting Area codes; US Department of Agriculture's Food Access Research Atlas database classified residence in food desert. MAIN OUTCOMES AND MEASURES Poor diet quality was defined as lowest quartile of dietary concordance with the 2020 American Cancer Society recommendations for cancer prevention score, based on sex-specific intake categories of vegetables and legumes, whole fruits, whole grains, red and processed meat, highly processed foods and refined grains, and sugar-sweetened beverages. RESULTS Among 155 331 adults, 123 115 were women (79.3%), and the mean (SD) age was 52 (9.7) years), and there were 1408 American Indian or Alaskan Native individuals (0.9%); 2721 Asian, Native Hawaiian, or Pacific Islander individuals (1.8%); 3829 Black individuals (2.5%); 7967 Hispanic individuals (5.1%); and 138 166 White individuals (88.9%). All key exposures assessed were statistically significantly and independently associated with poor diet quality. Compared with White participants, Black participants had a 16% (95% CI, 8%-25%) higher risk of poor diet quality, while Hispanic/Latino had 16% (95% CI, 12%-21%) lower risk and Asian, Native Hawaiian, and Pacific Islander participants had 33% (95% CI, 26%-40%) lower risk of poor diet quality. After controlling for other characteristics, rural residence was associated with a 61% (95% CI, 48%-75%) higher risk of poor diet quality, and living in a food desert was associated with a 17% (95% CI, 12%-22%) higher risk. Associations of income with diet quality and education with diet quality varied by race and ethnicity (income: P for interaction = .01; education: P for interaction < .001). All diet score components were associated with disparities observed. CONCLUSIONS AND RELEVANCE This cross-sectional study found that multiple individual-level socioeconomic and geographic variables were independently associated with poor diet quality among a large, racially and ethnically and geographically diverse US cohort. These findings could help to identify groups at highest risk of outcomes associated with poor diet to inform future approaches for advancing health equity.
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Affiliation(s)
| | | | - Farhad Islami
- Department of Surveillance and Health Equity Science, American Cancer Society, Kennesaw, Georgia
| | - Erika Rees-Punia
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Caroline Y. Um
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Ying Wang
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Corinne R. Leach
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Kristen R. Sullivan
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
| | - Alpa V. Patel
- Department of Population Science, American Cancer Society, Kennesaw, Georgia
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Leach CR, Gapstur SM, Cella D, Deubler E, Teras LR. Age-related health deficits and five-year mortality among older, long-term cancer survivors. J Geriatr Oncol 2022; 13:1023-1030. [PMID: 35660092 DOI: 10.1016/j.jgo.2022.05.006] [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] [Received: 10/20/2021] [Revised: 05/05/2022] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Geriatric assessment evaluates multiple domains of health that, together, are superior to using chronologic age for predicting outcomes, such as hospitalization and mortality among patients with cancer. Most studies have not included comparison groups of individuals without cancer and assessed domains around the time of initial cancer diagnosis. Further, the potential for brief, self-reported measures to capture deficits that similarly predict mortality has not been well examined. This study compared age-related health deficit prevalence between older, long-term cancer survivors and individuals without a cancer history, and estimated associations between deficits and mortality risk among survivors. MATERIALS AND METHODS Analyses included participants in the Cancer Prevention Study (CPS)-II Nutrition Cohort who were cancer-free at enrollment in 1992/1993 and completed the Patient Reported Outcome Measurement Information System® (PROMIS®) global health questionnaire in 2011. Age-related deficits in five domains (comorbidities, functional status, mental health, malnutrition/weight loss, and social support) were self-reported. Cancer information was self-reported and confirmed via medical records or state cancer registries. Vital status through 2016 and cause of death was ascertained by linkage with the National Death Index. RESULTS Analyses included 9979 participants (median age = 80) diagnosed with invasive cancer 5-20 years prior to completing the 2011 survey and 63,578 participants without a cancer history (median age = 79). Overall deficits in the five domains were similar among long-term cancer survivors and controls. However, survivors of specific cancer types - non-Hodgkin lymphoma (NHL), lung, and kidney cancer - were more likely to report deficits in mental health and functional status than the control group. Among all survivors, each domain was independently associated with all-cause mortality, particularly functional status (hazard ratio [HR] = 2.02; 95% confidence interval [CI]: 1.80-2.27) and mental health (HR = 1.84; 95% CI: 1.65-2.04). Mortality risk increased with the number of deficits. DISCUSSION These results suggest that, several years after treatment, NHL, lung, and kidney cancer survivors are still more likely to experience age-related deficits compared to other similarly-aged individuals. Furthermore, results show that shorter, self-reported physical and mental health assessments, such as the PROMIS® global health questions, are predictive of mortality among older, long-term cancer survivors and, therefore, may be useful in clinical and research settings.
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Affiliation(s)
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Leach CR, Hudson SV, Diefenbach MA, Wiseman KP, Sanders A, Coa K, Chantaprasopsuk S, Stephens RL, Alfano CM. Cancer health self-efficacy improvement in a randomized controlled trial. Cancer 2022; 128:597-605. [PMID: 34668569 PMCID: PMC9930867 DOI: 10.1002/cncr.33947] [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] [Received: 03/25/2021] [Revised: 06/21/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND eHealth interventions can help cancer survivors self-manage their health outside the clinic. Little is known about how best to engage and assist survivors across the age and cancer treatment spectra. METHODS The American Cancer Society conducted a randomized controlled trial that assessed efficacy of, and engagement with, Springboard Beyond Cancer, an eHealth self-management program for cancer survivors. Intent-to treat analyses assessed effects of intervention engagement for treatment (on-treatment vs completed) overall (n = 176; 88 control, 88 intervention arm) and separately by age (<60 years vs older). Multiple imputation was used to account for participants who were lost to follow-up (n = 41) or missing self-efficacy data (n = 1) at 3 months follow-up. RESULTS Self-efficacy for managing cancer, the primary outcome of this trial, increased significantly within the intervention arm and for those who had completed treatment (Cohen's d = 0.26, 0.31, respectively). Additionally, participants with moderate-to-high engagement in the text and/or web intervention (n = 30) had a significantly greater self-efficacy for managing cancer-related issues compared to the control group (n = 68), with a medium effect size (Cohen's d = 0.44). Self-efficacy did not differ between the intervention and control arm at 3 months post-baseline. CONCLUSIONS Study results suggest that cancer survivors benefit variably from eHealth tools. To maximize effects of such tools, it is imperative to tailor information to a priori identified survivor subgroups and increase engagement efforts.
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Abstract
Public health concerns regarding opioids and marijuana have implications for their medical use. This study examined use motives and perceived barriers in relation to opioid and marijuana use and interest in use among US adult cancer survivors. Self-administered surveys were distributed using social media to assess use motives and perceived barriers among participants living with cancer. Overall, 40.9% of cancer survivors reported current (past 30-day) use of opioids, 42.5% used marijuana, and 39.7% used both. The most common use motives for either/both drugs were to cope with pain and stress/anxiety (>70%). Highest-rated barriers to using either/both drugs were missing symptoms of worsening illness and not wanting to talk about their symptoms. Controlling for sociodemographics, binary logistic regression indicated that current opioid use was associated with reporting greater barriers to use (OR = 1.17, p = .011; Nagelkerke R-square = .934) and that current marijuana use was associated with reporting greater barriers to use (OR = 1.37, p = .003; Nagelkerke R-square = .921). Cancer survivors report various use motives and barriers to use regarding opioids and marijuana. While use motives and barriers for both drugs were similar, these constructs were differentially associated with use and interest in use across drugs. Understanding patients' perceptions about opioids and marijuana is an essential component to effectively manage symptoms related to a cancer diagnosis and improve quality of life for cancer survivors.
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Affiliation(s)
- Jessica M Potts
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Eric Nehl
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Corinne R Leach
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd Street NW, 7th Floor, Washington, DC, 20052, USA.
- George Washington University Cancer Center, George Washington University, Washington, DC, USA.
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Rees-Punia E, Leach CR, Westmaas JL, Dempsey LF, Roberts AM, Nocera JR, Patel AV. Pilot Randomized Controlled Trial of Feasibility, Acceptability, and Preliminary Efficacy of a Web-Based Physical Activity and Sedentary Time Intervention for Survivors of Physical Inactivity-Related Cancers. Int J Behav Med 2022; 29:220-229. [PMID: 33954891 PMCID: PMC8099708 DOI: 10.1007/s12529-021-09999-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND This pilot study explored the feasibility, acceptability, and usability of a web-based intervention for survivors of physical inactivity-related cancers through a two-arm, 12-week randomized controlled trial. Secondarily, this study tested the change in physical activity (PA) and sedentary time with intervention exposure. METHODS Prior to randomization to the intervention (n = 45) or behavior "as usual" wait-listed control (n = 40) groups, participants completed baseline surveys and an accelerometer protocol. The intervention focused on increasing PA and decreasing sedentary time through social cognitive theory techniques. Follow-up acceptability/usability surveys (intervention group only) and accelerometers were sent after the intervention period. Information on intervention completion, adverse events, and user statistics were collected to determine feasibility. Median login time and mean acceptability/usability scores were calculated. RESULTS Participants (mean age = 60 ± 7 years) included female (n = 80, 94%) and male survivors of breast (82%), colon (6%), endometrial (6%), bladder (4%), and kidney (2%) cancer. Seventy-eight (91.7%) participants returned partially or fully complete post-intervention data. There were no reported injuries or safety concerns. Intervention participants logged into the website for a total of 95 min (Q1, Q3 = 11, 204). System usability scores (72 ± 3) indicated above average usability of the website. Changes in time spent active and sedentary were not statistically significantly different between groups (p = 0.45), but within-group changes suggested intervention group participants spent more time active and less time sedentary after the intervention. CONCLUSION Results of this pilot study suggest its feasibility and acceptability for survivors of several inactivity-related cancers. Additional research to determine long-term efficacy is warranted. This low-cost online-only intervention has the potential to have a very broad reach. TRIAL REGISTRATION Clinical Trials Number: NCT03983083. Date registered: June 12th, 2019.
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Affiliation(s)
- Erika Rees-Punia
- Department of Population Science, American Cancer Society, Atlanta, GA, USA.
| | - Corinne R. Leach
- Department of Population Science, American Cancer Society, Atlanta, GA USA
| | - J. Lee Westmaas
- Department of Population Science, American Cancer Society, Atlanta, GA USA
| | - Lauren F. Dempsey
- Department of Population Science, American Cancer Society, Atlanta, GA USA
| | - Amelia M. Roberts
- Department of Population Science, American Cancer Society, Atlanta, GA USA
| | - Joe R. Nocera
- Departments of Neurology and Rehabilitation Medicine, Emory University, Atlanta, GA USA ,Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA USA ,Cancer Prevention and Control Program, Winship Cancer Institute, Atlanta, GA USA
| | - Alpa V. Patel
- Department of Population Science, American Cancer Society, Atlanta, GA USA
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Umar S, Chybisov A, McComb K, Nyongesa C, Mugo-Sitati C, Bosire A, Muya C, Leach CR. COVID-19 and Access to Cancer Care in Kenya: Patient Perspective. Int J Cancer 2021; 150:1497-1503. [PMID: 34927724 PMCID: PMC9303218 DOI: 10.1002/ijc.33910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022]
Abstract
COVID‐19 disruptions severely impacted access to health services for noncommunicable diseases, including cancer, but few studies have examined patient perspectives of COVID‐19‐induced barriers to care in low/middle‐income countries. Data come from a survey completed online, over the phone or in person of 284 adult people with cancer in Kenya. One‐third (36%) of participants had primary or no education and 34% had some or complete secondary education. Half of the participants (49%) were aged 40 to 59, 21% were 18 to 39 and 23% were 60 or older. Two‐thirds were female (65%) and most visited a national referral hospital in Nairobi to receive care (84%). Mean travel time to Nairobi from the respondent county of residence was 2.47 hours (±2.73). Most participants reported decreased household income (88%) and were worried about their ability to afford cancer treatment due to COVID‐19 (79%). After covariate adjustment, participants who lost access to hospitals due to COVID‐19 travel restrictions were 15 times more likely to experience a cancer care delay (OR = 14.90, 95% CI: 7.44‐29.85) compared to those with continued access to hospitals. Every additional hour of travel time to Nairobi from their county of residence resulted in a 20% increase in the odds of a cancer care delay (OR = 1.20, 95% CI: 1.06‐1.36). Transportation needs and uninterrupted access to cancer care and medicines should be accounted for in COVID‐19 mitigation strategies. These strategies include permits for cancer patients and caregivers to travel past curfew time or through block posts to receive care during lockdowns, cash assistance and involving patient navigators to improve patient communication.
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Affiliation(s)
- Shahid Umar
- Office of Research and Implementation, American Cancer Society, Inc., New York, New York, USA
| | - Andriy Chybisov
- Office of Research and Implementation, American Cancer Society, Inc., Washington, District of Columbia, USA
| | - Kristie McComb
- Office of Research and Implementation, American Cancer Society, Inc., New York, New York, USA
| | | | | | | | - Charles Muya
- Kenyan Network of Cancer Organizations, Nairobi, Kenya
| | - Corinne R Leach
- Department of Population Science, American Cancer Society, Inc., Atlanta, Georgia, USA
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Leach CR, Rees-Punia E, Newton CC, Chantaprasopsuk S, Patel AV, Westmaas JL. Stressors and Other Pandemic-related Predictors of Prospective Changes in Psychological Distress. Lancet Reg Health Am 2021; 4:100069. [PMID: 34518825 PMCID: PMC8427739 DOI: 10.1016/j.lana.2021.100069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 01/03/2023]
Abstract
Background Numerous studies have documented mental health challenges during the COVID-19 pandemic. Few studies included pre-pandemic levels of mental health or were comprehensive in assessing factors likely associated with longer-term mental health impacts. Methods Analyses used prospective data from a subset of participants in the nationwide Cancer Prevention Study-3 (CPS-3) United States cohort (N=2,359; 1,534 women; 825 men) who completed surveys in 2018 and during the COVID-19 pandemic (July-September 2020). Logistic regressions examined associations of pandemic-related stressors, sociodemographic and other predictors with (i) overall psychological distress (PD) and depression and anxiety separately during the COVID-19 pandemic and (ii) change in PD from 2018 to during the pandemic (low/low; high to low; low to high; high/high). Findings During the pandemic, 10% of participants reported moderate-to-severe PD and almost half (42%) reported at least mild PD. Pandemic PD levels were associated with pre-pandemic PD (female OR=5.65; male OR=9.70), financial stressors (female OR=2.48; male OR=3.68), and work/life balance stressors (female OR=3.03; male OR=3.33) experienced since the pandemic began. These stressors also predicted an escalation from low PD in 2018 to high PD during the pandemic. Factors associated with high PD at both time points included younger age, female sex, and financial stressors. Interpretation These results highlight the importance of regular mental health assessment and support among those with a history of mental health problems and those experiencing pandemic-related stressors, such as those with caregiving responsibilities or job changes. Funding The American Cancer Society funds the creation, maintenance, and updating of the CPS-3.
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Affiliation(s)
- Corinne R Leach
- Department of Population Science, American Cancer Society, Atlanta GA
| | - Erika Rees-Punia
- Department of Population Science, American Cancer Society, Atlanta GA
| | | | | | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta GA
| | - J Lee Westmaas
- Department of Population Science, American Cancer Society, Atlanta GA
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14
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Rees-Punia E, Newton CC, Westmaas JL, Chantaprasopsuk S, Patel AV, Leach CR. Prospective COVID-19 related changes in physical activity and sedentary time and associations with symptoms of depression and anxiety. Ment Health Phys Act 2021; 21:100425. [PMID: 34611463 PMCID: PMC8483810 DOI: 10.1016/j.mhpa.2021.100425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/25/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022]
Abstract
PROBLEM The COVID-19 pandemic is associated with psychological distress. Decreased moderate-vigorous physical activity (MVPA) and increased sedentary time may be exacerbating pandemic-related symptoms of anxiety and depression, but existing studies exploring these associations are almost entirely cross-sectional. METHODS Reported data from 2018 and Summer 2020 were used to create change categories based on compliance with MVPA guidelines and relative sedentary time. Participants completed the Patient Health Questionnaire-4 (PHQ-4) in Summer 2020. Associations among changes in MVPA and sedentary time (separately and jointly) with psychological distress (total PHQ-4 score) were examined with ordinal logistic regression and associations with depressive or anxiety symptoms were examined with logistic regression. RESULTS Among 2,240 participants (65% women, mean age 57.5 years), 67% increased sedentary time and 21% became inactive between the two time points. After multivariate adjustment, participants who became (OR = 1.71, 95% CI: 1.05-2.78) or remained inactive (OR = 2.07, 1.34-3.22) were more likely to experience depressive symptoms compared to those who remained active. Participants who increased sedentary time were also more likely to experience depressive symptoms compared to those who maintained sedentary time (OR = 1.78, 1.13-2.81). Jointly, those who increased sedentary time while remaining (OR = 3.67, 1.83-7.38) or becoming inactive (OR = 3.02, 1.44-6.34) were much more likely to have depressive symptoms compared to the joint referent (remained active/maintained sedentary time). Associations with anxiety symptoms were not statistically significant. CONCLUSIONS These findings support the value of promoting MVPA and limiting sedentary time during stressful events associated with psychological distress, like the COVID-19 pandemic.
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Affiliation(s)
- Erika Rees-Punia
- Dept. of Population Science, American Cancer Society 3380 Chastain Meadows Pkwy NW Kennesaw, GA 30144 USA
| | - Christina C Newton
- Dept. of Population Science, American Cancer Society 3380 Chastain Meadows Pkwy NW Kennesaw, GA 30144 USA
| | - J Lee Westmaas
- Dept. of Population Science, American Cancer Society 3380 Chastain Meadows Pkwy NW Kennesaw, GA 30144 USA
| | - Sicha Chantaprasopsuk
- Dept. of Population Science, American Cancer Society 3380 Chastain Meadows Pkwy NW Kennesaw, GA 30144 USA
| | - Alpa V Patel
- Dept. of Population Science, American Cancer Society 3380 Chastain Meadows Pkwy NW Kennesaw, GA 30144 USA
| | - Corinne R Leach
- Dept. of Population Science, American Cancer Society 3380 Chastain Meadows Pkwy NW Kennesaw, GA 30144 USA
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15
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Leach CR, Alfano CM, Potts J, Gallicchio L, Yabroff KR, Oeffinger KC, Hahn EE, Shulman LN, Hudson SV. Personalized Cancer Follow-Up Care Pathways: A Delphi Consensus of Research Priorities. J Natl Cancer Inst 2021; 112:1183-1189. [PMID: 32333765 DOI: 10.1093/jnci/djaa053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 12/24/2022] Open
Abstract
Development of personalized, stratified follow-up care pathways where care intensity and setting vary with needs could improve cancer survivor outcomes and efficiency of health-care delivery. Advancing such an approach in the United States requires identification and prioritization of the most pressing research and data needed to create and implement personalized care pathway models. Cancer survivorship research and care experts (n = 39) participated in an in-person workshop on this topic in 2018. Using a modified Delphi technique-a structured, validated system for identifying consensus-an expert panel identified critical research questions related to operationalizing personalized, stratified follow-up care pathways for individuals diagnosed with cancer. Consensus for the top priority research questions was achieved iteratively through 3 rounds: item generation, item consolidation, and selection of the final list of priority research questions. From the 28 research questions that were generated, 11 research priority questions were identified. The questions were categorized into 4 priority themes: determining outcome measures for new care pathways, developing and evaluating new care pathways, incentivizing new care pathway delivery, and providing technology and infrastructure to support self-management. Existing data sources to begin answering questions were also identified. Although existing data sources, including cancer registry, electronic medical record, and health insurance claims data, can be enhanced to begin addressing some questions, additional research resources are needed to address these priority questions.
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Affiliation(s)
- Corinne R Leach
- Behavioral and Epidemiology Research Group, American Cancer Society, Inc, Atlanta, GA, USA
| | | | - Jessica Potts
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Inc, Atlanta, GA, USA; 6Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Kevin C Oeffinger
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Erin E Hahn
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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16
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Leach CR, Kirkland EG, Masters M, Sloan K, Rees-Punia E, Patel AV, Watson L. Cancer survivor worries about treatment disruption and detrimental health outcomes due to the COVID-19 pandemic. J Psychosoc Oncol 2021; 39:347-365. [PMID: 33624572 DOI: 10.1080/07347332.2021.1888184] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We examined cancer survivor worries about treatment, infection, and finances early in the U.S. COVID-19 pandemic. DESIGN Closed- and open-ended online survey questions were collected from adult cancer survivors (N = 972). METHODS Logistic regression identified factors associated with treatment, infection, and financial worry. Thematic qualitative analysis generated information around participants' experiences and worries related to COVID-19 and healthcare. FINDINGS Characteristics including marital status, race/ethnicity, cancer type, time since last treatment, education, and age were associated with health and healthcare worry outcomes. Survivors commonly expressed uncertainty about future care, fears about in-person appointments, rationed COVID-19 care, recurrence due to care delays, and distress about untreated symptoms, including mental health issues. CONCLUSIONS Early in the pandemic, survivors worried about and experienced cancer care delays, COVID infection, and how the pandemic would affect their prognosis. IMPLICATIONS Healthcare professionals need to be aware of cancer survivors' concerns and uncertainties to provide appropriate care.
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Affiliation(s)
- Corinne R Leach
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Elizabeth G Kirkland
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Matt Masters
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Kirsten Sloan
- Department of Policy, American Cancer Society Cancer Action Network, Washington, DC, USA
| | - Erika Rees-Punia
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Lesley Watson
- Department of Communications, American Cancer Society Cancer Action Network, Washington, DC, USA.,Department of Public Health, NORC at the University of Chicago, Atlanta, Georgia, USA
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17
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Sung H, Hyun N, Leach CR, Yabroff KR, Jemal A. Association of First Primary Cancer With Risk of Subsequent Primary Cancer Among Survivors of Adult-Onset Cancers in the United States. JAMA 2020; 324:2521-2535. [PMID: 33351041 PMCID: PMC7756242 DOI: 10.1001/jama.2020.23130] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE The number of cancer survivors who develop new cancers is projected to increase, but comprehensive data on the risk of subsequent primary cancers (SPCs) among survivors of adult-onset cancers are limited. OBJECTIVE To quantify the overall and cancer type-specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types and sex. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study from 12 Surveillance, Epidemiology, and End Results registries in the United States, that included 1 537 101 persons aged 20 to 84 years diagnosed with FPCs from 1992-2011 (followed up until December 31, 2017) and who survived at least 5 years. EXPOSURES First primary cancer. MAIN OUTCOMES AND MEASURES Incidence and mortality of SPCs per 10 000 person-years; standardized incidence ratio (SIR) and standardized mortality ratio (SMR) compared with those expected in the general population. RESULTS Among 1 537 101 survivors (mean age, 60.4 years; 48.8% women), 156 442 SPC cases and 88 818 SPC deaths occurred during 11 197 890 person-years of follow-up (mean, 7.3 years). Among men, the overall risk of developing any SPCs was statistically significantly higher for 18 of the 30 FPC types, and risk of dying from any SPCs was statistically significantly higher for 27 of 30 FPC types as compared with risks in the general population. Among women, the overall risk of developing any SPCs was statistically significantly higher for 21 of the 31 FPC types, and risk of dying from any SPCs was statistically significantly higher for 28 of 31 FPC types as compared with risks in the general population. The highest overall SIR and SMR were estimated among survivors of laryngeal cancer (SIR, 1.75 [95% CI, 1.68-1.83]; incidence, 373 per 10 000 person-years) and gallbladder cancer (SMR, 3.82 [95% CI, 3.31-4.39]; mortality, 341 per 10 000 person-years) among men, and among survivors of laryngeal cancer (SIR, 2.48 [95% CI, 2.27-2.72]; incidence, 336 per 10 000 person-years; SMR, 4.56 [95% CI, 4.11-5.06]; mortality, 268 per 10 000 person-years) among women. Substantial variation existed in the associations of specific types of FPCs with specific types of SPC risk; however, only a few smoking- or obesity-associated SPCs, such as lung, urinary bladder, oral cavity/pharynx, colorectal, pancreatic, uterine corpus, and liver cancers constituted considerable proportions of the total incidence and mortality, with lung cancer alone accounting for 31% to 33% of mortality from all SPCs. CONCLUSIONS AND RELEVANCE Among survivors of adult-onset cancers in the United States, several types of primary cancer were significantly associated with greater risk of developing and dying from an SPC, compared with the general population. Cancers associated with smoking or obesity comprised substantial proportions of overall SPC incidence and mortality among all survivors and highlight the importance of ongoing surveillance and efforts to prevent new cancers among survivors.
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Affiliation(s)
- Hyuna Sung
- Department of Data Science, American Cancer Society, Atlanta, Georgia
| | - Noorie Hyun
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee
| | - Corinne R. Leach
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - K. Robin Yabroff
- Department of Data Science, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Data Science, American Cancer Society, Atlanta, Georgia
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18
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Rees-Punia E, Patel AV, Beckwitt A, Leach CR, Gapstur SM, Smith TG. Research Participants' Perspectives on Using an Electronic Portal for Engagement and Data Collection: Focus Group Results From a Large Epidemiologic Cohort. J Med Internet Res 2020; 22:e18556. [PMID: 33001033 PMCID: PMC7563628 DOI: 10.2196/18556] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/03/2020] [Accepted: 09/02/2020] [Indexed: 12/04/2022] Open
Abstract
Background Epidemiologic cohort studies have begun to leverage electronic research participant portals to facilitate data collection, integrate wearable technologies, lower costs, and engage participants. However, little is known about the acceptability of portal use by research participants. Objective The aim of this study is to conduct focus groups among a sample of Cancer Prevention Study-3 (CPS-3) participants to better understand their preferences and concerns about research portals. Methods CPS-3 participants were stratified based on sex, race and ethnicity, age, and cancer status, and randomly invited to participate. Focus groups used an exploratory case design with semistructured guides to prompt discussion. Using a constant comparison technique, transcripts were assigned codes to identify themes. Results Participants (31/59, 52% women; 52/59, 88% White/non-Latinx) were favorably disposed toward using a research participant portal to take surveys, communicate with the study staff, and upload data. Most participants indicated that a portal would be beneficial and convenient but expressed concerns over data safety. Participants stressed the importance of an easy-to-use and trustworthy portal that is compatible with mobile devices. Conclusions In addition to being beneficial to researchers, portals may also benefit participants as long as the portals are secure and simple. Participants believe that portals can provide convenient ways to report data and remain connected to the study.
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Affiliation(s)
| | - Alpa V Patel
- American Cancer Society, Atlanta, GA, United States
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19
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Leach CR, Vereen RN, Rao AV, Ross K, Diefenbach MA. Impact of individual- and area-level race/ethnicity on illness intrusiveness among cancer survivors. Transl Behav Med 2020; 9:1208-1215. [PMID: 31228204 DOI: 10.1093/tbm/ibz088] [Citation(s) in RCA: 2] [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: 01/12/2023] Open
Abstract
Many cancer survivors experience illness intrusion or disruption in various life domains from cancer. The socioecological model posits that individual health status is produced by the interaction of individual biology and their surrounding physical, social, and cultural environment. Despite evidence of the need to consider such hierarchical influences, little is known about the impact of area-level factors on cancer-related outcomes, including illness intrusiveness. Data from 993 breast, colorectal, and prostate cancer survivors within the first year of completing treatment were analyzed. Individual-level data for the Illness Intrusiveness Ratings Scale were linked to census tract-level data to characterize neighborhood conditions. Logistic regression modeled the association between individual-level variables, neighborhood-level racial composition, and the interaction between individual and area-level race on illness intrusiveness. A significant number of survivors (232, 23.4%) reported relatively high illness intrusiveness (score >28). The model including the interaction between area- and individual-level race exhibited significantly improved model fit (p < .05). The final model showed that racial minorities living in areas with a higher percentage of racial minorities had higher odds of greater illness intrusion when compared to Whites living in areas with a low percentage of racial minorities (adjusted odds ratio: 1.65, confidence interval: 1.01, 2.68). Results suggest that area-level factors can have profound effects on survivors' processing of their past cancer experience. Findings may support the collective resources model which posits that the effect of area deprivation is greater in certain sociodemographic groups who may find it difficult to seek resources outside of their living area.
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Affiliation(s)
- Corinne R Leach
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, USA
| | - Rhyan N Vereen
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, USA
| | - Arthi V Rao
- Center for Quality Growth and Regional Development Georgia Institute of Technology, Atlanta, GA, USA
| | - Katherine Ross
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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20
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Patel AV, Strollo SE, Rees-Punia E, Teras LR, Wang Y, Leach CR, Fulton JE, Gapstur SM. Late Adulthood Physical Activity Trajectories In Relation To All-cause Mortality. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000680172.58934.a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bamishigbin ON, Stein KD, Leach CR, Stanton AL. Spirituality and depressive symptoms in a multiethnic sample of cancer survivors. Health Psychol 2020; 39:589-599. [PMID: 32378960 DOI: 10.1037/hea0000878] [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: 11/08/2022]
Abstract
OBJECTIVE This study aimed to (a) examine the relationships of 3 facets of spirituality (i.e., meaning, peace, faith), and their interaction, with depressive symptoms among Black, Latino, and White cancer survivors; and (b) test fear of cancer recurrence (FCR) and social support (SS) as mediators of these relationships. METHOD Data were analyzed from the American Cancer Society's Study of Cancer Survivors-I, a longitudinal population-based study of cancer survivors' quality of life. A national sample of Black (n = 194), Latino (n = 90), and White (n = 2,775) survivors of the top 10 incident cancers completed measures 1 year (Time 1, T1), 2 years (Time 2, T2), and 9 years (Time 3, T3) postdiagnosis. RESULTS After controlling for T1 depressed mood and demographic and medical characteristics, T1 lower meaning and lower peace, but not faith, predicted greater depressive symptoms at T3 in the total sample. A significant interaction showed that higher faith predicted greater depressive symptoms specifically in the context of lower meaning. Race/ethnicity did not affect these relationships. FCR at T2 partially mediated the relationships of T1 meaning and peace with T3 depressive symptoms, and SS partially mediated the relationship between T1 meaning and T3 depressive symptoms. CONCLUSIONS Cancer survivors with greater meaning and peace appear better able to integrate the cancer experience into their lives. An interaction between T1 meaning and faith on T3 depressive symptoms replicated previous findings. Future research should treat spirituality as a multidimensional construct and focus on identifying and influencing malleable mechanisms of the associations between spirituality and mental health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Kevin D Stein
- Department of Behavioral Sciences and Health Education
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22
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Anderson C, Gapstur SM, Leach CR, Smith TG, Teras LR. Medical conditions and physical function deficits among multiple primary cancer survivors. J Cancer Surviv 2020; 14:518-526. [PMID: 32166577 DOI: 10.1007/s11764-020-00872-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/02/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Survivors of multiple primary cancers make up a sizable proportion of all cancer survivors, yet little is known about the health of this population. We examined the prevalence of medical conditions and physical function deficits among multiple primary survivors compared with single primary survivors and individuals without a cancer history. METHODS Participants were enrolled in the Cancer Prevention Study (CPS)-II Nutrition Cohort in 1992/1993. Prevalent medical conditions (diabetes, heart conditions, cerebrovascular conditions, emphysema/chronic bronchitis, osteoporosis, osteoarthritis), physical function limitations, use of a cane or walker, balance difficulties, and falls within the past year were assessed on a follow-up survey completed in 2011. We estimated age- and sex-adjusted prevalence ratios (PRs), comparing multiple primary survivors (N = 1003) to single primary survivors (N = 12,849) and participants without cancer (N = 63,578). RESULTS The prevalence of medical conditions did not differ substantially between multiple primary survivors and either comparison group. However, multiple primary survivors were more likely to report severe limitations in physical function than the single primary (PR = 1.48 (95% CI, 1.28-1.71)) and no-cancer (PR = 1.64 (95% CI, 1.42-1.88)) groups. Using a cane or walker and balance difficulties were also significantly more common among multiple primary survivors. CONCLUSIONS Despite a similar prevalence of comorbid medical conditions, severe functional limitations were significantly more common among multiple primary survivors than single primary survivors or individuals without cancer. IMPLICATIONS FOR CANCER SURVIVORS Assessment of functional status and treatment of physical deficits may be an especially critical component of care for older patients with a history of multiple cancer diagnoses.
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23
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Canada AL, Murphy PE, Stein K, Alcaraz KI, Leach CR, Fitchett G. Examining the impact of cancer on survivors' religious faith: A report from the American Cancer Society study of cancer survivors-I. Psychooncology 2020; 29:1036-1043. [PMID: 32128944 DOI: 10.1002/pon.5374] [Citation(s) in RCA: 2] [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] [Received: 09/19/2019] [Revised: 02/14/2020] [Accepted: 02/29/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The impact of religion/spirituality (R/S) on cancer outcomes, including health-related quality of life (HRQoL), has been the topic of much investigation. Reports of the opposite, that is, the impact of cancer on R/S and associations with HRQoL, are few. The current study sought to explore the positive and negative impacts of cancer on the religious faith of survivors as well as the associations of such impacts with HRQoL. METHODS Participants included 2309 9-year survivors of cancer from the American Cancer Society's Studies of Cancer Survivors-I. The impact of cancer on R/S was measured using items from the Patient-Reported Outcomes Measurement Information System (PROMIS) psychosocial impact of illness-faith, and HRQoL was measured with the 12-item short form (SF-12). Hierarchical regressions were used to examine the impact of cancer on R/S controlling for medical and demographic covariates. RESULTS Consistent with hypotheses, the majority of survivors (70%) reported that cancer had a positive impact on religious faith, while the negative impact of cancer on religious faith was relatively rare (17%). In multivariable models, the negative impact of cancer on faith was associated with poorer HRQoL, both mental and physical, while the positive impact of cancer on faith was associated with greater mental well-being. CONCLUSIONS Cancer has a negative impact on religious faith for a minority of survivors. However, when it is reported, such negative impact is indicative of poorer mental and physical well-being. As such, it is important to identify those survivors at risk early in survivorship and provide support and intervention as needed.
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Affiliation(s)
- Andrea L Canada
- Rosemead School of Psychology, Biola University, La Mirada, California, USA
| | - Patricia E Murphy
- Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, USA
| | - Kevin Stein
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kassandra I Alcaraz
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia, USA
| | - Corinne R Leach
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia, USA
| | - George Fitchett
- Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, USA
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Koll TT, Magnuson A, Dale W, LaBarge MA, Leach CR, Mohile S, Muss H, Sedenquist M, Klepin HD. Developing a clinical and biological measures of aging core: Cancer and Aging Research Group infrastructure. J Geriatr Oncol 2020; 11:343-346. [PMID: 31537478 PMCID: PMC7054170 DOI: 10.1016/j.jgo.2019.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/08/2019] [Accepted: 09/05/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Thuy T Koll
- Division of Geriatrics, Gerontology, Palliative Care Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Allison Magnuson
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States of America; James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States of America
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States of America
| | - Mark A LaBarge
- Department of Population Sciences, Beckman Research Institute at City of Hope, Duarte, CA, United States of America
| | - Corinne R Leach
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, United States of America
| | - Supriya Mohile
- Department of Hematology and Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States of America; James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hyman Muss
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Geriatric Oncology Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Margaret Sedenquist
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Heidi D Klepin
- Section of Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
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Rees-Punia E, Patel AV, Nocera JR, Chantaprasopsuk S, Demark-Wahnefried W, Leach CR, Smith TG, Cella D, Gapstur SM. Self-reported physical activity, sitting time, and mental and physical health among older cancer survivors compared with adults without a history of cancer. Cancer 2020; 127:115-123. [PMID: 33079415 PMCID: PMC9105766 DOI: 10.1002/cncr.33257] [Citation(s) in RCA: 2] [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] [Received: 07/09/2020] [Revised: 08/28/2020] [Accepted: 09/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND To the authors' knowledge, few studies to date have examined associations between moderate to vigorous physical activity (MVPA) and sitting time with quality of life in cancer survivors compared with a cancer-free group. The current study examined differences in global mental health (GMH) and global physical health (GPH) across levels of MVPA and sitting among cancer survivors and cancer-free participants. METHODS Cancer Prevention Study II participants (59.9% of whom were female with an age of 77.8 ± 5.8 years) were grouped as: 1) survivors who were 1 to 5 years after diagnosis (3718 participants); 2) survivors who were 6 to 10 years after diagnosis (4248 participants); and 3) cancer-free participants (ie, no history of cancer; 69,860 participants). In 2009, participants completed MVPA, sitting, and Patient-Reported Outcomes Measurement Information System GMH/GPH surveys. Mean differences in GMH and GPH T scores across MVPA (none, 0 to <7.5, 7.5 to <15, 15 to <22.5, and ≥22.5 metabolic equivalent [MET]-hours/week) and sitting (0 to <3, 3 to <6, and ≥6 hours/day) were assessed using multivariate generalized linear models. RESULTS The mean GMH and GPH scores were statistically significantly higher in cancer-free participants compared with cancer survivor groups, although the differences were not clinically meaningful (mean difference of 0.52 for GMH and 0.88 for GPH). More MVPA was associated with higher GMH and GPH scores for all 3 groups (P for trend <.001), and differences between the least and most active participants were found to be clinically meaningful (mean differences of ≥4.34 for GMH and ≥6.39 for GPH). Similarly, a lower duration of sitting was associated with higher GMH and GPH scores for all groups (P for trend <.001), with clinically meaningful differences observed between the least and most sedentary participants (mean differences of ≥2.74 for GMH and ≥3.75 for GPH). CONCLUSIONS The findings of the current study provide evidence of the importance of increased MVPA and decreased sitting for improved health in older adults with or without a prior cancer diagnosis.
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Affiliation(s)
- Erika Rees-Punia
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V. Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Joseph R. Nocera
- Department of Neurology, Emory University, Atlanta, Georgia,Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Atlanta, Georgia,Cancer Prevention and Control Program, Winship Cancer Institute, Atlanta, Georgia
| | | | - Wendy Demark-Wahnefried
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Corinne R. Leach
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Tenbroeck G. Smith
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susan M. Gapstur
- Department of Population Science, American Cancer Society, Atlanta, Georgia
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DeSantis CE, Miller KD, Dale W, Mohile SG, Cohen HJ, Leach CR, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for adults aged 85 years and older, 2019. CA Cancer J Clin 2019; 69:452-467. [PMID: 31390062 DOI: 10.3322/caac.21577] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Adults aged 85 years and older, the "oldest old," are the fastest-growing age group in the United States, yet relatively little is known about their cancer burden. Combining data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics, the authors provide comprehensive information on cancer occurrence in adults aged 85 years and older. In 2019, there will be approximately 140,690 cancer cases diagnosed and 103,250 cancer deaths among the oldest old in the United States. The most common cancers in these individuals (lung, breast, prostate, and colorectum) are the same as those in the general population. Overall cancer incidence rates peaked in the oldest men and women around 1990 and have subsequently declined, with the pace accelerating during the past decade. These trends largely reflect declines in cancers of the prostate and colorectum and, more recently, cancers of the lung among men and the breast among women. We note differences in trends for some cancers in the oldest age group (eg, lung cancer and melanoma) compared with adults aged 65 to 84 years, which reflect elevated risks in the oldest generations. In addition, cancers in the oldest old are often more advanced at diagnosis. For example, breast and colorectal cancers diagnosed in patients aged 85 years and older are about 10% less likely to be diagnosed at a local stage compared with those diagnosed in patients aged 65 to 84 years. Patients with cancer who are aged 85 years and older have the lowest relative survival of any age group, with the largest disparities noted when cancer is diagnosed at advanced stages. They are also less likely to receive surgical treatment for their cancers; only 65% of breast cancer patients aged 85 years and older received surgery compared with 89% of those aged 65 to 84 years. This difference may reflect the complexities of treating older patients, including the presence of multiple comorbidities, functional declines, and cognitive impairment, as well as competing mortality risks and undertreatment. More research on cancer in the oldest Americans is needed to improve outcomes and anticipate the complex health care needs of this rapidly growing population.
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Affiliation(s)
- Carol E DeSantis
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - William Dale
- Department of Supportive Care Medicine, Center for Cancer and Aging, City of Hope National Medical Center, Duarte, California
| | - Supriya G Mohile
- Wilmot Cancer Center, Geriatric Oncology Research Program, University of Rochester Medical Center, Rochester, New York
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Corinne R Leach
- Behavioral and Epidemiology Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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Smith TG, Strollo S, Hu X, Earle CC, Leach CR, Nekhlyudov L. Understanding Long-Term Cancer Survivors' Preferences for Ongoing Medical Care. J Gen Intern Med 2019; 34:2091-2097. [PMID: 31367870 PMCID: PMC6816669 DOI: 10.1007/s11606-019-05189-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/21/2019] [Accepted: 06/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Due to risk for treatment-related late effects and concerns about cancer recurrence, long-term cancer survivors have unique medical needs. Survivors' preferences for care may influence adherence and care utilization. OBJECTIVE To describe survivors' preferences for care and factors associated with preferred and actual care. DESIGN Cross-sectional analysis of participants in a longitudinal study using mailed questionnaires. PARTICIPANTS Survivors of ten common cancers (n = 2,107, mean years from diagnosis 8.9). MAIN MEASURES (1) Survivors' preferences for primary care physician (PCP) and oncologist responsibilities across four types of care: cancer follow-up, cancer screening, preventive health, and comorbid conditions. (2) Survivor-reported visits to PCPs and oncologists. KEY RESULTS The response rate was 42.1%. Most long-term survivors preferred PCPs and oncologists share care for cancer follow-up (63%) and subsequent screening (65%), while preferring PCP-led preventive health (77%) and comorbid condition (83%) care. Most survivors (88%) preferred oncologists involved in cancer follow-up care, but only 60% reported an oncologist visit in the previous 4 years, and 96% reported a PCP visit in the previous 4 years. In multivariable regressions, those with higher fear of cancer recurrence were less likely to prefer PCP-led cancer follow-up care (OR = 0.96, CI = 0.93-0.98), as did survivors with advanced cancer stage (OR = 0.56, CI = 0.39-0.79). Those with higher fear of recurrence (OR = 1.03, CI = 1.01-1.04) or who preferred oncologist-led cancer follow-up care (OR = 2.08, CI = 1.63-2.65) had greater odds of seeing an oncologist in the last 4 years. CONCLUSIONS Most cancer survivors preferred PCPs and oncologists share care for cancer follow-up and screening, yet many had not seen an oncologist recently. Survivors preferred PCP-led care for other preventive services and management of comorbid conditions. These findings highlight the important role PCPs could play in survivor care, suggesting the need for PCP-oriented education and health system policies that support high-quality PCP-led survivor care.
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Affiliation(s)
- Tenbroeck G Smith
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA.
| | - Sara Strollo
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
| | - Xin Hu
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Craig C Earle
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Corinne R Leach
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
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Leach CR, Diefenbach MA, Fleszar S, Alfano CM, Stephens RL, Riehman K, Hudson SV. A user centered design approach to development of an online self‐management program for cancer survivors: Springboard Beyond Cancer. Psychooncology 2019; 28:2060-2067. [DOI: 10.1002/pon.5193] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/22/2019] [Accepted: 07/28/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Corinne R. Leach
- Behavioral and Epidemiology Research GroupAmerican Cancer Society Atlanta Georgia
| | | | - Sara Fleszar
- Department of Psychological SciencesUniversity of California Merced California
| | - Catherine M. Alfano
- Behavioral and Epidemiology Research GroupAmerican Cancer Society Atlanta Georgia
| | - Robert L. Stephens
- Behavioral and Epidemiology Research GroupAmerican Cancer Society Atlanta Georgia
| | - Kara Riehman
- Behavioral and Epidemiology Research GroupAmerican Cancer Society Atlanta Georgia
| | - Shawna V. Hudson
- Family Medicine and Community HealthRutgers Robert Wood Johnson Medical School New Brunswick New Jersey
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Fallon EA, Stephens RL, McDonald B, Diefenbach M, Leach CR. Disentangling Efficacy and Expectations: A Prospective, Cross-lagged Panel Study of Cancer Survivors' Physical Activity. Ann Behav Med 2019; 53:138-149. [PMID: 29688245 DOI: 10.1093/abm/kay022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Despite demonstrated utility of Bandura's social cognitive theory for increasing physical activity among cancer survivors, the validity of the originally hypothesized relationships among self-efficacy, outcome expectations, and physical activity behavior continues to be debated. Purpose To explore the temporal ordering of outcome expectations and self-efficacy as they relate to moderate-to-vigorous physical activity behavior. Methods Longitudinal data from cancer survivors (N = 1,009) recently completing treatment were used to fit six cross-lagged panel models, including one parent model, one model representing originally hypothesized variable relationships, and four alternative models. All models contained covariates and used full information maximum likelihood and weighted least squares mean and variance adjusted estimation. Tests of equal fit between the parent model and alternative models were conducted. Results The model depicting Bandura's originally hypothesized relationships showed no statistically significant relationship between outcome expectations and physical activity (p = .18), and was a worse fit to the data, compared with the parent model [Χ2 (1) = 5.92, p = .01]. An alternative model showed evidence of a reciprocal relationship between self-efficacy and outcome expectations, and was statistically equivalent to the parent model [Χ2(1) = 2.01, p = .16]. Conclusions This study provides evidence against Bandura's theoretical assertions that (a) self-efficacy causes outcome expectations and not vice versa, and (b) outcome expectation has a direct effect on physical activity. Replication within population subgroups and for other health behaviors will determine whether the social cognitive theory needs modification. Future trials should test whether differential construct ordering results in clinically meaningful differences in physical activity behavior change.
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Affiliation(s)
- Elizabeth A Fallon
- Behavioral and Epidemiology Research Group at the American Cancer Society, American Cancer Society, Atlanta, GA, USA
| | - Robert L Stephens
- Statistics and Evaluation Center at the American Cancer Society, American Cancer Society, Atlanta, GA, USA
| | - Bennett McDonald
- Behavioral and Epidemiology Research Group at the American Cancer Society, American Cancer Society, Atlanta, GA, USA
| | - Michael Diefenbach
- Department of Medicine & Urology, Northwell Health, Northwell Health, Manhasset, NY, USA
| | - Corinne R Leach
- Behavioral and Epidemiology Research Group at the American Cancer Society, American Cancer Society, Atlanta, GA, USA
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Alfano CM, Leach CR, Smith TG, Miller KD, Alcaraz KI, Cannady RS, Wender RC, Brawley OW. Equitably improving outcomes for cancer survivors and supporting caregivers: A blueprint for care delivery, research, education, and policy. CA Cancer J Clin 2019; 69:35-49. [PMID: 30376182 DOI: 10.3322/caac.21548] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cancer care delivery is being shaped by growing numbers of cancer survivors coupled with provider shortages, rising costs of primary treatment and follow-up care, significant survivorship health disparities, increased reliance on informal caregivers, and the transition to value-based care. These factors create a compelling need to provide coordinated, comprehensive, personalized care for cancer survivors in ways that meet survivors' and caregivers' unique needs while minimizing the impact of provider shortages and controlling costs for health care systems, survivors, and families. The authors reviewed research identifying and addressing the needs of cancer survivors and caregivers and used this synthesis to create a set of critical priorities for care delivery, research, education, and policy to equitably improve survivor outcomes and support caregivers. Efforts are needed in 3 priority areas: 1) implementing routine assessment of survivors' needs and functioning and caregivers' needs; 2) facilitating personalized, tailored, information and referrals from diagnosis onward for both survivors and caregivers, shifting services from point of care to point of need wherever possible; and 3) disseminating and supporting the implementation of new care methods and interventions.
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Affiliation(s)
| | - Corinne R Leach
- Senior Principal Scientist, Behavioral Research, American Cancer Society, Atlanta, GA
| | - Tenbroeck G Smith
- Senior Principal Scientist, Behavioral Research, American Cancer Society, Atlanta, GA
| | - Kim D Miller
- Senior Associate Scientist, Surveillance Research, American Cancer Society, Atlanta, GA
| | - Kassandra I Alcaraz
- Senior Principal Scientist, Behavioral Research, American Cancer Society, Atlanta, GA
| | - Rachel S Cannady
- Strategic Director, Cancer Caregiver Support, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical Officer, American Cancer Society, Atlanta, GA
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Abstract
INTRODUCTION The transition from active cancer treatment into survivorship, known as re-entry, remains understudied. During re-entry, clinicians can educate survivors on the benefits of healthy behaviors, including physical activity, as survivors adjust to life after cancer. We examine the prevalence of adherence to established aerobic physical activity guidelines (≥150 minutes of moderate-intensity physical activity per week) in addition to related medico-demographic factors among cancer survivors during re-entry. METHODS Data from 1,160 breast, colorectal, and prostate cancer survivors participating in the American Cancer Society's National Cancer Survivor Transition Study were examined. Multinomial logistic regression was used to calculate adjusted odds ratios (AOR) for various medico-demographic variables in relation to 4 established levels of physical activity (inactive, insufficiently active, 1-<2 times the guideline level, and ≥2 times the guideline level [referent group]). RESULTS Overall, 8.1% were inactive, 34.1% were insufficiently active, 24.3% were within 1 to less than 2 times the guidelines, and 33.4% exceeded guidelines by 2 or more times. Inactive people had significantly higher odds of being women (AOR, 1.88; 95% confidence interval [CI], 1.10-3.23) and having lower education levels (AOR, 2.02; 95% CI, 1.21-3.38) compared with those who exceeded guidelines by 2 or more times. Each additional comorbidity was associated with a 26% increase in odds of inactivity (AOR, 1.26; 95% CI, 1.08-1.47). CONCLUSION Patient education on the benefits of regular physical activity is important for all cancer survivors and may be especially important to review after treatment completion to promote healthy habits during this transition period. Survivors who are women, are less educated, and have comorbid conditions may be less likely to be compliant with physical activity guidelines.
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Affiliation(s)
- Alyssa N Troeschel
- Intramural Research Department, American Cancer Society, 250 Williams St, Atlanta, GA 30303.
| | - Corinne R Leach
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Kerem Shuval
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Kevin D Stein
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
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Patel AV, Hildebrand JS, Leach CR, Campbell PT, Doyle C, Shuval K, Wang Y, Gapstur SM. Walking in Relation to Mortality in a Large Prospective Cohort of Older U.S. Adults. Am J Prev Med 2018; 54:10-19. [PMID: 29056372 DOI: 10.1016/j.amepre.2017.08.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Engaging in >150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity weekly is recommended for optimal health. The relationship between walking, the most common activity especially for older adults, and total mortality is not well documented. METHODS Data from a large U.S. prospective cohort study including 62,178 men (mean age 70.7 years) and 77,077 women (mean age 68.9 years), among whom 24,688 men and 18,933 women died during 13 years of follow-up (1999-2012), were used to compute multivariable-adjusted hazard rate ratios and 95% CIs for walking as the sole form of activity or adjusted for other moderate- or vigorous-intensity physical activity in relation to total and cause-specific mortality (data analysis 2015-2016). RESULTS Inactivity compared with walking only at less than recommended levels was associated with higher all-cause mortality (hazard rate ratio=1.26, 95% CI=1.21, 1.31). Meeting one to two times the recommendations through walking only was associated with lower all-cause mortality (hazard rate ratio=0.80, 95% CI=0.78, 0.83). Associations with walking adjusted for other moderate- or vigorous-intensity physical activity were similar to walking only. Walking was most strongly associated with respiratory disease mortality followed by cardiovascular disease mortality and then cancer mortality. CONCLUSIONS In older adults, walking below minimum recommended levels is associated with lower all-cause mortality compared with inactivity. Walking at or above physical activity recommendations is associated with even greater decreased risk. Walking is simple, free, and does not require any training, and thus is an ideal activity for most Americans, especially as they age.
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Affiliation(s)
- Alpa V Patel
- Intramural Research Department, American Cancer Society, Atlanta, Georgia.
| | - Janet S Hildebrand
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Corinne R Leach
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Peter T Campbell
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Colleen Doyle
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Kerem Shuval
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Ying Wang
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Susan M Gapstur
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
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Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, Mohr D, Palesh OG, Peppone LJ, Piper BF, Scarpato J, Smith T, Sprod LK, Miller SM. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA Oncol 2017; 3:961-968. [PMID: 28253393 DOI: 10.1001/jamaoncol.2016.6914] [Citation(s) in RCA: 454] [Impact Index Per Article: 64.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Cancer-related fatigue (CRF) remains one of the most prevalent and troublesome adverse events experienced by patients with cancer during and after therapy. Objective To perform a meta-analysis to establish and compare the mean weighted effect sizes (WESs) of the 4 most commonly recommended treatments for CRF-exercise, psychological, combined exercise and psychological, and pharmaceutical-and to identify independent variables associated with treatment effectiveness. Data Sources PubMed, PsycINFO, CINAHL, EMBASE, and the Cochrane Library were searched from the inception of each database to May 31, 2016. Study Selection Randomized clinical trials in adults with cancer were selected. Inclusion criteria consisted of CRF severity as an outcome and testing of exercise, psychological, exercise plus psychological, or pharmaceutical interventions. Data Extraction and Synthesis Studies were independently reviewed by 12 raters in 3 groups using a systematic and blinded process for reconciling disagreement. Effect sizes (Cohen d) were calculated and inversely weighted by SE. Main Outcomes and Measures Severity of CRF was the primary outcome. Study quality was assessed using a modified 12-item version of the Physiotherapy Evidence-Based Database scale (range, 0-12, with 12 indicating best quality). Results From 17 033 references, 113 unique studies articles (11 525 unique participants; 78% female; mean age, 54 [range, 35-72] years) published from January 1, 1999, through May 31, 2016, had sufficient data. Studies were of good quality (mean Physiotherapy Evidence-Based Database scale score, 8.2; range, 5-12) with no evidence of publication bias. Exercise (WES, 0.30; 95% CI, 0.25-0.36; P < .001), psychological (WES, 0.27; 95% CI, 0.21-0.33; P < .001), and exercise plus psychological interventions (WES, 0.26; 95% CI, 0.13-0.38; P < .001) improved CRF during and after primary treatment, whereas pharmaceutical interventions did not (WES, 0.09; 95% CI, 0.00-0.19; P = .05). Results also suggest that CRF treatment effectiveness was associated with cancer stage, baseline treatment status, experimental treatment format, experimental treatment delivery mode, psychological mode, type of control condition, use of intention-to-treat analysis, and fatigue measures (WES range, -0.91 to 0.99). Results suggest that the effectiveness of behavioral interventions, specifically exercise and psychological interventions, is not attributable to time, attention, and education, and specific intervention modes may be more effective for treating CRF at different points in the cancer treatment trajectory (WES range, 0.09-0.22). Conclusions and Relevance Exercise and psychological interventions are effective for reducing CRF during and after cancer treatment, and they are significantly better than the available pharmaceutical options. Clinicians should prescribe exercise or psychological interventions as first-line treatments for CRF.
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Affiliation(s)
- Karen M Mustian
- Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Catherine M Alfano
- Behavioral Medicine Research Center, American Cancer Society, Washington, DC
| | - Charles Heckler
- Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Amber S Kleckner
- Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Ian R Kleckner
- Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Corinne R Leach
- Behavioral Medicine Research Center, American Cancer Society, Washington, DC
| | - David Mohr
- Department of Preventive Medicine, Northwestern University, Rochester, New York
| | - Oxana G Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Luke J Peppone
- Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Barbara F Piper
- Department of Nursing, School of Health and Human Services, National University, San Diego, California
| | - John Scarpato
- Department of Psychosocial and Biobehavioral Medicine, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Tenbroeck Smith
- Behavioral Medicine Research Center, American Cancer Society, Washington, DC
| | - Lisa K Sprod
- School of Health and Applied Human Sciences, University of North Carolina Wilmington
| | - Suzanne M Miller
- Department of Psychosocial and Biobehavioral Medicine, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Leach CR, Troeschel AN, Wiatrek D, Stanton AL, Diefenbach M, Stein KD, Sharpe K, Portier K. Preparedness and Cancer-Related Symptom Management among Cancer Survivors in the First Year Post-Treatment. Ann Behav Med 2017; 51:587-598. [DOI: 10.1007/s12160-017-9880-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Flannery M, Mohile SG, Dale W, Arora NK, Azar L, Breslau ES, Cohen HJ, Dotan E, Eldadah BA, Leach CR, Mitchell SA, Rowland JH, Hurria A. Interventions to improve the quality of life and survivorship of older adults with cancer: The funding landscape at NIH, ACS and PCORI. J Geriatr Oncol 2016; 7:225-33. [PMID: 27197917 DOI: 10.1016/j.jgo.2016.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/25/2015] [Revised: 12/16/2015] [Accepted: 02/01/2016] [Indexed: 12/20/2022]
Abstract
Identifying knowledge gaps and research opportunities in cancer and aging research was the focus of a three-part conference series led by the Cancer and Aging Research Group from 2010 to 2015. The third meeting, featured representatives from the NIA, NCI, ACS and PCORI each of whom discussed research priorities and funding opportunities in cancer and aging at their respective agencies. This manuscript reports on the proceedings of that conference with a specific focus on funding priorities for interventions to improve the quality of life and survivorship of older adults with cancer. Helpful tips from each funder regarding writing a scientifically strong research proposal are presented.
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Affiliation(s)
- Marie Flannery
- University of Rochester Medical Center, Box SON 601, Elmwood Avenue, Rochester, NY 14642, USA.
| | | | - William Dale
- University of Chicago, Department of Medicine, Section of Geriatrics & Palliative Medicine, MC 6098, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
| | - Neeraj K Arora
- Patient Centered Outcomes Research Institute (PCORI), 1919 M Street, NW, Suite 250, Washington, DC 20036, USA.
| | - Lauren Azar
- Patients Centered Outcomes Research Institute (PCORI), 1919 M Street, NW, 4th Floor, Washington, DC, USA.
| | - Erica S Breslau
- National Cancer Institute (NCI), 9609 Medical Center Drive, 3E520, Rockville, MD 20850, USA.
| | - Harvey Jay Cohen
- Room 3502 Blue Zone, Duke University Medical Center, Box 3003, Durham, NC 27710, USA
| | - Efrat Dotan
- Fox Chase Cancer Center, 333 Cottman Ave., Philadelphia, PA, USA.
| | - Basil A Eldadah
- National Institute on Aging (NIA), 7201 Wisconsin Ave, 3C307, Bethesda, MD 20892, USA.
| | - Corinne R Leach
- American Cancer Society (ACS), 250 Williams St, Atlanta, GA 30303, USA.
| | - Sandra A Mitchell
- National Cancer Institute (NCI), 9609 Medical Center Drive, 3E448, Rockville, MD 20850, USA.
| | - Julia H Rowland
- National Cancer Institute (NCI), 9609 Medical Center Drive, 4E450, Rockville, MD 20850, USA.
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA 910110, USA.
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Weaver KE, Leach CR, Leng X, Danhauer SC, Klepin HD, Vaughan L, Naughton M, Chlebowski RT, Vitolins MZ, Paskett E. Physical Functioning among Women 80 Years of Age and Older With and Without a Cancer History. J Gerontol A Biol Sci Med Sci 2016; 71 Suppl 1:S23-30. [PMID: 26858321 DOI: 10.1093/gerona/glv073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/13/2022] Open
Abstract
BACKGROUND Females 80 years and older comprise 22% of the total U.S. survivor population, yet the impact of cancer on the physical well-being of women is this age group has not been well characterized. METHODS We compared women, 80 years of age and older in the Women's Health Initiative extension 2, who did (n = 2,270) and did not (n = 20,272) have an adjudicated history of cancer during Women's Health Initiative enrollment; analyses focused on women >2-years postcancer diagnosis. The physical functioning subscale of the RAND-36 was the primary outcome. Demographic, health-status, and psychosocial covariates were drawn from Women's Health Initiative assessments. Analysis of covariance was used to examine the effect of cancer history on physical function, with and without adjustment for covariates. RESULTS In adjusted models, women with a history of cancer reported significantly lower mean physical functioning (56.6, standard error [SE] 0.4) than those without a cancer history (58.0, SE 0.1), p = .002. In these models, younger current age, lower body mass index, increased physical activity, higher self-rated health, increased reported happiness, and the absence of noncancer comorbid conditions were all associated with higher physical functioning in both women with and without a history of cancer. CONCLUSIONS Women older than 80 years of age with a cancer history have only a moderately lower level of physical function than comparably aged women without a cancer history. Factors associated with higher levels of physical functioning were similar in both groups.
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Affiliation(s)
- Kathryn E Weaver
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina.
| | - Corinne R Leach
- The American Cancer Society, Behavioral Research Center Atlanta, GA
| | - Xiaoyan Leng
- Wake Forest School of Medicine, Department of Biostatistical Sciences Winston-Salem, North Carolina
| | - Suzanne C Danhauer
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina. Wake Forest School of Medicine, Department of Internal Medicine, Section on Hematology and Oncology Winston-Salem, North Carolina
| | - Heidi D Klepin
- Wake Forest School of Medicine, Department of Internal Medicine, Section on Hematology and Oncology Winston-Salem, North Carolina
| | - Leslie Vaughan
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina
| | - Michelle Naughton
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina
| | - Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance, California
| | - Mara Z Vitolins
- Wake Forest School of Medicine, Department of Epidemiology and Prevention Winston-Salem, North Carolina
| | - Electra Paskett
- The Ohio State University, Department of Internal Medicine, College of Medicine Columbus, Ohio
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Mohile SG, Hurria A, Cohen HJ, Rowland JH, Leach CR, Arora NK, Canin B, Muss HB, Magnuson A, Flannery M, Lowenstein L, Allore HG, Mustian KM, Demark-Wahnefried W, Extermann M, Ferrell B, Inouye SK, Studenski SA, Dale W. Improving the quality of survivorship for older adults with cancer. Cancer 2016; 122:2459-568. [PMID: 27172129 DOI: 10.1002/cncr.30053] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [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: 02/03/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 12/31/2022]
Abstract
In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging through a U13 grant, convened a conference to identify research priorities to help design and implement intervention studies to improve the quality of life and survivorship of older, frailer adults with cancer. Conference attendees included researchers with multidisciplinary expertise and advocates. It was concluded that future intervention trials for older adults with cancer should: 1) rigorously test interventions to prevent the decline of or improve health status, especially interventions focused on optimizing physical performance, nutritional status, and cognition while undergoing cancer treatment; 2) use standardized care plans based on geriatric assessment findings to guide targeted interventions; and 3) incorporate the principles of geriatrics into survivorship care plans. Also highlighted was the need to integrate the expertise of interdisciplinary team members into geriatric oncology research, improve funding mechanisms to support geriatric oncology research, and disseminate high-impact results to the research and clinical community. In conjunction with the 2 prior U13 meetings, this conference provided the framework for future research to improve the evidence base for the clinical care of older adults with cancer. Cancer 2016;122:2459-68. © 2016 American Cancer Society.
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Affiliation(s)
- Supriya G Mohile
- Department of Medicine, University of Rochester, Rochester, New York
| | - Arti Hurria
- Medical Oncology and Experimental Therapeutics, City of Hope National Medical Center, Duarte, California
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Julia H Rowland
- Office of Cancer Survivorship, National Cancer Institute, Bethesda, Maryland
| | - Corinne R Leach
- Office of Cancer Survivorship, National Cancer Institute, Bethesda, Maryland
| | - Neeraj K Arora
- Patient-Centered Outcomes Research Institute, Washington, DC
| | | | - Hyman B Muss
- Breast Cancer, Geriatric Oncology Program, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Allison Magnuson
- Division of Medical Oncology, University of Rochester, Rochester, New York
| | - Marie Flannery
- Department of Surgery, University of Rochester, Rochester, New York
| | - Lisa Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heather G Allore
- Department of Medicine and Public Health Services, Yale University, New Haven, Connecticut
| | - Karen M Mustian
- Department of Surgery, University of Rochester, Rochester, New York
| | | | - Martine Extermann
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Betty Ferrell
- Department of Nursing, City of Hope National Medical Center, Duarte, California
| | - Sharon K Inouye
- Institute of Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - William Dale
- Division of Geriatrics, Department of Medicine, University of Chicago, Chicago, Illinois
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38
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Leach CR, Bellizzi KM, Hurria A, Reeve BB. Is it my cancer or am i just getting older?: Impact of cancer on age-related health conditions of older cancer survivors. Cancer 2016; 122:1946-53. [DOI: 10.1002/cncr.29914] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Corinne R. Leach
- Behavioral Research Center, American Cancer Society; Atlanta Georgia
| | - Keith M. Bellizzi
- Department of Human Development and Family Studies; University of Connecticut; Storrs Connecticut
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research; City of Hope Comprehensive Cancer Center; Duarte California
| | - Bryce B. Reeve
- Health Policy and Management; University of North Carolina; Chapel Hill North Carolina
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39
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Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 2016; 34:611-35. [PMID: 26644543 DOI: 10.1200/jco.2015.64.3809] [Citation(s) in RCA: 528] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made. This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for Clinicians and Journal of Clinical Oncology. Copyright © 2015 American Cancer Society and American Society of Clinical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Cancer Society or the American Society of Clinical Oncology.
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Affiliation(s)
- Carolyn D. Runowicz
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Corinne R. Leach
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - N. Lynn Henry
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Karen S. Henry
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Heather T. Mackey
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Rebecca L. Cowens-Alvarado
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Rachel S. Cannady
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Mandi L. Pratt-Chapman
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Stephen B. Edge
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Linda A. Jacobs
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Arti Hurria
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Lawrence B. Marks
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Samuel J. LaMonte
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Ellen Warner
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Gary H. Lyman
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Patricia A. Ganz
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
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40
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Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. CA Cancer J Clin 2016; 66:43-73. [PMID: 26641959 DOI: 10.3322/caac.21319] [Citation(s) in RCA: 404] [Impact Index Per Article: 50.5] [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] [Indexed: 12/12/2022] Open
Abstract
Answer questions and earn CME/CNE The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.
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Affiliation(s)
- Carolyn D Runowicz
- Executive Associate Dean for Academic Affairs and Professor, Department of Obstetrics and Gynecology, Herbert Wertheim College of Medicine Florida International University, Miami, FL
| | - Corinne R Leach
- Director, Cancer and Aging Research, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - N Lynn Henry
- Associate Professor, Division of Hematology/Oncology, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI
| | - Karen S Henry
- Nurse Practitioner, Oncology/Hematology Sylvester Cancer Center at the University of Miami, Miami, FL
| | | | | | - Rachel S Cannady
- Behavioral Scientist, Behavioral Research Center/National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA
| | | | | | - Linda A Jacobs
- Clinical Professor of Nursing, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Arti Hurria
- Associate Professor and Director, Cancer and Aging Research Program, City of Hope, Duarte, CA
| | - Lawrence B Marks
- Sidney K. Simon Distinguished Professor of Oncology Research and Chairman, Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Samuel J LaMonte
- Retired Head and Neck Surgeon, Survivorship Workgroup Member and Volunteer, American Cancer Society, Atlanta, GA
| | - Ellen Warner
- Professor of Medicine, University of Toronto, Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - Gary H Lyman
- Co-Director Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Patricia A Ganz
- Distinguished Professor of Medicine and Health Policy & Management, Schools of Medicine and Public Health, University of California, Los Angeles, CA
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Alfano CM, Smith T, de Moor JS, Glasgow RE, Khoury MJ, Hawkins NA, Stein KD, Rechis R, Parry C, Leach CR, Padgett L, Rowland JH. An action plan for translating cancer survivorship research into care. J Natl Cancer Inst 2014; 106:dju287. [PMID: 25249551 DOI: 10.1093/jnci/dju287] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
To meet the complex needs of a growing number of cancer survivors, it is essential to accelerate the translation of survivorship research into evidence-based interventions and, as appropriate, recommendations for care that may be implemented in a wide variety of settings. Current progress in translating research into care is stymied, with results of many studies un- or underutilized. To better understand this problem and identify strategies to encourage the translation of survivorship research findings into practice, four agencies (American Cancer Society, Centers for Disease Control and Prevention, LIVE STRONG: Foundation, National Cancer Institute) hosted a meeting in June, 2012, titled: "Biennial Cancer Survivorship Research Conference: Translating Science to Care." Meeting participants concluded that accelerating science into care will require a coordinated, collaborative effort by individuals from diverse settings, including researchers and clinicians, survivors and families, public health professionals, and policy makers. This commentary describes an approach stemming from that meeting to facilitate translating research into care by changing the process of conducting research-improving communication, collaboration, evaluation, and feedback through true and ongoing partnerships. We apply the T0-T4 translational process model to survivorship research and provide illustrations of its use. The resultant framework is intended to orient stakeholders to the role of their work in the translational process and facilitate the transdisciplinary collaboration needed to translate basic discoveries into best practices regarding clinical care, self-care/management, and community programs for cancer survivors. Finally, we discuss barriers to implementing translational survivorship science identified at the meeting, along with future directions to accelerate this process.
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Affiliation(s)
- Catherine M Alfano
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP).
| | - Tenbroeck Smith
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
| | - Janet S de Moor
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
| | - Russell E Glasgow
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
| | - Muin J Khoury
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
| | - Nikki A Hawkins
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
| | - Kevin D Stein
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
| | - Ruth Rechis
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
| | - Carla Parry
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
| | - Corinne R Leach
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
| | - Lynne Padgett
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
| | - Julia H Rowland
- Behavioral Research Program (CMA, CP, LP), Applied Research Program (JSdM), Implementation Science Team (REG), Epidemiology and Genomics Research Program (MJK), and Office of Cancer Survivorship (JHR), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (TS, KDS, CRL); Office of Public Health Genomics (MJK) and Division of Cancer Prevention and Control (NAH), Centers for Disease Control and Prevention, Atlanta, GA; LIVESTRONG Foundation, Austin, TX (RR); Present addresses: Department of Family Medicine, University of Colorado, Denver, CO (REG); Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA (CP)
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Portnoy DB, Leach CR, Kaufman AR, Moser RP, Alfano CM. Reduced fatalism and increased prevention behavior after two high-profile lung cancer events. J Health Commun 2013; 19:577-592. [PMID: 24274730 PMCID: PMC4642863 DOI: 10.1080/10810730.2013.821553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The positive impact of media coverage of high-profile cancer events on cancer prevention behaviors is well-established. However, less work has focused on potential adverse psychological reactions to such events, such as fatalism. Conducting 3 studies, the authors explored how the lung cancer death of Peter Jennings and diagnosis of Dana Reeve in 2005 related to fatalism. Analysis of a national media sample in Study 1 found that media coverage of these events often focused on reiterating the typical profile of those diagnosed with lung cancer; 38% of the media mentioned at least 1 known risk factor for lung cancer, most often smoking. Data from a nationally representative survey in Study 2 found that respondents reported lower lung cancer fatalism, after, compared with before, the events (OR = 0.16, 95% CI [0.03, 0.93]). A sustained increase in call volume to the national tobacco Quitline after these events was found in Study 3. These results suggest that there is a temporal association between high-profile cancer events, the subsequent media coverage, psychological outcomes, and cancer prevention behaviors. These results suggest that high-profile cancer events could be leveraged as an opportunity for large-scale public heath communication campaigns through the dissemination of cancer prevention messages and services.
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Affiliation(s)
- David B Portnoy
- a Cancer Prevention Fellowship Program, Center for Cancer Training, and the Behavioral Research Program, Division of Cancer Control and Population Sciences , National Cancer Institute , Rockville , Maryland , USA
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Forsythe LP, Parry C, Alfano CM, Kent EE, Leach CR, Haggstrom DA, Ganz PA, Aziz N, Rowland JH. Use of survivorship care plans in the United States: associations with survivorship care. J Natl Cancer Inst 2013; 105:1579-87. [PMID: 24096621 DOI: 10.1093/jnci/djt258] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Survivorship care plans (SCPs), including a treatment summary and follow-up plan, intend to promote coordination of posttreatment cancer care; yet, little is known about the provision of these documents by oncologists to primary care physicians (PCPs). This study compared self-reported oncologist provision and PCP receipt of treatment summaries and follow-up plans, characterized oncologists who reported consistent provision of these documents to PCPs, and examined associations between PCP receipt of these documents and survivorship care. METHODS A nationally representative sample of medical oncologists (n = 1130) and PCPs (n = 1020) were surveyed regarding follow-up care for breast and colon cancer survivors. All statistical tests were two-sided. Multivariable regression models identified factors associated with oncologist provision of treatment summaries and SCPs to PCPs (always/almost always vs less frequent). RESULTS Nearly half of oncologists reported always/almost always providing treatment summaries, whereas 20.2% reported always/almost always providing SCPs (treatment summary + follow-up plan). Approximately one-third of PCPs indicated always/almost always receiving treatment summaries; 13.4% reported always/almost always receiving SCPs. Oncologists who reported training in late- and long-term effects of cancer and use of electronic medical records were more likely to report SCP provision (P < .05). PCP receipt of SCPs was associated with better PCP-reported care coordination, physician-physician communication, and confidence in survivorship care knowledge compared to receipt of neither treatment summaries nor SCPs (P < .05). CONCLUSIONS Providing SCPs to PCPs may enhance survivorship care coordination, physician-physician communication, and PCP confidence. However, considerable progress will be necessary to achieve implementation of sharing SCPs among oncologists and PCPs.
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Affiliation(s)
- Laura P Forsythe
- Affiliations of authors: Office of Cancer Survivorship, Division of Cancer Control and Population Sciences (LPF, CP, CMA, EEK, JHR), and Cancer Prevention Fellowship Program, Division of Cancer Prevention (LPF, EEK), National Cancer Institute, National Institutes of Health, Bethesda, MD; Behavioral Research Center, American Cancer Society, Atlanta, GA (CRL); Veterans Affairs Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice, Indianapolis, IN (DAH); Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN (DAH); Indiana University Center for Health Services and Outcomes Research, Regenstrief Institute, Inc, Indianapolis, IN (DAH); University of California, Los Angeles School of Medicine and School of Public Health, Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA (PAG); Office of Extramural Programs, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD (NA) Present address: Patient-Centered Outcomes Research Institute, Washington, DC (LPF); Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EEK)
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Forsythe LP, Alfano CM, Leach CR, Ganz PA, Stefanek ME, Rowland JH. Who provides psychosocial follow-up care for post-treatment cancer survivors? A survey of medical oncologists and primary care physicians. J Clin Oncol 2012; 30:2897-905. [PMID: 22778322 PMCID: PMC3410404 DOI: 10.1200/jco.2011.39.9832] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 04/25/2012] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Addressing psychosocial needs, including key components of psychologic distress, physical symptoms, and health promotion, is vital to cancer follow-up care. Yet little is known about who provides psychosocial care. This study examined physician-reported practices regarding care of post-treatment cancer survivors. We sought to characterize physicians who reported broad involvement in (ie, across key components of care) and shared responsibility for psychosocial care. METHODS A nationally representative sample of medical oncologists (n = 1,130) and primary care physicians (PCPs; n = 1,021) were surveyed regarding follow-up care of breast and colon cancer survivors. RESULTS Approximately half of oncologists and PCPs (52%) reported broad involvement in psychosocial care. Oncologist and PCP confidence, beliefs about who is able to provide psychosocial support, and preferences for shared responsibility for care predicted broad involvement. However, oncologists' and PCPs' perceptions of who provides specific aspects of psychosocial care differed (P < .001); both groups saw themselves as the main providers. Oncologists' confidence, PCPs' beliefs about who is able to provide psychosocial support, and oncologist and PCP preference for models other than shared care were inversely associated with a shared approach to care. CONCLUSION Findings that some providers are not broadly involved in psychosocial care and that oncologists and PCPs differ in their beliefs regarding who provides specific aspects of care underscore the need for better care coordination, informed by the respective skills and desires of physicians, to ensure needs are met. Interventions targeting physician confidence, beliefs about who is able to provide psychosocial support, and preferred models for survivorship care may improve psychosocial care delivery.
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Affiliation(s)
- Laura P Forsythe
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Nichols HB, Sprague BL, Buist DSM, Erwin DO, Leach CR, Patrick H. Careers in cancer prevention: what you may not see from inside your academic department--a report from the American Society of Preventive Oncology's Junior Members Interest Group. Cancer Epidemiol Biomarkers Prev 2012; 21:1393-5. [PMID: 22695736 DOI: 10.1158/1055-9965.epi-12-0664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hazel B Nichols
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709, USA.
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Leach CR, Klabunde CN, Alfano CM, Smith JL, Rowland JH. Physician over-recommendation of mammography for terminally ill women. Cancer 2011; 118:27-37. [PMID: 21681736 DOI: 10.1002/cncr.26233] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/16/2011] [Accepted: 04/08/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND There has been recent, sometimes intense, debate about when to begin screening and how often to screen women for breast cancer with mammography. However, there should be no controversy regarding screening women who are unlikely to benefit from the procedure, such as those with a serious, life-limiting illness who would not live long enough to benefit from the potential detection and treatment of breast cancer. Identifying characteristics of physicians who recommend mammography for terminally ill women can help guide efforts to minimize patient risks and make better use of health care resources. METHODS The authors used data from a nationally representative survey of primary care physicians (PCPs) (N = 1196; response rate, 67.5%) conducted in 2006 and 2007 to examine PCPs' breast cancer screening recommendations for hypothetical patients ages 50 years, 65 years, and 80 years who were healthy, had a moderate comorbidity, or had a terminal comorbidity. RESULTS Many PCPs (47.7%) reported that they would recommend mammography to a woman aged 50 years, 65 years, or 80 years with terminal lung cancer, indicating over-recommendation. Physician characteristics associated with over-recommending mammography included obstetrician/gynecologist (odds ratio [OR], 1.69) or internal medicine (OR, 0.45) specialty, being a woman (OR, 1.40), being a racial/ethnic minority (OR, 1.72), and working in a smaller practice (OR, 1.41). CONCLUSIONS The current results indicated that physician over-recommendation of screening mammography among terminally ill women is common. Certain physician and practice characteristics, including specialty, were associated with over-recommending mammography. The authors concluded that an informed and shared mammography decision-making process for terminally ill women may eliminate unnecessary patient risks and health care expenditures.
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Affiliation(s)
- Corinne R Leach
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.
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Leach CR, Schoenberg NE, Hatcher J. Factors associated with participation in cancer prevention and control studies among rural Appalachian women. Fam Community Health 2011; 34:119-25. [PMID: 21378508 PMCID: PMC3086267 DOI: 10.1097/fch.0b013e31820de9bf] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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] [Indexed: 05/26/2023]
Abstract
Rural Appalachian women bear a disproportionate burden from many types of cancer yet often are underrepresented in cancer research. This article uses 2 case studies to illustrate barriers faced and strategies used when recruiting hard-to-reach rural participants. Recruitment barriers include the population's competing demands and lack of trust of outsiders. Strategies employed include involving insider advocates, highlighting the positive experiences of early participants, spending extensive time in the community, and emphasizing potential community benefits of the study. We suggest recruitment strategies to better involve rural women and others who, by virtue of being "hard-to-reach," often are overlooked.
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Affiliation(s)
- Corinne R. Leach
- Cancer Prevention Fellow, National Cancer Institute, Office of Cancer Survivorship, Bethesda MD,
| | - Nancy E Schoenberg
- Marion Pearsall Professor of Behavioral Science, Department of Behavioral Science, University of Kentucky, Lexington KY,
| | - Jennifer Hatcher
- Assistant Professor, College of Nursing, University of Kentucky, Lexington KY,
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Leach CR, Schoenberg NE. The vicious cycle of inadequate early detection: a complementary study on barriers to cervical cancer screening among middle-aged and older women. Prev Chronic Dis 2007; 4:A95. [PMID: 17875270 PMCID: PMC2099293] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Although rates of invasive cervical cancer have declined precipitously over the past 50 years, nearly 10,000 new cases and 3700 deaths result from this cancer annually. Given the efficacy of early detection, invasive cervical cancer should no longer constitute a health threat; however, national studies reveal that many women, especially older women, do not receive Papanicolaou (Pap) tests. METHODS In this complementary study, we examined data from the National Health Interview Survey focusing on the correlates of screening for women aged 55 years or older, an age group in which invasive cervical cancer rates escalate and rates of obtaining Pap tests decline. To more richly understand grounded perspectives, we queried 25 women who were rarely or never screened about factors and circumstances underlying their decision not to obtain a Pap test. RESULTS Quantitative data indicate an association between Pap test use and demographic factors (being married, being younger, and having suburban or urban residence) and access to preventive care (obtaining mammograms, having a regular source of health care, and having contact with an obstetrician/gynecologist). Participants who provided qualitative data echoed this theme of inadequate use of preventive services, particularly among women with weak social ties, who were older, and who lived in rural areas. Shortages of health care professionals and a lack of continuity of care and privacy contribute to suboptimal prevention. CONCLUSION A vicious cycle emerges: many women decline to pursue preventive care because of competing health and financial demands and insufficient resources to seek care. When such women do go to the doctor's office, they feel chastised by providers, which alienates them and thwarts future preventive care.
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Affiliation(s)
- Corinne R Leach
- Graduate Center for Gerontology, 306 Wethington Health Sciences Building, 900 S. Limestone, University of Kentucky, Lexington, KY 40536-0200, USA.
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Abstract
This review presents a historical account of studies of B chromosomes in the genus Brachycome Cass. (synonym: Brachyscome) from the earliest cytological investigations carried out in the late 1960s though to the most recent molecular analyses. Molecular analyses provide insights into the origin and evolution of the B chromosomes (Bs) of Brachycome dichromosomatica, a species which has Bs of two different sizes. The larger Bs are somatically stable whereas the smaller, or micro, Bs are somatically unstable. Both B types contain clusters of ribosomal RNA genes that have been shown unequivocally to be inactive in the case of the larger Bs. The large Bs carry a family of tandem repeat sequences (Bd49) that are located mainly at the centromere. Multiple copies of sequences related to this repeat are present on the A chromosomes (As) of related species, whereas only a few copies exist in the A chromosomes of B. dichromosomatica. The micro Bs share DNA sequences with the As and the larger Bs, and they also have B-specific repeats (Bdm29 and Bdm54). In some cases repeat sequences on the micro Bs have been shown to occur as clusters on the A chromosomes in a proportion of individuals within a population. It is clear that none of these B types originated by simple excision of segments from the A chromosomes.
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Affiliation(s)
- C R Leach
- School of Molecular and Biomedical Science (Genetics), The University of Adelaide, SA, Australia.
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Abstract
The objective of the present study was to identify predictors of institutionalization in African Americans who suffer from dementia. Data were derived from the Medicare Alzheimer's Disease Demonstration Evaluation (MADDE), which collected information on Alzheimer's patients and their family caregivers over a 3-year period. The baseline MADDE sample included 667 older African Americans suffering from dementia recruited from eight catchment areas in the United States. A Cox proportional hazards model was used to create a predictive model of institutionalization. Subsequent analyses found that care recipient age, sex, Medicaid eligibility, and cognitive impairment; site; and caregiving burden were significant predictors of time to placement. The results, among the first to examine predictors of nursing home placement of cognitively impaired African Americans, emphasize the clinical implications and complex interplay of race, dementia, and caregiving context in the institutionalization process.
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Affiliation(s)
- Joseph E Gaugler
- Department of Behavioral Science, The University of Kentucky, Lexington, Kentucky 40536, USA.
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