The AYUDA Pilot-Study Intervention: Psychosocial Support for Underserved Spanish-Speaking Latinas Undergoing Breast Cancer Treatment

Introduction: Early discontinuation (DC) of adjuvant endocrine therapy (AET) for hormone receptor positive breast cancer (BC) is associated with increased risk of recurrence and death. Symptoms and low socioeconomic status (SES) have both previously been associated with early AET DC. Prospective collection of patient-reported outcomes (PRO) is increasingly used in oncology practice, and can lead to improvements in quality of life and survival in advanced cancer. Compared to patients of high SES, those of low SES report higher symptom burden in multiple clinical settings. Whether PRO reporting during AET differs according to SES is unknown. Methods: We enrolled women initiating AET for stage 0-III BC in a prospective clinic-based cohort from March 2012 to Dec 2016. At baseline (BL), 3, 6, 12, and 24 months (mo), participants completed these PROs online: FACT-ES, MOS Sexual Problems, and NIH PROMIS measures for pain interference, fatigue, depression, anxiety, physical function and sleep disturbance. Neighborhood poverty (NP) rate, a surrogate for SES based on US Census estimates of the % of persons in a zip code below the federal poverty line, was categorized as 0-5% (low), >5-10% (moderate) and >10% (high). We assessed AET DC and cited reason for DC by chart review. Baseline characteristics were compared between NP groups using Fisher’s exact and t-tests. Changes in mean PRO scores from BL to follow-up (FU) time points for each NP group were estimated simultaneously from a linear mixed effects regression model with a random intercept for each patient. We evaluated differences in changes in mean scores for all 8 PRO measures over time according to NP group with an interaction test. Statistical significance of p < 0.05/8 = 0.006 was used, adjusting for multiple comparisons. Results: Among 320 women, mean age was 61 (range 26-90), 83% were White, 10% Black, 65% were post-menopausal and 84% had Stage I-II BC. NP categorization was: 97 (30.3%) low, 127 (39.7%) moderate and 96 (30%) high. Mean stage distribution, and proportions of participants who had mastectomy, chemotherapy and radiation did not differ by NP group. There were fewer post-menopausal women in the moderate/high NP groups (61%) compared to the low NP group (72%, p=0.04). The proportion of Black participants increased with NP group (low 5%, moderate 10%, high 16%, p=0.04). Overall, 180 (56%) were on an aromatase inhibitor (AI) and 140 (44%) were on tamoxifen. There was more AI use in the low NP group (64%) compared to the moderate/high NP groups (53%, p=0.08). At BL, there were no differences in mean score on any PRO by NP group. For all NP groups, endocrine symptoms worsened at all FU times (all p<0.05) and physical function improved at most FU times. Compared to BL, mean changes in pain interference over time differed by NP group (interaction p=0.005), with less pain interference at 6 and 12 mo in the moderate/high NP groups and no significant change in the low NP group. Mean changes in other PROs did not differ by NP group. At median FU of 41 mo (range 3-75), the proportion of participants who discontinued AET due to side effects/intolerance was similar across NP groups (low 12.6%, moderate 16%, high 17%, p=0.67). Discussion: We found that changes in PROs during AET were similar across SES based on NP rates with the exception of less reported pain interference over time in participants of lower SES. The lack of improvement in pain interference in participants of higher SES may be attributable to arthralgias due to more frequent AI use. Despite differences in pain interference, early DC of AET due to side effects/intolerance did not differ by SES in this cohort. Our findings suggest that PROs are generally similar among early BC patients of varied SES receiving AET and that factors other than symptoms may explain the previously reported association between early DC and low SES. Citation Format: Ramy Sedhom, Amanda Blackford, David Lim, Jennifer Ensminger, Claire Snyder, Vered Stearns, Karen Lisa Smith. Patient reported outcomes and early discontinuation of adjuvant endocrine therapy according to neighborhood poverty rate [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD10-07.

BackgroundIn the treatment and follow up of rheumatoid arthritis (RA) patients, it has become more desirable to detect changes in disease activity through telemonitoring, for which patient reported outcomes (PROs)...

Background: A growing number of lifestyle interventions are being developed to promote weight loss and adoption of a healthy lifestyle among breast cancer (BC) survivors. However, Black and Latina BC survivors remains underrepresented. We performed a scoping review to examine the available peer-reviewed literature to describe the content, design, methods, and primary outcomes of current diet and/or physical activity (PA) interventions designed specifically for Black and Latina BC survivors. Methods: PubMed, EMBASE, CINAHL, MEDLINE and Clinicaltrials.gov databases were queried up to May 14, 2022, using an inclusion criterion that consisted of four overarching concepts: 1) female breast cancer, 2) diet and/or PA intervention, 3) self-reported race, ethnicity as Black/African American and/or Hispanic/Latina and 4) randomized study design. Results: Our search yielded 1,436 trials, of which 22 trials met inclusion criteria for this review. We identified 6 efficacy trials, 12 pilot trials, and 5 currently ongoing studies. Nine trials were conducted among Latina BC survivors (4 diet, 5 PA, and 2 diet and PA interventions), 6 trials were among Black BC survivors (2 PA and 1 diet and PA interventions) and 7 were conducted among both groups (5 PA and 2 diet and PA interventions). Only 8 out of 22 trials incorporated intervention content on both diet and PA behaviors, of which, 3 incorporated a culturally focused approach for Latinas BC survivors and 1 for Black BC survivors (i.e., traditional/cultural foods, music, education materials in Spanish, bicultural health coaches, connections to spirituality). Among the 8 trials targeting both diet and PA, all of them were pilot studies and only 3 were found to have favorable impact on healthy diet and exercise behaviors. Out of 4 trials with one-year outcomes, 3 (1 diet, 1 PA and 1 diet and PA intervention) showed a change in behavior sustained at this time point with only 1 being an efficacy trial for PA. Electronic/mobile components (e.g., websites, mobile applications, emails) were incorporated in 6 trials (3 among Black BC survivors , 2 among Latina BC survivors , and 2 among both groups) and just 1 trial conducted among Latina BC survivors involved informal caregivers (i.e., family or friends). Lastly, most trials in this review were conducted in the Northeast (n=7, NY, NC, DC, NJ) and Texas (n=4), limiting generalizability of findings to Black and Latina BC survivors residing in other states and settings. Conclusions: There is a growing number of lifestyle interventions among BC survivors, yet few are designed and culturally tailored to the unique needs of Black and Latina BC survivors. There is an unmet need for dietary and PA randomized clinical interventions for Black and Latina BC survivors as well as randomized rials that incorporate technology and informal sources of support (e.g., caregivers, family, etc.)—factors that are critical to increase access, adoption, and maintenance of healthful lifestyles among cancer survivors. Citation Format: Yaideliz M. Romero-Ramos, Melinda Irwin, Ana I. Velazquez, Leah M. Ferruci, Tara Sanft, Brenda Cartmel, Margaret S. Pichardo. A scoping review of diet and physical activity interventions in Latina and Black breast cancer survivors [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C104.

In order to investigate patients’ experience of healthcare, repeated assessments of patient-reported outcomes (PRO) are increasingly performed in observational studies and clinical trials. Changes in PRO can however be difficult to interpret in longitudinal settings as patients’ perception of the concept being measured may change over time, leading to response shift (longitudinal measurement non-invariance) and possibly to erroneous interpretation of the observed changes in PRO. Several statistical methods for response shift analysis have been proposed, but they usually assume that response shift occurs in the same way in all individuals within the sample regardless of their characteristics. Many studies aim at comparing the longitudinal change of PRO into two groups of patients (treatment arm, different pathologies, …). The group variable could have an effect on PRO change but also on response shift effect and the perception of the questionnaire at baseline. In this paper, we propose to enhance the ROSALI algorithm based on Rasch Measurement Theory for the analysis of longitudinal PRO data to simultaneously investigate the effects of group on item functioning at the first measurement occasion, on response shift and on changes in PRO over time. ROSALI is subsequently applied to a longitudinal dataset on change in emotional functioning in patients with breast cancer or melanoma during the year following diagnosis. The use of ROSALI provides new insights in the analysis of longitudinal PRO data.

Introduction: Effective interventions tailored for rural Spanish-speaking Latina breast cancer survivors are needed to address their psychosocial health disparities. Purpose: Describe development of a rural community-based cognitive-behavioral stress management program, Nuevo Amanecer-R (NA-R) (New Dawn-R) and baseline characteristics of rural Latina breast cancer survivors enrolled in the RCT testing the program. Methods: Using community-based participatory research (CBPR) strategies, we applied a translational model appropriate for underserved populations that integrated an evidence-based intervention, a community best-practices program, and formative research to develop a program that could be delivered by trained breast cancer survivors (peers) in rural settings. We trained community recruiters to enroll, and collect hair and saliva biospecimens from, Spanish-speaking Latinas with nonmetastatic breast cancer in 3 rural California communities. Women were randomized to receive the program immediately or in 6 months. Primary outcomes include the Functional Assessment of Cancer Therapy-Breast Quality of Life (FACT-B) Total Score and its Physical, Social, Emotional, Functional Well-being, and Additional Concerns about Breast Cancer subscale scores (higher scores=better quality of life), with assessments at baseline, 3 months, and 6 months. Results: Based on input from survivors, advocates, and clinicians, modifications to the initial program for rural Latina survivors included further simplification of language, more visuals, developing stress management videos in Spanish and English, and expansion from 8 to 10 sessions to increase skills practice and healthy lifestyles information. Trained peers are delivering the 10-week NA-R program through weekly in-person 90-minute sessions in participants' homes. Components include managing the initial impact of cancer, finding cancer information and support, thoughts and mood management skills, behavioral stress management skills, and goal-setting. Of 231 women approached, 54 (24%) refused, 24 (10%) were ineligible, and 153 (66%) were randomized (76 to intervention, 77 to control group). To date, all baseline, 90% of 3-month, and 92% of 6-month assessments are completed. Participant characteristics are: mean age of 54.8 years (range, 28 to 88); 69% have < high school education; 66% are married; 80% have public/no health insurance; and 48% experienced financial hardship in the past year. Baseline FACT-B mean scores are: Total Score, 96.7 (possible range 0-144); Emotional Well-being, 17.3 (possible range 0-24); Functional Well-being, 18.2 (possible range 0-28); Social/Family Well-being, 18.2 (possible range 0-28); Physical Well-being, 20.4 (possible range 0-28); and Breast Cancer Concerns, 22.7 (possible range 0-36). Conclusions: Using CBPR principles in the design and implementation of community-based RCTs enhances cultural appropriateness, congruence with community contexts, and recruitment and retention. Citation Format: Jasmine Santoyo-Olsson, Anita L. Stewart, Carmen Ortiz, Steven Gregorich, Anna Maria Napoles. Baseline characteristics of rural Spanish-speaking Latina breast cancer survivors enrolled in a community-based RCT of a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer rural trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A043.

Cancer and diabetes are two severe chronic illnesses that often co-occur. In cancer patients, diabetes increases the risk for treatment complexities and mortality. Yet patient-reported outcomes with co-occurring chronic illness are understudied. This preliminary study investigated the association of diabetes with breast cancer-related morbidity among underserved Latina breast cancer survivors (BCS). 137 Latina BCS were recruited from the California Cancer Registry and hospitals.Setting and Main Outcome Measure(s): BCS completed a self-administered mailed questionnaire assessing demographic and medical characteristics e.g. Type2 diabetes mellitus (T2DM). 28% Latina BCS reported co-occurring T2DM at twice the general population rate. Diabetes was most prevalent among Latina BCS>65years (43%). Latina BCS with diabetes were more likely to report advanced cancer staging at diagnosis (P=0.036) and more lymphedema symptoms (P=0.036). Results suggest non-significant but lower general health and greater physical functioning limitations among BCS with T2DM. This study has relevance for precision population medicine by (i) consideration of routine diabetes screening in Latina BCS, (ii) underscoring attention to disease co-occurrence in treatment planning and care delivery and (iii) informing follow-up care and survivorship care planning e.g. patient self-management, oncology and primarily care surveillance and specialty care. Our findings can inform providers, survivors and caregivers about the impact of disease co-occurrence that influence clinically and patient responsive care for both initial treatment and long-term follow-up care to address disparities.

Early discontinuation of aromatase inhibitors (AIs) is common and leads to poor outcomes but is challenging to predict. In the Exemestane and Letrozole Pharmacogenetics trial, a high rate of early discontinuation due to intolerance was observed. We hypothesized that early changes in patient-reported outcomes (PROs) predict AI discontinuation and that biochemical factors are associated with changes in PROs. Postmenopausal women with early-stage breast cancer enrolled in a prospective randomized trial of exemestane versus letrozole completed questionnaires at baseline and serially over 24 months to assess overall quality of life (EuroQOL Visual Analog Scale [VAS]); mood; and multiple symptoms, including a musculoskeletal symptom cluster. A joint mixed-effects/survival model was used to estimate the effect of the change in PROs on AI discontinuation. Associations between biochemical factors and change in PROs were examined. A total of 490 patients were analyzed. Worsening of EuroQOL VAS and the musculoskeletal cluster were associated with the highest risk for early discontinuation (hazard ratio [HR], 2.77 [95% confidence interval (CI), 2.72-2.81; p = .015]; HR, 4.39 [95% CI, 2.40-8.02; p < .0001], respectively). Pharmacokinetics and estrogen metabolism were not consistently associated with change in PRO measures. No clinically significant differences in any PRO between AIs were observed. Changes in PROs early during AI therapy were associated with treatment discontinuation. Identification of these changes could be used to target interventions in patients at high risk for early discontinuation. Early changes in patient-reported outcomes (PROs) can predict nonpersistence to aromatase inhibitor therapy. If used in clinical practice, PROs might identify women at highest risk for early discontinuation and allow for interventions to improve tolerance before significant toxicities develop. Further research is needed to improve capturing PROs in routine clinical practice.

Purpose: Despite the benefits of diet and physical activity (PA) in improving breast cancer (BC) outcomes, few lifestyle interventions focus on Latina BC survivors who are at increased risk of cardiometabolic disorders, obesity and poor BC outcomes. We developed and tested the effectiveness of the culturally-tailored ¡Mi Vida Saludable! (My Healthy Life) in-person and/or electronic health (eHealth) program on improving diet and PA among Latina BC survivors. The program was developed in collaboration with community partners and used theory-based psychosocial determinants of behavior change. Methods: Latina BC survivors were post-treatment (endocrine therapy allowed) and consumed &amp;lt;5 daily servings of fruits/vegetables (F/V) and/or engaged in &amp;lt;150 minutes of moderate-to-vigorous PA (MVPA)/week. Women were randomized 1:1:1:1 in a 2x2 factorial design to: 1) 4 weekly in-person group sessions over 1 month + 11 months of eHealth health promotion messages (text messaging, eNewsletters, website), 2) in-person group sessions alone, 3) eHealth alone, or 4) control. Randomization was stratified by language preference and current use of endocrine therapy. All study activities were offered in Spanish and English. All participants received a Fitbit to self-monitor PA and a 30 min individual session on healthy lifestyle behaviors. Primary outcomes at 12 months were change in daily servings of targeted F/V and energy density (kcal/g of food). Secondary outcomes were change in min/week of MVPA, body mass index (BMI), and waist:hip ratio. One-way analysis of variance (ANOVA) examined main intervention effects (i.e., in-person group sessions, yes vs. no; eHealth, yes vs. no) from baseline to 12 months while controlling for stratification factors and baseline values. Two-way ANOVA compared differences between changes in the 4 arms. Results: Women (n=167) were randomized between January 2016 and September 2018. On average, women were 57±10 years old and 6±5 years post-diagnosis; 47% were on endocrine therapy and 83% were overweight/obese. Over 15 Latin American national backgrounds were represented. Retention at 12 months was 93.4%. At 12 months, main effect analyses showed in-person group sessions resulted in an increase of 0.78±2.8 servings/day of F/V (P=0.01) compared to control. Analyses comparing effects across the 4 arms showed increases in F/V in the in-person group session arm only (P=0.02). No other significant changes in F/V intake or energy density were observed. At 12 months, there were no significant changes in min/week of MVPA in any analyses. However, in main effect analyses, the control compared to eHealth increased in 79.9±422.0 min/week of moderate intensity exercise (P&amp;lt;0.01) and analyses comparing effects across the 4 arms, both in-person group sessions and the control showed increases (P=0.01). At 12 months, the in-person group sessions resulted in decreased BMI (0.48±1.3 kg/m2, P=0.04) and decreased waist circumference (3.4±7.7 cm, P=0.04) as compared to control. In analyses across the 4 arms, women in the in-person group sessions had greater decrease in waist:hip ratios (P=0.04). Conclusion: The 4-week culturally-tailored in-person ¡Mi Vida Saludable! diet and PA group sessions resulted in increased F/V intake, increased moderate physical activity, and improvements at 12 months in anthropometric measures in Latina BC survivors. Participation in the 11-month eHealth program did not result in changes in diet, PA, or anthropometric measures, despite similar content. Future studies need to continue to develop and test culturally relevant and scalable programs to promote and sustain long-term behavior change within at-risk patient populations, possibly focusing on group-based interventions. Citation Format: Heather Greenlee, Margarita Santiago-Torres, Pamela Koch, Wei-Yann Tsai, Heewon L Gray, Adam M Brickman, Ann Ogden Gaffney, Martha Eddy, Cynthia A Thomson, Tracy E Crane, Naxielly Dominguez, Jhack Sepulveda, Amanda M. Marin-Chollom, Rachel Paul, Zaixing Shi, Kathleene T Ulanday, Hanjie Shen, Marisol Castellano, Yanette Fuentes, Katherine Crew, Kevin Kalinsky, Melissa Accordino, Meghna Trivedi, Bret Taback, Melissa Beauchemin, Fernando J Camacho, Daniel T Friedman, Isobel Contento, Dawn L. Hershman. A randomized, controlled, 2x2 factorial trial of a diet and physical activity intervention among Latina breast cancer survivors: ¡Mi Vida Saludable! study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-10-07.

117. Ten-year BRYAN cervical disc arthroplasty: does change in angular motion have an effect on changes in patient-reported outcomes?

The application of patient reported outcomes (PROs) to build personalized patient education aids

Patient-Reported Outcomes in Clinical Trials of CKD-Related Therapies: Report of a Symposium Sponsored by the National Kidney Foundation and the US Food and Drug Administration

For Latina women, breast cancer is the leading cancer and we expect this trend to continue as the US Hispanic population expands. Latinas generally have lower survival rates for most cancers, even after accounting for differences in age and stage distribution, which may reflect less access to timely, high-quality treatment. Despite these challenges observed among Latina breast cancer survivors (BCS), there is very limited knowledge of survivorship-related issues and priorities among Latinas, specifically the effectiveness of using patient navigators (PN) to link Latina BCS with unmet psychosocial needs to appropriate psychosocial services, screening, risk reduction services and treatment follow-up. Methods: The Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio is conducting “Staying Healthy,” a two-year, two-arm randomized controlled trial (75 planned in each arm) of patient navigation among Latina BCS (Susan G. Komen for the Cure Grant #SAB-08-00005). The study compares Enhanced PN (PN+) to Usual PN over time. PN+ subjects receive tailored educational materials and regular personalized assistance including phone calls, meetings, and coordination of targeted care. Usual PN comparison subjects receive navigation upon request for specific needs. All navigation is conducted by trained paraprofessionals from the target community. Participants are Latina BCS age 18 and older who have completed primary treatment at least 3 months prior to study entry, have no metastatic disease, lack cancer or co-morbidity screening and have no ongoing neo-adjuvant therapy. Study outcomes include general and breast cancer-specific quality of life (QOL: Functional Assessment of Cancer Therapy-General, FACT-G, and breast cancer-specific, FACT-B), and compliance with health care recommendations and screening practices. The study includes overall descriptive statistics and hierarchical linear regression of QOL scores at baseline on self-efficacy (SE), communication (Perceived Efficacy in Patient-Physician Interactions, PEPPI), needs (Supportive Care Needs Survey, SCNS), levels of distress (adapted Cognitive Somatic Anxiety Questionnaire, CSAQ), and worry interference (WI), controlling by acculturation (Short Acculturation Scale for Hispanics, SASH), age, and time (months) since primary treatment. Results: We have conducted the baseline analyses of 120 enrolled Latina BCS who average 3.6 years post-diagnosis (SD=2.8 years) and 3.2 years post-primary treatment (SD=2.6 years). About 57% of participants reported having Medicare or Medicaid healthcare coverage. Participants were an average age of 57.3 (SD=9.5 years), 38% Spanish monolingual, 58% US born, 47% married or in an equivalent relationship, and 87% parents. More than three-fifths of the sample (61%) reported an annual household income below $25,000. Consistent with prior work with Latina BCS, our sample reported similar general health-related (M=82, SD=16.8) and breast cancer-specific (M=107, SD=21.4) QOL as measured by the FACT-G and FACT-B scales, respectively. Lower levels of distress (adapted CSAQ) were significantly associated with higher scores of both general QOL (β = -1.3, 95% CI -1.7, -0.9, for FACT-G) and disease-specific QOL (β = -1.9, 95% CI -2.3, -1.4, for FACT-B) after controlling by age, time since primary treatment, and acculturation score. Conclusion: These results show that among Latina BCS, levels of distress and QOL (general and breast cancer-specific) are inversely associated regardless of age, time since primary treatment, and degree of acculturation. Interventions to address unmet psychological needs may be one effective approach for ameliorating distress and enhancing QOL in this vulnerable population. Citation Format: Edgar Munoz, Alfredo A. Santillan-Gomez, Amanda Sintes-Yallen, Kipling Gallion, Amelie G. Ramirez. Improving quality of life among Latina breast cancer survivors using the “Staying Healthy” program. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B12.

The Importance of Outcome Measurement in Orthopaedics

65 Background: Survivorship care plans (SCPs) include treatment summaries and follow-up care recommendations intended to improve patient care and well-being after cancer treatment. Limited research has yielded mixed results regarding SCPs' impact on patient and system outcomes, but emphasized provider burden as an implementation barrier. We created a patient-centered SCP template and implemented its delivery at a safety net hospital that serves primarily racial/ethnic minority patients. Methods: In a single-arm feasibility study, oncologists and advanced practice nurses used the template to deliver SCPs to post-treatment breast cancer survivors (BCS) in consultation visits. We assessed changes in patient-reported outcomes from baseline (pre-SCP) to a 3-month follow-up, as well as provider time burden. Results: Female BCS participants (n = 75; mean age = 58.5 years) were primarily African-American (73%) and had high school/GED education or less (61%). Average time since diagnosis was 3.7 years (SD = 3.8); all received surgery; most received radiation (84%), hormone (77%), and/or chemotherapy treatment (73%). At follow-up, a majority rated their SCPs as good to excellent (92%), easy or very easy to understand (84%), a good to excellent summary of their treatment (92%) and as motivation for healthy lifestyles (88%). BCS follow-up scores improved significantly from baseline on breast cancer knowledge (p = .02), self-efficacy (p = .03), the QLQ-INFO25 (p &lt; .01), and the FACIT TS-PS satisfaction with health care staff communication subscale (p &lt; .01). No significant differences between baseline and follow-up scores (p &lt; .05) were found for overall treatment satisfaction, health behaviors, and health-related quality of life. Preparing and delivering SCPs took providers considerable time (M = 54 &amp; 22 minutes, respectively). Conclusions: This pilot study is limited by a single-arm design, but results suggest that SCPs may be related to improved survivor knowledge, information, self-efficacy and communication with health care staff. The individualized, comprehensive SCPs were well received by BCS in a safety net hospital but delivery was time-intensive. These findings will inform future research trials and clinical care initiatives.

Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis