Cancer-related Quality Of Life Research Articles

Changes In Anxiety, Fear Of Cancer Progression, And Quality Of Life In Prostate Cancer Patients On Active Surveillance After A 12-week Exercise Program: A Randomized Controlled Trial

PURPOSE: Prostate cancer (PCa) patients undergoing active surveillance often experience psychological distress such as anxiety or fear or cancer progression. This study was to investigate the impacts of a 12-week exercise program on patient-reported outcomes in PCa patients undergoing active surveillance. METHODS: 52 PCa patients on active surveillance were randomized to high-intensity interval training (HIIT; n = 26) or usual care (UC; n = 26). The HIIT group performed a 12-week, thrice-weekly, supervised, aerobic HIIT intervention. Patient-reported outcomes were assessed at baseline and postintervention (12-weeks), including PCa-specific anxiety (Memorial Anxiety Scale for Prostate Cancer; MAX-PC), fear of cancer progression (Fear of Cancer Recurrence Inventory; FCRI), PCa-related symptoms (Expanded Prostate Cancer Index Composite-26; EPIC-26), cancer-related quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30-item; EORTC QLQ-C30), and generic psychosocial outcomes (e.g., fatigue, stress, and self-esteem). Analysis of covariance was used to compare between-group differences. RESULTS: 50/52 (96%) participants completed patient-reported outcome assessments at 12-weeks and adherence to the HIIT program was 96%. Compared to UC, HIIT significantly reduced total PCa-specific anxiety (adjusted between-group mean difference, -2.7; 95% confidence interval[CI], -5.0 to -0.4; p = 0.024; d = 0.28) and fear of recurrence (adjusted between-group mean difference, -2.0; 95% CI, -3.5 to -0.4; p = 0.013; d = 0.67) in MAX-PC; hormonal dysfunction (p = 0.005) in EPIC-26; and perceived stress (p = 0.037), fatigue (p = 0.029), and self-esteem (p = 0.007). CONCLUSIONS: A 12-week supervised HIIT program reduced PCa-specific anxiety, fear of cancer progression, hormone symptoms, stress, and fatigue, and increased self-esteem in men with PCa on active surveillance. Larger trials are warranted to determine the longer-term effects of exercise on patient-reported outcomes and whether such effects influence willingness to continue on active surveillance.

A randomised controlled trial comparing internet-delivered cognitive behavioural therapy (iCBT) with and without main carer access versus treatment-as-usual for depression and anxiety among breast cancer survivors: Study protocol

BackgroundDepression and anxiety are common problems among breast cancer survivors. Carer support is one of the most important determinants of women's psychological wellbeing. Survivors' distress can be alleviated by giving carers access to survivors' evidence-based treatment, which will help carers understand what survivors have been going through and help survivors feel more supported. Given the limited access to evidence-based treatments, an adapted internet-delivered cognitive behavioural therapy (iCBT) intervention for breast cancer survivors, but also open for carers' access, has the potential to decrease survivors' depression and anxiety symptoms and improve cancer-related communication and relationship quality between survivors and carers. ObjectivesThis study evaluates (1) the effectiveness of a guided iCBT intervention for depression and/or anxiety symptoms among breast cancer survivors with and without main carer access, and (2) the acceptability and satisfaction with the iCBT programme. MethodIn this pilot study comparing the effectiveness of an adapted 7-week iCBT without main carer access against the iCBT with main carer access and treatment-as-usual control, 108 breast cancer survivors will be recruited and then randomised to either (1) treatment (n = 72) or (2) treatment-as-usual control group (n = 36) with a 2:1 ratio. The participants in the treatment group will be assigned to either iCBT alone or iCBT with the main carer also having access to the same content based on their preference. The primary outcome measure is the Hospital Anxiety and Depression Scale, and alongside secondary measures such as Cancer-Related Quality of Life, Breast Cancer Worry Scale, Brief COPE, and Medical Outcomes Study Social Support Survey will be completed by the survivors at baseline, post-treatment, and 2-month follow-up. Survivors who have carers will also complete Survivor-Carer Cancer Communication and Relationship Quality measures to provide insights into the effects of carer access. To assess the acceptability and satisfaction with the programme, survivors and their main carers will fill out the Helpful Aspects of Therapy Form (HAT) and Satisfaction with Online Treatment (SAT). Programme effectiveness and the effects of carer access on primary and secondary outcome measures will be evaluated on intention-to-treat and per-protocol basis using Linear-Mixed-Models. DiscussionThis is the first trial comparing the effectiveness and acceptability of iCBT with and without carer access for depression and anxiety among breast cancer survivors. The findings of this study will provide novel data on the acceptability of iCBT programmes for breast cancer survivors and the impact of carer access on them and their carers.

A study protocol for HEalth-Related quality of life-intervention in survivors of Breast and other cancers experiencing cancer-related fatigue using TraditionAL Chinese Medicine: the HERBAL trial

BackgroundCancer-related fatigue (CRF) is a debilitating condition which commonly affects cancer survivors. The management of CRF remains a challenge due to the lack of effective pharmacological interventions. Traditional Chinese medicine (TCM) could be a potential therapeutic option for CRF. The modified Xiang Bei Yang Rong Tang (XBYRT) is a TCM herbal decoction, formulated to improve fatigue symptoms in cancer survivors. This clinical trial aims to evaluate the efficacy and safety of XBYRT in improving CRF and quality of life (QOL) of cancer survivors.MethodsThis is a single centre, randomized, double-blind, placebo-controlled, parallel trial. Eighty cancer survivors will be recruited and randomized to receive the XBYRT or placebo decoction, in a ratio of 1:1. Participants will consume the XBYRT/placebo decoction daily for 8 weeks and undergo assessments at baseline and 4, 8 and 10 weeks after baseline. The participants will be assessed for patient-reported outcomes (PRO), blood biomarkers and adverse events at each time point. The primary outcome is the overall health and QOL status, at 8 weeks follow-up. The secondary outcomes are the effects of XBYRT on fatigue levels, cancer-related cognitive impairment and QOL, as assessed by PRO. The incidence of adverse events and the effects of the XBYRT decoction on blood biomarkers associated with CRF will also be evaluated.DiscussionEfficacy and safety outcomes from this trial will provide important clinical data to guide future large-scale randomized controlled trials, and the evaluation of the objective blood biomarkers can help to delineate the biological mechanisms of CRF.Trial registration numberClinicalTrials.govNCT04104113. Registered on 26 September 2019

Patient characteristics associated with sleep disturbance in breast cancer survivors.

Disturbed sleep is common among breast cancer survivors. Identifying patients at risk for disturbed sleep and its sequelae will aid in improving screening and intervention strategies to improve sleep and cancer-related quality of life (QOL). Women with stages I-III breast cancer undergoing neoadjuvant or adjuvant chemotherapy (N = 415) reported subjectively assessed sleep quality (PSQI) and actigraphy-assessed wake after sleep onset (AAS-WASO), total sleep time (AAS-TST), and sleep efficiency (AAS-SE), sociodemographic, and clinical characteristics and completed questionnaires assessing physical and mental health QOL at study entry and 3, 6, 12, and 15 months later. Being from a racially/ethnically underserved population was associated with poorer sleep in all indices (p's < .04). Lower income was associated with poorer subjective sleep and greater AAS-WASO (p's < .02). BMI was associated with lower AAS-SE (p < .001). Baseline subjective sleep complaints were positively associated with depression, fatigue, and health-related QOL and cancer-related symptoms across follow-up (p's < 0.05). Baseline AAS-WASO was positively associated with anxiety and negatively associated with physical health-related QOL at the 3-month follow-up (p's < .001). Baseline AAS-WASO and AAS-SE were associated with mental health-related QOL at the 6-month follow-up (p's < .05). In keeping with previous health disparity research, racially/ethnically underserved populations, lower household income, and higher BMI were associated with increased risk for disturbed sleep. Sleep disturbance may have long-term effects on multiple aspects of QOL for women undergoing treatment for breast cancer. Results may inform strategies to identify patients at greatest risk for disturbed sleep and its sequelae.

WeChat app-based reinforced education improves the quality of opioid titration treatment of cancer-related pain in outpatients: a randomized control study

BackgroundAs inadequate pain communication contributes to difficulties in optimizing outcomes of outpatients, we investigated the effect of reinforced education using WeChat App to the opioid titration treatment of cancer-related pain in the outpatient setting.MethodsWe conducted a prospective study to compare reinforced education using Wechat with care as usual from February to December 2019. Patients in the reinforced education group received reinforced education via Wechat, while those in the control group received care as usual. Effect measurements for both groups are carried out with questionnaires at the baseline and 3 days later. Questionnaires include pain intensity (NRS), treatment-related adverse events, cancer-related quality of life (QOL), sleep (PSQI), satisfaction, anxiety (GAD-7) and depression (PHQ-9). Number of patients whose NRS reduced to less than three points in 24 h was the primary outcomes. Secondary outcomes included treatment-related adverse events, cancer-related quality of life, sleep, satisfaction, anxiety and depression.ResultsAlthough there was no significant difference regarding pain intensity (NRS) between the two groups at 72 h, the rate of NRS that reduced to less than three points in 24 h was significantly higher in the Wechat group than in the control group. Patients’ satisfaction was significantly higher in the Wechat group than in the control group. There was no significant difference between the two groups regarding the other findings at 72 h, including pain intensity (NRS), cancer-related quality of life (QOL), anxiety (GAD-7), depression (PHQ-9), and sleep (PSQI). However, no significant difference was found between the two groups for constipation, nausea, vomiting, dizziness, somnolence, pruritus, loss of consciousness, and death.ConclusionsOur results indicated that receiving instructions delivered by Wechat resulted an increased number of patients with good pain control and better satisfaction. The study provided insight into the effectiveness of the reinforced education using a Wechat app delivered by a doctor to outpatients in the titration treatment of cancer-related pain.Trial registrationThis study was registered at chictr.org (Registration number: ChiCTR1900021150, Date of Registration: January 30, 2019).

Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT.

Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments. To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50-69 years. A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up. Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK. Between 2001 and 2009, 228,966 men aged 50-69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring (n = 545), radical prostatectomy (n = 553) or radical radiotherapy (n = 545) and 997 chose a treatment. The interventions were active monitoring, radical prostatectomy and radical radiotherapy. Definite or probable disease-specific mortality at the 10-year median follow-up in randomised participants. Overall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes. There were no statistically significant differences between the groups for 17 prostate cancer-specific (p = 0.48) and 169 all-cause (p = 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring, n = 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy, n = 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy, n = 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years; p = 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring (n = 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy (n = 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy (n = 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years; p < 0.001). Radical prostatectomy had the greatest impact on sexual function/urinary continence and remained worse than radical radiotherapy and active monitoring. Radical radiotherapy's impact on sexual function was greatest at 6 months, but recovered somewhat in the majority of participants. Sexual and urinary function gradually declined in the active monitoring group. Bowel function was worse with radical radiotherapy at 6 months, but it recovered with the exception of bloody stools. Urinary voiding and nocturia worsened in the radical radiotherapy group at 6 months but recovered. Condition-specific quality-of-life effects mirrored functional changes. No differences in anxiety/depression or generic or cancer-related quality of life were found. At the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year, the probabilities that each arm was the most cost-effective option were 58% (radical radiotherapy), 32% (active monitoring) and 10% (radical prostatectomy). A single prostate-specific antigen test and transrectal ultrasound biopsies were used. There were very few non-white men in the trial. The majority of men had low- and intermediate-risk disease. Longer follow-up is needed. At a median follow-up point of 10 years, prostate cancer-specific mortality was low, irrespective of the assigned treatment. Radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with side effects. Further work is needed to follow up participants at a median of 15 years. Current Controlled Trials ISRCTN20141297. This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 37. See the National Institute for Health Research Journals Library website for further project information.

Ffects Of Taichi-qigong Exercise On Mental Health Of Nasopharyngeal Carcinoma Survivors

The incidence of nasopharyngeal carcinoma (NPC) is high in endemic areas. The long-term chemotherapy and radiotherapy cause bodily dysfunction and extended psychological stress in NPC cancer survivors. The meditative exercise, especially Taichi-Qigong exercise (TQE), are getting more common and continues to grow among cancer survivors. Empirical evidence found positive effects in improving side effects induced by cancer therapy from practicing TQE, however, scientific evidence is still lacking. PURPOSE: to evaluate the effects of a 10-weeks TQE, as an non-pharmacological treatment, on mental health of NPC survivors. METHODS: 43 NPC survivors (age 32-79 yrs-old; men 45.5%) recruited from the Cancer Patient Resource Centers of a local hospital, were randomly assigned into either a TQE (n=23) or a control group (n=20). The TQE group practiced TQE for at least 3 times a week (one 60-min instructor-led session and two 30-min self-practice sessions) for 10 weeks, whereas control group maintained usual care. Both TQE and control groups received health & diet education once a month. The pre- and post- outcome measures included: questionnaires on cancer-related quality of life (FACT-G), cancer-related fatigue (Brief Fatigue Inventory; BFI), depression (Center for Epidemiologic Studies Depression Scale; CES-D) and sleep quality (Pittsburgh Sleep Quality Index; PSQ). Same measures were obtained 3-months after the intervention (maintenance tests). RESULTS: Two-way (group x pre-post) repeated measure ANCOVA with age, gender, and body mass index (BMI) as covariates, found TQE exhibited significant better overall quality of Life (FACT-G) (p≤ .05), and emotional sub-scale of FACT (p< .10). The benefits did not change at maintenance (p> .05). The TQE group also demonstrated improved PSQ after intervention (p< .10). There were no group difference in BFI and CES-D. (p > .05) CONCLUSIONS: The present study provides preliminary findings to suggest that, Taichi-Qigong exercise, as a typical mind-body exercise, may contribute to better quality of life, emotion, and sleep quality during the course of NPC rehabilitation. Further study with longer intervention is needed to examine the effects of TQE on other mental health outcomes of cancer survivors such as fatigue and depression, as well as physical health outcomes.

Abstract A063: Social context and cancer: Stress and quality of life in rural-dwelling Latina cancer survivors

Abstract Introduction: Latina breast and gynecologic cancer survivors (LCS) experience higher levels of distress and lower quality of life compared to non-Latinos. This randomized control trial examined the effect of a promotora-led 10-week Spanish language support program on levels of stress and cancer-related quality of life (QOL) in LCS. Methods: Fifty-nine LCS were randomized to receive the 10-week intervention (n=30) or to a delayed-intervention control (n=29) group. Measures were assessed at baseline (T1) and upon completion of the intervention period (T2) and included the: short Hispanic Stress Inventory (HSI) [subscales: extra-familial and intra-familial stress]-version 2, the Functional Assessment of Cancer Therapy (FACT-G) QOL scale [subscales: physical (P-QOL), functional (F-QOL), emotional (E-QOL), social (S-QOL)], the FACT-Fatigue QOL scale, and a demographic survey. RESULTS: No statistically significant differences were observed between the intervention and control groups for any of the outcome variables. Perceived stress scale [t(57)=0. 37, p=0. 72], Hispanic Stress Inventory extrafamilial subroup [t(57)=1. 8, p=0. 09], and Hispanic Stress Inventory intrafamilial subgroups [t(57)=1. 5, p=0. 18]. Results for quality of life subscales were physical [t(57)=-1. 66, p=0. 10], social [t(47)=-0. 32, p=0. 75], emotional [t(57)=-0. 41, p=0. 97], and functional [t(57)=1. 38, p=0. 17] well-being. Exploratory analyses a mediating effect of extrafamilial stress on a significant relationship between Spanish-only language and lower EQOL. Conclusions: The effect of the promotora-led intervention was not significant. However, an exploratory mediation analyses identified a significant role of extrafamilial (ethnic-based) stress among Spanish-only speakers with EQOL. A detailed presentation of study findings, including a critique of the intervention design and implications for the effect of social context on cancer-related outcomes will be discussed. Citation Format: Rachel M Ceballos, Genoveva Ibarra, Monica Escareno, Nora Gonzalez, Nathan Marchello. Social context and cancer: Stress and quality of life in rural-dwelling Latina cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A063.

Abstract P2-13-18: Catalyzing navigation for breast cancer survivors (CaNBCS)

Abstract Background; Survivorship care plans (SCPs) are personalized documents, provided at the end of the treatment by patients’ oncology clinicians that summarize the diagnosis and treatment, late and long-term adverse effects, ongoing surveillance for recurrence, screening for new cancers, and health maintenance of cancer survivors. Considered as a tool for cancer survivors, experts in cancer survivorship and accrediting organizations such as Commission on Cancer (CoC) have endorsed the use of SCPs even in the absence of firm evidence of their efficacy. Safety net hospitals are at the forefront of providing care for vulnerable low-income cancer survivors who may also have low educational attainment, low health literacy, and limited English proficiency. Cancer survivors who are racial and ethnic minorities and low income may experience higher symptom burden and limitation of function. Prior work has shown that patients who in safety net health setting, do not benefit from SCPs and only 25% share them with their primary care providers. Methods This study is a pilot randomized clinical trial to assess the role of patient navigation in cancer survivors. Breast cancer survivors were randomized to SCPs with or without patient navigation. In the intervention, arm navigators discussed the survivorship care planning and issues with patients at the time of delivery, 6 weeks by phone, at 3 months and then at 6 months. The primary outcome was breast cancer-related quality of life (QOL) was assessed by FACT B questionnaire. The secondary outcome was self-efficacy. In addition, we conducted focus groups for cancer survivors, patient navigators, and oncology providers to understand their perspective. Cancer survivors who had completed the treatment for breast cancer within 1-5 years were eligible to participate in the study. Participants spoke English(N=20), Chinese (n =10) or Spanish (n=10). Results: There were 20 participants in each arm, 10 English speaking and 5 each Spanish and Chinese speaking. At 6 months and final follow up, 32 patients were available for analysis. One patient developed metastatic cancer, two patients had changes in their insurance status and five were not available for final analysis. We performed Wilcoxon non-parametric analysis to assess changes in all five domains of FACT B. There were trends towards improvement in the change in emotional well-being score, functional well-being score and overall QOL in the intervention arm, but it was not statistically significant. Physical well-being score change was similar. There was no difference in the mean self-efficacy scores for both arms. At baseline, 57.7% breast cancer survivors reported being not all/a little bit satisfied with their sex life and 53.9% reported not all/a little bit feeling sexually attractive. 87.5 % of survivors reported having accepted their illness quite a bit/ very much. Conclusions Our study successfully recruited patient from a diverse patient population in safety net settings. Patient navigation combined with survivorship care showed encouraging trends in improvement in emotional well-being, physical well-being, and QOL, although it was not statistically significant. There was no difference in mean self-efficacy score. We are currently analyzing the qualitative data to assess the implementation of the intervention. Citation Format: Niharika Dixit, Barbara Cicerelli, Roy Cherian, Nancy Burke. Catalyzing navigation for breast cancer survivors (CaNBCS) [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 P2-13-18.

Quality of life in pediatric oncology patients, caregivers and siblings after psychosocial screening: a randomized controlled trial.

We evaluated whether conducting psychosocial screening using a validated measure (the Psychosocial Assessment Tool, PAT) and providing a summary of PAT results to the patient's treating team improves quality of life (QOL) in newly diagnosed patients with cancer, their caregivers and siblings, in general, and in relation to the initial family psychosocial risk. Families were randomly allocated to an intervention (IG, treating team received PAT summary describing low, medium, or high psychosocial risk) or control group (CG, no summary provided to treating team) in two Canadian pediatric cancer centers. Caregivers (N = 122) of children newly diagnosed with cancer, patients (n = 36), and siblings (n = 25) completed QOL assessments at 2-4 weeks (T1) and 6 months post-diagnosis (T2). Caregivers also completed PAT and proxy QOL for patient and sibling. In general, patient-proxy total QOL improved in IG compared to CG over time but only for high psychosocial risk patients (p < .05). Patient proxy cancer-related QOL improved over time regardless of group allocation; caregiver QOL also improved over time (ps < .05). This study demonstrated the benefits of psychosocial screening results only on proxy patient QOL outcomes with high psychosocial risk near diagnosis. Evaluating QOL benefits in pediatric oncology patients is critical for establishing the clinical value of psychosocial screening. NCT02788604 (REGISTERED WITH HTTPS://CLINICALTRIALS.GOV/CT2/SHOW/NCT02788604 ).

Effect of exercise during adjuvant chemotherapy for breast cancer.

6524 Background: In 2018, an estimated 266,120 women faced the challenge of living with breast cancer and approximately 40,920 died from their disease. Nearly 100% of these women experienced significant treatment related side effects that negatively impact quality of life (QOL). Exercise has repeatedly demonstrated to alleviate many of the side effects, improve QOL, and decrease cancer recurrence and mortality. In spite of this evidence, women do not maintain exercise during treatment for breast cancer. The purpose of this randomized controlled trial was to determine the effectiveness of exercising the day chemotherapy is administered on 1) the persistence with an exercise program, 2) side effects, and 3) QOL. Methods: Eligible women were randomly assigned to a control or experimental group. As part of their treatment plan, all participants were referred to one of 14 community-based exercise centers to exercise. Experimental group also exercised at one of two cancer centers each day chemotherapy was administered. Outcome measures include exercise retention and chemotherapy, completion; cancer-related fatigue, nausea/vomiting, peripheral neuropathy, weight gain, and QOL. Outcome measures were assessed prior to every second course of chemotherapy and 3- and 6-months post-chemotherapy. Results: 273 women with Stage I-III breast cancer receiving chemotherapy were enrolled in the study. The number of participants who withdrew from exercise was higher among those in the control group (n= 16; 12.4%) compared with those in the experimental group (n = 10; 6.9%). At cycle 5, those in the experimental group reported less motor peripheral neuropathy than those in the control group (p = .018) and higher physical well-being scores than those in the control group (p = .047). Conclusions: The highest impact of the intervention was on attrition from exercise. Since participants in both the control and experimental groups exercised throughout chemotherapy, it is not surprising that the groups performed comparably with regard to side effects and QOL. Given the positive effects exercise has demonstrated on persons receiving cancer treatment in numerous studies, having patients exercise in the cancer center on the day of chemotherapy is a significant step toward engaging persons receiving chemotherapy in an exercise program.

Differences in quality of life and emotional health by diagnosis among women with early-stage gynecological cancers.

e23180 Background: Psychosocial outcomes have been described in women with gynecological cancers, but potential differences by diagnosis have received less attention. We sought to compare quality of life (QOL) and emotional health among early stage gynecological cancer survivors by disease location. Methods: We present baseline data from an ongoing cohort study of gynecological cancer patients treated at an academic cancer center. Measures include cancer-related QOL, emotional health and negative (post-traumatic stress disorder-PTSD) and positive (post-traumatic growth-PTG) reactions to cancer. Univariate and multivariate linear regression models (restricted to stage I or II; excluding vaginal/vulvar) explored differences in QOL and emotional health by diagnosis. Potential confounders considered for inclusion in the final models were age, stage, education, income, partner status, treatment status, and race. Results: 222 patients with early stage disease completed the survey: 56 (25.2%) ovarian, 122 (55.5) endometrial, 33 cervical (14.9%), and 11 (5%) vaginal/vulvar cancer. Cervical and vaginal/vulvar cancer patients reported greater cancer-related distress, anxiety and PTSD scores (Table). Endometrial cancer patients reported lowest PTG scores. Conclusions: Our analyses suggest early stage gynecological cancer patients face different psychosocial sequelae based on diagnosis, with worse outcomes generally being associated with younger age. Further research is needed to assess low PTG among endometrial cancer patients, since PTG is considered a potentially beneficial psychosocial outcome of cancer. [Table: see text]

Prostate cancer-related quality of life and risk for anxiety and depression.

41 Background: Due to side effects of invasive treatments, prostate cancer (PC) patients face long-term quality of life (QoL) concerns and enduring psychosocial distress. We explored how QoL is linked to distress among a national sample of men with PC. Methods: 214 men with PC enrolled in the Cancer Support Community’s Cancer Experience Registry. Participants provided demographic/clinical background and completed the Prostate Cancer-Related QoL Scales, covering 6 QoL domains ( urinary control, sexual intimacy, sexual confidence, masculine self-esteem, cancer control, and treatment regret). Psychosocial distress was captured by CancerSupportSource, a 25-item tool with 2-item depression and anxiety screening subscales. Scores ≥3 indicate risk for clinically significant depression or anxiety respectively, and signal need for referral and further assessment. We examined bivariate correlations between demographic/clinical background, QoL, and prevalence of ‘risk for clinically significant anxiety and depression’, and used logistic regression to calculate odds of anxiety and depression risk by QoL, adjusting for demographic/clinical variables. Results: Participants were 93% White; mean ( SD) age=64 (12) years; mean ( SD) years since diagnosis=4.3 (4.9); 25% had metastatic disease. 54% underwent radiation; 55% surgery. 40% were at risk for clinically significant anxiety; 35% depression. Poorer QoL scores for sexual intimacy, sexual confidence, masculine self-esteem, cancer control, and treatment regret were bivariately associated with anxiety ( p&lt;.05) and depression ( p&lt;.001) risk. In logistic regression, poorer perceived cancer control predicted anxiety risk (R2=.44; OR=0.97; p&lt;.01). Lower masculine self-esteem predicted depression risk (R2=.68; OR=0.88; p&lt;.05). Conclusions: Questioning treatment efficacy and worrying about disease progression (i.e., lower perceived cancer control) predicts greater likelihood of anxiety risk. Lower masculine self-esteem predicts odds of depression risk. These findings elucidate the ways that PC patients’ perceptions of advancing disease and diminishing masculinity are linked to distress, thus identifying areas for psycho-educational and supportive interventions.

Promoting Physical and Psychological Rehabilitation Activities and Evaluating Potential Links Among Cancer-Related Fatigue, Fear of Recurrence, Quality of Life, and Physiological Indicators in Cancer Survivors.

Objectives: Cancer-related fatigue and fear of recurrence (FOR) are the most common symptoms in cancer survivors and severely affect quality of life (QOL). This study aims to promote and evaluate the effectiveness of physical and psychological rehabilitation activities for cancer survivors. Methods: A longitudinal study with an interventional research design was conducted. A total of 80 participants were randomly assigned to experimental groups E1 (Qigong exercise [QE]) or E2 (stress management [SM]) or the control group. The E1 and E2 groups received QE and SM, respectively, as interventions once a week for 12 weeks, and effects were assessed. Cancer-related fatigue, FOR, QOL, and heart rate variability (HRV) were evaluated at baseline (T0), after 12 weeks (T1), and at the 3-month follow-up (T2). Results: QE and SM effectively strengthened the physical and psychological functions of cancer survivors at the T1 phase. Although differences in FOR and QOL were not statistically significant, the scores were decreased and increased, respectively. Although the effects during the T2 phase were not as significant as those during T1, the score progress was maintained. The effects on HRV were significantly different among the E1, E2, and control groups at T1, which shows that the performance of both experimental groups was better than that of the control group. Conclusions: Physical and psychological rehabilitation activities should be practiced periodically and should be led by professional staff. Long-term educational resources and care should also be provided. HRV can be used to efficiently monitor the status of the mind-body balance and is a more suitable index than questionnaires for physical and psychological function evaluation in cancer survivors.

Abstract C43: Health changes in low-income men transitioning from prostate cancer coverage to comprehensive insurance

Abstract Introduction: The Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT) program was established in 2001 to provide free prostate cancer treatment and care navigation services for uninsured, low-income men in California. Prior work has highlighted the value of IMPACT's services on improving care coordination and mental well-being of enrolled men, as well as facilitating self-efficacy. The shift from IMPACT to comprehensive health insurance under the Patient Protection and Affordable Care Act (ACA) presented an opportunity to study the effects of the transition from a high-touch, disease-focused program to less-individualized but broader coverage. We hypothesized that health-related quality of life (QOL) would decline in men transitioning from IMPACT to comprehensive insurance relative to a group of men who remained in IMPACT. Methods: Concurrent with IMPACT enrollment, men were invited to participate in a longitudinal study of general and prostate cancer-related QOL. Using this data, we compared QOL between men who transitioned from IMPACT to full-scope insurance (n=24, intervention) and those who remained in IMPACT (n=39, control). We used the RAND 12-item short form health survey (SF-12 v2) and UCLA Prostate Cancer Index (PCI) to measure general and prostate cancer-related QOL, respectively. The SF-12 v2 includes a mental composite score, a physical composite score, and a measure of general health, each normalized to the general population. The PCI quantifies function and bother related to urinary, sexual, and bowel habits. Data were collected at baseline (6-16 months before exiting IMPACT), transition (4 months before, to 1 month after exit), and post-transition (10-13 months after exit). Mixed-effects models, controlling for type of and time from definitive treatment (surgery or radiation within 12 months), were used to compare measures between the two groups. Results: Mental, physical, and general health did not differ between the control and intervention groups at baseline. Men who left IMPACT had significantly worse physical health compared to controls at the post-transition time point (p=0.0049). In the mixed-effects model, physical health differed significantly between groups (p=0.0071). Mental health did not. Between the transition and post-transition time points, general health improved significantly in men who left IMPACT (p=0.024), though we found no difference between groups. Prostate cancer-related QOL did not differ over time between the control and intervention groups. Active treatment within one year from the time of data collection was associated with worse sexual bother (p=0.02); otherwise, there were no differences in prostate cancer-related QOL related to receipt of active treatment within one year from time of data collection. Conclusion: Disadvantaged men leaving a prostate-cancer treatment and navigation program for comprehensive insurance under the ACA reported worse physical health after the transition, relative to men staying in the program. Mental well-being and prostate cancer-specific QOL tracked similarly between the groups. Further investigation of the mechanisms underlying the decline in physical health after transitioning from IMPACT to full-scope insurance may provide policy makers with actionable information for newly insured vulnerable populations. Citation Format: Ruby Kuang, Jamal Nabhani, Hui Liu, Lorna Kwan, Mark S. Litwin. Health changes in low-income men transitioning from prostate cancer coverage to comprehensive insurance [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C43.

Survivorship care plans in safety net: Bridging the barriers.

68 Background: Survivorship care plans (SCPs) are considered an important tool in survivorship care. SCP should include treatment summaries and follow up care plans and are intended to improve survivorship care. Despite the institute of medicine (IOM) recommendation regarding SCPs, the uptake has been low in community cancer centers. The safety net hospitals face additional challenges to SCPs including patient who may have low health literacy and limited English proficiency. In addition, resources and personnel constraints can be important barriers for implementation of SCPs. Methods: Zuckerberg San Francisco General Hospital is a safety net hospital in the City and County of San Francisco. We created SCPs for breast cancer survivors, as it is our largest group of cancer survivors. Patients, who were within 5 years of completion of treatment with curative intent for breast cancer were candidates for receiving SCPs. We used ASCO survivorship template to create a survivorship care plan. ASCO breast cancer SCP was discussed in the focus groups and modified to match the needs of our patients. SCP committee and patient advisory board evaluated the SCP prior to a pilot of the SCPs in the clinic. We piloted the SCPs initially in English and Spanish to assess feedback from clinic providers. After requested modifications SCP was then translated in to simplified Chinese. The SCP delivery was embedded in the clinic flow and was done at time of routine clinic visit to reduce the burden of additional visits. Results: 104/175 eligible patients have already received the SCP over one year period. All providers in the clinic participated in delivery of SCPs. Conclusions: SCP in multiple languages can be implemented successfully in safety net setting in a patient population with low health literacy and limited English proficiency. Availability in multiple languages, provider buy–in and embedding SCPs in clinic flow appears to be important factors in implementation. We are evaluating the optimal process of SCP delivery with an ongoing randomized pilot study of SCPs with and without navigation with breast cancer related quality of life and self-efficacy measures. We are also evaluating the usefulness of SCPs in meeting the informational needs of primary care providers.

Health Changes in Low Income Men Transitioning from a State Funded Prostate Cancer Program to Comprehensive Insurance

We evaluated the effect of transitioning from a prostate cancer specific treatment program to comprehensive insurance under the ACA (Patient Protection and Affordable Care Act) on the physical, mental and prostate cancer related health of poor, previously uninsured men. We assessed general and prostate cancer specific health related quality of life using the RAND SF-12v2™ (12-Item Short Form Survey, version 2) and the UCLA PCI (Prostate Cancer Index) at 3 time points in 24 men who transitioned to comprehensive insurance as the insured group relative to 39 who remained in the prostate cancer program as the control group. We used mixed effects models controlling for treatment and patient factors to measure health differences between the groups during the transition period. Demographics, prostate cancer treatment patterns, and mental, physical and general health were similar before transition in the control and insured groups. After transition men who gained insurance coverage reported significantly worse physical health than men who remained in the prostate cancer program (p = 0.0038). After adjustment in the mixed effects model physical health remained worse in men who gained insurance (p = 0.0036). Mental health and prostate cancer related quality of life did not differ with time between the groups. Compared to controls who remained in the state funded prostate cancer treatment program for poor, uninsured men, newly insured men reported worse physical health after transitioning to ACA coverage. Providers and policy makers may draw important lessons from understanding the mechanisms of this paradoxical worsening in physical health after gaining insurance. These results inform the development of disease specific models of care in the broader health insurance context.

Disparities in women\u2019s cancer-related quality of life by Southern Appalachian residence

PurposeThe purpose was to determine whether Appalachian residence alone or in combination with violence was linked to poorer quality of life (QOL).MethodsWomen recently diagnosed and included in either the Kentucky or North Carolina Cancer Registries were interviewed by phone between 2009 and 2015 (n = 3320; mean age = 56.74). Response rates were similar by state (40.1 in Kentucky and 40.9% in North Carolina). Appalachian (N = 990) versus non-Appalachian residents (N = 2330) were hypothesized to have poorer QOL defined as (a) lower Functional Assessment of Cancer Therapy—General (FACT-G) scores and (b) more symptoms of depression, stress, or comorbid physical conditions. Lifetime intimate partner or sexual violence was first investigated as a moderator then mediator of regional differences. Multiple analyses of covariance (MANCOVA) models were used.ResultsViolence modified the effect of Appalachian residence on poorer QOL outcomes; FACT-G total scores (p = .02) were lowest for women living in Appalachia who had additionally experienced violence. Socioeconomic indicators appeared to mediate or explain differences in QOL outcomes by Appalachian residence such that when adjusting for income, education and insurance, Appalachian residence remained associated only with poorer physical QOL outcomes (p < .05).ConclusionsWhile violence rates did not differ by residence, the combined effect of living in Appalachia and experiencing violence resulted in significantly greater impact on poorer QOL among women recently diagnosed with cancer. Clinical consideration of patients’ residence, socioeconomic status and violence experienced may help identify and mitigate the longer-term impact of these identifiable factors associated with poorer QOL.

Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis.

This study aims to summarize and critically evaluate the effects of Tai Chi and Qigong (TCQ) mind-body exercises on symptoms and quality of life (QOL) in cancer survivors. A systematic search in four electronic databases targeted randomized and non-randomized clinical studies evaluating TCQ for fatigue, sleep difficulty, depression, pain, and QOL in cancer patients, published through August 2016. Meta-analysis was used to estimate effect sizes (ES, Hedges' g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed. Our search identified 22 studies, including 15 RCTs that evaluated 1283 participants in total, 75% women. RCTs evaluated breast (n = 7), prostate (n = 2), lymphoma (n = 1), lung (n = 1), or combined (n = 4) cancers. RCT comparison groups included active intervention (n = 7), usual care (n = 5), or both (n = 3). Duration of TCQ training ranged from 3 to 12weeks. Methodological bias was low in 12 studies and high in 3 studies. TCQ was associated with significant improvement in fatigue (ES = - 0.53, p < 0.001), sleep difficulty (ES = - 0.49, p = 0.018), depression (ES = - 0.27, p = 0.001), and overall QOL (ES = 0.33, p = 0.004); a statistically non-significant trend was observed for pain (ES = - 0.38, p = 0.136). Random effects models were used for meta-analysis based on Q test and I 2 criteria. Funnel plots suggest some degree of publication bias. Findings in non-randomized studies largely paralleled meta-analysis results. Larger and methodologically sound trials with longer follow-up periods and appropriate comparison groups are needed before definitive conclusions can be drawn, and cancer- and symptom-specific recommendations can be made. TCQ shows promise in addressing cancer-related symptoms and QOL in cancer survivors.

Palliative versus nonpalliative patients’ perceptions of the effect of alcohol consumption on clinical outcomes.

199 Background: Little is known about the perceptions of palliative patients on the impact of continued alcohol consumption after a cancer diagnosis and whether they are similar to the perceptions of patients who are considered potentially curative. Methods: Patients with diverse cancer subtypes were surveyed at a comprehensive cancer centre, cross-sectionally. Specifically, palliative and non-palliative cancer patients were asked about their perceptions on the benefits/harms of continued drinking on cancer-related quality of life, fatigue, and overall survival, and whether they had received information on their alcohol consumption from their health care providers. Palliative status was established by chart review. Results: Of 1049 patients, 48% were male, with median age of 58 (18-98) years; cancer sites included gastrointestinal, genitourinary, breast, thoracic, hematologic, and others; 16% were classified as being palliative at the time of survey; and 14% reported receiving counselling information on alcohol use sometime after their cancer diagnosis. Compared to curative patients, palliative patients were more likely to perceive continued alcohol consumption as harmful to their fatigue (OR=1.39, P=0.05) and survival (OR=1.45, P=0.03), but less so on quality of life (OR=1.16, P=0.35). When compared to those who had not been counselled, informed patients were twice as likely (OR=2.01, P&lt;0.01) to perceive continued drinking as harmful to their levels of fatigue, although there was less of a difference in their perception of quality of life (OR =1.39, P=0.20) and survival (OR=1.40, P=0.19). Conclusions: Palliative patients are more likely to perceive continued alcohol consumption as harmful to their fatigue and overall survival, when compared to non-palliative patients, especially after receiving counselling. Given the lack of data on the benefits or harm of mild-moderate alcohol use and a strong emphasis on quality of life, future research should focus on effects of alcohol in palliative patients, and there should be improved education to both providers and patients on regarding the current lack of information.