Cancer Survivorship Program Research Articles

MP19-03 COMPARISON OF FACT-G SCORES WITH CANCER AND GENERAL POPULATION NORMS IN CANADIAN PATIENTS UNDERGOING RADICAL CYSTECTOMY

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP19)1 Sep 2021MP19-03 COMPARISON OF FACT-G SCORES WITH CANCER AND GENERAL POPULATION NORMS IN CANADIAN PATIENTS UNDERGOING RADICAL CYSTECTOMY Julie Trudel, Ryan McLarty, and Conrad Maciejewski Julie TrudelJulie Trudel More articles by this author , Ryan McLartyRyan McLarty More articles by this author , and Conrad MaciejewskiConrad Maciejewski More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002004.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Functional Assessment of Cancer Therapy-General (FACT-G) is often used as a generic measure in Health-Related Quality of Life (HRQOL) assessment among cancer patients. Its reference values relating to the general population and patients with different diseases are useful for the interpretation of HRQOL scores and allow a better understanding of the patients needs and HRQOL. No study to date has yet compared FACT-G normative data scores to those of Canadian patients undergoing radical cystectomy (RC) for bladder cancer. The objective of this study was to compare our patients pre-cystectomy FACT-G scores with US cancer and general population norms. METHODS: Patients were recruited from the Diana Wood Cancer Survivorship Clinic at The Ottawa Hospital between January 2019 and August 2020. HRQOL was evaluated by the FACT-G and raw scores were obtained for each FACT-G subscale, higher scores indicating better HRQOL. Effect sizes (ES-Hedge's g statistics), confidence intervals and minimal clinical significant differences (MCIDs) were used to compare pre FACT-G subscale scores with normative data. As suggested by current literature, a change of at least 5% to 10% within the instrument range was used as an estimate calculation of the MCID. RESULTS: 55 patients completed the FACT-G questionnaire before RC. The mean age was 67 years (SD: 10 years), 71% were male, 80% were in a married/common law partnership and 84% lived with someone. Overall, ES between pre-surgery FACT-G subscale scores and US cancer norms were small (ES≤0.2) and the MCIDs were less than 5% of change in the FACT-G measurement scale except for the dimension “Physical Well-Being” (ES=0.3, reported MCID value of 1.77, 6% of change). ES calculated between FACT-G scores and those from the US general population showed small effect sizes (ES≤0.2) for all FACT-G subscales except for the dimensions “Emotional Well-Being” (Medium ES=-0.56, reported MCID value of 2.7, 11% of change) and “Social Well-Being” (Medium ES=0.37, reported MCID value of 2.5, 9% of change). CONCLUSIONS: In our survivorship clinic, patients undergoing RC reported broadly similar FACT-G scores to US cancer population norms, with a notable exception of increased perceived “Physical Well-Being”. When comparing our data to US population norms, we once again showed similar scores on FACT-G subscales with the exception of decreased “Emotional Well-Being” and higher “Social Well-Being”. These results emphasize unique aspects of the bladder cancer survivorship experience, and highlight the value of patient reported assessment of HRQOL in RC patients. Source of Funding: The Diana Wood Bladder Cancer Survivorship Program © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e328-e328 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julie Trudel More articles by this author Ryan McLarty More articles by this author Conrad Maciejewski More articles by this author Expand All Advertisement Loading ...

Beta-testing Of A Synchronous, Virtually-delivered Group-based Exercise Program For Cancer Survivors

PURPOSE: The COVID-19 pandemic forced many face-to-face exercise programs for cancer survivors to shut down or transition to online delivery. Supervision from a qualified instructor and social support from other participants are integral components for successful exercise program adherence, but it is challenging to create opportunities for tangible social connection when delivering exercise programs asynchronously (i.e., online without real-time interaction). A group-based exercise program delivered online, in real-time, is an innovative way to help cancer survivors increase physical activity (PA), improve health outcomes, and connect with other participants. This study examined the preliminary feasibility of an 8-week synchronous, group-based exercise program for cancer survivors. METHODS: The Fitness Therapy for Cancer (Fit Cancer) program has been operating since 2017, and was adapted for virtual delivery in August 2020. All program content remained the same, including group-based exercise and PA behavior change discussion sessions, and individual pre-and post-program assessments of PA, QOL, strength, and balance. The virtual program was delivered via Zoom, and participants were provided with a set of resistance bands. Preliminary feasibility was assessed by adherence, attrition, safety, and acceptability. RESULTS: Participants (n = 3 female, n = 1 male), were M = 54.3 ± 15.6 years old, diagnosed with breast, endometrial and head and neck cancer. Three participants completed treatment before program start (range 4.4 months to 3 years), and one was undergoing chemotherapy. Adherence was 100% for exercise and discussion sessions. All participants completed the post-program assessment, and no adverse events were reported. All participants responded “yes” to enjoying the program, feeling stronger, looking forward to exercise sessions, a sense of community and support from participants and staff, and would recommend the program to others. CONCLUSIONS: Preliminary results suggest a synchronous, virtual, group-based exercise program for cancer survivors is feasible. A larger pilot study (N = 40) is underway, with feasibility and effectiveness results expected by summer 2021. This work will contribute to advancements in remote delivery of group-based exercise programs for cancer survivors.

Impact of a Cancer Survivorship Program on Well-Being and Community Involvement: Role of OT and Future Directions

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This qualitative phenomenology explored the lived experiences of cancer survivors in a community-based, interprofessional survivorship program and explains further exploration for inclusion of OT. Personal themes describing impact on the individuals included (1) journey of spiritual and emotional healing, (2) growing into a new sense of self, and (3) moving from survival to life. Relational themes included (1) building a community of caring and connection and (2) embracing the value of altruism. Primary Author and Speaker: Lynne Murphy Additional Authors and Speakers: Kendall Ellis, Nicole Fox, Sarah Lee, Rachel Lennon, and Gloria Norton

Life Unpaused: An OT Cancer Survivorship Program

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The purpose of this research was to examine the efficacy of a 4-week OT-based cancer survivorship program named Life Unpaused (LU). The participants had the option to attend the program onsite or virtually on a Telehealth platform. LU addressed participation in roles and daily activities through education and training and by providing resources to participants.The outcome results showed increases in occupational performance, satisfaction, and quality-of-life scores. Primary Author and Speaker: Adrienne Marilla

Emerging and Ongoing Survivorship Challenges Among Childhood Cancer Survivors and Providing Risk-Based Focused Follow-Up Care.

To provide a summary of the emerging and ongoing survivorship challenges facing childhood, adolescent, and young adult cancer survivors and their families. Research and review articles, websites, and clinical guidelines specific to childhood cancer survivorship were used. Many challenges exist in assuring quality long-term follow-up and risk-based screening for childhood cancer survivors. Although many childhood cancer survivors survive well into adulthood, they are at risk for a vast number of later complications of their cancer treatment necessitating annual cancer surveillance. In addition, many childhood cancer survivors are not engaging in long-term follow-up recommendations for clinic attendance, risk-based surveillance, and screening for potentially life-ending events. Pediatric oncology nurses and advanced practice nurses have played an enormous role in the design of childhood cancer survivorship programs and are an integral member of the multidisciplinary health care team who care for this population. Nurses have an obligation to continue to advance the survivorship care of childhood cancer survivors and lead interventional opportunities to improve the lifelong health-related quality of life and overall physical health. Pediatric oncology nurses and advanced practice registered nurses must have a working knowledge of the many late effects that childhood cancer treatment has on the long-term health of childhood cancer survivors. Nurses are well-placed in positions to continue the efforts begun more than 2 decades prior by pediatric oncology nurses who saw the value and necessity of designated survivorship programs.

Survivors Overcoming and Achieving Resilience (SOAR): An 8-week breast cancer survivorship and nutrition program.

e24025 Background: The American Cancer Society (ACS) published Diet and Physical Activity Guidelines in 2020. Emerging evidence suggests that healthy dietary patterns are associated with reduced cancer risk, especially colon and breast. ACS estimates there are 3.5 million breast cancer survivors in the US. The transition from active treatment into survivorship is a critical period where they are uniquely positioned to adapt healthy behaviors, yet there is a lack of empirical research to best guide the transition. Methods: We developed an 8-week breast cancer survivorship program to educate and develop healthy habits. 40 participants were recruited through Moffitt breast and survivorship clinics, social media, and website. Weekly topics were: cancer survivorship, nutrition, emotional health and well-being, exercise, medical management after treatment, grocery store tour, meditation and mindful eating, and moving forward. To assess health-related quality of life (QoL), we used FACT-G Version 4, a validated patient-reported survey with 27 questions and 4 domains of wellbeing (physical, social/family, emotional, and functional) on a 5-point Likert scale (not at all to very much). Similarly, a nutrition questionnaire evaluated the understanding of healthy choices, confidence in making healthy changes, knowing how to purchase healthy foods and read nutrition labels, confidence in preparing healthy foods, and understanding of a plant-based diet. Surveys were administered pre- and post-intervention. Data analysis included those who completed both (n = 30). Pt characteristics and data trends were summarized using descriptive statistics. Paired Wilcoxon rank sum tests were used to assess the significance of the change in scores between surveys. Results: Participant ages ranged from 41 to 77. The majority (34.5%) completed treatment 13-24 months prior. Compared to baseline, greater proportions of participants had positive responses after intervention in all nutrition questions. The nutrition sum was significantly increased by 3.07 (p = 0.0001). There was no significant change in overall QoL (-1.77; p = 0.1178) or sub-domain wellbeing scores. Conclusions: Our 8-week intervention for breast cancer survivors showed significant improvement in nutrition domain. While a small sample size is limiting, it is evident that survivors can improve their confidence in making healthy changes and develop better understanding of a plant-based diet.[Table: see text]

Effect of an e-home based symptom management and mindfulness training program on quality of life in breast cancer survivors: A randomized clinical trial.

12080 Background: The first five years post-treatment for breast cancer are a critical phase, when the survivors may face a multitude of physical and psychosocial problems. We aimed to develop an e-home based symptom management and mindfulness training program to support women with breast cancer in transition to survivorship and to determine its effect on the endpoints including quality of life, symptom distress, psychosocial adjustment, and psychological morbidity. Methods: This parallel 4-arm, superiority randomized clinical trial together with a process evaluation using semi-structured interview recruited women who had completed cancer treatment for stage 0 to 3 breast cancer between 6 months to 5 years previously, from November 2016 through March 2020 at two tertiary hospitals. A total of 593 women were eligible, of these, 402 refused to participate and 191 women were randomized. However, 19 subjects withdrew from the study without completion of baseline assessments. Hence, 172 subjects were included in the intention-to-treat analysis (e-home based breast cancer survivorship program, experimental group; n = 44), comparison group 1 (online symptom management program only; n = 41), comparison group 2 (online mindfulness training program only; n = 44) or the usual care group (n = 43). The e-home based breast cancer survivorship program involved 5 weekly online education module regarding self-management strategies of common symptoms + various online self-administered mindfulness exercises. The primary endpoint included change of Quality of Life-Cancer Survivor Scale (QoL-CS) score measured at 8, 12 and 24 weeks from baseline. Secondary endpoints were changes of Social Support Questionnaire, Breast Cancer Survivor Self-Efficacy Scale, Memorial Symptom Assessment Scale, Psychosocial Adjustment to Illness Scale, Fear of Recurrence Scale, Hospital and anxiety Depression Scale, and Five Facet Mindfulness Questionnaire scores. Results: Of 172 subjects, mean ± SD age was 51.2 ± 9.4 years; 118 (77.7%) were in the first two years of cancer treatment completion; 165 (98.2%) underwent surgery; and 111 (73.5%) treated with adjuvant chemotherapy. All demographic and clinical characteristics were comparable among the four groups ( p>.05). There was no between-group difference in the primary endpoint; QoL-CS scores among groups at 8, 12 and 24 weeks from baseline ( p>.05). Secondary endpoints were also not different among groups ( p>.05). Two main themes; positive impact and gap/barrier, emerged from process evaluation data. Conclusions: In women who were in the first five years post-breast cancer treatment, an e-home based multidimensional cancer survivorship program did not affect outcomes. Nevertheless, the interview data revealed a positive experience in regards to the home-based approach in cancer survivorship care program. Clinical trial information: NCT02931864.

Experiences and perceptions of referrals to a community-based physical activity program for cancer survivors: a qualitative exploration

BackgroundPhysical activity rates in cancer survivors continue to be low despite the known benefits and availability of evidence-based programs. LIVESTRONG at the Y is a national community-based physical activity program offered cost-free to cancer survivors, though is underutilized. We explored perceptions and experiences of staff and participating survivors to better understand program awareness, referrals and participation.MethodsLIVESTRONG at the Y program staff [directors (n = 16), instructors (n = 4)] and survivors (n = 8) from 8 United States YMCAs took part in 30-min semi-structured phone interviews between March–May 2019. Interviews were digitally recorded, transcribed, and evaluated using a thematic analysis approach.ResultsProgram staff themes included: 1) Program awareness should be further developed for both the general public and medical providers; 2) Strong relationships with medical providers increased program referrals; 3) Electronic referral systems between providers and LIVESTRONG would help to streamline the referral process; and 4) Bi-directional communication between program staff and medical providers is key to providing patient progress updates. Survivor themes included: 1) Survivors trust their medical team and the information they provide about physical activity; 2) Providers need to incorporate an action plan and referrals for survivors to be active once treatments are completed; and 3) Personal experiences of those who participated in LIVESTRONG resonate with survivors and increase participation.ConclusionsLIVESTRONG staff reported the need for an integrated electronic referral system and bi-directional communication with providers about participant progress. Survivors want physical activity education, electronic referrals and follow-up from their healthcare team, coupled with peer support from other survivors. Cancer care provider knowledge and electronic referrals during and after treatment may expedite and increase participation in this community-based program.

Evaluation of the Pediatric Neuro-Oncology Resources Available in Chile.

PURPOSEPediatric neuro-oncology resources are mostly unknown in Chile. We report the human and material resources available in Chilean hospitals providing pediatric neuro-oncology services.METHODSA cross-sectional survey was distributed to 17 hospitals providing pediatric neuro-oncology services (Programa Infantil Nacional de Drogas Antineoplásicas [PINDA] hospitals, 11; private, 6).RESULTSResponse rate was 71% (PINDA, 8; private, 4). Pediatric neuro-oncology services were mainly provided within general hospitals (67%). Registries for pediatric CNS tumors and chemotherapy-related toxicities were available in 100% and 67% of hospitals, respectively. CNS tumors were treated by pediatric oncologists in 92% of hospitals; none were formally trained in neuro-oncology. The most used treatment protocols were the national PINDA protocols. All WHO essential medicines for childhood cancer were available in more than 80% of the hospitals except for gemcitabine, oxaliplatin, paclitaxel, and procarbazine. The median number of pediatric neurosurgeons per hospital was two (range, 2-6). General neuroradiologists were available in 83% of the centers. Pathology specimens were sent to neuropathologists (58%), adult pathologists (25%), and pediatric pathologists (17%). Intensity-modulated radiotherapy, conformal radiotherapy, and cobalt radiotherapy were used by 67%, 58%, and 42% of hospitals, respectively. Only one private hospital performed autologous hematopoietic cell transplant for children with CNS tumors.CONCLUSIONA wide range of up-to-date treatment modalities are available for children with CNS tumors. Our survey highlights future directions to improve the pediatric neuro-oncology services available in Chile such as the expansion of multidisciplinary clinics, palliative care services, long-term cancer survivorship programs, dedicated clinical research support teams, establishing standardized mechanism for sending pathologic specimen for second opinion to international specialized centers, and establishing specialized neuro-oncology training program.

A model of cancer survivorship care within a community health setting: The Good Life Cancer Survivorship program

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

A multidisciplinary working model for promoting return to work of cancer survivors.

Despite wide recognition of the necessity of an integrative maintenance and return to work (RTW) program for cancer survivors, no such program has been described in the literature. To examine a working model of an integrative multidisciplinary health care approach for promoting RTW, using the Delphi method. A working model for promoting cancer survivors' RTW by oncology health professionals was subjected to two rounds of evaluation by an expert panel in accordance with the Delphi research method. Twenty-six international experts in oncology (social workers, nurses, psychologists, physicians, and cancer patients) participated in the first round and 16 participated in the second round. The mean score of the working model's applicability was 6.07 (SD = 1.07, range = 1-7). The model outlines in detail an integrative approach for promotion of RTW according to two axes: the oncology health professionals' role and the timeline axis featuring four stages of oncology treatment and follow-up. Our proposed model addresses the need for an integrated program that may increase the rate of RTW and improve the quality of life of cancer survivors. The model should be subjected to further evaluation, especially its adaptability to different health systems in different countries.

Predictors of attendance during an exercise program for cancer survivors.

Exercise programs delivered in community- or clinic-based settings improve physical and psychosocial outcomes among cancer survivors; however, adherence is essential to achieve such benefits. This study examined predictors of attendance to an exercise program in a large, diverse sample of cancer survivors. Participants (n = 302) were enrolled in BfitBwell, an exercise program for adults diagnosed with cancer, and currently receiving or within 6 months of completing chemotherapy or radiation therapy. Participants were offered two supervised aerobic and resistance exercise sessions per week for 3 months. Predictors of attendance included demographics, cancer-related information, quality of life (QOL), fatigue, physical fitness, activity level, and importance of making various changes (e.g., improving fitness). Univariate linear regression first explored associations between predictor variables and adherence, and any important variables (p < .10) were included in a multivariate linear regression model. Participants were M = 54.9 ± 13.9 years old, mostly female (67.3%), white (83.6%), and most commonly diagnosed with breast cancer (34.8%). Average attendance was 16.2 ± 6.6 exercise sessions. Six-minute walk test distance, QOL, and fatigue were associated with exercise session attendance (p < .05). The multivariable model revealed that higher QOL predicted higher attendance (β = .351, p = .005), and working full- or part-time significantly predicted lower attendance (β =- .221, p =.021). Higher pre-program QOL and not working full- or part-time predicted higher exercise program attendance. Existing and future exercise programs for cancer survivors should consider ways to adapt program delivery to provide support to survivors who start with low QOL, and accommodate those who may face barriers to attending due to work schedule/conflict.

Fears of COVID-19 and cancer recurrence related to work sustainability among male cancer survivors

Purpose: Male cancer survivors represent an important at-risk population for COVID-19. The COVID-19 pandemic requires a global response for this most vulnerable population. This study purpose was to explore whether fear of COVID-19 and fear of cancer recurrence are related to the likelihood of remaining at work following treatment in male cancer survivors. Survivors and methods: A cross-sectional survey was used. Data were collected in China in May to June 2020. The Fear of COVID-19 Scale, Fear of Cancer Recurrence (FCR) Inventory-Short Form and work sustainability subscale of the Readiness for Return to Work Scale were completed by male cancer survivors. Results: A total of 121 employed male cancer survivors participated in this study. Fear of COVID-19 and fear of cancer recurrence were both negatively correlated with work sustainability (β = -0.11, and β = -0.19, respectively). Significant interaction effects between fear of COVID-19 and fear of cancer recurrence were observed (β = 0.46, P &lt; 0.01). Advanced disease stage, undergoing radiation therapy and having recently completed cancer treatment were all factors related to lower work sustainability scores (β = -0.28, β = -0.15, and β = -0.17, respectively). The overall path model yielded a good fit: χ2/df = 1.12 (P = 0.24), RMSEA = 0.07, TLI = 0.98, CFI = 0.99, IFI = 0.92, and NFI = 0.96. Conclusion: Fear of COVID-19 is a mediator between fear of cancer recurrence and work sustainability among Chinese male cancer survivors. The findings also indicated that male cancer survivors with higher FCR levels reported less confidence in their ability to remain at work. This information can assist in the development of new interventions and educational programs for cancer survivors, healthcare providers and employers, to improve employees' ability to remain at work.

Development and Effect of the Integrated Health Promotion Program for Cancer Survivors Living at Home

Purpose: This study aimed to develop an integrated health promotion program for cancer survivors residing in the community based on the shared care model, and evaluate its effectiveness. Methods: A quasi-experimental trial was conducted. The participants consisted of 35 cancer survivors with completed intensive cancer therapy at the cancer hospital. The intervention group (n=20) and the control group (n=15) were recruited from among a district home cancer patient registrations. The intervention group participated in an integrated health promotion program based on the MAPP (Mobilizing for Action through Planning and Partnership) development process. The program consisted of physical, psycho-social and body image units. The participants were assessed before the program, and immediately after the program. Data were collected between July 1 and September 2, 2018 using FACT-G quality of life (QOL), distress thermometer (DT), and resilience. The data were analyzed by performing a χ2 test, Fisher’s exact test, Mann-Whitney test, and ranked ANCOVA using SPSS. Results: The intervention group reported a higher QOL overall and significantly higher social/family well-being than the control group. Distress was significantly lower in intervention group than in the control group. Resilience had no significant difference between the two groups. Conclusion: These findings indicate that the integrated health promotion program base on the shared care model and MAPP development process could be effective intervention for improving social/family well-being and the QOL, and reducing distress of cancer survivors at home. Community health center nurses need to provide intervention to support self-care competency for cancer survivors’ comprehensive care with physical, psycho-social, and body image to help them adjust their life to a moderate risk group in the community.

Patient-reported shoulder morbidity and fatigue among the breast cancer survivors: An insight from a Tertiary Care Cancer Hospital

Context: Breast cancer is the most common cancer in Indian women with an annual mortality of around 87,000. Treatment for breast carcinoma may lead to swelling of the ipsilateral arm and shoulder stiffness and arm pain and cancer-related fatigue. Very few centers in India have reported the arm and shoulder morbidity treated in their hospital. Aims: The study aims to evaluate the predictive factors of arm and shoulder morbidity and fatigue among the survivors. Settings and Design: Retrospective analysis from a prospectively maintained database. Materials and Methods: Early and locally advanced cases of breast cancer patients were screened for the study during 2015–2018. Eligible participants were invited to fill up the predetermined questionnaire and their demographic and treatment-related information was accrued from a file archive. Follow-up period was estimated from the date of tissue diagnosis to last contact/time of interview. Statistical Analysis Used: Predictive factors of shoulder morbidity and fatigue were analyzed by independent sample t-test and univariate analysis. Significant predictive factors were selected for further validation in the multivariate cox regression model. A P ≤ 0.05 was considered significant. Results: Shoulder stiffness was the most common complaint followed by arm numbness. Obesity and diabetes played a crucial role in most of the morbidities and fatigue. The median fatigue score was 34 and the median time of appearance of lymphedema was 13 months. Modified radical mastectomy, and radiotherapy to axilla were significantly associated with greater shoulder stiffness and arm swelling. Conclusions: Obesity, diabetes, type of surgery, the extent of axillary dissection, and radiation plan are the major predictive factors of arm and shoulder morbidity. Further prospective validation is necessary for future breast cancer survivorship programs.

An Evidence-Based Walking Program in Oregon Communities: Step It Up! Survivors.

Physical activity can help mitigate the long-term symptoms and side effects of cancer and its treatment, but most cancer survivors are not active enough to achieve these benefits. An evidence-based strategy to promote physical activity among adults is a community group–based walking program. However, many evidence-based programs do not achieve intended population health outcomes because of the challenges of real-world implementation. We used the Interactive Systems Framework for Dissemination and Implementation to conceptualize implementation of a capacity-building intervention to support delivery of a community group–based walking program. We adapted an evidence-based guide for community group–based walking programs for cancer survivors and their support network. We provided a capacity-building intervention (technical assistance and small-grant funding) and evaluated this implementation intervention. We assessed effectiveness of the intervention by measuring adoption, acceptability, appropriateness, feasibility, fidelity, implementation costs, and penetration through monthly progress reports, site visit observations, interviews, and a final report. Eight organizations received a small grant and technical assistance and implemented Step It Up! Survivors (SIUS). SIUS helped cancer survivors increase their physical activity, establish social connections, and be part of a supportive environment. Despite receiving monthly technical assistance, some grantees experienced challenges in recruiting participants, developing community partnerships, and adhering to the prescribed implementation plan. Implementation facilitators included community partners and specific components (eg, incentives for participants, webinars). Organizations needed different amounts and types of assistance with adaptation and implementation. Overall fidelity to SIUS ranged from 64% to 88%. Some integrated SIUS within existing organizational programming for sustainability. The provision of funding and technical assistance was a successful implementation intervention. Our results suggest a need to better tailor technical assistance while organizations are in the process of adapting, implementing, and sustaining an evidence-based program in their local communities.

Physical, psychological and nutritional outcomes in a cohort of Irish patients with metastatic peritoneal malignancy scheduled for cytoreductive surgery (CRS) and heated intrapertioneal chemotherapy (HIPEC): An exploratory pilot study.

BackgroundTreatment for peritoneal malignancy (PM) can include cytoreductive surgery (CRS) and heated intrapertioneal chemotherapy (HIPEC) and is associated with morbidity and mortality. Physical, psychological and nutritional outcomes are important pre-operatively. The aim of this pilot study was to investigate these outcomes in patients with PM before and after CRS-HIPEC.MethodsBetween June 2018 and November 2019, participants were recruited to a single-centre study. Primary outcome was cardiopulmonary exercise testing (CPET) variables oxygen uptake (VO2) at anaerobic threshold (AT) and at peak. Secondary outcome measures were upper and lower body strength, health related quality of life (HRQoL) and the surgical fear questionnaire. Exploratory outcomes included body mass index, nutrient intake and post-operative outcome. All participants were asked to undertake assessments pre CRS-HIPEC and 12 weeks following the procedure.ResultsThirty-nine patients were screened, 38 were eligible and 16 were recruited. Ten female and 6 male, median (IQR) age 53 (42–63) years. Of the 16 patients recruited, 14 proceeded with CRS-HIPEC and 10 competed the follow up assessment at week 12. Pre-operative VO2 at AT and peak was 16.8 (13.7–18) ml.kg-1.min-1 and 22.2 (19.3–25.3) ml.kg-1.min-1, upper body strength was 25.9 (20.3–41.5) kg, lower body strength was 14 (10.4–20.3) sec, HRQoL (overall health status) was 72.5 (46.3–80) % whilst overall surgical fear was 39 (30.5–51). The VO2 at AT decreased significantly (p = 0.05) and HRQoL improved (p = 0.04) between pre and post- CRS-HIPEC. There were no significant differences for any of the other outcome measures.ConclusionThis pilot study showed a significant decrease in VO2 at AT and an improvement in overall HRQoL at the 12 week follow up. The findings will inform a larger study design to investigate a prehabilitation and rehabilitation cancer survivorship programme.

Rural Status of Equine Assisted Activities and Therapies and Cancer Survivors

Background: Although equine assisted activities and therapies (EAAT) are rapidly increasing, as are cancer survival rates, little is known about the engagement of cancer survivors in EAAT. One may conceptualize equine or horse related activities as occurring in rural areas; however, the rural status of EAAT centers are not fully reported.Purpose: To explore the rural status of EAAT centers, and whether EAAT is provided for cancer survivors and the more common service for post-traumatic stress disorder at those centers.Method: A quantitative descriptive analysis was conducted of publicly available data after an exempt status decision of an Institutional Review Board. Services using EAAT for those with terminal illnesses, post-traumatic stress disorder and cancer survivors were examined. Rural status was evaluated for all organizational members (N = 784) of Professional Association of Therapeutic Horsemanship International (PATH Intl.). Roy adaptation model was used as a theoretical framework in this project.Findings: All types of the organizational members, cluster in urban areas more than rural areas. Significant relationship (p = 0.039) was found between rural status and type of membership, where more urban than rural centers were premier accredited center members. Most of the contacted and responding centers stated that they do provided EAAT for cancer survivors (n = 204); however, only (n = 26) centers have programs specifically designed for cancer survivors.Conclusion: There are not only less EAAT rural than urban centers, but rural centers also tend to have lower quality level membership based on PATH Intl. standards. Although EAAT is provided for cancer survivors, identifying effective ways to provide EAAT and standardization of programs for cancer survivors is recommended.&#x0D; DOI: http://doi.org/10.14574/ojrnhc.v20i2.601

Development and Validation of a Risk Model for Breast Cancer–Related Lymphedema

Approximately 1 in 5 patients with breast cancer who undergo axillary lymph node dissection will develop lymphedema. To appropriately triage and monitor these patients for timely diagnosis and treatment, robust risk models are required. To evaluate the prognostic value of mammographic breast density in estimating lymphedema severity. This prognostic study collected data from July 16, 2018, to March 3, 2020, from the electronic health records of patients of the Cancer Rehabilitation and Survivorship Program at the Princess Margaret Cancer Centre in Toronto, Ontario, Canada. Participants included women who had completed curative treatment for a first diagnosis of breast cancer and who were referred to the program. Also included were a sample of patients in the general breast oncology population who were receiving follow-up care at the center during the same period but who were not referred to the program. All patients attended follow-up appointments at the Princess Margaret Cancer Centre from January 1, 2016, to May 1, 2018. The cohort was randomly split 2:1 to group patients into a training cohort and a validation cohort. Participant demographic and clinical characteristics included age, sex, body mass index (BMI), medical history, cancer characteristics, and cancer treatment. Spearman correlation coefficient between measured and predicted volume of lymphedema was calculated. Area under the curve (AUC) values were generated for predicting the occurrence of at least mild lymphedema (volume, >200 mL) and severe lymphedema (volume, >500 mL) at the time of initial lymphedema diagnosis. A total of 373 female patients (median [interquartile range] age, 52.3 [45.9-60.1] years) were eligible for this analysis. Multivariate linear regression identified 3 patient factors (age, BMI, and mammographic breast density), 1 cancer factor (number of pathological lymph nodes), and 1 treatment factor (axillary lymph node dissection) as independent prognostic variables. In validation testing, Spearman correlation revealed a statistically significant moderate correlation (coefficient, 0.42; 95% CI, 0.26-0.56; P < .001) between measured volume and predicted volume of lymphedema. The AUC values were 0.72 (95% CI, 0.60-0.83) for predicting the occurrence of mild lymphedema and 0.83 (95% CI, 0.74-0.93) for severe lymphedema. This prognostic study found that patients with low breast density appeared to be at a higher risk of developing severe lymphedema. The finding suggests that by combining breast density with established risk factors a multivariate linear regression model could be used to predict the development of lymphedema and provide volumetric estimates of lymphedema severity in patients with breast cancer.

Patient-Reported Shoulder Morbidity and Fatigue among Breast Cancer Survivors: An Insight from a Tertiary Care Cancer Hospital

Abstract Context: Breast cancer is the most common cancer in Indian women with an annual mortality of around 87,000. Treatment for breast carcinoma may lead to swelling of the ipsilateral arm, shoulder stiffness, arm pain, and cancer-related fatigue. Very few centers in India have reported the arm and shoulder morbidity treated in their hospitals. Aims: The aim was to evaluate the predictive factors of arm and shoulder morbidity and fatigue among breast cancer survivors. Settings and Design: This was a retrospective analysis based on a prospectively maintained database. Materials and Methods: Early and locally advanced cases of breast cancer patients were screened for the study during 2015–2018. Eligible participants were invited to fill up the predetermined questionnaire, and their demographic and treatment-related information was accrued from a file archive. Follow-up period was estimated from the date of tissue diagnosis to last contact/time of interview. Results: Shoulder stiffness was the most common complaint followed by arm numbness. Obesity and diabetes played a crucial role in most of the morbidities and fatigue. The median fatigue score was 34, and the median time of appearance of lymphedema was 13 months. Modified radical mastectomy and radiotherapy to axilla were statistically significantly (P = 0.04 and 0.01, respectively) associated with greater shoulder stiffness and arm swelling. Conclusions: Obesity, diabetes, type of surgery, the extent of axillary dissection, and radiation plan are the major predictive factors of arm and shoulder morbidity. Further prospective validation is necessary for future breast cancer survivorship programs.