Completion Of Cancer Treatment Research Articles

Factors associated with increased financial toxicity after the completion of radiation treatment for gynecologic cancer.

We evaluated financial toxicity (FT) in patients with gynecologic cancer treated with radiation and assessed the impact of the COVID-19 pandemic on patients' financial wellbeing. Patients completed a survey 1month after completing radiation from August 2019-March 2020 and November 2020-June 2021. The survey included the COmprehensive Score for Financial Toxicity (COST) tool, EQ-5D to measure quality of life (QOL) and pandemic-related questions for the second survey period. High FT was COST score ≤ 23. Of 97 respondents (92% response rate), 49% completed the survey pre-pandemic and 51% after; the majority were white (76%) and had uterine cancer (64%). Sixty percent received external beam radiation with or without brachytherapy; 40% had only brachytherapy. High FT was associated with worse QOL (r = -0.37, P < 0.001), younger age and type of insurance (both p ≤ 0.03). Respondents with high FT were 6.0 (95% CI 1.0-35.9) times more likely to delay/avoid medical care, 13.6 (95% CI 2.9-64.3) times more likely to borrow money, and 6.9 (95% CI 1.7-27.2) times as likely to reduce spending on basic goods. The pandemic cohort had a smaller proportion of respondents with high FT than the pre-pandemic cohort (20% vs. 35%, p = 0.10) and a higher median COST score (32 (IQR 25-35) vs. 27 (IQR 19-34), p = 0.07). Privately insured, younger respondents who received radiation for gynecologic cancer were at risk for FT. High FT was associated with worse QOL and economic cost-coping strategies. We observed less FT in the pandemic cohort, though not statistically different from the pre-pandemic cohort.

Gynecological Cancer Survivors' Experiences and Desire for Follow-up After Recent Treatment: A Phenomenological Hermeneutic Study.

Gynecological cancer survivors experience a variety of challenges after discharge from hospital treatment. Cancer support and rehabilitation are recognized as significant facilitators for quality of life in survivorship but are reported to be insufficient by gynecological cancer survivors. To describe the lived experiences of gynecological cancer survivors and how their needs for follow-up should be met following recently completed treatment. This study used a phenomenological hermeneutic design with individual in-depth interviews with 20 women after recently completed cancer treatment. Transcribed interviews were analyzed with the Lindseth and Norberg phenomenological hermeneutic method. Four themes were identified: "a brutal transition to life after cancer," "fear of recurrence overshadowing the existence," "a need for professional support," and "information is not given unless asked for." After completing gynecological cancer treatment, the fear of cancer recurrence is dominating, regardless of prognosis and diagnosis. At the same time, information and support from healthcare professionals are described as lacking. Participants expressed a need to be contacted directly as a formal routine by healthcare professionals after cancer treatment with cancer-specific information as this may alleviate the existential suffering that the cancer experience brings. A person-centered, systematic follow-up rehabilitation is needed as a continuation of the care provided during cancer treatment. Future research is needed to explore the impact on women's quality of life when gynecologic-specific information is given in advance of hospital discharge after completing treatment.

Evaluating differences in cancer survivorship care plans experienced by cancer survivors with disabilities.

e18597 Background: Survivorship Care Plans (SCPs) are crucial elements for short- and long-term follow-up care among cancer survivors and have been endorsed by leading oncologic organizations. Yet, limited research exists about the receipt of SCPs among survivors with disabilities who may face additional barriers to access the health care services. Our study examines the association between the disability status and receipt of SCPs after completion of cancer treatment among US adult cancer survivors. Methods: This secondary analysis included cross-sectional, nationally representative, population-based data from the 2021 Behavioral Risk Factor Surveillance System. We included 2110 respondents (aged ≥ 18 years) who self-reported cancer history (other than skin cancer). Outcomes were self-reported receipt of cancer treatment summaries and follow-up care instructions after completion of the cancer treatment. The independent variable was disability status, comprised of six specific disability types (having serious difficulty with hearing, vision, cognition, mobility, self-care, and independent living). We combined disability status into four groups—as having 1) no disability; 2) one disability; 3) two disabilities; and 4) three or more disabilities. We applied recommended sample weights and conducted weighted descriptive statistics and multivariable logistic regression adjusting for self-reported individual-level factors (age, sex, race, marital status, education, health insurance, provider type who provided majority of the care). Results: Overall, 4.2% self-reported as Black, 19.5% Hispanic, 70.0% White, 59.5% women, and 54.5% aged 65+ years. A total of 20.8% of participants reported having one disability, 11.1% two disabilities, and 11.7% reported three or more disabilities. Mobility disability was the most prevalent disability type (27.0%), followed by cognition (14.8%), independent living (14.5%), hearing (12.7%), vision (9.2%), and self-care (6.5%). About 18.0% did not receive follow-up care instructions, and 41.7% did not receive treatment summaries. Overall, 52.8% of survivors reported receiving both follow-up care instructions and treatment summaries. Survivors with three or more disabilities were 0.40 (95% CI 0.27-0.88, p = 0.019) times significantly less likely to report receiving follow-up care instructions than survivors without disabilities. Survivors’ disability status was not significantly associated with reporting the receipt of cancer treatment summaries. Conclusions: Nearly half of the survivors did not receive SCP upon treatment completion, which may lead to poor treatment adherence and deterioration of health. Our findings suggest disparities in follow-up instructions based on disability status, especially for people with multiple disabilities. Effective strategies are necessary to build more equitable cancer survivorship care.

Carvedilol for prevention of heart failure in anthracycline-exposed survivors of childhood cancer: Results from COG ALTE1621.

10013 Background: Carvedilol improves cardiac function in patients with heart failure (HF), but remains untested as cardioprotective therapy in long-term childhood cancer survivors at risk for HF due to high-dose anthracycline exposure. We hypothesized that low-dose carvedilol would be safe and efficacious in reducing anthracycline-related heart failure risk in long-term survivors without evidence of HF. Methods: This was a randomized, double-blind, placebo-controlled phase 2B trial (NCT02717507) conducted at 28 sites. Eligibility included ≥250 mg/m2 cumulative anthracycline exposure by age 21 years (y), ≥2y from completion of cancer treatment, and preserved systolic function (ejection fraction [EF] ≥55% and/or fractional shortening [FS] ≥28%) at enrollment. Patients were randomized 1:1 to take low-dose carvedilol (12.5 mg/day) or placebo for 2y; dose up-titration started at 3.125 mg/day. The primary objective was to determine the impact of carvedilol on echocardiographic indices of HF risk: standardized left ventricular (LV) wall thickness/dimension ratio (LVWT/Dz; primary endpoint), LV end-systolic wall stress (ESWS), LV chamber diameters, systolic and diastolic function. These indices were obtained every 6 months and measured centrally in a blinded fashion. Common Terminology Criteria for Adverse Events (CTCAE v4.0) was used to assess toxicity. Cardiac event was defined as relative EF/FS decline &lt; 20% from baseline or both &lt; 55% [EF] and &lt; 28% [FS]. Treatment effects were analyzed using the Generalized Estimating Equation for normally distributed data, assuming linear time-trend. Group differences were evaluated by treatment*time interaction. Results: Of 196 participants enrolled, 182 were eligible and randomized. Characteristics (median, range): age at enrollment, 24.7y (10.4-53.9); time from cancer diagnosis, 13.4y (2.9-43.6); anthracycline dose, 374 mg/m2 (250-1760); 19% had received chest-directed radiotherapy. There were no group differences in baseline participant demographics, cardiotoxic treatment exposure, or cardiac endpoints. LVWT/Dz was similar (+0.053, p = 0.15) between arms at 2y. However, treatment effects varied by time since diagnosis (p = 0.008) suggesting greater efficacy among longer-term survivors. Compared to placebo, carvedilol arm participants had significantly better LV end-diastolic diameter (-0.16 cm, p = 0.005) and LVESWS (-7.53, p = 0.027) at 2y. There were no CTCAE grade ≥3 events; all except 2 participants tolerated full dose escalation. Six out of eight cardiac events occurred on the placebo arm; longer-term follow-up of study participants is ongoing. Conclusions: In this randomized trial of long-term survivors of childhood cancer treated with high-dose anthracyclines, low-dose carvedilol was safe and effective in reducing established biomarkers of HF risk and could serve as a risk reduction strategy. Clinical trial information: NCT02717507 .

Assessing the acceptability and feasibility of using a computerized food frequency questionnaire (FFQ) to determine dietary patterns in survivors of head and neck cancer (HNC).

e24103 Background: Malnutrition and poor dietary habits are associated with worse outcomes and decreased quality of life (QOL) in patients with HNC. Given the lack of standardized assessment of diet in survivors of HNC but the concern for long term malnutrition risk, we piloted a recently developed computerized FFQ that provides individualized dietary feedback (Vioscreen) in survivors of HNC. We sought to assess its feasibility and acceptability and explore associations between diet quality, QOL, and patient/treatment characteristics. Methods: We recruited HNC patients who had completed cancer treatment (radiation alone, chemoradiation, surgery/radiation, surgery/chemoradiation) at least 6 months prior to study enrollment who did not have a feeding tube. Dietary assessment was conducted using Vioscreen. Dietary quality was defined by Healthy Eating Index (HEI) and calculated by the participant’s response. All patients received an individualized feedback report. Patients also completed the EORTC QLQ-C30 and H&amp;N35. At 6 weeks, we administered an acceptability questionnaire on usability of Vioscreen and perceived dietary changes. Results: 50 patients consented to participate. Of these, 34 (68%) completed all initial questionnaires. Of the 34 participants, majority were white/non-Hispanic, male, with oropharynx primaries, and median time from treatment was 68.4 months. Of the 27 who completed acceptability, 15 (56%) considered the Vioscreen tool to be useful, 9 (36%) reported they made changes to diet, and 16 (59%) would recommend to others. Mean HEI score was 63.2 (SD 11.3). There were no statistically significant differences in HEI scores between participants who were male vs female or based on time from treatment. There was a numeric difference in HEI scores for those with oral cavity/larynx cancers vs. oropharynx (58.3 vs 65.6; p = 0.06), and those with bimodality vs. trimodality treatment (66.1 vs 57.3; p = 0.07), but this did not reach statistical significance. There was a significant positive correlation with higher HEI scores and less trismus as reported on the EORTC H&amp;N35 questionnaire (r = .49, p &lt; .01). Additionally, the participants who found the Vioscreen useful were less likely to report swallowing difficulties on the EORTC H&amp;N35 (p = 0.046) and less likely to have had surgery as part of treatment (p = 0.046). Conclusions: For survivors of HNC, Vioscreen was useful to &gt; 50% of participants. Diet quality and swallowing issues were worse in patients receiving trimodality treatment; those reporting more swallowing complaints also reported the Vioscreen tool was less useful. Thus, using Vioscreen as a stand-alone intervention may be insufficient for these populations. Future studies will couple the Vioscreen FFQ with a nutrition counseling intervention.

Perspectives about healthy eating and exercise among patients and providers at the safety-net Lyndon B. Johnson (LBJ) hospital oncology clinic.

e24055 Background: Previous studies have described barriers and facilitators of healthy eating and exercise among cancer patients, but none have done so in a primarily low-income minority population. Understanding the perspectives of patients and providers from safety net hospitals has important implications for optimizing diet and exercise counseling and referral strategies to bridge disparities in cancer care and outcomes. Methods: The population at LBJ hospital is majority Hispanic and Black that are uninsured or underinsured. We conducted semi-structured interviews with patients who were either undergoing or completed cancer treatment at LBJ, as well as with clinic providers, to compare perceived barriers and facilitators of healthy eating and exercise. Interviews were audio-recorded, transcribed, and analyzed via hybrid analysis. Results: Thirty-one patients were interviewed, including 20 (65%) survivors and 11 (35%) who were on active treatment. Twenty-one (68%) were female, 22 (71%) Black, 5 (16%) Hispanic, and 4 (13%) other. Twenty-one healthcare providers were interviewed, including 5 (24%) physicians, 5 (24%) nursing professionals, 4 (19%) dietitians, and 7 (33%) ancillary staff. Barriers to healthy diet and exercise for patients as perceived by providers included lack of knowledge (100%), low access (80%) due to financial difficulties, transportation issues, work and family responsibilities, and low motivation (76%). This resulted in reluctance to counsel patients about healthy living, in part due to anticipated low adherence to recommendations (33%). Most patients could name components of and thought they had a healthy diet (65%), but did not exercise enough (75%) due to cancer-related physical and mental health symptoms (68%). Patients recognized benefits of healthy eating and exercise during and after cancer treatment (32% each) and recalled recommendations from providers about healthy living (48%). Patients voiced high motivation to participate in healthy eating and exercise programming (84%) and follow their medical team’s recommendations (84%), so long as programming was convenient (29%) and included flexibility of multiple options (56%). Patients acknowledged resource-related barriers to healthy living but cited proximity to grocery stores and exercise facilities (84%), help from family in cooking meals (52%), and ability to walk outside or exercise with friends (13%). Conclusions: Despite multiple barriers of capacity, opportunity, and motivation to healthy eating and exercise, cancer patients in a safety-net hospital recognized the importance of healthy living, wanted to participate in such programs, and to get additional information or referrals from their medical team. Based on these results, ongoing studies are evaluating the implementation of referral pathways to healthy living programs for cancer patients at LBJ.

Predictors of cancer center-based follow-up among pediatric and adolescent/young adult cancer survivors.

10055 Background: Though guidelines recommend lifelong follow-up for pediatric and adolescent/young adult (AYA) cancer survivors, this has been challenging to implement in clinical practice. We constructed an institutional cohort of pediatric/AYA cancer survivors in order to evaluate follow-up patterns and identify predictors of cancer center-based follow-up. We hypothesized that follow-up would be lower for patients with greater individual- and area-level socioeconomic disadvantage and longer time since treatment. Methods: This retrospective cohort study used EHR data at an academic medical center. We included all patients who completed cancer treatment between 2010-2019 and were aged 0-29 years at last treatment date. Treatment was defined by diagnosis/procedure codes and medication records for chemotherapy, radiation, stem cell transplant, and cancer surgery. The primary outcome of cancer center-based follow-up was defined by clinic visits in an oncology department through 12/31/2022. Patients who died were excluded after the date of death. Multivariate logistic regression models (overall, age 0-19, age 20-29) evaluated the association of follow-up with age, sex, race/ethnicity, treatment intensity, insurance type, primary language, distance to cancer center, and area deprivation index (ADI, a composite measure of socioeconomic disadvantage). Results: 2210 patients were included with an overall rate of cancer center-based follow-up that decreased from 94% 1 year after treatment to 61% at 2-3 years, 45% at 4-5 years, and 35% at 6-7 years. Follow-up was not significantly associated with race/ethnicity, insurance type, primary language, or ADI for overall or age-specific cohorts. Patients &gt;100 miles away had lower odds of follow-up. Increasing age was associated with decreased odds of follow-up, and this trend persisted over time since treatment (Table). Conclusions: Patterns of decreased pediatric/AYA cancer survivor follow-up were largely predicted by age and time since treatment. Further work is ongoing to understand drivers of follow-up disparities, including transfers of care and insurance type among AYA patients and the role of community support and telemedicine in healthcare access and health promotion. [Table: see text]

Long-term prospective data on correlation between overall mortality and HADS (Hospital Anxiety and Depression Scale) assessed psychological distress in prostate cancer patients (11 year follow-up data).

12091 Background: We prospectively assessed whether Psychological factors such as anxiety and depression can have a detrimental effect on long term overall survival of prostate cancer patients (pts). Methods: Prostate cancer pts participating in an ethics Committee approved, Prospective study evaluating an Andropause rating scale. All pts had radical radiotherapy with androgen deprivation therapy. Pts completed a baseline HADS questionnaire before any treatment was initiated &amp; at 3mths &amp; after completion of hormone therapy. Patient characteristics: Median age: 69 yrs (50 to 78 yrs). Charlson Comorbidity Index (CCI) prevalence at baseline as follows CCI-I 6.1%; CCI-II: 33.8%; CCI-III: 37.2%; CCI-IV: 14.2%; CCI-V: 6.1% and CCI-VI: 2.7%.; At the survival update in Feb 2023, 49.3% of patients have died [n = 148]; Gleeson grade was Low risk in 7.2%; Intermediate in 53.4% and high risk in 39.2%; Baseline PSA was &lt; 10 ug/L in 45.3%; 10-20 ug/L in 33.1% and &gt; 20 ug/L in 21.6% ; Tumour stage was T1 in 8.1% ; T2 in 63.5% and T3 in 28.4%. Baseline Median serum testosterone was 11.9 nmol/l (min 2.6 and max 26.7). Hormone duration was &lt; 3 mths in 22.3%; 3-6mths in 35.8% ; 6 to &lt; 36mths in 19.6% and &gt; 36mths in 22.3%. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) of overall mortality, while controlling for the following covariates (Age, T stage, Gleeson risk category, PSA Category, Baseline Serum Testosterone, ADT duration category and Charlson Comorbidity index). Results: Higher anxiety at time of diagnosis had a statistically significant adverse effect on overall survival (table); Higher depression symptoms at baseline did not affect survival but depressive symptoms after completing cancer treatment did affect all-cause mortality in this mature dataset with a median follow up of more than 11 years. Conclusions: Higher anxiety and depression symptoms in prostate cancer patients are associated with significantly higher long-term all-cause mortality. [Table: see text]

Evaluation of a mobile behavior change program for weight loss in breast cancer survivors: A prospective single-arm pilot study.

12070 Background: Post-diagnosis weight gain is common among women with early-stage breast cancer and is associated with increased risk of recurrence, breast cancer death, and all-cause mortality. Intentional weight loss following diagnosis is difficult to maintain. Targeted lifestyle interventions focusing on behavioral changes and education that can be implemented long-term are needed. Methods: This was a prospective single-arm pilot study in patients with history of early-stage breast cancer (NCT04753268). Key eligibility criteria included body mass index (BMI) ≥27.5 kg/m2, stage I-III breast cancer, and completion of active cancer treatment ≥6 months prior to study enrollment. Patients were recruited at the Dempsey Center in Lewiston, ME and via social media. Participants were given access to the Noom mobile application, which utilizes cognitive behavioral therapy, motivational interviewing, and self-determination theory to induce behavior change using an educational curriculum of daily articles, virtual health coaching, social networking, food records, and physical activity logs. The primary endpoint was change in self-reported weight from baseline to 26 weeks. Secondary endpoints included change in physical activity measured using step count and the Global Physical Activity Questionnaire (GPAQ), change in diet patterns analyzed using the Nutrition Data System for Research, patient-reported outcome (PRO) measures, and metrics for engagement with the mobile application. Results: 31 patients were enrolled; 24 at the Dempsey Center and 7 via social media. Mean age was 56.8 and mean baseline BMI was 33.5 kg/m2. Mean weight change was -4.8 kg (range +0.6 to -19.9 kg, p &lt; 0.001) and mean percent weight change was -5.6%; 11/31 patients (35.5%) lost ≥5% of their initial weight. Average daily step count increased by 54.7% (p = 0.004). Mean GPAQ score for physical activity increased from 990 to 1773 (p = 0.01), and the proportion of patients who met physical activity guidelines increased from 45.1% to 74.2%. Mean energy intake did not change significantly over 26 weeks (p = 0.779). Improvements were observed in PROMIS-Physical Functioning T-scores and Body Image Scale scores (p = 0.04, p &lt; 0.001 respectively). Metrics of engagement with Noom that were predictive of weight loss ≥5% included total articles read (p = 0.012), total weights logged (p = 0.006), total food records logged (p = 0.001), messages sent to coach (p = 0.001), and number of times the application was opened (p = 0.014). Conclusions: In this pilot study, breast cancer survivors lost weight and became more physically active using a commercially-available mobile application. This digital weight loss program is a scalable intervention, and these findings support future studies investigating impact on breast cancer outcomes. Clinical trial information: NCT04753268 .

0421 Synchronous Virtual Cognitive Behavioral Therapy for Insomnia: Preliminary Results of Sleep Pattern Changes among Cancer Survivors

Abstract Introduction For cancer survivors, insomnia is a frequent and distressing concern. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment, yet in-person care can be difficult for cancer survivors to access for a variety of socioeconomic, medical and logistical reasons. In a pilot randomized clinical trial, four, weekly sessions of virtually-delivered, synchronous CBT-I were feasible, acceptable, and seemingly efficacious for reducing insomnia among cancer survivors (vs. an enhanced usual care control). The aim of this secondary analysis was to characterize daily patterns in sleep diary metrics during the intervention phase. Methods Adults who had completed treatment for any non-metastatic cancer and had chronic insomnia (DSM-5 criteria and Insomnia Severity Index score &amp;lt;=15) and were randomized to receive CBT-I completed daily assessments of sleep quality (SQ), total sleep time (TST), time in bed (TIB), sleep efficiency (SE), sleep onset latency (SOL), and waking after sleep onset (WASO) for 21 days (i.e., from Session 1-4). Linear mixed models were used to compute trajectories of change for each sleep metric and -2 log likelihood, AIC, and BIC fit indices. Results Among 20 cancer survivors who received CBT-I (mean age 51.2 ± 17.1 years, 90% female), model fit indices indicated that across sleep metrics, linear growth models provided a better fit to the data than either quadratic or cubic growth models. Significant linear improvement was observed for SQ (B = 0.02, t = 3.60, p &amp;lt; 0.001), SE (B = 0.16, t = 2.01, p = 0.046), and SOL (B = -0.41, t = -2.47, p = 0.01), but not TIB, TST, or WASO (ts &amp;lt; 1.12, ps &amp;gt; 0.26). Conclusion Findings elucidate how sleep may be expected to change over the course CBT-I, in particular for the growing population of cancer survivors seeking virtual care for insomnia. The strengths, limitations, and potential modifications to optimize the intervention across sleep metrics will be discussed. Support (if any) This work was conducted with support from the American Cancer Society (Massachusetts General Hospital Institutional Research Grant, PI: Hall).

Factors associated with reproductive concerns among young female patients with colorectal cancer: A cross-sectional study.

The aim of this study was to describe the prevalence of reproductive concerns among young female patients with colorectal cancer and explore the associated factors. With the trend of longer survival and younger age at diagnosis of colorectal cancer patients, reproductive concerns have become increasingly prevalent among young female colorectal cancer patients. Cross-sectional design. The study included 150 young female patients with colorectal cancer who completed cancer treatment at 2 hospitals in Guangzhou, China, between November 2020 and December 2021 completed an investigation comprising A general questionnaire, The Reproductive Concerns After Cancer scale, The Family Adaptation and Cohesion Evaluation Scale II and unmet fertility information needs questionnaire. Multivariable linear regression analysis was performed in order to identify factors that influence reproductive concerns. This study was prepared and is reported according to the STROBE checklist. The mean (SD) score on the Reproductive Concerns After Cancer scale was 54.78 ± 8.97. The highest score was for the children's health subscale (3.84 ± .92) and the lowest was for acceptance (2.24 ± .70). Multiple regression analysis showed that patients with fewer children, female children, lower education level (less than undergraduate degree), earlier disease stage, lower family function and higher unmet need for fertility information had more reproductive concerns, which explained 26.9% of the total variation of the model. The patients with fewer children, female children, low cultural degree (less than bachelor), early clinical patients, poorer family function and higher unmet fertility information needs had higher reproductive concerns. These findings can guide the development of interventions to mitigate reproductive concerns, including understand and meet their fertility information needs, improve the level of family function. Survey questionnaires were completed by participants among young female with colorectal cancer in this study.

Adherence to adjuvant tamoxifen and associated factors in breast cancer survivors

Adjuvant endocrine therapy reduces the recurrence and mortality of early hormone receptor-positive breast cancer in both pre- and postmenopausal women. The aim of this study was to investigate adjuvant tamoxifen adherence and associated factors in breast cancer survivors. This descriptive, prospective study was conducted in 2019-2020 with the participation of 531 women who survived breast cancer and were under follow-up at the Senology Institute of a hospital in Istanbul. Inclusion criteria were having completed treatment for early hormone receptor-positive breast cancer, being prescribed tamoxifen, and being 18years or older. Data were collected using a patient information form and the Morisky Medication Adherence Scale-8 (MMAS-8). The mean age of the participants was 44.9 ± 6.5years, and the mean duration of tamoxifen use was 834.4 ± 685.7days. The women's mean MMAS-8 score was 6.86 ± 1.39. Medication adherence was significantly positively correlated with current age (p = 0.006) and age at diagnosis (p = 0.002). There was a statistically significant difference between tamoxifen adherence according to participants' employment status (p = 0.028), chronic disease status (p = 0.018), loss of libido (p = 0.012), treatment-related changes in mood changes (p = 0.004), and having negative effects affecting daily life (p < 0.001). Overall, breast cancer survivors in this study reported moderate adherence to tamoxifen. The women's individual characteristics and the adverse effects of treatment influenced medication adherence. Healthcare professionals can help increase adherence to this treatment, which reduces the risk of mortality, by explaining the importance of the medication, identifying and eliminating barriers to adherence, and informing women about evidence-based interventions to increase medication compliance.

Feasibility and acceptability of a culturally-adapted Women's Wellness After Cancer Programme for Chinese women treated for gynaecological cancer: A pilot randomised controlled trial

ObjectiveTo assess the feasibility and acceptability of a culturally-adapted Women's Wellness After Cancer Programme (WWACPHK) for improving health-related quality of life, anxiety and depressive symptoms and enhancing self-efficacy in engaging in healthy lifestyles among Chinese women treated for gynaecological cancer. MethodsThis pilot randomised controlled trial was conducted from May to December 2018. Twenty-six women aged 18 or above who had completed treatment for gynaecological cancer were recruited from a gynaecology outpatient clinic of a public hospital in Hong Kong. They were randomised into intervention (n = 15) or control (n = 11) groups. All data collectors were blinded to the group allocation. Intervention participants were given access to the WWACPHK website and an online discussion forum facilitated by a trained research nurse for 12 weeks, while control participants received standard care. Trial feasibility was assessed by recruitment, consent, and retention rates and website use. Acceptability was explored through semi-structured interviews. Additionally, we trialed the data collection procedure and collected preliminary data on health-related quality of life, anxiety and depressive symptoms, dietary and exercise self-efficacy. ResultsOf the 26 participants (Median age = 53.5 years) randomised, three participants dropped out of the study. Recruitment, consent and retention of participants and website use were satisfactory. No posting was made on the discussion forum. The intervention participants (n = 13) exhibited significantly greater improvement than the controls (n = 10) in perceived self-efficacy in adhering to an exercise routine at post-intervention (Cohen's d effect size(d) = 1.06, 95% confidence interval (CI): 0.18, 1.92) and 12-weeks after completion (d = 1.24, 95% CI: 0.32, 2.13). All participants were satisfied with the intervention. ConclusionsThe WWACPHK is feasible and acceptable to Chinese women treated for gynaecological cancer and may improve their exercise self-efficacy. A larger-scale study is required to confirm its effects. Trial registrationhttps://www.isrctn.com identifier: ISRCTN12149499.

Adapting the Voicing My CHOiCES Advance Care Planning Communication Guide for Australian Adolescents and Young Adults with Cancer: Appropriateness, Acceptability, and Considerations for Clinical Practice.

Background: Adolescents and young adults (AYAs) with life-threatening illnesses need support to discuss and voice their end-of-life choices. Voicing My CHOiCES (VMC) is a research-informed American advanced care planning guide designed to help facilitate these difficult discussions. This multi-perspective study aimed to evaluate its appropriateness, acceptability, and clinical considerations for Australian AYAs with cancer. Procedure: Forty-three participants including AYAs who were either undergoing or recently completed cancer treatment, their parents, and multidisciplinary health professionals assessed the acceptability of each VMC section quantitatively (appropriateness-yes/no, helpfulness and whether content caused stress-1 = not at all, to 5 = very) and qualitatively (sources of stress). AYAs also assessed the benefit and burden of completing several sections of the document, to inform clinical considerations. We conducted a mixed-methods analysis to obtain descriptive statistics and to identify prominent themes. Results: In terms of acceptability, almost all participants (96%) rated VMC as appropriate overall. Perceived helpfulness to their situation (to themselves/their child/their patients), to others, and stressfulness were rated, on average, as 4.1, 4.0, and 2.7/5, respectively. Stress was attributed to individual and personal factors, as well as interpersonal worries. All sections were considered more beneficial than burdensome, except for the Spiritual Thoughts section (Section 6). Conclusions: While VMC is an acceptable advance care planning guide for AYAs with cancer, changes to the guide were suggested for the Australian context. Health professionals implementing VMC will need to address and mitigate anticipated sources of stress identified here. Future research evaluating the impact of a new culturally adapted Australian VMC guide is an important next step. Finally, the clinical implications of the present study are suggested.

Discussing diet, nutrition, and body weight after treatment for gynecological cancer: a conversation analytic study of outpatient consultations

PurposeTo generate direct observational evidence for understanding how diet, nutrition, and weight-related topics are discussed during follow-up after treatment for gynecological cancer, as recommended by survivorship care guidelines.MethodsConversation analysis of 30 audio-recorded outpatient consultations, involving 4 gyne-oncologists, 30 women who had completed treatment for ovarian or endometrial cancer, and 11 family members/friends.ResultsFrom 21 instances in 18 consultations, diet, nutrition, or weight-related talk continued beyond initiation if the issue raised was ostensibly relevant to the clinical activity being undertaken at the time. These instances led to care-related outcomes (i.e., general dietary recommendations, referral to support, behavior change counseling) only when the patient identified needing further support. Diet, nutrition, or weight-related talk was not continued by the clinician if it was not apparently related to the current clinical activity.ConclusionsThe continuation of diet, nutrition, or weight-related talk during outpatient consultations after treatment for gynecological cancer, and the subsequent delivery of care-related outcomes, depends on its immediate clinical relevance and the patient indicating needing further support. The contingent nature of these discussions means there can be missed opportunities for the provision of dietary information and support post-treatment.Implications for Cancer SurvivorsIf seeking information or support for diet, nutrition, or weight-related issues post-treatment, cancer survivors may need to be explicit regarding their need for this during outpatient follow-up. Additional avenues for dietary needs assessment and referral should be considered to optimize the consistent delivery of diet, nutrition, and weight-related information and support after treatment for gynecological cancer.

Trajectories of sleep disturbance in cancer survivors during the first 2 years post-treatment.

To examine the trajectories of sleep disturbance in cancer survivors during the first 2 years post-treatment and to investigate whether psychological, cognitive, and physical factors differentiate trajectories. A total of 623 Chinese cancer survivors of diverse cancer types participated in a 2-year-long prospective study after the completion of cancer treatment. Sleep disturbance was measured using Pittsburgh Sleep Quality Index at 3 (T2), 6 (T3), 12 (T4), 18 (T5), and 24 (T6) months after baseline (within 6-months post-treatment; T1). Latent growth mixture modeling identified distinctive sleep disturbance trajectories and tested if these longitudinal patterns were predicted by baseline psychological distress, attentional control, attentional bias and physical symptom distress and T2 cancer-related distress. Fully adjusted multinomial logistic regression then identified whether these factors differentiated trajectories. Two distinct sleep disturbance trajectories were identified, namely stable good sleepers (69.7%) and persistent high sleep disturbance (30.3%). Compared to those in the stable good sleep group, patients in the persistent high sleep disturbance group were less likely to report avoidant (OR=0.49, 95% CI = 0.26-0.90), while more likely to report intrusive thoughts (OR = 1.76, 95% CI = 1.06-2.92) and cancer-related hyperarousal (OR = 3.37, 95% CI = 1.78-6.38). Higher depression scores also predicted persistent high sleep disturbance group membership (OR = 1.13, 95% CI = 1.03-1.25). Attentional bias, attentional control, anxiety, and physical symptom distress did not predict sleep trajectory membership. One in three cancer survivors experienced persistent high sleep disturbance. Screening and managing depressive symptoms and cancer-related distress in early cancer rehabilitation may reduce risk of persistent sleep disturbance among cancer survivors.

Abstract P4-07-35: Changes in Left Ventricular Global Longitudinal Strain in breast cancer patients receiving anti-HER2 and/or Adriamycin therapy and outcomes with early implementation of cardio-protective measures

Abstract Background: The treatment of Human Epidermal Growth Factor -2 (HER2) positive breast cancer has advanced since Trastuzumab and subsequently Pertuzumab were introduced and approved as antibody-targeted therapy. With the incorporation of anti-HER2 therapy, cardiotoxicity poses a significant risk and is a well know side effect. This toxicity can increase with concomitant use of Anthracyclines. Left Ventricular Global Longitudinal Strain is assessed using speckle tracking analysis on 2D echocardiogram and a relative reduction in LV global longitudinal strain (GLS) of 10-15% from baseline appears to have specificity to predict downstream reduction in Left Ventricular Ejection Fraction (LVEF). There is growing use for identification of GLS changes in these patients and its incorporation into medical decision making that impacts oncological and cardiac care. Methods: We conducted an analysis of 200 patients receiving anti-HER2 therapy at Henry Ford Cancer institute from Jan 1, 2016 to June 1, 2022 to determine if there was a 10-15% reduction in GLS detected prior to a decrease in ejection fraction and if and how these detections resulted in the implementation of cardio protective measures and downstream effects on cancer therapy. Results: There were 198 patients with GLS and LVEF data. 175 patients (88.3%) completed one year of cancer therapy 107/198 patients (54%) had no change in GLS or LVEF. 91/198 patients (45%) had changes in GLS and or LVEF. 41/91 (45%) patients with LVEF decline did not have cardioprotective intervention implemented. Despite this, 34 (83%) of these patients completed cancer treatment. 50/91 (55%) patients did have cardioprotective interventions with 40 (78%) patients from this subgroup completing cancer treatment. 81% of patients with EF decline were able to complete treatment. 50% of patients with EF decline had EF recovery within 6 months of completion of cancer therapy. The odds of LVEF decline were 9.8 times higher for those with GLS decline (OR=9.0, p&amp;lt; 0.001). Patients with LVEF decline were more likely to have cardio preventive intervention (OR=18.8, p&amp;lt; 0.001). Multivariate analysis did not find an association between cardiac risk factors such as hypertension, diabetes mellitus, smoking, obesity and hyperlipidemia with GLS decline. There was no disparity by race. Conclusion: Our study revealed that early changes in GLS and LVEF did not impact the completion of cancer treatment irrespective of implementation of cardioprotective measures. Citation Format: Hussna E. Abunafeesa, Cortney Mckay, Pin Li, Madhulata Reddy, Vrushali Dabak. Changes in Left Ventricular Global Longitudinal Strain in breast cancer patients receiving anti-HER2 and/or Adriamycin therapy and outcomes with early implementation of cardio-protective measures [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-35.

Cancer-Related Stigma in Malawi: Narratives of Cancer Survivors.

Stigma is an impediment across the cancer care continuum, leading to delayed presentation to care, elevated morbidity and mortality, and reduced quality of life. The goal of this study was to qualitatively examine the drivers, manifestations, and impacts of cancer-related stigma among individuals who received cancer treatment in Malawi, and to identify opportunities to address stigma. Individuals who had completed treatment for lymphoma (n = 20) or breast cancer (n = 9) were recruited from observational cancer cohorts in Lilongwe, Malawi. Interviews explored the individual's cancer journey, from first symptoms through diagnosis, treatment, and recovery. Interviews were audio-recorded and translated from Chichewa to English. Data were coded for content related to stigma, and thematically analyzed to describe the drivers, manifestations, and impacts of stigma along the cancer journey. Drivers of cancer stigma included beliefs of cancer origin (cancer as infectious; cancer as a marker of HIV; cancer due to bewitchment), perceived changes in the individual with cancer (loss of social/economic role; physical changes), and expectations about the individual's future (cancer as death sentence). Cancer stigma manifested through gossip, isolation, and courtesy stigma toward family members. The impacts of cancer stigma included mental health distress, impediments to care engagement, lack of cancer disclosure, and self-isolation. Participants suggested the following programmatic needs: community education about cancer; counseling in health facilities; and peer support from cancer survivors. The results highlight multifactorial drivers, manifestations, and impacts of cancer-related stigma in Malawi, which may affect success of cancer screening and treatment programs. There is a clear need for multilevel interventions to improve community attitudes toward people with cancer, and to support individuals along the continuum of cancer care.

Response to Ovarian Stimulation for Urgent Fertility Preservation before Gonadotoxic Treatment in BRCA-Pathogenic-Variant-Positive Breast Cancer Patients.

BRCA 1/2 pathogenic variants increase the risk of developing early and aggressive breast cancers (BC). For these patients, fertility potential can be directly affected by oncologic treatments. In addition, evidence indicates that BRCA-mutated women had a significant reduction in their ovarian reserve. In order to improve their chances of conception after the completion of cancer treatments, fertility preservation should be proposed before the administration of gonadotoxic drugs, ideally by oocyte vitrification after controlled ovarian hyperstimulation (COH). The present investigation aims to assess the ovarian response to COH in BRCA 1/2-pathogenic-variant carriers diagnosed with BC. Patient characteristics and COH outcomes were compared between BRCA-positive (n = 54) and BRCA-negative (n = 254) patients. The number of oocytes recovered did not differ between the two groups. However, the oocyte maturation rate and the number of mature oocytes obtained (7 (4.5-11.5) vs. 9 (5-14) oocytes, p = 0.05) were significantly lower in the BRCA-mutated patients. Although individualized COH protocols should be discussed, BRCA-mutated patients would benefit from FP before BC occurs, in order to cope with the potential accelerated decline of their ovarian reserve, optimize the success rate of FP by repeating COH cycles, and to preserve the feasibility of PGT-M by collecting a large amount of eggs.

Emergency department visits and hospitalizations in older women treated for early stage breast cancer

IntroductionOlder patients with cancer often require acute care treatment through emergency department (ED) visits and hospitalizations. This study investigates acute care utilization through ED visits and hospitalizations during treatment and in the two years following the completion of primary treatment for early stage breast cancer (EBC) in women aged 65 and older. Materials and MethodsA retrospective analysis including descriptive statistics, univariate analysis, and relative risk analysis of 256 women with EBC was performed through medical record review of demographics, comorbidities, disease characteristics, treatment details, and causes of hospitalizations and ED visits. ResultsBoth hospitalizations and ED visits were significantly more frequent for patients in the post-primary treatment period compared to during treatment (hospitalizations: 22% post-primary treatment vs 13% during treatment, 95% confidence interval [CI] of true difference = 2.5%-15.5; ED visits: 21% post-primary treatment vs 10% during treatment, 95% CI of true difference = 4.8%–17.2%). Both hospitalizations (79% versus 32%, 95% CI of true difference = 28.7%–65.3%) and ED visits (42% versus 12%, 95% CI of true difference = 9.1%–50.9%) were more often breast cancer related during primary treatment compared to following treatment. Following treatment, EBC related hospitalizations were most often for disease progression (42%) and EBC related ED visits were most often for post-systemic therapy complications (43%). Significant predictors for EBC related hospitalizations in the two years following treatment included stage III disease (relative risk [RR] = 8.77, 95% CI = 2.50–30.82), having underwent mastectomy (RR = 12.51, 95% CI = 2.91–53.78), and having received chemotherapy (RR = 3.95, 95% CI = 1.18–13.23). However, chemotherapy does not appear to be a significant predictor for hospitalization when controlling for stage III disease (RR = 2.22, 95% CI = 0.61–8.05), whereas stage III disease remains a significant risk factor when controlling for chemotherapy (RR = 6.09, 95% CI = 1.58–23.52). DiscussionOur findings suggests that stage III disease, undergoing mastectomy, and chemotherapy treatment predict higher likelihood of EBC related hospitalization following primary treatment in older EBC patients, with stage III disease likely the strongest risk factor.