Completion Of Active Therapy Research Articles

Treatment Methods For Neck And Head Cancer

Treatment for people diagnosed with cancer does not end after the completion of active therapy. The treating physician will continue to check for cancer recurrence, monitor all sorts of side effects, and monitor your overall health. This is called follow-up. It consists of regular medical examinations and tests. Treatment of malignant tumors is accompanied by various side effects. Long-term effects persist after therapy period. Delayed side effects can take months or even years to develop. Long-term and long-term effects can include physical and emotional changes. The standards of medical care for head and neck oncology are the best of modern treatment methods. As one of the treatment options, doctors recommend considering clinical trials. With the help of clinical trials, a new approach to treatment is being tested. Experts want to know if the new treatment is safe and effective. Clinical trials are an option for treatment and cancer care at all stages of cancer. An important factor in treatment is not only the elimination of the tumor, but also the preservation of the functions of the surrounding nerves, tissues and organs. In the treatment of head and neck oncology, the following techniques are used: surgery, radiation, targeted and chemotherapy

Abstract B018: Long-term epigenetic aging in older breast cancer survivors and non-cancer controls: Preliminary findings from the Thinking and Living with Cancer (TLC) Stud

Abstract Cancer and its treatments are thought to increase risk for accelerated aging in survivors, and biological aging may be a key mechanism; however, no research to date has examined epigenetic markers of aging in long-term breast cancer survivors. We used data from the Thinking and Living with Cancer (TLC) study to examine whether older breast cancer survivors have accelerated epigenetic aging compared to non-cancer controls several years after treatment completion and whether epigenetic aging related to cognitive and physical function. Non-metastatic breast cancer survivors ages 62–84 years (n=89) and frequency-matched controls (n=101) provided two blood samples between 24- and 60-months post-diagnosis. DNA methylation profiling (Illumina Infinium EPIC array) derived epigenetic aging measures: Horvath, Hannum, PhenoAge, GrimAge, and Dunedin Pace of Aging Methylation. Participants completed neuropsychological testing and questionnaires to assess cognitive and physical function at each visit. Mixed-effects models adjusted for chronological age and comorbidities and applied false discovery rate correction for multiple testing. Survivors were 1.04–2.22 years older biologically than controls at the first blood sample based on Horvath, Hannum, and GrimAge measures (corrected ps=.025, .025, and .058, respectively), with marginal differences for Dunedin Pace of Aging (corrected p=.096); however, survivors and controls showed similar changes in epigenetic aging over time. Exposure to prior chemotherapy (with or without hormonal therapy; n=29) was associated with an epigenetic age 1.97–2.71 years older than controls (corrected ps=.005 to .065). Among survivors who received chemotherapy, an older Hannum epigenetic age was associated with poorer self-reported cognition relative to controls (coeff=-0.64, uncorrected p=.047; n.s. after correction). Older breast cancer survivors, particularly those receiving chemotherapy, showed an accelerated epigenetic aging profile compared to their peers without cancer at 24 months or more post-diagnosis, following the completion of active therapy. This study also provides preliminary evidence that survivors who received chemotherapy may be at increased risk for poorer age-related survivorship outcomes. Citation Format: Kelly E. Rentscher, Wanting Zhai, Brent J. Small, Jaeil Ahn, Tim A. Ahles, Traci N. Bethea, Elizabeth C. Breen, Harvey J. Cohen, Martine Extermann, Deena M.A. Graham, Paul B. Jacobsen, Heather S.L. Jim, Brenna C. McDonald, Zev M. Nakamura, Sunita K. Patel, James C. Root, Andrew J. Saykin, Danielle B. Tometich, Kathleen M. Van Dyk, Xingtao Zhou, Jeanne S. Mandelblatt, Judith E. Carroll. Long-term epigenetic aging in older breast cancer survivors and non-cancer controls: Preliminary findings from the Thinking and Living with Cancer (TLC) Stud [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr B018.

Rapid Implementation of Telemedicine During the COVID-19 Pandemic: Perspectives and Preferences of Patients with Cancer

IntroductionThe use of telemedicine in oncology practice is rapidly expanding and is considered safe and cost effective. However, the implications of telemedicine on patient‐physician interaction, patient satisfaction, and absence of the personal touch have not been studied to date. Following the spread of COVID‐19, telemedicine services were rapidly incorporated at the Oncology Division of Tel Aviv Medical Center. We aimed to evaluate patients' perspectives and preferences regarding telemedicine and to assess whether this virtual communication platform affects the patient‐physician relationship.MethodsBetween March 2020 and May 2020, adult cancer patients who conducted at least one successful telemedicine meeting were interviewed by trained medical personnel. The interview was based on validated patient satisfaction questionnaires and focused on patient‐physician interaction in relation to the last in‐patient visit.ResultsOf 236 patients, 172 (74%) patients agreed to participate. The study population comprised mainly patients with gastrointestinal malignancies (n = 79, 46%) with a median age of 63 years (range 21–88). The majority of patients were male (n = 93, 54%). Eighty‐nine (51.7%) patients were receiving active oncologic treatment, and 58 (33.7%) were under routine surveillance following completion of active therapy. Almost all had a sense of secured privacy (n = 171, 96%), the majority of patients affirmed that their concerns were met (n = 166, 93%) and perceived that eye contact with the treating physician was perceived (n = 156, 87%). Only a minority felt that the absence of physical clinic visits harmed their treatment (n = 36, 20%). Most patients (n = 146, 84.9%) wished to continue telemedicine services. A multivariate analysis revealed that higher satisfaction and visits for routine surveillance were both predictors of willingness to continue future telemedicine meetings over physical encounters (odds ratio [OR] = 2.41, p = .01; OR = 3.34, p = .03, respectively).ConclusionTelemedicine is perceived as safe and effective, and patients did not feel that it compromised medical care or the patient‐physician relationship. Integration of telemedicine is ideal for patients under surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform.Implications for PracticeDuring the COVID‐19 pandemic, telemedicine was rapidly implemented worldwide to facilitate continuity of quality care and treatment. Despite many potential setbacks, telemedicine has become a useful and safe tool for oncology practitioners to care for their patients. The use of telemedicine regarding patients' perspectives, emotions, and patient‐physician communication in daily oncology practice has not been studied to date. This study demonstrated telemedicine is perceived as safe and effective and does not compromise medical care or the patient‐physician relationship. Its use is ideal for surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform.

184. Seven vs. 14 Days Treatment Duration for Afebrile Men with Urinary Tract Infections; A Randomized Clinical Trial

BackgroundTrials show that shorter-duration therapy is effective for many infectious diseases, but the optimal duration for UTI in men is unknown. Observational data suggests shorter-duration performs as well as longer-duration therapy, but trial data shows men with febrile UTI (a small but important subset of patients) do worse with 7 vs. 14 days of therapy. We performed a randomized controlled trial of afebrile men with UTI to determine whether 7 days of treatment was non-inferior to 14 days.MethodsMen with symptomatic UTI at 2 VA hospitals were enrolled. Inclusion criteria included male gender, outpatient treatment, prescribed 7 to 14 days of ciprofloxacin or trimethoprim/sulfamethoxazole, and new onset of at least 1 of: dysuria, frequency, urgency, hematuria, costovertebral angle tenderness, and perineal, flank, or suprapubic pain. Exclusion criteria included UTI treatment in the past 14 days, symptoms due to a non-UTI diagnosis, and inadequate empiric treatment. Enrolled subjects took their clinically-prescribed medications days 1–7, then study medication days 8–14. Study medications were placebo or the originally prescribed antimicrobial, different in appearance from the original medication. The primary outcome was percentage of subjects with symptom resolution 14 days after completion of active therapy. Secondary outcomes included recurrence of UTI and adverse events. A pre-specified minimally clinically significant difference of 10% was selected, with a P value of 0.05 considered to be significant. Primary analysis was per-protocol; intention-to-treat performed as secondary analysis.ResultsEnrollment totaled 273, with 272 randomized to 7 (n = 136) vs. 14 (n = 136) days of antimicrobials. Mean age was 67.8 (SD 11.6), with a mean Charlson comorbidity index of 1.3 (SD 1.6). Overall, 254 subjects were in the per-protocol analysis. Symptom resolution occurred in 122 of 131 (93.1%) subjects receiving 7 days treatment, and 111 of 123 (90.2%) receiving 14 days (difference 2.9%, 95% CI -4.7 to 10.5% P = .50), confirming non-inferiority. Intention-to-treat analysis (n = 272) showed similar results.ConclusionTreatment with 7 days of antimicrobials was non-inferior to 14 days for symptom resolution. Afebrile men with UTI should not be treated beyond 7 days.Disclosures All Authors: No reported disclosures

Abstract P1-12-14: Quality of life, fear of recurrence, impact of cancer, and dietary habits in breast cancer patients during the early survivorship period - Initial data from the pilot Cas-PET (Cancer Survivorship Patient Engagement Toolkit) study

Abstract Introduction – With heightened public awareness, earlier detection, and better treatment, the number of breast cancer survivors continues to grow. Many of these cancer survivors have physical, psychological, social, spiritual, and financial challenges that require coordinated, comprehensive care. Patient involvement programs that focus on education and health promotion may help breast cancer survivors to manage their symptoms and take better control of their health. At the University of Maryland, a collaborative group developed the Cancer Survivorship Patient Engagement Toolkit (CaS-PET). CaS-PET includes the following components: survivorship care plans, online support program (learning modules and discussion board), and ongoing communication between providers and patients using a patient portal. The main aim of the study is to test the preliminary impact of the CaS-PET using a small sample. Methods – After IRB approval, 30 cancer survivors at the University of Maryland Marlene and Stuart Greenebaum Comprehensive Cancer Center who were within 6 months of completion of active treatment were enrolled in a prospective pilot study that used a single group pre-post design. The outcome measures included changes in quality of life, fear of recurrence, impact of cancer, dietary and exercise behaviors, and selected cancer symptoms. In addition, participants' demographic characteristics, as well as Internet and patient portal experiences were also assessed at baseline. Currently, baseline surveys are completed and the 3-month follow-up data collection is ongoing. Results – Among the total of 30 patients, 15 (50%) were breast cancer survivors. The median age was 57.2+13 years and all were female. Ten survivors were African American (66.7%). Most survivors received combination of surgery, chemotherapy, and radiation treatments. At baseline, the mean scores for the positive impact and negative impact of cancer were 3.69 (range, 1-5, higher means more positive) and 2.57 (1-5, higher means more negative) respectively. Among various physical and mental cancer symptoms, breast cancer patients frequently experience lack of energy, pain, bloating, sadness, and constipation. The mean score for fear of recurrence was 14.16 +6.4 (range of 6-24, higher means more fear). The average scores for fat and fruit/vegetable consumption were 17.7+6.0 and 7.6+4.1, respectively, which indicated a diet high in fat and calories and low in fruit and vegetables. Discussion – This baseline assessment shows breast cancer survivors experience significant residual symptoms following completion of active therapy. Many patients are fearful of recurrence and struggle with other negative impacts of cancer. However, patients have also found positives in their experiences. Participants have expressed enjoyment and benefit of the CaS-PET study. Full outcomes will be available in early September 2019. Citation Format: Rosenblatt PY, McQuaige M, Miller K, Nahm E-S, Hertsenberg L. Quality of life, fear of recurrence, impact of cancer, and dietary habits in breast cancer patients during the early survivorship period - Initial data from the pilot Cas-PET (Cancer Survivorship Patient Engagement Toolkit) study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-14.

Post-treatment changes in permanent retention.

While permanent retention is today the method of choice to stabilize orthodontic treatment outcomes, recent studies have increasingly reported posttreatment changes in tooth position during permanent retention. We conducted this study to analyze changes in the anterior mandible, whether the changes follow an underlying movement pattern, and, aiming for a preventive strategy, whether any risk factors could be identified comparing findings with the pretreatment situations. We included 30 patients who had worn fixed Twistflex retainers (UK 3-3) extending from canine to canine in the mandible. Casts reflecting the intraoral situations before orthodontic treatment (T0), directly after completion of active therapy (T1), and 6months later (T2) were scanned and superimposed using Imageware Surfacer software. Posttreatment changes (T2-T1) of tooth position within the retainer block were analyzed on 3D virtual models and were compared to pretreatment (T0) and treatment-related (T1-T0) findings to identify potential risk factors. Almost all analyzed patients revealed three-dimensional changes in tooth position within the retainer block. Comparing these movements, we repeatedly found rotated retainer blocks in labio-oral direction, while the center of rotation was located at the first incisors. This pattern was associated with intercanine expansion and excessive overjet correction during orthodontic treatment. The canines underwent the most pronounced (rotational and translational) movements. In general permanent lingual retainers are safe but in special clinical cases retainers can induce undesired tooth movement. Risk factors seem to be intercanine expansion and excessive overjet correction during orthodontic treatment. In specific cases an additional retention device might be needed.

Patterns of Loss to Follow-Up Care Among Childhood Cancer Survivors.

Surveillance for long-term complications related to previous cancer therapy can help diagnose/manage chronic health conditions in childhood cancer survivors and improve survivor quality of life. However, a challenge to delivering long-term care to childhood cancer survivors is loss to follow-up; many patients discontinue care at specialized survivor care centers. The purpose of this study was to examine patterns of loss to follow-up among a cohort of childhood cancer survivors. This retrospective study examined follow-up patterns among a nonrandom representative sample of 370 childhood cancer survivors among 1116 patients from a single institution. The median age of patients at diagnosis was 10.2 years (range <1-21). Factors potentially related to follow-up were utilized to evaluate patterns of follow-up across 5-year intervals following completion of active therapy. The association between patient characteristics and follow-up was evaluated using univariate and multivariate binomial regression models. The probability of follow-up 1-5 years post-treatment was 91.2% (89.7%-92.5%) but dropped to 68.5% (66.2%-70.8%) during years 6-10, 47.7% (45.0%-50.3%) during years 11-15, and continued to steadily decrease over time. Overall, white race, diagnoses at younger ages, patients with lymphomas/leukemias, and decade of diagnosis were each associated with somewhat better rates of follow-up. These findings highlight the lack of follow-up by adult survivors of childhood cancer with only approximately one-half of patients returning for follow-up 10 years after completion of therapy. Interventions focused on educating both patients and primary care physicians may help to increase long-term follow-up care among this at-risk population.

A new survivorship model for adolescents and young adults (AYA).

43 Background: The AYA population is a growing group of cancer survivors, currently exceeding 600,000 in the US, with 70,000 new diagnoses each year. These survivors experience deficits in general health, mental health, and functional status. Unfortunately, many are lost to follow-up after the completion of active therapy. They lack clarity about where to go for care and why such care is needed. To further complicate this, many have not established a primary care provider (PCP). Methods: We present a model of survivorship care tailored to the AYA population. Our clinic has dedicated physical space and is staffed by pediatric- and adult-trained oncologists. Survivors are paired with age-matched peer navigators to guide them through the logistics of follow-up care and assist with age- related transitions in education, housing, and insurance. Additionally, we have established a new model of survivorship care, introduced immediately at the end of active therapy, utilizing a staged curriculum, survivorship care plans, and point-of-care health-related quality of life assessment. Results: Fifty-five unique patients seen in 182 visits provided data for this report. The median age was 26 years (range 18-40). Twenty-nine (53%) of the patients were female. The majority of patients (58%) had been treated for a hematologic malignancy. One third of patients had completed college (31%). Most were employed (71%), but a majority still lived with their parents (64%). The majority of patients had more than one late effect (62%). Twenty-three (43%) reported mental health symptoms, including anxiety, mood swings, or sleep problems. Conclusions: A survivorship clinic with tailored programs for AYAs is feasible and necessary. In our sample, many AYA survivors have late effects and almost half reported psychosocial distress. Clinicians need to monitor this age group closely to ensure that patients are not lost to follow-up as they transition from active treatment to survivorship care and from pediatric to adult-based care. Our clinic provides an integrated medical home for the AYA survivor that continues to care for them when active treatment comes to completion and provides ongoing care coordination with PCPs and subspecialists to co-manage their complex health issues.

Supervised exercise for cancer survivors during and after active therapy.

121 Background: Supervised exercise for cancer survivors can reduce symptoms and improve physical conditioning. This program evaluation reports the benefits of a nurse-supervised exercise program for cancer survivor participants both during and after active cancer therapy. Methods: The treating oncologist referred participants to the oncology rehabilitation program, called Moving On, either during or at the completion of active therapy. Participants enrolled in a 12-week program of supervised exercise for one hour, three days per week. Baseline and follow up evaluation included a patient reported fatigue score, on a scale from 1 to 10 (with higher scores indicating more fatigue), and the 6-minute walk test (6MWT), in feet. Results: In calendar 2011, 152 participants enrolled in the program and 91 completed all 12 weeks (completers). Participants were 71% female, 86% Caucasian, 14% African American, 68% enrolled on completion of active therapy, and 32% enrolled during active therapy. More than half were older than 60 years. More than half had cancer diagnoses other than breast cancer. A consistent decrease in fatigue and increase in exercise capacity was seen in subgroup analysis by gender, race, age, status on cancer therapy or after completion of therapy, and diagnosis. Conclusions: In this diverse group of cancer survivors, a program of 12 weeks of nurse-supervised exercise was feasible, substantially reduced fatigue, and increased exercise capacity. It is noteworthy that participants, both on active therapy and after, older and younger, and across diagnosis groups, experienced the benefits of the program. [Table: see text]

Rapid maxillary expansion. A study of the long-term effects

A study was made to determine whether skeletal alterations usually produced by rapid maxillary expansion may be compensated for in time by growth and/or comprehensive orthodontic treatment. In 30 patients, orthodontic treatment was started with rapid maxillary expansion, followed by fixed appliances, not combined with any other form of orthopedic device. Mean treatment time was 3.1 years. Nine measurements from the Ricketts analysis were studied, based on lateral cephalometric radiographs. Records were taken before orthodontic treatment and after completion of active therapy. A statistical analysis was made of the nine variables used, reflecting the vertical and anteroposterior skeletal proportions of the face, contrasting the changes before and after treatment. Of all the variables studied, the four that change with age according to the Ricketts analysis (mandibular plane angle, maxillary height, facial depth and facial convexity), yielded statistically significant differences after treatment, indicative of normal growth. The five remaining variables that remain constant with age according to the Ricketts analysis (facial axis, lower facial height, total facial height, palatal plane inclination and maxillary depth) showed no significant changes after treatment, also indicative of normal growth. (A M J O RTHOD D ENTOFAC O RTHOP 1996;109:361-7.)

Maintenance Therapy in Young Adults With Severe Generalized Periodontitis

The purpose of this study was to evaluate one year of maintenance therapy in young adults with severe periodontitis (SP) who had previously received periodontal therapy consisting of root planing and scaling followed by open flap debridement. Subjects were evaluated with clinical and microbiological measurements at 3, 6, 9, and 12 months following the completion of active therapy. Subjects were included in the study if they completed a minimum of two evaluation appointments. Monitoring of these subjects during the maintenance phase was analyzed by three methods. First, changes in mean attachment level and mean probing depth were calculated at 3-month intervals to determine if the subjects continued to lose or gain attachment and/or had periodontal pockets of increasing or decreasing depth. Second, the frequency of periodontal breakdown was determined and compared to breakdown rates of subjects in other patient populations. Third, future changes in attachment level were related to the presence or absence of two putative periodontal pathogens, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in subgingival plaque. Mean attachment level remained constant in 13 subjects who completed one year of maintenance therapy. However, mean probing depth increased at a yearly rate of 0.19 mm and in periodontally-involved sites pocket depth increased at a yearly rate of 0.65 mm both of which were statistically significantly different from 0 (P < .05). The frequency of periodontal breakdown in this study was higher than reported in other similar studies of different periodontitis patient populations. The remainder of the data in the study was from 21 subjects who had completed at least two recall appointments.(ABSTRACT TRUNCATED AT 250 WORDS)

On the design of looped orthodontic retainer wires.

Removable Hawley orthodontic retainers have long been prescribed by clinicians following completion of active therapy. Only minor changes have occurred in the design of the retainer over the past 40 years. Structural, in-service failures of this appliance are typically: 1) permanent (inelastic) deformation of the as-prepared labial bow from masticatory action that induces unwanted force transmitted by the appliance to the dentition; or 2) accumulated material damage from removal and replacement of the retainer that eventually results in fracture of the labial bow. This paper reports the results of a series of experimental studies; the overall objective was the optimization of the appliance design, focusing on the labial bow. Wire size, material, temper, canine-loop height, markings for bend placements, heat-treatment of the prepared bow, and two procedures for removing and replacing the appliance were investigated. The collective outcomes suggest a combination of design-parameter values to help maximize the life of the labial bow of the retainer.

Long-term maintenance of patients treated for advanced periodontal disease.

The aim of the present investigation was to evaluate the periodontal conditions of a group of patients who, following active treatment of extremely advanced periodontal disease, had been maintained for 14 years in a well-supervised maintenance care program. The present sample included 61 subjects out of an initial group of 75 individuals who in 1969 were referred to and treated by the authors. Following an initial examination, the patients were given detailed instructions in proper plaque control measures and were subjected to scaling and root planning and surgical elimination of pathologically deepened pockets. After the termination of the active treatment phase, the patients were placed in a maintenance care program including recall appointments every 3-6 months. At the initial examination, immediately after the completion of the active treatment phase and then once a year, all patients were examined regarding oral hygiene, gingival conditions, probing depths and clinical attachment levels. In addition, the interproximal alveolar bone height was determined from full mouth radiographs obtained before active treatment, at the completion of active therapy and 1, 3, 5, 8, 10, 12 and 14 years after treatment. The results from the repeated examinations demonstrated that treatment of advanced forms of periodontal disease resulted in clinically healthy periodontal conditions and that this state of "periodontal health" could be maintained in most patients and sites over a period of 14 years. It was also demonstrated that the treatment and maintenance programs described were equally effective in young and older patients. The individual mean values describing probing depths, attachment levels, and bone heights did not vary significantly over the 14 years of observation. A more detailed analysis of the data revealed, however, that a small number of sites in a few patients lost a substantial amount of attachment. This attachment loss occurred at different time intervals during the course of the maintenance period. Thus, 43 surfaces in 15 different patients were exposed to recurrent periodontal disease of a significant magnitude. This recurrent inflammatory periodontal disease caused the loss of 16 teeth in 7 different patients during the maintenance period. The data reported question the validity of using individual mean values to describe alterations of the periodontal conditions during maintenance following active periodontal therapy.