End Of Cancer Treatment Research Articles

Abstract B59: Cardiometabolic complications after pediatric cancer: Associations with chemotherapeutic agents and body-mass-index fluctuations

Abstract Introduction: Survivors of childhood cancer are at risk of cardiometabolic complications including dyslipidemia, obesity, insulin resistance, and hypertension. In addition, children undergoing chemotherapy often suffer from substantial side effects including rapid weight gain, transient hypertension, and elevated blood glucose and lipids. However, little is known about the cardiometabolic health of children shortly after cancer treatment. This study aims to describe the cardiometabolic profile of children after treatment and to study the factors associated with these complications. Methods: Participants were recruited at Sainte-Justine UHC in Montreal as part of the VIE Program (Valorization, Implication, Education). Cardiometabolic health was assessed with biochemical, clinical, and anthropometric measures. Data on treatment (diagnosis, chemotherapeutic agents, and doses) were obtained from medical files. Results: Evaluations were performed on 71 participants (45% boys; median age: 9.8 years; 42% with acute lymphoblastic leukemia; median time since last treatment: 1.4 years, range: 0.2-3.5 years). Our assessment showed that 28% had hypertension, 27% were obese, 19% had altered glucose metabolism, and 33% had dyslipidemia. The risk of having dyslipidemia was associated with higher age [relative risk (RR): 1.28, 95%CI: 1.14-1.44, P<0.01] and body mass index (BMI) (RR: 1.76, 95%CI: 1.11-2.78, P=0.02). Participants who increased their BMI during treatment were at higher risk of obesity (RR: 3.01, 95%CI: 1.44-6.29, P<0.01). The increase of BMI during treatment was associated with exposure to glucocorticoids (coefficient β: 0.56, 95%CI: 0.13-0.98, P=0.01) and to methotrexate (coefficient β: 0.73, 95%CI: 0.34-1.11, P<0.01). Conclusion: We found important alterations of children’s cardiometabolic profile shortly after the end of cancer treatment. Increased BMI during and after treatment and exposure to corticosteroids and methotrexate were factors associated with cardiometabolic health. This stresses the importance of maintaining a favorable nutritional status during cancer therapy. Early nutritional interventions promoting sustainable healthy eating habits may contribute to limit cardiometabolic complications in the short and long term. Citation Format: Veronique Belanger, Alexandre Warin, Elitsa Tonova, Isabelle Bouchard, Caroline Meloche, Daniel Curnier, Serge Sultan, Caroline Laverdiere, Daniel Sinnett, Valerie Marcil. Cardiometabolic complications after pediatric cancer: Associations with chemotherapeutic agents and body-mass-index fluctuations [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr B59.

Abstract D059: Bridge to Good Living: Thriving beyond lung cancer in West Virginia

Abstract Introduction: The goal of the Bridge Program is to improve the overall coordination of care, increase quality of life, and decrease the consequences of treatment for patients diagnosed with lung cancer. Brief Description: Patients diagnosed with late stage lung cancer are often referred to supportive or palliative care programs that provide symptom management, psychosocial support and follow up, as well as advanced planning. In contrast, the needs of patients diagnosed at a curable or early stage often go unaddressed. The focus of the Bridge Program is to develop and implement a comprehensive survivorship program for Stage 1-3 lung cancer patients completing curative treatment. The Bridge Program enrolls and assesses patients at the end of cancer treatment utilizing a multidisciplinary team approach. The Program’s goal is to improve patient and caregiver quality of life in the major life domains of physical, social, psychological, and spiritual. We see this program bridging patients from active cancer care to the next step on their journey in life. Using a multidisciplinary team approach creates an opportunity for collaboration and information sharing that leads to the development of an enhanced survivorship care plan. Summary of Data: Between March 2017 and June 2019, the Bridge Program enrolled 81 patients across three locations. At the end of cancer care, 100% of these patients had at least one unmet need and nearly half had seven or more. Assessment identified a total of 540 unmet needs which resulted in 132 clinician referrals. When categorizing unmet needs into physical, practical, and emotional domains, Bridge patients identified more unmet needs in the physical category than any other. The most common referrals were for Physical Therapy and Occupational Therapy. Following enrollment into the Program, 93% of Bridge patients showed a decrease in the number of unmet needs at their first recurrence and monitoring visit. When comparing a cohort of Bridge enrolled verses non-Bridge patients, we found that prior to visiting the Emergency Department, Bridge patients contacted their treatment team at a higher rate than non-Bridge patients and that the completion of Survivorship Care Plans was 100% for Bridge patients and only 38% for non-Bridge patients. Conclusion: Lung cancer patients have many unmet needs following active treatment for lung cancer. The Bridge Program addresses a cancer that is not frequently talked about in survivorship care: lung cancer. With increased screening and improvements in treatment, we can anticipate an increase in the number of lung cancer survivors. The Bridge Program provides a novel patient-centered model that addresses a cohort of patients that are often older and sicker than other cancer patients. Note: This abstract was not presented at the conference. Citation Format: Stephenie K Kennedy-Rea, Anne Swisher, Adrienne Duckworth, Tara Miller, Salman Osmon, Abby Starkey, Megan Burkart, Garth Graebe, Mary Anne Yanosik, Rachel Harper, Amy Allen. Bridge to Good Living: Thriving beyond lung cancer in West Virginia [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D059.

Survivorship care plans have minimal impact on health actions

Commentary on: Hawkins-Taylor C, Anderson DG, Carlson A, et al . Survivorship care plans: health actions taken and satisfaction after use. Oncol Nurs Forum 2019;46:585–94. Survivorship Care Plans (SCPs) are...

HoSAGE: Sarcopenia in Older Patients before and after Treatment with Androgen Deprivation Therapy and Radiotherapy for Prostate Cancer.

Sarcopenia is a muscle disease defined by a loss of muscle strength associated to a decrease in skeletal muscle mass. In addition to aging, many factors may contribute to sarcopenia as cancer and/or androgen deprivation therapy (ADT). The aims of this study are to describe the prevalence of sarcopenia in older prostate cancer patients before initiation of treatment with ADT and radiotherapy, and to evaluate the impact of ADT on the occurrence or aggravation of sarcopenia in this population. longitudinal study. Sarcopenia was prospectively evaluated in 31 consecutive patients aged 70 to 88 years, referred in one hospital unit of south eastern France, for a comprehensive geriatric assessment (CGA) before cancer treatment initiation. CGA, measures of muscle strength and physical performances were performed at baseline (T0) and at the end of cancer treatment (T1). Appendicular skeletal muscle mass was measured by Dual-energy X-ray absorptiometry (DXA) at the end of treatment. At T0, 8 patients (among 31) had a probable sarcopenia according to European consensus, and 18 had altered physical performance. At T1, 15 patients (among 19) had abnormal one leg balance test. Finally, only one patient had a sarcopenia confirmed by DXA. This preliminary study showed a high prevalence of muscle disorders before initiation of ADT in a population of elderly cancer prostate patients with intermediate frailty status, and an increased risk of falls at the end of ADT. This highlighted the importance of screening for sarcopenia before treatment initiation, to prevent the occurrence or aggravation of sarcopenia by possible adjustment of treatment, and implementation of appropriate exercise and nutrition interventions.

Development and Content Validation of End of Treatment Questionnaires for Children With Cancer.

Purpose: To describe the development and content validation of measures to assess the psychoeducational needs of children, adolescents/young adults (AYAs), and their parents at the end of successful treatment for cancer. Method: Professional experts, which included pediatric oncology nurses and advanced practice registered nurses, conducted a systematic review of the literature to determine specific end of treatment (EOT) needs of children and AYAs with cancer and their parents and evaluate available tools to measure these needs. From this review, two EOT questionnaires were initially developed. Oncology Family Advisory Board (FAB) members served as experiential experts in refining and validating these questionnaires. FAB members participated in a content validation process, rating questionnaires online, and subsequently participating in a focus group to establish content validity (n = 6). Results: Three EOT questionnaires were ultimately developed. The Child/AYA questionnaire was divided into two separate measures for developmental and literacy considerations. The Parent/Caregiver and the AYA questionnaires each contain 38 items with a content validity index score of 100%. The Child questionnaire contains 37 items with a content validity index score of 100%. Conclusion: Content validity was established for three EOT questionnaires, each of which has the potential to elicit information regarding needs and potential gaps in services perceived by childhood cancer survivors and their parents. Further psychometric testing is needed to determine stability (test-retest reliability) and construct validity of the questionnaires.

CN47 - Young people’s experiences when active cancer treatment ends

BackgroundThe end of active treatment is known to be a period of high stress in young people’s cancer timeline but little is known about young people’s experiences in this transition phase. This study aimed to understand the experiences and needs of young people at the end of treatment (EoT), how these are currently being met, and how best to provide support to young people. MethodsThis was a multi-stage, mixed methods study, conducted from January to December 2018, exploring the EoT experience from the perspectives of young people and healthcare professionals caring for them. This paper reports on the EoT experiences of young people (n=11), all within 12 months of EoT, who participated in semi-structured telephone or face-to-face interviews. Interviews were transcribed and analysed using thematic analysis. ResultsThree key themes emerged from the data relating to young people’s experience of ending active treatment: 1) Challenges with social reintegration; 2) Expectations versus the reality of ending treatment; 3) Sudden loss of the safe “bubble” of treatment. Some young people reported feeling isolated from their peers after they finished treatment, feeling they no longer belonged to previous peer groups. Young people reported challenges in managing both their own expectations and expectations of others about how they would feel at the end of treatment, versus the reality of how they actually felt both physically and psychosocially. They did not expect to experience onerous ongoing physical issues including pain, nausea and fatigue. Additionally, young people experienced a range of conflicting emotions: excitement, happiness, nerves, fear, shock, surprise and uncertainty. They described realising they were no longer regularly surrounded by healthcare professionals, and feared the loss of the familiar routine of regular hospital visits. ConclusionsEnd of treatment is a transition that results in changed relationships, routines, assumptions and roles. Young people often lacked awareness of and were under prepared for this. Having a better understanding of the unpredictable and ongoing nature of both physical and psychosocial issues they may face at the EoT would be beneficial, as would reassurance that challenges during this transition period are both acceptable and expected. Legal entity responsible for the studyUniversity College London Hospitals NHS Foundation Trust. FundingTeenage Cancer Trust. DisclosureAll authors have declared no conflicts of interest.

End of treatment bells in cancer wards: sound of hope or upsetting jangle?

Ringing a bell to mark the end of cancer treatment is becoming more common in the NHS but, while some find it rewarding and positive, others find it distressing

Return to work after breast cancer treatments: Rebuilding everything despite feeling "in-between".

The aim of this longitudinal qualitative study is to describe the return-to-work (RTW) journey from the end of breast cancer (BC) treatments to RTW. Nine BC survivors were recruited in the province of Quebec (Canada). The participants, francophones between 30 and 60 years old, had received chemotherapy treatments and planned to RTW in the next six months. The interviews were performed at the end of cancer treatments (n = 9), one month before RTW (n = 9), and after RTW (n = 5). A content analysis was performed based on an iterative process. The first six months after the end of treatment was identified as an "in-between" period, during which participants questioned their ability to return to normal life due to the impact of side effects and a sense of withdrawal from health-care services. A three-stage journey similar to a rite of passage process (Van Gennep, 1969) was observed. 1) BC survivors became aware of feeling on the fringes of the workplace as they awaited RTW. 2) During that waiting period, BC survivors were rebuilding a "normal routine" and taking actions on their own in order to re-enter their workplace. 3) After RTW, they needed to make adjustments to maintain a work routine. Support for BC survivors resuming their active lives needs to be optimized. BC survivors require support on side effect management, RTW decision-making, and resources for resuming daily activities. Nurses must be aware of the "in-between" period so that they can help BC survivors rebuild their confidence during this rite of passage process.

Gaps and delays in survivorship care in the return-to-work pathway for survivors of breast cancer-a qualitative study.

The number of survivors of breast cancer (bca) in Canada has steadily increased thanks to major advances in cancer care. But the resulting clientele face new challenges related to survivorship. The lack of continuity of care and the side effects of treatment affect the resumption of active life by survivors of bca, including return to work (rtw). The goal of the present article was to outline gaps and delay in survivorship care in the rtw pathway of survivors of bca. This qualitative interpretative descriptive study recruited 9 survivors of bca in the province of Quebec. Interviews were conducted at the end of cancer treatments (n = 9), 1 month before rtw (n = 9), and after rtw (n = 5). In an iterative process, a content analysis was performed. The interviews highlighted gaps in survivorship care and the paucity of dedicated resources for cancer survivors. Participants received neither a survivorship care plan nor information about cancer survivorship (for example, transition to a new normal, side effects, rtw). Support for survivors of bca resuming their active lives has to be optimized. We suggest that health professionals have to intervene at 1, 3, and 6 months after cancer treatment. At those points, survivors of bca need support for side-effects management, the rtw decision, resource navigation, and reintegration of daily activities. Also, delay in clinical pathways seems to be longer, and much attention is needed to accompany the transition to a "normal life" after cancer.

Experiences of adult cancer survivors in transitions

PurposeTo understand the experiences of adult cancer survivors as they transition from the end of cancer treatment to follow-up care as a basis for developing actionable recommendations to integrate cancer care delivery and survivorship care.MethodsA national survey was conducted in collaboration with ten Canadian provinces to identify unmet needs and experiences with follow-up for cancer survivors between 1 and 3 years post-treatment. Surveys were available in English and French and completed either on paper or on-line. Samples were drawn from provincial cancer registries and packages distributed by mail.ResultsA total of 40,790 survey packages were mailed out across the ten provinces and 12,929 surveys were completed by adults (age 30+ years), and 329 surveys were completed by adolescents and young adults (age 18 to 29 years) giving an overall response rate of 33.3%. For the purposes of this publication, the focus will be on the adult sample. In the adult cohort (age 30+ years), 51% of the sample were females, 60% were 65 years of age or older, and 77% had not experienced metastatic spread. Three-quarters reported their health as good/very good and 82% that their quality of life was good/very good. Overall, 87% experienced at least one physical concern, 78% experienced at least one emotional concern, and 44% experienced at least one practical concern. The average number of concerns reported for each domain ranged from 2.0 to 3.8. For those who sought help, a third experienced difficulty obtaining assistance or did not receive it. The most frequently cited reasons for not seeking help was that someone had told them what they were experiencing was normal.ConclusionsThe results indicate that many adult survivors have concerns about physical, emotional, and practical issues but are not receiving help to reduce their suffering. It is imperative we take action to correct this current reality.

Issues experienced and support provided to adolescents and young adults at the end of active treatment for cancer: A rapid review of the literature

The end of active treatment is a stressful period for adolescents and young adults (AYA), but little is known about AYA experiences at this time point. The aim was to describe the issues young people experienced and identify interventions to support AYA at the end of treatment. We conducted a rapid review of published primary research to identify what is currently known about AYA experiences of the end of treatment, the issues which arise and existing interventions to support AYA at this time. Searches identified 540 papers of which 16 met the inclusion criteria. Five main themes were identified: physical/medical issues; psychological, social and emotional issues; information and support needs; sources of information and support; and difficulties accessing information and support. Within these broader themes, several subthemes were identified and explored further. Adolescents and young adults are under prepared for the unpredictable and ongoing nature of the physical, psychological and social issues they face at the end of cancer treatment. Enabling young people's inclusion within their relevant social and educational peer networks should be a priority. Timely, structured and equitable information/support is needed to prepare AYA for treatment ending and subsequent reintegration to "everyday" life.

Survivorship: The UHealth patient experience.

183 Background: The University of Miami has a formal Survivorship Program based on the Commission on Cancer (CoC) requirements. CoC requires accredited institutions to deliver survivorship care plans (SCP) to patients who fit analytic criteria. There is a lack of research on the patient experience as it pertains to survivorship care. Methods: Using a Likert-type scale, dual language survey (English and Spanish), patients were asked 6 questions about the Survivorship Clinic visit ranging from scheduling feasibility to information received during the visit and any opinions to improve the visit for future patients. Patients were given two weeks to complete the survey through a secure, HIPAA compliant online source (REDCap). Those who did not reply were called on the phone by a registered nurse to obtain a statistically significant sample size. Results: Of the 236 patients that were contacted, 45 responded (Breast 38.3%, Gastrointestinal 12.8%, Prostate 10.6%, Gynecologic 8.5%, Lymphoma 6.4%, Lung 6.4%, Sarcoma 4.3%, Other 12.8%). Our results found that 95.7% of patients would recommend this visit to anyone who has completed cancer treatment. Also, 59.6% of patients found the SCP to be most helpful, followed by Survivorship Provider input (38.3%) and then American Cancer Society Healthy living tips (36.2%). As a note, it was mentioned in free text that 11.1% would have preferred a similar visit at the beginning of treatment, at the completion of treatment and/or incremental follow up. Of those surveyed, 88.9% were referred to nutrition, 44.4% to exercise physiology and 27.8% to psychology/psychiatry. Conclusions: Of the patients surveyed 95.7% were satisfied with the survivorship visit. Our conclusion based on survey results shows that institutions should continue to provide formal survivorship care as per CoC requirements. Future directions should look at expanding services to patients at diagnosis and throughout the continuum of treatment and follow up. As survivorship programs grow, practices should consider increasing resources to accommodate the identified needs of patients at the beginning and end of cancer treatment.

Staying alive? Navigating Uncertainty in Cancer in Childhood

Abstract In this article we explore how institutions and individuals in Denmark deal with uncertainty of cancer in childhood. Based on a seven months ethnographic fieldwork conducted on a paediatric oncology ward from 2011-2013, we examine how uncertainty and insecurities manifest in the interface between cancer treatment and childhood in the Danish welfare state. We develop our argument theoretically with the American pragmatist philosophy and its ideas that people are responding to a hazardous world in constant transformation. Through a focus on micro practices we explore how uncertainty manifests especially for children and their families, and how they navigate insecurities. Important collective attempts to create some measure of certainty and security are done in treatment practices, but we argue that biomedical practices dealing with uncertainty of cancer paradoxically give rise to existential and social uncertainty among children and their families, which they struggle with, also after the end of cancer treatment, as long-term social effects of cancer in childhood. We suggest that more attention could be paid to assist children in dealing with uncertainty and insecurities imminent to being in cancer treatment in the Danish welfare state and the social effects of this.

Where did everybody go? Working with anxiety when cancer treatment ends

Anticipating the end of cancer treatment, we think we will be nothing but relieved. In most cases, there is significant relief, but also significant fear. To add to the difficulty, when cancer treatment finishes, so do most supportive programs. People expect us to be “back to normal” now that we “have our life back”, even though our perspective on life may well have changed during the process of cancer treatment. Ultimately, we can feel quite alone, worried about the cancer coming back and not being sure how to live this new reality.This workshop invites practicing psychosocial clinicians and allied health professionals to learn to integrate a host of effective holistic techniques to patients and caregivers at this uniquely stressful time. In this experiential workshop learn body-centered tools to soften the fear of recurrence, re-balance the nervous system and help people both settle and thrive into this “new normal” life.

A Real-Life Analysis of Reproductive Outcome after Fertility Preservation in Female Cancer Patients

Background: Fertility preservation before or during cancer treatment in young women has become an important health issue because of delayed motherhood and improved survival rates. This study evaluates the necessity and the efficacy of fertility preservation, with a focus on actual pregnancy wish and outcome after fertility preservation and cancer treatment. Patients and Methods: All consecutive patients who received fertility preservation in 2 university referral centers before or during cancer treatment were included. After a minimal follow-up of 3 years, pregnancy wish, pregnancy attempts and fertility outcome were assessed during a dedicated consultation or during a telephone interview. Results: A total of 159 patients received fertility preservation including hormonal protection with gonadotropin-releasing hormone agonist (n = 93, 58.5%), ovarian tissue cryopreservation (n = 44, 27.7%), and combined hormonal protection and ovarian tissue cryopreservation (n = 22, 13.8%). Among the 91 (57.2%) patients in remission after a mean follow-up of 61.5 months, 29 (31.9%) women actively attempted pregnancy. Patients who had received ovarian cryopreservation were more likely to attempt pregnancy (18/66) than those who only received hormonal protection (11/93, p = 0.02). Out of the 29 women who attempted pregnancy, 16 (55.2%) became pregnant, and most of them conceived spontaneously (87.5%, 14/16). Out of the 13 women who did not become pregnant, 1 patient adopted a child and 12 patients still wanted to become pregnant, including 1 patient who underwent a transplantation of her cryopreserved ovarian tissue without success. Conclusion: In one of the first studies reporting real-life experience in centers for fertility preservation, we found that, within 5 years following the end of cancer treatment, only one third of patients in remission attempted to become pregnant, with a pregnancy rate of 55%, mostly after spontaneous conception.

Long-term effectiveness and moderators of a web-based tailored intervention for cancer survivors on social and emotional functioning, depression, and fatigue: randomized controlled trial

PurposeThe web-based computer-tailored Kanker Nazorg Wijzer (Cancer Aftercare Guide) supports cancer survivors with psychosocial issues during cancer recovery. The current study investigates whether the 6-month effects in increasing emotional and social functioning and reducing depression and fatigue hold at 12 months from baseline. Moreover, it explores whether patient characteristics moderate the 6- and 12-month intervention effectiveness.MethodsCancer survivors from 21 Dutch hospitals (November 2013–June 2014) were randomized to an intervention (n = 231) or a wait-list control group (n = 231). Intervention effects on emotional and social functioning (EORTC QLQ-C30), depression (HADS), and fatigue (CIS) were evaluated through multilevel linear regression analyses.ResultsAt 12 months from baseline, the intervention group no longer differed from the control group in emotional and social functioning, depression, and fatigue. Moderator analyses indicated that, at 6 months, the intervention was effective in improving social functioning for men (d = 0.34), reducing fatigue for participants ≤56 years (d = 0.44), and reducing depression for participants who received chemotherapy (d = 0.36). At 12 months, participants with a medium educational level reported higher social functioning (d = 0.19), while participants with a low educational level reported lower social functioning (d = 0.22) than participants with a similar educational level in the control group.ConclusionsThe intervention gave cancer patients a head start to psychological recovery after the end of cancer treatment. The control group caught up in the long run.Implications for cancer survivorsThe Cancer Aftercare Guide expedited recovery after cancer treatment. Being a low intensity, easy accessible, and relatively low cost intervention, it could serve as a relevant step in recovery and stepped care.

Existential support needs following cancer treatment with curative intent

Aims Research in recent years reveals that people can experience a range of existential difficulties following the end of cancer treatment. However, few studies have examined how to best support people with these needs. The aim of this study is to explore what support may be required to help people manage their existential concerns following the end of treatment. It is the second part of a study that examined the existential concerns of the same participants (Lagerdahl, Moynihan and Stollery 2014). Method Eight participants recounted their post-treatment experiences through qualitative methods, and inductive thematic analysis was used to systematically organise those experiences. Results Participants wished for greater continuity of care and information following the end of treatment, and requested mandatory and holistically focused follow-up appointments, as well as specialised psychological support. Conclusion In accord with National Cancer Survivorship Initiative goals, there is a need to establish holistic support in hospitals with follow-up consultations that acknowledge existential experiences, to effectively aid patients in their transition to life beyond cancer.

Prevalence of obstructive sleep apnoea syndrome following oropharyngeal cancer treatment: A prospective cohort study

To evaluate the prevalence of obstructive sleep apnoea syndrome (OSAS) in a population of patients treated for an advanced oropharyngeal cancer (AJCC Stage III or IV), depending on treatment strategy, and to evaluate its impact on quality of life. Prospective cohort study. University Teaching Hospital of La Conception, Marseille, France. Fifty-one disease-free patients were included. Forty-one patients received a combined chemoradiotherapy, while 10 patients were treated by surgery followed by chemoradiotherapy. Every patient underwent a formal sleep consultation and was asked to complete the Epworth Sleepiness Scale and EORTC QLQ C-30 and the EORTC H&N 35 questionnaires. A home overnight respiratory polygraphy was performed in every subject. The mean time between the end of cancer treatment and the OSAS analysis was 54.04 months [20; 84]. An OSAS was found in 25.49% of our patients. There was no significant difference between patients treated with either surgery (30%) or CRT (24.39%), P=.79. The EORTC QLQ C-30 questionnaire showed a significant difference between positive and negative OSAS groups in the Global Health Status Scale (50.64 vs 67.11, P=.02) and in the fatigue item (35.04 vs 17.25, P=.03). Our population with advanced oropharyngeal cancer, whatever the treatment strategy it may be, was at risk of developing OSAS with negative impact on quality of life. A routine screening and treatment of OSAS seems necessary to improve the quality of life of patients treated for advanced oropharyngeal cancer.

Unmet psychosocial supportive care needs and psychological distress in haematological cancer survivors: The moderating role of psychological flexibility

BackgroundThe period immediately after the end of cancer treatment is a time when supportive care for the cancer patient decreases; this is known to increase risk of psychological distress and poor wellbeing. While there is broad recognition that unmet psychological and supportive care needs correlate with psychological wellbeing, little is understood about the factors that influence this relationship. This study explores the role of psychological flexibility, with a particular focus on its potential moderating role between unmet needs and psychological distress in haematological cancer survivors. Materials and methodHaematological cancer survivors were recruited for this cross-sectional study through two major UK blood cancer charities. Participants (n=91) were all over the age of 16 and had been diagnosed with any sub-type of haematological cancer more than 18 months previously. Participants completed self-report questionnaires assessing unmet psychological and supportive care needs (SCNS SF34), anxiety and depression (HADS), quality of life (EORTC QLQ-C30) and psychological flexibility (AAQ II). ResultsHigh levels of both unmet need and distress were present in the sample, indicating on-going care needs for these cancer survivors. Statistically significant correlations between unmet needs, psychological flexibility and all outcome variables (anxiety, depression, quality of life) were found. Using regression analysis based on Hayes’ methodology (Hayes, 2013), psychological flexibility was found to act as a moderator between unmet need and distress in four out of 15 models; specifically, the statistical relationship between need and distress emerged only when levels of psychological flexibility were at average level or above. DiscussionHaematological cancer survivors have on-going supportive care needs that persist well beyond the end of active treatment. Unmet needs can, in turn, increase levels of anxiety and depression, and reduce quality of life in this patient group. The understanding offered by our data that psychological flexibility plays a moderating relationship between need and psychological distress creates opportunities for the development of theoretically-informed interventions to reduce both unmet need and distress in cancer patients. As such, these findings support the growing emphasis on Acceptance and Commitment based interventions for cancer patients.

Hearing loss after platinum treatment is irreversible in noncranial irradiated childhood cancer survivors

ABSTRACTCisplatin and carboplatin are effective antineoplastic agents. They are also considered to be potentially highly ototoxic. To date, no long-term follow-up data from well-documented cohorts with substantial numbers of childhood cancer survivors (CCS) with platinum-related hearing loss are available. Therefore, in this study, we studied the reversibility of ototoxicity from discontinuation of treatment onwards in a national cohort of platinum-treated survivors with hearing loss at the end of cancer treatment. Of the 168 CCS with follow-up audiograms, we longitudinally evaluated the course of hearing function in 61 CCS who showed hearing impairment at discontinuation of treatment according to the Münster criteria (>20 dB at ≥4–8 kHz). Survivors were treated with platinum (median total cumulative dose cisplatin: 480 mg/m2 and median total cumulative dose carboplatin: 2520 mg/m2). Median follow-up time was 5.5 years (range: 1.0–28.8 years). The results showed that none of these survivors revealed improvement of hearing function even till 28.8 years after discontinuation of treatment (grade <2b during long-term follow-up). An increase in hearing loss with two or three Münster degrees was observed in five of 61 survivors after 1.6–19.6 years. Overall, this indicates that ototoxicity after platinum treatment may be irreversible and that longitudinal clinical audiological monitoring and care is required in long-term survivors of childhood cancer on a large scale.