Survivorship Factors Research Articles

Gastropods from the Cretaceous-Palaeogene boundary in Denmark.

Gastropods constituted one of the most successful faunal groups in the Danish Basin around the Cretaceous-Palaeogene (K-Pg) boundary, both with regard to abundance and diversity. Only 19 species were known previously; this number is here increased to 140. The end-Cretaceous Danish fauna is represented by 79 taxa of which 85 % became extinct at the boundary. A new fauna of 72 species arose within a remarkably short time interval of less than half a million years. The extinction seems to have hit rather randomly with regard to feeding strategies, while geographical range stands out as the single most important factor in survivorship. The succeeding speciation was controlled by changes in substrate and food availability, where non-carnivores and taxa dependent on a hard substrate were replaced by hunting carnivores and mud-adapted taxa in response to the disappearance of the Cretaceous bryozoan mounds. The gastropod genus Loxotoma Fischer, 1885 is renamed as Palaeoloxotoma nom. nov. due to its junior synonymy with a moth. 38 new species are erected. These are Acirsa torensis n. sp., Acmaea selandica n. sp., Ageria laxa n. sp., Ageria skeldervigensis n. sp., Amaea alicae n. sp., Amaea stevniensis n. sp., Amaurellina ravni n. sp., Arene jakobseni n. sp., Ataphrus (Ataphrus) knoesensis n. sp., Bathrotomaria jakobseni n. sp., Ceratia rodvigensis n. sp., Cerithiella selandica n. sp., Cerithiopsis restemlongis n. sp., Claviscala minor n. sp., Coniscala umbilica n. sp., Cranopsis cretacea n. sp., Cylichna stevniensis n. sp., Dolicholatirus lorenzi n. sp., Epalxis? rosenkrantzi n. sp., Epetrium s.l. skeldervigensis n. sp., Eucycloscala gracilicostatus n. sp., Fusinus schnetleri n. sp., Mathilda dania n. sp., Mesalia danica n. sp., Opaliopsis carlsbergi n. sp., Pseudocochlespira transversa n. sp., Pseudotoma danica n. sp., Tatara pseudosassia n. sp., Tectus? indecorus n. sp., Temnotropis stevniensis n. sp., Thereitis carlsbergi n. sp., Thereitis cretacea n. sp., Thylacodes contendis n. sp., Unitas heinbergi n. sp., Vatopsis heinbergi n. sp., Vexillum? rosenkrantzi n. sp., Vexillum tenestolidum n. sp. and Zebinella selandica n. sp.

Longitudinal trajectory of frailty and related factors in 376 breast cancer patients aged 50+ compared to controls.

e21532 Background: Frailty, a clinical syndrome of vulnerability, is associated with adverse outcomes; however, the trajectory of frailty in cancer patients is not well understood. This longitudinal analysis evaluates frailty, and related factors, over the course of chemotherapy in breast cancer patients (BCa pts) aged 50+. Methods: BCa pts aged 50+ scheduled to receive adjuvant/neoadjuvant chemotherapy (n = 376) and age matched controls without cancer (n = 234) were recruited from the University of Rochester NCI Community Oncology Research Program as part of an observational study. Frailty was assessed by a modified Fried frailty score (range 0-4) using self-reported weakness, exhaustion, physical activity, and walk speed. Cognition was assessed objectively (Controlled Oral Word Association [COWA]) and subjectively (FACT-Cog). Frailty and cognition were measured pre- and post-chemotherapy (similar time lapse for controls). Linear regression models evaluated associations between cognition and frailty, controlling for age, race, marital status, education, performance status and baseline frailty score. Results: Average age was 59 (50-64: 77%; 65-79: 23%). At baseline, the cancer group had more people aged 65+ (24% vs 20%, p = 0.002), a higher mean frailty score (1.2 vs 0.73, p < 0.001), and lower mean FACT-Cog score (158.5 vs 167.4, p < 0.001) compared to controls. In unadjusted analysis, BCa pts had greater increase in frailty and cognitive problems than controls over time (mean change frailty score: cancer 0.87 vs control 0.05; mean change FACT-Cog: cancer 12.78 vs control 1.58; mean change COWA: cancer -0.41 vs control 0.43; p < 0.001 for all). In adjusted analysis, cancer (p < 0.001) and lower baseline FACT-Cog score (p = 0.01) were associated with an increase in frailty score over time. In a separate model, a decline in subjective and objective cognition was associated with increased frailty score (COWA p = 0.03, FACT-Cog p = 0.07). Conclusions: Frailty is prevalent in BCa pts prior to chemotherapy and increases during treatment. Lower baseline cognition and decline in cognition were associated with increased frailty. Frailty and cognition are important survivorship factors for BCa pts aged 50+.

Training a survivorship care workforce with a novel web-based training curriculum.

16 Background: The Commission on Cancer (CoC) standard 3.3 requires survivorship care plan (SCP) delivery to patients who complete treatment with curative intent. The Coleman Supportive Oncology Collaborative (CSOC) is focused on improving supportive and survivorship care through tools, processes and training of health professionals. Methods: A collaborative of 30+ clinicians (faculty) from 25 institutions (academic, community and safety net), funded by The Coleman Foundation, reviewed existing supportive oncology and survivorship care training for content, availability, and cost. They developed a unique fundamental survivorship care training curriculum. Results: Although SCP dissemination training is available, it lacks 1+ attributes: <15 minutes to complete; online access; and CME/CEU credit at no cost. Utilizing existing guidelines and literature, the CSOC identified survivorship (9), palliative (11) and distress (6) modules supporting CoC requirements developed by 2+ expert faculty. Standardized modules include references and a slide presentation with links to additional training, guidelines and literature. Modules were reviewed by The National Comprehensive Cancer Network (NCCN) scientists, and edited. Audio was recorded by faculty. Tech assistance aligned video, graphics and narrated audio into a MP4 (movie) format. Survivorship modules include: Cancer Survivorship Defined, Patient Needs at Survivorship Visit and Coc Requirements for SCPs; Cancer Survivor Care; Survivorship Factors (Lifestyle & Behavior, Psychosocial Challenges and Late and Long Term Effects); Cancer Survivors’ Screening and Prevention Strategies; and Genetic Testing for Patients, Families and Survivors. The NCCN Education Portal published the training (https://education.nccn.org/supportive-oncology-care) available publicly (w CME/CEU) for no charge. Conclusions: Various forms of survivorship training for health professionals exist, but they lack needed attributes. The CSOC developed 9 concise survivorship training modules for NCCN’s education portal, with CME/CEU credit available at no cost to participants. CSOC will collect feedback from training enrollees to determine effectiveness and future training needs.

Nutritional status and weakness following pediatric hematopoietic cell transplantation.

Survivorship after pediatric HCT has increased over the past decade. Focus on long-term care and well-being remains critical due to risk of poor dietary habits and exaggerated sedentary behavior, which can lead to muscle weakness, increased risk for obesity, and cardiometabolic disorders. Nutrition and physical activity are key factors in survivorship; however, data are limited. Comprehensive nutritional assessments, including nutrition-focused physical examination, grip strength, and food/activity surveys, were completed in 36 pediatric HCT survivors (aged 2-25years). Patients were divided into undernutrition, normal-nutrition, and overnutrition categories. Fifty percent of participants were classified as normal nutrition, 22% undernutrition, and 28% overnutrition. Few patients met the U.S. Dietary Guidelines recommended intake for vegetables, fiber, saturated fat, and So FAS. Patients in the undernutrition group demonstrated significantly lower grip strength than those in the normal- and overnutrition groups. When grip strength was normalized to body mass, patients in the overnutrition group had the highest prevalence of weakness. Using NHANES reference data, maximum grip strength and NGS cutoffs were identified that could significantly distinguish the nutrition groups. Comprehensive nutritional assessments and grip strength measurements are feasible, non-invasive, easy to perform, and inform both under- and overnutrition in pediatric HCT survivors.

Depression and cancer survivorship: importance of coping self‐efficacy in post‐treatment survivors

An estimated 30% of cancer patients are expected to experience clinically significant psychological distress during the treatment phase of their disease. Despite significant attention being directed to the mental health needs of individuals undergoing and completing treatment, there is less known about the mental health needs of survivors and the role of potential protective factors in survivorship, such as coping self-efficacy and social support. One hundred and twenty-four post-treatment cancer survivors (mean age = 62.23 years, women = 70%, average 9.3 years post-treatment) were asked to complete measures of physical symptoms, coping self-efficacy, social support, and depression as part of a national convenience sample of cancer patients and survivors. About 20% of participants possessed scores on the Center for Epidemiologic Studies-Depressed Mood Scale indicative of clinically relevant depression. Coping self-efficacy was not only a significant predictor of depression (43% Variance Accounted For); it also partially mediated the relationship between symptoms and depression. Social support accounted for limited variance and was not a significant predictor of depression in a model containing both social support and coping self-efficacy as predictors. A substantial minority of post-treatment survivors reported depression symptomatology. Coping self-efficacy may be an important component of patients' adjustment and possible target for intervention. These results highlight the ongoing mental health and support needs of cancer survivors.

Optimising the therapeutic ratio in head and neck cancer

The intensity of contemporary treatment for locally advanced head and neck cancer is at the upper limit of human tolerance of acute toxicities. While impressive gains in locoregional control have been achieved, improvements in overall survival have been more modest. We hypothesise that unrecognised sequelae of highly toxic contemporary treatments substantially contribute to patient mortality. This possibility provides motivation to investigate reducing treatment intensity in selected patients with locally advanced head and neck cancer. With the demonstration of a good prognosis among subgroups of patients with head and neck cancer, major improvements in the technical delivery of radiotherapy, and further research into relevant factors in survivorship, we may be able to improve overall survival of patients with locally advanced disease without further increasing, and possibly reducing, treatment intensity.

Complementary and alternative therapies among very long-term breast cancer survivors

Breast cancer patients may have different complementary and alternative medicine (CAM) usage rates and may turn to CAM for different reasons than healthy adults. CAM has mostly been studied in recently diagnosed women; no studies have included survivors 10 years post-diagnosis. We examined very long-term breast cancer survivors to determine whether CAM users had dissimilar patterns of association with survivorship factors. Interviews of 374 breast cancer case patients from a population-based case-control breast cancer study of young women from Los Angeles County, California, during the 1980s occurred at follow-up; 371 patients with complete information were included. CAM represented 28 herbal remedies. Quality-of-life originated from the Medical Outcomes Study Short Form 36 questionnaire (SF-36). Higher rates of CAM (59%) usage occurred compared to nationwide estimates. CAM users resembled non-users on follow-up age, exercise, original disease, treatment, smoking, body-mass index, alcohol, and fear of recurrence. CAM users had a higher prevalence of medical co-morbidities (P = 0.0005), and scored significantly lower on the SF-36 emotional well-being subscale than non-CAM users (P = 0.01). CAM users and non-users did not differ on the SF-36 physical sub-scale. Very long-term breast cancer survivors who use CAM may have poorer emotional functioning and more medical problems than non-users.

Parasite-induced changes in the behaviour of cestode-infected beetles: adaptation or simple pathology?

Although the cause is often unclear, many parasites alter the behaviour of their intermediate hosts. The larval form of the rat tapeworm, Hymenolepis diminuta, has previously been shown to modify the behaviour of its intermediate host, the flour beetle, Tribolium confusum, in a manner that may be adaptive to the parasite. To test this explanation we observed host behaviours including activity, concealment, and the response to and production of pheromones. Infected female beetles examined both 4–5 and 11–12 days post infection were slower moving and slower to conceal themselves than uninfected conspecifics; however, they did not differ from uninfected individuals in staying concealed. Infection of T. confusum did not affect the production of pheromones by mated and virgin females or the response of females to male pheromones. A second hypothesis for altered behaviours may be that modified behaviours result from pathology. The survivorship of mated infected female beetles was significantly lower than that of infected virgin beetles and uninfected beetles. Thus, both mated status and infection were important factors in survivorship, but only infection had significant effects on the altered behaviours. In this system, therefore, the hypothesis that behavioural changes are due to adaptive manipulation of the host by the parasite is supported.