Cancer Follow-up Research Articles

A Health Information Technology Protocol to Enhance Colorectal Cancer Screening.

This study addresses barriers to electronic health records-based colorectal cancer screening and follow-up in primary care through the development and implementation of a health information technology protocol.

Gynecological cancer survivors' experiences with sexual health communication in nurse-led follow-up consultations.

Gynecological cancer and its treatment may cause sexual difficulties in terms of physical and psychosocial health. Considering the essential role that nurses play in cancer care, they are well positioned to be ideal providers for addressing sexual health concerns in the follow-up phase of gynecological cancer. The aim of this study was to gain in-depth knowledge of how gynecological cancer survivors experience sexual health communication in nurse-led follow-up consultations. Using a qualitative hermeneutic approach, we conducted individual semi-structured interviews with 17 women from five different hospitals in Norway between April 4, 2022, and June 2, 2022. The women participated in a large intervention study on cancer follow-up that included sexual health as one of several topics addressed by trained nurses in three consultations in the first year of follow-up. A five-stage Gadamerian-inspired research method was utilized for data collection and analysis. We identified three themes: (1) the importance of nurses listening to the women's own perceptions of sexuality, (2) post-treatment sexual challenges influence the women's need to communicate about sexual health, and (3) nursing communication can help women regain their sexual health. Women who have undergone treatment for gynecological cancer find communication with trained nurses regarding sexual health beneficial. We recommend integration of trained nurses in the follow-up team. The nurses should adjust communication according to each gynecological cancer survivor's unique understanding of sexuality and inform women with sexual health concerns at that end of treatment, that sexual health can improve during follow-up.

Mail-Based Self-Sampling to Complete Colorectal Cancer Screening: Accelerating Colorectal Cancer Screening and Follow-up Through Implementation Science

Mail-Based Self-Sampling to Complete Colorectal Cancer Screening: Accelerating Colorectal Cancer Screening and Follow-up Through Implementation Science

Follow-up assessment of sleep-related symptoms in patients aftertreatment forcancer: responses to continuous positive airway pressure treatment for co-morbid obstructive sleep apnoea.

To assess changes in sleep-related symptoms in patients withbreastcancer, endometrial cancer and melanoma previously examined for sleep-related symptoms and the presence of PSG (polysomnography)-determined OSA, ≥ 3years post-treatment; and to evaluate how CPAP treatment affects sleep-related symptoms in patients previously diagnosed with OSA. Patients initially recruited from breast cancer, endometrial cancer, and melanoma follow-up clinics at Westmead Hospital (Sydney, Australia) participated in this questionnaire-based study. Demographic and change in cancer status data were collected at follow-up. Patients completed the Pittsburgh Sleep Quality Index [poor sleep quality, PSQITOTAL ≥ 5au], Insomnia Severity Index, Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire; with ΔPSQITOTAL ≥ 3au indicating a clinically meaningful change in sleep quality over follow-up. PSG-determined OSA was confirmed using the apnoea-hypopnoea index. CPAP compliance was determinedvia self-report (CPAP compliant, CPAP; not compliant, non-CPAP). Logistic regression models determined if changes in cancer status, AHI, cancer subgroup or CPAP treatment was predictive of ΔPSQITOTAL ≥ 3 auand p < 0.05 indicated statistical significance. The 60 patients recruited had breast cancer (n = 22), endometrial cancer (n = 15), and melanoma (n = 23).Cancer subgroups were similarly aged, and all had median follow-up PSQITOTAL scores ≥ 5au; breast cancer patients scoring the highest (p < 0.05). TheCPAPgroup had significantly reduced PSQITOTAL scores (p = 0.02)at follow-up, unlike thenon-CPAP group. Cancer subgroups had similar median ISITOTAL, ESSTOTAL and FOSQ-10TOTAL scoresat follow-up, regardless of CPAP treatment. There were no significant predictors of ΔPSQITOTAL ≥ 3 au at follow-up. Sleep-related symptoms persist in patients withcancer ≥ 3years aftertreatment, although these symptoms improve with CPAP. Future studies should evaluate how CPAP affects survival outcomes in cancer patients with comorbid OSA.

INCIDENTAL BLADDER MELANOSIS WITH CHRONIC CYSTITIS

Abstract Introduction/Objective Melanosis is a black or brown discoloration due to melanin deposition in the skin or on the mucosa of body organs such as conjunctiva, lips, mouth, genitalia, colon, and rectum. For example, melanosis coli is associated with chronic laxative use. However, melanosis on the bladder mucosa is an extremely rare, incidental, and benign finding which is commonly associated with bladder cancer or melanoma. We report an unusual case of incidental bladder melanosis with chronic cystitis in a patient diagnosed with bladder cancer. Methods/Case Report A 77-year-old male current smoker presented for a follow-up of recurrent bladder cancer (high-grade T1 Transitional Cell Carcinoma, TCC) diagnosed in 2016 with currently no symptoms. His past medical history included high blood pressure, papillary thyroid carcinoma status post thyroid lobectomy, and Type 2 diabetes mellitus. He had completed two cycles of treatment of Bacillus Calmette-Guerin (BCG) and BCG/Interferon for 6 weeks each. He had multiple transurethral bladder resections and biopsies in the past which revealed invasive high- grade papillary urothelial carcinoma, not invading muscularis propria. A recent computerized tomography scan of the abdomen and pelvis revealed diffuse bladder wall thickening and trabeculation along the dome and posterior urinary bladder. His lab workup including urinalysis, complete blood count, and chemistry were within normal limits. This time, the patient underwent urinary bladder midline and back wall cystoscopic biopsies and transurethral resection of the right lateral wall. The biopsies showed mild chronic cystitis with melanosis, however, the resection showed non- invasive high-grade papillary urothelial carcinoma. Results (if a Case Study enter NA) NA Conclusion Bladder melanosis has been reported less than 25 times in the literature worldwide. The etiology of melanosis is still unknown. No specific symptoms or treatment guidelines have been established for bladder melanosis so far due to decreased number of cases reported and therefore, reduced follow-up surveillance. Nonetheless, the general behavior of bladder melanosis alone seems to be benign. To the best of our knowledge, this is the first report of bladder melanosis with chronic cystitis. Further studies are required to establish the association of bladder melanosis with chronic cystitis and to probe its clinicopathologic course, and implications.

Development of an Evidence-Based Clinical Tool for Childhood Cancer Survivorship Care in Tanzania

CONCLUSIONS Three in every four childhood cancer survivors experience late effects from treatment. As childhood cancer outcomes improve globally, it is important for providers to screen for these potential late effects to reduce morbidity. The present study aims to increase survivorship care capacity in low-resource settings by developing a digital clinical tool that integrates patient diagnosis and treatment exposure with evidenced-based surveillance recommendations to provide comprehensive childhood cancer follow-up guidelines. Surveys with key stakeholders at each of the four childhood cancer treatment centers in Tanzania were completed to determine the current capacity to provide off-therapy surveillance. This informed the selection of late-effect screening tests by the International Late Effects of Childhood Cancer Guideline Harmonization Group's 2023 guidelines that were both evidenced-based and feasible in our setting. Qualtrics software was utilized to create a provider-facing digital survey to enter patient diagnosis, treatment exposures, and cumulative dosing. The clinical tool was successfully created and implemented in our setting. In addition to entering patient demographic data, the survey burden for providers is anywhere from 5 to 11 questions in length. Using entered treatment exposures, the clinical tool uses a programmed algorithm to determine the late effect risk category, cardiovascular risk score, and personalized screening recommendations. Recommendations include both screening tests and frequency, to improve provider compliance with current best practice guidelines. This tool can be adapted for other settings based on current capacity and provides personalized surveillance recommendations. This can help standardize treatment guidelines by increasing provider capacity and knowledge, with the potential to improve adherence to follow-up guidelines among childhood cancer survivors in LMICs, like Tanzania.

Moving Toward Personalized Colorectal Cancer Follow-Up Care

Moving Toward Personalized Colorectal Cancer Follow-Up Care

Urinary markers for bladder cancer diagnosis: A review of current status and future challenges.

Bladder cancer is a common urological cancer with a high recurrence rate that requires long-term follow-up, and early detection positively affects prognosis. To date, the initial diagnosis and follow-up for bladder cancer rely on cystoscopy, which is an invasive and expensive procedure. Therefore, urinary markers for the detection of bladder cancer have attracted research attention for decades to reduce unnecessary cystoscopies. Urine, which is in continuous contact with bladder cancer, is considered a suitable fluid for providing tumor information. Urinary cytology is the only widely used urinary marker in clinical practice; however, it has poor sensitivity for low-grade tumors; indicating the need for novel urinary markers. Considerable research has been conducted on this topic over the years, resulting in a complex landscape with a wide range of urinary markers, including protein-, exfoliated cell-, RNA-, DNA-, and extracellular vesicle-based markers. Although some of these markers have been approved by the U.S. Food and Drug Administration and are commercially available, their use in clinical practice is limited. To facilitate clinical application, potential urinary markers must withstand prospective clinical trials and be easy for patients and clinicians to understand and utilize in a clinical context. This review provides a comprehensive overview of currently available and recently reported promising urinary markers for bladder cancer. Additionally, the challenges and the prospects of these urinary markers for clinical implementation in bladder cancer treatment were discussed.

Adapting and implementing breast cancer follow-up in primary care: protocol for a mixed methods hybrid type 1 effectiveness-implementation cluster randomized study

BackgroundAdvances in detection and treatment for breast cancer have led to an increase in the number of individuals managing significant late and long-term treatment effects. Primary care has a role in caring for patients with a history of cancer, yet there is little guidance on how to effectively implement survivorship care evidence into primary care delivery.MethodsThis protocol describes a multi-phase, mixed methods, stakeholder-driven research process that prioritizes actionable, evidence-based primary care improvements to enhance breast cancer survivorship care by integrating implementation and primary care transformation frameworks: the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and the Practice Change Model (PCM). Informed by depth interviews and a four round Delphi panel with diverse stakeholders from primary care and oncology, we will implement and evaluate an iterative clinical intervention in a hybrid type 1 effectiveness-implementation cluster randomized design in twenty-six primary care practices. Multi-component implementation strategies will include facilitation, audit and feedback, and learning collaboratives. Ongoing data collection and analysis will be performed to optimize adoption of the intervention. The primary clinical outcome to test effectiveness is comprehensive breast cancer follow-up care. Implementation will be assessed using mixed methods to explore how organizational and contextual variables affect adoption, implementation, and early sustainability for provision of follow-up care, symptom, and risk management activities at six- and 12-months post implementation.DiscussionStudy findings are poised to inform development of scalable, high impact intervention processes to enhance long-term follow-up care for patients with a history of breast cancer in primary care. If successful, next steps would include working with a national primary care practice-based research network to implement a national dissemination study. Actionable activities and processes identified could also be applied to development of organizational and care delivery interventions for follow-up care for other cancer sites.Trial registrationRegistered with ClinicalTrials.gov on June 2, 2022: NCT05400941.

Abstract 11600: Association Between Obesity and Risk of Total and Obesity-Related Cancer in Persons With Incident Cardiovascular Disease

Introduction: Cardiovascular disease (CVD) and cancer often occur in the same people, in part due to shared risk factors. In a Global Burden of Disease analysis of cohorts from &gt;180 countries, obesity was a top 3 modifiable risk factor for CVD and cancer. Beyond shared risk factors, CVD pathophysiologies may synergize with obesity to influence carcinogenesis. If so, an excess cancer risk in obese persons with CVD has implications for clinical management. Hypothesis: Obesity is positively associated with obesity-related cancer (ObCa) risk in persons with incident CVD independent of shared risk factors. Methods: We used data from the Atherosclerosis Risk in Communities (ARIC) study, a cohort with 28 years of cancer follow-up. The analytic cohort was 5127 participants with incident CVD among whom 1511 were diagnosed with a first primary cancer. Follow up began at incident CVD diagnosis date after visit 1. Obesity was classified by BMI, waist circumference (WC), and waist-to-hip ratio (WHR) measured by trained technicians. We calculated incidence rate differences (RD) between obesity groups adjusted for age, sex, and center. The obesity-cancer association was estimated using Fine-Gray regression adjusted for shared risk factors, including smoking. Results: In people with CVD, cancer incidence was higher in the obese (BMI: RD=226.6/100,000 person-years) than normal weight group. In people with CVD, obesity was suggestively positively associated with ObCa (Table 1). In females with CVD, obesity was associated with increased ObCa risk. Associations were null in males, including after excluding prostate cancer. Conclusion: In this prospective study, obesity is positively associated with ObCa risk in women with incident CVD independent of shared risk factors. More work is needed to investigate why the association appeared in women only, and to identify possible mechanisms by which CVD pathophysiologies may interact with obesity to produce cancer risk.

Unusual metastases of breast cancer: a single-center retrospective study

Objectives: While clinical and radiological awareness of the usual, frequent metastatic sites of breast cancer is high, unexpected 'atypical' localisations may be more easily overlooked in the cancer management process. The aim of this article is to contribute to this awareness in order to facilitate and improve the diagnosis and follow-up of breast cancer. Methods: In this study, we retrospectively evaluated breast cancer patients who were diagnosed and followed up between 2017 and 2022 in our hospital, which is an important oncology center. Results: Of the 852 patients included in this study, 79 had an unusual metastasis localization. The most common unusual metastasis sites were mediastinal lymph nodes and brain. These sites were followed by atypical bone involvement, mesenteric lymph nodes, cervical lymph nodes, hilar lymph nodes and surrenal metastases. The most rare metastases were more common in the uterus and ovary, followed by pancreas, parotid gland, spleen, colon, pericardium-atrium, orbital soft tissues and lacrimal gland. . The unusual site of metastasis was mediastinal lymph nodes in 17.7% (n = 14), brain in 17.7% (n = 14), atypical bone sites in 12.6% (n = 10), mesenteric lymph nodes in 11.3% (n = 9), cervical lymph nodes in 11.3% (n = 9), hilar lymph nodes in 5% (n = 4) and surrenal in 6.3% (n = 5). Conclusions: Sharing knowledge and experience about unusual metastases of breast cancer will contribute to the diagnosis and treatment of metastatic diseases by increasing the awareness of this issue. For this, multicentre studies should be conducted to combine these experiences.

Experiences of everyday discrimination and use of online resources in a population-based sample of breast cancer survivors.

318 Background: For many cancer survivors, clinical spaces may not feel safe for support and information seeking. Individuals experiencing more discrimination in their daily lives may be more likely to seek resources online. Given the varying quality of online resources, understanding this relationship is important as it may exacerbate existing breast cancer survivorship disparities. Methods: The iCanCare study is a longitudinal study of women diagnosed with breast cancer in 2014-15 identified in the Los Angeles and Georgia Surveillance, Epidemiology and End Results registries. Women were surveyed during initial treatment and again 6 years later in survivorship (2021-22) (Expected final N=1430, 60% current response rate). Respondents were asked about the frequency of 5 types of perceived discrimination in the past 12 months using the short Everyday Discrimination scale. Responses were averaged to generate a mean discrimination frequency (range: 0 (never) - 5 (almost every day)). Respondents were also asked, in the past 12 months 1) how often they had looked online for medical information related to their breast cancer follow-up care and 2) how often they had used social medial to offer or receive support for breast cancer related issues. Responses were categorized into never vs. any. The associations between everyday discrimination and dependent variables 1) online information seeking and 2) online support seeking were evaluated using multivariable-adjusted logistic regression models adjusted for demographics and socioeconomic status. Results: In this sample of 1,058 women with complete responses, 42.2% reported seeking medical information related to survivorship care online and 22.0% reported seeking online support related to their breast cancer. Being treated with less respect than other people (24.3%) and people acting as if they think you are not smart (20.2%) were the most experienced types of discrimination, but “never” was the most common frequency for each type of discrimination. The mean discrimination frequency across the sample was 0.25 (range: 0 (never)-4.2 (once a week)). Mean discrimination frequency was highest in black women (mean=0.35), Latina women (mean=0.31), and people with no insurance (mean=0.49) (P&lt;0.01). In the adjusted model, a one-unit increase in average discrimination frequency was associated with 50% higher odds of online information seeking (OR 1.52 CI 1.16, 1.99) and twice the odds of using social media for breast cancer support (OR 2.15 CI 1.31, 3.52). Conclusions: In this sample of early-stage breast cancer survivors, more frequent experiences of discrimination were associated with higher likelihood of online information and support seeking for breast cancer. Future work delineating the validity of information sources for patients is needed to prevent worsening disparities.

Delayed Cystoscopic Follow-up of Non-muscle Invasive Bladder Cancer during the COVID-19 Pandemic may Increase Recurrence Rates but not Progression Rates

Background: This study aimed to investigate whether there is a difference in recurrence and progression rate before and after the pandemic in patients who applied for bladder cancer and/or were followed-up-treatment-operated in the urology clinic during the pandemic.&#x0D; Material and Methods: A total of 116 non-muscle invasive bladder cancer (NMIBC) patients with delayed cystoscopy and 90 control patients with timely cystoscopy were included in the study between June and July 2020. Demographic data of the patients were recorded. Recurrences and progression scores were calculated and grouped according to these scores. The cystoscopy delay time was calculated from the planned cystoscopy time to the performed cystoscopy time. The recurrence and progression status of the patients were recorded, and a comparison was made between the two groups.&#x0D; Results: The median age was 63.6 years (interquartile range [IQR] 35–85) in the delayed cystoscopy group and 67.3 (25-87) in the control group. In the delayed cystoscopy group, 29 (25%) patients had tumour recurrence on follow-up cystoscopy, and 3 (10.34%) patients had tumour progression on subsequent TUR-BT. The mean cystoscopy delay time is 89.27±27.35 days. As a result of the chi-square analysis performed on the group with 10-17 recurrence points found a statistically significant relationship between the experimental and control groups (χ2=5.792; p=.016; p0.05).&#x0D; Conclusions: In this study, we reported that superficial bladder cancers with low recurrence scores could wait 3-6 months, but delaying 3-6 months in cases with a recurrence score of 10 or more increases the recurrence rate.

Uterine transposition for fertility and ovarian function preservation after radiotherapy

ObjectiveTo evaluate the feasibility of uterine transposition as a method of preserving fertility and ovarian function after pelvic radiation.MethodsThis prospective multicenter observational study included patients with non-gynecologic pelvic cancers who...

Patient satisfaction of specialist nurse-led renal cancer follow-up.

For many patients with locally advanced renal cancer, management is surgery followed by surveillance imaging for several years. There is no concrete data regarding specialist nurse follow-up for patients after they have had surgery. The authors' aim was to assess patient satisfaction with specialist nurse follow-up for patients with renal cancer who have undergone surgery. A questionnaire was used to measure patient satisfaction of the specialist nurse consultation. There were 100 patients invited who had been followed up in the nurse-led clinic between January 2020 and May 2021. These patients were given a phone call to complete the questionnaire. The audit revealed that in terms of general satisfaction, 97.1% of patients felt totally satisfied with their visit/consultation at the specialist nurse clinic. Furthermore, 94.2% of patients felt that they had good continuity of care with specialist nurse follow-up. Nurse-led follow-up was found to have high levels of patient satisfaction.

Hub-and-Spoke centralized intervention to optimize colorectal cancer screening and follow-up: A pragmatic, cluster-randomized controlled trial protocol

BackgroundGuidelines recommend screening for colorectal cancer (CRC), but participation and abnormal test follow up rates are suboptimal, with disparities by demography. Evidence-based interventions exist to promote screening, but community adoption and implementation are limited. MethodsThe San Diego Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) program is an academic-community partnership testing regional implementation of a Hub-and-Spoke model for increasing CRC screening and follow-up. The “hub” is a non-academic, non-profit organization that includes 17 community health center (CHC) systems, serving over 190 rural and urban clinic sites. The “spokes” are 3 CHC systems that oversee 11–28 clinics each, totaling over 60 clinics. Using a cluster-randomized trial design, 9 clinics were randomized to intervention and 16 to usual care. Within intervention clinics, approximately 5000 eligible patients not up-to-date with CRC screening per year were identified for intervention. Interventions include an invitation primer, a mailed fecal immunochemical test with completion instructions, and phone and text-based reminders (hub) and patient navigation protocol to promote colonoscopy completion after abnormal FIT (spoke). Outcomes include: 1) proportion of patients up-to-date with screening after three years in intervention versus non-intervention clinics; 2) proportion of patients with abnormal FIT completing colonoscopy within six months of the abnormal result. Implementation science measures are collected to assess acceptability, intervention and usual care adaptations, and sustainability of the intervention strategies. ConclusionThis large-scale, regional cluster randomized trial among CHCs serving diverse populations is anticipated to accelerate progress in CRC prevention in underserved populations.Trial registration: NCT04941300

Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version

The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.

338P Breast cancer follow-up: A population-based cohort study

338P Breast cancer follow-up: A population-based cohort study

CN49 Nurse–patient sexual health communication in gynecological cancer follow-up: A qualitative study from nurses’ perspectives

CN49 Nurse–patient sexual health communication in gynecological cancer follow-up: A qualitative study from nurses’ perspectives

Outcome of Incidental Pulmonary Nodules in a Real-World Setting

ObjectivesEarly diagnosis of lung cancer is imperative to improve survival. Incidental pulmonary nodules (IPN) may represent early stages of lung cancer and appropriate follow-up and management of these nodules is important, but also very resource demanding. We aim to describe the results of the CT-based follow-up on a cohort of patients with IPN in terms of detected malignancies, the proportion undergoing invasive procedures, and the subsequent outcome. Materials and MethodsRetrospective cohort study of patients in a CT IPN follow-up program who underwent a needle biopsy of the lung from 2018 to 2021 at Aarhus University Hospital. ResultsA total of 4181 patients with IPN were followed with CT control scans. Out of these 249 (6%) were diagnosed with lung cancer of which 224 (90%) were diagnosed as a result of the IPN follow-up. Seventy-five percent of the patients were diagnosed in stages I to II and curable treatment was possible in 77.9% of the patients. In the CT IPN follow-up program 449 patients underwent a CT guided needle biopsy. Out of these 190 patients underwent biopsy without the detection of malignancy, corresponding to 4.5% of the entire IPN population. ConclusionThe cumulated incidence of lung cancer in our population in the IPN follow-up program was 6%. The probability of malignancy when undergoing an invasive procedure on an IPN was 55.7% of which lung cancer was vastly predominant. The majority of lung cancers were diagnosed in an early and potentially curable stage.