Intervention For Cancer Survivors Research Articles

Dual cigarette and e-cigarette use in cancer survivors: an analysis using Population Assessment of Tobacco Health (PATH) data.

Cancer survivors who smoke cigarettes face health risks from continued smoking. Some smokers use e-cigarettes to reduce combustible cigarette use, but research on whether cancer survivors do the same is limited. Research is needed to understand whether smokers who are cancer survivors use e-cigarettes at higher rates than smokers never diagnosed with cancer, to inform provider-patient discussions about e-cigarettes. Using cross-sectional data from current cigarette smokers in Wave 1 (2013-2014) of the Population Assessment of Tobacco Health (PATH) study, we compared cancer survivors (n = 433) and those without a prior cancer diagnosis (n = 10,872) on e-cigarette use and reasons for use. Among smokers, 59.4% of cancer survivors and 63.2% of those without a cancer diagnosis had ever used e-cigarettes, and nearly one-quarter of both groups (23.1% and 22.3%, respectively) reported being current users. Multivariate results, however, suggest that cancer survivors might be more likely to be ever (OR = 1.28; p = .05) or current (OR = 1.25; p = .06) e-cigarette users compared to those never diagnosed, although results were marginally significant. The majority of both groups (> 71%) reported using e-cigarettes for perceived health-related reasons-including smoking reduction. Our study found that among smokers, cancer survivors were using e-cigarettes at similar rates as never-diagnosed smokers and both groups used e-cigarettes largely for perceived health-related reasons. Clinicians who treat cancer survivors may need to routinely ask their patients who smoke about e-cigarette use and address the limited research on the efficacy of e-cigarettes as a cessation aid as compared to other evidence-based options.

A randomized controlled trial of a group acceptance-based intervention for cancer survivors experiencing anxiety at re-entry (\u2018Valued Living\u2019): study protocol

BackgroundAnxiety is a common concern of cancer survivors during the transition from active cancer treatment to cancer survivorship (the re-entry phase). This paper presents the study protocol for a novel group-based behavioral intervention to improve mental health, well-being, and medical use outcomes among anxious cancer survivors at re-entry.Methods/DesignThis two-armed, prospective randomized controlled trial will randomize a minimum of 100 re-entry-phase cancer survivors with moderate to high anxiety to the intervention or a usual care control condition. The intervention is delivered in a group format over 7 weeks; content is based on Acceptance and Commitment Therapy (ACT), an acceptance, mindfulness, and values-based intervention. Participants will be recruited from community cancer care centers and the intervention will be led by the onsite clinical social workers. Participants will be assessed at baseline, mid-intervention, post-intervention, and 3- and 6-month follow-up. ACT participants will complete process measures before the beginning of group sessions 2, 4, and 6; all participants will complete the process measures during the regular assessments. The primary outcome is anxiety symptoms; secondary outcomes include anxiety disorder severity, fear of recurrence, depressive symptoms, cancer-related trauma symptoms, sense of life meaning, vitality/fatigue, and medical utilization.DiscussionThis clinical trial will provide valuable evidence regarding the efficacy of the group ACT intervention in community oncology settings.Trial registrationClinicaltrials.gov NCT02550925.

Cancer Survivors and Returning to Work Perspectives from Occupational Health Physicians in Korea.

BackgroundThis study was conducted from an occupational health perspective to document cancer survivors' ability to return to work, the role of clinical care, and the current status of effective return-to-work.MethodsThis cross-sectional study was conducted to evaluate the experiences and opinions of occupational health physicians (OHPs) regarding cancer survivors' return-to-work. A self-reported survey was conducted from December 30, 2015, to January 30, 2016, targeting 337 OHPs. Questions included: 1) treatment experiences of survivors in the words of OHPs, 2) current status of the assessments of fitness for work of cancer survivors, 3) experiences associated with workplace and treatment, and 4) problems of returning to work and overcoming system.ResultsOnly 25% of the respondents said that they had experience treating cancer survivors, and the average number of patients was 12.6 per annum, which indicated that few cancer survivors were treated. Eleven cases included conducting assessment of fitness for work. There were 17 respondents who did not treat cancer survivors. Both those who had and did not have experience in treating survivors showed higher musculoskeletal system disorders (53.8 vs. 63.5) than cancer (15.5 vs. 11.2) in terms of frequency of the diseases in the assessment of fitness for work. Most respondents said that OHPs evaluate the current role appropriately and preferred OHPs in the future. They responded that OHPs found it difficult to treat cancer survivors, and it was psychologically tough to communicate with them (61.4%). Regarding the association of patient rehabilitation with workplaces, 48.9% said that workplaces provide inadequate support.ConclusionAs a preliminary study, we found that OHPs were found to have little experience in treating cancer survivors and undergo difficulties owing to poor collaboration with workplaces and communication with patients. This study will provide basic data for future studies to promote cancer survivors' return to workplaces.

Supplemental Material for What Works in Smoking Cessation Interventions for Cancer Survivors? A Meta-Analysis

Supplemental Material for What Works in Smoking Cessation Interventions for Cancer Survivors? A Meta-Analysis

Effectiveness and components of self-management interventions in adult cancer survivors: a protocol for a systematic review and planned meta-analysis

BackgroundSelf-management interventions have been proposed as effective strategies to improve health and well-being and promote optimal coping in cancer survivors. Several reviews have shown benefits of self-management interventions on a variety of patient-reported outcomes. Effective self-management strategies in other chronic disease populations are typically based on theories of behavior change, but the extent of theoretical underpinnings in cancer self-management programs has not been evaluated to date. Our aim is to expand on previous reviews by evaluating the effectiveness of self-management interventions in cancer survivors as well as the theoretical components of such interventions.MethodsWe will conduct a systematic review of self-management interventions for adults who have completed primary treatment for their solid or hematological cancer. Interventions tested using experimental or quasi-experimental methods, with any type of comparator, will be included. A search strategy will be designed with a health sciences librarian and then performed using MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, the Cochrane database of systematic reviews, the National Institutes of Health clinical trials registry, and the Cochrane CENTRAL registry of controlled trials. Data synthesis will include a narrative and tabular summary of the results. Appropriate statistical analysis may include a meta-analysis using random effects methods to determine the effectiveness of self-management interventions and a meta-regression to evaluate how characteristics of the interventions are associated with the intervention effect. Risk of bias will be evaluated using the Cochrane risk of bias tool or the Risk of Bias in Non-randomized studies tool (RoBANS).DiscussionThe results of this systematic review will add to previous reviews and expand the existing knowledge base of the effectiveness and active components of self-management interventions for adult cancer survivors.Systematic review registrationPROSPERO CRD42018085300

National guidelines may reduce socioeconomic disparities in treatment selection for esophageal cancer.

The 2011 National Comprehensive Cancer Network guidelines first incorporated the results of the landmark CROSS trial, establishing induction therapy (chemotherapy±radiation)andsurgery as the treatment standard for locoregional esophageal cancer in the United States. The effect of guideline publication on socioeconomic status (SES) inequalities in cancer treatment selection remains unknown. Patients diagnosed with Stage II/III esophageal cancer between 2004 and 2013 who underwent curative treatment with definitive chemoradiation or multimodality treatment (induction and surgery) were identified from the Surveillance, Epidemiology and End Results (SEER)-Medicare registry. Clinicopathologic characteristics were compared between the two therapies. Multivariable regression analysis was used to adjust for known factors associated with treatment selection. An interaction term with respect to guideline publication and SES was included Of the 2,148 patients included, 1,478 (68.8%) received definitive chemoradiation and 670 (31.2%) inductionandsurgery. Guideline publication was associated with a 16.1% increase in patients receiving inductionandsurgery in the low SES group (21.4% preguideline publication vs. 37.5% after). In comparison, a 4.5% increase occurred during the same period in the high SES status group (31.8% vs. 36.3%). After adjusting for factors associated with treatment selection, guideline publication was associated with a 78% increase in likelihood of receiving inductionandsurgery among lower SES patients (odds ratio 1.78; 95% confidence interval (CI): 1.05,3.03). Following the new guideline publication, patients living in low SES areas were more likely to receive optimal treatment. Increased dissemination of guidelines may lead to increased adherence to evidence-based treatment standards.

Finding My Way: results of a multicentre RCT evaluating a web-based self-guided psychosocial intervention for newly diagnosed cancer survivors.

This multicentre randomised controlled trial examined the efficacy of Finding My Way (FMW), a 6-week/6-module online self-guided psychotherapeutic intervention for newly diagnosed curatively treated cancer survivors, in reducing cancer-related distress and improving quality of life compared to an online attention control. Participants were randomised on a 1:1 ratio using a gender-stratified block design to intervention (n = 94) or attention control (n = 97), and were blinded to condition. Assessments were completed at baseline (T0), post-intervention (T1), 3months (T2), and 6months (T3) post-intervention. Mixed model repeated measures analyses examined differences between groups for cancer-specific distress (primary outcome) and general distress, quality of life (QoL), coping, and health service utilisation (secondary outcomes). While both groups reported reduced cancer-specific and general distress over time, between-group differences were not significant. Intervention participants reported lower total health service utilisation and supportive care utilisation post-intervention than controls (total HS use: between-group mean difference = - 1.07 (- 1.85 to - 0.28); supportive care use: between-group mean difference = - 0.64 (- 1.21 to - 0.06)) and significantly higher emotional functioning at 3months (between-group mean difference = 7.04 (0.15 to 13.9)). At 6months, the supportive care utilisation finding reversed (between-group mean difference = 0.78 points (0.19 to 1.37). Across remaining QoL and coping outcomes, no significant group differences emerged. While both groups experienced reductions in distress, between-group differences were not significant. This contrasts with the significantly improved emotional functioning observed in FMW participants at 3months and the short-term reductions in health service utilisation. Long-term increases in supportive care service utilisation suggest FMW only met needs while being actively used. ACTRN12613000001796; http://www.ANZCTR.org.au/ACTRN12613000001796.aspx.

Development of Nursing Algorithms towards the Goal of Harmonization of Social Roles with Treatment of Cancer Survivors

Development of Nursing Algorithms towards the Goal of Harmonization of Social Roles with Treatment of Cancer Survivors

P2.09-14 The Detection of EGFR Gene Mutation from Washing Solution of Devices used for the Bronchoscopic Examination

The detection of epidermal growth factor receptor (EGFR) gene mutation is necessary for selection of lung cancer treatment. Recently, biopsy specimens are used in many genomic and immunohistochemical examination methods to select the treatment policy, so it is important not to waste valuable cancer cell samples. For detection of EGFR gene mutation we examine the washing solution of devices used for the bronchoscopic examination in order to solve the issue. In this report, we investigate the detection ratio of EGFR mutation using this cytological sample. A total of 336 washing solution samples from lung cancer patients were examined for EGFR gene mutation testing in the period between November 2010 and October 2017. 328 cases of 336 excepting 8, which were carried out as re-biopsy, were surveyed in this examination. After the regular biopsy or scraping method, all devices were washed with 10ml saline liquid. Half volume of washing solution was used for regular cell examination to detect cancer cells. Only if a sufficient amount of non-small cancer cells were observed from it, the other volume was submitted for EGFR mutation examination. Final diagnosis was decided by histological specimen. Presence or absence of EGFR mutation and their types were observed from 328 samples retrospectively. Histological diagnosis of all 328 biopsy specimens are as follows; 200 Adenocarcinoma (AD), 100 Squamous cell carcinoma (SQ), 13 non-small cell lung carcinoma(NSCLC), 3 adenosquamous cell carcinoma(ADSQ), 7 high grade neuroendocrine carcinoma (HGNEC), and 5 others. The detection number of EGFR mutation from AD, SQ, ADSQ and NSCLC are 65, 4, 2, and 3 respectively. There is no EGFR mutation from remaining histology cases. In all of 74 EGFR mutation positive cases, Exon 19 deletion was detected in 33 cases (45%) and Exon 21 L858R was detected in 33 cases (45%). The detection rate of EGFR gene mutation from washing solution of devices is 33% (65/200) in AD and 4% (4/100) in SQ. These results are approximate to previous reports. Consequently, it is acceptable to use this method to investigate EGFR gene mutation of non-small lung cancer patients. Furthermore, it is an advantage that we can carry out an EGFR mutation test using this method with a cytology sample earlier than a method with a histology sample.

Multi-focused psychosocial residential rehabilitation interventions improve quality of life among cancer survivors: a community-based controlled trial

BackgroundEven though multi-focused psychosocial residence rehabilitation intervention (MPRRI) programs are widely implemented by the Shanghai Cancer Rehabilitation Club, these programs have not been rigorously evaluated. In this study, we evaluated the effects of a 21-day MPRRI program, on the quality of life (QoL) among cancer survivors.MethodsA total of 388 cancer patients were enrolled to either receive the 21-day MPRRI (n = 129) intervention or a waiting-list comparison (WLC) intervention (n = 259). The intervention group was offered community-based 21-day MPRRI program, combining supportive-expressive group, cognitive-behavioral therapy, and Guolin Qigong. QoL was measured using the European Organization for Research and Treatment Quality of Life Version 3 Questionnaire. Multivariable linear models were used to compare changes in QoL values between the two groups.ResultsAfter adjustment for the QoL score and other covariates at baseline, there was no significant difference in global health status (mean = 3.8, 95% CI − 1.3–9.0, P = 0.14) between the two groups after 6 months intervention. While compared with the WLC group, the intervention group showed significant improvements in the QoL score (all P < 0.05); however, there were no clinically relevant changes in subscales including emotional functioning (ES = 0.58), cognitive functioning (ES = 0.53), pain (ES = 0.52), physical functioning (ES = 0.36), and insomnia (ES = 0.30).ConclusionsThese preliminary results suggest the MPRRI program is both feasible and acceptable intervention for cancer survivors in community settings and is effective in significant improving QoL above.

Unfavorable Pathology, Tissue Biomarkers and Genomic Tests With Clinical Implications in Prostate Cancer Management.

Prostate cancer management has traditionally relied upon risk stratification of patients based on Gleason score, pretreatment prostate-specific antigen and clinical tumor stage. However, these factors alone do not adequately reflect the inherent complexity and heterogeneity of prostate cancer. Accurate and individualized risk stratification at the time of diagnosis is instrumental to facilitate clinical decision-making and treatment selection tailored to each patient. The incorporation of tissue and genetic biomarkers into current prostate cancer prediction models may optimize decision-making and improve patient outcomes. In this review we discuss the clinical significance of unfavorable morphologic features such as cribriform architecture and intraductal carcinoma of the prostate, tissue biomarkers and genomic tests and assess their potential use in prostate cancer risk assessment and treatment selection.

Psychosocial interventions for rehabilitation and reintegration into daily life of pediatric cancer survivors and their families: A systematic review.

BackgroundThe survival rate of childhood cancer patients increased over the past decades. However, even after successful treatment the transition back to normalcy is often a major challenge for the whole family. Therefore, this study aims to provide an overview of psychosocial interventions for childhood cancer survivors and their families in the first years after the end of cancer treatment.MethodsWe conducted a systematic review following the PRISMA Checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PROSPERO registration number: CRD42017059782). In November 2016 and September 2017, we searched the databases CINAHL, MEDLINE, PSYNDEX, and Web of Science. We included studies investigating psychosocial interventions for childhood cancer survivors diagnosed under the age of 21, their family members or the family as a whole. Further, we summarized the study characteristics and conducted a narrative synthesis of the results. Finally, we assessed the study quality with the Effective Public Health Practice Project Quality Assessment Tool.ResultsWe identified a total of 8215 records based on our database searches and 17 additional records through hand searches. We included 33 articles in the qualitative synthesis. Most of the studies described interventions for the cancer survivor (n = 15). Nine studies investigated interventions for the whole family, and two studies interventions for siblings. The interventions mainly take place in an outpatient group setting (n = 15). Overall, most of the studies reported a significant psychosocial benefit of the interventions. However, the quality of the included studies was limited.ConclusionIn summary, we identified a broad range of different interventions and thus could give a comprehensive overview of existing interventions for childhood cancer survivors and their families. However, there is a necessity for high quality studies. The results may help to optimize health care services that support families with the re-entry into daily life.

Social inequality in cancer survivors' health behaviours-A Danish population-based study.

The aim of this study was to compare health behaviours (smoking, alcohol consumption, physical activity and diet), to explore social inequality in these behaviours among cancer survivors and individuals with no history of cancer, respectively, and to study the impact of time since diagnosis on cancer survivors' health behaviours. Data from the Danish National Health Survey from 2013 were linked with data from the Danish Cancer Registry to identify all cancer diagnoses among the respondents during the period 1945-2012. In total, 11,166 cancer survivors and 151,117 individuals with no history of cancer were included. Cancer survivors smoked less and had a more sedentary lifestyle than individuals with no history of cancer. In relation to alcohol and dietary habits, no differences were found between the groups. Wide variations in health behaviours were seen across cancer sites, and in particular lung, bladder and oral cancer survivors had poor health behaviours. We found a clear social gradient in cancer survivors' health behaviours which reveals the need for greater focus on socially differentiated initiatives within prevention and patient education for cancer survivors. Our study revealed rather blurred results in relation to identifying the optimal timing for health-related behavioural interventions in cancer survivors.

Long After Chemotherapy, Cisplatin and Hearing Loss Remain

It is an unfortunate reality that cancer survivors face a lifetime of health consequences related to their cancer treatment. As the population of cancer survivors continues to grow, so does the importance of addressing their medical needs. For patients treated with the chemotherapeutic drug cisplatin, one common consequence of treatment is permanent hearing loss. Reported rates of cisplatin ototoxicity vary widely, though it is believed that at least half of all patients treated with cisplatin will suffer hearing loss. As cisplatin is widely used, this rate of ototoxicity translates to hundreds of thousands of patients affected each year in the United States alone.chemo, cancer, hearing lossAs was detailed in a recent article in this journal, efforts to prevent ototoxicity during cisplatin chemotherapy are ongoing (Hearing Journal. 2018;71(1):26). The success of these efforts likely hinges upon understanding why the cochlea is particularly susceptible to damage by cisplatin. Our recent study, reported in the journal Nature Communications, illustrates the importance of cisplatin pharmacokinetics—the movement of the drug within the body—in understanding ototoxicity (Nat Commun. 2017 Nov 21;8(1):1654). CISPLATIN OTOTOXICITY To effectively study cisplatin ototoxicity in the laboratory, we needed to be able to generate cisplatin-induced hearing loss in mice. Just as a patient receives multiple cycles of cisplatin, each separated by several days of recovery, so did the mice in our study. Auditory brainstem response and distortion product otoacoustic emission testing was performed on the mice, and it showed that cisplatin caused progressive hearing loss that worsened with each successive cycle of administration. Notably, hearing loss also continued to progress weeks after cisplatin administration was ceased, as has been reported for some human patients (J Pediatr Hematol Oncol. 2010 Mar;32(2):119; J Pediatr Hematol Oncol. 2004 Oct;26(10):649; Int J Pediatr Otorhinolaryngol. 2010 Aug;74(8):913). At the core of the cisplatin drug is the metal platinum. In fact, the name cisplatin (“cis-platinum”) is derived from the platinum that gives the drug its cancer-killing properties. This core platinum allowed us to measure tissue concentrations of cisplatin using a highly sensitive technique for detecting metals known as inductively coupled plasma mass spectrometry (ICP-MS). As the mice received successive cycles of cisplatin, drug concentrations across different organs were measured by ICP-MS. Most organs (like the liver, heart, kidney, etc.) effectively eliminated cisplatin in the days and weeks after the drug was given. However, cisplatin remained in the cochlea for much longer, showing no significant decrease in concentration even two months later. We went on to analyze postmortem inner ear tissue from human patients who had received cisplatin, and we found that the drug was retained in their cochleae even 18 months after treatment. In both the laboratory mice and these deceased patients, concentrations of retained cisplatin were highest in the stria vascularis region of the cochlea. This region is responsible for providing blood supply to the cochlea and for maintaining the composition of cochlear fluid. PREVENTIVE OPTIONS Our results demonstrated that over time the cochlea has a higher cumulative exposure to cisplatin than other organs and that, unlike other tissues, the cochlea has very little capacity for removing cisplatin. This may explain why the cochlea is particularly susceptible to cisplatin toxicity. For researchers working to develop a method of preventing cisplatin ototoxicity, our results suggest that the best method of preventing cisplatin ototoxicity may be via prevention of cisplatin uptake into the cochlea in the first place. Once inside the cochlea, cisplatin seems to be there to stay. Identification of drugs that block the uptake of cisplatin through the stria vascularis or directly bind and/or inactivate cisplatin as it enters the cochlea may be a viable path toward prevention of cisplatin ototoxicity. For audiologists, the results of our study underscore the importance of long-term hearing monitoring in patients who have received cisplatin therapy. Late-onset hearing loss is known to occur long after cessation of cisplatin treatment, and these study results suggest that this delayed hearing loss may be related to long-retained cisplatin in the cochlea. Until researchers make significant progress in preventing cisplatin ototoxicity in cancer therapy, it is crucial to continue identifying and treating cancer survivors with cisplatin-induced hearing loss.Andrew M. Breglio, DPhilLisa L. Cunningham, PhD

Increasing physical activity in cancer survivors using eHealth: A focus group study.

107 Background: Physical activity (PA) is beneficial in reducing disease and treatment related side‐effects of cancer. However, insufficient PA levels are common among cancer survivors. eHealth may offer an innovative delivery platform to support cancer survivors to increase PA. Few qualitative studies have explored the views of cancer survivors towards eHealth based PA interventions. Our aim was to use cancer survivors’ input to inform the design of a feasibility study of eHealth for PA promotion. Methods: A ten-item scoping questionnaire-based cross-sectional study was administered to 102 cancer survivors. It evaluated their knowledge of PA guidelines, their access to smartphones and interest in eHealth interventions designed to increase PA levels. Questions were refined and evaluated in a follow-up focus group study (7 groups, n=23). Focus groups were audio recorded and transcribed. Transcripts were coded using NVivo software and themes identified by thematic content analysis. Results: In the questionnaire study, only 17.6% (n=18) of participants correctly identified PA guidelines. Sixty-two (60.8%) participants reported having access to a smartphone. Interest in participating in an eHealth intervention was expressed by 56.9% of all participants (n=58) and by 75.8% (n=47) of those with access to a smartphone. Emergent themes from the focus groups included: the physical barriers to PA, the need for PA goals, the importance of both information from healthcare professionals about PA and of a support network (e.g. peer support), the need for technological support and a motivation to improve general health. Conclusions: Very few cancer survivors were aware of the correct PA guidelines. However, over half of our sample was interested in participating in an eHealth intervention for PA, demonstrating that the cancer survivor population is responsive to a PA program delivered using technology. The focus groups have given us insights about the key elements of an effective PA intervention for cancer survivors using eHealth. We are conducting a feasibility study (The IMPETUS study; NCT03036436) of an eHealth intervention targeting PA in cancer survivors; its design was informed by those insights.

Prostate cancer presentation, treatment selection, and outcomes among men with HIV/AIDS: A clinical, stage, and age-matched analysis.

245 Background: The clinical presentation, oncologic outcomes and the optimal management of prostate cancer (PC) among human immunodeficiency virus-seropositive (HIV+) men are poorly described. Our objective was to compare the clinical characteristics, treatment decisions and oncologic outcomes in a contemporary series of HIV+ and HIV negative (HIV-) men with PC. Methods: Clinical data for 3135 men treated for PC at Cook County Hospital (2000-16) were reviewed. HIV+ patients (N = 46) were matched 1:2-3 by age and clinical stage to HIV-negative controls (N = 137). Clinicopathologic features, primary treatment, and oncologic outcomes were compared with Kaplan Meier and Cox proportional hazards analyses. Results: HIV- and HIV+ patients were similar with respect to median age (58.2 vs. 57.2 years, p = 0.2), initial PSA (10.6 vs. 10.5 ng/mL, p = 1), clinical stage (94% cT1/2 vs. 88%, p = 0.4), 8% cN1 vs. 6.5%, p = 1; 10.9% cM1 vs. 10.9%, p = 1), ECOG performance status (0-1 in 99% vs. 100%, p = 1). Among HIV+ men, 67.4% had a history of AIDS, and 91.3% were on HAART at diagnosis with median viral load and CD4+ count of 40 copies/mL and 400 cells/mm3. Median time from HIV diagnosis to PC diagnosis was 8.6 years. Among men with localized disease (N = 153), HIV+ men (N = 37) were more likely to receive radiation therapy (59.5% vs. 44.8%) or no therapy at all (13.5% vs. 4.3%) and less likely to receive surgery (16.2% vs. 30.2%), or to initiate active surveillance (10.8% vs. 16.4%; p = 0.04 overall) than HIV-. There were no differences in rates of biochemical recurrence (Hazard ratio [HR] 0.79; p = 0.6), clinical progression (HR 0.89, p = 0.8), castration resistance (HR 0.71, p = 0.1), or PC-death (HR 3, p = 0.1). However, HIV+ status was associated with an increased risk of all-cause death (HR 2.89, p = 0.04) with median follow-up of 4.2 years (range 0-14). Conclusions: Matched by age and stage, HIV+ men with localized PC were observed to receive surgery and definitive treatment overall at significantly lower rates than HIV- controls. Oncologic outcomes were similar between HIV+ and HIV- men. Further research is necessary to define optimal PC treatment selection in men with HIV.

Abstract P1-05-04: Progestin receptor content of breast cancer associated with expression of gene subsets for peptide/protein hormones and cognate receptors in LCM-procured cells that impact clinical outcomes

Abstract Assessing breast cancer prognosis and treatment selection was first enhanced by discovery that estrogen (ER) and progestin receptor (PR) proteins were clinically relevant biomarkers. Later reports suggested expression of certain protein hormones in breast cancer cells appear to be related to clinical behavior. We deciphered clinically relevant relationships between PR content in tissue biopsies and relative expression levels of genes directing synthesis of peptide/protein hormones and their cognate receptors in LCM-procured breast cancer cells. This global approach revealed unique relationships between both PR+ or PR- carcinomas and small subsets of genes for these peptide/protein hormones and cognate receptors as independent predictors of risk of recurrence. Methods: Expression of genes for 61 peptide/protein hormones and 81 cognate receptor proteins were measured by microarray analyses of LCM-procured carcinoma cells from de-identified primary breast carcinoma biopsies. Using an IRB-approved biorepository and database, previously total RNA was extracted from carcinoma cells to determine expression levels of ˜22,000 genes. Univariable and multivariable Cox regressions with interaction of each hormone eceptor gene, individually or paired, and use of LASSO were determined with relative gene expression values of each protein ligand and its cognate receptor. PR content and ligand binding affinity of each carcinoma were quantified by FDA approved assays. Results: Using de-identified clinical outcomes that extended up to 12 years, univariable Cox regression analyses of 142 candidates revealed AVPR1A, AVPR2, CALCR, CRH, LHB, POMC, SCT, SST, SSTR1 and TMSB10 independently predicted PFS or OS. Violin plots identified candidate genes associated with PR content. Multivariable analyses of relative gene expression of 115 hormone-receptor pairs showed IAPP-CALCR, RLN2-RXFP1, GHRH-GHRHR, CGA-TSHR, EDN1-ENDRA and POMC-MC5R exhibited statistically significant interaction for predicting OS among 145 PR+ cancers. Four gene pairs (HCRT-HCRTR2, CRH-CRHR1, HCRT-HCRTR1 and CORT-SSTR4) were associated with OS among 101 PR- lesions. Using LASSO, PR+ lesions expressing either (CGA &amp; SSTR2) or (CGA) predicted OS and PFS, respectively. Similarly, for PR- cancers, gene subsets (GRP, TMSB15, VIP2) or (AGT, GH1, GRP, TMSB15A) predicted OS and PFS, respectively. Three of four signatures were externally validated with SurvExpress. Conclusion: Different gene expression profiles for protein hormones and cognate receptors were identified in PR+ or PR- carcinomas at time of diagnosis that predict PFS and OS regardless of treatment. Combining PR content with gene expression of LCM-procured cells is likely to provide insight into alternative treatments whereby standard of care performed poorly or to identify genes that correlate with cancer progression regardless of treatment modality. Collectively, results suggest that many primary breast cancers exhibit considerable endocrine autonomy for controlling disease progression, supporting investigation of protein products of gene candidates in isolated populations of breast carcinoma cells to develop novel biomarker assays. Citation Format: Daniels MW, Brock GN, James WL. Progestin receptor content of breast cancer associated with expression of gene subsets for peptide/protein hormones and cognate receptors in LCM-procured cells that impact clinical outcomes [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-05-04.

Predictors of enrollment in individual- and couple-based lifestyle intervention trials for cancer survivors.

To utilize data from lifestyle intervention pilot studies for cancer survivors to elucidate demographic, disease-related, and health behavior factors that might predict enrollment in this type of research. Additionally, factors were differentially compared based on intervention design (i.e., individual versus couple-based). Secondary data analysis was conducted regarding predictors of enrollment into lifestyle intervention studies, including Healthy Moves Weight Loss (individual participants, screened n = 89, enrolled n = 30) and Healthy Moves Couples (survivors and their partners, screened n = 197, enrolled n = 23). Due to small sample sizes, common in pilot studies, random forest analyses were used to maximize information yielded by the data. Results identified numerous important predictors of enrollment in individual and couple-based lifestyle interventions. Percent energy from fat and physical activity minutes were identified as important predictors for both recruitment methods. Age, cancer site, and marital status were important predictors of enrollment in the individual-based intervention. Weight, fiber consumption, and disease-related symptom severity and interference were important predictors of enrollment in the couple-based intervention. Although there was some overlap in predictors for enrollment between studies, many differential predictors were identified between individual versus couple-based study designs for lifestyle intervention in cancer survivors. Future lifestyle intervention studies for cancer survivors may benefit from targeting different predictors of enrollment based on study design to optimize recruitment. Additionally, understanding predictors may allow certain barriers to enrollment (i.e., symptom burden) to be directly addressed, making lifestyle intervention research more feasible and acceptable to difficult-to-recruit survivors.

Results from an institutional universal reflex testing program for MSI/MMR in colorectal cancer.

796 Background: In colorectal cancer (CRC), clinical guidelines and immunotherapy treatment selection requires knowledge of tumor DNA mismatch repair gene deficiencies (dMMR) or accumulation of microsatellite repeats through genomic errors (MSI-H). Tumors harboring dMMR/MSI-H are found in 15- 20% of early stage CRC while the prevalence is ~5% in metastatic disease. Reflex testing of CRC to identify these important subsets has been proposed as a system-solution to improve identification. We present a large, single-institutional database of CRC reflexively profiled for MSI/MMR status at the University of Florida (UF). Methods: Beginning in 2009, stage IV CRC underwent reflex testing for MSI/MMR status. Earlier stage CRC testing began in subsequent years. For all new CRC diagnosed at UF, concurrent testing for dMMR by IHC (MLH1, PMS2, MSH2, MSH6), MSI by PCR (Promega MSI kit) and NGS is performed with appropriate positive and negative controls. IHC protein loss is confirmed by second GI pathologist. MSI is not performed if inadequate adjacent normal tissue. We conducted a retrospective analysis of all CRC samples analyzed between 2009 and 2017. Clinical data was collected from the EMR. This study was approved by the UF IRB. Results: A total of 388 new CRC cases were reflex tested (16% Stage I, 23% Stage II, 35% Stage III, and 25% Stage IV). Median age at diagnosis was 63 yrs (range: 17-98 yrs), 51% male and 79% white. Both MMR and MSI were performed in 244 (63%) tumors with 100% concordance when concurrently tested. dMMR/MSI-H incidence (20% in overall population) decreased with stage: I/II (31%), III (18%) and IV (~9%) and was associated with BRAF V600E mut in 36/76 cases (47%). Importantly, in pts &lt; 50 yrs, 13% of stage IV patients were dMMR/MSI-H. Conclusions: Reflex testing of MMR/MSI status in CRC is feasible with concordant results. Routine testing results in identification of dMMR/MSI-H at or higher than published rates. Notable findings include the high prevalence in those with sporadic CRC and/or younger than 50 yrs. Continued impact analysis of this approach is warranted to maximize IO therapy offering.

High-intensity exercise interventions in cancer survivors: a systematic review exploring the impact on health outcomes.

There is an increasing body of evidence underpinning high-intensity exercise as an effective and time-efficient intervention for improving health in cancer survivors. The aim of this study was to, (1) evaluate the efficacy and (2) the safety of high-intensity exercise interventions in improving selected health outcomes in cancer survivors. Design Systematic review. Data sources Google Scholar and EBSCO, CINAHL Plus, Computers and Applied Sciences Complete, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition, MEDLINE, Web of Science and SPORTDiscuss from inception up until August 2017. Eligibility criteria Randomized controlled trials of high-intensity exercise interventions in cancer survivors (all cancer types) with health-related outcome measures. The guidelines adopted for this review were the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The search returned 447 articles, of which nine articles (n = 531 participants mean, age 58 ± 9.5years) met the eligibility criteria. Exercise interventions of between 4 and 18 weeks consisting of high-intensity interval bouts of up to 4-min were compared with a continuous moderate intensity (CMIT) intervention or a control group. High-intensity exercise interventions elicited significant improvements in VO2 max, strength, body mass, body fat and hip and waist circumference compared with CMIT and/or control groups. The studies reviewed showed low risk in participating in supervised high-intensity exercise interventions. Mixed mode high-intensity interventions which included both aerobic and resistance exercises were most effective improving the aerobic fitness levels of cancer survivors by 12.45-21.35%, from baseline to post-intervention. High-intensity exercise interventions improved physical and physiological health-related outcome measures such as cardiovascular fitness and strength in cancer survivors. Given that high-intensity exercise sessions require a shorter time commitment, it may be a useful modality to improve health outcomes in those who are time poor. The risk of adverse events associated with high-intensity exercise was low.