Oncology Survivorship Research Articles

Abstract PO2-20-06: Using the Australian Cardio-Oncology Registry to study long-term cancer therapy related cardiac dysfunction in adult oncology patients – The Chris O’Brien Lifehouse experience

Abstract Background Cancer therapy related cardiac dysfunction (CTRCD) is a significant side effect of several chemotherapies, targeted agents, and immunotherapies integral to treatment. Anthracyclines are an example of a commonly used chemotherapy drug class that can cause irreversible early and late onset heart failure. CTRCD often leads to dose reductions and treatment delays or cessation, limiting treatment success and contributing to increased mortality and life-long morbidity in oncology survivors. In Australia, there are currently no multi-centre, longitudinal studies examining CTRCD in adult oncology patients. Trial design The Australian Cardiology-Oncology Registry (ACOR) is a prospective observational non-interventional study involving 14 sites across Australia. Patient information is obtained from hospital medical records and de-identified upon entry into the registry. Patient demographics, medical history, cancer diagnosis, treatment, cardiac evaluations, and the management of demonstrated CTRCD are recorded. Data is collected at baseline (prior to treatment), and then at six-monthly intervals thereafter. Additionally, patients who develop anthracycline-induced cardiotoxicity (ACT) will be asked to participate in the biobanking study, which will involve a one-off 12mL peripheral blood draw that will be processed at an external site for whole genome exome sequencing and the development of pluripotent derived stem cell cardiomyocytes. Eligibility criteria Inclusion Criteria • Adult oncology patients (>18+ years of age) treated with cardiotoxic therapies within the last 5-years Exclusion Criteria • Diagnosis of Trisomy 21 • Patients being treated with palliative intent Specific aims Chris O’Brien Lifehouse aims to use the ACOR to explore the epidemiology, clinical presentation, and management of CTRCD amongst adult oncology patients receiving cardiotoxic therapies. In addition, a biobanking sub-study will attempt to identify gene polymorphisms predisposing individuals to developing ACT. It is hoped that such longitudinal data collection can lead to the introduction of an ACT susceptibility genetic screening test allowing for the inclusion of patient risk stratification prior to anthracycline exposure in routine cancer treatment. Statistical methods Descriptive statistics will be used for variables for quantitative analysis. Kaplan Meier analyses will be used for survival curves, freedom from cardiac failure since enrolment and freedom from arrhythmia since enrolment. An annual report will be produced. Present accrual and target accrual At the time of submission, 224 adult oncology patients have been recruited to the ACOR via Chris O’Brien Lifehouse with the opening of the biobanking sub-study currently in progress. The ACOR anticipates with full registered site capacity to capture 600 patients annually. Citation Format: Jocelyn Finney, Ben Felmingham, Sanjeev Kumar, Alina Mahmood, Lisa Horvath, David Celermajer, Rachel Conyers. Using the Australian Cardio-Oncology Registry to study long-term cancer therapy related cardiac dysfunction in adult oncology patients – The Chris O’Brien Lifehouse experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-20-06.

Advancing survivorship at a comprehensive cancer center: integrating clinical care, education and research initiativesat NorthwesternMedicine and the Robert H. Lurie Comprehensive Cancer Center.

The unprecedented and growing number of cancer survivors requires comprehensive quality care that includes cancer surveillance, symptom management, and health promotion to reduce morbidity and mortality and improve quality of life. However, coordinated and sustainable survivorship care has been challenged by barriers at multiple levels. We outline the survivorship programs at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center that have evolved over two decades. Our current survivorship clinics comprise STAR (Survivors Taking Action and Responsibility) for adult survivors of childhood cancers; Adult Specialty Survivorship for survivors of breast, colorectal and testicular cancers, lymphomas, and leukemias; and Gynecologic Oncology Survivorship. Care provision models align with general, disease/treatment-specific, and integrated survivorship models, respectively. Reimbursement for survivorship services has been bolstered by institutional budget allocations. We have standardized survivor education, counseling, and referrals through electronic health record (EHR)-integrated survivorship care plan (SCP) templates that incorporate partial auto-population. We developed EHR-integrated data collection tools (e.g., dashboards; SmartForm, and registry) to facilitate data analytics, personalized patient referrals, and reports to the Commission on Cancer (CoC). We report to the CoC on SCP delivery, dietitian encounters, and DEXA scans. For the last decade, our Cancer Survivorship Institute has aligned the efforts of clinicians, researchers, and educators. The institute promotes evidence-based care, high-impact research, and state-of-the-science educational programs for professionals, survivors, and the community. Future plans include expansion of clinical services and funding for applied research centered on the unique needs of post-treatment cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: The survivorship programs at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Centerunderscore the imperative for comprehensive, coordinated, and sustainable survivorship care to address the needsof increasing numbers of cancer survivors, with a focus on evidence-based clinical practices, associated research,and educational initiatives.

Identifying Barriers to HPV Vaccination for Patients With Sickle Cell Disease and Childhood Cancer Survivors.

Human papillomavirus (HPV) vaccination prevents the development of HPV-associated malignancies. Adolescent and young adult survivors of childhood cancers and patients with sickle cell disease (SCD) are vulnerable patient populations who would significantly benefit from HPV vaccination. In this multimethod study, a retrospective chart review found a notable difference between the rate of HPV vaccinations and other age-appropriate vaccinations in 177 childhood cancer survivors and in 70 patients with SCD. We then sought to describe patient and caregiver beliefs regarding HPV vaccination, through semistructured interviews with 21 patients and 48 caregivers. Interviews were analyzed with a thematic content approach to understand attitudes regarding the HPV vaccination. Qualitative interviews noted that many caregivers and adolescents had baseline misconceptions regarding the HPV vaccination in general and in context with their chronic illness. It was found that a strong recommendation from a trusted subspecialty provider would create reassurance about vaccination and reduce misconceptions and concerns about side effects in the context of a chronic illness. Counseling from subspecialists could have a strong impact on understanding the HPV vaccine in the context of chronic illness. This would likely help overcome many of the barriers to vaccination that are encountered by patients with SCD or oncology survivors.

(012) Gynecologic Oncology Survivorship: Seeking Help for Sexual Distress

Abstract Introduction Addressing sexual side effects is an important component of gynecologic cancer survivorship. In order to provide patient-centered care, it is important to determine which patients have the highest risk of sexual problems following treatment. Objective The purpose of this study is to quantify and identify predictors of help-seeking for sexual distress in gynecologic oncology patients undergoing routine surveillance. Methods We performed a cross-sectional study of patients who have completed treatment for gynecologic malignancy at a single academic institution. Sexual activity was defined to include masturbation, oral sex, and sexual intercourse. The instrument contained the validated Female Sexual Distress Survey-Revised (FSDS-R), for which a score of 11 or above indicates sexually-related personal distress. We also assessed patient experience and preferences regarding the communication of sexual information with their healthcare team and selected resources. We performed one-sided t-test and logistic regression statistical analyses using STATA version 17.0. Results Between May to November 2022, 250 (of 331) eligible patients completed the survey (75% response rate). The median age of respondents was 60-years-old (range 27-85; IQR 19). Thirty-eight percent of patients had ovarian cancer, 42% uterine, and 20% cervical/vaginal/vulvar cancer. The majority (64%) had Stage I disease. The median years from finishing treatment (IQR) was 3.6 (2) years. The sample was diverse, with 44% self-identified as non-white (Asian, Black, Latinx or pacific Islander), while the vast majority (93%) was cis-gender, and 83% were heterosexual. Sixty-seven percent were married or in a relationship. Overall, 133 (53%) reported being sexually active within the past 30 days. FSDS-R scores ranged from 0-52 with a median (IQR) of 5 (15). 38% met criteria for sexually-related personal distress. Age was significantly associated with less sexual distress (OR 0.96; 95% CI: 0.94–0.99; P = 0.01). Uterine cancer was significantly associated with less sexual distress (OR, 0.49; 95% CI: 0.24–0.97; P = 0.04). In contrast, the combined group of cervical/vagina/vulvar cancer patient were also found to have a significantly increased rate of sexual distress (OR, 3.56; 95% CI: 1.56–8.10; P<0.01). Twenty-five percent of patients “somewhat” or “strongly disagreed” that they were adequately informed about sexual side effects of their cancer-directed care while another 42% felt neutral. 86.6% believed that physicians should routinely ask about sexual health, with 75% welcoming this anytime throughout treatment. Over half (53.1%) of respondents reported that healthcare providers “never” or “rarely” asked about sexual difficulties over the past 3 years and 33% of patients had previously discussed their sexual health with their gynecologic oncologist. Most patients (86%) found a sexual health conversation helpful. Patients had varied interest in speaking to a sexual medicine expert (35%) or a psychologist and relationship counselor (22%). Conclusions Patients are interested in sexual health with their gynecologic oncologist. An even larger proportion of patients desired to connect with a sexual health specialist, psychologist or relationship counselor, emphasizing the need for a multidisciplinary approach in gynecologic oncology survivorship. Disclosure No

PO-1068 Radiation Oncology Survivorship program in Latin America: Accessing acceptance and viability

PO-1068 Radiation Oncology Survivorship program in Latin America: Accessing acceptance and viability

Are Young Adult Survivors of Pediatric Cancer Being Overlooked? Cognitive Testing Results and Referrals in Child, Adolescent, and Young Adult Survivors.

Treatment gaps in meeting the neuropsychological needs of young adult (YA) cancer survivors can be attributed to several clinical and systemic reasons. Access to neurocognitive care can be increased through the effective integration of neuropsychological monitoring and intervention in survivorship care. In this brief report, we aim to compare the efficacy of a brief neuropsychological screener (DIVERGT) in meeting the assessment and referral needs of pediatric and YA cancer survivors (n = 40) as part of a wellness and survivorship clinic. Participants (n = 40) were patients who presented to a pediatric oncology survivorship clinic over the span of 15 months.

Integrating transition readiness assessment into clinical practice: Adaptation of the UNC TRXANSITION index into the Cerner electronic medical record

PurposeTo describe the process of developing, and evaluating the feasibility and acceptability of, an EMR-based transition readiness assessment. Design and methodsA Cerner-based version of the UNC TRxANSITION Index was implemented across four pediatric subspecialty clinics: epilepsy, inflammatory bowel disease; type 1 diabetes, oncology survivorship. The feasibility was assessed by each's clinic's ability to meet form completion goals and their assessment rate. Acceptability was assessed via family refusal rate, a staff-completed feedback questionnaire, and whether the form was adopted into routine clinical care after completion of the pilot study. ResultsAll clinics met form completion goals (N = 10/clinic). The assessment rate ranged from 66 to 100% across clinics. No families refused completion of the form. Most staff (70%) reported completing the form in <10 min. Staff reported on challenges experienced and provided recommendations to streamline administration and enhance clinical care. All staff reported the form helped them identify knowledge gaps in their patients. Two clinics continued using the form following completion of the pilot study. ConclusionsImplementation was most feasible in clinics that were well-staffed and had lengthier patient visits, however, time and staff resources were the biggest challenges to implementation across clinics. Based on staff feedback to improve efficiency and developmentally-tailor assessment, the form will be divided into Beginner Skills and Advanced Skills. Practical implicationsIntegrating transition readiness assessment into the EMR has the potential to improve clinical care by facilitating staff's ability to efficiently identify knowledge gaps in their transition-aged patients and intervene.

Radiation Oncology Survivorship Program in a Latin America Continental Country: Accessing Acceptance and Viability according to Patients and Health Professionals

<h3>Purpose/Objective(s)</h3> Most cancer patients need rehabilitation for sequelae left by treatments such as radiation therapy, chemotherapy and the most diverse surgeries. The professionals at the head of such processes do not always have the necessary expertise for a satisfactory rehabilitation from radiation therapy, due to the generalized training they receive in colleges nationwide. Survivorship programs have facilitated access to more specialized professionals, but they are scarce in developing countries. We evaluated the viability of a <b>s</b>urvivorship program for radiation oncology patients and their acceptance by health professionals involved in all stages of treatment in Brazil. <h3>Materials/Methods</h3> A questionnaire including relevance scores was carried out with patients who completed radiation therapy treatment in the last 2 years and with several professionals involved in rehabilitation. For patients, data such as rehabilitation treatments that they had or are still doing, weekly frequency of them, degree of satisfaction with the results, geographic distance and knowledge about survivorship programs were collected. For professionals, we accessed the number of cancer patients assisted by month, the professional's comfort in treating these patients, difficulties faced, specialization in oncology, perception and knowledge about survivorship programs. A Multivariate analysis was performed, completed with multivariate regression and Cox proportional hazard model. <h3>Results</h3> Of the 1998 patients who performed the survey, 93% did not know about any survivorship program and 63.5% of these showed great interests in participating. The majority, 78%, needed to receive some treatment for rehabilitation in the first six months after radiotherapy and an important portion, 59%, still do it at least 2 times a week until the moment of the interview. Also, 72% rated the possibility of concentrating the most diverse services in the same physical location as very valid. Data collected from 137 professionals showed that only 10% claimed to have some specialization in oncology. About the survivorship programs, 92% did not participate or had no knowledge, 3% had already been invited to join a program and 5% were actually already part of it. The vast majority, 97%, indicated an interest in joining a survivorship program if invited. <h3>Conclusion</h3> There is a real demand, from both patients and health professionals, to increase efforts and investments for new survivorship programs in a developing country of continental dimensions like Brazil. Such programs can really reflect in a greater quality of life for patients after radiation therapy, by providing access to rehabilitation with subspecialist professionals, and for professionals, a safer practice by enabling both scientific and clinical exclusive dedications.

P070: Design of the INSIGHT study, evaluation of long-term follow-up care for lymphoma survivors in the Netherlands: does survivorship care at the BETER clinics reduce morbidity and mortality from late effects of lymphoma treatment and associated costs?

Background: Hodgkin lymphoma (HL) survivors are at substantial risks of serious late adverse treatment effects. The BETER consortium developed a nationwide infrastructure of outpatient clinics where 5-year HL survivors are screened and treated for adverse effects of lymphoma treatment according to nationally approved screening guidelines. BETER survivorship care includes risk-based screening for and treatment of (risk factors for) cardiovascular disease (CVD), breast cancer, hypothyroidism and (functional) asplenia. So far, evidence for the actual cost-effectiveness of structured cancer survivorship care in clinical practice is lacking. Current knowledge is based on simulation and modelling approaches and evidence from other populations (e.g. BRCA mutation carriers). In the INSIGHT study we will assess the (cost-)effectiveness of BETER survivorship care using data from clinical practice. Methods: The first BETER clinics started in 2013–2016 and the number of centres participating in BETER is quickly expanding: several centres started/will start a BETER clinic in 2021–2024. This allows for a retrospective cohort study with a quasi-experimental design to evaluate the effectiveness of BETER survivorship care by comparing survivors who did and did not receive BETER survivorship care. Once full nationwide implementation is in place, this comparison is no longer possible. In the INSIGHT study we will compare 450 HL survivors invited for BETER survivorship care in 2013–2016 with 450 matched survivors invited by a BETER clinic starting in 2021–2024, allowing for a median follow-up of ~8 years. The primary outcomes are burden of disease (in disability-adjusted life-years, DALYs) from CVD, breast cancer, hypothyroidism and (functional) asplenia, associated health care costs, quality of life and health-related productivity losses. Secondary outcomes are BETER clinic attendance, guideline adherence and knowledge and risk perception of late effects. In a cost-effectiveness analysis we will calculate costs/DALY and costs/QALY of BETER survivorship care. Conclusion: BETER is an internationally unique initiative of an elaborate infrastructure for adult oncology survivorship care. To our knowledge, INSIGHT is the first evaluation of (cost-)effectiveness of cancer survivorship care in clinical practice. The results will contribute to more effective, evidence-based long-term cancer survivorship care. At ISHL12 we will present design details as well as participation rates.

Sluggish cognitive tempo profiles in survivors of childhood cancer as compared to children with attention-deficit/hyperactivity disorder.

Neurocognitive late effects including problems with attention have been reported in pediatric oncology survivors. While some researchers have characterized these late effects as similar to symptoms of attention-deficit/hyperactivity disorder, inattentive presentation (ADHD-I), there remains some controversy as to whether these concerns in oncology patients are best conceptualized according to an ADHD-I or sluggish cognitive tempo (SCT) framework. The aim of this study was to describe SCT symptoms in children with ADHD-I or oncology diagnoses; identify groups of SCT symptoms among children with brain tumors (BT), acute lymphoblastic leukemia (ALL), or ADHD-I; and identify whether specific SCT profiles are associated with these diagnoses. The sample was comprised of 364 youth (146 BT, 149 ADHD-I, 69 ALL) referred for a neuropsychological evaluation at an academic medical center. Caregivers completed the SCT scale as part of the clinical evaluation. Groups differed on mean scores for the SCT scales (Total, Sleepy/sluggish, Low initiation, and Daydreamy) by diagnosis (all p < 0.05), with the ADHD-I group having higher SCT symptoms on all scales. Latent profile analysis showed significant differences between latent SCT classes according to ADHD-I versus cancer diagnosis. The ADHD-I group was significantly more likely to be in the high SCT class compared to the oncology groups. Findings add to the understanding of SCT symptoms in pediatric oncology survivors. There is utility in applying the SCT framework to the oncology population; however, pediatric survivors are likely to be rated differently than youth with ADHD-I. Implications and future directions are discussed.

Using a Network Physiology Approach to Prescribe Exercise for Exercise Oncology.

Current American College of Sports Medicine (ACSM) exercise guidelines for exercise oncology survivors are generic one-size fits all recommendations, which assume ideal or prototypic health and fitness state in order to prescribe. Individualization is based on the objective evaluation of the patient's baseline physiological status based on a linear dose response relationship of endpoints. This is only a partial snapshot of both the acute and chronic responses exercise can provide. Each acute exercise session represents a unique challenge to whole-body homeostasis and complex acute and adaptive responses occur at the cellular and systemic levels. Additionally, external factors must be considered when prescribing exercise. Network physiology views the human organism in terms of physiological and organ systems, each with structural organization and functional complexity. This organizational approach leads to complex, transient, fluctuating and nonlinear output dynamics which should be utilized in exercise prescription across health states. Targeting health outcomes requires a multi-system approach as change doesn't happen in only one system at a time or in one direction Utilizing a multi-system or person-centered approach, allows for targeting and personalization and understands and targets non-linear dynamics of change. Therefore, the aims of this review are to propose a paradigm shift towards a Network Physiology approach for exercise prescription for cancer survivors. Cancer treatment affects multiple systems that interact to create symptoms and disruptions across these and therefore, prescribing exercise utilizing both external daily factors and internal physiological networks is of the highest order.

Evaluation of fertility preservation counseling and treatments in an urban pediatric Canadian center

Background: Increases in pediatric oncology survivorship has led to numerous considerations including long term preservation of fertility. Several international organisations and guidelines have recommended implementation of structured fertility preservation (FP) discussions with patients and their families prior to initiation of chemotherapy and radiation treatments in children. This study aimed to identify current trends and rates in FP counseling and treatments at a Canadian pediatric tertiary care center.

Interprofessional Collaborative Practice and Education in Oncology: Practical Applications and Experiences, From Physical Therapy Classroom to Clinic

Oncology is a complex clinical domain that requires physical therapists (PTs) to engage in multidisciplinary collaboration to achieve optimal patient outcomes. The emerging role of PT in oncology highlights the need to include interprofessional education (IPE) and interprofessional collaborative practice (IPCP) during entry-level training, yet few curricular models, which integrate IPE and IPCP, exist. New clinical opportunities in oncology within our Doctor of Physical Therapist (DPT) program create a multidimensional platform for students to engage with the entire health care team to address the complex needs of this population, and to demonstrate the value of the PT as a member. Such opportunities not only meet the standards and required elements of DPT education, but are initiatives supported by the World Health Organization, and the American Physical Therapy Association. The purpose of this article is to highlight opportunities and practical strategies employed by one academic institution to integrate IPE and IPCP into their entry-level program, share lessons learned, and ideas for future development of this important topic. In our integrated curricular model, physical therapist students learn about the roles and responsibilities of each interprofessional team member, learn to share information, and collaborate during a dynamic and practical clinical environment under the supervision of faculty. Knowledge from previous didactic coursework is applied to pediatric and adult oncology survivors participating in a wellness program or group exercise class. All activities and exercises are modified based on the patients' needs and responses.

Changes in executive function in pediatric brain tumor survivors.

Pediatric oncology survivors are at risk for executive function (EF) and working memory (WM) deficits, which can be measured via performance-based measures or rating scales. Previous studies have shown these measurement methods to be weakly correlated. This study aimed to describe parent-rated EF and performance-based WM (PBWM) in pediatric brain tumor (BT) survivors, examine change in EF and PBWM across time, and investigate the relationship between parent-rated WM and PBWM. The sample included 56 patients diagnosed with a BT in childhood (Mage =6.94years; SD=4.05) seen twice for clinical neuropsychological evaluation. PBWM was examined via the auditory WM scale from a Wechsler intelligence measure or Differential Ability Scales-II. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF)/BRIEF-P/BRIEF-2 as a measure of global EF (Global Executive Composite [GEC]), metacognitive skills (Metacognitive Index/Cognitive Regulation Index [MI/CRI]), behavioral regulation (Behavior Regulation Index [BRI]), and emotional regulation (Emotion Regulation Index [ERI]). GEC, MI/CRI, and ERI at Time 1 were significantly above the mean (p<.01); BRI and PBWM did not differ from the normative mean. All measures were significantly higher than the normative mean at Time 2 (p<.05). PBWM was both clinically and statistically elevated (p<.001). There was a significant change across time in PBWM (p<.05), but not GEC, MI/CRI, ERI, or BRI. PBWM was weakly correlated with the BRIEF WM subscale at Time 1 and Time 2 (all p>.05). Multiple measures of EF should be considered when providing diagnoses and recommendations for pediatric BT survivors. Furthermore, given declines across time, findings document need for continued monitoring and reassessment of survivors as they get further out from treatment.

Childhood Cancer Survivors and Distance Education Challenges: Lessons Learned From the COVID-19 Pandemic.

Pediatric cancer survivors have historically struggled to receive adequate educational supports. In Spring 2020, the COVID-19 pandemic forced an emergency switch from traditional in-person education models to distance education, but little information is available regarding experiences of pediatric survivors' coping with schooling since that time. This article presents exploratory mixed methods findings from a quality improvement project including qualitative interviews and a quantitative survey conducted with parents of pediatric oncology survivors identified through neuropsychological assessment, and the use of school-based services as having educationally relevant neurocognitive impacts of disease or treatment. The interviews explored experiences of education and instructional delivery during the COVID-19 school closures in spring of 2020 and the beginning of the 2020-2021 school year and served as the foundation for a quantitative survey to determine the generalizability of findings. Qualitative interviews highlighted 3 emergent themes regarding the shared experiences of distance schooling for children with cancer during the COVID-19 school closures: (a) attention, (b) mental health, and (c) access to instruction. A follow-up quantitative survey supported the qualitative findings and their generalizability to the schooling experiences of other children with cancer during the pandemic. This article describes and explores each theme and offers suggestions for pediatric supports and changes to provider service delivery (including weblinks to access project-developed resources) as a result of ongoing pandemic-related schooling needs.

Neuropsychological assessment in pediatric oncology survivorship care: utilization of services, results of evaluation, and educational and behavioral health outcomes.

Neuropsychological evaluation has become a standard component of long-term follow-up care for survivors of pediatric cancer. The purpose of the present study was to examine access to, and benefits of, neuropsychological evaluation for survivors. A retrospective chart review was conducted on cancer survivors who were referred for neuropsychological evaluation from a multidisciplinary long-term follow-up (LTFU) clinic approximately 5years following treatment cessation. Descriptive statistics were calculated, and t-tests and chi-square analyses were utilized to examine variables that may impact survivors' access to neuropsychological services. One hundred seven survivors between 6 and 26years old were referred for a neuropsychological evaluation. Referred male patients were less likely than female patients to schedule an evaluation. Consultation with a neuropsychologist in the LTFU clinic was related to more referrals but did not improve attrition rates (55%). Twenty-four percent of evaluated patients displayed severe cognitive impairment and 75% were diagnosed with a psychological disorder. Utilization of educational and behavioral health services did not significantly change following evaluation. Survivors' utilization of neuropsychological services is lower for males than females. The presence of a neuropsychologist in a multidisciplinary team clinic can improve identification of survivors that may benefit from neuropsychological evaluation. Many survivors did not receive recommended services, suggesting patients and families may need additional supports following evaluation. Future research should focus on improving survivors' access to neuropsychological services and identifying barriers to receiving recommended services.

Survivorship care planning, quality of life, and confidence to transition to survivorship: a randomized controlled trial with women ending treatment for breast cancer

Purpose The Polaris Oncology Survivorship Transition (POST) system is a computer-based program that integrates information from the electronic health record, oncology team, and the patient to produce a personalized Survivorship Care Plan. The purpose of this study was to compare the POST to treatment as usual on confidence, quality of life, and interest in mental health referrals in women ending treatment for breast cancer. Sample Two hundred women (100 POST, 100 treatment as usual) ending treatment for breast cancer were enrolled in a randomized controlled trial. Design Women randomized to the POST condition received a personalized care plan during a baseline/intervention appointment. At enrollment and baseline/intervention, a number of outcomes were examined in this study, including confidence to enter survivorship measured by the Confidence in Survivorship Index (CSI) and Quality of Life (QOL). One, three, and six month follow up assessments were also conducted. Findings Treatment groups did not differ in terms of QOL scores at any time points. Mean CSI scores were statistically different between POST and treatment as usual at baseline for the total CSI score and both subscales, but only for confidence in knowledge about prevention and treatment at the 1-month follow-up. All significant differences were in favor of the POST intervention as mean CSI scores were higher for participants who received the POST intervention as opposed to treatment as usual. These findings disappeared at the 3 and 6 month follow up assessments. Finally, patients who received the POST intervention were twice as likely to request mental health/social services referrals compared to women who received treatment as usual. Implications Oncologists may use the POST to build personalized care plans for women ending treatment for cancer, which may enhance patients’ confidence in the short term as well as encourage use of mental health resources.

The contribution of sluggish cognitive tempo to processing speed in survivors of pediatric brain tumors

ABSTRACT Sluggish Cognitive Tempo (SCT) describes a pattern of under-activity, poor initiation, and slowness. It was first reported within the Attention Deficit Hyperactivity Disorder (ADHD) literature and found to be positively associated with the inattentive symptoms of ADHD and negatively or not significantly associated with the hyperactivity/impulsivity symptoms of ADHD. SCT has since been considered applicable to the pediatric oncology population given the emergence of inattentive, sluggish symptoms secondary to cancer treatment. The present study examined the unique contribution of SCT to various processing speed skills in a clinical sample of pediatric brain tumor (BT) survivors in order to determine the degree to which SCT explained timed “cognitive” processing components. Measures included speeded naming, graphomotor speed, and speeded inhibition. Hierarchical linear regression analyses were used to predict performance-based measures of processing speed. After controlling for verbal ability and inattention, SCT, particularly Daydreamy SCT (β = −0.698, p = 0.023), explained 28% of variance in speeded inhibition. SCT did not add significantly to the prediction of speeded naming or graphomotor speed. Findings suggest that the “daydreamy” aspect of SCT, rather than “sluggishness” per se, may be related to more complex, cognitively-demanding tasks with greater executive functioning burdens in BT survivors. Implications for intervention for oncology survivors as well as future research directions are discussed.

Oncology expressive arts: providing a window to reflect on a stressful experience

Purpose Evaluate changes in mood, perceived need for help, and task enjoyment after participation in a one-time Oncology on Canvas expressive arts workshop intervention. Methods Mixed methods design. Sample: military-veteran oncology survivors and their adult `ohana (family members, caregivers, friends, healthcare providers, volunteers). Measurement tools: Emotion Thermometers, Multiple Affect Adjective Checklist-Revised, Task Enjoyment Question, semi-structured interviews, and self-reflective narratives. Colaizzi’s Phenomenological Method was used to conduct a thematic analysis. Findings Significant improvements in mood, increased task enjoyment, and decreased perceived need for help, with continued effects for up to 30-60 days post-intervention. Conclusions A one-time expressive arts workshop intervention can provide a window for oncology survivors and their adult `ohana to reflect on a stressful experience. Implications for Psychosocial Providers Psychosocial healthcare providers (APRNs, nurse educators, LCSWs, psychologists) who are not professional art therapists can effectively implement expressive arts workshops as a cost-effective intervention for oncology survivors and their `ohana.

52. Low Rate of Hpv Vaccination in a Tertiary Oncology Survivorship Clinic

Survivors of childhood cancers are at increased risk of subsequent HPV-related cancers and their sequelae. Anecdotal data suggests increased vaccine hesitancy in this group, and it is unclear whether this is general vaccine hesitancy or specific to HPV vaccine. We compared rates of HPV to other adolescent vaccinations in a pediatric cancer survivor population. We define a missed opportunity as a patient missing an HPV vaccine who is otherwise up to date and no mention of HPV vaccine-specific counselling.