Recommendations For Follow-up Care Research Articles

The Utility of the Early Postoperative Follow-up and Radiographs After Operative Treatment of Supracondylar Humerus Fractures in Children.

Supracondylar humerus (SCH) fractures are common elbow injuries in pediatric patients. The American Academy of Orthopedic Surgeons published guidelines for the standard of care in the treatment of displaced SCH fractures, however, no recommendations for follow-up care were made. With the recent push to eliminate unnecessary radiographs and decrease health care costs, many are questioning postoperative protocols. The purpose of our study was to evaluate the utility of the 1-week follow-up appointment after closed reduction and percutaneous pinning (CRPP) of displaced SCH fractures. A retrospective review performed at a single institution from 2014 to 2016 included patients under 14 years of age with a closed, displaced SCH fracture treated with CRPP. Exclusion criteria included patients without complete clinical or radiographic follow-up. Variables examined included time to initial follow-up, change in treatment plan after 1-week x-rays, complications, demographics, fracture type, pin number and configuration, reduction parameters, immobilization, time to pin removal, duration of casting, and clinical outcome. A total of 412 patients were divided into 2 groups based on time to initial follow-up. Overall, 368 had an initial follow-up at 7 to 10 days (group 1) and 44 at 21 to 28 days (group 2). There was no difference in age, sex, fracture type, pin configuration, or a number of pins between groups. Statistically significant findings included time to initial follow-up and days to pin removal (group 1 at 26.2 d vs. group 2 at 23.8 d), type of immobilization (group 1 with 5% circumferential casts and group 2 with 70%), and time to surgery (26.2 vs. 62.9 h, respectively). There was no significant difference in complication rates and only a 0.5% rate of change in management in group 1. Early postoperative follow-up and radiographs did not change the patient outcome and might be eliminated in children with displaced SCH fractures treated with CRPP. Given the current focus of on efficiency and cost-effective care, eliminating the 1-week postoperative appointment would improve appointment availability and decrease medical cost. Level III-Therapeutic.

Screening for childhood adversity among adult primary care patients.

Over half of Americans reports a history of adverse childhood experiences (ACEs), which have been associated with many chronic health conditions. Yet primary care providers infrequently screen patients for ACEs and fail to consider the relationship between ACEs and adult health. Therefore, the purposes of this study were to test the effectiveness and feasibility of a screening interview for ACEs and to confirm the prevalence of ACEs among individuals with chronic health conditions. Screening interviews were conducted with 71 adults in a primary care setting. Patients' ACE history, nurse practitioner comfort with screening, time to screen, and patient follow-up care recommendations were gathered through questionnaires. Adverse childhood experience prevalence was analyzed by descriptive statistics. Relationships between ACEs, number of clinic visits, time to screen, and follow-up care recommendations were analyzed by bivariate statistics. Over half of participants reported more than four ACEs, with ACEs common among participants with chronic health conditions (93%). Adverse childhood experience scores were positively correlated with number of clinic visits, time to screen, and recommendations for follow-up care. Findings support screening primary care patients for ACEs. Adverse childhood experiences are prevalent among primary care patients with chronic conditions. Using interviews to screen for ACEs in primary care settings is effective and feasible.

Evaluating Checklist Use in Companion Animal Wellness Visits in a Veterinary Teaching Hospital: A Preliminary Study.

The number of companion animal wellness visits in private practice has been decreasing, and one important factor cited is the lack of effective communication between veterinarians and pet owners regarding the importance of preventive care. Checklists have been widely used in many fields and are especially useful in areas where a complex task must be completed with multiple small steps, or when cognitive fatigue is evident. The use of checklists in veterinary medical education has not yet been thoroughly evaluated as a potential strategy to improve communication with pet owners regarding preventive care. The authors explored whether the use of a checklist based on the American Animal Hospital Association/American Veterinary Medical Association canine and feline preventive care guidelines would benefit senior veterinary students in accomplishing more complete canine and feline wellness visits. A group of students using provided checklists was compared to a control group of students who did not use checklists on the basis of their medical record notes from the visits. The students using the checklists were routinely more complete in several areas of a wellness visit vs. those who did not use the checklists. However, neither group of students routinely discussed follow-up care recommendations such as frequency or timing of follow-up visits. The study authors recommend considering checklist use for teaching and implementing wellness in companion animal primary care veterinary clinical teaching settings.

Caregiver needs during transition from acute cancer: Findings from focus group discussions with cancer survivors and caregivers.

84 Background: The Institute of Medicine recommends that all cancer patients receive a survivorship care plan to help alleviate challenges faced when transitioning from acute treatment to long-term survivorship. As nearly three million Americans act as caregivers for a loved one with cancer, it is important that the survivorship care planning process consider the needs of not only the survivor, but also caregivers. Methods: In preparation for a randomized controlled trial of survivorship care planning, we conducted four focus groups with adult survivors of breast, prostate, and colorectal cancer (n = 28) and two with self-identified caregivers of people who had been treated for these three cancers (n = 20). Focus group participants were recruited from a large, urban academic medical center and a rural community cancer center. Discussions focused on needs and expectations during the transition from cancer treatment to survivorship. Each discussion was recorded, transcribed, and analyzed qualitatively. Data analysis also included review of findings by an advisory board of patients and caregivers. Results: Six themes emerged, some raised by both survivors and caregivers, and some only by caregivers. The need for information on side effects and follow-up care recommendations, confusion regarding the role each provider plays once treatment is complete, and the need for resources and support to help deal with issues such as physical and emotional distress and living a healthy lifestyle were brought up by both caregivers and survivors. In addition, caregivers discussed uncertainty about their role as a caregiver, their own mental and emotional health needs, and the idea that adjusting to ‘a new normal’ is not just for the patient, but also caregivers. Conclusions: Caregivers have distinct needs in addition to those of the patient. These caregiver concerns may need to be addressed during the survivorship care planning process. Based on these findings, we are including a caregiver-specific resource in our survivorship care planning randomized controlled trial.

Piloting breast cancer survivorship care planning in a safety net hospital.

65 Background: Survivorship care plans (SCPs) include treatment summaries and follow-up care recommendations intended to improve patient care and well-being after cancer treatment. Limited research has yielded mixed results regarding SCPs' impact on patient and system outcomes, but emphasized provider burden as an implementation barrier. We created a patient-centered SCP template and implemented its delivery at a safety net hospital that serves primarily racial/ethnic minority patients. Methods: In a single-arm feasibility study, oncologists and advanced practice nurses used the template to deliver SCPs to post-treatment breast cancer survivors (BCS) in consultation visits. We assessed changes in patient-reported outcomes from baseline (pre-SCP) to a 3-month follow-up, as well as provider time burden. Results: Female BCS participants (n = 75; mean age = 58.5 years) were primarily African-American (73%) and had high school/GED education or less (61%). Average time since diagnosis was 3.7 years (SD = 3.8); all received surgery; most received radiation (84%), hormone (77%), and/or chemotherapy treatment (73%). At follow-up, a majority rated their SCPs as good to excellent (92%), easy or very easy to understand (84%), a good to excellent summary of their treatment (92%) and as motivation for healthy lifestyles (88%). BCS follow-up scores improved significantly from baseline on breast cancer knowledge (p = .02), self-efficacy (p = .03), the QLQ-INFO25 (p < .01), and the FACIT TS-PS satisfaction with health care staff communication subscale (p < .01). No significant differences between baseline and follow-up scores (p < .05) were found for overall treatment satisfaction, health behaviors, and health-related quality of life. Preparing and delivering SCPs took providers considerable time (M = 54 & 22 minutes, respectively). Conclusions: This pilot study is limited by a single-arm design, but results suggest that SCPs may be related to improved survivor knowledge, information, self-efficacy and communication with health care staff. The individualized, comprehensive SCPs were well received by BCS in a safety net hospital but delivery was time-intensive. These findings will inform future research trials and clinical care initiatives.

Suicide Prevention in Health Care.

Decreasing suicide rates through health care system change is an example of how improving patient safety warrants psychiatrists’ awareness, training, teamwork, and leadership in system-based solutions. It has been over 15 years since the Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System (2), reported that “at least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented.” In March of 2001, IOM’s next catalyzing report, Crossing the Quality Chasm, concluded that “merely making incremental improvements in current systems of care will not suffice.” These reports inspired the nation’s campaign to improve quality and safety in health care (3). However, adverse events causing morbidity and mortality continue. The Six Sigma comparison of industries ranks the many health care “defects per million opportunities” near that of the Internal Revenue Service tax advice phone-in service; domestic airline flight fatality rates achieve superior Six Sigma safety rates (4). Many of the country’s top sentinel events are mental health related, including restraint-related events, elopements, selfinflicted injuries, and suicides (5). Some of the top sentinel event settings include psychiatric hospitals, psychiatric units, and behavioral health facilities, totaling 19% of all locations for sentinel events since 2004. In comparison, emergency departments account for only 5.4%, and office-based surgery, 0.9%. Approximately 1,500 inpatient suicides occur per year in theUnited States (6). In juxtaposition, themost recent data from aviation fatalities from theNational Transportation Safety Board reveal a total of only 443 aviation deaths (7). If psychiatrists are the pilots of the mental health system, then what can they do in collaboration with others to transform the industry to the next level of safety at a systems level? Many organizations support this system transformation, including IOM, the Agency for Healthcare Research and Quality, the Joint Commission, the American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association. In addition, the American Board of Medical Specialties is highlighting safety standards by integrating patient safety principles into its program for maintenance of certification (MOC) requirements (9). The American Board of Psychiatry and Neurology is part of this leadership drive (10). Focus will begin attending to MOC safety requirements and providing a review of current clinical safety practice. Patient safety is a vital function of psychiatric services and a core objective of the mental health system. Without safety, there would be neither treatment nor recovery. Suicide is one of the top safety challenges that our health care system faces. Psychiatrists and other mental health clinicians practice standards of care in their provision of suicide risk assessment, risk management, and biopsychosocial treatments. However, in the system of care some failure modes are root causes of suicide and are beyond the realm of the psychiatrist’s assessment and treatment. If there were board exam questions on suicide data and suicide risk assessment, psychiatrists would readily know the answers (noted at the end of this column):

Who Should Transition? Defining a Target Population of Youth with Depression and Anxiety That Will Require Adult Mental Health Care.

The process of transitioning youth from child to adult mental health services is poorly managed, and many adolescents disengage from services during transfer. The waxing and waning of symptoms over time means that some youth who are asymptomatic prior to transfer (15-17years) will be at high risk for recurrence during the transition period. There are no clear, evidence-based guidelines about who should transfer to adult care. Objectives were to propose: (1) criteria to define anxious or depressed youth (16-21years) that should transfer and (2) levels of service needed in young adulthood. Natural history of psychopathology and treatment response for depression and anxiety was reviewed. Risk factors for recurrence and persistence, such as initial severity, comorbidity, and family functioning, can help to identify youth requiring transfer. Few controlled treatment studies have examined predictors of long-term course. Recommendations for follow-up care and ongoing monitoring during young adulthood are discussed.

Impact of lymphoma survivorship clinic visit on patient-centered outcomes.

64 Background: The goals of our Lymphoma Survivorship Clinic (SC) are to coordinate care, educate patients, and create a survivorship care plan (SCP). The aim of this study was to determine if patient-centered outcomes are improved after a SC visit. Methods: From 11/13-5/15, surveys were mailed to recently-treated lymphoma patients who were within 4 weeks of their last visit and in remission. Quality of life (QOL) was measured with PROMIS and distress was measured with the Impact of Events scale. Responses between those who attended SC and those who were eligible but did not attend were analyzed. Results: There were 96 surveys sent to the SC group; 59 were returned (61% response rate). Of the non-SC group, 140 surveys were sent and 84 were returned (60% response rate). Mean age was 57 years (range 23-77) in the SC group and 59 years (23-88) in the non-SC group. There were more females in the SC group (52% vs 30%) but no differences in race, marital status, education, or health literacy. Those who attended the SC were more likely to recall receiving a summary of cancer treatment and recommendations for follow-up care (90% SC vs. 75% non-SC, p = 0.03). Furthermore, SC attendees were more likely to “definitely” recall discussion on improving health or preventing illness (89% vs. 53%), getting help in making changes in habits/lifestyle (76% vs. 50%), diet (80% vs. 31%), and exercise (82% vs. 51%), all p < 0.001. There were no differences in discussions regarding smoking, follow-up testing, and symptom monitoring. The SC group was less likely to need more information regarding sexuality (6% vs 20%, p = 0.045). There were no differences in need for information regarding anxiety, fitness, familial cancer risk, fertility, complementary therapies, and social issues. The SC group was slightly more confident that they could get information or advice related to cancer (completely confident 76% vs. 61%, p = 0.07). There were no differences in QOL or distress. Conclusions: A Lymphoma SC visit increased receipt of SCP and provided more information on survivorship issues, particularly health behaviors, but did not improve QOL or distress. Further study is needed to determine if this leads to long-term health benefits.

Oncologists' perception of residual cancer recurrence risk and recommended follow-up care.

151 Background: Many medical oncologists avoid using the word "cure" even at 20 years post-diagnosis. Little data has been reported on oncologists' perceptions of patients’ residual risk of recurrence and their recommendations for follow-up care. Methods: E-mail requests were sent to oncologists to review four brief case scenarios and to indicate their perception of the patients’ residual risk of recurrence (Essentially Zero, 1-10%, 11-25%, 26-50%, 51-75%, 76-100%) and their recommended follow-up care. We also conducted a literature review to estimate actual recurrence risks for these stated scenarios. Results: 130 medical oncologists responded. The percentage who perceived a zero or essentially zero risk of recurrence steadily increased at the 5,10, 15, and 20+ year post-diagnosis time points in patients with Stage II triple negative breast, Stage II colon, Stage II lung, and Diffuse Large B-cell Lymphoma. Follow-up for 20+ years was recommended by 43%, 27%, 32%, and 38% of respondents respectively. Among respondents who recommended this long-term follow-up 37%, 63%, 57%, and 58% perceived no residual risk of recurrence after 20 years. There was no statistically significant relationship between recommending follow-up at > 20 years and the perception of the patient having a non-zero risk of recurrence. Even at twenty years post-diagnosis a > 10% risk of recurrence was expected by 14%, 8%, 10%, and 11% of respondents.However,a literature review indicated recurrence risks of < 5% after 10 years of disease free survival for patients with each described scenario. At 10 and 15 years, participants indicated the two most common reasons for follow up were screening for late and long-term effects followed by screening for new cancer Conclusions: The risk of cancer recurrence is typically greatest in the initial years after diagnosis and then decreases, especially after 10 years. In this study, many medical oncologists still perceived a > 10% residual risk of recurrence at 10, 15, and 20 years post-diagnosis and recommended follow-up visits.

Recommendations for Follow-up Care for Gynecologic Cancer Survivors.

Gynecologic cancer survivors are expected to increase in number over the coming years. This is attributable in part to an increased incidence of gynecologic malignancies as the population ages. Earlier detection and improved treatments will lead to improved survival. Women who have completed their cancer treatment and are disease-free enter a phase of follow-up care. This care can be provided by gynecologic oncologists, general gynecologists, or primary care practitioners, depending on local practices and geographic area. The key components of follow-up include complete history and physical examination. There should be judicious use of appropriate testing to detect disease recurrence, assessment, and management of therapy-related symptoms and provision of psychosocial support. Well-woman care and ongoing screening for other malignancies remain an important component of care that should not be overlooked. This review provides recommendations regarding follow-up care for women with gynecologic malignancies. There is very little high-quality evidence available to guide such care.

Development of a standard survivorship care plan template for radiation oncologists

PurposeIn response to a need expressed by members of the American Society for Radiation Oncology (ASTRO), the ASTRO Board of Directors approved an initiative to create a radiation oncology-specific survivorship care plan (SCP) template. Methods and MaterialsMembers of the ASTRO Health Services Research Committee (which was subsequently renamed the Clinical, Translational, and Basic Science Advisory Committee) were charged with this task. Creation of the ASTRO SCP template was informed by existing SCP templates published by other organizations and modified to add radiation treatment details felt to be important by committee members. An emphasis was placed on describing diagnostic and treatment details in ways that patients and referring physicians can understand. The resulting template subsequently underwent ASTRO committee review, public comment, and was ultimately approved by the ASTRO Board of Directors. ResultsThe standardized template includes 2 components: the first 2 pages represent an SCP that is to be given to the patient and referring physicians, whereas page 3 includes additional technical radiation therapy details which are usually included in a traditional radiation treatment summary. That is, the template serves two purposes—obviating the need for radiation oncologists to create an SCP for patients and a separate treatment completion note. ConclusionsThe standardized ASTRO SCP template serves an immediate need of practicing radiation oncologists to have a template that is radiation-specific and meets current requirements for SCP and radiation treatment summary. Potential future work may include development of disease-specific templates that will include more granular details regarding expected toxicities and follow-up care recommendations and working with electronic medical record system vendors to facilitate autocreation of SCP documents to reduce the burden on physicians and other staff. These future developments can make this intervention more helpful to patients, and further reduce the burden of creating SCPs.

Survivorship Issues for Patients with Lung Cancer

Survivorship concerns for patients with lung and bronchus cancers include quality of life and physical and psychological aspects. Recommendations for follow-up care should incorporate a survivorship paradigm and practices for these patients. The authors conducted a literature review on lung cancer survivorship and the late- and long-term effects of treatment, which can impair quality of life in this patient population. Lung cancer is a diagnosis associated with heavy disease burden, and patients may benefit from survivorship care. High levels of physical and psychological distress leading to diminished quality of life are common in those with lung cancer. Recognition of the potential late- and long-term effects of treatment may help health care professionals intervene early to minimize negative implications. Survivorship care for patients with cancer requires a multidisciplinary effort and team approach. Addressing the survivorship needs of these patients and their caregivers, along with providing a continuum of cancer care, should improve their quality of life. Further research on evidence-based practices on the long-term effects of lung cancer survivorship care is necessary.

An asthma sports camp series to identify children with possible asthma and cardiovascular risk factors

Background: The prevalence of asthma and obesity in children has increased over the past several years, with obesity being associated with higher rates of asthma. In response to known disparities in asthma prevalence and morbidity, along with barriers to diagnosis, assessment and education, a comprehensive asthma sports camp series was developed and implemented.Objective: The primary objective was to evaluate the effectiveness of utilizing a sports camp model to identify children with undiagnosed and uncontrolled asthma, and to provide recommendations for follow-up care. The secondary objectives were to identify the presence of and associations between related co-morbidities and risk factors for asthma morbidity such as obesity, hypertension and exposure to tobacco smoke; and to assess asthma medication use.Methods: Six daylong camps at an inner-city university were offered to children 5–17 years of age over a period of two years. Asthma, body mass index, blood pressure (BP) and carbon monoxide screenings were conducted at each camp.Results: In this sample, 43.7% of children had previously diagnosed asthma, and 12.6% were classified as having potential, undiagnosed asthma. Of the children with previously diagnosed asthma, 76% were considered uncontrolled. Thirty-eight percent were determined to be overweight or obese and 17% had elevated BP.Conclusions: An interdisciplinary sports camp model can be used to identify children with undiagnosed and uncontrolled asthma and cardiovascular risk factors; and to provide recommendations for follow-up care.

News

The number of cancer survivors has been steadily increasing due in part to the aging population and advancements in cancer care and treatment. Of the current 13.7 million cancer survivors in the United States, most are 65 or older. Aging changes and the presence of comorbidities add complexity to the care of cancer survivors. In addition. common long-term cancer-related symptoms and late effects of cancer treatments provide challenges to nurses and other health professionals caring for older cancer survivors. Transition from oncology care to primary or shared care requires understanding of detailed information about the specific cancer diagnosis, treatments received, and recommendations for follow-up care to prevent recurrence, recognize treatment-associated health effects, and understand strategies for health promotion. Nurses in all practice areas will care for cancer survivors and must be prepared to deliver safe and effective care.

Clinical Considerations for Care of Older Adult Cancer Survivors

The number of cancer survivors has been steadily increasing due in part to the aging population and advancements in cancer care and treatment. Of the current 13.7 million cancer survivors in the United States, most are 65 or older. Aging changes and the presence of comorbidities add complexity to the care of cancer survivors. In addition, common long-term cancer-related symptoms and late effects of cancer treatments provide challenges to nurses and other health professionals caring for older cancer survivors. Transition from oncology care to primary or shared care requires understanding of detailed information about the specific cancer diagnosis, treatments received, and recommendations for follow-up care to prevent recurrence, recognize treatment-associated health effects, and understand strategies for health promotion. Nurses in all practice areas will care for cancer survivors and must be prepared to deliver safe and effective care. [ Journal of Gerontological Nursing, 39 (9), 8–12.]

Female reproductive health after childhood, adolescent, and young adult cancers: guidelines for the assessment and management of female reproductive complications.

As more young female patients with cancer survive their primary disease, concerns about reproductive health related to primary therapy gain relevance. Cancer therapy can often affect reproductive organs, leading to impaired pubertal development, hormonal regulation, fertility, and sexual function, affecting quality of life. The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer (COG-LTFU Guidelines) are evidence-based recommendations for screening and management of late effects of therapeutic exposures. The guidelines are updated every 2 years by a multidisciplinary panel based on current literature review and expert consensus. This review summarizes the current task force recommendations for the assessment and management of female reproductive complications after treatment for childhood, adolescent, and young adult cancers. Experimental pretreatment as well as post-treatment fertility preservation strategies, including barriers and ethical considerations, which are not included in the COG-LTFU Guidelines, are also discussed. Ongoing research will continue to inform COG-LTFU Guideline recommendations for follow-up care of female survivors of childhood cancer to improve their health and quality of life.

Hematopoietic stem cell transplantation: a review and recommendations for follow-up care for the general practitioner

The first hematopoietic stem cell transplantation (HSCT), the replacement of the hematopoietic system, by hematopoietic stem cells from the patient (autologous HSCT) or from another person (allogeneic HSCT), was performed almost 45 years ago. Today autologous HSCT is used to bridge hematopoietic failure after high dose chemotherapy for the treatment of selected hematopoietic and non-hematopoietic tumours. Allogeneic HSCT is used to treat congenital or acquired marrow failure, and, more commonly, to exploit the graft versus tumour effect of allogeneic cells against high risk hematologic malignancies. In 2010, 30,000 patients were treated with HSCT (12,000 allogeneic and 18,000 autologous HSCT) in Europe. Substantial progress has been made in the field of allogeneic HSCT in the last decade. First the article describes advances in patient and donor selection, the current concepts of choosing the optimal stem cell source and the most appropriate preparative regimen. Furthermore, recent advances in supportive care are described. We describe how these innovations have allowed indications for allogeneic HSCT to be expanded. Finally, prospects for future developments will be outlined.

Abstract A90: Ethnic differences in cancer worry following an abnormal mammogram result: The roles of risk perception and follow-up care beliefs.

Abstract Purpose: Abnormal mammogram results can lead to elevated psychological distress, which has been shown to impede and delay adherence to follow-up care recommendations. Latinas exhibit greater psychological distress following receipt of abnormal mammogram results as well as are less likely to receive and more likely to delay recommended follow-up care than non-Latina White counterparts. Latinas may believe they are at greater risk for breast cancer and be more likely to associate the need for follow-up care with breast abnormalities due to cultural beliefs. Little research to date has addressed these factors among women with abnormal mammogram results and less work has related them to cancer disparities. Objective: For this study, we provide preliminary findings regarding ethnic differences in 1) perceived cancer risk; 2) risk factors; and 3) beliefs concerning follow-up care. Methods: For this multi-site study, we recruited a convenience sample of Latinas and a size-matched sample of non-Latina White women who have recently received an abnormal mammogram. Qualitative, semi-structured interviews allowed for assessment of perceived cancer risk (high versus low/none), associated risk factors as well as included items regarding follow-up care (“What do you think follow-up appointments are for?”). Data were analyzed using principles of grounded theory. Results: Latinas were more likely to be worried about cancer than White women (86% vs. 12.5%). Latinas and White women identified age, general health, health behaviors (e.g., smoking, diet), and family history of cancer as factors contributing to their perceived cancer risk. Importantly, Latinas were more likely to attribute these to higher cancer risk (e.g., bad eating habits), whereas White women utilized these domains to perceive low risk (e.g., no family history). Additionally, some Latinas perceived other behaviors (e.g., adultery) to contribute to their risk due to spiritual beliefs. Latinas were more likely to perceive follow-up care to be needed because mammograms revealed abnormalities. White women were more likely to attribute follow-up care recommendations due to technical problems during initial mammography appointments. Conclusions: Preliminary evidence suggests Latinas perceive themselves to be at greater risk when they receive abnormal mammogram results than their White counterparts. Greater risk perception appears to be related to perception of shared and unique risk factors as well as beliefs concerning follow-up care recommendations. Future interventions should address how ethnic differences in cancer risk perception contribute to follow-up care adherence as well as identify strategies to reduce overestimated risk perception among Latinas who receive an abnormal cancer screening result. Citation Format: Yamile Molina, Linda K. Ko, Beti Thompson, Shirley A.A. Beresford. Ethnic differences in cancer worry following an abnormal mammogram result: The roles of risk perception and follow-up care beliefs. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A90.

Male reproductive health after childhood, adolescent, and young adult cancers: a report from the Children's Oncology Group.

The majority of children, adolescents, and young adults diagnosed with cancer will become long-term survivors. Although cancer therapy is associated with many adverse effects, one of the primary concerns of young male cancer survivors is reproductive health. Future fertility is often the focus of concern; however, it must be recognized that all aspects of male health, including pubertal development, testosterone production, and sexual function, can be impaired by cancer therapy. Although pretreatment strategies to preserve reproductive health have been beneficial to some male patients, many survivors remain at risk for long-term reproductive complications. Understanding risk factors and monitoring the reproductive health of young male survivors are important aspects of follow-up care. The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer (COG-LTFU Guidelines) were created by the COG to provide recommendations for follow-up care of survivors at risk for long-term complications. The male health task force of the COG-LTFU Guidelines, composed of pediatric oncologists, endocrinologists, nurse practitioners, a urologist, and a radiation oncologist, is responsible for updating the COG-LTFU Guidelines every 2 years based on literature review and expert consensus. This review summarizes current task force recommendations for the assessment and management of male reproductive complications after treatment for childhood, adolescent, and young adult cancers. Issues related to male health that are being investigated, but currently not included in the COG-LTFU Guidelines, are also discussed. Ongoing investigation will inform future COG-LTFU Guideline recommendations for follow-up care to improve health and quality of life for male survivors.

Contemporary Vibroacoustic Therapy: Perspectives on Clinical Practice, Research, and Training

Vibroacoustic therapy (VAT), traditionally considered to be a physical and receptive type of music therapy intervention, uses pulsed, sinusoidal, low-frequency sound on a specially designed bed or chair. Today VAT is viewed as a multimodal approach, whereby the therapist works with the client’s physiological and psychological experiences, incorporating a mind–body approach. This article provides current knowledge in clinical practice emphasizing the systematic and documented implementations of VAT. This includes presentation and explication of the key elements of VAT, assessments, treatment plans and procedures, documen- tation, and evaluation of the treatment with recommendations for follow-up care in health and rehabilitation. Recent research is presented, and directions for future research are considered. Applicable views on clinical training and required competencies are outlined.