Years Of Treatment Completion Research Articles

Survivorship preparedness and activation among survivors of lymphoma.

Taking an active role in managing post-treatment care has emerged as a key aspect of promoting a successful transition into survivorship and is associated with better patient outcomes. In this study, we focus on two key aspects of active self-management, activation and preparedness. Activation was defined as understanding one's role in the care process and having the knowledge, skill, and confidence to take on a role in managing self-care. Preparedness was defined as the extent to which individuals perceived they had sufficient information about what to expect after cancer treatments are completed. The study goal was to characterize survivorship preparedness and activation among lymphoma survivors within 5years of treatment completion in New Jersey and examine the association of sociodemographic, medical, care transition experiences, practical concerns, and psychosocial factors with activation and preparedness. One hundred and one Hodgkin lymphoma or non-Hodgkin lymphoma survivors who had completed treatment within 5years completed a survey of survivorship care experiences (response rate = 34.12%). Approximately 60% of survivors reported high activation, with similar percentages for higher preparedness. Less activated survivors were significantly (p < .05) younger, married, resided in a more deprived geographic area, and reported more fatigue and information needs. Less activated survivors reported recalling that their providers were significantly (p < .05) less likely to discuss long-term side effects, psychosocial needs, risk-reducing lifestyle recommendations, and how to manage other medical concerns. Fewer care transition practices were most strongly associated with lower preparedness. A significant proportion were not activated for survivorship, and both activation and preparedness were strongly associated with providers' survivorship transition practices. Implementing programs to foster more activation and preparedness for lymphoma survivorship care would benefit from education about recommended follow-up care and healthy lifestyle practices. Providers should routinely ask about their patients' confidence and preparedness for survivorship and provide referrals for appropriate care as needed.

A digital, coach-assisted intervention to address the psychosocial needs of young adult cancer survivors: Randomized controlled trial protocol and intervention adaptation process

BackgroundGiven the increasing number of young adult cancer survivors and the impacts of cancer on various life domains, interventions addressing the psychosocial needs of young adult survivors are crucial. However, such intervention research is limited, and the existing literature has often: 1) overlooked young adult survivors' psychosocial needs; 2) targeted depression, anxiety, or fear of recurrence – rather than positive outcomes like well-being; and 3) failed to consider scalable approaches, like digital health. MethodsThis paper documents the development and refinement of an 8-week digital, coach-assisted intervention targeting hope among young adult cancer survivors (ages 18–39, within 3 years of treatment completion) and presents the protocol of the 2-arm RCT (comparing intervention vs. attention control). The intervention builds upon a 2017–2018 pilot trial (n = 56); intervention refinements were based on subsequent semi-structured interviews among young adult survivors (n = 23). ResultsThe pending trial design involves an increased sample size (n = 150) to increase power and diversified recruitment efforts (i.e., clinic-based, social media, community-based organizations, etc.) to facilitate intervention reach, accessibility, and scalability. The intervention was enhanced by integrating highly relevant theoretical and therapeutic frameworks, specifically the concept of hope and Acceptance and Commitment Therapy, as well as updating intervention delivery technology. Intervention outcomes include feasibility and acceptability at end-of-treatment and preliminary efficacy on hope (primary outcome) and quality of life measures (secondary outcomes) at end-of-treatment and 16-week follow-up. ConclusionsThis paper may facilitate discussion regarding approaches for addressing the significant psychosocial challenges faced by young adult survivors and catalyze dissemination of trial results.Trial Registration:NCT05905250

(118) Clinical Predictors of Long-Term Satisfaction with Treatment of Collagenase Clostridium Histolyticum for Patients with Peyronie’s Disease

Abstract Introduction Collagenase clostridium histolyticum (CCH) is the only FDA-approved medication for Peyronie’s Disease (PD) in the United States. Roughly half of patients who received CCH experience improvements in curvature by more than 20% in the IMPRESS I/II trials. Current literature reports varying satisfaction rates of 67-81% within one year of treatment completion. However, little is known of long-term patient satisfaction following CCH treatment and its clinical predictors. Objective The aim of this study was to identify clinical predictors of long-term satisfaction with CCH for PD. Methods An Institutional Review Board approved retrospective chart review and standardized questionnaire was conducted for all patients with PD who received CCH from 2009-2022. Patients who received CCH before presenting to our institution were excluded. The questionnaire utilized the Treatment Satisfaction Questionnaire for Medication (TSQM), which is validated across the subdomains of satisfaction with effectiveness, side effects (SE), convenience, and global satisfaction (GS), and summed to generate the TSQM total score. Statistical analyses were performed in R using Wilcoxon rank sum test and independent T-test to compare continuous variables with TSQM scores, and Spearman’s rank correlation to compare categorical variables with TSQM scores. Results Of the 243 eligible patients, 80 (32.9%) responded (Table 1). Of these, 34 (42.5%) reported satisfaction with CCH treatment. On average, surveys were completed 4.7 (SD 2.3) years after last CCH injection. Age at presentation, at last CCH injection, and at survey completion were significantly correlated with satisfaction with side effects (Spearman's ρ= 0.32, 0.32, 0.33, respectively; p&amp;lt;0.004 for all) (Table 2). Curvature degree, plaque diameter, and plaque volume measured before CCH treatment and the amount of change in these parameters were not significantly associated with TSQM scores. However, having any improvement in curvature significantly increased the GS subdomain score without affecting the TSQM total score (GS means 37.6 change v 20.7 no change; p=0.03). Greater final curvature degree and plaque volume after CCH completion were significantly correlated with lower TSQM total scores (Spearman's ρ= -0.36, -0.32, respectively; p&amp;lt;0.04 for both). 10 (12.5%) patients reported depression, which significantly decreased scores of the effectiveness subdomain, GS subdomain, and TSQM total (p&amp;lt;0.04 for all). 10 (12.5%) patients proceeded to surgical intervention after CCH treatment and reported significantly decreased scores in the effectiveness subdomain and TSQM total (p= 0.008, 0.001, respectively). Conclusions Our data suggests that older patients exhibit greater long-term satisfaction and tolerability of side effects from CCH. Additionally, final curvature and plaque volume after CCH completion were the most important objective predictors of long-term satisfaction rather than the degree of change in these parameters. Patients with depression also reported lower long-term satisfaction rates with CCH treatment. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: M.K. acts as a consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast. M.K. is an investor of Sprout. L.L. acts as a consultant for AbbVie, Aytu BioScience, Contraline, Lipocine. L.L. acts as an advisor for Inherent Bioscences. L.L. acts as consultant/speaker for Endo Pharmaceuticals. L.L. acts as a speaker for American Medical Systems/Boston Scientific.

Virtual follow-up care among breast and prostate cancer patients during and beyond the COVID-19 pandemic: Association with distress.

The purpose of this study was to investigate associations between self-reported distress (anxiety/depression) and satisfaction with and desire for virtual follow-up (VFU) care among cancer patients during and beyond the COVID-19 pandemic. Breast and prostate cancer patients receiving VFU at an urban cancer centre in Toronto, Canada completed an online survey on their sociodemographic, clinical, and technology, characteristics and experience with and views on VFU. EQ5D-5 L was used to assess distress. Statistical models adjusted for age, gender, education, income and Internet confidence. Of 352 participants, average age was 65 years, 48% were women,79% were within 5 years of treatment completion, 84% had college/university education and 74% were confident Internet users. Nearly, all (98%) had a virtual visit via phone and 22% had a virtual visit via video. The majority of patients (86%) were satisfied with VFU and 70% agreed that they would like VFU options after the COVID-19 pandemic. Participants who reported distress and who were not confident using the Internet for health purposes were significantly less likely to be satisfied with VFU (OR = 0.4; 95% CI: 0.2-0.8 and OR = 0.19; 95% CI: 0.09-0.38, respectively) and were less likely to desire VFU option after the COVID-19 pandemic (OR = 0.49; 95% CI: 0.30-0.82 and OR = 0.41; 95% CI: 0.23-0.70, respectively). The majority of respondents were satisfied with VFU and would like VFU options after the COVID-19 pandemic. Future research should determine how to optimize VFU options for cancer patients who are distressed and who are less confident using virtual care technology.

School Attendance Among Pediatric Oncology Patients During the COVID-19 Pandemic in Ontario, Canada.

Supporting schooling for current and past pediatric oncology patients is vital to their quality of life and psychosocial recovery. However, no study has examined the perspectives toward in-person schooling among pediatric oncology families during the COVID-19 pandemic. In this online survey study, we determined the rate of and attitudes toward in-person school attendance among current and past pediatric oncology patients living in Ontario, Canada during the 2020-2021 school year. Of our 31-family cohort, 23 children (74%) did attend and 8 (26%) did not attend any in-person school during this time. Fewer children within 2 years of treatment completion attended in-person school (5/8; 62%) than those more than 2 years from treatment completion (13/15; 87%). Notably, 22 of 29 parents (76%) felt that speaking to their care team had the greatest impact compared to other potential information sources when deciding about school participation, yet 13 (45%) were unaware of their physician's specific recommendation regarding whether their child should attend. This study highlights the range in parental comfort regarding permitting in-person schooling during the COVID-19 pandemic. Pediatric oncologists should continue to address parental concerns around in-person school during times of high transmission of COVID-19 and potentially other communicable diseases in the future.

Use of an Integrated Functional Quantitation of Modulation of Transcriptional Pathways (IFQ) Assay in Untreated Mantle Cell Lymphoma Patients

Background: Mantle cell lymphoma (MCL) is an extremely heterogenous cancer, with substantial variation in clinical presentation and genetic makeup among individual patients. Chronic exposure to cytokines or inflammatory mediators is hypothesized to mediate pathogenesis and influence presentation in MCL, thus representing a key area of interest for prognostication and identification of therapeutic targets. However, measuring a large panel of individual cytokines, binding proteins, and soluble receptors does not give an integrated measure of how much a given pathway is activated within individual cells from a patient. Therefore, we have developed a cell-based reporter assay that can measure in an integrated way the activating potential of patient plasma samples on four central transcription factor-driven pathways: the interferon pathway (STAT1), the acute phase response (STAT3), lymphocyte-targeted cytokines (STAT5), and the inflammatory pathway (NF-κB). In this study, we applied this Integrated Functional Quantitation of Modulation of Transcriptional Pathways (IFQ) assay to plasma from patients with untreated MCL. We hypothesized that the IFQ assay of these transcriptional pathways would be associated with response to treatment and provide prognostic information on the outcome of these patients. Methods: Reporter cell lines were generated in which the activity of each of these four transcription factors, STAT1, STAT3, STAT5, and NF-κB, regulated expression of a luciferase reporter gene (Figure 1). We identified stored plasma samples collected from patients with untreated MCL who had consented to an IRB-approved research protocol. Cells from the 4 cell lines were plated in quadruplicate in 96-well plates at a concentration of 5000 cells per well and treated with patient plasma prior to incubation for 1 hour. Stimulator media was then added to each well and the plates were incubated for 6 hours after which luciferase activity was quantitated by luminometry. Values were normalized to stimulator-only control and media-only control. Results: Plasma from 14 patients with untreated MCL was analyzed. The luciferase assay system was successful for all patients, with results shown in Figure 2. Five of 6 patients with downregulation of STAT1 compared to stimulator-only control went into remission without a reported relapse following frontline therapy, whereas both samples with upregulation of STAT1 later had relapsed disease within 1 year of treatment completion. Conversely, 4 of 6 samples found to have upregulation of STAT3 went into sustained remission following therapy, while the single sample showing downregulation went into sustained remission after frontline therapy. Six samples did not reveal a conclusive change in regulation of the STAT3 gene when measured against the control. When evaluating NF-κB expression levels, 12 samples showed downregulation of the gene compared to the stimulator-only control, although no pattern in treatment response was discerned. STAT5 expression showed fewer differences compared to the stimulator-only control group, as 12 of 14 plasma samples conveyed no upregulation or downregulation of the gene. Discussion: Evaluation of transcription factor expression in the plasma of patients with MCL using the luciferase reporter system is feasible. In our patient population, NF-κB was downregulated in the majority of patients, whereas STAT1 and STAT3 showed differential patterns of expression. STAT1 and STAT3 merit further investigation as possible biomarkers of treatment response, perhaps due to their role in initiating and sustaining inflammation. In the future, we hope to augment these data to strengthen this correlation and to implement this assay to aid in prognostication and treatment selection.

Correlation of Post-Treatment Biopsy and Fluorodeoxyglucose PET/CT Findings Following Definitive Chemotherapy and Radiation for Cervical Cancer

Concurrent chemotherapy and external beam radiation with brachytherapy boost is considered standard of care for treatment of locally advanced cervical cancer. Post treatment surveillance fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging is recommended 3-6 months after completion of therapy. Persistent FDG avidity is commonly observed at the cervix on surveillance scans, indeterminate for residual malignancy versus post treatment inflammatory change. To better understand the clinical significance of residual hypermetabolic activity, we performed an analysis of surveillance FDG-PET/CT images, correlating findings with post treatment cervical biopsy results after completion of therapy. The medical records of all patients treated with definitive chemotherapy and radiation for locally advanced (FIGO IB3 to IVA) cervical cancer at a single academic medical center between 2017 and 2022 were reviewed. Patients were treated with curative intent using a combination of pelvic external beam radiation with concurrent cisplatin chemotherapy followed by intracavitary or combined intracavitary/interstitial brachytherapy boost. Patients underwent FDG-PET/CT imaging at 3-6 months upon completion of therapy, followed by biopsy either for suspected residual disease or equivocal findings on physical exam or FDG-PET/CT scans. Biopsies were obtained within 100 days of FDG-PET/CT imaging (median, 14 days). Twenty-three patients met inclusion criteria. One patient was excluded from analysis due to lack of FDG avidity on her pre-treatment FDG-PET/CT. Among the 22 evaluable scans, median pre-treatment FDG- PET/CT SUVmax of the cervix was 16.3 (range, 4.9-55). Median post-treatment SUVmax was 4.4 (range, 2.1-7.4). Median change in SUVmax from pre-treatment to post-treatment was 11.8 (range, 1.1 to 50.6). Twenty patients had a post-treatment SUVmax of greater than 3. Among post treatment scans, eight showed no residual uptake; two showed uptakes equal to the liver; eleven showed uptakes moderately higher than liver; and one showed uptake markedly increased relative to liver. None of the biopsy specimens showed evidence of residual malignancy, instead showing fibroinflammatory necrosis and reactive changes. None of the patients developed clinical evidence of disease progression at the cervix within one year of treatment completion. Residual hypermetabolic activity at the cervix is common following definitive chemotherapy and radiation for cervical cancer. This is unlikely to represent residual viable malignancy. Post treatment FDG-PET/CT imaging remains valuable for detecting locoregional or distant disease progression/persistence following therapy.

Argon plasma coagulation therapy in hemorrhagic radiation proctitis following pelvic radiation in gynecological malignancies.

Chronic radiation proctitis is a common chronic complication of malignant pelvic diseases after pelvic radiation therapy. Although, the incidence has decreased after advent of intensity-modulated radiotherapy due to better control of radiation dose to rectum. In the era of conventional two-field radiotherapy to pelvis, this was a common complication usually presenting after 1-2 years of treatment completion. Rectal bleeding caused by radiation proctitis is difficult to manage. Argon plasma coagulation (APC) is an electrocoagulation technique that appears to be an effective and low-cost alternative to the use of lasers in gastrointestinal endoscopy. The aim of this study was to evaluate the efficacy of APC, as well as patients' tolerance of the procedure, in the treatment of bleeding radiation-induced proctitis. Between January 2015 and August 2017, 29 patients of cancer cervix treated with definite radiotherapy both external and brachytherapy who suffered from rectal bleeding due to radiation proctitis were included for treatment with argon plasma laser (APC). Twenty-three patients suffered from anemia, 16 of whom required blood transfusion. APC was performed, applying the no-touch spotting technique at an electrical power of 40 Watt and an argon gas flow of 1.5-2.0 l/min. Pulse duration was <0.5 s. Treatment sessions were carried out at intervals of 3 weeks. Subjects received 2-4 treatment sessions. Twenty-eight out of 29 patients were accessible for effects and results. APC led to persistent clinical and endoscopic remission of rectal bleeding after a median of three sessions. No adverse effects were encountered after initial treatment. All the patients were in complete remission. APC is an effective, safe, and well-tolerated treatment for rectal bleeding caused by chronic radiation proctitis. It should be considered as a first-line therapy for radiation proctitis.

Baseline gut microbiota composition is associated with oral mucositis and tumour recurrence in patients with head and neck cancer: a pilot study.

Mounting evidence suggests thatthe gut microbiome influences radiotherapy efficacy and toxicity by modulating immune signalling. However, its contribution to radiotherapy outcomes in head and neck cancer (HNC) is yet to be investigated. This study, therefore, aimed to uncover associations between an individual's pre-therapy gut microbiota and (i) severity of radiotherapy-induced oral mucositis (OM), and (ii) recurrence risk in patients with HNC. In this prospective pilot study, 20 patients with HNC scheduled to receive radiotherapy or chemoradiotherapy were recruited. Stool samples were collected before treatment and microbial composition was analysed using 16S rRNA gene sequencing. OM severity was assessed using the NCI-CTCAE scoring system. Patients were also followed for 12 months of treatment completion to assess tumour recurrence. Overall, 80% of the patients were male with a median age of 65.5 years. Fifty-three percent experienced mild/moderate OM while 47% developed severe OM. Furthermore, 18% experienced tumour relapse within 1 year of treatment completion. A pre-treatment microbiota enriched of Eubacterium, Victivallis, and Ruminococcus was associated with severe OM. Conversely, a higher relative abundance of immunomodulatory microbes Faecalibacterium, Prevotella, and Phascolarctobacterium was associated with a lower risk of tumour recurrence. Our results indicate that a patient's gut microbiota composition at the start of treatment is linked to OM severity and recurrence risk. We now seek to validate these findings to determine their ability to predict treatment outcomes in HNC, with the goal of using this data to inform second-generation microbial therapeutics to optimise treatment outcomes for patients with HNC.

Impact of Routine Surveillance Imaging on Recurrence in Sinonasal Malignancies.

There is significant variation in post-treatment surveillance imaging for sinonasal malignancies. This study examined the utility of surveillance imaging in detecting recurrence in patients treated for sinonasal malignancies. We performed a retrospective review on an IRB-approved dataset of patients with sinonasal malignancies treated at a single institution between 2005 to 2021. Patients were categorized into groups based on the frequency of annual imaging and total number of imaging studies. We compared time-to-recurrence between the groups using log-rank test. A two-sided p-value of <0.05 was considered as the threshold for significance. A total of 93 patients were eligible for this study with a median follow up of 42.3 months and 25.8% (n=24) of patients had documented recurrence. Sensitivity and specificity for recurrence based on computed tomography (CT) scans within one year of treatment completion were 50.0% and 19.5%; positron emission tomography/CT was 90.0% and 19.5%; and magnetic resonance imaging was 60.0% and 61.0%, respectively. Regardless of the type of imaging, symptomatic presentation after treatment had a specificity of 91.0% with a positive likelihood ratio of recurrence of 2.95 (95%CI=1.06-8.22). The frequency of scans was not associated with the risk of recurrence (HR=0.55; 95%CI=0.23-1.29, p=0.17). Similarly, no association was noted between the total number of scans and risk of recurrence (HR=0.64; 95%CI=0.27-1.51, p=0.31). The total number of frequency of scans within the first year after treatment had no association with time to recurrence of sinonasal malignancies. Symptomatic presentation was strongly associated with recurrence and should be investigated with appropriate imaging.

Impact of Routine Surveillance Imaging with Recurrence in Sinonasal Malignancies

<h3>Purpose/Objective(s)</h3> There is significant variation in post-treatment surveillance imaging for sinonasal malignancies. This study examines the utility of surveillance imaging in detecting recurrence in patients treated for sinonasal malignancies. <h3>Materials/Methods</h3> Of an available 267 patients (pts), we performed a retrospective review on an IRB approved dataset of 89 consecutive pts with sinonasal malignancies treated at a single institution between 2005 to 2021. Pts with incomplete surveillance imaging or histologic sarcomas, lymphomas, and melanoma were excluded from the study. Information regarding tumor location, staging, pathology, treatment modalities, and surveillance imaging including type, frequency, concern for and actual recurrence were collected. Pts were categorized into groups based on the annual frequency and total number of imaging studies done. We compared recurrence-free survival between the groups using log-rank test. A two-sided p-value of < 0.05 was considered the threshold for significance. <h3>Results</h3> Median follow up was 42.3 months. Overall, 60.7% (n=54) pts had primary nasal cavity malignancies and 39.3% (n=35) had paranasal sinus disease. 43.8% of pts (n = 35) had squamous cell carcinoma, 25.0% (n=20) had esthesioneuroblastoma, 11.2% (n=9) had sinonasal undifferentiated carcinomas, and 6.2% (n=5) had adenocarcinoma. Most pts had locally advanced disease at diagnosis (AJCC 7^th edition). 78.7% (n=70) pts underwent surgical resection, 88.8% (n=79) received radiotherapy, and 52.9% (n=46) received chemotherapy. Approximately 25% (n=23) of pts had recurrence. 21.3% (n=19) had locoregional recurrence and 4.5% (n=4) had distant recurrence. CT surveillance scans within one year of treatment completion had a sensitivity of 74.7%, but specificity of 20.0%. Similarly, PET/CT had a sensitivity of 82.3%, while the specificity was 20.0%. Surveillance MRI had a sensitivity of 43.0%, but a specificity of 60.0%. Regardless of imaging, symptomatic presentation of a pt after treatment had a specificity of 91.0% with a positive likelihood ratio of recurrence of 2.95 (95% CI: 1.06-8.22). However, the sensitivity was 27%. There was no association of frequency (0-2 vs. >2) of surveillance scans within the first year with risk of recurrence (HR: 0.55; 95% CI: 0.23-1.29, P=0.17). Similarly, no association was noted with total number of scans (0-3 vs >3) with risk of recurrence (HR: 0.64; 95% CI: 0.27-1.51, P=0.31). Recurrence-free survival at 2-year was 41% and 36% in pts with 0-3 scans/year and >3 scans/year, respectively. <h3>Conclusion</h3> In our study, with a median follow-up just short of 4 years, approximately 1/4^th patients recurred. Total number or frequency of scans in the first year after treatment was not associated with time to recurrence. Symptomatic presentation was strongly associated with recurrence and should be investigated with appropriate imaging.

P287 A case of cerebral aspergillosis in Sri Lanka

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM IntroductionCerebral aspergillosis is a rare disease entity that is usually associated with high mortality. In accordance with most systemic fungal infections, immunocompromised patients are the predominant victims affected. Nonspecific clinical and radiological features may contribute to difficulty and delay in diagnosis, further contributing to the poor prognosis of cerebral aspergillosis. Obtainment of proper specimens for laboratory diagnosis is a key to make a timely diagnosis that may be lifesaving.Case ReportA 74-year-old female presented with a frontal headache for 2 weeks’ duration. She had been diagnosed with a low-grade lymphoma and had completed the chemotherapy and high-dose prednisolone 4 weeks prior to this presentation. Other than the frontal headache, which progressed slowly over 2 weeks, she did not disclose any associated symptoms. Physical examination was normal, with neither sign of raised intracranial pressure nor of a CNS infection. Basic investigations revealed no abnormalities, and the white cell count was 7.5 × 109/l and the CRP was 7 mg/l.An MRI of the brain indicated right frontal sinusitis with a secondary small abscess in the right frontal lobe inferiorly. Therefore, she was treated with parenteral antibiotics for a bacterial infection and was discharged.The patient presented with a headache again after 3 months. A repeat MRI of the brain revealed an increase in the size of the lesion in the right frontal lobe and the possibility of a cerebral tumor was suggested. A diagnostic biopsy was performed, and the specimen was subjected to fungal studies. The direct microscopic examination revealed fungal filaments and the culture yielded a pure growth of Aspergillus fumigatus.She was started on intravenous amphotericin B, followed by oral voriconazole. Her headache gradually subsided with antifungal therapy. The duration of therapy was guided by serial radiological imaging, and the patient achieved a complete recovery at the end of 1-year of treatment. She remains asymptomatic to date, after 2 years of treatment completion.DiscussionImmunocompromised patients with cerebral aspergillosis may present with minimal clinical symptoms and signs. Obtaining a proper specimen for laboratory testing is vital to arrive at a definitive diagnosis. Radiological investigations may play an important role in the diagnosis as well as during the follow-up of a patient with cerebral aspergillosis. Appropriate antifungal treatment for a prolonged duration, with or without neurosurgical intervention and reversal or reduction of immunosuppressive therapy leads to a good prognosis.

Clinicopathological Profile, Treatment Response and Survival of Cervical Cancer Patients from a Tertiary Cancer Centre in North Karnataka

Background: North Karnataka consisting of large rural population doesnot have any report on carcinoma cervix clinical profile and treatment outcomes. Objectives: analysing the clinicopathological profile and survival data from a tertiary cancer Centre in north Karnataka and comparing it with that of data published worldwide. Methods: We analysed carcinoma cervix patients from our centre between Oct 2014 to Oct 2016. The clinicopathological, treatment-related parameters, outcomes were analysed. Results: A total of 360/450 patients treated radically, 60% of the patients were between 40-60 years with the youngest being 22 years and the eldest 84 years. 33.3% of patients had Comorbidity, 85% patients had History of bleeding. 87%were from rural area, 44.8% were literate. 46.6% of patients had stage IIIB followed by II (27.8%), 3.8%had para-aortic node and 3.1% had pelvic nodes. 93.3% had SCC, 80% received chemoradiation, 13%received adjuvant Radiation/chemoradiation and 7% only surgery. Response data available for 320 patients (88.8%) among 320, 74.6% had complete response, Residual disease present in 14%, 3% patients had stable disease and progressive disease in 7%. At 18 months post-treatment, the survival data were available for only 244 (67.7%) patients, out of which 187 patients (67.7%) were alive. Overall 50% of the patients lost to follow up within 3 years of treatment completion. The 3-year survival for the patients who followed up until 3 years was 62.3% (111/178 patients). The stage-wise 3-year survival was 70.6% for stage I, 83.6% for II, 60% for IIIA, 49% for IIIB, 33.3% for IIIC2 (para-aortic nodal involvement) and 28.6% for stage IVA (P-0.001). Conclusion: Awareness about carcinoma cervix in the rural population is still lacking and they are presenting at an advanced stage, which largely effects on survival of the patients.

Long-term survival rates of patients with nasopharyngeal carcinoma treated by radiochemotherapy: a retrospective cohort study

BackgroundNasopharyngeal cancer (NPC) is showing an increasing incidence in Iran. Radiation is the main treatment of this cancer. Use of new techniques such as intensity-modulated radiotherapy (IMRT) is on the rise. Here, we aimed to evaluate the oncological outcomes of NPC patients treated with three-dimensional conformal radiotherapy (3DCRT) for a more reliable comparison with IMRT in the future.ResultsWe reviewed the medical records of 106 patients with NPC treated by definitive radiotherapy from 2007 to 2016. Patients were treated with 70 Gy in 2-Gy fractions. Twenty-one patients died during the follow-up period. Twenty-nine patients suffered from locoregional or distant recurrences. Of these, 6 recurred after 2 years of treatment completion. The 2-year and 5-year overall survival rates were 81% and 76%, respectively. The 2-year and 5-year progression-free survival rates were 72% and 63%, respectively. The 5-year locoregional recurrence and distant metastasis-free survival rates were 68% and 69%, respectively.ConclusionDue to high survival rates of NPC and the importance of receiving planned total dose of RT, the treatment-related toxicity and quality of life are critical considerations both for patients during active treatment and for survivors.

Improved cancer coping from a web-based intervention for prostate cancer survivors: A randomized controlled trial.

Prostate cancer (PCa) survivors report poor physical functioning alongside negative psychological outcomes as they cope with treatment side effects and practical concerns after treatment completion. This study evaluated PROGRESS, a web-based intervention designed to improve adaptive coping among PCa survivors. Localized PCa patients (N=431) within one year of treatment completion were randomized to receive educational booklets or PROGRESS+educational booklets. Surveys completed at baseline, 1-, 3-, and 6-months assessed patient characteristics; functional quality of life and coping (primary outcomes); and psychosocial outcomes (e.g., self-efficacy, marital communication; secondary outcomes). Intent-to-treat and as-treated analyses were completed to assess change in outcomes from baseline to 6 months using linear mixed effects regression models. In the intent-to-treat analyses, participants randomized to the intervention group had improved diversion coping (i.e., healthy redirection of worrying thoughts about their cancer), but more difficulties in marital communication (ps<0.05). However, PROGRESS usage was low among those randomized to the intervention group (38.7%). The as-treated analyses found PROGRESS users reported fewer practical concerns but had worse positive coping compared to PROGRESS non-users (ps<0.05). The findings suggest PROGRESS may improve certain aspects of adaptive coping among PCa survivors that use the website, but does not adequately address the remaining coping and psychosocial domains. Additional research is needed to better understand the gaps in intervention delivery contributing to low engagement and poor improvement across all domains of functional quality of life and adaptive coping.

Exercise-induced modulation of monocytes in breast cancer survivors

BackgroundExercise training reduces inflammation in breast cancer survivors; however, the mechanism is not fully understood. ObjectivesThe effects of acute and chronic exercise on monocyte toll-like receptor (TLR2 and 4) expression and intracellular cytokine production were examined in sedentary breast cancer survivors. MethodsEleven women with stage I, II, or III breast cancer within one year of treatment completion performed an acute, intermittent aerobic exercise trial. Blood samples were obtained before, immediately, and 1 h after a 45-min acute exercise trial that was performed before and after 16 weeks of combined aerobic and resistance. LPS-stimulated intracellular IL-1ß, TNF, and IL-6 production, and TLR2 and TLR4 expression were evaluated in CD14+CD16- and CD14+CD16+ monocytes using flow cytometry. ResultsExercise training decreased IL-1ß+CD14+CD16- proportion (24.6%, p=0.016), IL-1ß+CD14+CD16- mean fluorescence intensity (MFI) (−9989, p=0.014), IL-1ß+CD14+CD16+ MFI (−11101, p=0.02), and IL-6+CD14+CD16- proportion (16.9%, P=0.04). TLR2 and TLR4 expression did not change following exercise training but decreased 1 h after acute exercise in CD14+CD16- (−63, p=0.002) and CD14+CD16+ (−18, p=0.006) monocytes, respectively. Immediately after the acute exercise, both monocyte subgroup cell concentration increased, with CD14+CD16+ concentrations being decreased at 1 h post without changes in intracellular cytokine production. ConclusionsExercise training reduced monocyte intracellular pro-inflammatory cytokine production, especially IL-1ß, although these markers did not change acutely. While acute exercise downregulated the expression of TLR2 and TLR4 on monocytes, this was not sustained over the course of training. These results suggest that the anti-inflammatory effect of combined aerobic and resistance exercise training in breast cancer survivors may be, in part, due to reducing resting monocyte pro-inflammatory cytokine production.

IMPROVE, a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and Non-Hispanic White breast cancer survivors from diverse socioeconomic backgrounds: Recruitment strategies and baseline characteristics.

Behavioral intervention studies in older breast cancer survivors, particularly older African American (AA) and socioeconomic status-disadvantaged breast cancer survivors, are lacking. To inform future studies, the authors examined recruitment strategies in older breast cancer survivors who participated in an exercise intervention study. IMPROVE is a randomized trial designed to evaluate a group-based exercise intervention versus a support group (ClinicalTrials.gov identifier, NCT02763228). Participants were aged ≥65 years who had survived stage I through III breast cancer and were within 5 years of treatment completion. Participants were recruited through multiple approaches, including peripheral, linguistic, and constituent-involving strategies that incorporated the identification of potentially eligible patients from 3 local hospitals and from State of Ohio registries and through direct clinician and community organization referrals. Between October 2016 and November 2019, 7487 patients were screened, 4790 were potentially eligible, and 213 were randomized into the study. The eligible:randomization rates were 4.4% overall and 84%, 8%, and 2% for recruitment using direct referrals, hospital registries, and state registries, respectively. The median age of the randomized cohort was 70 years (range, 65-88 years) and included 44% AA and 44% socioeconomic status-disadvantaged breast cancer survivors. Compared with all registry-eligible patients, directly referred-eligible patients were more likely to be AA versus Non-Hispanic White (41% vs 19%; P = .006), to be contacted successfully (100% vs 33%; P < .0001), and to accept study participation (88% vs 16%; P < .0001). Direct referrals appeared to be the most efficient strategy for recruiting AA survivors. Behavioral intervention studies seeking to target older AA and socioeconomic status-disadvantaged breast cancer survivors should include strategies that foster direct referrals to study participation.

Patterns and predictors of cancer-related fatigue in ovarian and endometrial cancers: 1-year longitudinal study.

Fatigue is a common and distressing symptom for patients with gynecologic cancers. Few studies have empirically examined whether it spontaneously resolves. This study was aimed at identifying longitudinal patterns of fatigue and predictors of clinically significant fatigue 1year after treatment completion. This was a prospective cohort study of women with newly diagnosed ovarian (n=81) or endometrial cancer (n=181) that did not progress or recur within 1year of treatment completion. Symptoms of fatigue, depression, and anxiety were assessed after surgery and 6 and 12months after treatment completion with the Fatigue Assessment Scale and the Hospital Anxiety and Depression Scale. Patients' fatigue scores over time were classified (scores of 22-50, clinically significant; scores of 10-21, not clinically significant). Logistic regression models were fit to examine associations between fatigue and patient characteristics. Among 262 participants, 48% reported clinically significant fatigue after surgery. One year later, 39% reported fatigue. There were 6 patterns over time: always low (37%), always high (25%), high then resolves (18%), new onset (10%), fluctuating (6%), and incidental (5%). Patients with fatigue after surgery were more likely to report fatigue at 12months in comparison with others (odds ratio [OR], 6.08; 95% confidence interval [CI], 2.82-13.11; P<.001). Patients with depressive symptoms also had higher odds of fatigue (OR, 3.36; 95% CI, 1.08-10.65; P=.039), although only one-third of fatigued patients reported depressive symptoms. Nearly half of women with gynecologic cancers had clinically significant fatigue after surgery, whereas 44% and 39% had fatigue 6months and 1year later; this suggests that spontaneous regression of symptoms is relatively rare. Women who reported fatigue, depressive symptoms, or 2 or more medical comorbidities had higher odds of reporting fatigue 1year later. Future studies should test scalable interventions to improve fatigue in women with gynecologic cancers.

Living life post cancer treatment (LLPCT): An assessment of a 12-week multidimensional wellness intervention to improve quality of life and physical activity in cancer survivors.

12052 Background: Cancer survivors face unique health challenges with implications on health-related quality of life (HRQoL) and physical, social, and emotional wellbeing. With advancements in cancer treatment and aging populations, the prevalence of cancer survivors is expected to grow prompting the need for improved survivorship care delivery and comprehensive rehabilitative services. Living Life Post Cancer Treatment (LLPCT) is a community-based 12-week program that provides multidimensional support to patients of any cancer diagnosis transitioning from active treatment to post-treatment life. This single-arm intervention study aims to assess the program’s impact on HRQoL and physical activity in cancer survivors. Methods: A total of 125 participants within 2 years of treatment completion were enrolled in a 12-week program comprised of 9 sessions of engaging workshops, personalized exercise training, and nutrition and psychosocial counseling with an interprofessional team of oncology providers, social workers, exercise trainers, and dietitians. The program consisted of 8 consecutive weekly sessions followed by a 1-month follow-up session at week 12. Ninety-six (77%) participants completed the eighth or ninth session of the program and were included in the analysis. A series of questionnaires were administered at baseline and weeks 8 and 12. Primary outcomes assessed were HRQoL using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire and physical activity using average daily steps by pedometer and 2-minute step test performance. Results: Among the 96 participants (mean age 60.4 ± 11.7) who completed the program, the majority were female, white, and married. Post-intervention median FACT-G scores significantly increased from baseline at weeks 8 (+8.8, p = 0.002) and 12 (+7.3, p &lt; 0.001). Average daily steps by pedometer increased by 1063 (p = 0.003) and 1233 (p = 0.015) and 2-minute step test performance increased by 18 (p &lt; 0.001) and 21 (p &lt; 0.001) steps at weeks 8 and 12, respectively. Participants reported high levels of satisfaction and improved self-efficacy to incorporate lifestyle modifications. Conclusions: These findings suggest that this 12-week intervention improves HRQoL and step-based physical activity levels in cancer survivors and could serve as a multidimensional model for post-treatment support. Further research is needed to determine if these benefits are sustained long-term.

Improve, a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and non-hispanic white breast cancer survivors from diverse socioeconomic backgrounds: Recruitment strategies and baseline characteristics.

e24052 Background: We conducted an exercise study to IMPROVE health outcomes in older breast cancer survivors (BCS) from diverse racial and socioeconomic backgrounds. Here, we report cohort recruitment strategies and baseline characteristics. Methods: ‘IMPROVE’ is a randomized trial, designed to evaluate a group-based exercise intervention compared to support group. Participants were ≥ 65 years, had stage I-III breast cancer and within five years of treatment completion. Enrollment target was 220 participants, 25% in each of four strata defined by race (AA versus Non-Hispanic Whites [NHW]) and SES (low vs. high). Participants were recruited through hospital-based tumor registries, the state tumor registry or direct referrals. Results: Between October 2016 and November 2019, 7487 patients were screened, 4790 were potentially eligible, 230 were consented and 213 randomized into the study. The Eligible-to-Randomization rates were 4.4% overall, and 84%, 8%, and 2% for recruitment utilizing direct referrals, hospital and state registries, respectively. Median age of the randomized cohort was 70 years (range: 65-88 years) and included 25% AA/Low SES, 20% AA/High SES, 19% NHW/Low SES and 36% NHW/High SES Older BCS. Compared with registry-eligible patients, directly referred patients were more likely to be AA vs. NHW (41% vs. 19%, p = 0.003) and to accept study participation (88% vs. 16%, p &lt; 0.0001). Conclusions: Direct referrals resulted in the highest recruitment yield and was the most effective strategy for recruiting AA patients. Behavioral intervention studies seeking to target older BCS from racial minority and SES disadvantaged backgrounds should focus on strategies that foster direct referrals to study participation. Clinical trial information: NCT02763228 .