The Journal of Community and Supportive Oncology

Background Limited access to cancer genetic counselors (GC) may result in the lack of patient identification and/or failure to show due to travel distance and complicated treatment schedules.

Objective We hypothesized that access would improve when a GC collaborated with distant nongenetics health care providers to provide services locally.

Methods Patients at a collaborative site were offered a risk assessment survey that was reviewed remotely by a licensed, boardcertified GC. Patients were triaged such that the onsite registered nurse (RN) provided basic risk assessment and offered genetic testing for straight-forward hereditary breast and ovarian cases. Ongoing training and support was provided by the GC. Followup and complex cases were scheduled with the GC during a monthly outreach visit to the collaborative site.

Results During the 1-year study period, the total number of patients who accessed genetic counseling services from the target region was 4 times greater than the previous year. Ten of 17 patients who were triaged for genetic counseling and testing underwent genetic risk assessment services as a result of this identification and triage protocol.

Conclusion This defines a workable approach for patient identification and triage for hereditary cancer risk assessment and genetic counseling in a community setting. This collaborative approach may be applicable to centers that do not have access to a board-certified GC, especially important in light of the 2012 Commission on Cancer Standards that require cancer risk assessment, genetic counseling and testing services on site or by referral.

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Background Limited access to cancer genetic counselors (GC) may result in the lack of patient identification and/or failure to show due to travel distance and complicated treatment schedules.

Objective We hypothesized that access would improve when a GC collaborated with distant nongenetics health care providers to provide services locally.

Methods Patients at a collaborative site were offered a risk assessment survey that was reviewed remotely by a licensed, boardcertified GC. Patients were triaged such that the onsite registered nurse (RN) provided basic risk assessment and offered genetic testing for straight-forward hereditary breast and ovarian cases. Ongoing training and support was provided by the GC. Followup and complex cases were scheduled with the GC during a monthly outreach visit to the collaborative site.

Results During the 1-year study period, the total number of patients who accessed genetic counseling services from the target region was 4 times greater than the previous year. Ten of 17 patients who were triaged for genetic counseling and testing underwent genetic risk assessment services as a result of this identification and triage protocol.

Conclusion This defines a workable approach for patient identification and triage for hereditary cancer risk assessment and genetic counseling in a community setting. This collaborative approach may be applicable to centers that do not have access to a board-certified GC, especially important in light of the 2012 Commission on Cancer Standards that require cancer risk assessment, genetic counseling and testing services on site or by referral.

Click on the PDF icon at the top of this introduction to read the full article.

Background Limited access to cancer genetic counselors (GC) may result in the lack of patient identification and/or failure to show due to travel distance and complicated treatment schedules.

Objective We hypothesized that access would improve when a GC collaborated with distant nongenetics health care providers to provide services locally.

Methods Patients at a collaborative site were offered a risk assessment survey that was reviewed remotely by a licensed, boardcertified GC. Patients were triaged such that the onsite registered nurse (RN) provided basic risk assessment and offered genetic testing for straight-forward hereditary breast and ovarian cases. Ongoing training and support was provided by the GC. Followup and complex cases were scheduled with the GC during a monthly outreach visit to the collaborative site.

Results During the 1-year study period, the total number of patients who accessed genetic counseling services from the target region was 4 times greater than the previous year. Ten of 17 patients who were triaged for genetic counseling and testing underwent genetic risk assessment services as a result of this identification and triage protocol.

Conclusion This defines a workable approach for patient identification and triage for hereditary cancer risk assessment and genetic counseling in a community setting. This collaborative approach may be applicable to centers that do not have access to a board-certified GC, especially important in light of the 2012 Commission on Cancer Standards that require cancer risk assessment, genetic counseling and testing services on site or by referral.

Click on the PDF icon at the top of this introduction to read the full article.

Background Locally advanced pancreatic cancer (LAPC) is associated with poor outcome, and clinical trials are imperative to address this. However, barriers to trial enrollment often exist, particularly in socio-economically challenged populations.

Objective To evaluate the outcome of socio-economically challenged patients who had LAPC, multiple comorbidities, and who were not enrolled on clinical trials, but who were treated with the best standard-of-care.

Methods We retrospectively reviewed the charts of 32 patients diagnosed as having LAPC who were referred to an urban cancer center between 2005 and 2010, analyzing the treatment and outcomes of 19 who underwent treatment at our center.

Results In all 26.3% of the analyzed patients had commercial insurance, 31.6% did not identify English as their preferred language, and 84.2% had 3 or more comorbidities. The median overall survival was 19.1 months, with estimated 1- and 2-year survivals of 60.8% and 36.5%, respectively. The median survival for patients receiving chemotherapy followed by chemoradiation was 26.6 months. Toxicities were controllable. Translation services were required by 26% and social services interventions by 84%. Survival analysis based on insurance coverage did not show a significant association with levels of reimbursement.

Limitations Retrospective study, small sample size, differences in chemotherapy types.

Conclusions These patients, representative of a diverse and socio-economically challenged community, were able to receive standard-of-care therapies with acceptable toxicity and to achieve survivals comparable with clinical trials. This was achieved with intense supportive services.

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Background Locally advanced pancreatic cancer (LAPC) is associated with poor outcome, and clinical trials are imperative to address this. However, barriers to trial enrollment often exist, particularly in socio-economically challenged populations.

Objective To evaluate the outcome of socio-economically challenged patients who had LAPC, multiple comorbidities, and who were not enrolled on clinical trials, but who were treated with the best standard-of-care.

Methods We retrospectively reviewed the charts of 32 patients diagnosed as having LAPC who were referred to an urban cancer center between 2005 and 2010, analyzing the treatment and outcomes of 19 who underwent treatment at our center.

Results In all 26.3% of the analyzed patients had commercial insurance, 31.6% did not identify English as their preferred language, and 84.2% had 3 or more comorbidities. The median overall survival was 19.1 months, with estimated 1- and 2-year survivals of 60.8% and 36.5%, respectively. The median survival for patients receiving chemotherapy followed by chemoradiation was 26.6 months. Toxicities were controllable. Translation services were required by 26% and social services interventions by 84%. Survival analysis based on insurance coverage did not show a significant association with levels of reimbursement.

Limitations Retrospective study, small sample size, differences in chemotherapy types.

Conclusions These patients, representative of a diverse and socio-economically challenged community, were able to receive standard-of-care therapies with acceptable toxicity and to achieve survivals comparable with clinical trials. This was achieved with intense supportive services.

Click on the PDF icon at the top of this introduction to read the full article.

Background Locally advanced pancreatic cancer (LAPC) is associated with poor outcome, and clinical trials are imperative to address this. However, barriers to trial enrollment often exist, particularly in socio-economically challenged populations.

Objective To evaluate the outcome of socio-economically challenged patients who had LAPC, multiple comorbidities, and who were not enrolled on clinical trials, but who were treated with the best standard-of-care.

Methods We retrospectively reviewed the charts of 32 patients diagnosed as having LAPC who were referred to an urban cancer center between 2005 and 2010, analyzing the treatment and outcomes of 19 who underwent treatment at our center.

Results In all 26.3% of the analyzed patients had commercial insurance, 31.6% did not identify English as their preferred language, and 84.2% had 3 or more comorbidities. The median overall survival was 19.1 months, with estimated 1- and 2-year survivals of 60.8% and 36.5%, respectively. The median survival for patients receiving chemotherapy followed by chemoradiation was 26.6 months. Toxicities were controllable. Translation services were required by 26% and social services interventions by 84%. Survival analysis based on insurance coverage did not show a significant association with levels of reimbursement.

Limitations Retrospective study, small sample size, differences in chemotherapy types.

Conclusions These patients, representative of a diverse and socio-economically challenged community, were able to receive standard-of-care therapies with acceptable toxicity and to achieve survivals comparable with clinical trials. This was achieved with intense supportive services.

Click on the PDF icon at the top of this introduction to read the full article.

Oncologists frequently have to make diagnoses that portend bad outcomes and difficulties in management, among them, for stage IV lung or pancreatic cancer. Many recent studies have shown the importance of appropriate implementation of palliative care and the need for discussing with the patient the goals of treatment early in diagnosis.^1-3

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Oncologists frequently have to make diagnoses that portend bad outcomes and difficulties in management, among them, for stage IV lung or pancreatic cancer. Many recent studies have shown the importance of appropriate implementation of palliative care and the need for discussing with the patient the goals of treatment early in diagnosis.^1-3

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Oncologists frequently have to make diagnoses that portend bad outcomes and difficulties in management, among them, for stage IV lung or pancreatic cancer. Many recent studies have shown the importance of appropriate implementation of palliative care and the need for discussing with the patient the goals of treatment early in diagnosis.^1-3

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Background and objective The optimal primary intervention for treatment of clinically localized high-grade prostate adenocarcinoma remains to be identified. The present investigation reports disease control and survival outcomes in patients treated with primary radical prostatectomy.

Methods Eligible patients were diagnosed with Gleason score 8-10 at diagnostic biopsy and prostate-specific antigen (PSA) greater than  30 ng/mL, treated with primary radical prostatectomy, without clinical evidence of distant metastatic disease, seminal vesicle invasion, or lymph node involvement. Demographic, treatment, and outcome data were retrospectively collected and analyzed from a clinical database. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints.

Results Fifty patients were eligible for the present analysis, with Gleason 8 and 9 in 32 (64%) and 18 (36%) patients, respectively. Surgical margin, seminal vesicle, and lymph node involvement were noted 32 (64%), 18 (36%), and 6 (12%) patients, respectively; only 4 (8%) received adjuvant radiotherapy. At a median follow-up of 44.9 months (range, 4.2-104.6), 33 patients (66%) had experienced PSA relapse, of whom 7 have been successfully salvaged. Four patients died, all with uncontrolled disease. The estimated 5-year freedom from failure was 17%. Interval from biopsy to prostatectomy, surgical margin status, and seminal vesicle involvement were associated with decreased overall survival.

Conclusions High-risk Gleason score at biopsy is associated with suboptimal PSA control at 5 years following prostatectomy alone; however, in the setting of uninvolved seminal vesicles and lymph nodes, the dominant pattern of failure appears to be local, and early postoperative radiotherapy should be considered.

Click on the PDF icon at the top of this introduction to read the full article.

Background and objective The optimal primary intervention for treatment of clinically localized high-grade prostate adenocarcinoma remains to be identified. The present investigation reports disease control and survival outcomes in patients treated with primary radical prostatectomy.

Methods Eligible patients were diagnosed with Gleason score 8-10 at diagnostic biopsy and prostate-specific antigen (PSA) greater than  30 ng/mL, treated with primary radical prostatectomy, without clinical evidence of distant metastatic disease, seminal vesicle invasion, or lymph node involvement. Demographic, treatment, and outcome data were retrospectively collected and analyzed from a clinical database. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints.

Results Fifty patients were eligible for the present analysis, with Gleason 8 and 9 in 32 (64%) and 18 (36%) patients, respectively. Surgical margin, seminal vesicle, and lymph node involvement were noted 32 (64%), 18 (36%), and 6 (12%) patients, respectively; only 4 (8%) received adjuvant radiotherapy. At a median follow-up of 44.9 months (range, 4.2-104.6), 33 patients (66%) had experienced PSA relapse, of whom 7 have been successfully salvaged. Four patients died, all with uncontrolled disease. The estimated 5-year freedom from failure was 17%. Interval from biopsy to prostatectomy, surgical margin status, and seminal vesicle involvement were associated with decreased overall survival.

Conclusions High-risk Gleason score at biopsy is associated with suboptimal PSA control at 5 years following prostatectomy alone; however, in the setting of uninvolved seminal vesicles and lymph nodes, the dominant pattern of failure appears to be local, and early postoperative radiotherapy should be considered.

Click on the PDF icon at the top of this introduction to read the full article.

Background and objective The optimal primary intervention for treatment of clinically localized high-grade prostate adenocarcinoma remains to be identified. The present investigation reports disease control and survival outcomes in patients treated with primary radical prostatectomy.

Methods Eligible patients were diagnosed with Gleason score 8-10 at diagnostic biopsy and prostate-specific antigen (PSA) greater than  30 ng/mL, treated with primary radical prostatectomy, without clinical evidence of distant metastatic disease, seminal vesicle invasion, or lymph node involvement. Demographic, treatment, and outcome data were retrospectively collected and analyzed from a clinical database. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints.

Results Fifty patients were eligible for the present analysis, with Gleason 8 and 9 in 32 (64%) and 18 (36%) patients, respectively. Surgical margin, seminal vesicle, and lymph node involvement were noted 32 (64%), 18 (36%), and 6 (12%) patients, respectively; only 4 (8%) received adjuvant radiotherapy. At a median follow-up of 44.9 months (range, 4.2-104.6), 33 patients (66%) had experienced PSA relapse, of whom 7 have been successfully salvaged. Four patients died, all with uncontrolled disease. The estimated 5-year freedom from failure was 17%. Interval from biopsy to prostatectomy, surgical margin status, and seminal vesicle involvement were associated with decreased overall survival.

Conclusions High-risk Gleason score at biopsy is associated with suboptimal PSA control at 5 years following prostatectomy alone; however, in the setting of uninvolved seminal vesicles and lymph nodes, the dominant pattern of failure appears to be local, and early postoperative radiotherapy should be considered.

Click on the PDF icon at the top of this introduction to read the full article.

Omacetaxine mepesuccinate has been granted accelerated approval for the treatment of adult patients with chronic phase (CP) or accelerated phase (AP) chronic myeloid leukemia (CML) with resistance or intolerance to 2 or more tyrosine kinase inhibitors (TKIs).^1,2 Approval was based on response rates observed in a combined cohort of adult CML patients from 2 clinical trials. As yet, no clinical trials have verified improved disease-related symptoms or increased survival with omacetaxine treatment.

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Omacetaxine mepesuccinate has been granted accelerated approval for the treatment of adult patients with chronic phase (CP) or accelerated phase (AP) chronic myeloid leukemia (CML) with resistance or intolerance to 2 or more tyrosine kinase inhibitors (TKIs).^1,2 Approval was based on response rates observed in a combined cohort of adult CML patients from 2 clinical trials. As yet, no clinical trials have verified improved disease-related symptoms or increased survival with omacetaxine treatment.

Click on the PDF icon at the top of this introduction to read the full article.

Omacetaxine mepesuccinate has been granted accelerated approval for the treatment of adult patients with chronic phase (CP) or accelerated phase (AP) chronic myeloid leukemia (CML) with resistance or intolerance to 2 or more tyrosine kinase inhibitors (TKIs).^1,2 Approval was based on response rates observed in a combined cohort of adult CML patients from 2 clinical trials. As yet, no clinical trials have verified improved disease-related symptoms or increased survival with omacetaxine treatment.

Click on the PDF icon at the top of this introduction to read the full article.

When your beloved authors were studying research and statistics, around the time that Methuselah was celebrating his first birthday, we thought we knew the difference between hypothesis testing and hypothesis generating. With the former, you begin with a question, design a study to answer it, carry it out, and then do some statistical mumbo-jumbo on the data to determine if you have reasonable evidence to answer the question. With the latter, usually done after you’ve answered the main questions, you don’t have any preconceived idea of what’s going on, so you analyze anything that moves. We know that’s not really kosher, because the probability of finding something just by chance (a Type I error) increases astronomically as you do more tests.1 So, in the hypothesis generating phase, you don’t come to any conclusions; you just say, “That’s an interesting finding. Now we’ll have to do a real study to see if our observation holds up.”

Click on the PDF icon at the top of this introduction to read the full article.

When your beloved authors were studying research and statistics, around the time that Methuselah was celebrating his first birthday, we thought we knew the difference between hypothesis testing and hypothesis generating. With the former, you begin with a question, design a study to answer it, carry it out, and then do some statistical mumbo-jumbo on the data to determine if you have reasonable evidence to answer the question. With the latter, usually done after you’ve answered the main questions, you don’t have any preconceived idea of what’s going on, so you analyze anything that moves. We know that’s not really kosher, because the probability of finding something just by chance (a Type I error) increases astronomically as you do more tests.1 So, in the hypothesis generating phase, you don’t come to any conclusions; you just say, “That’s an interesting finding. Now we’ll have to do a real study to see if our observation holds up.”

Click on the PDF icon at the top of this introduction to read the full article.

When your beloved authors were studying research and statistics, around the time that Methuselah was celebrating his first birthday, we thought we knew the difference between hypothesis testing and hypothesis generating. With the former, you begin with a question, design a study to answer it, carry it out, and then do some statistical mumbo-jumbo on the data to determine if you have reasonable evidence to answer the question. With the latter, usually done after you’ve answered the main questions, you don’t have any preconceived idea of what’s going on, so you analyze anything that moves. We know that’s not really kosher, because the probability of finding something just by chance (a Type I error) increases astronomically as you do more tests.1 So, in the hypothesis generating phase, you don’t come to any conclusions; you just say, “That’s an interesting finding. Now we’ll have to do a real study to see if our observation holds up.”

Click on the PDF icon at the top of this introduction to read the full article.

Purpose To assess the feasibility of using a multimedia program to teach caregivers of Veterans with cancer how to offer basic massage for supportive care at home.

Methods Feasibility was assessed according to partner availability, compliance with watching training materials and practicing massage regularly, compliance with data collection; perceived study materials burden; clarity of instructional and other study materials. Pre- and post-massage changes in patients’ symptom scores were measured using a numerical rate scale. A semistructured exit interview was answered by patient and caregiver at the end of the study.

Results A total of 27 dyads were recruited. Veterans were 78% male. Forty-eight percent were diagnosed with hematologic malignancies (85%, advanced stage); 52% were diagnosed with solid tumors (64% advanced stage). Caregivers were 78% female; 81% were spouses. Out of the 27 pairs, 11 completed 8 weeks of data and practiced massage weekly. The majority of attrition (69%) was due to caregivers’ burden. Caregivers reported instructional  materials were clear, high quality, and easy to use. Patients were highly satisfied with receiving touch from their partners regularly. Post-massage  symptom scores showed statistically significant decreases in pain, stress/anxiety, and fatigue. Perceived burden of data collection instruments was high, particularly for patients.

Conclusion It is feasible to use the TCC program to train caregivers of Veterans with cancer to offer massage for supportive
care at home. Future studies should evaluate ways of providing support to caregivers, including offering massage to them, and
easing the burden of data collection for patients.

*For a PDF of the full article, click on the link to the left of this introduction.

Purpose To assess the feasibility of using a multimedia program to teach caregivers of Veterans with cancer how to offer basic massage for supportive care at home.

Methods Feasibility was assessed according to partner availability, compliance with watching training materials and practicing massage regularly, compliance with data collection; perceived study materials burden; clarity of instructional and other study materials. Pre- and post-massage changes in patients’ symptom scores were measured using a numerical rate scale. A semistructured exit interview was answered by patient and caregiver at the end of the study.

Results A total of 27 dyads were recruited. Veterans were 78% male. Forty-eight percent were diagnosed with hematologic malignancies (85%, advanced stage); 52% were diagnosed with solid tumors (64% advanced stage). Caregivers were 78% female; 81% were spouses. Out of the 27 pairs, 11 completed 8 weeks of data and practiced massage weekly. The majority of attrition (69%) was due to caregivers’ burden. Caregivers reported instructional  materials were clear, high quality, and easy to use. Patients were highly satisfied with receiving touch from their partners regularly. Post-massage  symptom scores showed statistically significant decreases in pain, stress/anxiety, and fatigue. Perceived burden of data collection instruments was high, particularly for patients.

Conclusion It is feasible to use the TCC program to train caregivers of Veterans with cancer to offer massage for supportive
care at home. Future studies should evaluate ways of providing support to caregivers, including offering massage to them, and
easing the burden of data collection for patients.

*For a PDF of the full article, click on the link to the left of this introduction.

Purpose To assess the feasibility of using a multimedia program to teach caregivers of Veterans with cancer how to offer basic massage for supportive care at home.

Methods Feasibility was assessed according to partner availability, compliance with watching training materials and practicing massage regularly, compliance with data collection; perceived study materials burden; clarity of instructional and other study materials. Pre- and post-massage changes in patients’ symptom scores were measured using a numerical rate scale. A semistructured exit interview was answered by patient and caregiver at the end of the study.

Results A total of 27 dyads were recruited. Veterans were 78% male. Forty-eight percent were diagnosed with hematologic malignancies (85%, advanced stage); 52% were diagnosed with solid tumors (64% advanced stage). Caregivers were 78% female; 81% were spouses. Out of the 27 pairs, 11 completed 8 weeks of data and practiced massage weekly. The majority of attrition (69%) was due to caregivers’ burden. Caregivers reported instructional  materials were clear, high quality, and easy to use. Patients were highly satisfied with receiving touch from their partners regularly. Post-massage  symptom scores showed statistically significant decreases in pain, stress/anxiety, and fatigue. Perceived burden of data collection instruments was high, particularly for patients.

Conclusion It is feasible to use the TCC program to train caregivers of Veterans with cancer to offer massage for supportive
care at home. Future studies should evaluate ways of providing support to caregivers, including offering massage to them, and
easing the burden of data collection for patients.

*For a PDF of the full article, click on the link to the left of this introduction.