Original Report

Background The importance of social support for cancer patients has been established in previous studies. However, much of the existing research has identified associations between general measures of social support and various health indicators. Nevertheless, some research has begun to suggest the utility of more nuanced understandings of how patients receive and use social support.

Objective To examine the roles of nondirective (ie, support that accepts recipients’ feelings and is cooperative with their plans) and directive support (ie, support that prescribes “correct” choices and feelings) as well as social support needs and desires among patients with advanced breast cancer.

Methods We conducted semi-structured interviews (qualitative method) with 8 patients with stage IV breast cancer to collect qualitative information about the disease-related challenges they faced, the support they received from their families and medical teams, and the appropriateness of directive and nondirective support. In addition, we used the 14-item Hospital Anxiety and Depression Scale (HADS) to assess clinically relevant cut-offs for anxiety and depression and the 16-item Social Support Inventory to assess the provision of nondirective and directive social support to the patients (quantitative method).

Results Qualitative findings suggested that there was considerable variability among patients’ reports of social support provided by family, friends, and the medical team. From the qualitative data, patients reported directive support as more useful in times of acute need and emphasized the importance of supportive systems rather than supportive persons in providing emotional support. From the quantitative data, patients reported nondirective support as more typical of support received from both family and medical teams than directive support. On the HADS, 1 patient had a score of 9 on the anxiety subscale, above the score of 7 that is for mild anxiety. No patients scored above the criterion for mild depression, also a score of 7.

Limitations Very small sample limits the ability to generalize findings.

Conclusions The right type of support for patients with advanced breast cancer is contingent on a range of variables, which suggests that the key characteristic of support may not be any particular feature, but the nuanced adjustment of its content and style of delivery to the patient’s circumstances.

Funding Peers for Progress

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Background The importance of social support for cancer patients has been established in previous studies. However, much of the existing research has identified associations between general measures of social support and various health indicators. Nevertheless, some research has begun to suggest the utility of more nuanced understandings of how patients receive and use social support.

Objective To examine the roles of nondirective (ie, support that accepts recipients’ feelings and is cooperative with their plans) and directive support (ie, support that prescribes “correct” choices and feelings) as well as social support needs and desires among patients with advanced breast cancer.

Methods We conducted semi-structured interviews (qualitative method) with 8 patients with stage IV breast cancer to collect qualitative information about the disease-related challenges they faced, the support they received from their families and medical teams, and the appropriateness of directive and nondirective support. In addition, we used the 14-item Hospital Anxiety and Depression Scale (HADS) to assess clinically relevant cut-offs for anxiety and depression and the 16-item Social Support Inventory to assess the provision of nondirective and directive social support to the patients (quantitative method).

Results Qualitative findings suggested that there was considerable variability among patients’ reports of social support provided by family, friends, and the medical team. From the qualitative data, patients reported directive support as more useful in times of acute need and emphasized the importance of supportive systems rather than supportive persons in providing emotional support. From the quantitative data, patients reported nondirective support as more typical of support received from both family and medical teams than directive support. On the HADS, 1 patient had a score of 9 on the anxiety subscale, above the score of 7 that is for mild anxiety. No patients scored above the criterion for mild depression, also a score of 7.

Limitations Very small sample limits the ability to generalize findings.

Conclusions The right type of support for patients with advanced breast cancer is contingent on a range of variables, which suggests that the key characteristic of support may not be any particular feature, but the nuanced adjustment of its content and style of delivery to the patient’s circumstances.

Funding Peers for Progress

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

Background The importance of social support for cancer patients has been established in previous studies. However, much of the existing research has identified associations between general measures of social support and various health indicators. Nevertheless, some research has begun to suggest the utility of more nuanced understandings of how patients receive and use social support.

Objective To examine the roles of nondirective (ie, support that accepts recipients’ feelings and is cooperative with their plans) and directive support (ie, support that prescribes “correct” choices and feelings) as well as social support needs and desires among patients with advanced breast cancer.

Methods We conducted semi-structured interviews (qualitative method) with 8 patients with stage IV breast cancer to collect qualitative information about the disease-related challenges they faced, the support they received from their families and medical teams, and the appropriateness of directive and nondirective support. In addition, we used the 14-item Hospital Anxiety and Depression Scale (HADS) to assess clinically relevant cut-offs for anxiety and depression and the 16-item Social Support Inventory to assess the provision of nondirective and directive social support to the patients (quantitative method).

Results Qualitative findings suggested that there was considerable variability among patients’ reports of social support provided by family, friends, and the medical team. From the qualitative data, patients reported directive support as more useful in times of acute need and emphasized the importance of supportive systems rather than supportive persons in providing emotional support. From the quantitative data, patients reported nondirective support as more typical of support received from both family and medical teams than directive support. On the HADS, 1 patient had a score of 9 on the anxiety subscale, above the score of 7 that is for mild anxiety. No patients scored above the criterion for mild depression, also a score of 7.

Limitations Very small sample limits the ability to generalize findings.

Conclusions The right type of support for patients with advanced breast cancer is contingent on a range of variables, which suggests that the key characteristic of support may not be any particular feature, but the nuanced adjustment of its content and style of delivery to the patient’s circumstances.

Funding Peers for Progress

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

Background Decision-making about palliative chemotherapy is complex because treatment goals include increased survival, symptom control, and functional improvement.

Objective To examine whether retrospective assessment by chemotherapy-experienced patients could inform decision-making support for future patients.

Methods 51 patients with thoracic or gastrointestinal malignancy, with no further systemic treatment options, completed the Functional Assessment of Chronic Illness Therapy–Treatment Satisfaction (FACIT-TS) survey and answered free-text questions about their past decisions about therapy.

Results FACIT-TS subscale of treatment effectiveness showed 36% of 49 eligible patients rating effectiveness as being worse than expected, 25% as expected, 37% better. 51% found side effects worse than expected, 19% as expected, and 28% better than expected. Textual analysis of survey responses indicated the majority of patients stood by their decision to take chemotherapy but wished they’d had more information about what to expect. Overall, 55% found chemotherapy to have been worthwhile, 37% not, 8% were undecided.

Limitations Accrual was slower than expected, in part because of a lack of awareness by patients that there were no further chemotherapy options available to them. Selection bias may have favored enrolment from teams open to soliciting patient feedback.

Conclusions Although the majority of patients stood by their decisions about palliative chemotherapy based on their understanding of the therapy at the time of making their decisions, there is a discrepancy between initial expectations about chemotherapy and retrospective assessment of chemotherapy effectiveness and side effects. The introduction of end-of-treatment feedback surveys as a routine quality assurance procedure should be considered.

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Background Decision-making about palliative chemotherapy is complex because treatment goals include increased survival, symptom control, and functional improvement.

Objective To examine whether retrospective assessment by chemotherapy-experienced patients could inform decision-making support for future patients.

Methods 51 patients with thoracic or gastrointestinal malignancy, with no further systemic treatment options, completed the Functional Assessment of Chronic Illness Therapy–Treatment Satisfaction (FACIT-TS) survey and answered free-text questions about their past decisions about therapy.

Results FACIT-TS subscale of treatment effectiveness showed 36% of 49 eligible patients rating effectiveness as being worse than expected, 25% as expected, 37% better. 51% found side effects worse than expected, 19% as expected, and 28% better than expected. Textual analysis of survey responses indicated the majority of patients stood by their decision to take chemotherapy but wished they’d had more information about what to expect. Overall, 55% found chemotherapy to have been worthwhile, 37% not, 8% were undecided.

Limitations Accrual was slower than expected, in part because of a lack of awareness by patients that there were no further chemotherapy options available to them. Selection bias may have favored enrolment from teams open to soliciting patient feedback.

Conclusions Although the majority of patients stood by their decisions about palliative chemotherapy based on their understanding of the therapy at the time of making their decisions, there is a discrepancy between initial expectations about chemotherapy and retrospective assessment of chemotherapy effectiveness and side effects. The introduction of end-of-treatment feedback surveys as a routine quality assurance procedure should be considered.

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

Background Decision-making about palliative chemotherapy is complex because treatment goals include increased survival, symptom control, and functional improvement.

Objective To examine whether retrospective assessment by chemotherapy-experienced patients could inform decision-making support for future patients.

Methods 51 patients with thoracic or gastrointestinal malignancy, with no further systemic treatment options, completed the Functional Assessment of Chronic Illness Therapy–Treatment Satisfaction (FACIT-TS) survey and answered free-text questions about their past decisions about therapy.

Results FACIT-TS subscale of treatment effectiveness showed 36% of 49 eligible patients rating effectiveness as being worse than expected, 25% as expected, 37% better. 51% found side effects worse than expected, 19% as expected, and 28% better than expected. Textual analysis of survey responses indicated the majority of patients stood by their decision to take chemotherapy but wished they’d had more information about what to expect. Overall, 55% found chemotherapy to have been worthwhile, 37% not, 8% were undecided.

Limitations Accrual was slower than expected, in part because of a lack of awareness by patients that there were no further chemotherapy options available to them. Selection bias may have favored enrolment from teams open to soliciting patient feedback.

Conclusions Although the majority of patients stood by their decisions about palliative chemotherapy based on their understanding of the therapy at the time of making their decisions, there is a discrepancy between initial expectations about chemotherapy and retrospective assessment of chemotherapy effectiveness and side effects. The introduction of end-of-treatment feedback surveys as a routine quality assurance procedure should be considered.

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Background Elderly cancer patients are a special population, and their management should include specialists in oncology, geriatrics, palliative care, and social work. Based on this approach, we designed a multidisciplinary care model (MCM) and prospectively assessed its results.

Objectives To evaluate the applicability of the MCM, to describe the geriatric features of our sample, and to assess the impact of the MCM on treatment choices.

Methods Patients older than 69 years of age with solid tumors were included. The MCM included the following decision algorithm: Patients with an unequivocal condition of frailty, assessed in the corresponding tumor committee, were directly referred to the palliative care team (Group A). In the other cases (Group B), patients over age 79 years underwent the Comprehensive Geriatric Assessment (CGA) and patients aged between 70 and 79 years completed a frailty test. If the frailty test was positive, CGA was also per formed.

Results 295 patients meeting the inclusion criteria were identified during one year. 186 (63%) were included in the MCM. A total of 66 CGA were performed. CGA modified the therapeutic plan in 5 patients older than 80 (13.8%), and in 2 septuagenarian patients (6.6%).

Limitations This study was designed to evaluate the feasibility of a multidisciplinary approach in geriatric oncology patients in a real clinical setting. Therefore, some variables were not fully controlled in the design, such as the willingness of different specialists to refer their patients to the model.

Conclusions MCM in elderly oncology patients is feasible in a general hospital, although several reasons often hinder patient recruitment for this kind of program. CGA can modify the therapeutic plan, especially in the octogenarian population.

Funding/sponsorship This study has been financially supported by a grant from the Fundació Joan Costa Romà. 

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

Background Elderly cancer patients are a special population, and their management should include specialists in oncology, geriatrics, palliative care, and social work. Based on this approach, we designed a multidisciplinary care model (MCM) and prospectively assessed its results.

Objectives To evaluate the applicability of the MCM, to describe the geriatric features of our sample, and to assess the impact of the MCM on treatment choices.

Methods Patients older than 69 years of age with solid tumors were included. The MCM included the following decision algorithm: Patients with an unequivocal condition of frailty, assessed in the corresponding tumor committee, were directly referred to the palliative care team (Group A). In the other cases (Group B), patients over age 79 years underwent the Comprehensive Geriatric Assessment (CGA) and patients aged between 70 and 79 years completed a frailty test. If the frailty test was positive, CGA was also per formed.

Results 295 patients meeting the inclusion criteria were identified during one year. 186 (63%) were included in the MCM. A total of 66 CGA were performed. CGA modified the therapeutic plan in 5 patients older than 80 (13.8%), and in 2 septuagenarian patients (6.6%).

Limitations This study was designed to evaluate the feasibility of a multidisciplinary approach in geriatric oncology patients in a real clinical setting. Therefore, some variables were not fully controlled in the design, such as the willingness of different specialists to refer their patients to the model.

Conclusions MCM in elderly oncology patients is feasible in a general hospital, although several reasons often hinder patient recruitment for this kind of program. CGA can modify the therapeutic plan, especially in the octogenarian population.

Funding/sponsorship This study has been financially supported by a grant from the Fundació Joan Costa Romà. 

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

Background Elderly cancer patients are a special population, and their management should include specialists in oncology, geriatrics, palliative care, and social work. Based on this approach, we designed a multidisciplinary care model (MCM) and prospectively assessed its results.

Objectives To evaluate the applicability of the MCM, to describe the geriatric features of our sample, and to assess the impact of the MCM on treatment choices.

Methods Patients older than 69 years of age with solid tumors were included. The MCM included the following decision algorithm: Patients with an unequivocal condition of frailty, assessed in the corresponding tumor committee, were directly referred to the palliative care team (Group A). In the other cases (Group B), patients over age 79 years underwent the Comprehensive Geriatric Assessment (CGA) and patients aged between 70 and 79 years completed a frailty test. If the frailty test was positive, CGA was also per formed.

Results 295 patients meeting the inclusion criteria were identified during one year. 186 (63%) were included in the MCM. A total of 66 CGA were performed. CGA modified the therapeutic plan in 5 patients older than 80 (13.8%), and in 2 septuagenarian patients (6.6%).

Limitations This study was designed to evaluate the feasibility of a multidisciplinary approach in geriatric oncology patients in a real clinical setting. Therefore, some variables were not fully controlled in the design, such as the willingness of different specialists to refer their patients to the model.

Conclusions MCM in elderly oncology patients is feasible in a general hospital, although several reasons often hinder patient recruitment for this kind of program. CGA can modify the therapeutic plan, especially in the octogenarian population.

Funding/sponsorship This study has been financially supported by a grant from the Fundació Joan Costa Romà. 

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

Background Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. It is challenging to deliver standard rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy in the very elderly or elderly with comorbidities because of age-related changes in metabolism and performance.

Objectives To describe outcomes of a unique approach to the delivery of standard R-CHOP chemotherapy in split-doses for the treatment of elderly DLBCL patients.

Methods We performed a single center, retrospective analysis of all patients with DLBCL treated with split-dose R-CHOP during January 2007-April 2015. The patients received R-CHOP at a 50% dose reduction on days 1 and 15 of each 28-day cycle (split dose), with full dose rituximab on day 1 for up to 6 cycles. The total amount of chemotherapy delivered during each 28-day cycle of split-dose R-CHOP was equivalent to the cumulative dose in each 21-day cycle of standard R-CHOP.

Results We identified 22 patients who had been treated with split-dose R-CHOP (median age, 81 years). 10 patients had a Charlson Comorbidity Index score of 2 or more, and 13 were aged 80 or older. 12 patients completed their prescribed treatments, and 10 required further de-escalation or early termination owing to toxicity. All of the patients who completed therapy were in a complete remission at the end of treatment. The median overall survival for the entire cohort was 47 months, and median progression-free survival was 43 months.

Limitations Retrospective, single institution study, small cohort Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Funding/sponsorship Cancer Center Research Training Program, NCI 5-T32 CA09615-25 (fellowship funding for Dr Shah).
 

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Background Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. It is challenging to deliver standard rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy in the very elderly or elderly with comorbidities because of age-related changes in metabolism and performance.

Objectives To describe outcomes of a unique approach to the delivery of standard R-CHOP chemotherapy in split-doses for the treatment of elderly DLBCL patients.

Methods We performed a single center, retrospective analysis of all patients with DLBCL treated with split-dose R-CHOP during January 2007-April 2015. The patients received R-CHOP at a 50% dose reduction on days 1 and 15 of each 28-day cycle (split dose), with full dose rituximab on day 1 for up to 6 cycles. The total amount of chemotherapy delivered during each 28-day cycle of split-dose R-CHOP was equivalent to the cumulative dose in each 21-day cycle of standard R-CHOP.

Results We identified 22 patients who had been treated with split-dose R-CHOP (median age, 81 years). 10 patients had a Charlson Comorbidity Index score of 2 or more, and 13 were aged 80 or older. 12 patients completed their prescribed treatments, and 10 required further de-escalation or early termination owing to toxicity. All of the patients who completed therapy were in a complete remission at the end of treatment. The median overall survival for the entire cohort was 47 months, and median progression-free survival was 43 months.

Limitations Retrospective, single institution study, small cohort Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Funding/sponsorship Cancer Center Research Training Program, NCI 5-T32 CA09615-25 (fellowship funding for Dr Shah).
 

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

Background Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. It is challenging to deliver standard rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy in the very elderly or elderly with comorbidities because of age-related changes in metabolism and performance.

Objectives To describe outcomes of a unique approach to the delivery of standard R-CHOP chemotherapy in split-doses for the treatment of elderly DLBCL patients.

Methods We performed a single center, retrospective analysis of all patients with DLBCL treated with split-dose R-CHOP during January 2007-April 2015. The patients received R-CHOP at a 50% dose reduction on days 1 and 15 of each 28-day cycle (split dose), with full dose rituximab on day 1 for up to 6 cycles. The total amount of chemotherapy delivered during each 28-day cycle of split-dose R-CHOP was equivalent to the cumulative dose in each 21-day cycle of standard R-CHOP.

Results We identified 22 patients who had been treated with split-dose R-CHOP (median age, 81 years). 10 patients had a Charlson Comorbidity Index score of 2 or more, and 13 were aged 80 or older. 12 patients completed their prescribed treatments, and 10 required further de-escalation or early termination owing to toxicity. All of the patients who completed therapy were in a complete remission at the end of treatment. The median overall survival for the entire cohort was 47 months, and median progression-free survival was 43 months.

Limitations Retrospective, single institution study, small cohort Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Conclusions Split-dose R-CHOP allowed administration of curative-intent therapy in an elderly population with encouraging outcomes.

Funding/sponsorship Cancer Center Research Training Program, NCI 5-T32 CA09615-25 (fellowship funding for Dr Shah).
 

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Background Tumor lysis syndrome (TLS) is serious complication of anticancer chemotherapy, leading to substantial morbidity and mortality in adults and pediatric patients.

Objective To report the incidence and outcomes of TLS in pediatric patients with hematologic malignancies at a center in Pakistan.

Methods Retrospective chart review of 317 pediatric patients with hematologic malignancies during January 2008-December 2013. Demographic features and clinical and laboratory parameters of TLS, with immediate and 6-month outcomes were determined using a semi-structured questionnaire.

Results Median age at diagnosis was 9 years, with the 79.2% patients being male. Laboratory TLS was present in 36 patients (11.4%), with 27 (8.5%) developing clinical TLS and 13 (4.1%) requiring intensive care support. Hyperphosphatemia was the most frequent metabolic abnormality (14.2%), followed by hypocalcemia (13.9%), hyperuricemia (12.6%), and hyperkalemia (1.3%). 45 patients (14.2%) developed acute kidney injury (AKI). Patients who developed TLS had a signficantly higher white blood cell count at initiation of chemotherapy (142.0 x 109/L [SD, 173.1] vs 31.5 x 109/L [SD, 58.0]; P = .01) and a higher incidence of AKI (58.3% vs 8.5% of patients; P < .001).

Limitations Retrospective design of study, high rate of loss to follow-up, and unavailability of lactate dehydrogenase levels in a majority of patients.

Conclusion The incidence of TLS pediatric hematologic malignancies was 11.4% at our center. The main cause of death was sepsis. Hyperphosphatemia was the common metabolic derangement and hyperkalemia was the least common. TLS warrants intensive supportive care to prevent further morbidity and decrease mortality.

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Background Tumor lysis syndrome (TLS) is serious complication of anticancer chemotherapy, leading to substantial morbidity and mortality in adults and pediatric patients.

Objective To report the incidence and outcomes of TLS in pediatric patients with hematologic malignancies at a center in Pakistan.

Methods Retrospective chart review of 317 pediatric patients with hematologic malignancies during January 2008-December 2013. Demographic features and clinical and laboratory parameters of TLS, with immediate and 6-month outcomes were determined using a semi-structured questionnaire.

Results Median age at diagnosis was 9 years, with the 79.2% patients being male. Laboratory TLS was present in 36 patients (11.4%), with 27 (8.5%) developing clinical TLS and 13 (4.1%) requiring intensive care support. Hyperphosphatemia was the most frequent metabolic abnormality (14.2%), followed by hypocalcemia (13.9%), hyperuricemia (12.6%), and hyperkalemia (1.3%). 45 patients (14.2%) developed acute kidney injury (AKI). Patients who developed TLS had a signficantly higher white blood cell count at initiation of chemotherapy (142.0 x 109/L [SD, 173.1] vs 31.5 x 109/L [SD, 58.0]; P = .01) and a higher incidence of AKI (58.3% vs 8.5% of patients; P < .001).

Limitations Retrospective design of study, high rate of loss to follow-up, and unavailability of lactate dehydrogenase levels in a majority of patients.

Conclusion The incidence of TLS pediatric hematologic malignancies was 11.4% at our center. The main cause of death was sepsis. Hyperphosphatemia was the common metabolic derangement and hyperkalemia was the least common. TLS warrants intensive supportive care to prevent further morbidity and decrease mortality.

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

Background Tumor lysis syndrome (TLS) is serious complication of anticancer chemotherapy, leading to substantial morbidity and mortality in adults and pediatric patients.

Objective To report the incidence and outcomes of TLS in pediatric patients with hematologic malignancies at a center in Pakistan.

Methods Retrospective chart review of 317 pediatric patients with hematologic malignancies during January 2008-December 2013. Demographic features and clinical and laboratory parameters of TLS, with immediate and 6-month outcomes were determined using a semi-structured questionnaire.

Results Median age at diagnosis was 9 years, with the 79.2% patients being male. Laboratory TLS was present in 36 patients (11.4%), with 27 (8.5%) developing clinical TLS and 13 (4.1%) requiring intensive care support. Hyperphosphatemia was the most frequent metabolic abnormality (14.2%), followed by hypocalcemia (13.9%), hyperuricemia (12.6%), and hyperkalemia (1.3%). 45 patients (14.2%) developed acute kidney injury (AKI). Patients who developed TLS had a signficantly higher white blood cell count at initiation of chemotherapy (142.0 x 109/L [SD, 173.1] vs 31.5 x 109/L [SD, 58.0]; P = .01) and a higher incidence of AKI (58.3% vs 8.5% of patients; P < .001).

Limitations Retrospective design of study, high rate of loss to follow-up, and unavailability of lactate dehydrogenase levels in a majority of patients.

Conclusion The incidence of TLS pediatric hematologic malignancies was 11.4% at our center. The main cause of death was sepsis. Hyperphosphatemia was the common metabolic derangement and hyperkalemia was the least common. TLS warrants intensive supportive care to prevent further morbidity and decrease mortality.

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Background Colorectal cancer (CRC) screening rates remain low, especially among low-income populations.

Objective To determine if a CRC screening intervention (video, brochure) improves knowledge about CRC and CRC screening, attitudes toward screening, and intention to complete CRC screening among average-risk adults with different health literacy skills, seeking medical care at a Federally Qualified Health Center (FQHC).

Methods Average-risk adults (50 years or older) who were not within CRC screening guidelines completed face-to-face pre- and post-intervention interviews that focused on knowledge about CRC and CRC screening, attitudes toward CRC screening, and intention to complete CRC screening.

Results Of the 270 participants, 64% were women, 72% were black/African American, 86% were not married, 79% had an annual household income of <$20,000, and 57% did not have health insurance. Reading levels by Rapid Estimate of Adult Literacy in Medicine health literacy test were: 3rd grade or lower, 17 participants (6.3%); 4th-6th grade, 27 (10.0%); 7th-8th grade, 101 (37.4 %); and high school, 125 (46.3%). CRC screening knowledge mean score improved, and perceived CRC susceptibility and self-efficacy to complete screening significantly increased, irrespective of health literacy (all P < .01). There were no significant changes in other attitudes or intention to complete screening.

Limitations The study was conducted in a single FQHC, so the results may not be generalizable to other health centers or populations of low-income and minority patients.

Conclusion A CRC screening intervention improved CRC screening knowledge and attitudes across levels of health literacy and may be an important strategy for improving CRC screening in the primary care setting. Funding National Cancer Institute K07 CA107079 (Ohio State University) and P30 CA016058 (Behavioral Measurement Shared Resource at The Ohio State University).

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

Background Colorectal cancer (CRC) screening rates remain low, especially among low-income populations.

Objective To determine if a CRC screening intervention (video, brochure) improves knowledge about CRC and CRC screening, attitudes toward screening, and intention to complete CRC screening among average-risk adults with different health literacy skills, seeking medical care at a Federally Qualified Health Center (FQHC).

Methods Average-risk adults (50 years or older) who were not within CRC screening guidelines completed face-to-face pre- and post-intervention interviews that focused on knowledge about CRC and CRC screening, attitudes toward CRC screening, and intention to complete CRC screening.

Results Of the 270 participants, 64% were women, 72% were black/African American, 86% were not married, 79% had an annual household income of <$20,000, and 57% did not have health insurance. Reading levels by Rapid Estimate of Adult Literacy in Medicine health literacy test were: 3rd grade or lower, 17 participants (6.3%); 4th-6th grade, 27 (10.0%); 7th-8th grade, 101 (37.4 %); and high school, 125 (46.3%). CRC screening knowledge mean score improved, and perceived CRC susceptibility and self-efficacy to complete screening significantly increased, irrespective of health literacy (all P < .01). There were no significant changes in other attitudes or intention to complete screening.

Limitations The study was conducted in a single FQHC, so the results may not be generalizable to other health centers or populations of low-income and minority patients.

Conclusion A CRC screening intervention improved CRC screening knowledge and attitudes across levels of health literacy and may be an important strategy for improving CRC screening in the primary care setting. Funding National Cancer Institute K07 CA107079 (Ohio State University) and P30 CA016058 (Behavioral Measurement Shared Resource at The Ohio State University).

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

Background Colorectal cancer (CRC) screening rates remain low, especially among low-income populations.

Objective To determine if a CRC screening intervention (video, brochure) improves knowledge about CRC and CRC screening, attitudes toward screening, and intention to complete CRC screening among average-risk adults with different health literacy skills, seeking medical care at a Federally Qualified Health Center (FQHC).

Methods Average-risk adults (50 years or older) who were not within CRC screening guidelines completed face-to-face pre- and post-intervention interviews that focused on knowledge about CRC and CRC screening, attitudes toward CRC screening, and intention to complete CRC screening.

Results Of the 270 participants, 64% were women, 72% were black/African American, 86% were not married, 79% had an annual household income of <$20,000, and 57% did not have health insurance. Reading levels by Rapid Estimate of Adult Literacy in Medicine health literacy test were: 3rd grade or lower, 17 participants (6.3%); 4th-6th grade, 27 (10.0%); 7th-8th grade, 101 (37.4 %); and high school, 125 (46.3%). CRC screening knowledge mean score improved, and perceived CRC susceptibility and self-efficacy to complete screening significantly increased, irrespective of health literacy (all P < .01). There were no significant changes in other attitudes or intention to complete screening.

Limitations The study was conducted in a single FQHC, so the results may not be generalizable to other health centers or populations of low-income and minority patients.

Conclusion A CRC screening intervention improved CRC screening knowledge and attitudes across levels of health literacy and may be an important strategy for improving CRC screening in the primary care setting. Funding National Cancer Institute K07 CA107079 (Ohio State University) and P30 CA016058 (Behavioral Measurement Shared Resource at The Ohio State University).

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Background There is a lack of data that systematically address toxicity with docetaxel, cisplatin, and 5-fluorouracil (TPF) regimen in routine care.

Objective To detect, profile, and quantify the toxicity in Indian patients with head and neck cancers who received neoadjuvant TPF chemotherapy in a routine clinical practice (non-trial setting).

Methods 58 patients with locally advanced head and neck cancer who received TPF chemotherapy were selected for this analysis. They received 2 cycles of TPF chemotherapy every 21 days. The patients were monitored for the occurrence of adverse drug reactions in accordance with Common Terminology Criteria for Adverse Events (version 4.03) during the hospitalization (median length of stay in cycle 1, 10 days), daily (at least until day 8 after chemotherapy initiation), then at days 15 and 20. Descriptive statistics was done and factors predicting for toxicity were identified using logistic regression analysis.

Results The cumulative rate of grade ¦3 anemia, neutropenia, and thrombocytopenia were 12.1%, 56.9%, and 5.2%, respectively. The cumulative incidence of febrile neutropenia was 20.7% (12 of 58 patients). The cumulative incidences of mucositis and diarrhea were 67.2% and 74.1%, respectively. There was no mortality associated with induction chemotherapy, and all of the patients completed the planned 2 cycles of TPF. None of the tested factors predicted for any of the adverse events considered in the study.

Limitations Small, single-center study

Conclusion The incidence of TPF-related toxicity in Indian patients in routine practice is high, and the toxicities differ substantially from the toxicities seen in trial settings.

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Background There is a lack of data that systematically address toxicity with docetaxel, cisplatin, and 5-fluorouracil (TPF) regimen in routine care.

Objective To detect, profile, and quantify the toxicity in Indian patients with head and neck cancers who received neoadjuvant TPF chemotherapy in a routine clinical practice (non-trial setting).

Methods 58 patients with locally advanced head and neck cancer who received TPF chemotherapy were selected for this analysis. They received 2 cycles of TPF chemotherapy every 21 days. The patients were monitored for the occurrence of adverse drug reactions in accordance with Common Terminology Criteria for Adverse Events (version 4.03) during the hospitalization (median length of stay in cycle 1, 10 days), daily (at least until day 8 after chemotherapy initiation), then at days 15 and 20. Descriptive statistics was done and factors predicting for toxicity were identified using logistic regression analysis.

Results The cumulative rate of grade ¦3 anemia, neutropenia, and thrombocytopenia were 12.1%, 56.9%, and 5.2%, respectively. The cumulative incidence of febrile neutropenia was 20.7% (12 of 58 patients). The cumulative incidences of mucositis and diarrhea were 67.2% and 74.1%, respectively. There was no mortality associated with induction chemotherapy, and all of the patients completed the planned 2 cycles of TPF. None of the tested factors predicted for any of the adverse events considered in the study.

Limitations Small, single-center study

Conclusion The incidence of TPF-related toxicity in Indian patients in routine practice is high, and the toxicities differ substantially from the toxicities seen in trial settings.

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Background There is a lack of data that systematically address toxicity with docetaxel, cisplatin, and 5-fluorouracil (TPF) regimen in routine care.

Objective To detect, profile, and quantify the toxicity in Indian patients with head and neck cancers who received neoadjuvant TPF chemotherapy in a routine clinical practice (non-trial setting).

Methods 58 patients with locally advanced head and neck cancer who received TPF chemotherapy were selected for this analysis. They received 2 cycles of TPF chemotherapy every 21 days. The patients were monitored for the occurrence of adverse drug reactions in accordance with Common Terminology Criteria for Adverse Events (version 4.03) during the hospitalization (median length of stay in cycle 1, 10 days), daily (at least until day 8 after chemotherapy initiation), then at days 15 and 20. Descriptive statistics was done and factors predicting for toxicity were identified using logistic regression analysis.

Results The cumulative rate of grade ¦3 anemia, neutropenia, and thrombocytopenia were 12.1%, 56.9%, and 5.2%, respectively. The cumulative incidence of febrile neutropenia was 20.7% (12 of 58 patients). The cumulative incidences of mucositis and diarrhea were 67.2% and 74.1%, respectively. There was no mortality associated with induction chemotherapy, and all of the patients completed the planned 2 cycles of TPF. None of the tested factors predicted for any of the adverse events considered in the study.

Limitations Small, single-center study

Conclusion The incidence of TPF-related toxicity in Indian patients in routine practice is high, and the toxicities differ substantially from the toxicities seen in trial settings.

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Background Prostate cancer affects not only men with the disease, but their partners and families as well. These affects can include changes to everyday lifestyle activities, incontinence, and sexual dysfunction, and sometimes, relationships.

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Background Prostate cancer affects not only men with the disease, but their partners and families as well. These affects can include changes to everyday lifestyle activities, incontinence, and sexual dysfunction, and sometimes, relationships.

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Background Prostate cancer affects not only men with the disease, but their partners and families as well. These affects can include changes to everyday lifestyle activities, incontinence, and sexual dysfunction, and sometimes, relationships.

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Background Sleep impairment, fatigue, and anxiety are common conditions in cancer survivors. Small studies suggest mindfulness- based interventions may be helpful for cancer-related fatigue.

Objective To evaluate mindfulness-based cancer recovery (MBCR) for cancer survivors who are recovering from chemotherapy or radiation therapy.

Methods 42 cancer survivors who were within 6 months of completion of chemotherapy or radiation were randomized 2:1 to 8 weekly MBCR classes (n = 28) or wait-list control (n = 14). The Pittsburgh Sleep Quality Index (PSQI), Functional Assessment in Cancer Therapy – Fatigue (FACT-F), and 20-item State-Trait Anxiety Inventory (STAI) were used to assess sleep, fatigue, and anxiety at baseline (time of enrollment), at 2 months (on completion of the MBCR course), and 4 months (2 months after completion of the course). 32 of 42 participants participated in an optional blood draw to assess immune function.

Results 79% of the MBCR group attended at least 7 of the 9 MBCR sessions. At the 2-month assessment, sleep quality (PSQI, range 0-21, >5 = poorer sleep quality) in the MBCR group improved from the baseline 8.9 to 6.4, compared with the wait-list group (baseline 7.2 to 7.6); and at 4 months after course completion, it was 6.1 compared with 7.8, respectively (P = .03). There was a non-statistically significant improvement in fatigue (FACIT-F, P = .19). There was a trend toward improvement in the anxiety scores (STAI, range 20-80, higher score = greater anxiety) in the MBCR group compared with the wait-list group at 2 months (31.8 vs 39.4, respectively; P = .07) and 4 months (32.8 vs 40.7; P = .10). Immune function measures were not statistically significant.

Limitations It is possible the psychological support of being in contact with a facilitator and/or other cancer survivors had a beneficial effect in the outcomes of those in the MBCR group.

Conclusion MBCR has a high compliance rate and results in sustained improvements in sleep quality, fatigue, and anxiety. MBCR may be useful for cancer survivors struggling with sleep, fatigue, and anxiety.

Funding Hourglass Fund, Masonic Cancer Center, University of Minnesota; University of Minnesota Foundation (immune function protocol); National Institutes of Health Office of Women’s Health Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) NIH # K12-HD055887.

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Background Sleep impairment, fatigue, and anxiety are common conditions in cancer survivors. Small studies suggest mindfulness- based interventions may be helpful for cancer-related fatigue.

Objective To evaluate mindfulness-based cancer recovery (MBCR) for cancer survivors who are recovering from chemotherapy or radiation therapy.

Methods 42 cancer survivors who were within 6 months of completion of chemotherapy or radiation were randomized 2:1 to 8 weekly MBCR classes (n = 28) or wait-list control (n = 14). The Pittsburgh Sleep Quality Index (PSQI), Functional Assessment in Cancer Therapy – Fatigue (FACT-F), and 20-item State-Trait Anxiety Inventory (STAI) were used to assess sleep, fatigue, and anxiety at baseline (time of enrollment), at 2 months (on completion of the MBCR course), and 4 months (2 months after completion of the course). 32 of 42 participants participated in an optional blood draw to assess immune function.

Results 79% of the MBCR group attended at least 7 of the 9 MBCR sessions. At the 2-month assessment, sleep quality (PSQI, range 0-21, >5 = poorer sleep quality) in the MBCR group improved from the baseline 8.9 to 6.4, compared with the wait-list group (baseline 7.2 to 7.6); and at 4 months after course completion, it was 6.1 compared with 7.8, respectively (P = .03). There was a non-statistically significant improvement in fatigue (FACIT-F, P = .19). There was a trend toward improvement in the anxiety scores (STAI, range 20-80, higher score = greater anxiety) in the MBCR group compared with the wait-list group at 2 months (31.8 vs 39.4, respectively; P = .07) and 4 months (32.8 vs 40.7; P = .10). Immune function measures were not statistically significant.

Limitations It is possible the psychological support of being in contact with a facilitator and/or other cancer survivors had a beneficial effect in the outcomes of those in the MBCR group.

Conclusion MBCR has a high compliance rate and results in sustained improvements in sleep quality, fatigue, and anxiety. MBCR may be useful for cancer survivors struggling with sleep, fatigue, and anxiety.

Funding Hourglass Fund, Masonic Cancer Center, University of Minnesota; University of Minnesota Foundation (immune function protocol); National Institutes of Health Office of Women’s Health Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) NIH # K12-HD055887.

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Background Sleep impairment, fatigue, and anxiety are common conditions in cancer survivors. Small studies suggest mindfulness- based interventions may be helpful for cancer-related fatigue.

Objective To evaluate mindfulness-based cancer recovery (MBCR) for cancer survivors who are recovering from chemotherapy or radiation therapy.

Methods 42 cancer survivors who were within 6 months of completion of chemotherapy or radiation were randomized 2:1 to 8 weekly MBCR classes (n = 28) or wait-list control (n = 14). The Pittsburgh Sleep Quality Index (PSQI), Functional Assessment in Cancer Therapy – Fatigue (FACT-F), and 20-item State-Trait Anxiety Inventory (STAI) were used to assess sleep, fatigue, and anxiety at baseline (time of enrollment), at 2 months (on completion of the MBCR course), and 4 months (2 months after completion of the course). 32 of 42 participants participated in an optional blood draw to assess immune function.

Results 79% of the MBCR group attended at least 7 of the 9 MBCR sessions. At the 2-month assessment, sleep quality (PSQI, range 0-21, >5 = poorer sleep quality) in the MBCR group improved from the baseline 8.9 to 6.4, compared with the wait-list group (baseline 7.2 to 7.6); and at 4 months after course completion, it was 6.1 compared with 7.8, respectively (P = .03). There was a non-statistically significant improvement in fatigue (FACIT-F, P = .19). There was a trend toward improvement in the anxiety scores (STAI, range 20-80, higher score = greater anxiety) in the MBCR group compared with the wait-list group at 2 months (31.8 vs 39.4, respectively; P = .07) and 4 months (32.8 vs 40.7; P = .10). Immune function measures were not statistically significant.

Limitations It is possible the psychological support of being in contact with a facilitator and/or other cancer survivors had a beneficial effect in the outcomes of those in the MBCR group.

Conclusion MBCR has a high compliance rate and results in sustained improvements in sleep quality, fatigue, and anxiety. MBCR may be useful for cancer survivors struggling with sleep, fatigue, and anxiety.

Funding Hourglass Fund, Masonic Cancer Center, University of Minnesota; University of Minnesota Foundation (immune function protocol); National Institutes of Health Office of Women’s Health Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) NIH # K12-HD055887.

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