Cancer survivors' self-efficacy to self-manage in the year following primary treatment

PURPOSE

Cancer survivors are increasingly expected to manage the consequences of cancer and its treatment for themselves. There is evidence that self-efficacy is important for successful self-management and that this can be enhanced with support. The purpose of this study was to assess self-efficacy to manage problems in the year following primary treatment.

METHODS

This cross-sectional online survey included cancer survivors who had completed their treatment within the past 12 months. Self-efficacy was assessed and variables expected to be associated with self-efficacy were measured using validated scales including quality of life, well-being, illness perceptions, depression and social support.

RESULTS

One hundred eighty-two respondents (mean age 50; 81% female) completed the survey. They had been treated for a range of cancers; most commonly breast (45%). Self-efficacy scores varied between individuals and according to the illness-related task to be managed. Respondents were least confident in managing fatigue and most confident in accessing information about their cancer. Individuals most likely to report low self-efficacy were women, those experiencing higher levels of pain and/or depression, lower well-being scores, lower socio-economic status, low levels of social support, or a more negative perception of cancer.

CONCLUSIONS

Self-efficacy to self-manage problems faced as a consequence of cancer and its treatment can vary widely in the year following treatment. Fatigue may be particularly difficult to manage.

IMPLICATIONS FOR CANCER SURVIVORS

Variations in self-efficacy highlight the importance of assessing specific problems faced and people's confidence to manage them in order to tailor appropriate self-management support.

Assessment of the impact of the London Olympics 2012 on selected non-genitourinary medicine clinic sexual health services

With minimal information on sexual health provision during mass-gathering events, our aim was to describe the use of sexual health, contraceptive, sex worker and sexual assault services during the London 2012 Olympics. We analysed data from five sources. One contraceptive service provider reported a 10% increase in attendance during the main Games, while emergency contraception prescriptions rose during the main Olympics, compared to the week before, but were similar or lower than at the beginning and end of the summer period. A health telephone advice line reported a 16% fall in sexual health-related calls during the main Olympics, but a 33% increase subsequently. London sexual assault referral centres reported that 1.8% of sexual assaults were Olympics-linked. A service for sex workers reported that 16% started working in the sex industry and 7% moved to London to work during the Olympics. Fifty-eight per cent and 45% of sex workers reported fewer clients and an increase in police crack-downs, respectively. Our results show a change in activity across these services during the 2012 summer, which may be associated with the Olympics. Our data are a guide to other services when anticipating changes in service activity and planning staffing for mass-gathering events.

Mycosis fungoides: an important differential diagnosis for acquired palmoplantar keratoderma

Mycosis fungoides is the most common subtype of primary cutaneous lymphoma and has several clinical variants. We report a 74-year-old man presenting with an acquired palmoplantar keratoderma initially diagnosed and treated as psoriasis with suboptimal improvement. Several months later the patient developed patches and plaques that were histologically consistent with mycosis fungoides. These lesions were ameliorated with the treatment of the underlying mycosis fungoides and the palmoplantar keratoderma resolved promptly with radiotherapy. This case highlights the importance of considering mycosis fungoides as an infrequent but serious cause of acquired palmoplantar keratoderma.

Abstract P4-16-01: A novel approach to breast cancer prevention: Exploiting autologous fat grafting for the local delivery of cancer therapeutics

Background: Breast cancer remains a considerable health concern, despite major advances in the treatment and prevention of breast cancer. Inhibition of estrogen receptor signaling is one of the most effective therapies for patients with hormone receptor positive breast cancer. However, even after chemotherapy and hormonal therapy, local recurrence occurs frequently, and undesirable side effects lead to drug discontinuation in an estimated 40% of patients on adjuvant therapy.

Autologous fat transfer is an emerging therapy used in breast reconstruction to restore surgical deformities after lumpectomy, or to rebuild the breast following mastectomy. This is an attractive option for both radiated and non-radiated patients, as complication rates in both groups are exceedingly low. Fat is injected into the breast or surgical cavity to maximize its contact with local vascularized tissue, to promote re-vascularization and survival of the adipose tissue. Thus, fat cells are injected throughout the tissue surrounding the surgical margin. We hypothesize that harvested adipose tissue can be loaded with a lipophilic drug prior to its re-injection into the breast cavity and its surrounding tissue. With the release of drug from the transplanted adipose tissue over time, the local concentration of an anti-estrogen within the breast parenchyma would be increased and systemic toxicity may be minimized.

Method: Human adipose tissue was acquired from patients undergoing liposuction for autologous grafting. Tissue was washed with warm PBS, divided into 0.5 mL aliquots, and incubated in complete DMEM (10% FBS) containing increasing concentrations of 4-OH tamoxifen (0, 10, 20, or 40 uM) or fulvestrant (0, 0.1, 0.5, or 1.0 uM) for 12 hours. Following incubation, adipose tissue was washed thoroughly and co-cultured with MCF7 cells for 96 hours. Adipocyte co-cultured MCF7 were then collected and evaluated for proliferation, viability and effects on estrogen receptor signaling and compared to MCF7 directly exposed to anti-estrogens.

Results: When co-culturing tamoxifen- or fulvestrant-loaded human adipocytes with MCF7 breast cancer cells in vitro, we observed a dose-dependent reduction in cell proliferation (tamoxifen, 60% reduction; fulvestrant, 40% reduction) and viability (20%), comparable to directly drugged media. Examination of the molecular response to fulvestrant demonstrated a dose dependent down regulation of ER protein expression and activity (e.g. PgR and Cyclin D1). Currently, we are characterizing the pharmacokinetics of anti-estrogen uptake and release in both in vitro and in vivo.

Summary: Our preliminary data suggest that co-culturing human adipocytes with an anti-estrogen results in tumor growth inhibition and abrogation of estrogen receptor signaling. Human adipocytes used to fill the tumor bed cavity or mastectomy pocket could therefore be used as a vehicle to deliver anti-estrogens to residual tumor cells and prevent tumor regrowth. This method may be a novel technology to combine reconstructive surgery and anti-cancer therapy and prevention.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-16-01.

Uncertainty and anxiety in the cancer of unknown primary patient journey: a multiperspective qualitative study

BACKGROUND

Patients with cancer of unknown primary (CUP) have metastatic malignant disease without an identifiable primary site; it is the fourth most common cause of cancer death.

OBJECTIVES

To explore patients' informal and professional carers' experiences of CUP to inform development of evidence-based, patient-centred care.

METHODS

Qualitative study involving development of multiple exploratory case studies, each comprising a patient and nominated informal and professional carers, with contextual data extracted from medical records.

RESULTS

17 CUP patients, 14 informal and 13 professional carers participated in the study. Two inter-related themes distinct to CUP emerged: uncertainty and continuity of care. In the absence of a primary diagnosis, patients and informal carers experienced uncertainty regarding prognosis, possible recurrence and the primary's hereditary potential. Professional carers experienced difficulty communicating uncertainty to patients, ambiguity in deciding optimal treatment plans in the absence of trial data and a test or treat dilemma: when to discontinue seeking the primary and start treatment. Common problems with care continuity were amplified for CUP patients relating to coordination, accountability and timeliness of care. The remit of multidisciplinary teams (MDTs) often excluded CUP, leading to "MDT tennis" where patients were "bounced" between MDTs.

CONCLUSIONS

The experience of those with CUP is distinctive and it can serve to amplify some of the issues encountered by people with cancer. The clinical uncertainties related to CUP compound existing shortcomings in continuity of care, increasing the likelihood of a disrupted patient journey. However, while little can be done to overcome uncertainty, more could be done to address issues regarding continuity of care.

Anticardiolipin antibodies and lupus anticoagulants among women undergoing in vitro fertilization in Jamaica

OBJECTIVE

The aims of this study were to evaluate the effect of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) on the outcome of the in vitro ferlitization (IVF) cycles and to determine the prevalence of these antibodies in infertile women seeking IVF in Jamaica.

METHODS

A retrospective cohort study was performed to determine if screening patients for aCL and LA had any significant impact on the outcome of the IVF process. Each patients hospital record, between March 2000 and March 2010, was collected and the relevant data extracted.

RESULTS

The prevalence of aCL in this cohort of Jamaican women was moderate/high positive 3.88%, low positive 0.68% and those with negative aCL results 95.4%. The prevalence of women who were LA positive was 4.1% and 0.9% of the women were positive for both LA and aCL. Of the patients who were LA and/or aCL positive, eight out of 30 patients (26.7%) had a positive pregnancy test in comparison to 61 out of 181 patients (33.7%) who were LA and/or aCL negative (p = 0.5787).

CONCLUSION

The prevalence of positive aCL and/or LA in infertile women seeking IVF in Jamaica is 7.76%. The presence of these antibodies did not affect the pregnancy rate of these women nor did it demonstrate an increased risk for IVF cycle cancellation or ovarian hyperstimulation syndrome. Screening women undergoing IVF for these antibodies is not justified.

SU-E-J-127: An Initial Application of Evaluating Lung Tumor Motion Throughout Radiotherapy

PURPOSE

We present a novel method for evaluating lung tumor motion incorporating planning CT scan, imaging for patient localization, and during treatment delivery.

METHODS

Tumor motion is evaluated at three stages of the treatment process. Following the acquisition of 4D CT scans for treatment planning, tumors are contoured at one phase and registered to other phases to obtain tumor motion patterns. Tumor motion prior to each treatment is evaluated by identifying tumors directly on every raw projection of the daily localization CBCT scans. Finally, tumor motion during treatment is evaluated by analyzing MV treatment beam images. Every frame of image is evaluated as three components, each with separate DRRs: all non-moving structures, the tumor, and other moving structures. The locations of three components are determined though a registration process. In order to quantify tumor motion, the cumulated probability, the percentage of time when the tumor motion is equal to or smaller than a given range, is evaluated at every stage.

RESULTS

This methodology has been applied to five lung cancer patients undergoing radiotherapy. More than 5400 frames from MV treatment beam images and 24 CBCT scans were acquired from 12 fractions. Both the average tumor position and the cumulated probability with the range were evaluated. The tumor motion ranges are generally larger than those obtained from 4D CT. Significant variation in motion patterns was observed as well.

CONCLUSIONS

Information obtained from 4DCT is insufficient for motion assessment. In contrast, our novel methodology is capable of accurately characterizing lung tumor motion on a daily basis, without the need for implanted fiducial markers and without additional imaging dose. It provides daily verification that the tumor range is within prior estimates and covered by the treatment planning volume. This research is supported by CPRIT Individual Investigator Award RP110329.

P3-01-04: Differential Impact of Gefitinib and PLX4720 on Proliferation of MCF10A and Isogenic Lines as Measured with a Metastasis Expression Score

Background: We previously reported that a published “Metastasis Score” (MS) could be used to evaluate the effects of a PI3K inhibitor (GDC-0941) on mutated human isogenic breast cancer cell lines. MS, based on the expression of14 genes, has been shown to predict distant metastasis in ER(+), node (−), breast cancer. We were interested to determine the impact of gefitinib (EGFR inhibitor) and PLX-4720 (selective inhibitor of BRAF V600E) on MS to assess the applicability of this score to a broader class of targeted agents. In addition, given the cross-talk between metabolism and proliferation, we also profiled genes involved in glycolysis, fatty acid metabolism and oxidative phosphorylation.

Methods: Parental MCF10A (WT for all genes) and isogenic lines of MCF10A harboring PI3K (H1047R), p53 null or KRAS(G12V) mutations were cultured overnight in DMEM:F12 media under identical conditions. Cells were then treated with gefitinib, PLX4720, or DMSO (vehicle control) and further incubated for 24hr. Expression analysis was performed by RT-PCR.

Results: The MS of the PI3K (H1047R) and p53 null lines was higher than the parental line and lower for the KRAS (G12V) line. Treatment of parental, PI3K and KRAS cell lines with gefitinib resulted in dose-dependent decreases in MS, as reported for GDC-0941, with a higher dose required to inhibit growth of PI3K (H1047R) cells. Treatment of p53 null cells with gefitinib, however, had only a modest effect on MS. In contrast to gefitinib, MS increased with PLX-4720 treatment in all 4 lines; the greatest increase was observed in KRAS (G12V) cells. The expression of metabolic genes differed significantly depending on the oncogenic mutation harbored by the cell line. ACTA2, ACLY, RPIA, KHK, GLS2 were most highly expressed in p53 null but lowest in KRAS (G12V), while GLUT5, PFKFB4, ENO3, SLC27A1, PGK2, GLUT1, TKT were expressed most highly in KRAS (G12V) but lowest in PI3K(H1047R). Upon treatment with gefitinib or PLX-4720, genes that were downregulated in the mutated lines generally showed a dose-dependent increase; those that were upregulated relative to the parental, showed a dose-dependent decrease with treatment.

Discussion: The decrease in MS of the parental, PI3K (H1047R) and KRAS (G12V) cell lines treated with gefitinib supports the impact of this EGFR inhibitor on cell proliferation. The modest effect on MS in p53 null cells supports the findings that sensitivity to gefitinib requires active p53 in order to induce apoptosis through a p53-dependent pathway. Increases in MS were observed in all 4 cell lines treated with PLX-4720, with the largest increase observed in KRAS (G12V). The enhanced proliferation of a BRAF WT cell line with a KRAS mutation is consistent with the Ras-dependent nature of this pathway. The metabolic genes showed diverse expression patterns that differed with different oncogenic mutations and likely reflect the multiple mechanisms controlling metabolism in cancer. An improved understanding of the expression of metabolic genes relative to proliferation in cell lines with various oncogenic mutations may provide additional insights into the dysregulation of these cellular processes and the possible role of anti-metabolite intervention.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-01-04.