Bringing a creative writing intervention for young adult cancer survivors online

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Background: Studies show the importance of age-specific, young adult cancer (YAC) psychosocial interventions. They demonstrate psychological interventions “reduce emotional stress and increase coping skills needed to adjust to life after a cancer diagnosis."(Peckham JL, et al. JAYAO. 2017;6:50-52.) With YAC survivors spread around the country, many lack access to such interventions. This feasibility study considered online delivery of a structured, long term writing intervention in YAC survivors and the perceived participant benefit. Methods: Lacuna Loft held three structured, creative writing workshops over 10 weeks, 10 weeks, and 8 weeks. An online video chat platform delivered the workshops, allowing participant connection via video and voice. The workshop followed the methods used in Unspoken Ink.(Peckham JL, et al. JAYAO. 2017;6:50-52.) Each week used a different cancer topic and several prompts were given. Participants completed questionnaires at the start and end of each workshop. Results: Over three writing workshops, twenty-one people completed a workshop, five participated in multiple, and ninety expressed interest in future workshops. People from nine states and three countries participated. The online platform allowed writers to join from any location including the hospital. Participants expressed a decrease in feelings of isolation at the completion of a workshop as well as an increase in feelings of connection to other YAC survivors. All participants stated they would refer another YAC survivor to the workshop. The online nature of the program proved inconsequential. Conclusions: Research shows that structured writing workshops for YAC survivors “to explore their cancer experiences may be an effective psychosocial intervention.”(Peckham JL, et al. JAYAO. 2017;6:50-52.) This study used online video chat platform to deliver the workshop and connect participants. All participants expressed decreased feelings of isolation and increased feelings of connection to their YAC survivor peers at the conclusion. Most had never participated in an online group previous to this online workshop. Online delivery of structured writing interventions thus allows for more wide-spread accessibility of psychosocial interventions for YAC survivors.

Feasibility of utilizing a novel mhealth platform to deliver an evidence-based exercise intervention among testicular cancer survivors (TCS)

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Background: Cardiovascular disease results in significant morbidity among TCS. Exercise for Cancer Patients (EXCAP) is a self-directed, individually tailored intervention that improves cardiovascular fitness in cancer patients, yet this has not been tested in TCS. We conducted a randomized phase II feasibility study of a novel exercise intervention using a mHealth delivery platform for EXCAP. Methods: We developed mHealth-EXCAP, which integrates data from a wearable digital activity tracker (DAT) into a patient’s electronic medical record (EMR), allowing providers to monitor and adjust EXCAP prescriptions via a patient-centered virtual portal. We randomized TCS ( < 69 yr at diagnosis, any treatments, not in active or maintenance stage of exercise behavior) into 3 study arms: Arm 1 (mHealth-EXCAP), Arm 2 (EXCAP) and Arm 3 (usual care). TCS in both Arm 1 and 2 completed a 12 week EXCAP program with the goal of 12,000 daily steps and daily resistance exercises but Arm 1 used the mHealth platform. Arm 3 used a TCS care plan that promotes exercises. Results: 74 TCS were screened (32 ineligible; 23 declined), 19 consented and 14 (74%) completed study (3 withdrew; 2 lost to follow up) as of 1/31/17. Median age (yr) was 35 (Arm 1; n = 6), 48 (Arm 2; n = 4), and 48 (Arm 3; n = 4). In Arm 1, 83% TCS wore DAT and synced daily step data to EMR > 90% of days. EXCAP prescriptions were adjusted via EMR portal on average 5 times over 12 weeks for each TCS and their weekly daily step goals were met 73% of the time. The number of daily steps recorded by DAT and those synced from DAT to EMR differed by a mean of 1.5% steps (±1.8). Median baseline number of daily steps were 5,525 (Arm 1), 6,795 (Arm 2), and 5,904 (Arm 3) and increased by 5,236, 1,160, and 1,544 respective steps at 12 weeks, with only Arm 1 (50% TCS) achieving > 12,000 daily steps. At 3 months after intervention, 33% TCS in Arm 1 maintained > 12,000 daily steps. On average, TCS in Arm 1 performed resistance exercises 26 minutes a day/5 times a week vs. 28 minutes a day/4 times a week in Arm 2. Conclusions: mHealth-EXCAP is feasible to implement among TCS and may decrease sedentary behavior. Ongoing research will examine its effects on cardiovascular fitness and risk factors.

Feasibility of an electronic implementation method of an evidence-based exercise intervention among testicular cancer survivors (TCS)

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Background: Cardiovascular (CV) disease results in significant morbidity among TCS. The effects of exercise on mitigating these late effects remain unknown in this population. Exercise for Cancer Patients (EXCAP) is a self-directed, individually tailored intervention that has been shown to improve CV fitness in cancer patients. We conducted a randomized phase II feasibility study of a novel electronic implementation method (mHealth) of EXCAP. Methods: We developed mHealth-EXCAP that integrates data from a wearable digital activity tracker (DAT) into a patient’s electronic medical record (EMR), allowing providers to monitor and adjust EXCAP prescriptions via a patient-centered virtual portal. We randomized TCS ( < 69 yr at diagnosis, any treatments, not in active or maintenance stage of exercise behavior) into 3 study arms: Arm 1 (mHealth-EXCAP), Arm 2 (EXCAP) and Arm 3 (usual care). Both Arm 1 and 2 completed a 12 week EXCAP program with the goal of 12,000 daily steps and daily resistance exercises and Arm 1 has integration of mHealth. Arm 3 received a TCS care plan that encourages exercises. Results: 52 TCS were screened (23 ineligible; 12 declined), 17 consented and 13 (80.9%) completed study (3 withdrew; 1 lost to follow up) as of May 31, 2016. Median age (yr) was 34 (Arm 1; n = 6), 52 (Arm 2; n = 3), and 48 (Arm 3; n = 4). In Arm 1, 83% TCS wore DAT and synced daily step data to EMR > 90% of days. Further, EXCAP prescriptions were adjusted via EMR portal on average 5 times over 12 weeks for each TCS and their weekly daily step goals were met 73% of the time. The number of daily steps recorded by DAT and those synced from DAT to EMR differed by a mean of 1.5% steps (±1.8). Median baseline number of daily steps were 5,432 (Arm 1), 6,737 (Arm 2), and 5,875 (Arm 3) and increased by 6,161, 1,742, and 1,921 respective steps, with only Arm 1 (50% TCS) achieving > 12,000 daily steps at study completion. On average, TCS in Arm 1 and 2 performed resistance exercises 15 minutes a day/2 times a week and 34 minutes a day/3 times a week, respectively. Conclusions: mHealth-EXCAP is feasible to implement among TCS and may decrease sedentary behavior. Ongoing research will examine its effects on CV risk factors and cardiopulmonary function.

Biopsychosocial distress assessment among testicular cancer survivors (TCS) using electronic patient reported outcomes (PROs)

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Background: Distressis a frequently endorsed experience by cancer patients.Many organizations advocate formal distress screening as part of clinical care in order to better meet the “psychological, social, and/or spiritual needs of patients that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatments.” The primary objective of this study is to characterize distress levels among TCS using electronic PROs via a modified version of the National Comprehensive Cancer Network Distress Thermometer (DT) and Patient Reported Outcomes Measurement System (PROMIS). Methods: Eligible TCS ( < 69 years at diagnosis, any treatments, not in active or maintenance stage of exercise behavior) enrolled onto a pilot study of an electronic, self-directed, individually tailored “EXercise for CAncer Patients” (EXCAP) program were offered iPad-based distress screening during routine medical oncology clinic visits. Screening consisted of a modified DT, where patients self-report distress on a scale of 1-10, wherein scores of greater than 4 refer to increased distress, as well as PROMIS domains for anxiety and depression, where scores range from 0-100, 50 is the average for the United States (US) general population, and higher values indicate more anxiety or depression. Results: A total of 18 TCS (median age 44) enrolled in the EXCAP study as of May 31, 2016. Among participants, 56%, 28% and 17% had stage I, II, and III testicular cancer, respectively. Treatment modality and median time from treatment to enrollment were: 78% orchiectomy, 23.5 months (range 1-204); 33% retroperitoneal lymph node dissection, 8 months (range 1-48); and 72% chemotherapy, 22 months (range 3-587). TCS completed a median of 2 distress screenings (range 1-8). The median DT score was 3 (range 1-8). Median PROMIS anxiety and depression scores were 52.88 (32.87-69.36) and 51.02 (34.17-6.65). Conclusions: TCS self-report low levels of distress on the DT and PROMIS scores for anxiety and depression that are comparable to the US general population. Future research will explore associations between patient- and disease-specific factors and distress in TCS.

Comparative study of the biodegradability of porous silicon films in simulated body fluid

The biodegradability of oxidized microporous, mesoporous and macroporous silicon films in a simulated body fluid with ion concentrations similar to those found in human blood plasma were studied using gravimetry. Film dissolution rates were determined by periodically weighing the samples after removal from the fluid. The dissolution rates for microporous silicon were found to be higher than those for mesoporous silicon of comparable porosity. The dissolution rate of macroporous silicon was much lower than that for either microporous or mesoporous silicon. This is attributed to the fact that its specific surface area is much lower than that of microporous and mesoporous silicon. Using an equation adapted from [Surf. Sci. Lett. 306 (1994), L550-L554], the dissolution rate of porous silicon in simulated body fluid can be estimated if the film thickness and specific surface area are known.

Discovery of novel pyridyl carboxamides as potent CCR5 antagonists and optimization of their pharmacokinetic profile in rats

A novel series of pyridyl carboxamide-based CCR5 inhibitors was designed, synthesized, and demonstrated to be highly potent against HIV-1 infection in both HOS and PBL assays. Attempts to evaluate this series of compounds in a rat PK model revealed its instability in rat plasma. A hypothesis for this liability was proposed, and strategies to overcome this issue were pursued, leading to discovery of highly potent 40 and 41, which featured dramatically improved rat PK profiles.

Novel 4,4-disubstituted piperidine-based C-C chemokine receptor-5 inhibitors with high potency against human immunodeficiency virus-1 and an improved human ether-a-go-go related gene (hERG) profile

We recently described ( J. Med. Chem. 2008 , 51 , 6538 - 6546 ) a novel class of CCR5 antagonists with strong anti-HIV potency. Herein, we detail SAR converting leads 1 and 2 to druglike molecules. The pivotal structural motif enabling this transition was the secondary sulfonamide substituent. Further fine-tuning of the substituent pattern in the sulfonamide paved the way to enhancing potency and bioavailability and minimizing hERG inhibition, resulting in discovery of clinical compound 122 (GSK163929).

Discovery of N-benzyl-N'-(4-pipyridinyl)urea CCR5 antagonists as anti-HIV-1 agents (II): modification of the acyl portion

Modification of the acyl moiety in the CCR5 lead molecule 2 led to identification of several new classes of CCR5 antagonists. Antiviral activity and pharmacokinetic properties of the synthesized compounds were evaluated. Structure-activity relationship (SAR) derived from these studies further guided the optimization efforts, ultimately leading to the discovery of 36 with an acceptable drug-like profile.

Discovery of N-benzyl-N'-(4-pipyridinyl)urea CCR5 antagonists as anti-HIV-1 agents (I): optimization of the amine portion

Several series of carbamate, urea and carboxamide-based CCR5 antagonists have been discovered via optimizations at the amine portion of lead compound 2. All compounds were evaluated for their antiviral activities. Lead urea 29 showed good pharmacokinetic properties, justifying further development of this series.

Novel pyrazolopyrimidine derivatives as GSK-3 inhibitors

A series of [1-aryl-1H-pyrazolo[3,4-d]pyrimidin-4-yl]arylhydrazones were discovered as novel inhibitors glycogen synthase kinase-3 (GSK-3). Based on initial modeling a detailed SAR was constructed. Modification of the interior binding aryl ring (Ar(1)) determined this to be a tight binding region with little room for modification. As predicted from the model, a large variety of modifications could be incorporated into the hydrazone aryl ring. This work led to GSK-3 inhibitors in the low nano-molar range.

Subchronic inhalation toxicity studies with hydrochlorofluorocarbon 123 (HCFC 123)

Hydrochlorofluorocarbon 123 (HCFC 123) is one of the chemicals being considered as a replacement for the chlorofluorocarbons. Four subchronic inhalation toxicity studies from 1 to 3 months in duration have been conducted with HCFC 123. One study utilized rats and dogs, while the others were limited to rats only. The exposure levels have ranged from 300 ppm up to 20,000 ppm. Although the studies were conducted over a 14-year period, the results were consistent. In all studies, increases in liver weights were seen at 1000 ppm and above; additionally, one showed this effect at 500 ppm. Histopathological findings were minimal, consisting primarily of focal necrosis in the liver of the dogs at 10,000 ppm. Induction of peroxisomal activity, lowering of serum cholesterol and triglyceride levels, and an increase in urinary fluoride levels were also seen. The 4-hr LC50 in the rat has been reported as 35,000 ppm. At 20,000 ppm for 6 hr, the total daily dose on a concentration times time basis is almost equal to the LC50, yet, in the 4-week study, with 20 exposures at this level, there was no mortality or even marked signs of toxicity. There appeared to be no evidence for cumulative toxicity from multiple exposures in these studies. Overall, HCFC 123 appears to have a low level of toxicity by the inhalation route.