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McLouth LE, Stapleton JL, Bursac V, Zelaya CM, Shelton BJ, Thakur K, Hands I, Blu C, Chih MY, McFarlin JM. Piloting a Patient Tool to Aid Palliative Care Referrals during Advanced Lung Cancer Treatment. J Pain Symptom Manage 2024; 67:337-345.e2. [PMID: 38219963 PMCID: PMC10939763 DOI: 10.1016/j.jpainsymman.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/16/2024]
Abstract
CONTEXT Patient misperceptions are a strong barrier to early palliative care discussions and referrals during advanced lung cancer treatment. OBJECTIVES We developed and tested the acceptability of a web-based patient-facing palliative care education and screening tool intended for use in a planned multilevel intervention (i.e., patient, clinician, system-level targets). METHODS We elicited feedback from advanced lung cancer patients (n = 6), oncology and palliative care clinicians (n = 4), and a clinic administrator (n = 1) on the perceived relevance of the intervention. We then tested the prototype of a patient-facing tool for patient acceptability and preliminary effects on patient palliative care knowledge and motivation. RESULTS Partners agreed that the intervention-clinician palliative care education and an electronic health record-integrated patient tool-is relevant and their feedback informed development of the patient prototype. Advanced stage lung cancer patients (n = 20; age 60 ± 9.8; 40% male; 70% with a technical degree or less) reviewed and rated the prototype on a five-point scale for acceptability (4.48 ± 0.55), appropriateness (4.37 ± 0.62), and feasibility (4.43 ± 0.59). After using the prototype, 75% were interested in using palliative care and 80% were more motivated to talk to their oncologist about it. Of patients who had or were at risk of having misperceptions about palliative care (e.g., conflating it with hospice), 100% no longer held the misperceptions after using the prototype. CONCLUSION The palliative care education and screening tool is acceptable to patients and may address misperceptions and motivate palliative care discussions during treatment.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA; Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA; Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA.
| | - Jerod L Stapleton
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA; Department of Health, Behavior, and Society, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Vilma Bursac
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA; Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA
| | - Carina M Zelaya
- Department of Communication, University of Maryland, Baltimore, Maryland, USA
| | - Brent J Shelton
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA; Department of Internal Medicine, Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Kshitij Thakur
- Department of Internal Medicine, Gastroenterology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Isaac Hands
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Chaney Blu
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Ming-Yuan Chih
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA; Department of Health and Clinical Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Jessica M McFarlin
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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McLouth LE, Shelton BJ, Bursac V, Burris JL, Cheavens JS, Weyman K, Peterman AH, Corum L, Studts JL, Arnold SM. "Pathways": A hope-enhancing intervention for patients undergoing treatment for advanced lung cancer. Psychooncology 2024; 33:e6316. [PMID: 38446540 DOI: 10.1002/pon.6316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Observational data suggest hope is associated with the quality of life and survival of people with cancer. This trial examined the feasibility, acceptability, and preliminary outcomes of "Pathways," a hope intervention for people in treatment for advanced lung cancer. METHODS Between 2020 and 2022, we conducted a single-arm trial of Pathways among participants who were 3-12 weeks into systemic treatment. Pathways consisted of two individual sessions delivered during infusions and three phone calls in which participants discussed their values, goals, and goal strategies with a nurse or occupational therapist. Participants completed standardized measures of hope and goal interference pre- and post-intervention. Feasibility was defined as ≥60% of eligible patients enrolling, ≥70% of participants completing three or more sessions, ≥70% of participants completing post-assessments, and mean acceptability ratings ≥7 out of 10 on intervention relevance, helpfulness, and convenience. Linear regression fixed effects models with covariates modeled pre-post changes in complete case analysis and multiple imputation models. RESULTS Fifty two participants enrolled: female (59.6%), non-Hispanic White (84.6%), rural (75.0%), and with low educational attainment (51.9% high school degree or less). Except for enrollment (54%), feasibility and acceptability markers were surpassed (77% adherence, 77% retention, acceptability ratings ≥8/10). There was moderate improvement in hope and goal interference from pre-to post-intervention (d = 0.51, p < 0.05 for hope; d = -0.70, p < 0.005 for goal interference). CONCLUSIONS Strong feasibility, acceptability, and patient-reported outcome data suggest Pathways is a promising intervention to increase hope and reduce cancer-related goal interference during advanced lung cancer treatment.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Brent J Shelton
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Division of Cancer Biostatistics, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Vilma Bursac
- Department of Behavioral Science, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Jessica L Burris
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Psychology, University of Kentucky College of Arts and Sciences, Lexington, Kentucky, USA
| | | | - Kaitlyn Weyman
- Medical College of Wisconsin Affiliated Hospitals, Madison, Wisconsin, USA
| | - Amy H Peterman
- Department of Psychological Science, University of North Carolina-Charlotte, Charlotte, North Carolina, USA
| | - Lauren Corum
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Jamie L Studts
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Susanne M Arnold
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Division of Medical Oncology, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Nightingale CL, Snavely AC, McLouth LE, Dressler EV, Kent EE, Adonizio CS, Danhauer SC, Cannady R, Hopkins JO, Kehn H, Weaver KE, Sterba KR. Processes for identifying caregivers and screening for caregiver and patient distress in community oncology: results from WF-1803CD. J Natl Cancer Inst 2024; 116:324-333. [PMID: 37738445 PMCID: PMC10852602 DOI: 10.1093/jnci/djad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Despite their vital roles, informal caregivers of adult cancer patients are commonly overlooked in cancer care. This study describes processes for identifying cancer caregivers and processes for distress screening and management among caregivers and patients in the understudied community oncology setting. METHODS Supportive care leaders from the National Cancer Institute Community Oncology Research Program practices completed online survey questions regarding caregiver identification, caregiver and patient distress screening, and distress management strategies. We described practice group characteristics and prevalence of study outcomes. Multivariable logistic regression explored associations between practice group characteristics and caregiver identification in the electronic health record (EHR). RESULTS Most (64.9%, 72 of 111) supportive care leaders reported routine identification and documentation of informal caregivers; 63.8% record this information in the EHR. Only 16% routinely screen caregivers for distress, though 92.5% screen patients. Distress management strategies for caregivers and patients are widely available, yet only 12.6% are routinely identified and screened and had at least 1 referral strategy for caregivers with distress; 90.6% are routinely screened and had at least 1 referral strategy for patients. Practices with a free-standing outpatient clinic (odds ratio [OR] = 0.29, P = .0106) and academic affiliation (OR = 0.01, P = .04) were less likely to identify and document caregivers in the EHR. However, higher oncologist volume was associated with an increased likelihood of recording caregiver information in the EHR (OR = 1.04, P = .02). CONCLUSIONS Despite high levels of patient distress screening and management, few practices provide comprehensive caregiver engagement practices. Existing patient engagement protocols may provide a promising platform to build capacity to better address caregiver needs.
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Affiliation(s)
- Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Laurie E McLouth
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Christian S Adonizio
- Center for Oncology Research and Innovation, Geisinger Health, Danville, PA, USA
| | - Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel Cannady
- Cancer Caregiver Support, American Cancer Society, Atlanta, GA, USA
| | - Judith O Hopkins
- Hematology and Oncology, Novant Health Cancer Institute, Southeast Clinical Oncology Research Consortium National Cancer Institute Community Oncology Research Program, Winston-Salem, NC, USA
| | - Heather Kehn
- Metro Minnesota Community Oncology Research Consortium, Minneapolis, MN, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina College of Medicine, Charleston, SC, USA
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Edward JS, Rayens MK, McLouth LE, Eisele LP, Scales J, Williams LB, Hildebrandt G. A dyadic analysis of financial toxicity and health-related quality of life among bone marrow transplant patients and their caregivers. Psychooncology 2024; 33:e6303. [PMID: 38342820 PMCID: PMC10947586 DOI: 10.1002/pon.6303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Relatively few dyad-based studies have evaluated the shared psychosocial and financial toxicity (FT) experiences of hematologic patients and their caregivers, especially those undergoing bone marrow transplantations (BMTs). This study evaluated the association of FT with health-related quality of life (QOL) among BMT patient-caregiver dyads. METHODS Survey and electronic health record data were collected between April 2021 and January 2022 from BMT patients and their caregivers pre- (T1) and post-intervention (T2). Thirty-four patient-caregiver dyads completed surveys; all dyads included a patient experiencing elevated T1 FT. The effect of the total FT score (i.e., the combination of psychological response, coping behaviors, and material conditions domain scores) on physical health, mental health, anxiety, depression and distress scores was evaluated using Actor-Partner Interdependence Modeling (APIM). RESULTS Patients and caregivers who reported lower total FT scores had better physical and mental health, and lower anxiety, depressive symptoms, distress (APIM actor effects). None of the partner effects were significant in the APIM models. Other model findings indicated that compared with caregivers, patients had lower reported physical health; mental health scores were higher, on average, for all participants at the T2 compared with T1; and members of dyads whose caregiver took time off work reported better physical health and lower depressive symptoms and distress than those whose caregiver did not. CONCLUSIONS Our study addresses a significant gap in dyad-based cancer FT studies; the findings underscore the need for additional research to help develop tailored dyad-level FT interventions for improving health-related QOL among BMT patients.
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Affiliation(s)
- Jean S Edward
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Laurie E McLouth
- Department of Behavioral Health, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Lori P Eisele
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Joan Scales
- Psycho-oncology Program, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | | | - Gerhard Hildebrandt
- Ellis Fischel Cancer Center, Missouri University Health Care, Columbia, Missouri, USA
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Gabbard J, Nur S, Levine BJ, Lycan TW, Pajewski N, Frechman E, Callahan KE, Klepin H, McLouth LE. The Association Between an Electronic Health Record (EHR)-Embedded Frailty Index and Patient-Reported Outcomes Among Patients with Metastatic Non-Small-Cell Lung Cancer on Immunotherapy: A Brief Report. Am J Hosp Palliat Care 2023:10499091231223964. [PMID: 38133583 DOI: 10.1177/10499091231223964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background: While frailty is a well-established predictor of overall mortality among patients with metastatic non-small cell lung cancer (mNSCLC), its association with patient-reported outcomes is not well-characterized. The goal of this study was to examine the association between an electronic frailty index (eFI) score and patient-reported outcome measures along with prognostic awareness among patients with mNSCLC receiving immunotherapy. Methods: In a cross-sectional study, patients with mNSCLC who were on immunotherapy completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) and the National Cancer Institute Patient Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). We utilized bivariate analyses to compare quality of life, symptoms, supportive services, and prognostic awareness among 3 groups defined by e-frailty status. Results: Sixty patients (mean age 62.5 years, 75% Caucasian, 60% women) participated. Most patients were pre-frail (68%), with 13% being frail and 18% non-frail. Pre-frail and frail patients had significantly lower physical function scores (mean 83.9 fit vs 74.8 pre-frail vs 60.0 frail, P = .04) and higher rates of self-reported pain (75% frail vs 41.5% pre-frail vs 18.2% fit; P = .04) compared to non-frail patients. We found no differences in palliative referral rates. Conclusion: Pre-frail and frail mNSCLC patients identified by the eFI have higher rates of pain and physical functional impairments than non-frail patients. These findings highlight the importance of emphasizing preventive interventions targeting social needs, functional limitations, and pain management, especially among pre-frail patients to reduce further decline.
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Affiliation(s)
- Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Saadia Nur
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Beverly J Levine
- Department of Social Sciences and Health Policy, School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Thomas W Lycan
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nicholas Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Erica Frechman
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kathryn E Callahan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Heidi Klepin
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Laurie E McLouth
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Salsman JM, McLouth LE, Tooze JA, Little-Greene D, Cohn M, Kehoe MS, Moskowitz JT. An eHealth, Positive Emotion Skills Intervention for Enhancing Psychological Well-Being in Young Adult Cancer Survivors: Results from a Multi-Site, Pilot Feasibility Trial. Int J Behav Med 2023; 30:639-650. [PMID: 36890329 PMCID: PMC10485177 DOI: 10.1007/s12529-023-10162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Young adult (YA) cancer survivors experience clinically significant distress and have limited access to psychosocial support. Given growing evidence for unique adaptive benefits of positive emotion in the context of health-related and other life stress, we developed an eHealth positive emotion skills intervention for post-treatment survivors called EMPOWER (Enhancing Management of Psychological Outcomes With Emotion Regulation) and evaluated feasibility and proof of concept for reducing distress and enhancing well-being. METHOD In this single-arm pilot feasibility trial, post-treatment YA cancer survivors (ages 18-39) participated in the EMPOWER intervention which included 8 skills (e.g., gratitude, mindfulness, acts of kindness). Participants completed surveys at baseline (pre-intervention), 8 weeks (post-intervention), and 12 weeks (1-month follow-up). Primary outcomes included feasibility (assessed by participation percentage) and acceptability (would recommend EMPOWER skills to a friend). Secondary outcomes included psychological well-being (mental health, positive affect, life satisfaction, meaning/purpose, general self-efficacy) and distress (depression, anxiety, anger). RESULTS We assessed 220 YAs for eligibility; 77% declined. Of those screened, 44 (88%) were eligible and consented, 33 began the intervention, and 26 (79%) completed the intervention. Overall retention was 61% at 12 weeks. Average acceptability ratings were high (8.8/10). Participants (M = 30.8 years, SD = 6.6) were 77% women, 18% racial/ethnic minorities, and 34% breast cancer survivors. At 12 weeks, EMPOWER was associated with improved mental health, positive affect, life satisfaction, meaning/purpose, and general self-efficacy (ps < .05, ds = .45 to .63) and decreased anger (p < .05, d = - 0.41). CONCLUSION EMPOWER demonstrated evidence of feasibility and acceptability as well as proof of concept for enhancing well-being and reducing distress. Self-guided, eHealth interventions show promise for addressing YA cancer survivors' needs and warrant additional research to optimize survivorship care. TRIAL REGISTRATION ClinicalTrials .gov NCT02832154, https://clinicaltrials.gov/ct2/show/NCT02832154.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine & Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Laurie E McLouth
- Department of Behavioral Science and Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine & Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Denisha Little-Greene
- Health Care Education, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Mia Sorkin Kehoe
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Lei F, Vanderpool RC, McLouth LE, Romond EH, Chen Q, Durbin EB, Tucker TC, Tai E, Huang B. Influence of depression on breast cancer treatment and survival: A Kentucky population-based study. Cancer 2023; 129:1821-1835. [PMID: 37063057 DOI: 10.1002/cncr.34676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 04/18/2023]
Abstract
BACKGROUND Depression is common among breast cancer patients and can affect concordance with guideline-recommended treatment plans. Yet, the impact of depression on cancer treatment and survival is understudied, particularly in relation to the timing of the depression diagnosis. METHODS The Kentucky Cancer Registry data was used to identify female patients diagnosed with primary invasive breast cancer who were 20 years of age or older in 2007-2011. Patients were classified as having no depression, depression pre-cancer diagnosis only, depression post- cancer diagnosis only, or persistent depression. The impact of depression on receiving guideline-recommended treatment and survival was examined using multivariable logistic regression and Cox regression, respectively. RESULTS Of 6054 eligible patients, 4.1%, 3.7%, and 6.2% patients had persistent depression, depression pre-diagnosis only, and depression post-diagnosis only, respectively. A total of 1770 (29.2%) patients did not receive guideline-recommended cancer treatment. Compared to patients with no depression, the odds of receiving guideline-recommended treatment were decreased in patients with depression pre-diagnosis only (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.54-1.04) but not in patients with post-diagnosis only or persistent depression. Depression post-diagnosis only (hazard ratio, 1.51; 95% CI, 1.24-1.83) and depression pre-diagnosis only (hazard ratio, 1.26; 95% CI, 0.99-1.59) were associated with worse survival. No significant difference in survival was found between patients with persistent depression and patients with no depression (p > .05). CONCLUSIONS Neglecting depression management after a breast cancer diagnosis may result in poorer cancer treatment concordance and worse survival. Early detection and consistent management of depression is critical in improving patient survival.
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Affiliation(s)
- Feitong Lei
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Robin C Vanderpool
- Division of Cancer Control and Population Sciences, Behavioral Research Program, Health Communication and Informatics Research Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Laurie E McLouth
- Department of Behavioral Science, Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Edward H Romond
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Quan Chen
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Division of Cancer Biostatistics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Eric B Durbin
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Thomas C Tucker
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Eric Tai
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bin Huang
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Division of Cancer Biostatistics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Edward JS, McLouth LE, Rayens MK, Eisele LP, Davis TS, Hildebrandt G. Coverage and Cost-of-Care Links: Addressing Financial Toxicity Among Patients With Hematologic Cancer and Their Caregivers. JCO Oncol Pract 2023; 19:e696-e705. [PMID: 36888937 PMCID: PMC10414719 DOI: 10.1200/op.22.00665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/31/2023] [Indexed: 03/10/2023] Open
Abstract
PURPOSE This study examined the feasibility, acceptability, and preliminary effectiveness of an oncology financial navigation (OFN) intervention, Coverage and Cost-of-Care Links (CC Links), among patients with hematologic cancer and their caregivers who are at increased risk of experiencing financial toxicity (FT). METHODS All patients who presented to the Division of Hematology and Bone and Marrow Transplant (BMT) at an National Cancer Institute-designated cancer center between April 2021 and January 2022 were screened for FT during inpatient and outpatient visits. Patients who screened positive for FT and met the inclusion criteria were recruited to participate in CC Links that provided financial navigation and assistance via a financial navigator. Caregivers of patients undergoing BMTs were also recruited to participate. Primary outcomes were defined as improvements in FT, distress, and physical and mental quality of life. RESULTS Fifty-four patients and 32 caregivers completed the intervention and pre-/postintervention surveys. CC Links resulted in statistically significant decreases in the Comprehensive Score for FT for both patients (|t| = 2.42, P = .019) and caregivers (|t| = 2.43, P = .021) and total FT (|t| = 2.13, P = .041) and material conditions scores (|t| = 2.25, P = .031) for caregivers only. Only 27% of eligible patients participated in the study, whereas 100% of eligible caregivers participated. The majority of participants rated the intervention highly for acceptability (89%) and appropriateness (88%). An average of $2,500 (USD) in financial benefits was secured per participant via CC Links. CONCLUSION CC Links was effective in decreasing FT among patients with hematologic cancer and their caregivers while demonstrating high acceptability and appropriateness ratings.
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Affiliation(s)
- Jean S. Edward
- College of Nursing, University of Kentucky, Lexington, KY
| | - Laurie E. McLouth
- Department of Behavioral Health, College of Medicine, University of Kentucky, Lexington, KY
| | | | - Lori P. Eisele
- Patient Financial Experience, University of Kentucky HealthCare, Lexington, KY
| | - Tani S. Davis
- Markey Cancer Center, Division of Hematology and Blood and Marrow Transplants, Lexington, KY
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Mossman B, Perry LM, Gerhart JI, McLouth LE, Lewson AB, Hoerger M. Emotional distress predicts palliative cancer care attitudes: The unique role of anger. Psychooncology 2023; 32:692-700. [PMID: 36799130 PMCID: PMC10164101 DOI: 10.1002/pon.6113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/21/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Although palliative care can mitigate emotional distress, distressed patients may be less likely to engage in timely palliative care. This study aims to investigate the role of emotional distress in palliative care avoidance by examining the associations of anger, anxiety, and depression with palliative care attitudes. METHODS Patients (N = 454) with heterogeneous cancer diagnoses completed an online survey on emotional distress and palliative care attitudes. Emotional distress was measured using the Patient-Reported Outcomes Measurement Information System anger, anxiety, and depression scales. The Palliative Care Attitudes Scale was used to measure palliative care attitudes. Regression models tested the impact of a composite emotional distress score calculated from all three symptom measures, as well as individual anger, anxiety, and depression scores, on palliative care attitudes. All models controlled for relevant demographic and clinical covariates. RESULTS Regression results revealed that patients who were more emotionally distressed had less favorable attitudes toward palliative care (p < 0.001). In particular, patients who were angrier had less favorable attitudes toward palliative care (p = 0.013) while accounting for depression, anxiety, and covariates. Across analyses, women had more favorable attitudes toward palliative care than men, especially with regard to beliefs about palliative care effectiveness. CONCLUSIONS Anger is a key element of emotional distress and may lead patients to be more reluctant toward timely utilization of palliative care. Although psycho-oncology studies routinely assess depression or anxiety, more attention to anger is warranted. More research is needed on how best to address anger and increase timely utilization of palliative cancer care.
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Affiliation(s)
- Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, LA
| | - Laura M. Perry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James I. Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan
| | - Laurie E. McLouth
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY
| | - Ashley B. Lewson
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, LA
- Departments of Psychiatry and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, LA
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Myint ZW, St. Clair WH, Strup SE, Yan D, Li N, Allison DB, McLouth LE, Ellis CS, Wang P, James AC, Hensley PJ, Otto DE, Arnold SM, DiPaola RS, Kolesar JM. A Phase I Dose Escalation and Expansion Study of Epidiolex (Cannabidiol) in Patients with Biochemically Recurrent Prostate Cancer. Cancers (Basel) 2023; 15:2505. [PMID: 37173971 PMCID: PMC10177512 DOI: 10.3390/cancers15092505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/09/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE Cannabinoids (CBD) have anti-tumor activity against prostate cancer (PCa). Preclinical studies have demonstrated a significant decrease in prostate specific antigen (PSA) protein expression and reduced tumor growth in xenografts of LNCaP and DU-145 cells in athymic mice when treated with CBD. Over-the-counter CBD products may vary in activity without clear standardization, and Epidiolex is a standardized FDA-approved oral CBD solution for treatment of certain types of seizures. We aimed to assess the safety and preliminary anti-tumor activity of Epidiolex in patients with biochemically recurrent (BCR) PCa. EXPERIMENTAL DESIGN This was an open-label, single center, phase I dose escalation study followed by a dose expansion in BCR patients after primary definitive local therapy (prostatectomy +/- salvage radiotherapy or primary definitive radiotherapy). Eligible patients were screened for urine tetrahydrocannabinol prior to enrollment. The starting dose level of Epidiolex was 600 mg by mouth once daily and escalated to 800 mg daily with the use of a Bayesian optimal interval design. All patients were treated for 90 days followed by a 10-day taper. The primary endpoints were safety and tolerability. Changes in PSA, testosterone levels, and patient-reported health-related quality of life were studied as secondary endpoints. RESULTS Seven patients were enrolled into the dose escalation cohort. There were no dose-limiting toxicities at the first two dose levels (600 mg and 800 mg). An additional 14 patients were enrolled at the 800 mg dose level into the dose expansion cohort. The most common adverse events were 55% diarrhea (grade 1-2), 25% nausea (grade 1-2), and 20% fatigue (grade 1-2). The mean PSA at baseline was 2.9 ng/mL. At the 12-week landmark time-point, 16 out of 18 (88%) had stable biochemical disease, one (5%) had partial biochemical response with the greatest measurable decline being 41%, and one (5%) had PSA progression. No statistically significant changes were observed in patient-reported outcomes (PROs), but PROs changed in the direction of supporting the tolerability of Epidiolex (e.g., emotional functioning improved). CONCLUSION Epidiolex at a dose of 800 mg daily appears to be safe and tolerable in patients with BCR prostate cancer supporting a safe dose for future studies.
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Affiliation(s)
- Zin W. Myint
- Department of Medicine, Division of Medical Oncology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - William H. St. Clair
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Radiation Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Stephen E. Strup
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Urology, University of Kentucky, Lexington, KY 40536, USA
| | - Donglin Yan
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA
| | - Ning Li
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA
| | - Derek B. Allison
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Laurie E. McLouth
- Department of Behavioral Science, University of Kentucky, Lexington, KY 40536, USA
| | - Carleton S. Ellis
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
| | - Peng Wang
- Department of Medicine, Division of Medical Oncology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Andrew C. James
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Urology, University of Kentucky, Lexington, KY 40536, USA
| | - Patrick J. Hensley
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Urology, University of Kentucky, Lexington, KY 40536, USA
| | - Danielle E. Otto
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
| | - Susanne M. Arnold
- Department of Medicine, Division of Medical Oncology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Robert S. DiPaola
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Jill M. Kolesar
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA
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McLouth LE, Gabbard J, Levine BJ, Golden SL, Lycan TW, Petty WJ, Weaver KE. Prognostic Awareness, Palliative Care Use, and Barriers to Palliative Care in Patients Undergoing Immunotherapy or Chemo-Immunotherapy for Metastatic Lung Cancer. J Palliat Med 2023. [PMID: 36912809 DOI: 10.1089/jpm.2022.0352] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Background and Objectives: This study describes patients' prognostic awareness and palliative care use in the setting of immunotherapy for metastatic non-small cell lung cancer (mNSCLC). Design: We surveyed 60 mNSCLC patients receiving immunotherapy at a large academic medical center; conducted follow-up interviews with 12 survey participants; and abstracted palliative care use, advance directive completion, and death within a year of survey completion from the medical record. Results: Forty seven percent of patients surveyed thought they would be cured; 83% were not interested in palliative care. Interviews suggested oncologists emphasized therapeutic options when discussing prognosis and that commonly used descriptions of palliative care may exacerbate misperceptions. Only 7% had received outpatient palliative care and 8% had an advance directive a year after the survey; only 16% of the 19 patients who died had received outpatient palliative care. Conclusions: Interventions are needed to facilitate prognostic discussions and outpatient palliative care during immunotherapy. Clinical Trial Registration Number NCT03741868.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Jennifer Gabbard
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Beverly J Levine
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Thomas W Lycan
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - W Jeffrey Petty
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathryn E Weaver
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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McLouth LE, Borger T, Bursac V, Hoerger M, McFarlin J, Shelton S, Shelton B, Shearer A, Kiviniemi MT, Stapleton JL, Mullett T, Studts JL, Goebel D, Thind R, Trice L, Schoenberg NE. Palliative care use and utilization determinants among patients treated for advanced stage lung cancer care in the community and academic medical setting. Support Care Cancer 2023; 31:190. [PMID: 36847880 PMCID: PMC9969037 DOI: 10.1007/s00520-023-07649-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/18/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Despite clinical guidelines, palliative care is underutilized during advanced stage lung cancer treatment. To inform interventions to increase its use, patient-level barriers and facilitators (i.e., determinants) need to be characterized, especially among patients living in rural areas or those receiving treatment outside academic medical centers. METHODS Between 2020 and 2021, advanced stage lung cancer patients (n = 77; 62% rural; 58% receiving care in the community) completed a one-time survey assessing palliative care use and its determinants. Univariate and bivariate analyses described palliative care use and determinants and compared scores by patient demographic (e.g., rural vs. urban) and treatment setting (e.g., community vs. academic medical center) factors. RESULTS Roughly half said they had never met with a palliative care doctor (49.4%) or nurse (58.4%) as part of cancer care. Only 18% said they knew what palliative care was and could explain it; 17% thought it was the same as hospice. After palliative care was distinguished from hospice, the most frequently cited reasons patients stated they would not seek palliative care were uncertainty about what it would offer (65%), concerns about insurance coverage (63%), difficulty attending multiple appointments (60%), and lack of discussion with an oncologist (59%). The most common reasons patients stated they would seek palliative care were a desire to control pain (62%), oncologist recommendation (58%), and coping support for family and friends (55%). CONCLUSION Interventions should address knowledge and misconceptions, assess care needs, and facilitate communication between patients and oncologists about palliative care.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, College of Medicine, University of Kentucky, 760 Press Avenue, 467 Healthy Kentucky Research Building, Lexington, KY, 40536, USA.
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA.
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
| | - Tia Borger
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Vilma Bursac
- Department of Behavioral Science, College of Medicine, University of Kentucky, 760 Press Avenue, 467 Healthy Kentucky Research Building, Lexington, KY, 40536, USA
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
| | - Michael Hoerger
- Departments of Psychology, Psychiatry, and Medicine, Freeman School of Business and Tulane Cancer Center, Tulane University, New Orleans, LA, USA
- Department of Palliative Medicine and Supportive Care, University Medical Center of New Orleans, New Orleans, LA, USA
| | - Jessica McFarlin
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Shaylla Shelton
- Lincoln Memorial University- DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Brent Shelton
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Departmental of Internal Medicine, Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Andrew Shearer
- Departmental of Internal Medicine, Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Marc T Kiviniemi
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Health, Behavior and Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Jerod L Stapleton
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Health, Behavior and Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Timothy Mullett
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jamie L Studts
- Department of Medicine, University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - David Goebel
- King's Daughters Health System, Ashland, KY, USA
| | | | | | - Nancy E Schoenberg
- Department of Behavioral Science, College of Medicine, University of Kentucky, 760 Press Avenue, 467 Healthy Kentucky Research Building, Lexington, KY, 40536, USA
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
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13
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McLouth LE, Zheng Y, Smith S, Hodi FS, Rao UN, Cohen GI, Amatruda TT, Dakhil SR, Curti BD, Nakhoul I, Chandana SR, Bane CL, Marinier DE, Lee SJ, Sondak VK, Kirkwood JM, Tarhini AA, Wagner LI. Patient-reported tolerability of adjuvant ipilimumab (3 or 10 mg/kg) versus high-dose interferon alfa-2b for resected high-risk stage III-IV melanoma in phase III trial E1609. Qual Life Res 2023; 32:183-196. [PMID: 36029412 PMCID: PMC9839512 DOI: 10.1007/s11136-022-03226-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Trial E1609 demonstrated superior overall survival with ipilimumab 3 mg/kg (ipi3) compared to high-dose interferon (HDI) for patients with resected high-risk melanoma. To inform treatment tolerability, we compared health-related quality of life (HRQoL), gastrointestinal (GI), and treatment-specific physical and cognitive/emotional symptoms. We also compared treatment-specific concerns between all arms. METHODS We assessed HRQoL using the Functional Assessment of Cancer Therapy-General, physical and cognitive/emotional concerns using the FACT-Biologic Response Modifier subscale, and GI symptoms with the Functional Assessment of Chronic Illness Therapy-Diarrhea subscale pre-treatment and every 3 months. The primary outcome was the difference in HRQoL at 3 months between ipi3/ipi10 vs. HDI. RESULTS 549 patients (n = 158 ipi3; n = 191 ipi10; n = 200 HDI) were analyzed. 3-month completion was 58.7%. Compared to HDI, ipilimumab patients reported better HRQoL (ipi3 = 87.5 ± 14.6 vs. HDI = 74.7 ± 15.4, p < .001; ipi10 = 84.9 ± 16.5 vs. HDI, p < .001) and fewer physical (ipi3 = 22.3 ± 4.6 vs. HDI = 17.1 ± 5.4, p < .001; ipi10 = 21.8 ± 5.0 vs. HDI p < .001) and cognitive/emotional (ipi3 = 18.6 ± 4.4 vs. HDI = 15.0 ± 5.3, p < .001; ipi10 = 17.7 ± 4.8 vs. HDI p < .001) concerns, but worse GI symptoms (ipi3 = 40.8 ± 5.0 vs. HDI = 42.2 ± 2.9, p = .011; ipi10 = 39.5 ± 7.0 vs. HDI, p < .001). Fewer ipilimumab patients reported worsening treatment-specific concerns (e.g., 52% of ipi3 and 58% of ipi10 reported worsening fatigue vs. 82% HDI, p's < .001). CONCLUSION PROs demonstrated less toxicity of ipi3 compared to HDI and ipi10. Priorities for symptom management among patients receiving ipilimumab include GI toxicities, fatigue, weakness, appetite loss, arthralgia, and depression. TRIAL REGISTRATION NCT01274338, January 11, 2011 (first posted date) https://clinicaltrials.gov/ct2/show/NCT01274338?term=NCT01274338&draw=2&rank=1 .
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, College of Medicine, Markey Cancer Center, University of Kentucky, 467 Healthy Kentucky Research Building, 760 Press Avenue, Lexington, KY, 40508, USA.
| | - Yue Zheng
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Stephanie Smith
- Nancy N. and J.C. Lewis Cancer and Research Pavilion, St. Joseph's/Candler, Savannah, GA, USA
| | - F Stephen Hodi
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, USA
- Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, MA, USA
| | - Uma N Rao
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Gary I Cohen
- Greater Baltimore Medical Center, Baltimore, MD, USA
| | | | | | - Brendan D Curti
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, USA
| | - Ibrahim Nakhoul
- Regional Cancer Center at Indian Path Community Hospital, Kingsport, TN, USA
| | - Sreenivasa R Chandana
- Cancer and Hematology Centers of Western Michigan/Cancer Research Consortium of West Michigan NCORP, Grand Rapids, MI, USA
| | | | | | - Sandra J Lee
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | - John M Kirkwood
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | | | - Lynne I Wagner
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
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14
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McLouth LE, Ford CG, Pustejovsky JE, Park CL, Sherman AC, Trevino K, Salsman JM. A systematic review and meta-analysis of effects of psychosocial interventions on spiritual well-being in adults with cancer. Psychooncology 2021; 30:147-158. [PMID: 34602807 PMCID: PMC8485897 DOI: 10.1002/pon.5562] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective Spiritual well-being (SpWb) is an important dimension of health-related quality of life for many cancer patients. Accordingly, an increasing number of psychosocial intervention studies have included SpWb as a study endpoint, and may improve SpWb even if not designed explicitly to do so. This meta-analysis of randomized controlled trials (RCTs) evaluated effects of psychosocial interventions on SpWb in adults with cancer and tested potential moderators of intervention effects. Methods Six literature databases were systematically searched to identify RCTs of psychosocial interventions in which SpWb was an outcome. Doctoral-level rater pairs extracted data using Covidence following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Standard meta-analytic techniques were applied, including meta-regression with robust variance estimation and risk-of-bias sensitivity analysis. Results Forty-one RCTs were identified, encompassing 88 treatment effects among 3883 survivors. Interventions were associated with significant improvements in SpWb (g = 0.22, 95% CI [0.14, 0.29], p < 0.0001). Studies assessing the FACIT-Sp demonstrated larger effect sizes than did those using other measures of SpWb (g = 0.25, 95% CI [0.17, 0.34], vs. g = 0.10, 95% CI [-0.02, 0.23], p = 0.03]. No other intervention, clinical, or demographic characteristics significantly moderated effect size. Conclusions Psychosocial interventions are associated with small-to-medium-sized effects on SpWb among cancer survivors. Future research should focus on conceptually coherent interventions explicitly targeting SpWb and evaluate interventions in samples that are diverse with respect to race and ethnicity, sex and cancer type.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - C Graham Ford
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - James E Pustejovsky
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Allen C Sherman
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kelly Trevino
- Memorial Sloan Kettering Cancer Centre, New York City, New York, USA
| | - John M Salsman
- Wake Forest School of Medicine and the Wake Forest Baptist Comprehensive Cancer Centre, Winston-Salem, North Carolina, USA
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Sannes TS, Gerhart JI, McLouth LE, Hoerger M. Response to Henderson et al., Staffing a Specialist Palliative Care Service, a Team-Based Approach: Expert Consensus White Paper (DOI: 10.1089/jpm.2019.0314). J Palliat Med 2021; 23:598-599. [PMID: 32378996 DOI: 10.1089/jpm.2019.0656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Timothy S Sannes
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - James I Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Laurie E McLouth
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- University of Kentucky Center for Health Equity Transformation and Markey Cancer Center, Lexington, Kentucky, USA
| | - Michael Hoerger
- Department of Psychology and Medicine (Oncology), Tulane Cancer Center, Tulane University, New Orleans, Louisiana, USA
- Department of Palliative Medicine and Supportive Care, University Medical Center of New Orleans, New Orleans, Louisiana, USA
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16
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Salsman JM, Danhauer SC, Moore JB, Ip EH, McLouth LE, Nightingale CL, Cheung CK, Bingen K, Tucker-Seeley RD, Little-Greene D, Howard DS, Reeve BB. Systematic review of financial burden assessment in cancer: Evaluation of measures and utility among adolescents and young adults and caregivers. Cancer 2021; 127:1739-1748. [PMID: 33849081 PMCID: PMC8113116 DOI: 10.1002/cncr.33559] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/06/2022]
Abstract
The cost of cancer care is rising and represents a stressor that has significant and lasting effects on quality of life for many patients and caregivers. Adolescents and young adults (AYAs) with cancer are particularly vulnerable. Financial burden measures exist but have varying evidence for their validity and reliability. The goal of this systematic review is to summarize and evaluate measures of financial burden in cancer and describe their potential utility among AYAs and their caregivers. To this end, the authors searched PubMed, Embase, the Cochrane Library, CINAHL, and PsycINFO for concepts involving financial burden, cancer, and self-reported questionnaires and limited the results to the English language. They discarded meeting abstracts, editorials, letters, and case reports. The authors used standard screening and evaluation procedures for selecting and coding studies, including consensus-based standards for documenting measurement properties and study quality. In all, they screened 7250 abstracts and 720 full-text articles to identify relevant articles on financial burden. Eighty-six articles met the inclusion criteria. Data extraction revealed 64 unique measures for assessing financial burden across material, psychosocial, or behavioral domains. One measure was developed specifically for AYAs, and none were developed for their caregivers. The psychometric evidence and study qualities revealed mixed evidence of methodological rigor. In conclusion, several measures assess the financial burden of cancer. Measures were primarily designed and evaluated in adult patient populations with little focus on AYAs or caregivers despite their increased risk of financial burden. These findings highlight opportunities to adapt and test existing measures of financial burden for AYAs and their caregivers.
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Affiliation(s)
| | | | | | - Edward H. Ip
- Wake Forest School of Medicine, Winston Salem, NC
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Brainson CF, Huang B, Chen Q, McLouth LE, He C, Hao Z, Arnold SM, Zinner RG, Mullett TW, Bocklage TJ, Orren DK, Villano JL, Durbin EB. Description of a Lung Cancer Hotspot: Disparities in Lung Cancer Histology, Incidence, and Survival in Kentucky and Appalachian Kentucky. Clin Lung Cancer 2021; 22:e911-e920. [PMID: 33958300 DOI: 10.1016/j.cllc.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Kentucky is recognized as the state with the highest lung cancer burden for more than 2 decades, but how lung cancer differs in Kentucky relative to other US populations is not fully understood. PATIENTS AND METHODS We examined lung cancer reported to the Surveillance, Epidemiology, and End Results (SEER) Program by Kentucky and the other SEER regions for patients diagnosed between 2012 and 2016. Our analyses included histologic types, incidence rates, stage at diagnosis, and survival in Kentucky and Appalachian Kentucky relative to other SEER regions. RESULTS We found that both squamous cell carcinomas and small-cell lung cancers represent larger proportions of lung cancer diagnoses in Kentucky and Appalachian Kentucky than they do in the SEER registries. Furthermore, age-adjusted cancer incidence rates were higher in Kentucky for every subtype of lung cancer examined. Most notably, for Appalachian women the rate of small-cell carcinomas was 3.5-fold higher, and for Appalachian men the rate of squamous cell carcinoma was 3.1-fold higher, than the SEER rates. In Kentucky, lung cancers were diagnosed at later stages and lung cancer survival was lower for adenocarcinoma and neuroendocrine carcinomas than in SEER registries. Squamous cell carcinomas and small-cell carcinomas were most lethal in Appalachian Kentucky. CONCLUSION Together, these data highlight the considerable disparities among lung cancer cases in the United States and demonstrate the continuing high burden and poor survival of lung cancer in Kentucky and Appalachian Kentucky. Strategies to identify and rectify causes of these disparities are discussed.
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Affiliation(s)
- Christine F Brainson
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY; Markey Cancer Center, University of Kentucky, Lexington, KY.
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, KY; Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Quan Chen
- Markey Cancer Center, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Laurie E McLouth
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Behavioral Science, Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY
| | - Chunyan He
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Zhonglin Hao
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Susanne M Arnold
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Ralph G Zinner
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Timothy W Mullett
- Department of Surgery, Division of Cardiothoracic Surgery, College of Medicine, University of Kentucky, Lexington, KY
| | - Therese J Bocklage
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Kentucky, Lexington, KY
| | - David K Orren
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY; Markey Cancer Center, University of Kentucky, Lexington, KY
| | - John L Villano
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Eric B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY; Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY
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18
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McLouth LE, Weyman K, Golden SL, Cheavens JS, Peterman A, Bursac V, Gabbard J, Weaver KE. Developing pathways, a hope-enhancing intervention for metastatic lung cancer patients receiving cancer treatment. Psychooncology 2021; 30:863-873. [PMID: 33638288 DOI: 10.1002/pon.5650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Between 40% and 65% of lung cancer patients report concern about maintaining valued activities and roles, yet few interventions address this concern. Hope, a patient's perceived ability to generate goals and identify ways to pursue them, may be a promising intervention target to support function among lung cancer patients. The goal of this study was to assess metastatic non-small cell lung cancer (mNSCLC) patient interest and preferences for a hope-enhancing intervention. METHODS We conducted a sequential mixed-methods (survey followed by semi-structured interviews) study with patients with mNSCLC. Surveys assessed patient interest in, perceived helpfulness of, and preferences for a hope intervention. A subset of 12 patients (and caregivers, when present) completed semi-structured interviews to elicit feedback on proposed intervention content and procedures. RESULTS Survey data from 60 patients (40% male; Mean age = 62.5; SD = 9.3) suggested high perceived importance of pursuing personal goals during cancer treatment, moderate perceived helpfulness in discussing personal goals, and preference for a nurse-led intervention. Based on these data, a 5-session, nurse-led intervention protocol was drafted and reviewed with 12 patients. Interviewed patients and caregivers agreed working towards goals was beneficial, liked the intervention concept, and thought prompts and rating scales on handouts would facilitate discussion. The majority preferred nurse delivery during infusions. CONCLUSIONS A nurse-led hope-enhancing intervention delivered primarily during infusions may be acceptable to mNSCLC patients. Future work should test feasibility and identify ways to incorporate caregivers and oncology providers into hope interventions.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Kaitlyn Weyman
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Shannon L Golden
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Amy Peterman
- Department of Psychological Science, University of North Carolina-Charlotte, Charlotte, North Carolina, USA
| | - Vilma Bursac
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Jennifer Gabbard
- Department of Internal Medicine, Wake Forest School of Medicine, Section on Gerontology and Geriatric Medicine, Winston-Salem, North Carolina, USA
| | - Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
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19
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McLouth LE, Nightingale CL, Levine BJ, Burris JL, McDougall JA, Lycan TW, Gabbard J, Ruiz J, Farris M, Blackstock AW, Grant SC, Petty WJ, Weaver KE. Unmet Care Needs and Financial Hardship in Patients With Metastatic Non-Small-Cell Lung Cancer on Immunotherapy or Chemoimmunotherapy in Clinical Practice. JCO Oncol Pract 2021; 17:e1110-e1119. [PMID: 33539182 DOI: 10.1200/op.20.00723] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Immunotherapy or chemoimmunotherapy is now standard treatment for most patients with metastatic non-small-cell lung cancer (mNSCLC), yet patient supportive care needs (SCNs) on immunotherapy are not well defined. This study characterized the SCNs and financial hardship of patients with mNSCLC treated with immunotherapy or chemoimmunotherapy and examined the relationship between patient and caregiver cancer-related employment reductions and patient financial hardship. METHODS Patients with mNSCLC on immunotherapy or chemoimmunotherapy from a single academic medical center completed the SCNs Survey-34, items indexing material, psychological, and behavioral financial hardship, and the Comprehensive Score for Financial Toxicity. Univariate and bivariate analyses examined care needs, financial hardship, and impact of cancer-related employment reductions on patient financial hardship. RESULTS Sixty patients (40% male; 75% White, mean age = 62.5 years, 57% on immunotherapy alone) participated. Fifty-five percent reported unmet needs in physical or daily living and psychological domains. Financial hardship was common (33% material, 63% psychological, and 57% behavioral). Fifty-two percent reported hardship in at least two domains. Forty percent reported a caregiver cancer-related employment reduction. Caregiver employment reduction was related to patient financial hardship (68% of those reporting caregiver employment reduction reported at least two domains of hardship v 40% of those without reduction, P = .03) and patient financial distress (mean Comprehensive Score for Financial Toxicity = 19.6 among those with caregiver employment reduction v 26.8 without, P = .01). CONCLUSION Patients with mNSCLC treated with immunotherapy or chemoimmunotherapy report multiple unmet care needs and financial hardship. Psychological, functional, financial, and caregiver concerns merit assessment and intervention in this population.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC.,Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Beverly J Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC.,Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Jean A McDougall
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Thomas W Lycan
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jimmy Ruiz
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC.,W. G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC
| | - Michael Farris
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Arthur W Blackstock
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stefan C Grant
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - W Jeffrey Petty
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC.,Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
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20
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Stapleton JL, Ray AE, Glenn SD, McLouth LE, Parmar V, Manne SL. A randomized controlled trial of a web-based personalized feedback intervention targeting frequent indoor tanning bed users: Engagement, acceptability, and preliminary behavioral outcomes. J Health Psychol 2020; 27:923-935. [PMID: 33353412 DOI: 10.1177/1359105320982038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Frequent indoor tanning bed use is an established public health concern, yet research on tanning cessation interventions for frequent tanners is lacking. We describe the protocol for a brief, web-based tanning behavior change intervention and present evidence that it is acceptable and engaging to frequent indoor tanners. Lower tanning rates were not observed among participants receiving the intervention in a randomized controlled trial but participants' interest in changing tanning increased. This intervention could be a useful approach to increasing frequent tanners' interest in behavior change and openness to engaging within a more intensive, multi-component tanning cessation program.Trial Registration: NCT03448224 Clinical Trials.gov (https://clinicaltrials.gov/ct2/show/NCT03448224?cond=NCT03448224&draw=2&rank=1).
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Affiliation(s)
| | - Anne E Ray
- University of Kentucky College of Public Health, USA
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21
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McLouth LE, Nightingale CL, Dressler EV, Snavely AC, Hudson MF, Unger JM, Kazak AE, Lee SJC, Edward J, Carlos R, Kamen CS, Neuman HB, Weaver KE. Current Practices for Screening and Addressing Financial Hardship within the NCI Community Oncology Research Program. Cancer Epidemiol Biomarkers Prev 2020; 30:669-675. [PMID: 33355237 DOI: 10.1158/1055-9965.epi-20-1157] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer-related financial hardship is associated with poor care outcomes and reduced quality of life for patients and families. Scalable intervention development to address financial hardship requires knowledge of current screening practices and services within community cancer care. METHODS The NCI Community Oncology Research Program (NCORP) 2017 Landscape Assessment survey assessed financial screening and financial navigation practices within U.S. community oncology practices. Logistic models evaluated associations between financial hardship screening and availability of a cancer-specific financial navigator and practice group characteristics (e.g., safety-net designation, critical access hospital, proportion of racial and ethnic minority patients served). RESULTS Of 221 participating NCORP practice groups, 72% reported a financial screening process and 50% had a cancer-specific financial navigator. Practice groups with more than 10% of new patients with cancer enrolled in Medicaid (adjOR = 2.81, P = 0.02) and with less than 30% racial/ethnic minority cancer patient composition (adjOR = 3.91, P < 0.01) were more likely to screen for financial concerns. Practice groups with less than 30% racial/ethnic minority cancer patient composition (adjOR = 2.37, P < 0.01) were more likely to have a dedicated financial navigator or counselor for patients with cancer. CONCLUSIONS Most NCORP practice groups screen for financial concerns and half have a cancer-specific financial navigator. Practices serving more racial or ethnic minority patients are less likely to screen and have a designated financial navigator. IMPACT The effectiveness of financial screening and navigation for mitigating financial hardship could be tested within NCORP, along with specific interventions to address cancer care inequities.See related commentary by Yabroff et al., p. 593.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, University of Kentucky, Markey Cancer Center, Center for Health Equity Transformation, Lexington, Kentucky.
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matthew F Hudson
- NCORP of the Carolinas, Prisma Health, Greenville, South Carolina
| | - Joseph M Unger
- Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, SWOG Statistics and Data Management Center, Seattle, Washington
| | - Anne E Kazak
- Centers for Healthcare Delivery Service, Nemours Children's Health System, Wilmington, Delaware
| | - Simon J Craddock Lee
- Department of Population and Data Sciences, University of Texas-Southwestern Medical Center, Dallas, Texas
| | - Jean Edward
- College of Nursing, University of Kentucky, Markey Cancer Center, UK Healthcare, Lexington, Kentucky
| | - Ruth Carlos
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Heather B Neuman
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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22
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Nightingale CL, Sterba KR, McLouth LE, Kent EE, Dressler EV, Dest A, Snavely AC, Adonizio CS, Wojtowicz M, Neuman HB, Kazak AE, Carlos RC, Hudson MF, Unger JM, Kamen CS, Weaver KE. Caregiver engagement practices in National Cancer Institute Clinical Oncology Research Program settings: Implications for research to advance the field. Cancer 2020; 127:639-647. [PMID: 33136296 DOI: 10.1002/cncr.33296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/20/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Supportive care interventions have demonstrated benefits for both informal and/or family cancer caregivers and their patients, but uptake generally is poor. To the authors' knowledge, little is known regarding the availability of supportive care services in community oncology practices, as well as engagement practices to connect caregivers with these services. METHODS Questions from the National Cancer Institute Community Oncology Research Program (NCORP)'s 2017 Landscape Survey examined caregiver engagement practices (ie, caregiver identification, needs assessment, and supportive care service availability). Logistic regression was used to assess the relationship between the caregiver engagement outcomes and practice group characteristics. RESULTS A total of 204 practice groups responded to each of the primary outcome questions. Only 40.2% of practice groups endorsed having a process with which to systematically identify and document caregivers, although approximately 76% were routinely using assessment tools to identify caregiver needs and approximately 63.7% had supportive care services available to caregivers. Caregiver identification was more common in sites affiliated with a critical access hospital (odds ratio [OR], 2.44; P = .013), and assessments were less common in safety-net practices (OR, 0.41; P = .013). Supportive care services were more commonly available in the Western region of the United States, in practices with inpatient services (OR, 2.96; P = .012), and in practices affiliated with a critical access hospital (OR, 3.31; P = .010). CONCLUSIONS Although many practice groups provide supportive care services, fewer than one-half systematically identify and document informal cancer caregivers. Expanding fundamental engagement practices such as caregiver identification, assessment, and service provision will be critical to support recent calls to improve caregivers' well-being and skills to perform caregiving tasks.
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Affiliation(s)
- Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Laurie E McLouth
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alexandra Dest
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christian S Adonizio
- Center for Oncology Research and Innovation, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Mark Wojtowicz
- Center for Oncology Research and Innovation, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Matthew F Hudson
- NCORP of the Carolinas, Prisma Health Cancer Institute, Greenville, South Carolina
| | - Joseph M Unger
- SWOG Cancer Research Network Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles S Kamen
- Department of Surgery, University of Rochester, Rochester, New York
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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23
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Gabbard J, Johnson D, Russell G, Spencer S, Williamson JD, McLouth LE, Ferris KG, Sink K, Brenes G, Yang M. Prognostic Awareness, Disease and Palliative Understanding Among Caregivers of Patients With Dementia. Am J Hosp Palliat Care 2020; 37:683-691. [PMID: 31854201 PMCID: PMC10581031 DOI: 10.1177/1049909119895497] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Persons with dementia (PwD) often have significant cognitive deficits and functional limitations, requiring substantial caregiver assistance. Given the high symptom burden and terminal nature of dementia, good prognostic awareness and integration of palliative care (PC) is needed. OBJECTIVE To evaluate prognostic awareness, disease, and PC understanding among caregivers of PwD and to assess for improvements in routine care. DESIGN A cross-sectional study of 2 cohorts at a single-academic medical center. Surveys were mailed to 200 caregivers of PwD in 2012 (cohort 1). Surveys were sent to new subset of caregivers of PwD (n = 80) in 2018 (cohort 2) to assess trends over time. RESULTS A total of 154 of caregivers completed the survey (response rate 55%). Compared to 2012, a higher proportion of caregivers in 2018 reported having conversations about prognosis with PwD's physicians (25% in 2012 vs 45% in 2018; P = .027). However, a large percentage (43% in 2012 and 40% in 2018) of caregivers reported no understanding of the PwD's prognosis. Despite most stating dementia was not curable, only 39% in 2012 and 52% in 2018 (P = .015) understood that dementia was a terminal disease. In addition, only 32% in 2012 and 40% in 2018 (P = .39) felt that they were knowledgeable about PC. CONCLUSIONS Prognostic discussions between caregivers of PwD and the PwD's physicians may be occurring more often; however, a high percentage of caregivers report a poor understanding about the terminal nature of dementia and the role of PC.
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Affiliation(s)
- Jennifer Gabbard
- Section on Gerontology & Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Devin Johnson
- Section on Gerontology & Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Greg Russell
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Shenita Spencer
- Center for Supportive Care and Survivorship, Atrium Health, Charlotte, NC, USA
| | - Jeff D. Williamson
- Section on Gerontology & Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Laurie E. McLouth
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Keren G. Ferris
- Section on Gerontology & Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kaycee Sink
- Product Development—Neuroscience, Genentech Inc, South San Francisco, CA, USA
| | - Gretchen Brenes
- Section on Gerontology & Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mia Yang
- Section on Gerontology & Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, NC, USA
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24
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Salsman JM, McLouth LE, Cohn M, Tooze JA, Sorkin M, Moskowitz JT. A Web-Based, Positive Emotion Skills Intervention for Enhancing Posttreatment Psychological Well-Being in Young Adult Cancer Survivors (EMPOWER): Protocol for a Single-Arm Feasibility Trial. JMIR Res Protoc 2020; 9:e17078. [PMID: 32463014 PMCID: PMC7290453 DOI: 10.2196/17078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/10/2020] [Accepted: 02/27/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Adolescent and young adult cancer survivors (AYAs) experience clinically significant distress and have limited access to supportive care services. Interventions to enhance psychological well-being have improved positive affect and reduced depression in clinical and healthy populations but have not been routinely tested in AYAs. OBJECTIVE The aim of this protocol is to (1) test the feasibility and acceptability of a Web-based positive emotion skills intervention for posttreatment AYAs called Enhancing Management of Psychological Outcomes With Emotion Regulation (EMPOWER) and (2) examine proof of concept for reducing psychological distress and enhancing psychological well-being. METHODS The intervention development and testing are taking place in 3 phases. In phase 1, we adapted the content of an existing, Web-based positive emotion intervention so that it would be suitable for AYAs. EMPOWER targets 8 skills (noticing positive events, capitalizing, gratitude, mindfulness, positive reappraisal, goal setting, personal strengths, and acts of kindness) and is delivered remotely as a 5-week, Web-based intervention. Phase 2 consisted of a pilot test of EMPOWER in a single-arm trial to evaluate feasibility, acceptability, retention, and adherence and to collect data on psychosocial outcomes for proof of concept. In phase 3, we are refining study procedures and conducting a second pilot test. RESULTS The project was part of a career development award. Pilot work began in June 2015, and data collection was completed in March 2019. The analysis is ongoing, and results will be submitted for publication by May 2020. CONCLUSIONS If this intervention proves feasible and acceptable, EMPOWER will be primed for a subsequent large, multisite randomized controlled trial. As a scalable intervention, it will be ideally suited for AYA survivors who would otherwise not have access to supportive care interventions to help manage posttreatment distress and enhance well-being. TRIAL REGISTRATION ClinicalTrials.gov NCT02832154, https://clinicaltrials.gov/ct2/show/NCT02832154. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17078.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Laurie E McLouth
- Department of Behavioral Science, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Michael Cohn
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Mia Sorkin
- Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, United States
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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