Designing an exercise intervention for adult survivors of childhood cancers

BACKGROUND

This study examined current physical activity levels and preferences for exercise settings and activities among adult survivors of childhood cancers as a strategy to inform the feasibility and design of such programs.

METHODS

A mixed-methods design was used to investigate current activity levels as well as barriers to and preferences for physical activity among 20 adult survivors of pediatric cancer.

RESULTS

One-half of participants reported engaging in regular physical activity, although the frequency, intensity, and duration varied. Overall, 17 of the 20 participants (85%) stated they would be interested in participating in a structured exercise intervention, and they expressed a strong interest in walking (76%), bicycling (53%), and weight training (53%). Common barriers to participation in a potential structured exercise program were insufficient time, current health issues, and program location/distance. Nearly all participants agreed that information on nutrition and diet should be included as part of an exercise intervention.

CONCLUSIONS

These findings will help inform the design and implementation of future exercise programs to enhance physical activity among this high-risk group of cancer survivors.

Rare-earth-doped biological composites as in vivo shortwave infrared reporters

The extension of in vivo optical imaging for disease screening and image-guided surgical interventions requires brightly-emitting, tissue-specific materials that optically transmit through living tissue and can be imaged with portable systems that display data in real-time. Recent work suggests that a new window across the short wavelength infrared region can improve in vivo imaging sensitivity over near infrared light. Here we report on the first evidence of multispectral, real-time short wavelength infrared imaging offering anatomical resolution using brightly-emitting rare-earth nanomaterials and demonstrate their applicability toward disease-targeted imaging. Inorganic-protein nanocomposites of rare-earth nanomaterials with human serum albumin facilitated systemic biodistribution of the rare-earth nanomaterials resulting in the increased accumulation and retention in tumor tissue that was visualized by the localized enhancement of infrared signal intensity. Our findings lay the groundwork for a new generation of versatile, biomedical nanomaterials that can advance disease monitoring based on a pioneering infrared imaging technique.

Abstract B50: Effects of automated tobacco assessment and cessation on survival for thoracic cancer patients

Purpose: Most tobacco cessation studies in cancer patients rely upon retrospective reviews in a small subsample of cancer patients presenting for treatment. The purpose of this study is to describe the tobacco use and cessation patterns for all patients (100% sampling) presenting to a thoracic oncology clinic at a NCI Designated Comprehensive Cancer Center using a standardized assessment and automatic tobacco cessation referral program.

Methods: Patients presenting to the thoracic oncology clinic at Roswell Park Cancer Institute (RPCI) were screened with a standardized tobacco assessment and all patients who used tobacco within the past 30 days were automatically referred to a dedicated tobacco cessation program. Demographic and health information were obtained from the electronic medical record, as well as the RPCI tumor registry, for all thoracic patients referred to the cessation program between October 2010 and October 2012. Tobacco information was collected by the cessation specialist. Descriptive and multivariate analyses were used to identify significant associations between demographics and disease characteristics with participation rates and self-reported quit rates.

Results: Among the 978 patients referred to the cessation program, 531 (54.2%) had information in the tumor registry. 476 (89.6%) patients had a form of lung cancer and 55 (5.6%) had another thoracic cancer, such as esophageal, bronchial, thymus, mediastinum or pleura cancer. 226 out of the 531 (42.6%) patients with tumor registry information were deceased, of whom the majority died from the primary thoracic cancer or complication from that cancer (N=151/226; 66.8%). Among those who were deceased, those who self-reported former tobacco use status (not currently using) at the first visit had a significantly longer survival time (n=53; mean=20.40 months, SD=30.91) compared to current users at first visit (n=157; mean=13.75 months, SD=15.41; p=0.042). Change in quit status from diagnosis to the first contact was not statistically associated with survival outcomes after controlling for age, packyears, sex and clinical stage of disease. Compared to being a current tobacco user at diagnosis and first contact, a significant difference in survival was not observed among those who quit between diagnosis and the first contact by the cessation service (HR=1.16, 95%CI: 0.63-2.13), those who relapsed between diagnosis and the first contact (HR=0.80, 95% CI: 0.36-1.79), and those who self-reported being quit at diagnosis and the first contact (HR=0.61, 95% CI: 0.28-1.34). However, age (HR=1.03; 95% CI: 1.01-1.05); being male compared to female (HR=1.64; 95% CI: 1.07-2.51) and clinical stage of disease (clinical stage compared to stage 1: HRstage2=2.20; 95% CI: 0.84-5.78; HRstage3=3.48; 95% CI: 1.67-7.24; HRstage4=8.49; 95% CI: 4.35-16.58) were significantly associated with survival. Although the association of quitting after diagnosis and survival was not statistically significant, the number of those who quit was small, limiting statistical power.

Conclusions: Patients who participated in an automated institutional cessation program and who quit smoking may have a reduced risk of death.

Citation Format: Katharine Dobson Amato, Mary Reid, Robert Reed, Patricia Hysert, Robert Hysert, Stephanie Segal, Gary Giovino, Maansi Travers, Heather Ochs-Balcom, Michael Zevon, Kenneth Michael Cummings, Chukwumere Nwogu, James Marshall, Martin Mahoney, Andrew Hyland, Graham Warren. Effects of automated tobacco assessment and cessation on survival for thoracic cancer patients. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B50.

Evaluation of a dedicated institutional tobacco cessation service for thoracic clinic cancer patients

1603

Background: Tobacco use by cancer patients is associated with poor therapeutic outcomes including increased toxicity, decreased quality of life, and decreased survival. Though recommendations provide for tobacco assessment and cessation for cancer patients, few oncologists provide cessation support. Presented are data from universal tobacco assessment and cessation program for patients presenting at a thoracic oncology clinic in a NCI Designated Comprehensive Cancer Center. Methods: A standard set of evidence based tobacco assessment questions were incorporated into an automated electronic medical record based system delivered by nursing at initial consult and at follow-up. Patients eligible for tobacco cessation support (i.e. patients self-reporting tobacco use within 30 days) were automatically referred to a dedicated tobacco cessation service. All referred patients are sent a standardized packet of cessation materials with telephone-based follow-up by trained cessation counselors. Results: A total of 980 new thoracic clinic patients were referred to the cessation service from January 2011 and October 2012. Two-thirds of the patients referred (n=728) referred into the system were current smokers and the remainder had quit in the 30 days prior to assessment. Among the 788 patients with contact attempts by the cessation service, 81.2% (n=640) were successfully contacted and only 2.5% (n=20) refused the offer of cessation support. At first contact, 75.6% (n=484) of patients reported continued current tobacco use. Follow-up calls were placed for 53.1% (n=340) of those who participated in the first contact an average of 39 days after the first successful contact. The follow-up had a 93.2% (n=317) participation rate which revealed that 33.3% (n=106) reported not smoking, an 8.9% increase since the first cessation service telephone call. Conclusions: Data demonstrate that an automated tobacco assessment and cessation service for thoracic oncology patients can effectively generate a large mandatory referral base with high patient interest in cessation, and that cessation support can be implemented and maintained in high risk cancer patients.

Increasing access to tobacco cessation support for cancer patients: Results of an institution-wide screening and referral program in an NCI-designated comprehensive cancer center

1566

Background: Guidelines from ASCO and other national organizations recommend assessment of tobacco use and structured tobacco cessation support for cancer patients. However, most oncology providers fail to provide cessation assistance to cancer patients who use tobacco. Reported are results of a systematic approach to assessing tobacco use and delivering cessation support for cancer patients in a comprehensive cancer center. Methods: A standard set of evidence based tobacco assessment questions were incorporated into an automated electronic medical record based system delivered by nursing at initial consult and follow-up. Patients eligible for tobacco cessation support (i.e. patients self-reporting tobacco use within 30 days) were automatically referred to a dedicated tobacco cessation service providing primarily phone based cessation support. Results: Of approximately 11,900 patients screened over 26 months, 2,978 patients were automatically triaged for cessation support. Contact priority was given to newly diagnosed patients in tobacco related disease sites. Using 1.25 full time cessation specialists, 1,531 received only a standard tobacco cessation mailing and no further contacts were attempted by the cessation service. In 1447 patients with attempted phone contact by the cessation service, 1189 (82.2%) were reached within 5 contact attempts. In 1,189 patients contacted, 52 (4.4%) were inappropriate referrals, 245 (20.6%) were in an active quitting phase, 465 (39.1%) were willing to prepare, and only 24 (2.0%) refused any intervention at initial contact. At the most recent follow-up, 44 patients (3.7%) requested no further contact and 90 additional patients (7.6%) were lost to follow-up. In the 1,045 remaining patients, 338 (32.3%) reported quitting tobacco use. Notably, in the 1,531 patients with no phone contact by the cessation service, only 14 proactively contacted the cessation service for assistance. Conclusions: An institution wide program to automate the delivery of tobacco cessation services was feasible with high patient contact rates, low patient refusal, and moderately high tobacco cessation rates.

Outcomes from an electronic medical record (EMR)-based standardized tobacco assessment and cessation program in a NCI-designated comprehensive cancer center

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Background: Tobacco assessment and cessation is advocated by ASCO and national clinical oncology guidelines, but there is little information on large scale clinically efficient models to assess tobacco use and provide cessation in a structured evidence based manner. Automation through the electronic medical record (EMR) could reduce subjective interpretation by clinicians and assist in increasing data tracking accuracy to enhance meaningful use initiatives. Methods: A standard set of evidence based tobacco assessment questions were incorporated into an annotated fixed-variable response system in the EMR delivered by nursing at initial consult and at follow-up. A logic based EMR referral system was developed to determine patient eligibility for mandatory automated referral to a dedicated tobacco cessation service. An evidence based institutional clinical cessation program was developed to provide cessation support to referred patients. The evidence based screening and referral algorithms will be presented. Results: Over 13 months, 677 patients were referred and 529 patients were successfully contacted to date for cessation support. In the 529 patients, 21 (3.9%) were inappropriate referrals (never smokers or long term former smokers), 48 patients (9.1%) did not want to enroll, but wanted to discuss cessation at a later date. Notably, only 18 patients (3.4%) refused any intervention. In a total of 415 patients enrolled in the cessation program, 104 patients (25.1%) were thinking about quitting (contemplation), 134 patients (32.3%) were preparing to quit, 169 patients (40.7%) were quitting (action phase), and 8 patients (1.9%) have relapsed. Tobacco assessments and automated referrals through the EMR took a median of 4 minutes to complete. Conclusions: A large volume of patients were screened and referred to a dedicated cessation program with low patient refusal for intervention without impeding physician workflow. These data suggest that this nursing driven EMR based assessment is a highly efficient clinical model for tobacco assessment and cessation.

Gender-associated differences in the quality of life after allogeneic BMT

The purpose of this study was to compare the quality of life (QOL) of male and female allogeneic BMT recipients. One hundred and nine BMT patients participated in this cross-sectional survey and completed the following instruments: Functional Assessment of Cancer Treatment (FACT-BMT version 3), shortened version of Profile of Mood States (POMS), MOS Survey of Social Support, and A Brief Measure of Social Support (SSQ6). Independent of the time post-BMT, perceived physical well-being, age at BMT, and education, females reported worse emotional well-being and more fatigue than males. Females also indicated more tiredness and less quality sleep. Males were found to experience less satisfaction with social support regardless of marital status. On the other hand, married males were more satisfied with their sexual life, more interested in sexual relationships, and more sexually active compared to married females. However, no significant differences between males and females were found in terms of overall physical, functional, and social well-being assessed by the FACT-BMT. The present results indicated that important gender differences exist among allogeneic BMT recipients which need to be addressed when designing post-treatment intervention programs for BMT recipients.

Quality of life and factors related to perceived satisfaction with quality of life after allogeneic bone marrow transplantation

The quality of life after bone marrow transplantation (BMT) was studied in 109 adult allogeneic BMT recipients transplanted on at the Helsinki University Central hospital for a haematological malignancy. Physical, functional, emotional and social well-being was measured on the Functional Assessment of Cancer Therapy Scale (FACT-BMT) and a shortened version of the Profile of Mood States Scale (POMS) and by the MOS social support survey and a Brief Measure of Social Support (SSQ6). The results of the present study replicate those of previous investigations by finding that physical well-being, educational level, age at BMT and social support have an impact on the perceived quality of life of BMT patients. Our results indicate that these factors have a varying impact at different time points during the post-BMT recovery process. During the first three years after BMT, physical well-being proved to be a highly significant (P < 0.001) factor for perceived life satisfaction. Moreover, physical well-being showed an average significant improvement after the first post-BMT year. The percentage of the recipients experiencing the highest levels of satisfaction with life increased from 51% during the first year after BMT to 81% for those patients five years post-BMT. One year after BMT, 75.6% of the BMT recipients were able to work, 67.8% of the patients were actively participating in work/school and 7.8% were unemployed.

Involving family members in cancer care: focus group considerations of patients and oncological providers

Family members are an integral part of a patient's cancer care from the moment the diagnosis is delivered to the conclusion of treatment. Family members bring with them a range of emotional reactions, interpersonal dynamics and expectations for the care the patient receives. This study is part of a multi-institutional project to continue to improve the process of cancer care. In this study, 19 focus groups (11 patient and 8 provider) were conducted concerning issues related to doctor-patient communication in eight cancer centers in the United States. The content of the conversations was analyzed and thematic categories emerged that highlight the various strengths and difficulties associated with family involvement. The focus groups' comments support the need for explicit conversations between professional caregivers, patients and their loved ones, in order to negotiate the expectations and needs of each team member. Implications for clinical practice and strategies for working with family members are offered.

Gaining research access to retarded children in public schools

The issue of gaining research access to mentally retarded children attending public schools is discussed. Preliminary steps completed prior to conducting a research investigation in the school settings were described within the framework of two independent studies. The important role of the special education teacher in conducting research in the natural environment is delineated.