Social support and quality of life of prostate cancer patients after radiotherapy treatment

QUEENAN J.A., FELDMAN‐STEWART D., BRUNDAGE M. & GROOME P.A. (2010) European Journal of Cancer Care 19 , 251–259
Social support and quality of life of prostate cancer patients after radiotherapy treatment Research suggests that social support can have an impact on health‐related quality of life (HRQOL). Social support can be structural support (SSS) or functional support (FSS). Our study was designed to clarify the relationships between HRQOL, FSS and SSS. We conducted a cross‐sectional survey and a detailed chart review. The study population was men attending a follow‐up clinic after receiving radiotherapy for prostate cancer. Functional social support was measured by using the MOS Social Support Survey. Structural social support was measured by using questions adapted from the 1994–1995 National Population Health Survey conducted by Statistics Canada. Health‐related quality of life was measured by using the European Organization for Research and Treatment of Cancer's QLQ‐C30. We found a statistically significant positive correlation between FSS and HRQOL but no association between overall SSS and HRQOL. Worsening urinary symptoms were significantly associated with lower levels of FSS and with lower HRQOL. This study underscores that the perception of support (functional) is more important than the amount or size of support (structural). We also identified a subgroup of men who have lower FSS and lower HRQOL that suffer from urinary side effects of their treatment. Further research to clarify the relationship between FSS and urinary symptoms will also clarify how an intervention could improve the HRQOL of these men.     

Comorbidities are associated with poorer quality of life and functioning and worse symptoms in the 5 years following colorectal cancer surgery: Results from the ColoREctal Well‐being (CREW) cohort study

Objective

More people are living with the consequences of cancer and comorbidity. We describe frequencies of comorbidities in a colorectal cancer cohort and associations with health and well‐being outcomes up to 5 years following surgery.

Methods

Prospective cohort study of 872 colorectal cancer patients recruited 2010 to 2012 from 29 UK centres, awaiting curative intent surgery. Questionnaires administered at baseline (pre‐surgery), 3, 9, 15, 24 months, and annually up to 5 years. Comorbidities (and whether they limit activities) were self‐reported by participants from 3 months. The EORTC QLQ‐C30 and QLQ‐CR29 assessed global health/quality of life (QoL), symptoms, and functioning. Longitudinal analyses investigated associations between comorbidities and health and well‐being outcomes.

Results

At baseline, the mean age of participants was 68 years, with 60% male and 65% colon cancer. Thirty‐two per cent had 1 and 40% had ≥2 comorbidities. The most common comorbidities were high blood pressure (43%), arthritis/rheumatism (32%), and anxiety/depression (18%). Of those with comorbidities, 37% reported at least 1 that limited their daily activities. Reporting any limiting comorbidities was associated with poorer global health/QoL, worse symptoms, and poorer functioning on all domains over 5‐year follow‐up. Controlling for the most common individual comorbidities, depression/anxiety had the greatest deleterious effect on outcomes.

Conclusions

Clinical assessment should prioritise patient‐reported comorbidities and whether these comorbidities limit daily activities, as important determinants of recovery of QoL, symptoms, and functioning following colorectal cancer. Targeted interventions and support services, including multiprofessional management and tailored assessment and follow‐up, may aid recovery of health and well‐being in these individuals.

     

Social support and cancer incidence and mortality: the JPHC study cohort II

Background

Studies conducted in Western countries have found a robust association between higher social support and improved cancer outcomes, particularly for breast cancer incidence and prognosis. However, less is known about the influence of social support on cancer among Asian populations where the measures of social support may differ in social relationships. In this prospective cohort study in Japan, we sought to examine the associations between the incidence and mortality of total and site-specific cancer.

Methods

We examined prospectively the association between social support and risk of cancer incidence and mortality within a cohort of 44,152 Japanese men and women, aged 40–69 years, free of prior diagnosis of cancer and cardiovascular disease. Social support was measured by emotional support defined as receipt of confidant support and esteem support from family members or friends and by social isolation. A total of 3,444 cases of newly diagnosed cancer and 1,561 cancer deaths occurred between the baseline questionnaire (1993–1994) and the end of follow-up in January 2004.

Results

The multivariate hazard ratios (HR) and 95 % confidence intervals for colorectal cancer incidence and mortality in the highest social support versus lowest social support group were 1.48 (1.06–2.05) and 3.07 (1.65–5.69) in men, respectively. Social support was not associated with other site-specific cancer incidence or cancer outcomes in women.

Conclusions

Low social support was associated with higher risk of both colorectal cancer incidence and mortality in men. Social support may affect colorectal cancer onset and prognosis via a range of factors, including healthier lifestyles as well as adherence to therapeutic regimens.     

The effect of an attachment‐oriented couple intervention for breast cancer patients and partners in the early treatment phase: A randomised controlled trial

Objective

Patients and partners both cope individually and as a dyad with challenges related to a breast cancer diagnosis. The objective of this study was to evaluate the effect of a psychological attachment‐oriented couple intervention for breast cancer patients and partners in the early treatment phase.

Methods

A randomised controlled trial including 198 recently diagnosed breast cancer patients and their partners. Couples were randomised to the Hand in Hand (HiH) intervention in addition to usual care or to usual care only. Self‐report assessments were conducted for both patients and partners at baseline, postintervention (5 months), and follow‐up (10 months), assessing cancer‐related distress, symptoms of anxiety and depression, and dyadic adjustment. Patients' cancer‐related distress was the primary outcome.

Results

Cancer‐related distress decreased over time in both patients and partners, but the intervention did not significantly affect this decrease at postintervention (P = .08) or follow‐up (P = .71). A significant positive effect was found on dyadic adjustment at follow‐up for both patients (P = .04) and partners (P = .02).

Conclusions

There was no significant effect of the HiH intervention cancer‐related distress. The results suggest that most couples can cope with cancer‐related distress in the context of usual care. However, the positive effect on dyadic adjustment implies that the HiH intervention benefitted both patients and partners. Future studies should investigate how to integrate a couple focus in usual cancer care to improve dyadic coping in the early treatment phase.

     

Improving social network support for partners facing spousal cancer while caring for minors: Four‐month outcomes of a single‐centre randomised controlled trial

Social support is an important predictor of the well‐being of partners of cancer patients. Those who are caring for minors (well parents) may be in special need of such support. The aim of this study was to evaluate the 4‐month impact of a psychoeducational social support intervention, named the Cancer‐PEPSONE programme (CPP), on well parents’ received and perceived social support, as well as on their psychological distress, quality of life (QOL) and parental capacity. The study was an open randomised controlled trial with a parallel‐group design (N = 35; Intervention = 17, Controls = 18). The participants in the intervention group received CPP in their homes. Controls received support as usual. Data were collected in Norway using validated self‐report questionnaires. Questionnaires were sent by post, before randomisation (T1), and at three‐ (T2) and six‐month (T3) follow‐up. Linear mixed models analyses revealed intervention effects on received (p = 0.04, d = 0.6) and perceived (p = 0.01, d = 1.0) social support, as well as on parental capacity (p = 0.02, d = 1.0), but not on psychological distress and QOL. Social support mediated the relationship between receiving CPP and later psychological distress. CPP may help well parents in maintaining social support and enhancing parental capacity. An improvement in social support may alleviate well parents’ psychological distress.     

How does patient‐clinician information engagement influence self‐reported cancer‐related problems?

BACKGROUND:

Past research has linked patient‐physician communication with improved emotional, physical, and social health. One component of communication, patient‐clinician information engagement (PCIE), predicts improved short‐term patient‐reported outcomes, such as treatment satisfaction, through perceptions of feeling informed. However, to the authors' knowledge, the relation between PCIE and longer term cancer‐related problems has not been examined previously. The authors examined the influence of PCIE on self‐reported problems associated with cancer diagnosis and treatment based on a longitudinal survey among a randomly selected sample from the 2005 Pennsylvania Cancer Registry.

METHODS:

In total, 1293 respondents were surveyed who were diagnosed with colorectal, breast, or prostate cancers during 2006 and 2007. The baseline response rate was 64%, and the retention rate was 65%. The authors predicted an index of cancer‐related problems at 1‐year follow‐up with the baseline cancer‐related problem index and PCIE, controlling for demographic and clinical factors using regression analyses. The mean age of participants was 65 years, approximately 50% were women, and 86% were white.

RESULTS:

Having more cancer‐related problems and PCIE at baseline significantly predicted more cancer‐related problems at follow‐up. In addition, baseline cancer‐related problems and PCIE interacted significantly (P = .01): PCIE was associated with more cancer‐related problems at follow‐up among participants who reported more symptoms rather than fewer symptoms at baseline.

CONCLUSIONS:

If respondents reported engaging more with their physicians at baseline, then they reported experiencing more cancer‐related issues at follow‐up; this pattern was stronger among those who reported more baseline problems. The current results indicated that increased discussion of cancer information with physicians may maintain the salience of these problems in cancer survivors' minds over time. Cancer 2011. © 2011 American Cancer Society.     

Impact of chemotherapy on quality of life in patients with metastatic esophagogastric cancer

BACKGROUND:

Health‐related quality of life (HRQoL) is a key issue in patients with metastatic esophagogastric cancer, a disease associated with survival times rarely exceeding 10 months. The objective of the current review was to evaluate the effects of chemotherapy on the HRQoL of patients with metastatic or locally advanced, inoperable esophagogastric cancer.

METHODS:

A systematic MEDLINE search was performed to address a predefined question list: Does chemotherapy improve or maintain HRQoL? Do available data favor a particular chemotherapy? What relation exists between HRQoL and the efficacy and tolerability of therapy?

RESULTS:

The majority of studies, including large randomized studies, indicated no significant improvements in mean HRQoL scores versus baseline after chemotherapy. However, scores were maintained and symptomatic relief or improved performance status was observed in many patients. HRQoL was maintained in approximately 50% of patients for up to 6 months but deteriorated in the remaining patients. In randomized phase 3 trials, only cisplatin/fluorouracil plus either docetaxel or epirubicin were found to provide superior HRQoL versus comparators. Between‐regimen differences in HRQoL scores appeared to correspond to differences in the efficacy rather than the toxicity of treatment regimens.

CONCLUSIONS:

Chemotherapy maintained HRQoL in a substantial proportion of patients with advanced esophagogastric cancer. This effect appeared to correspond to the efficacy of the treatment. Cancer 2010. © 2010 American Cancer Society.     

Depressive symptoms in relation to overall survival in people with head and neck cancer: A longitudinal cohort study

Objective

The objective of the study is to investigate the relation between pretreatment depressive symptoms (DS) and the course of DS during the first year after cancer diagnosis, and overall survival among people with head and neck cancer (HNC).

Methods

Data from the Head and Neck 5000 prospective clinical cohort study were used. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) pretreatment, at 4 and 12‐month follow‐up. Also, socio‐demographic, clinical, lifestyle, and mortality data were collected. The association between before start of treatment DS (HADS‐depression > 7) and course (never DS, recovered from DS, or persistent/recurrent/late DS at 12‐month follow‐up) and survival was investigated using Cox regression. Unadjusted and adjusted analyses were performed.

Results

In total, 384 of the 2144 persons (18%) reported pretreatment DS. Regarding DS course, 63% never had DS, 16% recovered, and 20% had persistent/recurrent/late DS. People with pretreatment DS had a higher risk of earlier death than people without DS (hazard ratio (HR) = 1.65; 95% confidence interval (CI) 1.33‐2.05), but this decreased after correcting for socio‐demographic, clinical, and lifestyle‐related factors (HR = 1.21; 95% CI 0.97‐1.52). Regarding the course of DS, people with persistent/recurrent/late DS had a higher risk of earlier death (HR = 2.04; 95% CI 1.36‐3.05), while people who recovered had a comparable risk (HR = 1.12; 95% CI 0.66‐1.90) as the reference group who never experienced DS. After correcting for socio‐demographic and clinical factors, people with persistent/recurrent/late DS still had a higher risk of earlier death (HR = 1.66; 95% CI 1.09‐2.53).

Conclusions

Pretreatment DS and persistent/recurrent/late DS were associated with worse survival among people with HNC.

     

Methodological considerations for disentangling a risk factor's influence on disease incidence versus postdiagnosis survival: The example of obesity and breast and colorectal cancer mortality in the Women's Health Initiative

Often, studies modeling an exposure's influence on time to disease‐specific death from study enrollment are incorrectly interpreted as if based on time to death from disease diagnosis. We studied 151,996 postmenopausal women without breast or colorectal cancer in the Women's Health Initiative with weight and height measured at enrollment (1993–1998). Using Cox regression models, we contrast hazard ratios (HR) from two time‐scales and corresponding study subpopulations: time to cancer death after enrollment among all women and time to cancer death after diagnosis among only cancer survivors. Median follow‐up from enrollment to diagnosis/censoring was 13 years for both breast (7,633 cases) and colorectal cancer (2,290 cases). Median follow‐up from diagnosis to death/censoring was 7 years for breast and 5 years for colorectal cancer. In analyses of time from enrollment to death, body mass index (BMI) ≥ 35 kg/m² versus 18.5–<25 kg/m² was associated with higher rates of cancer mortality: HR = 1.99; 95% CI: 1.54, 2.56 for breast cancer (p trend <0.001) and HR = 1.40; 95% CI: 1.04, 1.88 for colorectal cancer (p trend = 0.05). However, in analyses of time from diagnosis to cancer death, trends indicated no significant association (for BMI ≥ 35 kg/m², HR = 1.25; 95% CI: 0.94, 1.67 for breast [p trend = 0.33] and HR = 1.18; 95% CI: 0.84, 1.86 for colorectal cancer [p trend = 0.39]). We conclude that a risk factor that increases disease incidence will increase disease‐specific mortality. Yet, its influence on postdiagnosis survival can vary, and requires consideration of additional design and analysis issues such as selection bias. Quantitative tools allow joint modeling to compare an exposure's influence on time from enrollment to disease incidence and time from diagnosis to death.     

Effects of interruptions of external beam radiation therapy on outcomes in patients with prostate cancer

Introduction

To evaluate if interruptions of external beam radiation therapy impact outcomes in men with localized prostate cancer (PCa).

Methods

We included men with localized PCa treated with three‐dimensional conformal radiotherapy (3D‐CRT) or intensity‐modulated radiation therapy (IMRT) of escalated dose (≥74 Gy in 1.8 or 2 Gy fractions) between 1992 and 2013 at an NCI‐designated cancer centre. Men receiving androgen deprivation therapy were excluded. The non‐treatment day ratio (NTDR) was defined as the number of non‐treatment days divided by the total elapsed days of therapy. NTDR was analysed for each National Comprehensive Cancer Network (NCCN) risk group.

Results

There were 1728 men included (839 low‐risk, 776 intermediate‐risk and 113 high‐risk), with a median follow up of 53.5 months (range 12–185.8). The median NTDR was 31% (range 23–71%), translating to approximately 2 breaks (each break represents a missed treatment that will be made up) for 8 weeks of RT with 5 treatments per week. The 75 percentile of NTDR was 33%, translating to approximately 4 breaks, which was used as the cutoff for analysis. There were no significant differences in freedom from biochemical failure, freedom from distant metastasis, cancer specific survival, or overall survival for men with NTDR ≥33% compared to NTDR<33% for each risk group. Multivariable analyses including NTDR, age, race, Gleason score, T stage, and PSA were performed using the proportional hazards regression procedure. NTDR≥33% was not significantly associated with increased hazard ratio for outcomes in each risk group compared to NTDR<33%.

Conclusion

Unintentional treatment breaks during dose escalated external beam radiation therapy for PCa did not cause a significant difference in outcomes, although duration of follow up limits the strength of this conclusion.     

A population‐based study of follow‐up care for Hodgkin lymphoma survivors

BACKGROUND:

The majority of Hodgkin lymphoma (HL) patients are cured, and post‐treatment visits are a major component of their management. Little is known about the quality of follow‐up care received by these survivors.

METHODS:

All patients who were diagnosed with HL in Ontario from 1992 through 2000 were identified from a population‐based cancer registry. Individual‐level linkage with physician claims was used to examine the follow‐up care received by 2071 1‐year survivors for up to 15 years after their HL diagnosis. Physician visits, imaging studies, and the use of routine and HL‐specific cancer screening tests were evaluated.

RESULTS:

Most patients had visits with both a primary care provider and an oncologist in Years 2 through 5 after their HL diagnosis. In Year 5 after HL diagnosis, 31.8% of patients had at least 1 computed tomography (CT) scan, and 62.9% had a chest x‐ray. There were 5352 CT scans performed in Years 2 through 5, and 125 patients subsequently received chemotherapy within 6 months of a CT. Among the survivors who met age criteria for routine screening, 62.5% had no evidence of colorectal cancer screening during Years 2 through 15, 32.3% had no evidence of breast cancer screening, and 19.9% had no evidence of cervical cancer screening. Among young women potentially at high risk of breast cancer because of radiation therapy, 87.1% had not received the recommended breast cancer screening.

CONCLUSIONS:

Radiologic surveillance of HL survivors rarely led to salvage therapy. Despite frequent physician contact, many survivors did not receive established cancer screening interventions, and the recommended early initiation of breast cancer screening among young women at high risk was not widely used. Cancer 2010. © 2010 American Cancer Society.     

Fractures among long‐term survivors of childhood cancer

BACKGROUND:

Although reductions in bone mineral density are well documented among children during treatment for cancer and among childhood cancer survivors, little is known about the long‐term risk of fracture. The objective of this study was to ascertain the prevalence of and risk factors for fractures among individuals participating in the Childhood Cancer Survivor Study (CCSS).

METHODS:

Analyses included 7414 ≥5‐year survivors of childhood cancer diagnosed between 1970 and 1986 who completed the 2007 CCSS follow‐up questionnaire and a comparison group of 2374 siblings. Generalized linear models stratified by sex were used to compare the prevalence of reported fractures between survivors and siblings.

RESULTS:

The median ages at follow‐up among survivors and siblings were 36.2 years (range, 21.2‐58.8 years) and 38.1 years (range, 18.4‐62.6 years), respectively, with a median 22.7 years of follow‐up after cancer diagnosis for survivors. Approximately 35% of survivors and 39% of siblings reported ≥1 fracture during their lifetime. The prevalence of fractures was lower among survivors than among siblings, both in males (prevalence ratio, 0.87; 95% confidence interval, 0.81‐0.94; P < .001) and females (prevalence ratio, 0.94; 95% confidence interval, 0.86‐1.04; P = .22). In multivariable analyses, increasing age at follow‐up, white race, methotrexate treatment, and balance difficulties were associated with increased prevalence of fractures among female survivors (P = .015). Among males, only smoking history and white race were associated with an increased prevalence of fracture (P < .001).

CONCLUSIONS:

Findings from this study indicated that the prevalence of fractures among adult survivors did not increase compared with that of siblings. Additional studies of bone health among aging female cancer survivors may be warranted. Cancer 2012. © 2012 American Cancer Society.     

Metabolic factors and the risk of colorectal cancer in 580,000 men and women in the metabolic syndrome and cancer project (Me‐Can)

BACKGROUND:

The metabolic syndrome (MetS) has been related to an increased risk of colorectal cancer, but the modest size of previous studies precluded detailed characterization of the role of individual MetS factors and their interaction on risk.

METHODS:

In the Metabolic Syndrome and Cancer Project (Me‐Can), data on body mass index (BMI), blood pressure, and blood levels of glucose, cholesterol, and triglycerides were available for 578,700 men and women. The mean age of participants at baseline was 44 years, and the mean follow‐up was 12 years. Relative risks (RR) of colorectal cancer per 1 standard deviation increment in Z score of factors and for a combined MetS score, were calculated from Cox regression models, including adjustment for potential confounders.

RESULTS:

During follow‐up, 2834 men and 1861 women were diagnosed with colorectal cancer. The RR of colorectal cancer for the MetS score was 1.25 (95% confidence interval [CI], 1.18‐1.32) in men, and 1.14 (95% CI, 1.06‐1.22) in women. Significant associations also were observed in men for BMI (RR, 1.07; 95% CI, 1.02‐1.13), blood pressure (RR, 1.10; 95% CI, 1.02‐1.18), and triglycerides (RR, 1.17; 95% CI, 1.06‐1.28) and, in women, for BMI (RR, 1.08; 95% CI, 1.01‐1.15). There was no significant positive interaction between the metabolic factors on risk.

CONCLUSIONS:

The combination of metabolic factors and some separate factors was related to an increased risk of colorectal cancer, but there was no interaction between metabolic factors. Cancer 2011;. © 2010 American Cancer Society.     

A snapshot of smokers after lung and colorectal cancer diagnosis

BACKGROUND:

Continued smoking after a cancer diagnosis may adversely affect treatment effectiveness, subsequent cancer risk, and survival. The prevalence of continued smoking after cancer diagnosis is understudied.

METHODS:

In the multi‐regional Cancer Care Outcomes Research and Surveillance cohort (lung cancer [N = 2456], colorectal cancer [N = 3063]), the authors examined smoking rates at diagnosis and 5 months after diagnosis and also study factors associated with continued smoking.

RESULTS:

Overall, 90.2% of patients with lung cancer and 54.8% of patients with colorectal cancer reported ever smoking. At diagnosis, 38.7% of patients with lung cancer and 13.7% of patients with colorectal cancer were smoking; whereas, 5 months after diagnosis, 14.2% of patients with lung cancer and 9.0% of patients with colorectal cancer were smoking. Factors that were associated independently with continued smoking among patients with nonmetastatic lung cancer were coverage by Medicare, other public/unspecified insurance, not receiving chemotherapy, not undergoing surgery, prior cardiovascular disease, lower body mass index, lower emotional support, and higher daily ever‐smoking rates (all P < .05). Factors that were associated independently with continued smoking among patients with nonmetastatic colorectal cancer were male sex, high school education, being uninsured, not undergoing surgery, and higher daily ever‐smoking rates (all P < .05).

CONCLUSIONS:

After diagnosis, a substantial minority of patients with lung and colorectal cancers continued smoking. Patients with lung cancer had higher rates of smoking at diagnosis and after diagnosis; whereas patients with colorectal cancer were less likely to quit smoking after diagnosis. Factors that were associated with continued smoking differed between lung and colorectal cancer patients. Future smoking‐cessation efforts should examine differences by cancer type, particularly when comparing cancers for which smoking is a well established risk factor versus cancers for which it is not. Cancer 2012;118: 3153–64. © 2012 American Cancer Society.     

Systematic review and meta-analysis of the association between P53 codon 72 polymorphism and colorectal cancer

Background

A number of studies has evaluated the association between P53 codon 72 polymorphism and colorectal cancer. However, results were inconsistent. To clarify the role of this polymorphism in colorectal cancer, we conducted a meta-analysis on this topic.

Methods

Two authors independently searched the PubMed and EMBASE database from 1966 to January 2010 for studies regarding the association of P53 codon 72 polymorphism with colorectal cancer. Summary odds ratios with their corresponding 95% confidence intervals were calculated by using random-effects model.

Results

The combined results showed that P53 codon 72 variant genotypes were not associated with colorectal cancer risk when compared to Arg/Arg genotype (Pro/Pro: OR = 1.02, 95% CI = 0.80–1.29; Arg/Pro: OR = 1.00, 95% CI = 0.86–1.16; Pro allele: OR = 1.00, 95% CI = 0.86–1.17). When stratifying for study population, design and cancer location, no statistically significant results were observed either.

Conclusion

Our data indicate that the P53 codon 72 polymorphism may be not associated with colorectal cancer risk.     

Body mass index and risk of colorectal cancer in Chinese Singaporeans: the Singapore Chinese Health Study

BACKGROUND:

The authors chose to examine the association between body mass index (BMI) and incident colorectal cancer across the spectrum of BMI, including underweight persons, because detailed prospective cohort data on this topic in Asians is scarce, as is data on underweight persons (BMI, <18.5 kg/m²) in any population.

METHODS:

Analysis of the Singapore Chinese Health Study included 51,251 men and women aged 45‐74 years enrolled in 1993‐1998 and followed through 2007. Incident cancer cases and deaths among cohort members were identified through record linkage, and 980 cases were identified. Cox regression models were used to investigate the association of baseline BMI with risk of incident colorectal cancer during a mean of 11.5 years of follow‐up.

RESULTS:

A significant, U‐shaped, quadratic association was observed between BMI and colon cancer risk, with increased risk in BMIs ≥27.5 and <18.5 kg/m². The association was more pronounced in never smokers and most prominent when further limiting the sample to those free of diabetes and cases with longer than 5 years of follow‐up. Localized cases had a more pronounced association in BMIs ≥27.5, whereas advanced cases had a more pronounced association in BMIs <18.5 kg/m². No association was found in relation to rectal cancer risk. The association was also stronger among patients aged 65 years and older.

CONCLUSIONS:

BMI displays a U‐shaped, quadratic association with colon cancer risk in this Chinese population in Southeast Asia. Cancer 2011;. © 2011 American Cancer Society.     

Influence of health insurance coverage on breast,cervical, and colorectal cancer screening in rural primary care settings

BACKGROUND:

The current study was performed to determine, in rural settings, the relation between the type and status of insurance coverage and being up‐to‐date for breast, cervical, and colorectal cancer screening.

METHODS:

Four primary care practices in 2 rural Oregon communities participated. Medical chart reviews that were conducted between October 2008 and August 2009 assessed insurance coverage and up‐to‐date status for breast, cervical, and colorectal cancer screening. Inclusion criteria involved having at least 1 health care visit within the past 5 years and being aged ≥ 55 years.

RESULTS:

The majority of patients were women aged 55 years to 70 years, employed or retired, and who had private health insurance and an average of 2.5 comorbid conditions. The overall percentage of eligible women who were up‐to‐date for cervical cancer screening was 30%; approximately 27% of women were up‐to‐date for clinical breast examination, 37% were up‐to‐date for mammography, and 19% were up‐to‐date for both mammography and clinical breast examination. Approximately 38% of men and 35% of women were up‐to‐date for colorectal cancer screening using any test at appropriate screening intervals. In general, having any insurance versus being uninsured was associated with undergoing cancer screening. For each type of screening, patients who had at least 1 health maintenance visit were significantly more likely to be up‐to‐date compared with those with no health maintenance visits. A significant interaction was found between having health maintenance visits, having any health insurance, and being up‐to‐date for cancer screening tests.

CONCLUSIONS:

Overall, the percentage of patients who were up‐to‐date for any cancer screening, especially cervical cancer screening, was found to be very low in rural Oregon. Patients with some form of health insurance were more likely to have had a health maintenance visit within the previous 2 years and to be up‐to‐date for breast, cervical, and/or colorectal cancer screening. Cancer 2012. © 2012 American Cancer Society.     

Late dysphagia after radiotherapy‐based treatment of head and neck cancer

BACKGROUND:

Changing trends in head and neck cancer (HNC) merit an understanding of the late effects of therapy, but few studies examine dysphagia beyond 2 years of treatment.

METHODS:

A case series was examined to describe the pathophysiology and outcomes in dysphagic HNC survivors referred for modified barium swallow (MBS) studies ≥5 years after definitive radiotherapy or chemoradiotherapy (January 2001 through May 2011). Functional measures included the penetration‐aspiration scale (PAS), performance status scale–head and neck (PSS‐HN), National Institutes of Health Swallowing Safety Scale (NIH‐SSS), and MBS impairment profile (MBSImp).

RESULTS:

Twenty‐nine patients previously treated with radiotherapy (38%) or chemoradiotherapy (62%) were included (median years posttreatment, 9; range, 5‐19). The majority (86%) had oropharyngeal cancer; 52% were never‐smokers. Seventy‐five percent had T2 or T3 tumors; 52% were N+. The median age at diagnosis was 55 (range, 38‐72). Abnormal late examination findings included: dysarthria/dysphonia (76%), cranial neuropathy (48%), trismus (38%), and radionecrosis (10%). MBS studies confirmed pharyngeal residue and aspiration in all dysphagic cases owing to physiologic impairment (median PAS, 8; median NIH‐SSS, 10; median MBSImp, 18), whereas stricture was confirmed endoscopically in 7 (24%). Twenty‐five (86%) developed pneumonia, half requiring hospitalization. Swallow postures/strategies helped 69% of cases, but no patient achieved durable improvement across functional measures at last follow‐up. Ultimately, 19 (66%) were gastrostomy‐dependent.

CONCLUSIONS:

Although functional organ preservation is commonly achieved, severe dysphagia represents a challenging late effect that may develop or progress years after radiation‐based therapy for HNC. These data suggest that novel approaches are needed to minimize and better address this complication that is commonly refractory to many standard dysphagia therapies. Cancer 2012. © 2012 American Cancer Society.     

Acceptability and satisfaction of project MOVE: A pragmatic feasibility trial aimed at increasing physical activity in female breast cancer survivors

Objective

Despite the physical and psychological health benefits associated with physical activity (PA) for breast cancer (BC) survivors, up to 70% of female BC survivors are not meeting minimum recommended PA guidelines. The objective of this study was to evaluate acceptability and satisfaction with Project MOVE, an innovative approach to increase PA among BC survivors through the combination of microgrants and financial incentives.

Methods

A mixed‐methods design was used. Participants were BC survivors and support individuals with a mean age of 58.5 years. At 6‐month follow‐up, participants completed a program evaluation questionnaire (n = 72) and participated in focus groups (n = 52) to explore their experience with Project MOVE.

Results

Participants reported that they were satisfied with Project MOVE (86.6%) and that the program was appropriate for BC survivors (96.3%). Four main themes emerged from focus groups: (1) acceptability and satisfaction of Project MOVE, detailing the value of the model in developing tailored group‐base PA programs; (2) the importance of Project MOVE leaders, highlighting the value of a leader that was organized and a good communicator; (3) breaking down barriers with Project MOVE, describing how the program helped to address common BC related barriers; and (4) motivation to MOVE, outlining how the microgrants enabled survivors to be active, while the financial incentive motivated them to increase and maintain their PA.

Conclusion

The findings provide support for the acceptability of Project MOVE as a strategy for increasing PA among BC survivors.