Patient & Survivor Care

WASHINGTON – A substantial proportion of cancer patients say they want more information than they are getting about the costs of their care, investigators report.

Of 176 patients currently receiving treatment for cancer, 40.8% said they wanted more information than they were given on the cost of their treatment to society, and 48.7% said they weren’t given enough information about the costs to themselves, said Ashley Varner, manager for psycho-social oncology at the DeCesaris Cancer Institute, Anne Arundel Medical Center in Annapolis, Md.

“It’s very important for clinicians to be thinking that patients may want to know the costs of care, and that patients deserve to have that knowledge as part of the shared decision-making process,” she said in an interview.

It’s no secret that the costs of cancer care are high and climbing ever higher, with annual U.S. expenditures on cancer expected to reach $158 billion by 2020. The strains on budgets are felt by providers and patients alike, with 42%-50% of cancer patients reporting high financial distress, Ms. Varner and colleagues reported in a poster presentation at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To see which factors predicted patients’ desires for information about the costs of their care, the investigators surveyed a convenience sample of 176 patients from the ages of 28 through 87 years (median age 63) who were currently undergoing cancer treatment at a community medical center.

What’s it to you?

The patients were asked with structured questionnaires about their preferences for information and degree of control over medical decisions, and about the information they received from their oncologists, including about the costs of their care. The patients were also asked to estimate their monthly out-of-pocket treatment costs and were screened for psychological distress with the four-item Patient Health Questionnaire on anxiety and depression.

A majority of patients reported that their preferences were met with regard to the information they received about diagnosis (77%), treatment side effects (71.6%), and treatment effectiveness (75%). Similarly, most patients felt they were adequately informed about the chance of cure (65.6%) and life expectancy (56.3%).

But when it came to costs, just over half (52.2%) said they had been given sufficient information about the costs of their care to society, and less than half (47.4%) reported satisfaction with the information they got about the cost of care to them.

People with partners were significantly more likely to want more information about costs than singles, and younger people were significantly more likely to ask to know more than older people (P less than .05 for both comparisons).

“A nuanced assessment of each patient’s psychosocial characteristics, including control preferences and psychological and financial distress is warranted in order to anticipate and meet specific information preferences,” the investigators said.

Asked how clinicians can pluck financial information from the morass of health plan data, Ms. Varner explained that at her center, when a treatment has been decided on – whether chemotherapy, radiation, surgery, targeted agents, or a combination – financial coordinators contact each patient’s insurance company and develop written estimates which they offer to share with the patient at his or her discretion.

“That allows us then to put into place drug replacement programs or other types of assistance. For example, we know that patients who have Medicare only with no supplemental plan are at very high financial risk – they’re going to owe 20% of the cost of care, which is substantial. But there are often some resources that we can tap into if we know that ahead of time,” Ms. Varner said. 


WASHINGTON – A substantial proportion of cancer patients say they want more information than they are getting about the costs of their care, investigators report.

Of 176 patients currently receiving treatment for cancer, 40.8% said they wanted more information than they were given on the cost of their treatment to society, and 48.7% said they weren’t given enough information about the costs to themselves, said Ashley Varner, manager for psycho-social oncology at the DeCesaris Cancer Institute, Anne Arundel Medical Center in Annapolis, Md.

“It’s very important for clinicians to be thinking that patients may want to know the costs of care, and that patients deserve to have that knowledge as part of the shared decision-making process,” she said in an interview.

It’s no secret that the costs of cancer care are high and climbing ever higher, with annual U.S. expenditures on cancer expected to reach $158 billion by 2020. The strains on budgets are felt by providers and patients alike, with 42%-50% of cancer patients reporting high financial distress, Ms. Varner and colleagues reported in a poster presentation at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To see which factors predicted patients’ desires for information about the costs of their care, the investigators surveyed a convenience sample of 176 patients from the ages of 28 through 87 years (median age 63) who were currently undergoing cancer treatment at a community medical center.

What’s it to you?

The patients were asked with structured questionnaires about their preferences for information and degree of control over medical decisions, and about the information they received from their oncologists, including about the costs of their care. The patients were also asked to estimate their monthly out-of-pocket treatment costs and were screened for psychological distress with the four-item Patient Health Questionnaire on anxiety and depression.

A majority of patients reported that their preferences were met with regard to the information they received about diagnosis (77%), treatment side effects (71.6%), and treatment effectiveness (75%). Similarly, most patients felt they were adequately informed about the chance of cure (65.6%) and life expectancy (56.3%).

But when it came to costs, just over half (52.2%) said they had been given sufficient information about the costs of their care to society, and less than half (47.4%) reported satisfaction with the information they got about the cost of care to them.

People with partners were significantly more likely to want more information about costs than singles, and younger people were significantly more likely to ask to know more than older people (P less than .05 for both comparisons).

“A nuanced assessment of each patient’s psychosocial characteristics, including control preferences and psychological and financial distress is warranted in order to anticipate and meet specific information preferences,” the investigators said.

Asked how clinicians can pluck financial information from the morass of health plan data, Ms. Varner explained that at her center, when a treatment has been decided on – whether chemotherapy, radiation, surgery, targeted agents, or a combination – financial coordinators contact each patient’s insurance company and develop written estimates which they offer to share with the patient at his or her discretion.

“That allows us then to put into place drug replacement programs or other types of assistance. For example, we know that patients who have Medicare only with no supplemental plan are at very high financial risk – they’re going to owe 20% of the cost of care, which is substantial. But there are often some resources that we can tap into if we know that ahead of time,” Ms. Varner said. 


WASHINGTON – A substantial proportion of cancer patients say they want more information than they are getting about the costs of their care, investigators report.

Of 176 patients currently receiving treatment for cancer, 40.8% said they wanted more information than they were given on the cost of their treatment to society, and 48.7% said they weren’t given enough information about the costs to themselves, said Ashley Varner, manager for psycho-social oncology at the DeCesaris Cancer Institute, Anne Arundel Medical Center in Annapolis, Md.

“It’s very important for clinicians to be thinking that patients may want to know the costs of care, and that patients deserve to have that knowledge as part of the shared decision-making process,” she said in an interview.

It’s no secret that the costs of cancer care are high and climbing ever higher, with annual U.S. expenditures on cancer expected to reach $158 billion by 2020. The strains on budgets are felt by providers and patients alike, with 42%-50% of cancer patients reporting high financial distress, Ms. Varner and colleagues reported in a poster presentation at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To see which factors predicted patients’ desires for information about the costs of their care, the investigators surveyed a convenience sample of 176 patients from the ages of 28 through 87 years (median age 63) who were currently undergoing cancer treatment at a community medical center.

What’s it to you?

The patients were asked with structured questionnaires about their preferences for information and degree of control over medical decisions, and about the information they received from their oncologists, including about the costs of their care. The patients were also asked to estimate their monthly out-of-pocket treatment costs and were screened for psychological distress with the four-item Patient Health Questionnaire on anxiety and depression.

A majority of patients reported that their preferences were met with regard to the information they received about diagnosis (77%), treatment side effects (71.6%), and treatment effectiveness (75%). Similarly, most patients felt they were adequately informed about the chance of cure (65.6%) and life expectancy (56.3%).

But when it came to costs, just over half (52.2%) said they had been given sufficient information about the costs of their care to society, and less than half (47.4%) reported satisfaction with the information they got about the cost of care to them.

People with partners were significantly more likely to want more information about costs than singles, and younger people were significantly more likely to ask to know more than older people (P less than .05 for both comparisons).

“A nuanced assessment of each patient’s psychosocial characteristics, including control preferences and psychological and financial distress is warranted in order to anticipate and meet specific information preferences,” the investigators said.

Asked how clinicians can pluck financial information from the morass of health plan data, Ms. Varner explained that at her center, when a treatment has been decided on – whether chemotherapy, radiation, surgery, targeted agents, or a combination – financial coordinators contact each patient’s insurance company and develop written estimates which they offer to share with the patient at his or her discretion.

“That allows us then to put into place drug replacement programs or other types of assistance. For example, we know that patients who have Medicare only with no supplemental plan are at very high financial risk – they’re going to owe 20% of the cost of care, which is substantial. But there are often some resources that we can tap into if we know that ahead of time,” Ms. Varner said. 


WASHINGTON – Patients with cancer who have good coping skills – the ability to roll with the punches – are more likely to want an active role in treatment decisions, investigators say.

Among adults who were currently undergoing chemotherapy for a variety of cancers, those with a more active coping style, greater psychological resilience, and greater “openness to experience” were more likely to be active participants in the clinical decision-making process, reported Alexis Colley, a third-year medical student at the University of California Berkeley and UC San Francisco joint medical program.

Demographic factors also appear to play a role in patient participation.

“There has been quite a bit of research which shows that certain factors like younger age, higher education, and higher income tend to be associated with people who want to participate actively,” Ms. Colley said in an interview at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To explore the role of psychological factors in patients’ decision-making choices, the investigators enrolled 868 adults, mean age 57, with breast, lung, gastrointestinal, or gynecologic cancers, who had received chemotherapy within the last 4 weeks and were scheduled for at least two additional cycles.

The patients were asked to report their decision-making roles and psychological factors on several validated instruments. These included evaluations of:

• The patient’s self-reported and actual decision-making roles with the Control Preferences Scale.

• Coping ability with the Brief COPE Scale.

• Resilience with the Connor–Davidson Resilience Scale.

• Personality with the Neuroticism-Extraversion-Openness Five-Factor Inventory.

In multivariate analysis, factors significantly associated with more active decision-making included the demographic factors of younger age (P less than .001) and more years of education (P = .011), and the psychological variables of active coping style (P less than .001), greater use of emotional support in coping (P = .002), openness to experience (P = .014), and higher levels of neuroticism (P less than .030).

In contrast, people with more comorbidities were less prone to be active decision makers (P = .028), as were those who experienced more evening fatigue (P less than .001).

“This relationship between decision-making role and number of comorbid conditions may indicate that serious illness affects patient involvement in the decision-making process because of a need for increased support and guidance as illness progresses,” the authors write in a poster presentation.

There was a high degree of concordance (89.5%) between patients’ preferred and actual decision-making roles, the authors found. They noted that “patients with more active roles and preferred roles that match their actual role have better health outcomes and are more satisfied.”

The study points to the need for further study of the role that psychological factors can play in patient decision making, Ms. Colley said.

“The question arises as to how one’s coping style might be a strong influence on the way they want to participate in decision making, and perhaps as clinicians we can support or teach various coping styles that might help people achieve the role they want and/or achieve a more active role which might then lead to better outcomes, “ she said.

WASHINGTON – Patients with cancer who have good coping skills – the ability to roll with the punches – are more likely to want an active role in treatment decisions, investigators say.

Among adults who were currently undergoing chemotherapy for a variety of cancers, those with a more active coping style, greater psychological resilience, and greater “openness to experience” were more likely to be active participants in the clinical decision-making process, reported Alexis Colley, a third-year medical student at the University of California Berkeley and UC San Francisco joint medical program.

Demographic factors also appear to play a role in patient participation.

“There has been quite a bit of research which shows that certain factors like younger age, higher education, and higher income tend to be associated with people who want to participate actively,” Ms. Colley said in an interview at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To explore the role of psychological factors in patients’ decision-making choices, the investigators enrolled 868 adults, mean age 57, with breast, lung, gastrointestinal, or gynecologic cancers, who had received chemotherapy within the last 4 weeks and were scheduled for at least two additional cycles.

The patients were asked to report their decision-making roles and psychological factors on several validated instruments. These included evaluations of:

• The patient’s self-reported and actual decision-making roles with the Control Preferences Scale.

• Coping ability with the Brief COPE Scale.

• Resilience with the Connor–Davidson Resilience Scale.

• Personality with the Neuroticism-Extraversion-Openness Five-Factor Inventory.

In multivariate analysis, factors significantly associated with more active decision-making included the demographic factors of younger age (P less than .001) and more years of education (P = .011), and the psychological variables of active coping style (P less than .001), greater use of emotional support in coping (P = .002), openness to experience (P = .014), and higher levels of neuroticism (P less than .030).

In contrast, people with more comorbidities were less prone to be active decision makers (P = .028), as were those who experienced more evening fatigue (P less than .001).

“This relationship between decision-making role and number of comorbid conditions may indicate that serious illness affects patient involvement in the decision-making process because of a need for increased support and guidance as illness progresses,” the authors write in a poster presentation.

There was a high degree of concordance (89.5%) between patients’ preferred and actual decision-making roles, the authors found. They noted that “patients with more active roles and preferred roles that match their actual role have better health outcomes and are more satisfied.”

The study points to the need for further study of the role that psychological factors can play in patient decision making, Ms. Colley said.

“The question arises as to how one’s coping style might be a strong influence on the way they want to participate in decision making, and perhaps as clinicians we can support or teach various coping styles that might help people achieve the role they want and/or achieve a more active role which might then lead to better outcomes, “ she said.

WASHINGTON – Patients with cancer who have good coping skills – the ability to roll with the punches – are more likely to want an active role in treatment decisions, investigators say.

Among adults who were currently undergoing chemotherapy for a variety of cancers, those with a more active coping style, greater psychological resilience, and greater “openness to experience” were more likely to be active participants in the clinical decision-making process, reported Alexis Colley, a third-year medical student at the University of California Berkeley and UC San Francisco joint medical program.

Demographic factors also appear to play a role in patient participation.

“There has been quite a bit of research which shows that certain factors like younger age, higher education, and higher income tend to be associated with people who want to participate actively,” Ms. Colley said in an interview at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To explore the role of psychological factors in patients’ decision-making choices, the investigators enrolled 868 adults, mean age 57, with breast, lung, gastrointestinal, or gynecologic cancers, who had received chemotherapy within the last 4 weeks and were scheduled for at least two additional cycles.

The patients were asked to report their decision-making roles and psychological factors on several validated instruments. These included evaluations of:

• The patient’s self-reported and actual decision-making roles with the Control Preferences Scale.

• Coping ability with the Brief COPE Scale.

• Resilience with the Connor–Davidson Resilience Scale.

• Personality with the Neuroticism-Extraversion-Openness Five-Factor Inventory.

In multivariate analysis, factors significantly associated with more active decision-making included the demographic factors of younger age (P less than .001) and more years of education (P = .011), and the psychological variables of active coping style (P less than .001), greater use of emotional support in coping (P = .002), openness to experience (P = .014), and higher levels of neuroticism (P less than .030).

In contrast, people with more comorbidities were less prone to be active decision makers (P = .028), as were those who experienced more evening fatigue (P less than .001).

“This relationship between decision-making role and number of comorbid conditions may indicate that serious illness affects patient involvement in the decision-making process because of a need for increased support and guidance as illness progresses,” the authors write in a poster presentation.

There was a high degree of concordance (89.5%) between patients’ preferred and actual decision-making roles, the authors found. They noted that “patients with more active roles and preferred roles that match their actual role have better health outcomes and are more satisfied.”

The study points to the need for further study of the role that psychological factors can play in patient decision making, Ms. Colley said.

“The question arises as to how one’s coping style might be a strong influence on the way they want to participate in decision making, and perhaps as clinicians we can support or teach various coping styles that might help people achieve the role they want and/or achieve a more active role which might then lead to better outcomes, “ she said.

Febuxostat achieved significantly better serum uric acid control, compared with allopurinol, important for the prevention of tumor lysis syndrome (TLS), reported Dr. Michele Spina and coauthors from the division of medical oncology at the National Cancer Institute in Aviano, Italy.

Serum uric acid control is of key relevance in tumor lysis syndrome prevention as it correlates with both tumor lysis syndrome (TLS) and renal events risk, the investigators said.

In a randomized trial of 346 patients with hematologic malignancies and intermediate to high TLS risk, patients were given either a fixed dose of 120 mg of febuxostat or a dose of allopurinol at either 200, 300, or 600 mg. Febuxostat performed significantly better than allopurinol in reducing serum uric acid (P less than .0001). Both drugs achieved similar renal function preservation (P = .0903) and drug-related adverse events were reported in 6.4% of patients in both treatment arms.

The study is the “largest adult trial performed in TLS prevention,” Dr. Spina and her colleagues said in the paper. “Febuxostat achieved a significant superior serum uric acid control with one fixed dose in comparison to allopurinol with comparable renal function preservation and safety profile,” they concluded.

Read the full report in Annals of Oncology here.

Febuxostat achieved significantly better serum uric acid control, compared with allopurinol, important for the prevention of tumor lysis syndrome (TLS), reported Dr. Michele Spina and coauthors from the division of medical oncology at the National Cancer Institute in Aviano, Italy.

Serum uric acid control is of key relevance in tumor lysis syndrome prevention as it correlates with both tumor lysis syndrome (TLS) and renal events risk, the investigators said.

In a randomized trial of 346 patients with hematologic malignancies and intermediate to high TLS risk, patients were given either a fixed dose of 120 mg of febuxostat or a dose of allopurinol at either 200, 300, or 600 mg. Febuxostat performed significantly better than allopurinol in reducing serum uric acid (P less than .0001). Both drugs achieved similar renal function preservation (P = .0903) and drug-related adverse events were reported in 6.4% of patients in both treatment arms.

The study is the “largest adult trial performed in TLS prevention,” Dr. Spina and her colleagues said in the paper. “Febuxostat achieved a significant superior serum uric acid control with one fixed dose in comparison to allopurinol with comparable renal function preservation and safety profile,” they concluded.

Read the full report in Annals of Oncology here.

Febuxostat achieved significantly better serum uric acid control, compared with allopurinol, important for the prevention of tumor lysis syndrome (TLS), reported Dr. Michele Spina and coauthors from the division of medical oncology at the National Cancer Institute in Aviano, Italy.

Serum uric acid control is of key relevance in tumor lysis syndrome prevention as it correlates with both tumor lysis syndrome (TLS) and renal events risk, the investigators said.

In a randomized trial of 346 patients with hematologic malignancies and intermediate to high TLS risk, patients were given either a fixed dose of 120 mg of febuxostat or a dose of allopurinol at either 200, 300, or 600 mg. Febuxostat performed significantly better than allopurinol in reducing serum uric acid (P less than .0001). Both drugs achieved similar renal function preservation (P = .0903) and drug-related adverse events were reported in 6.4% of patients in both treatment arms.

The study is the “largest adult trial performed in TLS prevention,” Dr. Spina and her colleagues said in the paper. “Febuxostat achieved a significant superior serum uric acid control with one fixed dose in comparison to allopurinol with comparable renal function preservation and safety profile,” they concluded.

Read the full report in Annals of Oncology here.

The increased risk of malignancy following childhood cancer persists past the age of 40 years, according to an analysis of 3,171 members of the Childhood Cancer Survivor Study published online Aug. 10 in the Journal of Clinical Oncology.

Survivors “have a substantial risk of a new malignancy in the fifth and sixth decades of life in excess of what is expected among the general U.S. population ... Being free of SN [subsequent neoplasms] before age 40 years does not preclude survivors from having an increased risk of future [neoplasms] ... These data suggest the need for life-long monitoring and should inform anticipatory guidance provided to survivors of childhood cancer,” said the investigators, led by Dr. Lucie Turcotte, a pediatric oncologist at the University of Minnesota, Minneapolis (J Clin Oncol. 2015 Aug 10. doi: 10.1200/JCO.2015.60.9487).

The Childhood Cancer Survivor Study (CCSS) is an ongoing project to gauge the late effects of childhood cancers. Previous reports found an increased risk of malignancy in early adulthood.

The 3,171 patients in the latest analysis were diagnosed from the period of 1970-1986, and had completed at least one follow-up questionnaire after age 40.

Among them, there were 679 subsequent neoplasms (SNs) over the age of 40, including 196 subsequent malignant neoplasms (SMNs) in 180 people, as well as 419 nonmelanoma skin cancers, 21 nonmalignant meningiomas, and 43 other benign neoplasms.

At age 55 years, the cumulative incidence after the age of 40 of new SNs was 34.6% and new SMNs 16.3%.

Survivors were twice as likely as was the general population to be diagnosed with an SMN after age 40 (standardized incidence ratio [SIR] 2.2; 95% CI 1.9-2.5). Among SMNs, risk was increased for breast cancer (SIR 5.5; 95% CI 4.5-6.7), renal cancer (SIR 3.9; 95% CI 2.0-7.5), soft tissue sarcoma (SIR 2.6; 95% CI 1.5- 4.4), and thyroid cancer (SIR 1.9; 95% CI 1.0-3.5).

On multivariate analysis, female sex (relative risk [RR] 1.9; 95% CI 1.3-2.6), platinum chemotherapy (RR 2.3; CI 1.0-5.2), and therapeutic radiation exposure (RR 2.2; 95% CI 1.4-3.3) increased the risk of SMN.

“Therapeutic radiation exposure continues to place survivors at increased risk for SMNs ... well into their fifth and sixth decades of life, indicating a need for ongoing monitoring of this at-risk subgroup,” the authors said.

Females and Hodgkin lymphoma survivors were at increased risk for breast cancer, driven by high-dose, chest-directed radiation as children, which was previously a central component of treatment.

Routine mammography is typically started around age 40-50, but “the risks experienced by the survivor population are unique,” and may warrant greater vigilance. “Survivors without an SN before age 40 may be particularly vulnerable because they have not had previous neoplasms that may have altered screening practices,” the investigators said.

They did not find an excess risk for subsequent head, neck, lung, colon, or female genital tract malignancies. “This contrasts with observations in previous CCSS publications showing an increased risk for these malignancies among [younger adult] survivors ... It is possible that the period of highest risk for these malignancies among survivors occurs before age 40 years and that, as the incidence of these cancers increases with age in the general population, the risk beyond what is experienced by the general population is diminished,” they said.

Male survivors aged older than 40 years who were not irradiated as children did not have an increased risk of SMNs, regardless of their SN history before age 40.

The work was funded in part by the National Institutes of Health and the Children’s Cancer Research Fund. Dr. Turcotte has no disclosures.

[email protected]

The increased risk of malignancy following childhood cancer persists past the age of 40 years, according to an analysis of 3,171 members of the Childhood Cancer Survivor Study published online Aug. 10 in the Journal of Clinical Oncology.

Survivors “have a substantial risk of a new malignancy in the fifth and sixth decades of life in excess of what is expected among the general U.S. population ... Being free of SN [subsequent neoplasms] before age 40 years does not preclude survivors from having an increased risk of future [neoplasms] ... These data suggest the need for life-long monitoring and should inform anticipatory guidance provided to survivors of childhood cancer,” said the investigators, led by Dr. Lucie Turcotte, a pediatric oncologist at the University of Minnesota, Minneapolis (J Clin Oncol. 2015 Aug 10. doi: 10.1200/JCO.2015.60.9487).

The Childhood Cancer Survivor Study (CCSS) is an ongoing project to gauge the late effects of childhood cancers. Previous reports found an increased risk of malignancy in early adulthood.

The 3,171 patients in the latest analysis were diagnosed from the period of 1970-1986, and had completed at least one follow-up questionnaire after age 40.

Among them, there were 679 subsequent neoplasms (SNs) over the age of 40, including 196 subsequent malignant neoplasms (SMNs) in 180 people, as well as 419 nonmelanoma skin cancers, 21 nonmalignant meningiomas, and 43 other benign neoplasms.

At age 55 years, the cumulative incidence after the age of 40 of new SNs was 34.6% and new SMNs 16.3%.

Survivors were twice as likely as was the general population to be diagnosed with an SMN after age 40 (standardized incidence ratio [SIR] 2.2; 95% CI 1.9-2.5). Among SMNs, risk was increased for breast cancer (SIR 5.5; 95% CI 4.5-6.7), renal cancer (SIR 3.9; 95% CI 2.0-7.5), soft tissue sarcoma (SIR 2.6; 95% CI 1.5- 4.4), and thyroid cancer (SIR 1.9; 95% CI 1.0-3.5).

On multivariate analysis, female sex (relative risk [RR] 1.9; 95% CI 1.3-2.6), platinum chemotherapy (RR 2.3; CI 1.0-5.2), and therapeutic radiation exposure (RR 2.2; 95% CI 1.4-3.3) increased the risk of SMN.

“Therapeutic radiation exposure continues to place survivors at increased risk for SMNs ... well into their fifth and sixth decades of life, indicating a need for ongoing monitoring of this at-risk subgroup,” the authors said.

Females and Hodgkin lymphoma survivors were at increased risk for breast cancer, driven by high-dose, chest-directed radiation as children, which was previously a central component of treatment.

Routine mammography is typically started around age 40-50, but “the risks experienced by the survivor population are unique,” and may warrant greater vigilance. “Survivors without an SN before age 40 may be particularly vulnerable because they have not had previous neoplasms that may have altered screening practices,” the investigators said.

They did not find an excess risk for subsequent head, neck, lung, colon, or female genital tract malignancies. “This contrasts with observations in previous CCSS publications showing an increased risk for these malignancies among [younger adult] survivors ... It is possible that the period of highest risk for these malignancies among survivors occurs before age 40 years and that, as the incidence of these cancers increases with age in the general population, the risk beyond what is experienced by the general population is diminished,” they said.

Male survivors aged older than 40 years who were not irradiated as children did not have an increased risk of SMNs, regardless of their SN history before age 40.

The work was funded in part by the National Institutes of Health and the Children’s Cancer Research Fund. Dr. Turcotte has no disclosures.

[email protected]

The increased risk of malignancy following childhood cancer persists past the age of 40 years, according to an analysis of 3,171 members of the Childhood Cancer Survivor Study published online Aug. 10 in the Journal of Clinical Oncology.

Survivors “have a substantial risk of a new malignancy in the fifth and sixth decades of life in excess of what is expected among the general U.S. population ... Being free of SN [subsequent neoplasms] before age 40 years does not preclude survivors from having an increased risk of future [neoplasms] ... These data suggest the need for life-long monitoring and should inform anticipatory guidance provided to survivors of childhood cancer,” said the investigators, led by Dr. Lucie Turcotte, a pediatric oncologist at the University of Minnesota, Minneapolis (J Clin Oncol. 2015 Aug 10. doi: 10.1200/JCO.2015.60.9487).

The Childhood Cancer Survivor Study (CCSS) is an ongoing project to gauge the late effects of childhood cancers. Previous reports found an increased risk of malignancy in early adulthood.

The 3,171 patients in the latest analysis were diagnosed from the period of 1970-1986, and had completed at least one follow-up questionnaire after age 40.

Among them, there were 679 subsequent neoplasms (SNs) over the age of 40, including 196 subsequent malignant neoplasms (SMNs) in 180 people, as well as 419 nonmelanoma skin cancers, 21 nonmalignant meningiomas, and 43 other benign neoplasms.

At age 55 years, the cumulative incidence after the age of 40 of new SNs was 34.6% and new SMNs 16.3%.

Survivors were twice as likely as was the general population to be diagnosed with an SMN after age 40 (standardized incidence ratio [SIR] 2.2; 95% CI 1.9-2.5). Among SMNs, risk was increased for breast cancer (SIR 5.5; 95% CI 4.5-6.7), renal cancer (SIR 3.9; 95% CI 2.0-7.5), soft tissue sarcoma (SIR 2.6; 95% CI 1.5- 4.4), and thyroid cancer (SIR 1.9; 95% CI 1.0-3.5).

On multivariate analysis, female sex (relative risk [RR] 1.9; 95% CI 1.3-2.6), platinum chemotherapy (RR 2.3; CI 1.0-5.2), and therapeutic radiation exposure (RR 2.2; 95% CI 1.4-3.3) increased the risk of SMN.

“Therapeutic radiation exposure continues to place survivors at increased risk for SMNs ... well into their fifth and sixth decades of life, indicating a need for ongoing monitoring of this at-risk subgroup,” the authors said.

Females and Hodgkin lymphoma survivors were at increased risk for breast cancer, driven by high-dose, chest-directed radiation as children, which was previously a central component of treatment.

Routine mammography is typically started around age 40-50, but “the risks experienced by the survivor population are unique,” and may warrant greater vigilance. “Survivors without an SN before age 40 may be particularly vulnerable because they have not had previous neoplasms that may have altered screening practices,” the investigators said.

They did not find an excess risk for subsequent head, neck, lung, colon, or female genital tract malignancies. “This contrasts with observations in previous CCSS publications showing an increased risk for these malignancies among [younger adult] survivors ... It is possible that the period of highest risk for these malignancies among survivors occurs before age 40 years and that, as the incidence of these cancers increases with age in the general population, the risk beyond what is experienced by the general population is diminished,” they said.

Male survivors aged older than 40 years who were not irradiated as children did not have an increased risk of SMNs, regardless of their SN history before age 40.

The work was funded in part by the National Institutes of Health and the Children’s Cancer Research Fund. Dr. Turcotte has no disclosures.

[email protected]

Childhood cancer survivors are at an increased risk for developing an intestinal obstruction requiring surgery (IOS) 5 or more years after the initial cancer diagnosis, according to a study based on data from the Childhood Cancer Survivor Study.

The risk was greater among those who had a pelvic or abdominal tumor and had been exposed to pelvic or abdominal radiotherapy, reported the authors, who pointed out that no study has “rigorously” investigated the incidence of intestinal obstruction in childhood cancer survivors. The study appeared online in the Journal of Clinical Oncology (2015 Aug 10 doi: 10.1200/JCO.2015.61.5070).

The subjects in the study had been diagnosed with cancer before age 21 years between 1970 and 1986 and were followed longitudinally in the CCSS. The sample included 12,316 childhood cancer survivors who had survived at least 5 years from the time they were diagnosed with cancer and 4,023 of their siblings.

The cumulative incidence of “late” IOS (occurring at least 5 years after the cancer diagnosis) was 5.8% among those who had an abdominopelvic tumor and 1% among those who had other types of cancer, compared with 0.3% among siblings, who served as controls in the study. After adjusting for year of diagnosis, age at diagnosis, cancer type, radiotherapy, surgery, and other confounding factors, the risk of late IOS was significantly increased among those who had an abdominopelvic tumor (3.6 times greater) and those who had received abdominal/pelvic radiotherapy (2.4 times greater). Mortality was also almost twofold higher among those who developed late IOS when adjusted for the same factors, but there was no association with chemotherapy, cyclophosphamide equivalent dose, or platinum agent score and late IOS.

“The risk of IOS extends for decades beyond cancer diagnosis, implying the need for long-term vigilance, especially among survivors with abdominal or pelvic tumors and survivors who have undergone treatment with abdominal or pelvic surgery or radiotherapy,” concluded lead author Dr. Arin Madenci of Boston Children’s Hospital and his coauthors.

“Widespread awareness of the signs and symptoms of IOS will facilitate timely presentation and effective management of this complication. Although prevention of IOS is not currently possible, education of survivors of cancer, their families, and their health care providers is critical,” they added.

The study was supported by grants from the National Cancer Institute and Cancer Center Support (Centers of Research Excellence) and by the American Lebanese Syrian Associated Charities. Dr. Madenci and nine other authors had no disclosures. The remaining three authors had disclosures that included receiving honoraria, travel, and expenses from Sandoz, holding stock or other ownership in Pfizer and Novartis, serving as a consultant or advisor to United Therapeutics, and having an immediate family member with stock or other ownership in several pharmaceutical companies.

[email protected]

Childhood cancer survivors are at an increased risk for developing an intestinal obstruction requiring surgery (IOS) 5 or more years after the initial cancer diagnosis, according to a study based on data from the Childhood Cancer Survivor Study.

The risk was greater among those who had a pelvic or abdominal tumor and had been exposed to pelvic or abdominal radiotherapy, reported the authors, who pointed out that no study has “rigorously” investigated the incidence of intestinal obstruction in childhood cancer survivors. The study appeared online in the Journal of Clinical Oncology (2015 Aug 10 doi: 10.1200/JCO.2015.61.5070).

The subjects in the study had been diagnosed with cancer before age 21 years between 1970 and 1986 and were followed longitudinally in the CCSS. The sample included 12,316 childhood cancer survivors who had survived at least 5 years from the time they were diagnosed with cancer and 4,023 of their siblings.

The cumulative incidence of “late” IOS (occurring at least 5 years after the cancer diagnosis) was 5.8% among those who had an abdominopelvic tumor and 1% among those who had other types of cancer, compared with 0.3% among siblings, who served as controls in the study. After adjusting for year of diagnosis, age at diagnosis, cancer type, radiotherapy, surgery, and other confounding factors, the risk of late IOS was significantly increased among those who had an abdominopelvic tumor (3.6 times greater) and those who had received abdominal/pelvic radiotherapy (2.4 times greater). Mortality was also almost twofold higher among those who developed late IOS when adjusted for the same factors, but there was no association with chemotherapy, cyclophosphamide equivalent dose, or platinum agent score and late IOS.

“The risk of IOS extends for decades beyond cancer diagnosis, implying the need for long-term vigilance, especially among survivors with abdominal or pelvic tumors and survivors who have undergone treatment with abdominal or pelvic surgery or radiotherapy,” concluded lead author Dr. Arin Madenci of Boston Children’s Hospital and his coauthors.

“Widespread awareness of the signs and symptoms of IOS will facilitate timely presentation and effective management of this complication. Although prevention of IOS is not currently possible, education of survivors of cancer, their families, and their health care providers is critical,” they added.

The study was supported by grants from the National Cancer Institute and Cancer Center Support (Centers of Research Excellence) and by the American Lebanese Syrian Associated Charities. Dr. Madenci and nine other authors had no disclosures. The remaining three authors had disclosures that included receiving honoraria, travel, and expenses from Sandoz, holding stock or other ownership in Pfizer and Novartis, serving as a consultant or advisor to United Therapeutics, and having an immediate family member with stock or other ownership in several pharmaceutical companies.

[email protected]

Childhood cancer survivors are at an increased risk for developing an intestinal obstruction requiring surgery (IOS) 5 or more years after the initial cancer diagnosis, according to a study based on data from the Childhood Cancer Survivor Study.

The risk was greater among those who had a pelvic or abdominal tumor and had been exposed to pelvic or abdominal radiotherapy, reported the authors, who pointed out that no study has “rigorously” investigated the incidence of intestinal obstruction in childhood cancer survivors. The study appeared online in the Journal of Clinical Oncology (2015 Aug 10 doi: 10.1200/JCO.2015.61.5070).

The subjects in the study had been diagnosed with cancer before age 21 years between 1970 and 1986 and were followed longitudinally in the CCSS. The sample included 12,316 childhood cancer survivors who had survived at least 5 years from the time they were diagnosed with cancer and 4,023 of their siblings.

The cumulative incidence of “late” IOS (occurring at least 5 years after the cancer diagnosis) was 5.8% among those who had an abdominopelvic tumor and 1% among those who had other types of cancer, compared with 0.3% among siblings, who served as controls in the study. After adjusting for year of diagnosis, age at diagnosis, cancer type, radiotherapy, surgery, and other confounding factors, the risk of late IOS was significantly increased among those who had an abdominopelvic tumor (3.6 times greater) and those who had received abdominal/pelvic radiotherapy (2.4 times greater). Mortality was also almost twofold higher among those who developed late IOS when adjusted for the same factors, but there was no association with chemotherapy, cyclophosphamide equivalent dose, or platinum agent score and late IOS.

“The risk of IOS extends for decades beyond cancer diagnosis, implying the need for long-term vigilance, especially among survivors with abdominal or pelvic tumors and survivors who have undergone treatment with abdominal or pelvic surgery or radiotherapy,” concluded lead author Dr. Arin Madenci of Boston Children’s Hospital and his coauthors.

“Widespread awareness of the signs and symptoms of IOS will facilitate timely presentation and effective management of this complication. Although prevention of IOS is not currently possible, education of survivors of cancer, their families, and their health care providers is critical,” they added.

The study was supported by grants from the National Cancer Institute and Cancer Center Support (Centers of Research Excellence) and by the American Lebanese Syrian Associated Charities. Dr. Madenci and nine other authors had no disclosures. The remaining three authors had disclosures that included receiving honoraria, travel, and expenses from Sandoz, holding stock or other ownership in Pfizer and Novartis, serving as a consultant or advisor to United Therapeutics, and having an immediate family member with stock or other ownership in several pharmaceutical companies.

[email protected]

WASHINGTON – Fatigue and sleep disturbances are common among patients who have undergone hematopoietic stem cell transplants, but those who feel they have good social support can rest a little easier, say investigators.

Patients who prior to undergoing HSCT had a sense of worth, felt integrated in a social network, and had close attachments were more likely to have better-quality sleep than were their counterparts who felt more isolated and detached, reported Savitri Viozat, a research assistant at the University of Wisconsin Carbone Cancer Center in Madison.

“Devising interventions to optimize social support during the pretransplant period may help to improve sleep quality,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

The investigators asked 431 adults who were scheduled to undergo either autologous or allogeneic HSCT to complete before transplant the Social Provisions Scale, a validated instrument measuring social support, and to complete the Pittsburgh Sleep Quality Inventory and Fatigue Symptom Inventory before transplant and at 1, 3, 6, and 12 months post HSCT.

To gauge the effects of support on sleep, the researchers created mixed-effects linear regression models controlling for transplant regimen, age, and time since transplant.

They found that in the 12 months following HSCT, patients who reported having better social support before transplant had significantly better sleep quality, fewer nighttime sleep disturbances, less sleep-related dysfunction during waking hours, and longer sleep duration (P less than .05 for all comparisons). In addition, patients with better support had shorter sleep latency (time to fall alseep, P less than .01).

There were no significant associations between social support and either sleep efficiency or use of sleep-aid medications, the authors found.

As Ms. Viozat mentioned, the association between support and better sleep was strongest at the 1- and 3-month post-HSCT intervals.

The three dimensions of support most strongly associated with better quality sleep were worth, social integration, and attachment. The dimension of reliable alliance (assurance of continued assistance) also was associated with better sleep duration and lower disturbance, and the dimension of guidance was significantly associated with lower daytime dysfunction and shorter sleep latency.

Nurturance, the only dimension of social support that includes caring for others as well as being cared for by others, was not associated with any improvements in posttransplant sleep quality.

Insomnia interventions

Two other studies presented at the meeting looked at insomnia interventions in patients with cancer.

Kevin Hochard, Ph.D., and colleagues at the University of Chester, England, conducted a systematic review of studies on insomnia interventions for patients with cancer being treated with curative intent. They found that cognitive behavioral therapy (CBT) and mindfulness interventions were common and generally resulted in small but significant improvement in sleep, quality of life, and mood.

A cognitive behavioral therapy intervention for cancer survivors was the focus of a different study, led by Eric Zhou, Ph.D., of the Dana-Farber Cancer Institute in Boston.

Twenty-five of 34 participants completed a program consisting of three CBT sessions over 4 weeks emphasizing sleep restriction and stimulus control, with brief discussions of cognitive factors related to insomnia and sleep hygiene.

There were overall improvements in both sleep efficiency (from 77.8% to 88.7%), and reductions in the mean Insomnia Severity Index total (16.5 to 10.6) from preintervention to postintervention (P less than .01 for all comparisons).

“All participants believed the program helped to improve their understanding of insomnia and all but one reported overall satisfaction with the program. Only 1 in 3 had discussed their insomnia symptoms with medical providers in the prior year,” Dr. Zhou and colleagues wrote.

WASHINGTON – Fatigue and sleep disturbances are common among patients who have undergone hematopoietic stem cell transplants, but those who feel they have good social support can rest a little easier, say investigators.

Patients who prior to undergoing HSCT had a sense of worth, felt integrated in a social network, and had close attachments were more likely to have better-quality sleep than were their counterparts who felt more isolated and detached, reported Savitri Viozat, a research assistant at the University of Wisconsin Carbone Cancer Center in Madison.

“Devising interventions to optimize social support during the pretransplant period may help to improve sleep quality,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

The investigators asked 431 adults who were scheduled to undergo either autologous or allogeneic HSCT to complete before transplant the Social Provisions Scale, a validated instrument measuring social support, and to complete the Pittsburgh Sleep Quality Inventory and Fatigue Symptom Inventory before transplant and at 1, 3, 6, and 12 months post HSCT.

To gauge the effects of support on sleep, the researchers created mixed-effects linear regression models controlling for transplant regimen, age, and time since transplant.

They found that in the 12 months following HSCT, patients who reported having better social support before transplant had significantly better sleep quality, fewer nighttime sleep disturbances, less sleep-related dysfunction during waking hours, and longer sleep duration (P less than .05 for all comparisons). In addition, patients with better support had shorter sleep latency (time to fall alseep, P less than .01).

There were no significant associations between social support and either sleep efficiency or use of sleep-aid medications, the authors found.

As Ms. Viozat mentioned, the association between support and better sleep was strongest at the 1- and 3-month post-HSCT intervals.

The three dimensions of support most strongly associated with better quality sleep were worth, social integration, and attachment. The dimension of reliable alliance (assurance of continued assistance) also was associated with better sleep duration and lower disturbance, and the dimension of guidance was significantly associated with lower daytime dysfunction and shorter sleep latency.

Nurturance, the only dimension of social support that includes caring for others as well as being cared for by others, was not associated with any improvements in posttransplant sleep quality.

Insomnia interventions

Two other studies presented at the meeting looked at insomnia interventions in patients with cancer.

Kevin Hochard, Ph.D., and colleagues at the University of Chester, England, conducted a systematic review of studies on insomnia interventions for patients with cancer being treated with curative intent. They found that cognitive behavioral therapy (CBT) and mindfulness interventions were common and generally resulted in small but significant improvement in sleep, quality of life, and mood.

A cognitive behavioral therapy intervention for cancer survivors was the focus of a different study, led by Eric Zhou, Ph.D., of the Dana-Farber Cancer Institute in Boston.

Twenty-five of 34 participants completed a program consisting of three CBT sessions over 4 weeks emphasizing sleep restriction and stimulus control, with brief discussions of cognitive factors related to insomnia and sleep hygiene.

There were overall improvements in both sleep efficiency (from 77.8% to 88.7%), and reductions in the mean Insomnia Severity Index total (16.5 to 10.6) from preintervention to postintervention (P less than .01 for all comparisons).

“All participants believed the program helped to improve their understanding of insomnia and all but one reported overall satisfaction with the program. Only 1 in 3 had discussed their insomnia symptoms with medical providers in the prior year,” Dr. Zhou and colleagues wrote.

WASHINGTON – Fatigue and sleep disturbances are common among patients who have undergone hematopoietic stem cell transplants, but those who feel they have good social support can rest a little easier, say investigators.

Patients who prior to undergoing HSCT had a sense of worth, felt integrated in a social network, and had close attachments were more likely to have better-quality sleep than were their counterparts who felt more isolated and detached, reported Savitri Viozat, a research assistant at the University of Wisconsin Carbone Cancer Center in Madison.

“Devising interventions to optimize social support during the pretransplant period may help to improve sleep quality,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

The investigators asked 431 adults who were scheduled to undergo either autologous or allogeneic HSCT to complete before transplant the Social Provisions Scale, a validated instrument measuring social support, and to complete the Pittsburgh Sleep Quality Inventory and Fatigue Symptom Inventory before transplant and at 1, 3, 6, and 12 months post HSCT.

To gauge the effects of support on sleep, the researchers created mixed-effects linear regression models controlling for transplant regimen, age, and time since transplant.

They found that in the 12 months following HSCT, patients who reported having better social support before transplant had significantly better sleep quality, fewer nighttime sleep disturbances, less sleep-related dysfunction during waking hours, and longer sleep duration (P less than .05 for all comparisons). In addition, patients with better support had shorter sleep latency (time to fall alseep, P less than .01).

There were no significant associations between social support and either sleep efficiency or use of sleep-aid medications, the authors found.

As Ms. Viozat mentioned, the association between support and better sleep was strongest at the 1- and 3-month post-HSCT intervals.

The three dimensions of support most strongly associated with better quality sleep were worth, social integration, and attachment. The dimension of reliable alliance (assurance of continued assistance) also was associated with better sleep duration and lower disturbance, and the dimension of guidance was significantly associated with lower daytime dysfunction and shorter sleep latency.

Nurturance, the only dimension of social support that includes caring for others as well as being cared for by others, was not associated with any improvements in posttransplant sleep quality.

Insomnia interventions

Two other studies presented at the meeting looked at insomnia interventions in patients with cancer.

Kevin Hochard, Ph.D., and colleagues at the University of Chester, England, conducted a systematic review of studies on insomnia interventions for patients with cancer being treated with curative intent. They found that cognitive behavioral therapy (CBT) and mindfulness interventions were common and generally resulted in small but significant improvement in sleep, quality of life, and mood.

A cognitive behavioral therapy intervention for cancer survivors was the focus of a different study, led by Eric Zhou, Ph.D., of the Dana-Farber Cancer Institute in Boston.

Twenty-five of 34 participants completed a program consisting of three CBT sessions over 4 weeks emphasizing sleep restriction and stimulus control, with brief discussions of cognitive factors related to insomnia and sleep hygiene.

There were overall improvements in both sleep efficiency (from 77.8% to 88.7%), and reductions in the mean Insomnia Severity Index total (16.5 to 10.6) from preintervention to postintervention (P less than .01 for all comparisons).

“All participants believed the program helped to improve their understanding of insomnia and all but one reported overall satisfaction with the program. Only 1 in 3 had discussed their insomnia symptoms with medical providers in the prior year,” Dr. Zhou and colleagues wrote.

WASHINGTON – Exercise can have significant and clinically important mental health benefits for both cancer patients and their caregivers, investigators report.

Among patients with cancer and depression, those who took part in a home-based exercise program had the most rapid improvement of depressive symptoms, whereas patients enrolled in a supervised, structured exercise program had the longest-lasting benefits. Both groups had better resolution of depression than did controls, reported Dr. Gregory T. Levin, an accredited exercise physiologist and postdoctoral research fellow at the University of Calgary (Alta.).

©iStock/thinkstockphotos.com

Exercise should be considered as a component of precision medicine, where we can tailor an exercise intervention for a person depending on their mental health status, their cancer status, or the outcomes that we’re trying to attain, whether that’s [creating] changes in depression or improving muscle strength and muscle function,” Dr. Levin said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Levin and his colleagues conducted a study to determine whether certain types of exercise programs might be more effective than others at reducing symptoms of depression in cancer survivors, compared with controls.

They first screened the participants to ensure that only cancer patients with established clinical depression or elevated depressive symptoms would be invited to take part. Patients were eligible if they reported that they were currently being treated for depression, if they scored more than 10 on the Hospital Anxiety and Depression Scale (HADS), or if they met diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) self-rating scale for depression.

They enrolled 32 participants with a mean age of 58.9 years to either a 12-week, clinic-based supervised exercise program (10 patients), a home-based exercise program (8), or usual care (14).

Patients in the supervised exercise group had two weekly sessions of resistance and aerobic training. Patients in the home-based group were given printed material and asked to keep an exercise diary, and were encouraged to exercise at least 150 minutes each week. These patients also received a weekly follow-up phone call. Controls were not told to exercise but were encouraged to maintain usual activities, did not receive printed material, and were not contacted regarding exercise.

For the primary endpoint of depression, both the home-based intervention and the supervised exercise groups had significant reductions in mean HADS scores after 12 weeks, from a baseline of 6.4 to 2.2 for the home-based group (P = .006), and from 6.9 to 2.4 for the supervised group (P = .021). In contrast, controls had a slight increase in scores, from a mean of 7.22 at baseline to 7.76 at week 12.

The most rapid change occurred among the home-based exercisers, who saw the greatest gain during the first 6 weeks. During the second 6 weeks, however, the supervised exercisers saw a sharper decline in scores, compared with the other two groups, possibly because of a loss of motivation among the home-based group.

There was no interaction effect for anxiety over the 12 weeks, but the pattern of decline in anxiety was similar to that seen with depression, with home-based exercisers having a steep decline over the first 6 weeks of the program and then plateauing, while the supervised exercisers saw a greater drop in anxiety scores over the second 6-week period.

Mental health questionnaire scores also favored the exercise groups, compared with controls.

“The exercise program was able to alleviate the depressive symptoms, but the rate of change differed. The home-based [exercise program] initially was favored, and that might be largely due to psychological reasons of distraction, self-efficacy, and mastery, where those self-managed patients take on an exercise regime, are proud of themselves for sticking to it, and notice rapid changes. But then it might become boring and they might stop any time they don’t see changes of such high magnitude,” Dr. Levin said.

Caregiver study

The effects of exercise on the psychological well-being of caregivers was the focus of a scientific poster by Dr. Sylvie Lambert and her colleagues from McGill University in Montreal and the Princess Margaret Cancer Centre in Toronto.

They conducted a systematic review of 14 studies evaluating the effects of exercise and specific types of physical activity on caregivers’ psychosocial well-being. The studies looked at caregivers of patients with cancer and other chronic diseases or disabilities.

They found that overall, exercise has significant beneficial effects on decreasing depression, burden, stress, anger, and anxiety. Most of the interventions used a combination of physical activities, including walking, yoga, meditation, aerobics, tai chi, strength training, stretching, and daily activities such as gardening, housework, etc.

“Physical activity interventions hold promise to improve caregivers’ outcomes, and the findings of this review would suggest that health care providers could promote their use among caregivers,” Dr. Lambert and her colleagues wrote.

WASHINGTON – Exercise can have significant and clinically important mental health benefits for both cancer patients and their caregivers, investigators report.

Among patients with cancer and depression, those who took part in a home-based exercise program had the most rapid improvement of depressive symptoms, whereas patients enrolled in a supervised, structured exercise program had the longest-lasting benefits. Both groups had better resolution of depression than did controls, reported Dr. Gregory T. Levin, an accredited exercise physiologist and postdoctoral research fellow at the University of Calgary (Alta.).

©iStock/thinkstockphotos.com

Exercise should be considered as a component of precision medicine, where we can tailor an exercise intervention for a person depending on their mental health status, their cancer status, or the outcomes that we’re trying to attain, whether that’s [creating] changes in depression or improving muscle strength and muscle function,” Dr. Levin said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Levin and his colleagues conducted a study to determine whether certain types of exercise programs might be more effective than others at reducing symptoms of depression in cancer survivors, compared with controls.

They first screened the participants to ensure that only cancer patients with established clinical depression or elevated depressive symptoms would be invited to take part. Patients were eligible if they reported that they were currently being treated for depression, if they scored more than 10 on the Hospital Anxiety and Depression Scale (HADS), or if they met diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) self-rating scale for depression.

They enrolled 32 participants with a mean age of 58.9 years to either a 12-week, clinic-based supervised exercise program (10 patients), a home-based exercise program (8), or usual care (14).

Patients in the supervised exercise group had two weekly sessions of resistance and aerobic training. Patients in the home-based group were given printed material and asked to keep an exercise diary, and were encouraged to exercise at least 150 minutes each week. These patients also received a weekly follow-up phone call. Controls were not told to exercise but were encouraged to maintain usual activities, did not receive printed material, and were not contacted regarding exercise.

For the primary endpoint of depression, both the home-based intervention and the supervised exercise groups had significant reductions in mean HADS scores after 12 weeks, from a baseline of 6.4 to 2.2 for the home-based group (P = .006), and from 6.9 to 2.4 for the supervised group (P = .021). In contrast, controls had a slight increase in scores, from a mean of 7.22 at baseline to 7.76 at week 12.

The most rapid change occurred among the home-based exercisers, who saw the greatest gain during the first 6 weeks. During the second 6 weeks, however, the supervised exercisers saw a sharper decline in scores, compared with the other two groups, possibly because of a loss of motivation among the home-based group.

There was no interaction effect for anxiety over the 12 weeks, but the pattern of decline in anxiety was similar to that seen with depression, with home-based exercisers having a steep decline over the first 6 weeks of the program and then plateauing, while the supervised exercisers saw a greater drop in anxiety scores over the second 6-week period.

Mental health questionnaire scores also favored the exercise groups, compared with controls.

“The exercise program was able to alleviate the depressive symptoms, but the rate of change differed. The home-based [exercise program] initially was favored, and that might be largely due to psychological reasons of distraction, self-efficacy, and mastery, where those self-managed patients take on an exercise regime, are proud of themselves for sticking to it, and notice rapid changes. But then it might become boring and they might stop any time they don’t see changes of such high magnitude,” Dr. Levin said.

Caregiver study

The effects of exercise on the psychological well-being of caregivers was the focus of a scientific poster by Dr. Sylvie Lambert and her colleagues from McGill University in Montreal and the Princess Margaret Cancer Centre in Toronto.

They conducted a systematic review of 14 studies evaluating the effects of exercise and specific types of physical activity on caregivers’ psychosocial well-being. The studies looked at caregivers of patients with cancer and other chronic diseases or disabilities.

They found that overall, exercise has significant beneficial effects on decreasing depression, burden, stress, anger, and anxiety. Most of the interventions used a combination of physical activities, including walking, yoga, meditation, aerobics, tai chi, strength training, stretching, and daily activities such as gardening, housework, etc.

“Physical activity interventions hold promise to improve caregivers’ outcomes, and the findings of this review would suggest that health care providers could promote their use among caregivers,” Dr. Lambert and her colleagues wrote.

WASHINGTON – Exercise can have significant and clinically important mental health benefits for both cancer patients and their caregivers, investigators report.

Among patients with cancer and depression, those who took part in a home-based exercise program had the most rapid improvement of depressive symptoms, whereas patients enrolled in a supervised, structured exercise program had the longest-lasting benefits. Both groups had better resolution of depression than did controls, reported Dr. Gregory T. Levin, an accredited exercise physiologist and postdoctoral research fellow at the University of Calgary (Alta.).

©iStock/thinkstockphotos.com

Exercise should be considered as a component of precision medicine, where we can tailor an exercise intervention for a person depending on their mental health status, their cancer status, or the outcomes that we’re trying to attain, whether that’s [creating] changes in depression or improving muscle strength and muscle function,” Dr. Levin said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Levin and his colleagues conducted a study to determine whether certain types of exercise programs might be more effective than others at reducing symptoms of depression in cancer survivors, compared with controls.

They first screened the participants to ensure that only cancer patients with established clinical depression or elevated depressive symptoms would be invited to take part. Patients were eligible if they reported that they were currently being treated for depression, if they scored more than 10 on the Hospital Anxiety and Depression Scale (HADS), or if they met diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) self-rating scale for depression.

They enrolled 32 participants with a mean age of 58.9 years to either a 12-week, clinic-based supervised exercise program (10 patients), a home-based exercise program (8), or usual care (14).

Patients in the supervised exercise group had two weekly sessions of resistance and aerobic training. Patients in the home-based group were given printed material and asked to keep an exercise diary, and were encouraged to exercise at least 150 minutes each week. These patients also received a weekly follow-up phone call. Controls were not told to exercise but were encouraged to maintain usual activities, did not receive printed material, and were not contacted regarding exercise.

For the primary endpoint of depression, both the home-based intervention and the supervised exercise groups had significant reductions in mean HADS scores after 12 weeks, from a baseline of 6.4 to 2.2 for the home-based group (P = .006), and from 6.9 to 2.4 for the supervised group (P = .021). In contrast, controls had a slight increase in scores, from a mean of 7.22 at baseline to 7.76 at week 12.

The most rapid change occurred among the home-based exercisers, who saw the greatest gain during the first 6 weeks. During the second 6 weeks, however, the supervised exercisers saw a sharper decline in scores, compared with the other two groups, possibly because of a loss of motivation among the home-based group.

There was no interaction effect for anxiety over the 12 weeks, but the pattern of decline in anxiety was similar to that seen with depression, with home-based exercisers having a steep decline over the first 6 weeks of the program and then plateauing, while the supervised exercisers saw a greater drop in anxiety scores over the second 6-week period.

Mental health questionnaire scores also favored the exercise groups, compared with controls.

“The exercise program was able to alleviate the depressive symptoms, but the rate of change differed. The home-based [exercise program] initially was favored, and that might be largely due to psychological reasons of distraction, self-efficacy, and mastery, where those self-managed patients take on an exercise regime, are proud of themselves for sticking to it, and notice rapid changes. But then it might become boring and they might stop any time they don’t see changes of such high magnitude,” Dr. Levin said.

Caregiver study

The effects of exercise on the psychological well-being of caregivers was the focus of a scientific poster by Dr. Sylvie Lambert and her colleagues from McGill University in Montreal and the Princess Margaret Cancer Centre in Toronto.

They conducted a systematic review of 14 studies evaluating the effects of exercise and specific types of physical activity on caregivers’ psychosocial well-being. The studies looked at caregivers of patients with cancer and other chronic diseases or disabilities.

They found that overall, exercise has significant beneficial effects on decreasing depression, burden, stress, anger, and anxiety. Most of the interventions used a combination of physical activities, including walking, yoga, meditation, aerobics, tai chi, strength training, stretching, and daily activities such as gardening, housework, etc.

“Physical activity interventions hold promise to improve caregivers’ outcomes, and the findings of this review would suggest that health care providers could promote their use among caregivers,” Dr. Lambert and her colleagues wrote.

WASHINGTON – Treating depression in cancer patients has the potential to simultaneously improve the patients’ mental health while reducing health care costs, investigators say.

Patients with cancer and depression have significantly more emergency and nonemergency visits and are more likely to be hospitalized as well as rehospitalized within 30 days than nondepressed cancer patients, suggesting that active treatment of depression in cancer patients can pay off in both better patient care and lower costs, reported Dr. Brent Mausbach, a clinical psychologist at the University of California, San Diego Moores Cancer Center.

“If we’re looking at 1,000 depressed cancer patients and we compare them to 1,000 nondepressed cancer patients, what this essentially equates to is over $4 million in extra cost – and this only includes the cost of the emergency department and hospitalizations; it does not include the cost of other visits that these patients may be making,” he said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Mausbach and colleagues took a retrospective look at the charts of 5,055 patients with cancer treated at their center in 2011, including 561 with a diagnosis of depression and 4,494 with no depression.

The investigators counted the total number of visits, emergency department (ED) visits, and 30-day readmissions, and calculated the probability that a randomly selected depressed patient would have more visits than a randomly selected nondepressed patient.

They controlled for patient demographics (age, sex, and race/ethnicity), insurance status, months since cancer diagnosis, comorbidities, and metastasis.

They found that patients who were depressed had a mean of 26.9 visits over 12 months vs. 15 for nondepressed patients. Compared with nondepressed patients, depressed patients had a 72.5% probability of having more health care visits.

The median number of visits to the health care system among depressed cancer patients was 21, compared with 8 for nondepressed patients.

In all, 28.3% of depressed patients had one or more emergency department visits for any reason, compared with 11.5% of nondepressed patients (odds ratio, 3.05; adjusted OR, 2.45).

Similarly, depressed patients were significantly more likely to be hospitalized than their nondepressed counterparts (OR, 2.41; aOR, 1.81), and to be rehospitalized within 30 days (OR, 2.31; aOR, 2.03).

Patients with depression also had significantly longer hospital stays, at a mean of 6.1 vs. 4.7 for those without depression.

“For the emergency department, hospitalization, and 30-day rehospitalization data, we think the effects seemed pretty consistent across all those outcomes. Essentially there was about a doubling of the risk for patients who have depression for all of those outcomes relative to patients without depression,” Dr. Mausbach said.

He noted that there is an “overwhelming temptation” for investigators to assume the between-person effects they saw could translate directly into within-person effects. For example, an observer might extrapolate from the data that treating depression in an individual patients could halve that patient’s use of health care resources, but a longitudinal study would be required to correctly address that question, he said.

Additionally, the study was limited by a lack of data on cancer stage and grade, and by the uncertainties surrounding a chart-recorded diagnosis of depression.

“Can we treat depression and then have an impact on lower health care use and overall costs? We need to demonstrate this using clinical trials or pseudo-experimental designs, which would include taking a look at people who actually received psychotherapy or medications, and checking to see whether by using these treatments they actually had a reduction in total number of health care visits,” Dr. Mausbach said.

The study was institutionally supported. The authors reported having no conflicts of interest.

WASHINGTON – Treating depression in cancer patients has the potential to simultaneously improve the patients’ mental health while reducing health care costs, investigators say.

Patients with cancer and depression have significantly more emergency and nonemergency visits and are more likely to be hospitalized as well as rehospitalized within 30 days than nondepressed cancer patients, suggesting that active treatment of depression in cancer patients can pay off in both better patient care and lower costs, reported Dr. Brent Mausbach, a clinical psychologist at the University of California, San Diego Moores Cancer Center.

“If we’re looking at 1,000 depressed cancer patients and we compare them to 1,000 nondepressed cancer patients, what this essentially equates to is over $4 million in extra cost – and this only includes the cost of the emergency department and hospitalizations; it does not include the cost of other visits that these patients may be making,” he said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Mausbach and colleagues took a retrospective look at the charts of 5,055 patients with cancer treated at their center in 2011, including 561 with a diagnosis of depression and 4,494 with no depression.

The investigators counted the total number of visits, emergency department (ED) visits, and 30-day readmissions, and calculated the probability that a randomly selected depressed patient would have more visits than a randomly selected nondepressed patient.

They controlled for patient demographics (age, sex, and race/ethnicity), insurance status, months since cancer diagnosis, comorbidities, and metastasis.

They found that patients who were depressed had a mean of 26.9 visits over 12 months vs. 15 for nondepressed patients. Compared with nondepressed patients, depressed patients had a 72.5% probability of having more health care visits.

The median number of visits to the health care system among depressed cancer patients was 21, compared with 8 for nondepressed patients.

In all, 28.3% of depressed patients had one or more emergency department visits for any reason, compared with 11.5% of nondepressed patients (odds ratio, 3.05; adjusted OR, 2.45).

Similarly, depressed patients were significantly more likely to be hospitalized than their nondepressed counterparts (OR, 2.41; aOR, 1.81), and to be rehospitalized within 30 days (OR, 2.31; aOR, 2.03).

Patients with depression also had significantly longer hospital stays, at a mean of 6.1 vs. 4.7 for those without depression.

“For the emergency department, hospitalization, and 30-day rehospitalization data, we think the effects seemed pretty consistent across all those outcomes. Essentially there was about a doubling of the risk for patients who have depression for all of those outcomes relative to patients without depression,” Dr. Mausbach said.

He noted that there is an “overwhelming temptation” for investigators to assume the between-person effects they saw could translate directly into within-person effects. For example, an observer might extrapolate from the data that treating depression in an individual patients could halve that patient’s use of health care resources, but a longitudinal study would be required to correctly address that question, he said.

Additionally, the study was limited by a lack of data on cancer stage and grade, and by the uncertainties surrounding a chart-recorded diagnosis of depression.

“Can we treat depression and then have an impact on lower health care use and overall costs? We need to demonstrate this using clinical trials or pseudo-experimental designs, which would include taking a look at people who actually received psychotherapy or medications, and checking to see whether by using these treatments they actually had a reduction in total number of health care visits,” Dr. Mausbach said.

The study was institutionally supported. The authors reported having no conflicts of interest.

WASHINGTON – Treating depression in cancer patients has the potential to simultaneously improve the patients’ mental health while reducing health care costs, investigators say.

Patients with cancer and depression have significantly more emergency and nonemergency visits and are more likely to be hospitalized as well as rehospitalized within 30 days than nondepressed cancer patients, suggesting that active treatment of depression in cancer patients can pay off in both better patient care and lower costs, reported Dr. Brent Mausbach, a clinical psychologist at the University of California, San Diego Moores Cancer Center.

“If we’re looking at 1,000 depressed cancer patients and we compare them to 1,000 nondepressed cancer patients, what this essentially equates to is over $4 million in extra cost – and this only includes the cost of the emergency department and hospitalizations; it does not include the cost of other visits that these patients may be making,” he said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Mausbach and colleagues took a retrospective look at the charts of 5,055 patients with cancer treated at their center in 2011, including 561 with a diagnosis of depression and 4,494 with no depression.

The investigators counted the total number of visits, emergency department (ED) visits, and 30-day readmissions, and calculated the probability that a randomly selected depressed patient would have more visits than a randomly selected nondepressed patient.

They controlled for patient demographics (age, sex, and race/ethnicity), insurance status, months since cancer diagnosis, comorbidities, and metastasis.

They found that patients who were depressed had a mean of 26.9 visits over 12 months vs. 15 for nondepressed patients. Compared with nondepressed patients, depressed patients had a 72.5% probability of having more health care visits.

The median number of visits to the health care system among depressed cancer patients was 21, compared with 8 for nondepressed patients.

In all, 28.3% of depressed patients had one or more emergency department visits for any reason, compared with 11.5% of nondepressed patients (odds ratio, 3.05; adjusted OR, 2.45).

Similarly, depressed patients were significantly more likely to be hospitalized than their nondepressed counterparts (OR, 2.41; aOR, 1.81), and to be rehospitalized within 30 days (OR, 2.31; aOR, 2.03).

Patients with depression also had significantly longer hospital stays, at a mean of 6.1 vs. 4.7 for those without depression.

“For the emergency department, hospitalization, and 30-day rehospitalization data, we think the effects seemed pretty consistent across all those outcomes. Essentially there was about a doubling of the risk for patients who have depression for all of those outcomes relative to patients without depression,” Dr. Mausbach said.

He noted that there is an “overwhelming temptation” for investigators to assume the between-person effects they saw could translate directly into within-person effects. For example, an observer might extrapolate from the data that treating depression in an individual patients could halve that patient’s use of health care resources, but a longitudinal study would be required to correctly address that question, he said.

Additionally, the study was limited by a lack of data on cancer stage and grade, and by the uncertainties surrounding a chart-recorded diagnosis of depression.

“Can we treat depression and then have an impact on lower health care use and overall costs? We need to demonstrate this using clinical trials or pseudo-experimental designs, which would include taking a look at people who actually received psychotherapy or medications, and checking to see whether by using these treatments they actually had a reduction in total number of health care visits,” Dr. Mausbach said.

The study was institutionally supported. The authors reported having no conflicts of interest.