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Objective: To evaluate association between Medicare accountable care organizations (ACOs) participation of hospitals on post-acute care (PAC) use and spending, and post-surgical outcomes in Medicare beneficiaries undergoing urologic cancer surgeries. Despite increasing prevalence of urologic cancer and surgical care contributing to a large proportion of total health care costs, and recent Medicare payment reforms such as accountable care organizations, the role of ACOs in urologic cancer care has been unexplored.Methods: We conducted a longitudinal analysis of 2011-2017 Medicare claims data to compare post-surgical outcomes between Medicare ACO and non-ACO patients before and after implementation of Medicare shared savings program (MSSP). Our outcomes of interest were Post-acute care (PAC) use (overall, institutional, and home health), Skilled Nursing Facility (SNF) length of stay and Medicare spending for SNF patients, 30-day and 90-day unplanned readmissions and complications after index procedure.Results: Study sample included a total of 334,514 Medicare patients undergoing bladder, prostate, kidney cancer surgeries at 524 Medicare ACO and 2066 non-ACO hospitals. For bladder cancer surgery, Medicare ACO participation was associated with significantly reduced overall post-acute care use, but not with changes in readmission or complication rate. For prostate cancer and kidney cancer surgery, we found no significant association between hospital participation in Medicare ACOs and PAC use or post-surgical outcomes.Conclusion: Hospital participation in MSSP ACOs leads to lower post-acute care use without compromising patient outcomes for Medicare beneficiaries undergoing bladder cancer surgery. Future research is needed to understand longer-term impact of ACO participation on urologic cancer surgery outcomes. [ABSTRACT FROM AUTHOR]

Objective To review existing exercise guidelines for cancer patients and survivors for the management of symptom clusters. Data Sources Review of PubMed literature and published exercise guidelines. Conclusion Cancer and its treatments are responsible for a copious number of incapacitating symptoms that markedly impair quality of life. The exercise oncology literature provides consistent support for the safety and efficacy of exercise interventions in managing cancer- and treatment-related symptoms, as well as improving quality of life in cancer patients and survivors. Implications for Nursing Practice Effective management of symptoms enhances recovery, resumption of normal life activities and quality of life for patients and survivors. Exercise is a safe, appropriate, and effective therapeutic option before, during, and after the completion of treatment for alleviating symptoms and symptom clusters. [ABSTRACT FROM AUTHOR]

Objective To examine the association between falls and health-related quality of life (HRQOL) in older cancer survivors. Materials and Methods Using the 2006–2011 Surveillance, Epidemiology, and End Results cancer registry system and the Medicare Health Outcomes Survey (SEER-MHOS) linkage database, a cross-sectional analysis was performed including 17,958 older cancer survivors. Multivariable regression models were used to evaluate the association of falls with HRQOL measured by the physical component summary (PCS) and mental component summary (MCS) scores on the Veteran RAND 12-item health survey after controlling for demographic, health- and cancer-related factors. A longitudinal analysis using the analysis of covariance (ANCOVA) models was also conducted comparing changes in HRQOL of older cancer survivors who fell with HRQOL of older patients with cancer who did not fall. Results In the cross-sectional analysis, 4524 (25%) cancer survivors who fell reported a significantly lower PCS (− 2.18; SE = 0.16) and MCS (2.00; SE = 0.17) scores compared to those who did not ( N = 13,434). In the longitudinal analysis, after adjusting for baseline HRQOL scores and covariates, patients who fell reported a decline in mean HRQOL scores of both PCS (− 1.54; SE = 0.26) and MCS (− 1.71; SE = 0.27). Presence of depression, functional impairment and comorbidities was significantly associated with lower HRQOL scores. Conclusion Falls are associated with lower HRQOL scores and are associated with a significant prospective decline in HRQOL in older cancer survivors. Further research is necessary to determine if assessment and intervention programs can help improve HRQOL by reducing the likelihood of falls. [ABSTRACT FROM AUTHOR]

Background Androgen deprivation therapy (ADT) can decrease the physical performance (PP) of older men with prostate cancer (PC). Methods We conducted a three-arm randomized pilot study ( n = 19) comparing a home-based walking and resistance intervention (EXCAP) and a technology-mediated walking and resistance intervention using Wii-Fit to a usual-care arm in men ≥ 70 years with PC receiving ADT. The intervention lasted for 6 weeks, with follow-up at 12 weeks. The primary pre-specified outcome was change in Short Physical Performance Battery (SPPB) score. Mixed effects regression models were used to assess change in outcomes over time. Results Mean participant age was 70 years (range: 67–93). Eight patients were randomized to the Wii-Fit arm, 6 to the EXCAP arm, and 5 to the usual-care arm. SPPB scores remained nearly constant in the usual-care arm ( β = − 0.12; p = 0.79), while individuals in the EXCAP arm had on average a 1.2 point increase at each follow-up ( β = 1.20; 95% CI: 0.36, 2.06). The Wii-fit arm had a non-significant increase in SPPB score over time relative to usual-care ( β = 0.32; 95% CI − 0.43, 1.06; p = 0.46). Individuals in the EXCAP arm had an increase in steps per day over time compared to the usual-care arm ( p -value = 0.006); the EXCAP arm had an increase of 2720 steps (95% CI: 1313, 4128) while the usual-care arm had an increase of 97 steps (95% CI: − 1140, 1333). Participants in the Wii-Fit arm had an increase of 1020 steps (95% CI: − 474, 1238, p = 0.710). Other outcomes (i.e., handgrip strength, lean muscle mass, and chest press repetitions) were not statistically significant. Conclusions A home-based aerobic and resistance exercise program, EXCAP, shows promise for improving PP in older men with PC on ADT. [ABSTRACT FROM AUTHOR]

Background Testicular cancer is the most common cancer among men aged 15 to 40 years, and the incidence of testicular cancer is steadily increasing. Despite successful treatment outcomes and the rate of survival at 5 to 10 years being 95%, survivors can experience late effects of both their cancer and the treatment they received, including secondary malignant neoplasms (SMNs). We discuss the development of non–germ cell SMNs that develop after diagnosis and treatment of testicular cancer and their effect on mortality. Results Patients diagnosed with testicular cancer frequently choose postoperative surveillance if they are diagnosed with clinical stage I disease. These patients may experience an increased risk for developing SMNs following radiation exposure from diagnostic imaging. Similarly, radiotherapy for testicular cancer is associated with increased risks of developing both solid tumors and leukemia. Studies have reported that patients exposed to higher doses of radiation have an increased risk of developing SMNs when compared with patients who received lower doses of radiation. Patients treated with chemotherapy also experience an increased risk of developing SMNs following testicular cancer, though the risk following chemotherapy and radiation therapy combined is not well described. A large population-based study concluded that the rate ratios for both cancer-specific and all-cause mortality for SMNs among testicular cancer survivors were not significantly different from those of matched first cancers. Conclusions Although it is known that patients who receive adjuvant chemotherapy or radiotherapy or who undergo routine diagnostic or follow-up imaging for a primary testicular cancer are at an increased risk for developing SMNs, the extent of this risk is largely unknown. It is critically important that research be conducted to determine this risk and its contributing factors as accurately as possible. [ABSTRACT FROM AUTHOR]

Objective To determine whether concurrent use of GnRH agonists with chemotherapy preserves ovarian function in women with breast cancer who did not use tamoxifen. Design Systematic review and meta-analysis. Setting University-based hospitals. Patient(s) Premenopausal women with breast cancer treated with chemotherapy who did not receive tamoxifen. Intervention(s) Randomization to concurrent GnRH agonists with chemotherapy or chemotherapy alone. Main Outcome Measure(s) Odds ratio (OR) of resumption of menses 1 year or more after chemotherapy. Result(s) Searches were conducted in PubMed, Scopus, Cochrane Trials Register, and the National Research Register through March 2014, and all randomized trials that reported resumption of menses 1 year or more after GnRH agonist with chemotherapy or chemotherapy alone among women with breast cancer who did not receive tamoxifen were included. Four studies were analyzed in the meta-analysis and included 252 patients (GnRH agonist with chemotherapy, n = 131; chemotherapy alone, n = 121). There was no significant difference in the rate of return of menses between the two groups (OR, 1.47; 95% confidence interval [0.60–3.62]). Heterogeneity among the trials was not significant ( I 2 = 16.6%). Conclusion(s) Concurrent GnRH agonists with chemotherapy may not preserve ovarian function in women with breast cancer. Furthermore, randomized data are limited regarding fertility after concurrent use of GnRH agonists with chemotherapy. [ABSTRACT FROM AUTHOR]