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BACKGROUND An expanding body of research documents the benefits of physical activity for cancer survivors' physical functioning and quality of life, but few successful models provide community-based physical activity programs to cancer survivors. This report presents an evaluation of Active Living After Cancer, an evidence-based physical activity program for breast cancer survivors, adapted for community delivery to minority and medically underserved survivors. METHODS Survivors were recruited from health care and community settings. The program consisted of 12 weekly group sessions providing training in cognitive and behavioral skills for behavior change, brief physical activity, and cancer survivorship-related content. At the baseline and follow-up, participants completed assessments of their physical activity, quality of life, and physical functioning (6-minute walk and 30-second sit-to-stand test). At follow-up, they also completed questionnaires to measure program content mastery and satisfaction. RESULTS The outcome analysis included 127 participants. Physical activity and quality of life (mental and physical) improved from the baseline to follow-up (all P < .01). Physical functioning improved, with increases in sit-to-stand repetitions (mean, 12.5 at the baseline vs 14.9 at the follow-up; P < .01) and 6-minute walk distances (mean, 428 m at the baseline vs 470 m at the follow-up; P < .01). CONCLUSIONS The results highlight the effectiveness of an evidence-based program adapted for community-based delivery to minority and medically underserved breast cancer survivors. The program could be delivered to improve outcomes in diverse survivor populations. LAY SUMMARY Physical activity in breast cancer survivors is related to better quality of life and longer cancer-free survival. However, there are few community-based programs to help breast cancer survivors to become more physically active. The Active Living After Cancer program was adapted from an evidence-based program and delivered in community-based settings to minority and medically underserved breast cancer survivors. It consisted of 12 weekly group sessions in which participants learned skills to increase their physical activity. The program participants increased their physical activity and improved their mental and physical well-being and physical functioning.

ObjectiveAlthough ovarian cancer is a deadly disease, approximately a third of women survive ≥9years after diagnosis. The factors associated with achieving long-term survival are not well understood. In this study, data from the Surveillance, Epidemiology, and End Results (SEER) program were used to determine predictors of survival trajectories among women with epithelial ovarian cancer and across histotype (high-grade serous carcinoma (HGSC) and non-HGSC).MethodsData on 35,868 women diagnosed with epithelial ovarian cancer in 2004-2016 were extracted from SEER. Extended Cox proportional hazards regression was used to estimate overall and histotype-specific associations between patient and tumor characteristics and all-cause mortality within each survival time (t) interval (t70years at diagnosis, where a high risk of mortality was observed in both the t&nbsp

Objectives. Remote monitoring (RM) of health-related outcomes may optimize cancer care and prevention outside of clinic settings. CYCORE is a software-based system for collection and analyses of sensor and mobile data. We evaluated CYCORE’s feasibility in studies assessing: (1) physical functioning in colorectal cancer (CRC) patients; (2) swallowing exercise adherence in head and neck cancer (HNC) patients during radiation therapy; and (3) tobacco use in cancer survivors post-tobacco treatment (TTP). Methods. Participants completed RM: for CRC, blood pressure, activity, GPS; for HNC, video of swallowing exercises; for TTP, expired carbon monoxide. Patient-reported outcomes were assessed daily. Results. For CRC, HNC and TTP, respectively, 50, 37, and 50 participants achieved 96%, 84%, 96% completion rates. Also, 91-100% rated ease and self-efficacy as highly favorable, 72-100% gave equivalent ratings for overall satisfaction, 72-93% had low/no data privacy concerns. Conclusion. RM was highly feasible and acceptable for patients across diverse use cases.

Background Only 8–23% of advanced epithelial ovarian cancer patients survive for 10 years or longer. Given the need for targeted interventions to improve survival, we interviewed this relatively rare survivor population to gain personalized insights into the reasons for their survival. The aim of this study was to characterize subjective attributions of survival and specific coping mechanisms long-term survivors of ovarian cancer. Methods Twenty-two semi-structured, qualitative interviews assessing survival attributions and coping strategies were conducted from April to November 2014. Data were analyzed in a multistep process using ATLAS.ti.8: codes were identified during review of the transcripts and refined with literature review; the frequency of codes and code co-occurrence was calculated, and codes were grouped into themes. Resulting themes were checked by a national leader of an ovarian cancer advocacy organization and compared against available literature. Results Thematic analysis found that participants credited their long-term survival to a variety of factors including medical, social, religious/spiritual, and lifestyle/personal characteristics. Some participants rejected these same attributions, concluding that the reason for survival was due to luck or unknowable. Several of Carver et al.’s theoretical dimensions of coping were evident in our sample: planning, positive reinterpretation, social support, religion and acceptance whereas three relatively new strategies were uncovered: conserving emotional energy, value-based activity coping, and self-care. Conclusions Long-term survivors’ perspectives were largely consistent with those of newly diagnosed ovarian cancer patients and ovarian cancer survivors of shorter duration. However, the long-term survivors were also willing to reject conventional attributions for survival and recognized the importance of disciplined self-preservational coping strategies.

97 Background: In order to maintain safety, clinical trial activities have been modified during the COVID-19 pandemic. As part of the TBCRC 057 survey, we assessed how pandemic-related modifications to trial activities affect breast cancer patients’ willingness to participate in clinical trials. Methods: US residents with breast cancer were eligible to complete the online survey 8/6/21 – 9/30/21. Respondents rated whether each of 11 modifications to clinical trial activities would affect their decision to participate in a trial during or after the pandemic. Items evaluated modifications that involved changing the location of trial activities to closer to home, switching trial activities to telemedicine and making the trial schedule more flexible and convenient. Response options were “much less likely to participate”, “somewhat less likely to participate”, “would not affect my decision whether or not to participate”, “somewhat more likely to participate” and “much more likely to participate”. Current trial participants were asked to consider how modifications would affect their decision to participate in another trial. Results are reported descriptively. Results: Among 385 respondents, median age was 52 (range 25-85), 88.6% were non-Hispanic White, 52.5% had metastatic disease, 93% were receiving active treatment, 48.6% received care at an academic center and 9.6% were current trial participants. Changing location of trial activities was viewed favorably, with 70.2%, 64.6% and 54.1% of respondents indicating they would be much or somewhat more likely to participate if they could complete trial blood tests, x-ray tests or doctor visits closer to home, respectively. Similarly, the option to complete trial activities electronically was viewed favorably, with 59.6%, 58.6% and 60.9% of respondents indicating they would be much or somewhat more likely to participate if they could complete trial doctor visits, consent and questionnaires via telemedicine, respectively. With regard to modifications to make the trial schedule more flexible and convenient, respondent feedback was also favorable. 71.4%, 67.7% and 82.4% of respondents indicated that requiring study site visits no more than once per 3 weeks, widening windows for trial activities and offering home delivery of oral study medications, respectively, would make them much or somewhat more likely to participate. Finally, 30.4% and 51.7% indicated that the flexibility to opt-out of research-only blood tests and biopsies, respectively, would make them much or somewhat more likely to participate. Conclusions: Patients view modifications to trial activities implemented during the pandemic favorably. Trials should be flexible and the option to conduct study activities close to home or electronically when possible should be maintained during the pandemic and beyond.

PURPOSE Nearly 40% of patients with breast cancer discontinue their adjuvant oral endocrine treatment (ET). We measured discontinuation rates of ET at a comprehensive cancer center. We then used an iterative approach to model patterns of determinants associated with discontinuation of ET. METHODS Patients with nonmetastatic breast cancer receiving active adjuvant ET were approached by nurse practitioners to complete an anonymous survey at one time point. We simulated a prospective model by iteratively regressing adverse effects onto adherence status across windowed time periods of 2 to 3 consecutive years, bootstrapping the smaller group of nonadherent patients and subsampling the larger adherent group. RESULTS From February to April 2013, 216 participants were enrolled in the study. Forty patients (18.5%) reported that they had discontinued ET during the first 5 years of ET, and an additional four patients (1.9%) missed > 20% of their doses. Using two-sided significance tests, simulations showed that all 13 ET adverse effects and reasons for discontinuation were significantly related to discontinuation at some time point during ET. Worry about ET cost (odds ratio [OR], 1.79), emotional distress (OR, 1.72), and bone and joint pain (OR, 1.69) were the three most impactful reasons for discontinuation, with varying patterns of influence over time. CONCLUSION These analyses provide preliminary evidence that there are varying patterns of discontinuation of ET. Although some reasons for discontinuation exerted a steady influence over the 6-year ET trajectory (ie, bone and joint pain), other reasons, such as cost, cognitive complaints, and general dislike of pills, became more important in the later years of ET.

Members of the Translational Breast Cancer Research Consortium conducted an expert-driven literature review to identify a list of domains and to evaluate potential measures of these domains for inclusion in a list of preferred measures. Measures were included if they were easily available, free of charge, and had acceptable psychometrics based on published peer-reviewed analyses. A total of 22 domains and 52 measures were identified during the selection process. Taken together, these measures form a reliable and validated list of measurement tools that are easily available and used in multiple cancer trials to assess patient-reported outcomes in relevant patients.

Shortened versions of self-reported questionnaires may be used to reduce respondent burden. When shortened screening tools are used, it is desirable to maintain equivalent diagnostic accuracy to full-length forms. This manuscript presents a case study that illustrates how external data and individual participant data meta-analysis can be used to assess the equivalence in diagnostic accuracy between a shortened and full-length form. This case study compares the Patient Health Questionnaire-9 (PHQ-9) and a 4-item shortened version (PHQ-Dep-4) that was previously developed using optimal test assembly methods. Using a large database of 75 primary studies (34,698 participants, 3,392 major depression cases), we evaluated whether the PHQ-Dep-4 cutoff of ≥ 4 maintained equivalent diagnostic accuracy to a PHQ-9 cutoff of ≥ 10. Using this external validation dataset, a PHQ-Dep-4 cutoff of ≥ 4 maximized the sum of sensitivity and specificity, with a sensitivity of 0.88 (95% CI 0.81, 0.93), 0.68 (95% CI 0.56, 0.78), and 0.80 (95% CI 0.73, 0.85) for the semi-structured, fully structured, and MINI reference standard categories, respectively, and a specificity of 0.79 (95% CI 0.74, 0.83), 0.85 (95% CI 0.78, 0.90), and 0.83 (95% CI 0.80, 0.86) for the semi-structured, fully structured, and MINI reference standard categories, respectively. While equivalence with a PHQ-9 cutoff of ≥ 10 was not established, we found the sensitivity of the PHQ-Dep-4 to be non-inferior to that of the PHQ-9, and the specificity of the PHQ-Dep-4 to be marginally smaller than the PHQ-9.

6076 Background: Remote patient monitoring (RPM) may improve the early detection and mitigation of cancer treatment-related complications, health-related outcomes and quality of life. RPM’s success may depend, in part, on patients’ adherence to remote monitoring protocols. However, factors that influence adherence to RPM are largely unknown. Daily blood pressure/pulse (BP/P), weight, and electronic patient-reported outcomes (ePROs) were monitored remotely in head and neck cancer (HNC) patients undergoing radiation treatment (RT) to identify dehydration risk. We evaluated potential factors associated with RPM adherence. Methods: During RT (average 6 to 7 weeks), participants were asked to take daily (Monday-Friday) measures of BP/P and weight using Bluetooth-enabled devices and to complete daily ePROs using a mobile tablet application (app). Data were provided to their physicians for daily review. The MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) was completed at baseline and end of RT, and 6-8 weeks post-RT completion. The Patient Activation Measure (PAM) was completed at baseline and 6-8 weeks post-RT completion. A device usability survey measuring perceived usefulness of RPM was completed at the end of RT. Adherence to daily monitoring was recorded objectively. Longitudinal analyses compared the relationship between demographic, clinical, and PRO data and monitoring adherence. Results: Participants (n = 169) were 80% male, 87% White, and 91% married. Overall adherence to monitoring BP/P, weight, and ePROs was 83%, 82% and 74%, respectively. Greater HN-specific symptom severity and interference was associated with decreased adherence to daily monitoring of BP/P, weight, and ePROs (P< 0.021). Higher PAM scores were associated with higher adherence to daily monitoring of BP/P only (p = 0.006). Participants reported modest levels of perceived usefulness of RPM across four categories: symptom management, early problem detection, illness monitoring by healthcare provider, and feeling of security during RT. Only a single item indicating perceived feeling of security was associated with greater adherence to daily monitoring of blood pressure/pulse (p = 0.032) and weight (p = 0.007). Conclusions: A benefit of frequent RPM may be early detection and mitigation of symptoms during RT for HNC, however, increasing symptom burden experienced during treatment may interfere with adherence to daily monitoring. Better adherence may be attributed to patients perceiving a sense of security from daily monitoring and may suggest a potentially important value that patients gain from RPM. Understanding factors that impact patient adherence to RPM may help improve acceptability and clinical utility of RPM in oncology. Clinical trial information: NCT02253238.

1564 Background: Enrollment in clinical trials has declined during the COVID-19 pandemic. Simultaneously, breast cancer patients have reported heightened anxiety. We assessed whether breast cancer patients’ anxiety about the pandemic affects their willingness to participate in trials. Methods: English or Spanish-speaking US residents with breast cancer were eligible to complete the online REDCap survey 8/6/21 – 9/30/21. Respondents rated their anxiety about the pandemic on an 11-point scale from 0 (no anxiety) to 10 (worst anxiety possible). Anxiety scores were categorized as no/mild (0-3), moderate (4-6) or severe (7-10). Knowledge about trials was assessed with 11 true/false items and attitudes toward trials with the Attitudes Toward Cancer Trials Scales - Cancer Treatment Subscale (ATCTS-CTS). Respondents rated their willingness to participate in a breast cancer clinical trial before and during the pandemic on 5-point scales from 0 (not at all willing) to 4 (definitely willing). Trial participants were considered “definitely willing.” Change in willingness to participate in trials during the pandemic compared to prior was defined as a binary outcome, "less willing" vs "no less willing." Means were compared via t-test and mean difference was tested via paired t-test. Multivariable logistic regression was used to model the association of anxiety and other factors with being less willing to participate in trials during compared to prior to the pandemic. Results: Among 385 respondents, median age was 52 (range 25-85), 271 (70%) were non-Hispanic White and 202 (53%) had metastatic disease. 154 (40%) received care at academic centers and 37 (10%) were current trial participants. Most rated their anxiety as moderate (43%) or severe (38%). Mean willingness to participate in a trial was lower during compared to prior to the pandemic (2.97 vs 3.10; p < 0.0001). Fifty (13%) respondents were less willing to participate in a trial during the pandemic compared to prior. After controlling for covariates, those with severe anxiety had 5.07 times odds of being less willing to participate during the pandemic compared to prior than those with no/mild anxiety (p = 0.01). For every 1-point increase in ATCTS-CTS score (indicating better attitude toward trials) there was a 3% decrease in the odds of being less willing to participate during the pandemic (p = 0.006). For every 1-point increase in the clinical trials knowledge score (indicating more knowledge) there was a 15% decrease in the odds of being less willing to participate during the pandemic (p = 0.02). Conclusions: Pandemic-related anxiety is common in breast cancer patients and is associated with being less willing to participate in trials during the pandemic compared to prior. Education about trials, including safety modifications implemented during the pandemic, may mitigate anxiety and improve willingness to participate.

Importance The Patient Health Questionnaire depression module (PHQ-9) is a 9-item self-administered instrument used for detecting depression and assessing severity of depression. The Patient Health Questionnaire-2 (PHQ-2) consists of the first 2 items of the PHQ-9 (which assess the frequency of depressed mood and anhedonia) and can be used as a first step to identify patients for evaluation with the full PHQ-9. Objective To estimate PHQ-2 accuracy alone and combined with the PHQ-9 for detecting major depression. Data sources MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-May 2018). Study selection Eligible data sets compared PHQ-2 scores with major depression diagnoses from a validated diagnostic interview. Data extraction and synthesis Individual participant data were synthesized with bivariate random-effects meta-analysis to estimate pooled sensitivity and specificity of the PHQ-2 alone among studies using semistructured, fully structured, or Mini International Neuropsychiatric Interview (MINI) diagnostic interviews separately and in combination with the PHQ-9 vs the PHQ-9 alone for studies that used semistructured interviews. The PHQ-2 score ranges from 0 to 6, and the PHQ-9 score ranges from 0 to 27. Results Individual participant data were obtained from 100 of 136 eligible studies (44 318 participants; 4572 with major depression [10%]; mean [SD] age, 49 [17] years; 59% female). Among studies that used semistructured interviews, PHQ-2 sensitivity and specificity (95% CI) were 0.91 (0.88-0.94) and 0.67 (0.64-0.71) for cutoff scores of 2 or greater and 0.72 (0.67-0.77) and 0.85 (0.83-0.87) for cutoff scores of 3 or greater. Sensitivity was significantly greater for semistructured vs fully structured interviews. Specificity was not significantly different across the types of interviews. The area under the receiver operating characteristic curve was 0.88 (0.86-0.89) for semistructured interviews, 0.82 (0.81-0.84) for fully structured interviews, and 0.87 (0.85-0.88) for the MINI. There were no significant subgroup differences. For semistructured interviews, sensitivity for PHQ-2 scores of 2 or greater followed by PHQ-9 scores of 10 or greater (0.82 [0.76-0.86]) was not significantly different than PHQ-9 scores of 10 or greater alone (0.86 [0.80-0.90]); specificity for the combination was significantly but minimally higher (0.87 [0.84-0.89] vs 0.85 [0.82-0.87]). The area under the curve was 0.90 (0.89-0.91). The combination was estimated to reduce the number of participants needing to complete the full PHQ-9 by 57% (56%-58%). Conclusions and relevance In an individual participant data meta-analysis of studies that compared PHQ scores with major depression diagnoses, the combination of PHQ-2 (with cutoff ≥2) followed by PHQ-9 (with cutoff ≥10) had similar sensitivity but higher specificity compared with PHQ-9 cutoff scores of 10 or greater alone. Further research is needed to understand the clinical and research value of this combined approach to screening.

Objectives: Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores >= 10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 >= 10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. Study Design and Setting: Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. Results: A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 >= 10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 >= 10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 >= 14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 >= 14 (95% prediction interval: -13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: -16.4%, 15.0%). Conclusion: PHQ-9 >= 10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies. (C) 2020 Elsevier Inc. All rights reserved.

// Desire K. Christensen 1 , Guillermo N. Armaiz-Pena 2 , Edgardo Ramirez 1 , Koji Matsuo 3 , Bridget Zimmerman 4 , Behrouz Zand 5, 6 , Eileen Shinn 7 , Michael J. Goodheart 8, 9 , David Bender 8 , Premal H. Thaker 10 , Amina Ahmed 11 , Frank J. Penedo 12 , Koen DeGeest 13 , Luis Mendez 14 , Frederick Domann 15 , Anil K. Sood 5, 6 , Susan K. Lutgendorf 1, 8, 9, 16 1 Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA 2 Department of Pharmacology, Ponce Health Sciences University, Ponce, Puerto Rico 3 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA 4 Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA 5 Department of Gynecologic Oncology and Reproductive Medicine, UT MD Anderson Comprehensive Cancer Center, Houston, Texas, USA 6 Department of Cancer Biology, and Center for RNA Interference and Noncoding RNA, UT MD Anderson Comprehensive Cancer Center, Houston, Texas, USA 7 Department of Behavioral Science, UT MD Anderson Comprehensive Cancer Center, Houston, Texas, USA 8 Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA 9 Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA 10 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri, USA 11 Department of Obstetrics and Gynecology, Lutheran General Hospital, Park Ridge, Illinois, USA 12 Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA 13 Division of Gynecologic Oncology, Oregon Health and Sciences University, Portland, Oregon, USA 14 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Florida International University School of Medicine, Miami, Florida, USA 15 Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA 16 Department of Urology, University of Iowa, Iowa City, Iowa, USA Correspondence to: Susan K. Lutgendorf, e-mail: susan-lutgendorf@uiowa.edu Keywords: selective serotonin reuptake inhibitors, epithelial ovarian cancer, serotonin, progression, cell proliferation Received: November 09, 2015 Accepted: April 02, 2016 Published: April 21, 2016 ABSTRACT Selective serotonin reuptake inhibitor (SSRI) use is common among ovarian cancer patients. We examined the effect of SSRIs on survival and progression in ovarian cancer patients and effects of 5-HT on ovarian cancer cell (OCC) proliferation. Ovarian cancer patients from a 6-site study between 1994 and 2010 were included. Cox proportional hazards models were used for multivariate analysis. SSRI use was associated with decreased time to disease recurrence (HR 1.3, CI 1.0-1.6, p =0.03), but not overall survival (HR 1.1, CI 0.9-1.3, p =0.56). Compared to normal ovarian cells, most OCCs had elevated 5-HT2A receptor mRNA expression (up to 1600 fold greater expression). Clonogenic survival increased in cells treated with 10 uM (1.6 fold, p

Studies have shown a modest relationship between depression and mortality in patients with cancer. Our study addressed methodological weaknesses in the literature by restricting the sample to patients with one cancer type, adjusting for factors known to affect outcome, and following up patients for a sufficient period.We prospectively followed patients newly diagnosed with squamous cell oropharyngeal cancer from the start of radiation therapy until death or until date of last clinical visit. All patients were optimally treated with radiation and sometimes chemotherapy. After adjusting for tumor stage, treatment, comorbidities, smoking, excessive alcohol use, and demographic factors, we assessed the effects of baseline self-reported depression on overall survival and recurrence.One hundred thirty participants were followed for a median of 5 years. The average age was 56 years, and 83% were male. Eighteen participants died during the study and 15 experienced disease recurrence. Self-reported depression was associated with decreased overall survival duration (hazard ratio = 3.6, 95% confidence interval = 1.2-10.8) and disease recurrence (hazard ratio = 3.8, 95% confidence interval = 1.2-12.2) in multivariate analysis. In addition, smoking was associated with disease recurrence.Patients with oropharyngeal cancer may benefit from depression screening and evidence-based treatments, if appropriate. Future studies are needed to determine whether depression is an independent prognostic factor of outcome and to elucidate biobehavioral mechanisms involved in patients with oropharyngeal cancer.

There is a need to monitor patients with cancer of the head and neck postradiation therapy, as diminished swallowing activity can result in disuse atrophy and fibrosis of the swallowing muscles. This paper describes a flexible strain sensor comprising palladium nanoislands on single-layer graphene. These piezoresistive sensors were tested on 14 disease-free head and neck cancer patients with various levels of swallowing function: from nondysphagic to severely dysphagic. The patch-like devices detected differences in (1) the consistencies of food boluses when swallowed and (2) dysphagic and nondysphagic swallows. When surface electromyography (sEMG) is obtained simultaneously with strain data, it is also possible to differentiate swallowing vs nonswallowing events. The plots of resistance vs time are correlated to specific events recorded by video X-ray fluoroscopy. Finally, we developed a machine-learning algorithm to automate the identification of bolus type being swallowed by a healthy subject (86.4%. accuracy). The algorithm was also able to discriminate between swallows of the same bolus from either the healthy subject or a dysphagic patient (94.7% accuracy). Taken together, these results may lead to noninvasive and home-based systems for monitoring of swallowing function and improved quality of life.

© 2017 Elsevier Inc. Purpose Long-term survival of women with advanced-stage ovarian cancer is relatively rare. Little is known about quality of life (QOL) and survivorship concerns of these women. Here, we describe QOL of women with advanced-stage ovarian cancer surviving for 8.5 years or longer and compare women with 0–1 recurrence to those with multiple recurrences. Methods Participants (n = 56) recruited from 5 academic medical centers and the Ovarian Cancer Research Fund Alliance completed surveys regarding QOL (FACT-O), mood (CESD), social support (SPS), physical activity (IPAQ-SF), diet, and clinical characteristics. Median survival was 14.0 years (range 8.8–33.3). Results QOL and psychological adjustment of long-term survivors was relatively good, with mean FACT-G scores (multiple recurrences: 80.81 ± 13.95; 0–1 recurrence: 89.05 ± 10.80) above norms for healthy community samples (80.1 ± 18.1). Survivors with multiple recurrences reported more compromised QOL in domains of physical and emotional well-being (p

Introduction Pharyngeal and laryngeal cancers are highly curable; however survivors are at high risk for long-term dysphagia after radiation. To address lack of access to preventive care in community settings, we developed a responsive web-based application to help patients adhere to preventive swallowing exercises and cope with radiation side effects. We conducted an interim study analysis to determine website usage characteristics and to examine the effect size for future trials. Methods Pharyngeal and laryngeal cancer patients were recruited for enrollment by speech language pathologists before primary radiation and introduced to the interactive website. The program (English and Spanish) features tracking logs for preventive exercises, instructional videos, patient stories and search features. Patients' self-reported swallowing function was assessed with the MD Anderson Dysphagia Inventory (MDADI) at baseline and at 6 months. Adherence to preventive exercises was assessed during the 10 week intervention. Number of unique website visits, total duration of website exposure, and rankings of the most popular webpages were calculated. Preliminary regression models were run using adherence and MDADI as outcomes. Results Of the 160 enrolled, 96 had 10-week adherence data and 61 had 6-month MDADI data. The average age was 63 (SD = 12.26), 49.4% were from rural counties, 44% had a high school education or lower, and 42% reported annual income of $30,000 or less. The average number of visits was 5.49 (SD = 9.96) and the average total time spent with the website was 41.09 min (SD =88.48). Preliminary analyses indicated that number of unique visits to the website was independently associated with increased adherence to preventive exercises (p = .001–.008). Conclusion Our website showed significant effects in promoting adherence to swallowing exercises. However, our return visit rate showed that the platform needs improvement in navigability and usability for this older population undergoing challenging treatment in community settings with low resources., Highlights • An adherence and coping website was developed for community-based head and neck cancer patients undergoing curative radiation • The website content utilized self-management concepts to promote adherence • During the 10-week program, patients averaged 5.5 unique visits and spent an average of 41 minutes total. • Adherence to swallowing and trismus exercises was significantly associated with increased number of unique webpage visits

Background To reduce the risk of long-term swallowing complications after radiation, swallowing exercises may be helpful. Both the rate of adherence to swallowing exercises and its impact on future swallowing function are unknown. Methods In all, 109 patients with oropharyngeal cancer beginning radiation were tracked for 2 years to determine adherence to swallowing exercises. Participants completed the MD Anderson Dysphagia Inventory (MDADI) 1–2 years after treatment, to assess self-reported swallowing function. Adherence, demographics, tumor, and treatment variables were multivariably regressed onto the MDADI physical subscale score. Results In accord with speech pathologist documentation, 13% of the participants were fully adherent and 32% were partially adherent. Adherence was associated with the Physical MDADI Subscale score in the multivariate model (p = .01). Conclusions The majority of patients with head and neck cancer are nonadherent to swallowing exercise regimens and may benefit from supportive care strategies to optimize their adherence. © 2013 Wiley Periodicals, Inc. Head Neck 35: 1707–1712, 2013

OBJECTIVES: We compared the diagnostic accuracy of 4 depression screening scales, using traditional and alternative scoring methods, to the gold standard Structured Clinical Interview-DSM IV major depressive episode (MDE) in ovarian cancer patients on active treatment. METHODS: At the beginning of a new chemotherapy regimen, ovarian cancer patients completed the following surveys on the same day: the Center for Epidemiological Studies Depression Scale (CES-D), the Beck Depression Inventory Fast-Screen for Primary Care (BDI-FastScreen), the Patient Health Questionnaire-9 (PHQ-9), and a 1-item screener (“Are you depressed?”). Each instrument's sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated with respect to major depression. To control for antidepressant use, the analyses were re-run for a subsample of patients who were not on antidepressants. RESULTS: One hundred fifty-three ovarian cancer patients were enrolled into the study. Only fourteen participants met SCID criteria for current MDE (9%). When evaluating all patients regardless of whether they were already being treated with antidepressants, the two-phase scoring approach with an alternate cutpoint of 6 on the PHQ-9 had the best positive predictive value (PPV=32%). Using a traditional cutpoint of 16 on the CES-D resulted in the lowest PPV (5%); using a more stringent cutpoint of 22 resulted in a slightly improved but still poor PPV, 7%. CONCLUSIONS: Screening with a two-phase PHQ-9 proved best overall, and its accuracy was improved when used with patients who were not already being treated with antidepressants.

Testing emerging technologies involves the evaluation of biologic plausibility, technical efficacy, clinical effectiveness, patient satisfaction, and cost-effectiveness. The objective of this study was to select an effective classification algorithm for optical spectroscopy as an adjunct to colposcopy and obtain preliminary estimates of its accuracy for the detection of CIN 2 or worse. We recruited 1,000 patients from screening and prevention clinics and 850 patients from colposcopy clinics at two comprehensive cancer centers and a community hospital. Optical spectroscopy was performed, and 4,864 biopsies were obtained from the sites measured, including abnormal and normal colposcopic areas. The gold standard was the histologic report of biopsies, read 2 to 3 times by histopathologists blinded to the cytologic, histopathologic, and spectroscopic results. We calculated sensitivities, specificities, receiver operating characteristic (ROC) curves, and areas under the ROC curves. We identified a cutpoint for an algorithm based on optical spectroscopy that yielded an estimated sensitivity of 1.00 [95% confidence interval (CI) = 0.92-1.00] and an estimated specificity of 0.71 [95% CI = 0.62-0.79] in a combined screening and diagnostic population. The positive and negative predictive values were 0.58 and 1.00, respectively. The area under the ROC curve was 0.85 (95% CI = 0.81-0.89). The per-patient and per-site performance were similar in the diagnostic and poorer in the screening settings. Like colposcopy, the device performs best in a diagnostic population. Alternative statistical approaches demonstrate that the analysis is robust and that spectroscopy works as well as or slightly better than colposcopy for the detection of CIN 2 to cancer.

There is a need to monitor patients with cancer of the head and neck post-radiation therapy, as diminished swallowing activity can result in disuse atrophy and fibrosis of the swallowing muscles. This paper describes a flexible strain sensor comprising palladium nanoislands on single-layer graphene. These piezoresistive sensors were tested on 14 disease-free head and neck cancer patients with various levels of swallowing function: from non-dysphagic to severely dysphagic. The patch-like devices detected differences in (1) the consistencies of food boluses when swallowed and (2) dysphagic and non-dysphagic swallows. When surface electromyography (sEMG) is obtained simultaneously with strain data, it is also possible to differentiate swallowing vs. non-swallowing events. The plots of resistance vs. time are correlated to specific events recorded by video X-ray fluoroscopy. Finally, we developed a machine learning algorithm to automate the identification of bolus type being swallowed by a healthy subject (86.4%. accuracy). The algorithm was also able to discriminate between swallows of the same bolus from either the healthy subject or a dysphagic patient (94.7% accuracy). Taken together, these results may lead to noninvasive and home-based systems for monitoring of swallowing function and improved quality of life.

6063Background: Assessment and intervention with mobile and sensor technology may improve early detection and mitigation of treatment-related symptoms, impact quality of life (QOL), reduce complications, and lower health care costs. The CYCORE (CYberinfrastructure for COmparative effectiveness Research) system utilizes sensor and mobile technology to remotely assess daily weight, blood pressure (BP)/pulse, and patient-reported outcomes in head and neck cancer (HNC) patients undergoing radiation treatment (RT). Clinicians reviewed data daily to identify early risk of dehydration and support early intervention to improve symptom management. We compared longitudinal symptom data in patients randomized to use CYCORE during RT versus those randomized to usual care. Methods: Methods: HNC patients (n = 357) completed the 28-item MD Anderson Symptom Inventory (MDASI) at RT initiation (baseline), completion of RT (6-7 weeks post-baseline), and 6-8 weeks post-RT completion. Symptom severity and interference were ra...

BACKGROUND: Research suggests that glucose levels in cancer patients may be an important prognostic indicator. In ovarian tumors, increased expression of glucose transporter 1 (GLUT1), a transmembrane protein responsible for glucose uptake, is related to shorter survival time in ovarian cancer patients. This study tested the hypothesis that higher presurgical glucose levels predict shorter disease-specific survival time and time to recurrence in ovarian cancer patients. METHODS: Nonfasting plasma glucose levels were determined for 74 patients with ovarian cancer at the time of their presurgical consultation and for 125 ovarian cancer patients in an independent validation set. Survival time and time to recurrence (disease-free interval [DFI]) were ascertained from medical records. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) for survival time and DFI in relation to glucose level, adjusting for body mass index (BMI), stage, grade, and cytoreduction as appropriate. RESULTS: Higher glucose levels were associated with shorter survival times in univariate analyses (HR, 1.88; P = .05). Multivariate analysis adjusting for stage showed that higher glucose levels were associated with shorter survival times (HR, 2.01; P = .04) and DFI (HR, 2.32; P = .05). In the validation set, higher glucose levels were associated with shorter survival times (HR, 2.01; P = .02) and DFI (HR, 2.48; P = .001) in univariate analysis, although glucose was not independent of the effect of cytoreduction when predicting survival time in this latter set. CONCLUSIONS: These findings contribute to mounting evidence that glucose levels have prognostic value in ovarian carcinoma. Cancer 2009. © 2009 American Cancer Society.

Many breast cancer survivors experience long term sequelae, including fatigue, decreased physical functioning, pain, and psychological distress. Physical activity can ameliorate these problems, but there is little research on how activity should be performed to be most beneficial. This study explores how dimensions of physical activity (total energy expenditure, frequency, and duration) are associated with symptoms among breast cancer survivors.We conducted a secondary analysis of data on physical activity behavior and symptoms in a cross-sectional study (n = 148) of breast cancer survivors who were off treatment and had been diagnosed within the past 5 years.Multivariate analyses showed that total energy expenditure was associated with better general health (p = 0.006) and fewer depressive symptoms (p = 0.014), while frequency of activity was linearly related to physical functioning (p = 0.047), pain (0.057), general health (p0.001), and depressive symptoms (p0.001). Duration was related to physical functioning, pain, and general health, but the worst outcomes were reported by the participants with the shortest and longest duration of activity (quadratic trend p values = 0.002, 0.003, 0.008, respectively).Greater total energy expenditure, higher physical activity frequency, and moderate duration were associated with better outcomes for most symptoms, although there was no relationship between any of the dimensions of physical activity and fatigue.The association of better outcomes with higher energy expenditure, higher frequency of activity, and moderate duration indicates that increasing activity through multiple short bouts may be the most beneficial for breast cancer survivors. However, randomized studies are needed to confirm this finding.

Objective This paper will report the results of a pilot test of a 6-month, 21-session intervention to increase breast cancer survivors’ physical activity by teaching them to incorporate short periods of moderate activity into their daily routines (lifestyle intervention). The effect of the intervention on physical performance, quality of life, and physical activity are reported. Methods Sixty breast cancer survivors were randomized to either a lifestyle intervention or a standard care control group. Physical performance, quality of life (Medical outcomes study short form-36 [SF-36]), and physical activity (7-day recall and motivation readiness), were assessed at baseline and 6 months. Results The lifestyle group had significantly better performance in the 6-min walk task than the controls ( p = 0.005) at 6 months. The intervention had positive effects on the bodily pain ( p = 0.020) and general health ( p = 0.006) subscales from the SF-36. The lifestyle group had a greater motivational readiness for physical activity at 6-month than standard care, but no significant differences were seen between the two in terms of number of minutes of moderate or more intense physical activity or number of days on which they did ≥30 min of moderate or more intense activity. Conclusions Despite the small sample size, the lifestyle intervention showed promise for improving physical functioning and quality of life and increasing physical activity, and should be tested in a larger randomized trial. Practice Implications If the lifestyle approach is shown to be effective in a larger trial, it represents a highly feasible intervention that it can be delivered to cancer survivors by health care institutions or community organizations without dedicated exercise facilities and equipment.

The potential of communication and health information technologies to transform research and improve clinical care in cancer has only begun to be realized (1,2). There is a need for innovative strategies and technologies that enable the aggregation and analysis of clinical and research data (including real-time health-related outcomes) and that foster the translation of knowledge gained into improvements in patient care (2–4). The use of health information technologies may alter how health-care providers and patients interact with personal health information by facilitating the collection, analysis, and dissemination of data to enhance clinical decision making (3). In turn, patients may report symptoms more readily and be reassured knowing that their providers are better informed about all aspects of their treatment and care. The American Society of Clinical Oncology has emphasized the need to use communication and information technology to better integrate clinical and translational research with patient care so that patients’ experiences can inform research and improve care (1). Accomplishing this goal requires a systems approach that enables greater and more rapid access to patient clinical information to better understand therapeutic responses, side effects, quality of life, and general health status (1). This approach may improve oncology care by synthesizing and distilling large amounts of data to identify earlier opportunities to manage treatment side effects and complications, as well as long-term survivorship issues (1,3). Systems that enable remote and real-time monitoring of patients’ symptoms and other health-related outcomes may offer cost-effective strategies to optimize cancer care outside of the clinic setting (5,6). Remote collection and transmission of patient health–related data to facilitate clinical decision making have been used in the management of chronic diseases other than cancer (7–12), and this has been shown to improve patient quality of life and symptom control, decrease emergency room visits and unplanned hospitalizations, and decrease overall health-care costs (12–15). Less is known about which patients and under which circumstances remote monitoring is most appropriate and effective, particularly in oncology (16,17). Studies evaluating remote real-time monitoring of cancer patients have reported positive outcomes (5); however, empiric evidence includes the collection of patient-reported outcomes largely using currently available telecommunications technologies (17,18). Systems that include biometric and self-reported feedback for cancer patients have been conceptualized; however, there is limited evidence regarding their feasibility or efficacy (19,20). This paper describes the results of an initial application of a novel system that incorporates data on environmental, psychological, treatment adherence, and lifestyle behaviors and the patient-reported outcomes into cancer treatment and research. The system, called CYCORE (CYberinfrastructure for COmparative effectiveness REsearch), is a software-based prototype of a user-friendly cyberinfrastructure that supports the acquisition, storage, visualization, analysis, and communication of data across the cancer continuum, using a suite of home-based and mobile sensors (19). Health-related data collected include symptoms, quality of life, performance status, and physiological parameters that can signal how patients are self-managing their treatment. The CYCORE prototype was rigorously tested in several diverse use cases that were grounded in challenging, real-world clinical problems in cancer prevention and treatment (19). One use case, which is the focus of this report, engaged head and neck cancer (HNC) patients in the use of home-based sensors for collecting and communicating blood pressure, pulse, weight, and patient-reported symptoms to their HNC radiation therapy (RT) clinicians. Clinicians reviewed these data outside of clinic visits for earlier identification of dehydration risk secondary to outpatient RT. HNCs are highly curable, yet primary RT is physically and emotionally challenging for patients (21). RT involves a 6- to 7-week course of 5 day/week treatments and causes serious locoregional side effects. In its severe form, mucositis, which occurs in up to 80% of irradiated HNC patients, makes it very difficult for patients to drink adequate levels of fluids (22). As a result, dehydration and its accompanying physiological changes can develop rapidly, often between weekly physician visits that are standard of care during RT. When unresolved, dehydration can lead to acute episodes requiring hospitalization and/or emergency care visits that are costly and potentially preventable. The number of patients affected is substantial, as up to 27% of HNC patients may be admitted to inpatient or emergency care units during RT (23–25) (personal communication, E. Shinn). Dehydration may represent one of the largest incremental health-care expenses in treating mucositis and related side effects for HNC (23). The development of systems to closely monitor hydration status has been suggested as a potentially valuable intervention that may reduce hospitalization and health-care costs, in addition to improving quality of life (26–28). Technology that supports remote monitoring of HNC patients during RT may enable greater access to clinical and patient-reported data that are currently unavailable, may provide greater insight into patients’ therapeutic response, and may help to identify opportunities for earlier and more effective intervention. In this context, CYCORE may serve as a new model of a communication architecture for improving clinical care and patient support outside of the clinic setting during critical periods of cancer treatment. This study evaluated the feasibility of using CYCORE to address early at-home identification of dehydration risk in HNC patients undergoing RT.

Background: A retrospective cohort study utilizing prospectively collected data was conducted from August 2003 until March 2008 at M.D. Anderson Cancer Center. It is unknown whether cardiovascular comorbidity and chronic stress impact ovarian cancer outcome, which remains poor despite advances in therapy. The purpose of this study was to determine whether cardiovascular disease and markers that may be associated with stress are also associated with survival in patients with ovarian cancer. Methods: Participants with newly diagnosed epithelial ovarian cancer were followed until time of death or truncation of study period (median follow-up = 4.2 years; n = 271). Tumor characteristics (stage, tumor grade, histology, debulking status), demographic variables, and cardiovascular comorbidity were documented and compared to overall survival. Results: Of the nine cardiovascular events tracked during follow-up, venous thromboembolism [VTE; HR, 3.2; 95% confidence interval (CI), 1.8–5.5] and pulmonary hypertension (HR, 8.5; 95% CI, 3.9–18.7) were associated with shorter survival in multivariate analysis. In addition, high tumor grade, suboptimal cytoreduction, and baseline heart rate (HR, 1.02; 95% CI, 1.01–1.04) were related to decreased survival. Conclusion: Careful management of certain cardiovascular comorbidities may extend survival in patients with ovarian cancer. Our findings suggest that increased baseline heart rate and the development of VTE and pulmonary hypertension after cancer diagnosis may be significant predictors of survival in women with ovarian cancer. Impact: Our study emphasizes the importance of identifying and optimally treating tachycardia, VTE, and pulmonary hypertension in conjunction with cancer therapy. Cancer Epidemiol Biomarkers Prev; 22(11); 2102–9. ©2013 AACR.

Introduction: While racial/ethnic disparities in cervical cancer incidence are mostly attributed to screening test utilization, lower rates of adherence to diagnostic and clinical follow-up after an abnormal Pap test may contribute to the higher cervical cancer mortality among racial/ethnic minorities. Psychological distress is a known contributor to non-adherence to diagnostic and therapeutic follow-up. The objective of this analysis is to explore racial/ethnic differences in distress following an abnormal Pap. Methods: Data were collected as part of a clinical trial to evaluate emerging optical technologies for the diagnosis of cervical dysplasia. Participants were non-pregnant women, age ≥18 years, with a recent abnormal Pap test and were recruited at one of the participating colposcopy clinics. Participants answered questionnaires before and after their colposcopy procedure. Distress regarding the abnormal Pap was assessed using the Cervical Dysplasia Distress Questionnaire (CDDQ). The CDDQ measures multiple domains of distress, including those related to the colposcopy procedure (i.e., Tension and Discomfort, Embarrassment), as well as those related to having a positive screening test for cervical cancer (i.e., Health Consequences, Sexual/Reproductive Consequences). Additional items assessed participants' fear of cancer. Subscale scores range from 1 to 4, with higher scores indicating higher levels of distress. Linear regression models were built to assess the differences in distress scores among Hispanic, non-Hispanic black, and non-Hispanic white women after controlling for age and education (Model 1) and age, education, trait anxiety and depression (Model 2). Trait anxiety and depression were respectively measured using the State-Trait Anxiety Inventory for Adults and the Center for Epidemiologic Studies Depression (CESD) scale. Results: Eighty-five Hispanic, 55 non-Hispanic black, and 86 non-Hispanic white women were included in these analyses. After controlling for age and education, there were statistically significant differences by race/ethnicity in distress scores, particularly for the domains of health consequences (p=0.02) and cancer worry (p = 0.014). In both domains, scores were highest among Hispanic women, compared to non-Hispanic black and non-Hispanic white women (mean health consequences scores = 2.45, 2.02, and 2.16, respectively; mean cancer worry scores = 2.02, 1.62, and 1.75, respectively). Furthermore, these racial/ethnic differences in domain-specific distress remained statistically significant after controlling for differences in underlying depression and trait anxiety. Discussion: Our results suggest that there are racial/ethnic differences in levels of distress following an abnormal Pap test, particularly related to concerns over health consequences and fear of cancer. Distress scores in these domains were significantly greater among Hispanic women compared to non-Hispanic blacks and non-Hispanic whites. Hispanic women may be more likely to perceive that their abnormal Pap test will have long-term health consequences and develop into cancer. Clinical and ancillary health professionals who communicate Pap test results to Hispanic patients should reinforce messages to address unrealistic fears about disease and alleviate distress. Citation Format: Jane R. Montealegre, Michael E. Scheurer, Eileen H. Shinn, Thelma Carrillo, Zuber Mulla, Michele Follen, Karen Basen-Engquist. Racial/ethnic variation in psychological distress following an abnormal Pap test. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C17.

152 Background: Early identification and mitigation of cancer therapy-induced complications can improve quality of life and reduce complications and health care costs. We are evaluating the efficacy of a system, called CYCORE (CYberinfrastructure for Comparative effectiveness Research), to systematically and accurately collect daily weight, blood pressure, pulse and symptom data from head and neck cancer (HNC) survivors during their 6 to 7-week radiation treatment (RT) regimen using home-based biometric and other sensors integrated with a cyber-physical system. Aims include: 1) evaluate CYCORE’s efficacy in reducing hospitalization and emergency room visits related to dehydration; and, 2) evaluate related impact on costs related to treating dehydration. Methods: Remote, sensor-based monitoring via CYCORE identifies HNC survivors at increased risk for dehydration (i.e., reduced blood pressure and weight, increased pulse, and patient-reported outcomes (PROs) including decreased food and fluid intake). Upon initation of RT, HNC survivors are randomized to either: 1) standard care plus use of the CYCORE system, wherein biometric sensor data and PROs (e.g., pain, nausea, medications, food/fluid intake) are collected ; or, 2) standard care. Outcomes include hospital and emergency room admissions, and related costs. Results: To date, 113 survivors are enrolled (88.9% recruitment and 90.3% retention rates). Those randomized to CYCORE take daily home readings of weight, blood pressure and pulse via Bluetooth-enabled devices, and complete daily PRO assessments on a mobile application. Survivors’ data are available for viewing and clinical decision-making via a Web-based interface by their physicians and other providers. Previously, 59% of HNC survivors on RT showed physiologic signs of dehydration while using the CYCORE system. Worse ratings of nausea and vomiting predicted dehydration risk. Conclusions: CYCORE may serve as one model for integrating mobile and sensor technologies during critical periods of cancer care that occur outside of the clinic setting, and may improve management of treatment side effects, quality of life, and greater satisfaction with care. Clinical trial information: NCT02253238.

Purpose To determine the prevalence rate of health behaviors in testis cancer survivors and to determine whether the rate of health behaviors in survivors was significantly different than those of their age-matched relative controls and a population-based control group matched for age, sex, education, and income. Patients and Methods The health behaviors of 162 testis cancer survivors were compared with their age-matched relative controls (n = 74) and an age-, sex-, education-, and income-matched population-based control group (n ranged from 1,123 to 9,775). Health behaviors were assessed with the telephone-administered Behavioral Risk Factor and Surveillance Survey. Results Nearly one in five testis cancer survivors reported current smoking and one third reported problem drinking. Only 11% reported having at least five servings of fruits and vegetables per day. Compared with their relative controls, the survivors were more likely to engage in regular exercise. For those participants who drank, survivors were twice as likely to engage in problem drinking and averaged a higher number of drinks compared to their Centers for Disease Control (CDC) controls. Survivors were also half as likely to have at least five servings of fruits and vegetables per day compared with the CDC controls. Conclusion The overall picture regarding testis cancer survivors' health behaviors was mixed compared with the relative and CDC control groups. Our results suggest that reduced alcohol use and increased fruit and vegetable consumption may be important targets for future disease prevention in testis cancer survivors.

Objectives:This study was undertaken to understand how women view characteristics of tests for cervical dysplasia, because these characteristics can affect patient decision-making about screening and follow-up.Methods:We recruited women who participated in a clinical trial of optical spectroscopy for the diagnosis of cervical dysplasia and used conjoint analysis to assess the women's preferences concerning test attributes. One group of women had a history of an abnormal Papanicolaou smear (diagnostic sample), while the other group did not (screening sample). Participants rated pairs of test scenarios that varied on characteristics such as test sensitivity and painfulness. Based on their responses, the relative importance of test sensitivity, specificity, timing of results feedback and treatment, and pain were calculated, and a cluster analysis was done to identify subgroups of participants with different preference patterns.Results:In the overall sample, sensitivity was the most important attribute, followed by timing, specificity, and pain. Cluster analysis revealed four distinct groups who placed varying importance on each characteristic. The participants in the cluster for which pain was the most important attribute were more likely to be diagnostic patients, non-white, and have low education levels. They also reported more anxiety and pain during the examination than participants in other clusters.Conclusions:To continue to reduce morbidity and mortality from cervical cancer, developers of new testing procedures should take into account test attributes such as these, which may affect adherence to screening and diagnostic follow-up to further minimize morbidity and mortality from cervical cancer.

Background. Psychological distress is severe in women who receive a report of abnormal findings on Pap smear, and may be one reason 10–61% of such women fail to undergo follow-up testing. Methods. Using the 14-question Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q) as a basis, we developed the 23-question Cervical Dysplasia Distress Questionnaire (CDDQ), testing its internal consistency and validity with 661 women undergoing colposcopy after an abnormal Pap smear finding in a three-phase analysis. Results. Items were divided into two sets and factor analyzed separately: one addressed distress during medical procedures, and the other concerned perceived consequences of an abnormal Pap smear. The medical procedures items yielded two factors: embarrassment regarding the procedures and discomfort/tension with the procedures. Factor analysis of the second set also resulted in two factors: concern about sexual and reproductive issues and concern about health consequences. Subscales created from items loading highly on each factor had high internal consistency (α ranged from 0.76 to 0.90) and demonstrated good concurrent validity with other psychometrically validated measures of distress. Conclusions. The CDDQ is a reliable and valid questionnaire for measuring multiple domains of distress unique to women who test positive on a cervical cancer screening test.

Purpose To characterize sexual functioning of ovarian cancer patients and identify factors predicting sexual activity, functioning or satisfaction, discomfort, and habit or frequency. Patients and Methods Data were collected on 232 women with epithelial ovarian cancer, 47% of whom were receiving treatment. Results Fifty percent of the patients had engaged in sexual activity in the past month. Of those who were sexually active, 47% reported no or little desire, 80% reported problems with vaginal dryness, and 62% reported pain or discomfort during penetration. Of those who were sexually inactive, reasons included no partner (44.1%), lack of interest (38.7%), physical problems making sex difficult (23.4%), and fatigue (10.8%). Partner factors also were identified, including physical problems (16.2%), lack of interest (15.3%), and fatigue (5.4%). A multivariate model was used to predict sexual activity and included demographic, medical, and psychosocial factors as predictors. Women who were married (P < .001), were younger than 56 years (P < .001), were not receiving active treatment (P < .01), had a longer time since original diagnosis (P = .104), and liked the appearance of their bodies (P = .004) were more likely to be sexually active. Univariate analyses indicated that demographic, medical, and psychosocial factors are significantly associated with sexual functioning or satisfaction, sexual discomfort, and sexual frequency or habit. Conclusion Sexual rehabilitation for ovarian cancer patients should address management of physical and psychologic symptoms and include the patient's partner when appropriate.

The aim of this investigation was to evaluate the impact of optical spectroscopy, a new approach for the detection of cervical dysplasia, on patient well-being and satisfaction.Patient distress and satisfaction with optical spectroscopy compared with the Papanicolaou test and colposcopically directed biopsy were measured in a volunteer sample of 314 women with no history of abnormal Papanicolaou test findings.Participants reported significantly less pain and anxiety (P.001) during optical spectroscopy than during the Papanicolaou test or colposcopically directed biopsy. Generally, participants found spectroscopy equal to the Papanicolaou test and to biopsy on a variety of questions that measured satisfaction. There were statistically significant differences between spectroscopy and the Papanicolaou test or biopsy on issues such as the discomfort and fear caused by the test, the amount of time taken, the room lighting, and perceptions of accuracy.That patients reported less distress during spectroscopy than during a Papanicolaou test, colposcopy, or biopsy suggests the possibility of improved adherence to cervical cancer screening and follow-up in settings in which it is used.

9585 Background: Remote monitoring of patients outside of the clinic setting during critical periods of care is an emerging paradigm in oncology. CYCORE (CYberinfrastructure for COmparative effecti...

Importance Data support proactive swallowing therapy during radiotherapy (RT) or chemoradiotherapy (CRT) for pharyngeal cancers. The benefits of adherence to a regimen of swallowing exercises and maintaining oral intake throughout treatment are reported, but independent effects are unclear. Objective To evaluate the independent effects of maintaining oral intake throughout radiotherapy and adherence to preventive swallowing exercise. Design Retrospective observational study. Setting The University of Texas MD Anderson Cancer Center, Houston. Patients The study included 497 patients treated with definitive RT or CRT for pharyngeal cancer (458 oropharynx, 39 hypopharynx) between 2002 and 2008. Main Outcomes and Measures Swallowing-related end points were final diet after RT or CRT and duration of gastrostomy dependence. Primary independent variables included oral intake status at the end of RT or CRT (no oral intake, partial oral intake, or full oral intake) and adherence to a swallowing exercise regimen. Multiple linear regression and ordered logistic regression models were analyzed. Results At the conclusion of RT or CRT, 131 patients (26%) had no oral intake and 74% maintained oral intake (167 partial [34%], 199 full [40%]). Fifty-eight percent (286 of 497) reported adherence to swallowing exercises. Maintenance of oral intake during RT or CRT and swallowing exercise adherence were independently associated with better long-term diet after RT or CRT (P = .045 andP Conclusions and Relevance The data indicate independent, positive associations of maintenance of oral intake throughout RT or CRT and swallowing exercise adherence with long-term swallowing outcomes. Patients who either eat or exercise fare better than those who do neither. Patients who both eat and exercise have the highest rate of return to a regular diet and shortest duration of gastrostomy dependence.

Background Optical spectroscopy has been studied for biologic plausibility, technical efficacy, clinical effectiveness, patient satisfaction, and cost-effectiveness. Objective We sought to identify health care provider attitudes or practices that might act as barriers or to the dissemination of this new technology. Methods Through an academic–industrial partnership, we conducted a series of focus groups to examine physician barriers to optical diagnosis. The study was conducted in 2 stages. First, a pilot group of 10 physicians (8 obstetrician gynecologists and 2 family practitioners) was randomly selected from 8 regions of the United States and each physician was interviewed individually. Physicians were presented with the results of a large trial (N=980) testing the accuracy of a spectroscopy-based device in the detection of cervical neoplasia. They were also shown a prototype of the device and were given a period of time to ask questions and receive answers regarding the device. They were also asked to provide feedback on a questionnaire that was then revised and presented to 3 larger focus groups (n=13, 15, and 17 for a total N=45). The larger focus groups were conducted during national scientific meetings with 20 obstetrician gynecologists and 25 primary care physicians (family practitioners and internists). Results When asked about the dissemination potential of the new cervical screening technology, all study groups tended to rely on established clinical guidelines from their respective professional societies with regard to the screening and diagnosis of cervical cancer. In addition, study participants consistently agreed that real-time spectroscopy would be viewed positively by their patients. Participants were positive about the new technology's potential as an adjunct to colposcopy and agreed that the improved accuracy would result in reduced health care costs (due to decreased biopsies and decreased visits). Although all participants saw the potential of real-time diagnosis, there were many perceived barriers. These barriers included changes in scheduling and work-flow, liability, documentation, ease of use, length of training, device cost, and reimbursement by third-party payers. Conclusions Barriers exist to the dissemination of optical technologies into physician practice. These will need to be addressed before cervical screening and diagnosis programs can take advantage of spectroscopy-based instruments for cancer control.

B28 Background Health literacy is an important determinant of health status. Developing and evaluating health education materials for low-literate audiences is a priority and critical to helping individuals participate in health care decisions and self-management. However, questions remain as to whether low-literacy materials are appropriate for all audiences. We sought to determine if low-literacy materials would be appropriate and effective in educating individuals at wide ranges of health literacy, or if materials should be tailored to a patient’s health literacy level. Methods Eighty patients returning for follow-up colposcopy appointments were randomized to read a brochure about cervical dysplasia that was written at either a high (8th grade) or low (4th grade) reading level. Before reading the brochure, patients completed assessments of health literacy (Short Test of Functional Health Literacy in Adults, STOFHLA; Rapid Assessment of Adult Literacy in Medicine, REALM), knowledge, and perceived risk. After reading, knowledge, perceived risk, and brochure evaluation assessments were completed. Results Overall, patients had a high level of health literacy (STOFHLA M=70.1, SD=2.3; REALM, 4 patients 7-8th grade level, 76 patients 9th grade level and above). Average knowledge score before reading was 12.9 (SD=2.4) on a 17-point scale. Patients receiving either high- or low-reading level brochures improved their knowledge scores after reading (Mpst = 14.4, SDpst=1.7, p Conclusions Brochures written at low reading levels can improve knowledge about cervical dysplasia, even for patients with high health literacy, and are judged by patients to be similar in quality. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B28.