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9. Physical Therapists in Oncology Settings: Experiences in Delivering Cancer Rehabilitation Services, Barriers to Care, and Service Development Needs

Author

Brennan, Louise, Sheill, Grainne, O'Neill, Linda, O'Connor, Louise, Smyth, Emily, and Guinan, Emer

Subjects
Cancer -- Care and treatment, Physical therapists -- Services, Health
Abstract

Objective. Physical therapist-delivered rehabilitation aims to manage the side effects of cancer and its treatments. Although access to cancer rehabilitation is not yet a standard of care in many countries, physical therapists practice in many types of cancer services with different cancer populations. The purpose of this study was to explore the experiences of physical therapists in cancer care practice with regard to their role, the factors influencing service delivery and development, and physical therapists' professional development needs. Methods. In this qualitative study with semistructured interviews, physical therapists in cancer care settings in the Republic of Ireland were interviewed via telephone. Participants (n = 17) represented a variety of clinical settings and roles. Two researchers performed thematic analysis of transcriptions using a semantic, inductive approach. Key themes and codes were identified and illustrative quotes were selected. Results. Six main themes were found: the need for more services, barriers to service development and delivery, a lack of awareness of the role of physical therapy, facilitators to service development, goals for the future of oncology physical therapy, and training needs of staff. Conclusions. Physical therapists provide valuable interventions across the spectrum of cancer care but experience barriers to the delivery and development of services. Investment in oncology physical therapy and developing international standards of care will allow physical therapists to meet the rehabilitation needs of survivors of cancer. Impact. As international guidelines increasingly recommend development of cancer rehabilitation programs, it is important to understand physical therapists' experiences of working in cancer care to assist in the development of effective oncology physical therapy services. This study demonstrates that physical therapist-led cancer rehabilitation services need investment and public promotion to enable the provision of optimal services to all patients with cancer and to meet standards of care. Keywords: Cancer Rehabilitation, Oncology, Physical Therapy, Qualitative, Introduction Advances in cancer diagnosis and treatment, along with growing and aging populations, have resulted in an increased number of cancer survivors worldwide. (1,2) This pattern means that more people [...]

Published
2022
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14. Updating a Healthcare System-wide Clinical Pathway for Managing Chest Pain and Acute Coronary Syndromes

Author

Zilinyi, Robert S., primary, Fertel, Baruch S., additional, Chang, Betty C., additional, Abrukin, Liliya, additional, Suh, Edward H., additional, Sayan, Osman R., additional, McCarty, Matthew, additional, Stant, Jennifer A., additional, Chuich, Taylor, additional, Smyth, Emily T., additional, Neuberg, Gerald, additional, Collins, Michael B., additional, Kirtane, Ajay J., additional, Moses, Jeffrey, additional, and Rabbani, LeRoy, additional

Published
2023
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15. Supplementary Data 1 from Clinical and Genomic Characteristics of Patients with Hormone Receptor–Positive, Human Epidermal Growth Factor Receptor 2–Negative Metastatic Breast Cancer Following Progression on Cyclin-Dependent Kinase 4 and 6 Inhibitors

Author

Rao, Xi, primary, Chen, Yongmei, primary, Beyrer, Julie, primary, Nash Smyth, Emily, primary, Morato Guimaraes, Claudia, primary, Litchfield, Lacey M., primary, Bowman, Lee, primary, Lawrence, Garreth W., primary, Aggarwal, Amit, primary, and Andre, Fabrice, primary

Published
2023
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16. Data from Clinical and Genomic Characteristics of Patients with Hormone Receptor–Positive, Human Epidermal Growth Factor Receptor 2–Negative Metastatic Breast Cancer Following Progression on Cyclin-Dependent Kinase 4 and 6 Inhibitors

Author

Rao, Xi, primary, Chen, Yongmei, primary, Beyrer, Julie, primary, Nash Smyth, Emily, primary, Morato Guimaraes, Claudia, primary, Litchfield, Lacey M., primary, Bowman, Lee, primary, Lawrence, Garreth W., primary, Aggarwal, Amit, primary, and Andre, Fabrice, primary

Published
2023
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17. Clinical and Genomic Characteristics of Patients with Hormone Receptor–Positive, Human Epidermal Growth Factor Receptor 2–Negative Metastatic Breast Cancer Following Progression on Cyclin-Dependent Kinase 4 and 6 Inhibitors

Author

Rao, Xi, primary, Chen, Yongmei, additional, Beyrer, Julie, additional, Nash Smyth, Emily, additional, Morato Guimaraes, Claudia, additional, Litchfield, Lacey M., additional, Bowman, Lee, additional, Lawrence, Garreth W., additional, Aggarwal, Amit, additional, and Andre, Fabrice, additional

Published
2023
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19. Low CD49d expression in newly diagnosed chronic lymphocytic leukaemia may be associated with high‐risk features and reduced treatment‐free‐intervals

Author

Smyth Elizabeth, Kelly Aidan, O' Brien David, Waldron Deirdre, Brophy Sarah, Atkinson Emer, Perera Kanthi, Gerard M. Crotty, Walsh Aileen, Connolly Michelle, Clifford Ruth, O'Leary Hilary, Khan Ashique, Christopher L. Bacon, Smyth Emily, Anthony M. McElligott, Quinn Fiona, Vandenberghe Elisabeth, and Waldron Carmel

Subjects
Adult, Aged, 80 and over, Cohort Studies, Integrin alpha4, Humans, Hematology, General Medicine, Middle Aged, Prognosis, ADP-ribosyl Cyclase 1, Leukemia, Lymphocytic, Chronic, B-Cell, Aged
Abstract

This study was carried out to assess the prognostic power of low CD49d expression (≥10%) in newly diagnosed CLL patients using a previously described cohort. Eighty-five patients were included. Median age at diagnosis; 70 years (43-88); CD49d was expressed in 33/85 (38.8%); 23/33 (69.7%) at ≥30% referred to as 'HiCD49d' and 10/33 (30.3%) between 10 and 30% with a bimodal pattern on scatterplot analysis referred to as 'LoCD49d'. Eleven patients (12.9%) presented as Binet stage B, of whom 8 (72.7%) were CD49d+ (HiCD49d 7/8; LoCD49d 1/8). Seven of 81 patients (8.6%) were NOTCH1 mutated and all were CD49d+ (p ≤ .01). IgVH analysis was performed on 29 (87.8%) of the CD49d+ cases, of whom 21 (72.4%) were unmutated and 8 (27.6%) were mutated. CD38+/CD49d+ accounted for 11/20 (55%) (CD38+/HiCD49D: 9/11; CD38+/LoCD49D: 2/11). At 42 months, treatment had been initiated in 18/85 (21%) patients, of these 10/33 (30.3%) were CD49d+ versus 8/52 (15.4%) of the CD49d- group. The median treatment free interval for the CD49d+ group was 11 months (HiCD49d; 14.5 months, LoCD49d; 11 months) compared to 21.5 months for the CD49d- group. These findings suggest that the predictive value of CD49d expression is retained at expression levels down to 10%.

Published
2022

20. Clinicogenomic factors and treatment patterns among patients with advanced non–small cell lung cancer with or without brain metastases in the United States.

Author

Smyth, Emily Nash, John, Jincy, Tiu, Ramon V, Willard, Melinda Dale, Beyrer, Julie Kay, Bowman, Lee, Sheffield, Kristin M, Han, Yimei, and Brastianos, Priscilla K

Subjects
BRAIN tumor genetics, BRAIN tumor risk factors, THERAPEUTIC use of antineoplastic agents, LUNG cancer, PLATINUM compounds, SCIENTIFIC observation, CANCER chemotherapy, METASTASIS, RETROSPECTIVE studies, ACQUISITION of data, BRAIN tumors, CANCER patients, RISK assessment, PROTEIN-tyrosine kinase inhibitors, GENOMICS, MEDICAL records, SURVIVAL analysis (Biometry), SOCIODEMOGRAPHIC factors, OVERALL survival, DISEASE complications
Abstract

Background: This retrospective, real-world study evaluated the prevalence of brain metastases, clinicodemographic characteristics, systemic treatments, and factors associated with overall survival among patients with advanced non–small cell lung cancer (aNSCLC) in the US. We also described the genomic characterization of 180 brain metastatic specimens and frequency of clinically actionable genes. Materials and Methods: De-identified electronic health records-derived data of adult patients diagnosed with aNSCLC between 2011 and 2017 were analyzed from a US-nationwide clinicogenomic database. Results: Of 3257 adult patients with aNSCLC included in the study, approximately 31% (n = 1018) had brain metastases. Of these 1018 patients, 71% (n = 726) were diagnosed with brain metastases at initial NSCLC diagnosis; 57% (n = 583) of patients with brain metastases received systemic treatment. Platinum-based chemotherapy combinations were the most common first-line therapy; single-agent chemotherapies, epidermal growth factor receptor tyrosine kinase inhibitors, and platinum-based chemotherapy combinations were used in second line. Patients with brain metastases had a 1.56 times greater risk of death versus those with no brain metastases. In the brain metastatic specimens (n = 180), a high frequency of genomic alterations in the p53, MAPK, PI3K, mTOR, and cell-cycle associated pathways was observed. Conclusion: The frequency of brain metastases at initial clinical presentation and associated poor prognosis for patients in this cohort underscores the importance of early screening for brain metastasis in NSCLC. Genomic alterations frequently identified in this study emphasize the continued need for genomic research and investigation of targeted therapies in patients with brain metastases. This article evaluates the prevalence of brain metastases, clinicodemographic characteristics, systemic treatments, and factors associated with overall survival among patients with advanced non–small cell lung cancer in the US. [ABSTRACT FROM AUTHOR]

Published
2023
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22. Phase II evaluation of LY2603618, a first-generation CHK1 inhibitor, in combination with pemetrexed in patients with advanced or metastatic non-small cell lung cancer

Author

Scagliotti, Giorgio, Kang, Jin Hyoung, Smith, David, Rosenberg, Richard, Park, Keunchil, Kim, Sang-We, Su, Wu-Chou, Boyd, Thomas E., Richards, Donald A., Novello, Silvia, Hynes, Scott M., Myrand, Scott P., Lin, Ji, Smyth, Emily Nash, Wijayawardana, Sameera, Lin, Aimee Bence, and Pinder-Schenck, Mary

Published
2016
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24. Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study

Author

Brennan, Louise, primary, Sadeghi, Fatemeh, additional, O’Neill, Linda, additional, Guinan, Emer, additional, Smyth, Laura, additional, Sheill, Grainne, additional, Smyth, Emily, additional, Doyle, Suzanne L., additional, Timon, Claire M., additional, Connolly, Deirdre, additional, O’Sullivan, Jacintha, additional, Reynolds, John V., additional, and Hussey, Juliette, additional

Published
2022
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25. Real world incidence and management of adverse events in patients with HR+, HER2− metastatic breast cancer receiving CDK4 and 6 inhibitors in a United States community setting

Author

Price, Gregory L., primary, Sudharshan, Lavanya, additional, Ryan, Paula, additional, Rajkumar, Jonathan, additional, Sheffield, Kristin M., additional, Nash Smyth, Emily, additional, Morato Guimaraes, Claudia, additional, Rybowski, Sarah, additional, Cuyun Carter, Gebra, additional, Gathirua-Mwangi, Wambui Grace, additional, and Huang, Yu-Jing, additional

Published
2022
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26. Real world incidence and management of adverse events in patients with HR+, HER2- metastatic breast cancer receiving CDK4 & 6 inhibitors in a United States community setting

Author

Price, Gregory L., Sudharshan, Lavanya, Ryan, Paula, Rajkumar, Jonathan, Sheffield, Kristin M., Smyth, Emily Nash, Guimaraes, Claudia Morato, Rybowski, Sarah, Carter, Gebra Cuyun, Gathirua-Mwangi, Wambui Grace, and Huang, Yu-Jing

Abstract

Objective To examine the real-world incidence and management of select adverse events (AEs) among female patients with hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC), receiving a cyclin-dependent kinase 4 and 6 (CDK4 and 6) inhibitor (palbociclib, abemaciclib, or ribociclib). Methods This retrospective study analyzed data from the US Oncology Network iKnowMed electronic health record database for 396 patients with an initial MBC diagnosis on/after January 1, 2014, and receipt of first CDK4 and 6 regimen between January 1, 2017 and December 31, 2018. In this descriptive study, the proportion of patients who experienced select AEs and associated dose modifications or discontinuations were reported. The occurrence of select health care resource utilization categories was also reported. Results Median follow-up time was 451, 262, and 355 days for patients in the palbociclib, abemaciclib, and ribociclib cohorts, respectively. The most common AEs were neutropenia (palbociclib, 44.8%; abemaciclib, 10.6%; ribociclib, 36.3%), diarrhea (palbociclib, 8.0%; abemaciclib, 43.0%; ribociclib, 8.8%), and fatigue (palbociclib, 12.9%; abemaciclib, 17.6%; ribociclib, 16.5%). AEs resulted in a treatment hold among 91 (23.0%), a dose reduction among 86 (21.7%), and permanent discontinuation among 48 (12.1%) patients overall. Conclusions This real-world study provides insight into the occurrence of AEs which varied by CDK4 and 6 inhibitor. Compared to clinical trials, frequencies of AEs were numerically lower but dose reductions due to AEs were numerically higher. It is possible these differences reflect proactive management of AEs on the part of clinicians to help patients remain on therapy. Cyclin-dependent kinase 4 and 6 inhibitors (CDK4 and 6 inhibitors) have changed the landscape for the treatment of metastatic breast cancer (MBC) among patients who are hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-). An understanding of the real-world management of adverse events (AEs) will help optimize treatment strategies. Here, data from the US Oncology Network electronic health record database for 396 HR+, HER2-, MBC patients receiving a CDK4 and 6 inhibitor were examined to describe the proportion of patients who experienced select AEs and the associated outcomes of these AEs. Compared to clinical trials, frequencies of AEs were numerically lower but dose reductions due to AEs were numerically higher. It is possible that these differences reflect a proactive management of AEs on the part of clinicians to help patients remain on therapy.

Published
2022
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32. Real-world treatment patterns and outcomes of abemaciclib for the treatment of HR+, HER2− metastatic breast cancer

Author

Cuyun Carter, Gebra, primary, Sheffield, Kristin M., additional, Gossai, Anala, additional, Huang, Yu-Jing, additional, Zhu, Yajun Emily, additional, Bowman, Lee, additional, Nash Smyth, Emily, additional, Mathur, Raina, additional, Cohen, Aaron B., additional, Rasmussen, Erik, additional, Balakrishna, Shreya, additional, Morato Guimaraes, Claudia, additional, Rybowski, Sarah, additional, and Seidman, Andrew D., additional

Published
2021
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34. ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol

Author

O'Neill, Linda, primary, Guinan, Emer, additional, Brennan, Louise, additional, Doyle, Suzanne L., additional, O'Connor, Louise, additional, Sheill, Grainne, additional, Smyth, Emily, additional, Fairman, Ciaran M., additional, Segurado, Ricardo, additional, Connolly, Deirdre, additional, O'Sullivan, Jacintha, additional, Reynolds, John V., additional, and Hussey, Juliette, additional

Published
2021
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35. HSR21-051: Treatment Outcomes Among HR+/HER2- Advanced/Metastatic Breast Cancer Patients Receiving CDK 4 & 6 Inhibitors in a United States Clinical Practice Setting

Author

Huang, Yu-Jing, primary, Ryan, Paula D., additional, Price, Gregory L., additional, Carter, Gebra Cuyun, additional, Sheffield, Kristin M., additional, Smyth, Emily Nash, additional, Guimaraes, Claudia Morato, additional, Rybowski, Sarah, additional, Rajkumar, Jonathan, additional, and Sudharshan, Lavanya, additional

Published
2021
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37. Prehabilitation during a pandemic: preoperative exercise to improve fitness in patients undergoing complex surgery for cancer of the lung or oesophagus, the PRE-HIIT trial: an updated study protocol

Author

Sheill, Grainne, primary, Guinan, Emer, additional, O'Neill, Linda, additional, Smyth, Emily, additional, Normand, Charles, additional, L. Doyle, Suzanne, additional, Moore, Sarah, additional, Newell, John, additional, McDermott, Grainne, additional, Ryan, Ronan, additional, V. Reynolds, John, additional, and Hussey, Juliette, additional

Published
2021
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39. ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol

Author

O'Neill, Linda, primary, Guinan, Emer, additional, Doyle, Suzanne L., additional, O'Connor, Louise, additional, Sheill, Grainne, additional, Smyth, Emily, additional, Fairman, Ciaran M., additional, Segurado, Ricardo, additional, Connolly, Deirdre, additional, O'Sullivan, Jacintha, additional, Reynolds, John V., additional, and Hussey, Juliette, additional

Published
2020
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40. Treatment patterns, adverse events, and direct and indirect economic burden in a privately insured population of patients with HR+/HER2– metastatic breast cancer in the United States

Author

Goyal, Ravi K., primary, Cuyun Carter, Gebra, additional, Nagar, Saurabh P., additional, Nash Smyth, Emily, additional, Price, Gregory L., additional, Parikh, Rohan C., additional, Huang, Yu-Jing, additional, Li, Li, additional, Davis, Keith L., additional, and Kaye, James A., additional

Published
2020
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41. Treatment patterns, adverse events, and direct and indirect economic burden in a privately insured population of patients with HR+/HER2– metastatic breast cancer in the United States.

Author

Goyal, Ravi K., Cuyun Carter, Gebra, Nagar, Saurabh P., Nash Smyth, Emily, Price, Gregory L., Parikh, Rohan C., Huang, Yu-Jing, Li, Li, Davis, Keith L., and Kaye, James A.

Abstract

Real-world evidence specific to HR+/HER2– metastatic breast cancer (MBC) prior to introduction of CDK4/6 inhibitors is limited. In an effort to provide context for the introduction of new treatments, we assessed treatment patterns, adverse events, productivity loss, and direct/indirect economic burden in a privately insured population of patients with HR+/HER2– MBC. Using a retrospective cohort design, patients aged 18–64 years, selected from MarketScan databases (2007–2014), were analyzed using descriptive and multivariable methods. Among 5,563 eligible patients, endocrine therapy was the most common first-line (1L) therapy; its utilization trended downward from 63% (1L) to 23% (4L), with a simultaneous increase in chemotherapy use, 25% (1L) to 50% (4L). Two hundred and seventy-eight unique treatment regimens were used in the 1L setting. The average per patient monthly all-cause costs were $14,424. The 12-month indirect costs for short-term disability were substantially higher in MBC patients ($10,397) than in matched noncancer patients ($394). The increasing use of chemotherapy as patients progressed to second and later lines and the substantial direct/indirect economic burden underscore an unmet need. The high number of 1L regimens highlights significant heterogeneity and a lack of consensus related to the management of HR+/HER2– MBC in routine practice. [ABSTRACT FROM AUTHOR]

Published
2021
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43. Syscad Neural Network Models for LSR Dynamic Sugar Crystal Growth Prediction.

Author

Marin, Tanai, Smyth, Emily, McFeaters, John, and McFeaters, Eleanor

Subjects
*ARTIFICIAL neural networks, *MACHINE learning, *CRYSTAL growth, *CONVOLUTIONAL neural networks, *SUPERVISED learning
Abstract

Sugar crystal growth is a non-linear process dependent on the complex interaction of several variables. This causes the development of first-principal models of the process to be exceedingly difficult and often inaccurate. Louisiana Sugar Refining has partnered with SysCAD to develop a machine learning model of crystal growth to incorporate into the digital twin infrastructure being developed at LSR. The collaboration has successfully developed a supervised training machine learning model based on Deep Feed Forward (DFF) and Convolutional Neural Network (ConvNet) models to simulate the crystal growth in vacuum pans. Initially, a proof-of-concept model showed promising results using both DFF and ConvNet architectures, which lead to the expansion of these models to include the entire white and recovery boiling schemes. In this paper we present the concept of using neural network dynamic models, their analysis, and results of predicted particle size distribution parameters compared to real field observations. These fully optimized models will be implemented as standard unit operation models in SysCAD to enhance the larger process simulation model used by LSR to monitor and predict process conditions in real-time. This machine learning technique will also be expanded to develop a concept model for other non-linear phenomena in the sugar industry including colour. [ABSTRACT FROM AUTHOR]

Published
2024

44. Identifying outcomes reported in exercise interventions in oesophagogastric cancer survivors: a systematic review.

Author

O'Connor, Louise, Smyth, Emily, Bennett, Annemarie E., Smith, Valerie, O'Neill, Linda, Reynolds, John V., Hussey, Juliette, and Guinan, Emer

Subjects
*CANCER survivors, *AEROBIC capacity, *QUALITY of life, *PHYSICAL mobility, *DATA extraction
Abstract

Background: Research investigating exercise interventions in oesophagogastric cancer survivors is sparse, and the outcomes are varied. The aim of this systematic review is to identify the domains and outcomes reported in exercise interventions in oesophagogastric cancer survivors to be included in a Delphi study, with a view to informing the development of a core outcome set (COS).Methods: EMBASE, PubMed, CINHAL, Cochrane Library, SCOPUS, and PEDro were searched up to March 2020 using a predefined search strategy. The outcomes identified during data extraction were categorised using the core areas outlined in the OMERACT Filter 2.0.Results: Fourteen domains and 63 outcomes were identified. The most frequently reported outcomes were in the domains of quality of life using the EORTC-QLQ-C30 questionnaire and the relevant disease-specific modules (100%), exercise capacity/fitness/physical function (100%), anthropometrics (83.33%), physical activity (66.67%), and biomarker analysis (50%).Conclusion: This systematic review quantifies and describes the domains and outcomes examined in exercise interventions in oesophagogastric cancer survivors. Some inconsistency exists within the domains and outcomes used, and little attention was given to nutritional or economic endpoints. In order to develop a COS, a Delphi consensus process with key stakeholders is needed to identify the relevant domains and outcomes for inclusion. [ABSTRACT FROM AUTHOR]

Published
2021
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49. Next-generation sequencing (NGS) results among hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC) patients treated with a CDK4 & 6 inhibitor: A retrospective observational study based on real-world data.

Author

Hamilton, Erika Paige, primary, Jansen, Valerie Malyvanh, additional, Nash Smyth, Emily Nash, additional, Schlauch, Daniel, additional, Cuyun Carter, Gebra, additional, Willard, Melinda D, additional, Misch, Amanda, additional, Bowman, Lee, additional, Zhu, Yajun Emily, additional, McNeely, Samuel, additional, Lin, Aimee Bence, additional, Picard, Shaita, additional, Blackwell, Kimberly, additional, Burris, Howard A., additional, and Spigel, David R., additional

Published
2019
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