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Purpose Prior research examining the impact of androgen deprivation therapy (ADT) for prostate cancer on cognitive performance has found inconsistent relationships. The purpose of this study was to systematically review the existing literature and determine the effect of ADT on performance across seven cognitive domains using meta-analysis. Methods A search of PubMed Medline, PsycINFO, Cochrane Library, and Web of Knowledge/Science databases yielded 157 unique abstracts reviewed by independent pairs of raters. Fourteen studies with a total of 417 patients treated with ADT were included in the meta-analysis. Objective neuropsychological tests were categorized into seven cognitive domains: attention/working memory, executive functioning, language, verbal memory, visual memory, visuomotor ability, and visuospatial ability. Results Separate effect sizes were calculated for each cognitive domain using pairwise comparisons of patients who received ADT with (1) prostate cancer patient controls, (2) noncancer controls, or (3) ADT patients’ own pre-ADT baselines. Patients treated with ADT performed worse than controls or their own baseline on visuomotor tasks ( g  = −0.67, p  = .008; n  = 193). The magnitude of the deficits was larger in studies with a shorter time to follow-up ( p  = .04). No significant effect sizes were observed for the other six cognitive domains ( p  = .08–.98). Conclusions Prostate cancer patients who received ADT performed significantly worse on visuomotor tasks compared to noncancer control groups. These findings are consistent with the known effects of testosterone on cognitive functioning in healthy men. Knowledge of the cognitive effects of ADT may help patients and providers better understand the impact of ADT on quality of life.

PurposeFear of cancer recurrence (FCR) is one of the most common and distressing issues affecting cancer survivors. This study examined (1) the association between modifiable cognitive, behavioral, and social characteristics and FCR, (2) the association between non-modifiable characteristics and FCR, and (3) the relative contributions of modifiable and non-modifiable characteristics to FCR.MethodsParticipants (n = 120) had been diagnosed with colorectal cancer and completed cancer treatment in the past 6 to 36 months. Participants completed self-report measures of modifiable cognitive (e.g., beliefs about worry), behavioral (e.g., health-related reassurance seeking), and social (e.g., social constraints) characteristics. Non-modifiable characteristics (e.g., age, disease severity) were assessed via self-report and medical record review.FindingsModifiable (i.e., perceived risk, self-efficacy, positive beliefs about worry, negative beliefs about worry, intolerance of uncertainty, rumination, reassurance seeking, health-related reassurance seeking, social constraints) and non-modifiable (i.e., age, gender, disease severity, neuroticism, conscientiousness) characteristics were associated with FCR (p’s < .05). Hierarchical linear regression analyses demonstrated that modifiable characteristics accounted for an additional 15% of the variance (p < .001) beyond that accounted for by non-modifiable characteristics (R2 = .45, p < .001), with perceived risk (B = .35) and health-related reassurance seeking (B = .22) emerging as significant predictors of FCR (p’s < .05).ImplicationsResults identify non-modifiable characteristics that may serve as risk factors for greater FCR and identify specific modifiable characteristics (i.e., perceived risk, health-related reassurance seeking) to be targeted by interventions to reduce FCR among cancer survivors.

Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing substantial challenges to delivering cancer care and resulting in important changes in care-delivery models, including the rapid adoption of telehealth. To estimate patient travel, time, and cost savings associated with telehealth for cancer care delivery. An economic evaluation of cost savings from completed telehealth visits from April 1, 2020, to June 30, 2021, in a single-institution National Cancer Institute-Designated Comprehensive Cancer Center. All patients aged 18 to 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. Data were analyzed from April 2020 to June 2021. The main outcome was estimated patient cost savings from telehealth, which included 2 components: costs of travel (defined as roundtrip distance saved from car travel) and potential loss of productivity due to the medical visit (defined as loss of income from roundtrip travel plus loss of income from in-person clinic visits). Two different models with a combination of 2 different mileage rates ($0.56 and $0.82 per mile) and census tract-level median hourly wages were used. The study included 25 496 telehealth visits with 11 688 patients. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits. Median (IQR) age was 55.0 (46.0-61.0) years among the telehealth visits, with 15 663 visits (61.4%) by women and 18 360 visits (72.0%) by Hispanic non-White patients. According to cost models, the estimated mean (SD) total cost savings ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile. For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean (SD) total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile. In this economic evaluation, telehealth was associated with savings in patients time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.

Patient-generated health data (PGHD), or health-related data gathered from patients to help address a health concern, are used increasingly in oncology to make regulatory decisions and evaluate quality of care. PGHD include self-reported health and treatment histories, patient-reported outcomes (PROs), and biometric sensor data. Advances in wireless technology, smartphones, and the Internet of Things have facilitated new ways to collect PGHD during clinic visits and in daily life. The goal of the current review was to provide an overview of the current clinical, regulatory, technological, and analytic landscape as it relates to PGHD in oncology research and care. The review begins with a rationale for PGHD as described by the US Food and Drug Administration, the Institute of Medicine, and other regulatory and scientific organizations. The evidence base for clinic-based and remote symptom monitoring using PGHD is described, with an emphasis on PROs. An overview is presented of current approaches to digital phenotyping or device-based, real-time assessment of biometric, behavioral, self-report, and performance data. Analytic opportunities regarding PGHD are envisioned in the context of big data and artificial intelligence in medicine. Finally, challenges and solutions for the integration of PGHD into clini-cal care are presented. The challenges include electronic medical record integration of PROs and biometric data, analysis of large and complex biometric data sets, and potential clinic workflow redesign. In addition, there is currently more limited evidence for the use of biometric data relative to PROs. Despite these challenges, the poten-tial benefits of PGHD make them increasingly likely to be integrated into oncology research and clinical care.

Survivors of head and neck cancer have complex nutritional and supportive care needs. These needs result from the tumour's proximity to organs essential for normal eating function and the intensive treatment targeting those organs. Despite the crucial role of nutrition and supportive care in head and neck cancer, research and funding are lacking compared with other cancer types. This Review was compiled and written by a team of multidisciplinary medical professionals. Topics include poor access to medical nutrition therapy (MNT), MNT reimbursement policies, long-term survivorship care needs, percutaneous endoscopic gastrostomy tube placement, nutrition literacy, psychological services, speech–language pathology care, and concomitant physical activity. The goal of this work is to define current issues in research and practice, advocate for the expansion of head and neck cancer funding opportunities, and raise awareness of head and neck cancer supportive care needs and challenges. This work provides a roadmap for health-care professionals, researchers, policy makers, and funding agencies to prioritise nutrition in head and neck cancer care, with the overarching goal of improving treatment outcomes and quality of life.

Abstract Background Chimeric antigen receptor-T (CAR-T) cell therapy has improved survival, yet its toxic profile may impact on survivors’ well-being. We examined patients’ and caregivers’ perspectives on the most common, severe, and distressing side effects across recovery (ie, first 60 days) and survivorship (ie, 60 days and onwards) and explored their perspectives on the education received to prepare for CAR-T. Materials and Methods We conducted semi-structured interviews with patients and caregivers addressing (1) how they prepared for CAR-T, (2) the side effects experienced during the first-year post-treatment, and (3) how to best educate future patients and caregivers. Results We included 19 patients and 12 caregivers. We identified 6 major themes. First, participants reported intense hope as well as stress and fear when presented with CAR-T, viewing it as a distinct and exceptional treatment. Second, following CAR-T infusion, some patients experienced intense symptoms (eg, fatigue, pain), while others were confused if not presenting with symptoms. Third, following discharge, patients experienced a myriad of ongoing symptoms, some of which were severe (eg, fatigue, cognitive symptoms, pain) and negatively impacted on their recovery. Fourth, some long-term survivors experienced ongoing symptoms but accepted this trade-off for being alive. Fifth, most patients and caregivers felt well prepared to cope with CAR-T, although some expressed the desire for more information on long-term side effects. Sixth, participants would recommend CAR-T to others while acknowledging the risk of experiencing side effects. Conclusions Participants commonly reported significant symptoms throughout treatment and recovery. Additional education on long-term survivorship is needed.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating symptom experienced by cancer survivors. Despite the burden of CIPN-related symptoms, interventions remain limited. Objectives: This narrative review seeks to propose a framework for CIPN predisposing, precipitating, and perpetuating factors (3Ps), which will provide a foundation for future research and clinical interventions aimed at mitigating CIPN-related symptoms and morbidity. Methods: A comprehensive literature search was performed using PubMed, guided by keywords related to “chemotherapy-induced peripheral neuropathy.” Studies were limited to those with full text available in English. Results: Predisposing factors outlined in this framework, such as older age and comorbid conditions, can be used to identify patients who have a higher risk of developing CIPN. The major precipitating factor of CIPN is the delivery of chemotherapy to peripheral nerves, which may be mitigated via cryotherapy or compression therapy during chemotherapy. Perpetuating factors can offer insight into psychological, cognitive, and behavioral modifications that could be treatment targets for CIPN management. Conclusion: The proposed 3P model can guide the development of effective interventions for CIPN by suggesting modifiable psychological and behavioral treatment targets that may mitigate the impact of CIPN for cancer patients.

Background Cancer‐related cognitive impairment (CRCI) has received little attention among adolescent and young adult (AYA; 18–39 years of age) cancer survivors. The goal of this study was to evaluate differences in objective and subjective cognitive performance and quality of life between AYA survivors and individuals without a cancer history. Methods AYA cancer survivors were recruited from clinic databases, and noncancer controls were identified through Research Match. Objective cognitive performance was measured using the Cambridge Neuropsychological Test Connect Automated Battery which assessed attention, executive functioning, and memory. Participants completed questionnaires on PROMIS measures of subjective cognition and quality of life (QOL). Mean differences were evaluated using ANCOVAs, independent of age and education. Results The sample included 88 AYA survivors and 96 noncancer controls (NC). The AYA survivors were older (MAYA = 34.1, MNC = 28.8, p < 0.001) and less likely to have a college education (%AYA = 67.0, %NC = 79.2, p = 0.063). The AYA group averaged almost 4 years since the end of treatment, and the majority were lymphoma/leukemia survivors (27%), followed by breast cancer survivors (14%). On objective tests of cognition, there was a trend (p = 0.061) for lower performance in attention among AYA survivors (d = 0.11), but no differences were observed for executive functioning (d = 0.03) or memory (d = 0.03). AYA survivors rated their cognition as worse than the NC group on PROMIS measures of subjective cognitive function (d = 0.69) and cognitive function abilities (d = 0.57; p < 0.001). Significant group differences were seen on multiple PROMIS QOL measures (d ranging from 0.32 to 0.77), all in favor of the NC group (p < 0.05). Conclusions Results indicated that AYA survivors performed similarly on measures of objective cognitive performance, despite reporting worse subjective cognitive functioning and poorer quality of life. Further research is needed to address the disconnect between objective and subjective cognitive performance among AYA cancer survivors.

Purpose Tyrosine kinase inhibitors (TKIs) are now standard treatment for chronic myeloid leukemia (CML). While TKIs have less toxicity than previous treatments, they have side effects that can impact quality of life (QOL). Methods This study compared CML patients taking a TKI for an average of 4.01 years (range 0.50–9.79 years) to age- and gender-matched controls with no history of cancer on measures of symptom burden, depression, fatigue, sleep, and health-related QOL. Results Compared to controls ( n  = 62), CML patients ( n  = 62) taking a TKI (imatinib 55 %, nilotinib 31 %, and dasatinib 14 %) reported significantly worse fatigue severity ( p  < .001), fatigue interference ( p  < .001), depression ( p  = .007), symptom burden ( p  < .001), and physical QOL ( p  < .001). TKI patients were also more likely meet established cutoffs for clinically meaningful fatigue ( p values < .001) and depression ( p  = .004). There were no differences in mental QOL or sleep ( p values > .010). Regarding specific symptoms, TKI patients were more likely to report nausea, diarrhea, itching, skin changes, swelling of arms or legs, and not looking like themselves ( p values < .001). Conclusions These data suggest the need for interventions to address QOL in CML patients taking TKIs.

Purpose Patients with head and neck cancer (HNC) experience significant symptom burden from combination chemotherapy and radiation (chemoradiation) that affects acute and long-term health-related quality of life (HRQOL). However, psychosocial impacts of HNC symptom burden are not well understood. This study examined psychosocial consequences of treatment-related symptom burden from the perspectives of survivors of HNC and HNC healthcare providers. Methods This was a cross-sectional, mixed-method study conducted at an NCI-designated comprehensive cancer center. Participants ( N  = 33) were survivors of HNC who completed a full course of chemoradiation ( n  = 20) and HNC healthcare providers ( n  = 13). Participants completed electronic surveys and semi-structured interviews. Results Survivors were M  = 61 years old (SD = 9) and predominantly male (75%), White (90%), non-Hispanic (100%), and diagnosed with oropharynx cancer (70%). Providers were mostly female (62%), White (46%) or Asian (31%), and non-Hispanic (85%) and included physicians, registered nurses, an advanced practice nurse practitioner, a registered dietician, and a speech-language pathologist. Three qualitative themes emerged: (1) shock, shame, and self-consciousness, (2) diminished relationship satisfaction, and (3) lack of confidence at work. A subset of survivors (20%) reported clinically low social wellbeing, and more than one-third of survivors (35%) reported clinically significant fatigue, depression, anxiety, and cognitive dysfunction. Conclusion Survivors of HNC and HNC providers described how treatment-related symptom burden impacts psychosocial identity processes related to body image, patient-caregiver relationships, and professional work. Results can inform the development of supportive interventions to assist survivors and caregivers with navigating the psychosocial challenges of HNC treatment and survivorship.