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Forsythe L.P.,U.S. National Cancer Institute | Forsythe L.P.,Patient-Centered Outcomes Research Institute | Rowland J.H.,U.S. National Cancer Institute | Padgett L.,U.S. National Cancer Institute | And 4 more authors.
Psycho-Oncology | Year: 2013

Objective Although the Institute of Medicine provided a vision for effective psychosocial care for cancer survivors, limited guidance exists regarding the essential components of comprehensive care or progressive steps for implementing each component. This paper describes the development of a unique tool for assessing capacity to provide quality psychosocial care to cancer survivors and the results of the first implementation of this tool in community settings. Methods The psychosocial working group of the National Cancer Institute Community Cancer Centers Program (NCCCP) developed the Cancer Psychosocial Care Matrix assessment tool. All NCCCP sites (n = 30, enrolled in 2007 and 2010) completed the matrix indicating their capacity for providing psychosocial care at entry into NCCCP ('baseline') after 2 years of NCCCP participation (2007 sites only) and within the coming year ('future aspirations'). Results At baseline, matrix responses reflected few or no systematic processes in place for most components of comprehensive psychosocial care. However, reported capacity to deliver specific components improved at 2 years post-NCCCP entry for the 2007 sites and in all NCCCP sites' future aspirations. Conclusions With growing demand on cancer centers to meet new metrics of quality care, the psychosocial matrix can help centers systematically identify and develop steps to address gap areas in their capacity to meet these new standards. The Cancer Psychosocial Care Matrix appears to enable evaluation of psychosocial programs, may promote intentions to improve psychosocial services, and can facilitate communication of 'best practices' among cancer centers. Copyright © 2013 John Wiley & Sons, Ltd. Copyright © 2013 John Wiley & Sons, Ltd.

Das M.,Stanford University | Riess J.W.,Stanford University | Frankel P.,City of Hope Cancer Center | Schwartz E.,Stanford University | And 8 more authors.
Lung Cancer | Year: 2012

Purpose: To utilize a novel circulating tumor cell (CTC) technology to quantify ERCC1 expression on CTCs and determine whether ERCC1 expression levels predict efficacy of platinum-based chemotherapy in patients with metastatic non-small-cell lung cancer (NSCLC). Experimental design: ERCC1 expression was measured in 17 metastatic NSCLC patients who received platinum-based therapy and had ≥2 intact CTCs with acceptable ERCC1 expression assay results. ERCC1 levels were determined from average expression on individual CTCs in each sample. Progression-free survival (PFS) was calculated from the date of therapy initiation. Results: PFS decreased with increasing ERCC1 expression (p<0.04, F-test, linear regression). Lack of ERCC1 expression was associated with longer PFS (266 days versus 172 days, log-rank, p<0.02) in a Kaplan-Meier analysis using ERCC expression level of 1 as a cutoff (range 0-30). The difference in survival was statistically significant with a hazard ratio of 4.20 (95% CI 1.25-14.1, p<0.02, log-rank). PFS was also observed to decrease with increased cytokeratin (CK) expression (p<0.01 long-rank (Cox regression) and F-test (linear regression)). The hazard ratio is 4.38 (95% CI 1.76-10.9) for each log-change in CK value until progression was noted on imaging. Conclusion: Low expression of ERCC1 on CTCs correlates with PFS in patients with metastatic NSCLC receiving platinum-based therapy. © 2012 Elsevier Ireland Ltd.

Nieva J.J.,Billings Clinic Cancer Center | Kuhn P.,Scripps Research Institute
Future Oncology | Year: 2012

Cancer is currently diagnosed and treated based on the results of a tissue biopsy of the primary tumor or a metastasis using invasive techniques such as surgical resection or needle biopsy. New technology for retrieving cancer cells from the circulation, developed in the last 5 years, has made it possible to obtain a 'fluid biopsy from the bloodstream without the need for an invasive procedure. This technological development makes it possible to diagnose and manage cancer from a blood test rather than from a traditional biopsy. It also allows the repeated sampling of cancer cells from a patient, making it possible, in a practical manner, to interrogate the disease repeatedly in order to understand the mechanisms by which cancer cells evolve within a given individual. The ability to obtain cancer cells repeatedly also has the potential to substantially advance drug development by enabling early ex vivo validation of both targets and early-stage compounds, as well as creating new efficiencies in the drug development process during clinical trials. © 2012 Future Medicine Ltd.

Nguyen M.-L.T.,New York Medical College | Stevens E.,SUNY Downstate Medical Center | Stevens E.,Billings Clinic Cancer Center | LaFargue C.J.,New York Medical College | And 5 more authors.
Journal of the Society of Laparoendoscopic Surgeons | Year: 2014

Background and Objectives: Our aim was to determine whether the use of routine cystoscopy increases lower urinary tract injury detection (bladder and/or ureter) after robotic surgery performed by gynecologic oncologists. Methods: A retrospective chart review of patients who presented for robotic hysterectomy from 2009–2012 was performed at 2 separate academic medical centers, one that performed routine cystoscopy and one that did not. Statistical analysis was performed with t tests and χ2 tests. Results: We identified 140 cases without cystoscopy and 109 cases with routine cystoscopy. There were no intraoperative or postoperative urinary injuries detected in either group. There were no significant differences in age and body mass index. In the non-cystoscopy group, a larger specimen size (P <.001), less blood loss (P <.013), and a longer mean operative time were observed (P <.0001). In the routine cystoscopy group, more lymphadenectomies were performed with hysterectomy (P =.007) and more patients underwent hysterectomy for ovarian cancer (P =.0192). There were no differences in surgical indications or secondary procedures including bilateral salpingo-oophorectomy, radical hysterectomy, ureterolysis, and pelvic organ prolapse–related procedures. The minimum follow-up period was 30 days in both groups. Conclusion: Routine use of cystoscopy did not appear to affect the detection rate of intraoperative lower urinary tract injury during robotic gynecologic surgery because this rate was zero in both groups. However, cystoscopy is relatively simple to perform and can be efficiently incorporated into robotic surgery to avoid the severe morbidity and possible litigation surrounding a urinary tract injury. © 2014 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. Published by the Society of Laparoendoscopic Surgeons, Inc.

Brant J.M.,Billings Clinic Cancer Center | Brant J.M.,University of Utah | Beck S.,University of Utah | Dudley W.N.,University of North Carolina | And 3 more authors.
Cancer Nursing | Year: 2011

Background: Cancer survivorship following cancer treatment is uncertain as physical and psychological sequelae related to the disease or its treatment may persist. However, little is known about the experience of symptoms after treatment. Objectives: The purposes of this study were to (1) examine postchemotherapy (post-CTX) symptom trajectories in cancer survivors and (2) determine whether demographic characteristics predicted symptom trajectories. METHODS: One hundred patients who recently completed CTX for lung cancer, colorectal cancer, or lymphoma rated symptoms on an electronic patient care monitor system prior to ambulatory care visits. Latent growth curve analyses were conducted to examine the trajectories of pain, fatigue, sleep disturbance, distress, and depression for 16 months after initial CTX. Results: Symptoms were present at the first follow-up visit following CTX (P < .0001) and persisted over 16 months. The depression trajectory was predicted by sex: males showed a convex curvilinear growth trajectory, whereas females showed a concave trajectory (P < .05). Higher distress was predicted by younger age (P < .05). Conclusions: Psychological and physical symptoms persisted over the 16-month period following CTX for the entire sample. Sex differences in coping could partially explain the different trajectories of growth for depression, but further studies are warranted. Younger patients may be more vulnerable for distress during this posttreatment phase. Implications for Practice: The posttreatment surveillance plan for cancer survivors should include a comprehensive assessment of psychological and physical symptoms. Persistence of symptoms can be expected in some patients, and supportive interventions should be tailored according to symptom reports. Copyright © 2010 Lippincott Williams & Wilkins.

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