Five Dimensions of Needs for Help: The Efficacy of a Technology-Based Intervention Among Asian American Breast Cancer Survivors.

Cancer survivors including Asian American breast cancer survivors have reported their high needs for help during their survivorship process. With the COVID-19 pandemic, the necessity of technology-based programs to address their needs for help without face-to-face interactions has been highlighted. The purpose of this randomized intervention study was to determine the efficacy of a technology-based program in reducing various types of needs for help among this specific population. This was a randomized clinical trial with repeated measures. A total of 199 participants were included in the data analysis. The recruitment settings included both online and offline communities/groups for Asian Americans. The needs for help were assessed using the Support Care Needs Survey-34 Short Form (SCNS) subscales measuring psychological, information, physical, support, and communication needs. Data analysis was conducted through an intent-to-treat approach. In the mixed effect models, psychological needs, information needs, physical needs, and communication needs decreased over time (P < .001). However, there were no significant group * time effects. Social support significantly mediated the effects of a technology-based intervention on psychological, information, and support needs at the pre-test and the post-1 month. This study supported significant decreases in the needs for help of Asian American breast cancer survivors by a technology-based intervention. Further studies are needed with other racial/ethnic groups of cancer survivors to confirm the efficacy of a technology-based intervention in reducing cancer survivors' needs for help during their survivorship process.

A randomized controlled trial testing a virtual program for Asian American women breast cancer survivors.

A culturally tailored virtual program could meet the survivorship needs of Asian American women breast cancer survivors (AABC). This study aims to determine the efficacy of a culturally tailored virtual information and coaching/support program (TICAA) in improving AABC's survivorship experience. A randomized clinical trial (NCT02803593) was conducted from January 2017 to June 2020 among 199 AABC. The intervention group utilized TICAA and the American Cancer Society [ACS] website while the control group used only ACS website for 12 weeks. The outcomes were measured using the SCNS-34SF (needs; primary), the MSAS-SF (symptoms; secondary), and the FACT-B (quality of life; secondary). The data were analyzed using an intent-to-treat approach. The intervention group showed significant reductions in their needs from the baseline (T0) to post 4 weeks (T1) and to post 12 weeks (T2). Although the changes were not statistically significant, the intervention group had decreased symptoms from T0 to T2 while the control group had an increase in their symptoms. The intervention group had a significant increase in their quality of life from T0 to T2. A culturally tailored virtual program could therefore improve quality of life in AABC patients. Trial Registration: To Enhance Breast Cancer Survivorship of Asian Americans (TICAA), NCT02803593, https://clinicaltrials.gov/ct2/show/NCT02803593?titles=TICAA&draw=2&rank=1.

Healing Hands: The Tactile Internet in Future Tele-Healthcare.

In the early 2020s, the coronavirus pandemic brought the notion of remotely connected care to the general population across the globe. Oftentimes, the timely provisioning of access to and the implementation of affordable care are drivers behind tele-healthcare initiatives. Tele-healthcare has already garnered significant momentum in research and implementations in the years preceding the worldwide challenge of 2020, supported by the emerging capabilities of communication networks. The Tactile Internet (TI) with human-in-the-loop is one of those developments, leading to the democratization of skills and expertise that will significantly impact the long-term developments of the provisioning of care. However, significant challenges remain that require today's communication networks to adapt to support the ultra-low latency required. The resulting latency challenge necessitates trans-disciplinary research efforts combining psychophysiological as well as technological solutions to achieve one millisecond and below round-trip times. The objective of this paper is to provide an overview of the benefits enabled by solving this network latency reduction challenge by employing state-of-the-art Time-Sensitive Networking (TSN) devices in a testbed, realizing the service differentiation required for the multi-modal human-machine interface. With completely new types of services and use cases resulting from the TI, we describe the potential impacts on remote surgery and remote rehabilitation as examples, with a focus on the future of tele-healthcare in rural settings.

Extragenital Screening of Chlamydia trachomatis and Neisseria gonorrhoeae Among Women in the College Health Setting.

BACKGROUND: Despite high frequencies of oral and receptive anal intercourse among young women, the Centers for Disease Control and Prevention does not recommend routine oropharyngeal or anorectal screening for CT and GC. Risk-based extragenital screening of women has not been adopted at the majority of college health centers, and existing research has not focused on the female or college population. METHODS: We examined health records of women at a college health center in a large urban university for 3 years to evaluate the effectiveness of CT and GC screening. We also evaluated the proportion of CT and GC infections that would have been missed if risk-based extragenital screening was not performed. Decisions to screen at extragenital sites were based on patient-reported risk behavior. RESULTS: For 8027 unique chlamydia screens and 7907 unique gonorrhea screens, approximately 20% of the visits used extragenital screening in response to self-reported risk behaviors. More than 44% of patients were non-Hispanic White, and approximately 48% fell within the 20- to 24-year age group. The case positivity rates for CT were 2.85% with urogenital-only screening and 1.30% with risk-prompted extragenital screening (1.1% throat, 4.3% rectal). The case positivity rates for GC were 0.11% with urogenital-only screening and 0.37% with risk-prompted extragenital screening (0.37% throat, 0% rectal). If the college health center had relied solely on urogenital screening rather than adding risk-based extragenital screening, 4.41% of CT infections would have been missed and 28.57% of GC infections would have been missed. CONCLUSIONS: Nearly 1 of 22 CT infections and nearly 1 of 3 GC infections would have been missed without extragenital screening in this analysis of college women. Inclusion of risk-prompted extragenital screening in asymptomatic STD screening protocols can help clinicians diagnose CT and GC infections that would be have been missed with urogenital-only screening. Although rectal GC infections among women seem to be less common, oropharyngeal testing, in particular, for GC is suggested for women based on sexual risk. However, clinicians might only identify these risks if they ask patients directly about these potential exposures. Because guidelines exist only for men, future studies should focus on extragenital screening in college women to build the evidence that this particular population of patients may benefit from this practice, given the high risk of STDs in young adults.

Individualised selection of left-sided breast cancer patients for proton therapy based on cost-effectiveness.

INTRODUCTION: The significantly greater cost of proton therapy compared with X-ray therapy is frequently justified by the expected reduction in normal tissue toxicity. This is often true for indications such as paediatric and skull base cancers. However, the benefit is less clear for other more common indications such as breast cancer, and it is possible that the degree of benefit may vary widely between these patients. The aim of this work was to demonstrate a method of individualised selection of left-sided breast cancer patients for proton therapy based on cost-effectiveness of treatment. METHODS: 16 left-sided breast cancer patients had a treatment plan generated for the delivery of intensity-modulated proton therapy (IMPT) and of intensity-modulated photon therapy (IMRT) with the deep inspiration breath-hold (DIBH) technique. The resulting dosimetric data was used to predict probabilities of tumour control and toxicities for each patient. These probabilities were used in a Markov model to predict costs and the number of quality-adjusted life years expected as a result of each of the two treatments. RESULTS: IMPT was not cost-effective for the majority of patients but was cost-effective where there was a greater risk reduction of second malignancies with IMPT. CONCLUSION: The Markov model predicted that IMPT with DIBH was only cost-effective for selected left-sided breast cancer patients where IMRT resulted in a significantly greater dose to normal tissue. The presented model may serve as a means of evaluating the cost-effectiveness of IMPT on an individual patient basis.

Patient selection for proton therapy: a radiobiological fuzzy Markov model incorporating robust plan analysis.

While proton therapy can offer increased sparing of healthy tissue compared with X-ray therapy, it can be difficult to predict whether a benefit can be expected for an individual patient. Predictive modelling may aid in this respect. However, the predictions of these models can be affected by uncertainties in radiobiological model parameters and in planned dose. The aim of this work is to present a Markov model that incorporates these uncertainties to compare clinical outcomes for individualised proton and X-ray therapy treatments. A time-inhomogeneous fuzzy Markov model was developed which estimates the response of a patient to a given treatment plan in terms of quality adjusted life years. These are calculated using the dose-dependent probabilities of tumour control and toxicities as transition probabilities in the model. Dose-volume data representing multiple isotropic patient set-up uncertainties and range uncertainties (for proton therapy) are included to model dose delivery uncertainties. The model was retrospectively applied to an example patient as a demonstration. When uncertainty in the radiobiological model parameter was considered, the model predicted that proton therapy would result in an improved clinical outcome compared with X-ray therapy. However, when dose delivery uncertainty was included, there was no difference between the two treatments. By incorporating uncertainties in the predictive modelling calculations, the fuzzy Markov concept was found to be well suited to providing a more holistic comparison of individualised treatment outcomes for proton and X-ray therapy. This may prove to be useful in model-based patient selection strategies.

Mechanism for the Binding of Netropsin to Hairpin DNA Revealed Using Nanoscale Ion Emitters in Native Mass Spectrometry.

Netropsin is one of the first ligands to be discovered that selectively binds to the minor groove of DNA and is actively used as a scaffold for developing potential anticancer and antibiotic agents. The mechanism by which netropsin binds to hairpin DNA remains controversial with two competing mechanisms having been proposed. In one mechanism, netropsin binding induces a hairpin-to-duplex DNA transition. Alternatively, netropsin binds in two thermodynamically different modes at a single duplexed AATT site. Here, results from native mass spectrometry (MS) with nanoscale ion emitters indicate that netropsin can simultaneously and sequentially bind to both hairpin and duplex DNA. Duplex DNA was not detected using conventional MS with larger emitters because nanoscale emitters significantly reduce the extent of salt adduction to ligand-DNA complex ions, including in the presence of relatively high concentrations of nonvolatile salts. Based on native MS and polyacrylamide gel electrophoresis results, the abundances of hairpin and duplex DNA are unaffected by the addition of netropsin. By native MS, the binding affinities for five ligand-DNA and DNA-DNA interactions can be rapidly obtained simultaneously. This research indicates a "simultaneous binding mechanism" for the interactions of netropsin with DNA.

Cost-effectiveness of proton therapy in treating base of skull chordoma.

While proton beam therapy (PBT) can offer increased sparing of healthy tissue, it is associated with large capital costs and as such, has limited availability. Furthermore, it has not been well established whether PBT has significant clinical advantages over conventional volumetric modulated arc therapy (VMAT) for all tumour types. PBT can potentially offer improved clinical outcomes for base of skull chordoma (BOSCh) patients compared with photon (X-ray) therapy, however the cost-effectiveness of these treatments is unclear. In this study, the cost-effectiveness of PBT in the treatment of BOSCh patients is assessed, based on an analysis of comparative radiotherapy treatment plans using a radiobiological Markov model. Seven BOSCh patients had treatment plans for the delivery of intensity modulated proton therapy and VMAT retrospectively analysed. The patient outcome (in terms of tumour local control and normal tissue complications) after receiving each treatment was estimated with a radiobiological Markov model. In addition, the model estimated the cost of both the primary treatment and treating any resultant adverse events. The incremental cost-effectiveness ratio (ICER) was obtained for each patient. PBT was found to be cost-effective for 5 patients and cost-saving for 2. The mean ICER was AUD$1,990 per quality adjusted life year gained. Variation of model parameters resulted in the proton treatments remaining cost-effective for these patients. Based on this cohort, PBT is a cost-effective treatment for patients with BOSCh. This supports the inclusion of PBT for BOSCh in the Medicare Services Advisory Committee 1455 application.

Exploring Communication Strategies for Promoting Hepatitis B Prevention among Young Asian American Adults.

In the United States, Asian Americans account for 50-60% of hepatitis B virus infections, leading to higher rates of liver cancer in this population. While some city-wide data have reported hepatitis B infection rates among young adults as high as 10-20%, little research has examined factors that impact hepatitis B beliefs, or the most effective strategies for reaching this particular population to promote hepatitis B awareness. An online survey was conducted with young Asian American adults (n = 418), aged 18-29 years old, to better understand their health information seeking, social media usage, and hepatitis B-related behaviors and beliefs. Results indicated that doctors and health organizations were the most trusted sources of health information, while the Internet was the most common source of health information. The majority of participants (99.8%) reported using social media and indicated they engaged in health-related behaviors on social media. Several factors, including non-receipt of hepatitis B vaccine, engaging in more health-related social media activities, and a higher mean score for difficulty with health information seeking, were significantly related to higher perceived susceptibility to hepatitis B. Future research should explore the effectiveness of using social media to reach young Asian American adults to promote hepatitis B awareness.

A radiobiological Markov simulation tool for aiding decision making in proton therapy referral.

PURPOSE: Proton therapy can be a highly effective strategy for the treatment of tumours. However, compared with X-ray therapy it is more expensive and has limited availability. In addition, it is not always clear whether it will benefit an individual patient more than a course of traditional X-ray therapy. Basing a treatment decision on outcomes of clinical trials can be difficult due to a shortage of data. Predictive modelling studies are becoming an attractive alternative to supplement clinical decisions. The aim of the current work is to present a Markov framework that compares clinical outcomes for proton and X-ray therapy. METHODS: A Markov model has been developed which estimates the radiobiological effect of a given treatment plan. This radiobiological effect is estimated using the tumour control probability (TCP), normal tissue complication probability (NTCP) and second primary cancer induction probability (SPCIP). These metrics are used as transition probabilities in the Markov chain. The clinical outcome is quantified by the quality adjusted life expectancy. To demonstrate functionality, the model was applied to a 6-year-old patient presenting with skull base chordoma. RESULTS: The model was successfully developed to compare clinical outcomes for proton and X-ray treatment plans. For the example patient considered, it was predicted that proton therapy would offer a significant advantage compared with volumetric modulated arc therapy in terms of survival and mitigating injuries. CONCLUSIONS: The functionality of the model was demonstrated using the example patient. The proposed Markov method may be a useful tool for deciding on a treatment strategy for individual patients.

Unmet Needs of Asian American and Pacific Islander Cancer Survivors.

In the USA, cancer is the leading cause of death for Asian Americans and Pacific Islanders (AAPIs), but little is known about the unmet needs of AAPI cancer survivors, especially from a national perspective. Using a community-based participatory research approach, we partnered with the Asian and Pacific Islander National Cancer Survivors Network and the Asian American Cancer Support Network to design and conduct a cross-sectional survey to understand the unmet needs of a national sample of AAPI cancer survivors. We assessed unmet needs in 10 domains: day-to-day activities, financial expenses, emotional concerns, medical treatment, cancer information, home care, nutrition, physical concerns, family relationships, and spirituality. We also assessed self-reported measures related to quality of life. This national sample of AAPI cancer survivors included people from 14 states and two territories who had been diagnosed with a broad range of cancers, including cancer of the breast, ovary/uterus/cervix, prostate, blood, and other sites. Over 80 % reported at least one unmet need. Participants reported an average of 8.4 unmet needs, spanning an average of 3.9 domains. Most commonly reported were unmet needs pertaining to physical concerns (66 %), day-to-day activities (52 %), and emotional concerns (52 %). This is the first report of unmet needs in a national sample of AAPI cancer survivors with a range of different cancer types. It describes the areas of greatest need and points to the importance of devoting more resources to identifying and addressing unmet needs for the underserved population of AAPI cancer survivors.

Cancer survivors' perspectives on delivery of survivorship care by primary care physicians: an internet-based survey.

BACKGROUND: Helping cancer survivors to transition from active treatment to long-term survivorship requires coordinated efforts by both oncologists and primary care physicians (PCPs). This study aims to evaluate cancer survivors' perspectives on PCP-delivered survivorship care. METHODS: We conducted an Internet-based cross-sectional survey of cancer survivors via www.OncoLink.org . Regression analyses were used to identify factors associated with perception of PCP-delivered survivorship care. RESULTS: The 352 respondents rated overall PCP-delivered survivorship care as 60 out of 100 (SD = 23). The areas of care most strongly endorsed were general care (62 %), psychosocial support (65 %), and holistic care (68 %). Survivors were less likely to perceive their PCPs as knowledgeable about cancer follow-up (43 %), late or long-term effects of cancer therapy (45 %), and diagnosis and treatment of symptoms related to cancer or cancer therapy (42 %). While 72 % of survivors reported satisfaction with their PCP's care overall, only 41 % felt that their PCPs and oncologists communicated well with one another. In a multivariate regression analysis, higher trust in PCP (p < 0.001), non-white race (p = 0.001), living in the United States (p = 0.007), and visiting a PCP two or more times per year (p = 0.009) were significantly associated with higher ratings of PCP-delivered survivorship care. CONCLUSIONS: While cancer survivors in general are satisfied with care delivery by PCPs, they perceived that their PCPs have limited abilities in performing cancer-specific follow-up and late effect monitoring and treatment. Better education of family physicians about survivorship issues and improved communication between PCPs and oncologists are needed to improve PCPs' delivery of survivorship care.

Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations.

This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late-stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.

Chemical probing of the human sirtuin 5 active site reveals its substrate acyl specificity and peptide-based inhibitors.

Sirtuins are NAD(+)-dependent deacetylases acting as sensors in metabolic pathways and stress response. In mammals there are seven isoforms. The mitochondrial sirtuin 5 is a weak deacetylase but a very efficient demalonylase and desuccinylase; however, its substrate acyl specificity has not been systematically analyzed. Herein, we investigated a carbamoyl phosphate synthetase 1 derived peptide substrate and modified the lysine side chain systematically to determine the acyl specificity of Sirt5. From that point we designed six potent peptide-based inhibitors that interact with the NAD(+) binding pocket. To characterize the interaction details causing the different substrate and inhibition properties we report several X-ray crystal structures of Sirt5 complexed with these peptides. Our results reveal the Sirt5 acyl selectivity and its molecular basis and enable the design of inhibitors for Sirt5.

Pap testing, awareness, and acceptability of a human papillomavirus (HPV) vaccine among Chinese American women.

Little is known about the knowledge and opinions of human papillomavirus (HPV) vaccine among Chinese immigrants, nor the impact of framing HPV as a sexually transmitted infection in this population. A cross-sectional survey was conducted focusing on knowledge and experience with HPV, HPV vaccine, cervical cancer and Pap testing, and attitudes toward HPV vaccine in response to different message frames. Chinese American women were recruited in a community setting (n = 162). Only 19 % had heard of HPV and 38 % had had a Pap test in the last 3 years. Multivariate logistic regression showed that English proficiency was associated with vaccination acceptance and insurance status was associated with HPV awareness; there was no observed correlation with message framing. Chinese American women with limited English proficiency have low HPV awareness. Community-based, culturally appropriate education about cervical cancer and HPV vaccine should be directed toward limited-English proficient Chinese American women.

Social cognitive and clinical factors associated with HPV vaccine initiation among urban, economically disadvantaged women.

OBJECTIVE: To learn more about human papilloma virus (HPV) knowledge and vaccination among teens and young women age 13 to 26 years from an economically disadvantaged, urban community. Our aim was to identify common beliefs about HPV vaccine initiation and describe the relationship between attitudes, norms, perceived control, and intention to receive HPV vaccine, drawing from the theory of planned behavior (TPB). DESIGN: Mixed method, descriptive design. Guided by the TPB, HPV vaccine beliefs were assessed through focus groups. Intention to receive the vaccine, demographic and clinical factors, and theoretical predictor variables (attitudes, norms, and control) were assessed through questionnaires. SETTING: After recruitment, focus groups were held at a convenient date and time for our participants in a small university conference room. PARTICIPANTS: Participants were economically disadvantaged young women, age 13 to 26 (N = 34). METHODS: Specific behavioral, normative, and control beliefs were elicited in focus groups and analyzed using content analysis. Simple and multivariate general linear modeling with adjustment for prognostic demographic and clinical factors was completed to assess the influence of the theoretical predictor variables on the outcome of HPV vaccine initiation. RESULTS: Influential beliefs toward vaccination were identified. Analysis indicated attitudes, norms, and perceived control toward HPV vaccine initiation were highly significant predictors of intent, as was tobacco use; all p's < .001. CONCLUSION: Barriers to HPV vaccine initiation were identified, and strong preliminary evidence supports use of the TPB to guide programs to promote urban, economically disadvantaged young women's intent to begin the HPV vaccine.

Cancer-related information seeking and scanning behavior of older Vietnamese immigrants.

Information seeking and scanning refers to active pursuit of information and passive exposure, respectively. Cancer is the leading cause of mortality for Asian Americans, yet little is known about their cancer information seeking/scanning behaviors (SSB). We aimed to evaluate cancer SSB among older limited English proficient (LEP) Vietnamese immigrants, compared with Whites/African Americans. One hundred four semistructured interviews about breast/prostate/colon cancer SSB (ages 50-70) were conducted in English and Vietnamese, transcribed, and coded for frequency of source use, active/passive nature, depth of recall, and relevance to decisions. Higher SSB was associated with cancer screening. In contrast to non-Vietnamese, SSB for Vietnamese was low. Median number of cancer screening sources was two (vs. eight to nine for non-Vietnamese). They also had less seeking, lower recall, and less decision-making relevance for information on colon cancer and all cancers combined. Overall, Vietnamese had lower use of electronic, print, and interpersonal sources for cancer SSB, but more research is needed to disentangle potential effects of ethnicity and education. This study brings to light striking potential differences between cancer SSB of older LEP Vietnamese compared with Whites/African Americans. Knowledge of SSB patterns among linguistically isolated communities is essential for efficient dissemination of cancer information to these at-risk communities.

Factors influencing the receipt of hepatitis B vaccination and screenings in Vietnamese Americans.

This study examined factors affecting the receipt of both hepatitis B vaccination and screening in the Vietnamese American community of Philadelphia. Hepatitis B is endemic in Southeast Asia; individuals emigrating from endemic areas are at a particularly high risk of hepatitis B infection, resulting in a higher prevalence of liver cancer in the population. Participants recruited at Vietnamese community events in Philadelphia completed a self-administered written questionnaire. In a sample of 207 participants (93% foreign-born), over one half reported that they had not received either a screening or vaccination for hepatitis B in their lifetime. The number one predictor of receiving either service was that the participant was aware of the cancer risk posed by hepatitis B. This association remained strong even when controlling for socio-demographic factors. Based on this finding, future interventions targeting this population should include messages on the cancer risk associated with hepatitis B.

Awareness of anticancer vaccines among Asian American women with limited english proficiency: an opportunity for improved public health communication.

BACKGROUND: Asian Americans suffer from liver and cervical cancers, both vaccine preventable, yet vaccine awareness has not been described. METHODS: Cross-sectional survey (6 languages, 380 adult women). RESULTS: Those with limited English proficiency (LEP) were less likely to have accurate knowledge of cervical cancer vaccine (44% vs. 76%, among the 34% aware of any cancer-preventive vaccines) and were more likely to believe vaccines existed for non-vaccine-preventable cancers. Awareness of anti-liver cancer vaccine was low for both LEP and non-LEP women. CONCLUSION: There is a great need to educate Asian Americans about vaccine-preventable cancers, especially among LEP women.

A dilemma in male engagement in preventive services: adolescent males' knowledge and attitudes toward testicular cancer and testicular self-exam.

The objective of this study was to determine the knowledge and attitudes toward testicular cancer (TC) and testicular self-exam (TSE) among adolescent males. To assess adolescent male perspectives, a cross-sectional study was conducted in a convenience sample of 203 male high school students. Among the study participants, 139 (68.5%) correctly identified the age group when TC most commonly occurs, and 74 (36.5%) believed that TSE should be performed monthly. In a logistic regression model, students who have never heard of TSE were more likely to report intention to delay health care seeking with symptoms of testicular cancer (odds ratio, 2.83; 95% confidence interval, 1.33-6.05; p = .007). The participants demonstrated significant awareness of TC. Given the tension between current recommendations against screening for TC and the potential benefits of engaging men in preventive health care utilization, it remains unclear how awareness of TC and TSE will affect the health-seeking and preventive care of men.