Cancer-Related Fatigue Outcome Measures in Integrative Oncology: Evidence for Practice and Research Recommendations.

Cancer-related fatigue (CRF) is one of the most common symptoms across the cancer continuum and is often underreported and undertreated. Defined as a distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or its treatment, CRF includes physical, emotional, cognitive, and spiritual dimensions. Patient-reported outcome (PRO) measures are the most widely used tool to screen for and assess fatigue and the associated negative impacts on quality of life. However, selecting subjective CRF measures can be complex. This has resulted in the availability of and inconsistent use of numerous PROs, limiting the ability to cross-compare outcomes clinically and within research. To address this, the PROs that are most widely reported in the literature are recommended to support the standardization of a core set of validated measures. The National Comprehensive Cancer Network single-item tool for clinical significance is recommended for quick use in clinical environments; the Brief Fatigue Inventory allows for fast, easy, helpful cutoffs on severity threshold for triage, and measures both severity and interference with daily functioning; while the MD Anderson Symptom Inventory allows for multisymptomatic assessment. In addition, a fundamental consideration for any PRO use is the administrative burden on the patient and clinician. In this review, we aim to summarize current, validated PROs specific to CRF to aid clinicians and researchers in patient care and in study design and implementation. We conclude with suggestions for future directions in CRF research that can increase the possibility for long-term impact on future guidelines of fatigue management.

Pain Improvement After Healing Touch and Massage in Breast Cancer: an Observational Retrospective Study.

BACKGROUND: Healing Touch (HT) and Oncology Massage (OM) are nonpharmacologic pain interventions, yet a comparative effectiveness study has not been conducted for pain in breast cancer. PURPOSE: This breast cancer subgroup analysis compared the effectiveness of HT vs. OM on pain. SETTING: The research occurred at an outpatient setting at an academic hybrid, multi-site, community-based cancer institute and Department of Supportive Oncology across four regional locations. PARTICIPANTS: Breast cancer outpatients along the cancer continuum who experienced routine clinical, nonexperimentally manipulated HT or OM. RESEARCH DESIGN: The study was an observational, retrospective, comparative effectiveness post hoc subanalysis of a larger dataset. Patients reporting pain < 2 were excluded. Pre- and posttherapy pain scores and differences were calculated. Logistic regression modeled posttherapy pain by modality, adjusting for pretherapy pain. The proportions experiencing ≥ 2-point (clinically significant) pain reduction were compared with chi-square tests. INTERVENTION: The study focused on the first session of either HT or OM. MAIN OUTCOME MEASURES: Pre- and posttherapy pain (range: 0 = no pain to 10 = worst possible pain). RESULTS: A total of 407 patients reported pre- and posttherapy pain scores, comprised of 233 (57.3%) who received HT and 174 (42.8%) who received OM. Pretherapy mean pain was higher in HT (M=5.1, ± 2.3) than OM (M=4.3, ± 2.1) (p < .001); posttherapy mean pain remained higher in HT (M=2.7, ± 2.2) than OM (M=1.9, ± 1.7) (p < .001). Mean difference in pain reduction was 2.4 for both HT and OM. Both HT (p < .001) and OM (p < .001) were associated with reduced pain. Proportions of clinically significant pain reduction were similar (65.7% HT and 69.0% OM, p = .483). Modality was not associated with pain improvement (p = .072). CONCLUSIONS: Both HT and OM were associated with clinically significant pain improvement. Future research should explore attitudes toward the modalities and potential influence of cancer stage and treatment status on modality self-selection.

Patient-Reported Outcomes of Pain and Related Symptoms in Integrative Oncology Practice and Clinical Research: Evidence and Recommendations.

Pain is a primary concern among patients with cancer and cancer survivors. Integrative interventions such as acupuncture, massage, and music therapy are effective nonpharmacologic approaches for cancer pain with low cost and minimal adverse events. Patient-reported outcomes (PROs) that have been validated in many clinical and research settings can be used to evaluate pain intensity, associated symptom burden, and quality of life. Clearly defined, reliable PROs can improve patient satisfaction and symptom control. As integrative oncology continues to evolve and expand, cancer-related pain PROs must be standardized to accurately guide clinicians and researchers. Well-validated pain PROs, such as the Brief Pain Inventory, are among the most commonly used for pain intensity assessment. Multiple symptom assessment tools such as the MD Anderson Symptom Inventory, the Memorial Symptom Assessment Scale, the Edmonton Symptom Assessment System, and the Patient-Reported Outcomes-Common Terminology Criteria for Adverse Events measurement system can also capture pain-associated symptom burden. Electronic PROs provide flexibility in collecting and analyzing PRO data. Clinical trials using carefully selected PROs and rigorous statistical analysis plans are fundamental to conducting high-quality integrative oncology research and promoting utilization of effective integrative interventions to improve patient outcomes. In this review, we aim to summarize current, validated PROs specific to cancer-related pain to aid integrative oncology clinicians and researchers in patient care and in study design and implementation.

Clinician's Experience and Self-Perceived Knowledge and Attitudes toward LGBTQ + Health Topics.

Phenomenon: Research on clinicians' knowledge and attitudes toward lesbian, gay, bisexual, transgender, queer/questioning, and other sexual and gender minorities (LGBTQ+) health topics has relied mostly on small early-career samples. The influence of clinical experience on knowledge and attitudes has not been examined. The study purpose was to examine physicians' and advanced practice providers' (a) self-perceived knowledge and attitudes about LGBTQ + health topics, (b) the relationship between clinical experience and self-perceived knowledge and attitudes, and (c) preferences for LGBTQ + medical education.Approach: An online anonymous survey was emailed to 3667 physicians and advanced practice providers at a large southeastern multisite healthcare institution. Logistic regression determined associations between clinical experience, knowledge, and attitudes.Findings: There were 880 (24.0%) respondents. Most were physicians (70%). Thirty-eight percent had more than 15 years of experience. Fifty-four percent preferred online education. Few reported sophisticated knowledge of six LGBTQ + health topics (6%-10%). The majority felt that these were either important or very important for all physicians. After accounting for demographics, experience was not associated with knowledge or attitudes.Insights: Knowledge gaps yet positive attitudes suggest that additional training on LGBTQ + patients is warranted and likely to be well received. The lack of influence of experience on knowledge and attitudes may suggest that training is applicable to clinicians of all experience levels. Future research should determine if knowledge and attitudes toward LGBTQ + health topics influence culturally competent healthcare practices.

Cultural Humility: A Way to Reduce LGBTQ Health Disparities at the End of Life.

Sexual and gender minorities experience disparities throughout the life course. These are especially detrimental at the end-of-life and can include disenfranchised grief, homophobia and transphobia from medical staff, and forced outing. The best healthcare training approach to ameliorate health disparities is debated. Cultural competency trainings for clinicians have been commonly proposed by major medical institutions and certifying bodies to ameliorate lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) health disparities. However, cultural competency trainings have limitations, including (1) false competence, (2) measurement issues, and (3) ecological fallacy (i.e., assuming individuals conform to the norms of their cultural group). The purpose of this commentary is to describe the limitations of cultural competency training and argue for healthcare systems to implement cultural humility trainings as a way to reduce LGBTQ health disparities at the end-of-life. The strengths of cultural humility training include focus on (1) individuals instead of their cultural groups, (2) self-reflection, and (3) active listening. While there are challenges to implementing cultural humility trainings in the health-care system, we assert that these trainings align with the aims of healthcare systems and can be an essential tool in reducing LGBTQ health disparities. We suggest practical components of successful cultural humility trainings including leadership buy-in, appropriate outcome measurements, multiple training sessions, and fostering a safe reflection space.

Group Acupuncture Model in a Cancer Institute: Improved Access and Affordability.

Cancer patients may experience significant symptom mitigation from acupuncture. However, this service may not be easily accessible or affordable at all cancer institutions. The development of a group acupuncture program provided one institution with improved availability, lower cost to patients, and a foundation for oncology acupuncture research. This care delivery model was deployed at a large southeastern cancer institution within a multistate academic-community hybrid hospital system. The cancer institute serves >15,000 patients annually. Acupuncture is provided through the institute's Integrative Medicine section of the Department of Supportive Oncology. The purpose of this commentary is to describe the successful transition from an individual to group acupuncture model at this cancer institute. With the implementation of group acupuncture, patient visits increased 275% from individual care delivery. Although successful implementation of a group acupuncture model may be affordable and clinically positive, the authors also share unique challenges learned through the development and expansion of this program.

Examining the Role of Twitter in Response and Recovery During and After Historic Flooding in South Carolina.

CONTEXT: Social media has played an increasing role in the response to emergency situations through information exchange and efforts to promote recovery. Understanding more about how social media users share and re-share information is particularly important to help emergency response entities determine best strategies for expanding reach and impact through social media in disseminating emergency messages. OBJECTIVE: This study examined the role and use of Twitter as a response and recovery strategy before, during, and after historic rainfall and flooding in the Midlands region of the greater Columbia, South Carolina, area in October 2015. DESIGN: A cross-sectional, thematic, and descriptive examination of Twitter data across 4 time periods (before the historic rainfall and flooding, during, immediately after a boil water advisory period, and 6 months later) was conducted. SETTING: Twitter posts containing "#SCFlood" with a focus on the Midlands region were extracted and analyzed. RESULTS: The most common themes of tweets across all 4 time periods were weather conditions, devastation description, resource distribution, volunteerism, actions to reduce threats to health, and appreciation. Tweets mostly originated from individual users, followed by media outlets, governmental agencies, and nonprofit agencies. Tweets from the first 3 time periods were largely focused on built and natural environment devastation and action to reduce threats to health, and tweets from the fourth time period were primarily focused on cleanup and repair. CONCLUSIONS: Twitter was utilized widely as a communication tool to provide time-sensitive and critical information before, during, and after the event. Ensuring that key social media users have developed disaster communication strategies inclusive of Twitter seems important in aiding response to and recovery from natural disasters.

Patients With Cancer and Social Media: Harness Benefits, Avoid Drawbacks.

Social media (SM) platforms such as Facebook, Instagram, Twitter, and online cancer support groups are an emerging source of social support. However, oncology care professionals may be unfamiliar with how patients use SM related to their cancer diagnosis. SM can be potentially beneficial by providing an avenue for patient engagement and empowerment, increasing psychosocial and informational support, strengthening patient-physician relationships, and relaying opportunities for clinical and research study participation. Conversely, it can spread misinformation, overwhelm with information overload, violate privacy, and expose users to financial exploitation. The purpose of this article is to describe five potential benefits and five potential drawbacks patients may experience while using SM and to encourage oncologists to become aware of these, to guide patients in using SM to their benefit. This review also provides specific care practice behaviors that oncologists can apply during care delivery to guide patients' SM use, to help avoid the potential drawbacks and harness the potential benefits.

Cancer Pain Relief After Healing Touch and Massage.

OBJECTIVES: To establish and compare the effectiveness of Healing Touch (HT) and Oncology Massage (OM) therapies on cancer patients' pain. DESIGN: pretest/post-test, observational, retrospective study. SETTINGS/LOCATION: Outpatient oncology setting at an academic hybrid, multisite, community-based cancer institute. SUBJECTS: n = 572 cancer outpatients. INTERVENTIONS: Patients reported pain before and after receiving a single session of either HT or OM from a certified practitioner. OUTCOME MEASURES: Pain scores from 0 = no pain to 10 = worst possible pain. RESULTS: Two hundred ninety-one patients (50.9%) receiving HT and 281 (49.1%) receiving OM reported pretherapy and post-therapy pain. Pretherapy mean pain was higher in HT patients (M = 5.1, ±2.2) than OM (M = 4.4, ±2.2), p < 0.001; post-therapy mean pain remained higher in HT patients (M = 2.6, ±2.1) than OM (M = 2.0, ±1.8), p < 0.001. Both HT (p < 0.01) and OM (p < 0.01) significantly reduced pain. Unadjusted rates of clinically significant pain improvement (defined as ≥2-point reduction in pain score) were 0.68 HT and 0.71 OM. Adjusted for pretherapy pain, OM was associated with increased odds of pain improvement (odds ratio [OR] 1.49 95% confidence interval (1.02-2.19); p = 0.041). For patients with severe pretherapy pain, OM was not more effective in yielding clinically significant pain reduction (p = 0.236) when adjusting for pretherapy pain score. CONCLUSIONS: Both HT and OM provided immediate pain relief. Future research should explore the duration of pain relief, patient attitudes about HT compared with OM, and how this may differ among patients with varied pretherapy pain levels.

Social Media for Networking, Professional Development, and Patient Engagement.

Social media has become an established method of communication, and many physicians are finding these interactive tools and platforms to be useful for both personal and professional use. Risks of social media, or barriers to its use, include perceived lack of time, privacy concerns, and the risk of damage to one's reputation by unprofessional behavior. Of the social media platforms, Twitter has become favored by physicians and other health care professionals. Although one of the most obvious uses of social media is for rapid dissemination and receipt of information, oncologists are finding that social media is important for networking through blogs, Facebook, and Twitter. These platforms also have potential for providing opportunities for professional development, such as finding collaborators through networking, participation in Twitter journal clubs, and participating in online case-based tumor boards. Social media can also be used for patient engagement, such as through participation in tweet chats. There is emerging data that patient engagement through these platforms may lead to improvement in some health-related outcomes; however, data are sparse for oncology-specific outcomes. Efforts are underway to determine how to assess how social media engagement impacts health outcomes in oncology patients.

Sick of our loans: Student borrowing and the mental health of young adults in the United States.

Student loans are increasingly important and commonplace, especially among recent cohorts of young adults in the United States. These loans facilitate the acquisition of human capital in the form of education, but may also lead to stress and worries related to repayment. This study investigated two questions: 1) what is the association between the cumulative amount of student loans borrowed over the course of schooling and psychological functioning when individuals are 25-31 years old; and 2) what is the association between annual student loan borrowing and psychological functioning among currently enrolled college students? We also examined whether these relationships varied by parental wealth, college enrollment history (e.g. 2-year versus 4-year college), and educational attainment (for cumulative student loans only). We analyzed data from the National Longitudinal Survey of Youth 1997 (NLSY97), a nationally representative sample of young adults in the United States. Analyses employed multivariate linear regression and within-person fixed-effects models. Student loans were associated with poorer psychological functioning, adjusting for covariates, in both the multivariate linear regression and the within-person fixed effects models. This association varied by level of parental wealth in the multivariate linear regression models only, and did not vary by college enrollment history or educational attainment. The present findings raise novel questions for further research regarding student loan debt and the possible spillover effects on other life circumstances, such as occupational trajectories and health inequities. The study of student loans is even more timely and significant given the ongoing rise in the costs of higher education.

Educational Attainment by Life Course Sexual Attraction: Prevalence and Correlates in a Nationally Representative Sample of Young Adults.

Researchers know relatively little about the educational attainment of sexual minorities, despite the fact that educational attainment is consistently associated with a range of social, economic, and health outcomes. We examined whether sexual attraction in adolescence and early adulthood was associated with educational attainment in early adulthood among a nationally representative sample of US young adults. We analyzed Waves I and IV restricted data from the National Longitudinal Study of Adolescent Health (n=14,111). Sexual orientation was assessed using self-reports of romantic attraction in Waves I (adolescence) and IV (adulthood). Multinomial regression models were estimated and all analyses were stratified by gender. Women attracted to the same-sex in adulthood only had lower educational attainment compared to women attracted only to the opposite-sex in adolescence and adulthood. Men attracted to the same-sex in adolescence only had lower educational attainment compared to men attracted only to the opposite-sex in adolescence and adulthood. Adolescent experiences and academic performance attenuated educational disparities among men and women. Adjustment for adolescent experiences also revealed a suppression effect; women attracted to the same-sex in adolescence and adulthood had lower predicted probabilities of having a high school diploma or less compared to women attracted only to the opposite-sex in adolescence and adulthood. Our findings challenge previous research documenting higher educational attainment among sexual minorities in the US. Additional population-based studies documenting the educational attainment of sexual minority adults are needed.