Awareness of the Harms of Continued Smoking Among Cancer Survivors.

BACKGROUND: Smoking cessation is an integral part of cancer survivorship. To help improve survivorship education, clinicians need an understanding of patient awareness of the harms of continued smoking. METHODS: Cancer survivors from Princess Margaret Cancer Centre (Toronto, ON) were surveyed on their awareness of the harms of continued smoking on cancer-related outcomes. Multivariable logistic regression models assessed factors associated with awareness and whether awareness was associated with subsequent cessation among smokers at diagnosis. RESULTS: Among 1118 patients, 23% were current smokers pre-diagnosis and 54% subsequently quit; 25% had lung and 30% head and neck cancers. Many patients reported being unaware that continued smoking results in greater cancer surgical complications (53%), increased radiation side effects (62%), decreased quality of life during chemotherapy (51%), decreased chemotherapy or radiation efficacy (57%), increased risk of death (40%), and increased development of second primaries (38%). Being a current smoker was associated with greater lack of awareness of some of these smoking harms (aORs = 1.53-2.20, P < 0.001-0.02), as was exposure to any second-hand smoke (aORs = 1.45-1.53, P = 0.006-0.04) and being diagnosed with early stage cancer (aORs = 1.38-2.31, P < 0.001-0.06). Among current smokers, those with fewer pack-years, being treated for cure, or had a non-tobacco-related cancer were more likely unaware. Awareness that continued tobacco use worsen quality of life after chemotherapy was associated with subsequent cessation (aOR = 2.26, P = 0.006). CONCLUSIONS: Many cancer survivors are unaware that continued smoking can negatively impact cancer-related outcomes. The impact of educating patients about the potential harms of continued smoking when discussing treatment plans should be further evaluated.

Moving average filtering with deconvolution (MAD) for hidden Markov model with filtering and correlated noise.

Ion channel data recorded using the patch clamp technique are low-pass filtered to remove high-frequency noise. Almanjahie et al. (Eur Biophys J 44:545-556, 2015) based statistical analysis of such data on a hidden Markov model (HMM) with a moving average adjustment for the filter but without correlated noise, and used the EM algorithm for parameter estimation. In this paper, we extend their model to include correlated noise, using signal processing methods and deconvolution to pre-whiten the noise. The resulting data can be modelled as a standard HMM and parameter estimates are again obtained using the EM algorithm. We evaluate this approach using simulated data and also apply it to real data obtained from the mechanosensitive channel of large conductance (MscL) in Escherichia coli. Estimates of mean conductances are comparable to literature values. The key advantages of this method are that it is much simpler and computationally considerably more efficient than currently used HMM methods that include filtering and correlated noise.

Utility of a repeat PET/CT scan in HPV-associated Oropharyngeal Cancer following incomplete nodal response from (chemo)radiotherapy.

OBJECTIVES: To assess the utility of a repeat positron emission tomography/computed tomography (PET/CT) instead of immediate neck dissection (ND) for incomplete nodal response (IR) in Human Papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPC) following chemoradiotherapy/radiotherapy [(chemo)RT]. MATERIALS AND METHODS: Patients with non-distant metastatic, node positive (N+) disease treated between Jan/2005 to Jan/2016, achieved complete response at the primary with no distant relapse on a 12-week re-staging PET/CT were evaluated. Patients underwent surveillance after complete nodal response (CR). Patients with IR underwent repeat PET/CT at 16 weeks to direct neck management. Primary endpoints were CR conversion rate and subsequent regional failure following a 16-week PET/CT directed ND. Secondary endpoints were predictive values (PV) of the 12- and 16-week PET/CT for residual nodal disease, predictors for requiring the 16-week PET/CT, 5 year regional, locoregional failure free survival (FFS) and overall survival (OS). RESULTS: 235 patients were evaluated. Median follow up was 56 (range 19-60) months. 41 patients underwent 16-week re-staging PET/CT, 29 (71%) converted to CR. No subsequent regional failures occurred following a 16-week PET/CT directed ND. Positive and negative PV of the 12- and 16-week PET/CT for residual nodal disease was 12% & 98%, and 33% & 97%, respectively. N-category (AJCC/UICC 7th edition) predicted for requiring a 16-week PET/CT on univariate analysis (P-value 0.02). 5 year regional, locoregional FFS and OS was 95.8%, 93.4% and 90.8%, respectively. CONCLUSION: For N+ HPV-associated OPC achieving IR on the 12-week re-staging PET/CT following (chemo)RT, a repeat 16-week PET/CT can spare patients from unnecessary surgery.

Perceptions of Continued Smoking and Smoking Cessation Among Patients With Cancer.

PURPOSE: Continued smoking after a cancer diagnosis leads to poorer treatment outcomes, survival, and quality of life. We evaluated the perceptions of the effects of continued smoking on quality of life, survival, and fatigue among patients with cancer after a cancer diagnosis and the effects of these perceptions on smoking cessation. PATIENTS AND METHODS: Patients with cancer from all disease subsites from Princess Margaret Cancer Centre (Toronto, Ontario) were surveyed between April 2014 and May 2016 for sociodemographic variables, smoking history, and perceptions of continued smoking on quality of life, survival, and fatigue. Multivariable regression models evaluated the association between patients' perceptions and smoking cessation and the factors influencing patients' perceptions of smoking. RESULTS: Among 1,121 patients, 277 (23%) were smoking cigarettes up to 1 year before diagnosis, and 54% subsequently quit; 23% had lung cancer, and 27% had head and neck cancers. The majority felt that continued smoking after a cancer diagnosis negatively affected quality of life (83%), survival (86%), and fatigue (82%). Current smokers during the peridiagnosis period were less likely to perceive that continued smoking was harmful when compared with ex-smokers and never-smokers ( P < .01). Among current smokers, perceiving that smoking negatively affected quality of life (adjusted odds ratio [aOR], 2.68 [95% CI, 1.26 to 5.72]; P = .011), survival (aOR, 5.00 [95% CI, 2.19 to 11.43]; P < .001), and fatigue (aOR, 3.57 [95% CI, 1.69 to 7.54]; P < .001) were each strongly associated with smoking cessation. Among all patients, those with a greater smoking history were less likely to believe that smoking was harmful in terms of quality of life (aOR, 0.98 [95% CI, 0.98 to 0.99]; P < .001), survival (aOR, 0.98 [95% CI, 0.98 to 0.99]; P < .001), and fatigue (aOR, 0.99 [95% CI, 0.98 to 0.99]; P < .001). CONCLUSION: The perceptions of continued smoking after a cancer diagnosis among patients with cancer are strongly associated with smoking cessation. Counseling about the harms of continued smoking in patients with cancer, and in particular among those who have lower risk perceptions, should be considered when developing a smoking cessation program.

Preferences for the Provision of Smoking Cessation Education Among Cancer Patients.

Many individuals who use tobacco will continue to smoke after a cancer diagnosis and throughout treatment. This study aims to better understand cancer patient preferences to learn about smoking cessation. All new patients seen at Princess Margaret Cancer Centre between 1 January 2014 and 30 June 2015 were asked to complete the Combined Tobacco History Survey as part of standard new patient assessments. Smoking status, second hand smoke exposure, years smoked, family support, cessation preferences, demographic and tumour details were collected. Multivariable regression assessed factors associated with smoking cessation educational preferences. Nine thousand and one hundred ten patients completed the survey. One thousand and six hundred ninety-one were current smokers (17 %) of which 43 % were female and median age was 57 years (range 18-95). One thousand and two hundred thirty-eight (73 %) were willing to consider quitting and 953 (56 %) reported a readiness to quit next month. Patients were most interested in pamphlets (45 %) followed by telephone support (39 %), speaking with a healthcare professional (29 %), website (15 %), support group (11 %) and speaking with successful former smokers (9 %). Younger patients (≤45 years) preferred receiving smoking cessation education over the telephone (50 %; p < 0.001), while older patients (46-65 years and >65 years) preferred smoking education to be provided in pamphlets (43 and 51 %, respectively; p = 0.07). In multivariable analyses, older patients were more likely to prefer pamphlets than younger patients OR 1.11 (95 % CI 1.01-1.23; p = 0.03). Older cancer patients preferred to receive smoking cessation education through pamphlets and younger patients preferred the telephone. Tailored provision of cessation education resources for cancer patients is warranted.

Partner's survivorship care needs: An analysis in head and neck cancer patients.

PURPOSE: To determine the number, type and predictors of unmet needs for head and neck cancer (HNC) survivors' partner's. METHODS: Partners of HNC patients were invited to complete the Cancer Survivors' Partners Unmet Needs Survey (CaSPUN). Analysis determined number, proportion and factors associated with greater unmet needs using linear regression. Agreement between the unmet needs of patients and their partners was determined. RESULTS: Among the 44 partners participated 29 reported ≥1 unmet need and 4 had a very high number of needs (31-35). The most common unmet needs were related to concerns about cancer returning, coping with supporting someone with cancer, and the changes cancer has caused. The highest reported needs were in the Relationships domain. Increasing patient unmet needs was significantly associated with increasing partner unmet needs (p<0.01). CONCLUSIONS: A significant proportion of head and neck cancer partners experience unmet needs, which often differ from the patient's needs.

Development and Evaluation of Patient Education Materials for Elderly Lung Cancer Patients.

Patients treated for lung cancer are often elderly presenting a unique challenge for developing patient education materials. This study developed and evaluated a patient education pamphlet on lung stereotactic body radiotherapy (SBRT) designed specifically for an elderly population. The SBRT pamphlet was developed using a participatory design involving a convenience sample of patients. This prospective study assessed patient's opinions of pamphlet effectiveness through self-report questionnaires. The pamphlet was deemed "effective" if patients rated 16/18 evaluation statements as "strongly agree" or "agree." Demographic data and health literacy (Rapid Estimate of Adult Literacy in Medicine short-form (REALM-SF)) were also assessed. Patient opinion of pamphlet "effectiveness" was compared between patients with REALM-SF scores of 7 versus <7 using Fisher's exact test. The overall EQ-5D-5L score was compared for patients who did and did not find the pamphlet effective using the Wilcoxon-Mann-Whitney test. Thirty-seven patients participated. The median age was 76 years (range 56-93) and 22 patients (59 %) had ≤high school education. Most patients preferred to have verbal (65 %) or written (78 %) educational materials as opposed to online information or educational classes. Thirty-two patients (86 %) rated the pamphlet as effective. The proportion of patients who found the pamphlet effective was 85.7 versus 86.7 % (p = 1.00) in those with REALM 7 versus <7. The mean EQ-5D score was 67.5 (SD 19.1) versus 71.8 (SD 8.7) (p = 0.84) in those who found the pamphlet effective versus not. Participatory design is an effective method for developing education materials for challenging patient groups such as elderly patients. Despite advanced age and comorbidity, this patient group had adequate health literacy.

Hidden Markov analysis of improved bandwidth mechanosensitive ion channel data.

The gating behaviour of a single ion channel can be described by hidden Markov models (HMMs), forming the basis for statistical analysis of patch clamp data. Extensive improved bandwidth (25 kHz, 50 kHz) data from the mechanosensitive channel of large conductance in Escherichia coli  were analysed using HMMs, and HMMs with a moving average adjustment for filtering. The aim was to determine the number of levels, and mean current, mean dwell time and proportion of time at each level. Parameter estimates for HMMs with a moving average adjustment for low-pass filtering were obtained using an expectation-maximisation algorithm that depends on a generalisation of Baum's forward-backward algorithm. This results in a simpler algorithm than those based on meta-states and a much smaller parameter space; hence, the computational load is substantially reduced. In addition, this algorithm maximises the actual log-likelihood rather than that for a related meta-state process. Comprehensive data analyses and comparisons across all our data sets have consistently shown five subconducting levels in addition to the fully open and closed levels for this channel.

Predictors of High eHealth Literacy in Primary Lung Cancer Survivors.

Lung cancer survivors are likely to have low health literacy which is an independent risk factor for poorer health outcomes. The eHealth literacy in lung cancer survivors has not been reported. The purposes of this study were to determine self-perceived eHealth literacy levels in lung cancer survivors and to explore predictors of higher eHealth literacy. A cross-sectional study was conducted at the Princess Margaret Cancer Centre in Toronto, Canada. Survivors completed a survey that collected demographic, self-perceived eHealth literacy (using the eHealth Literacy Scale), and quality of life information. Tumor and treatment details were extracted from medical records. Demographic data was summarized using descriptive statistics and compared against those with high and low eHealth literacy using Fisher's exact test. Eighty-three survivors were enrolled over 7 months. Median age was 71 years (range 44-89); 41 survivors (49%) were male. Forty-six (55%) survivors had some college education or higher. Most had access to eResources (78%) via computer, Internet, or smartphone. Fifty-seven (69%) scored 5 or greater (7=excellent) on the overall health scale. Twenty-eight (33.7%) perceived themselves to have high eHealth literacy. There was no statistically significant correlation between eHealth literacy groups and age (p=1.00), gender (p=0.82), living situation (p=1.00), overall health (p=1.00), overall quality of life (QoL) (p=1.00), or histology (p=0.74). High eHealth literacy correlated with the level of education received (p=0.003) and access to eResources (p=0.004). The self-perceived eHealth literacy of lung cancer survivors is generally low.

Determining an imaging literacy curriculum for radiation oncologists: an international Delphi study.

PURPOSE: Rapid evolution of imaging technologies and their integration into radiation therapy practice demands that radiation oncology (RO) training curricula be updated. The purpose of this study was to develop an entry-to-practice image literacy competency profile. METHODS AND MATERIALS: A list of 263 potential imaging competency items were assembled from international objectives of training. Expert panel eliminated redundant or irrelevant items to create a list of 97 unique potential competency items. An international 2-round Delphi process was conducted with experts in RO. In round 1, all experts scored, on a 9-point Likert scale, the degree to which they agreed an item should be included in the competency profile. Items with a mean score ≥ 7 were included, those 4 to 6 were reviewed in round 2, and items scored <4 were excluded. In round 2, items were discussed and subsequently ranked for inclusion or exclusion in the competency profile. Items with >75% voting for inclusion were included in the final competency profile. RESULTS: Forty-nine radiation oncologists were invited to participate in round 1, and 32 (65%) did so. Participants represented 24 centers in 6 countries. Of the 97 items ranked in round 1, 80 had a mean score ≥ 7, 1 item had a score <4, and 16 items with a mean score of 4 to 6 were reviewed and rescored in round 2. In round 2, 4 items had >75% of participants voting for inclusion and were included; the remaining 12 were excluded. The final list of 84 items formed the final competency profile. The 84 enabling competency items were aggregated into the following 4 thematic groups of key competencies: (1) imaging fundamentals (42 items); (2) clinical application (27 items); (3) clinical management (5 items); and (4) professional practice (10 items). CONCLUSIONS: We present an imaging literacy competency profile which could constitute the minimum training standards in radiation oncology residency programs.

SMS reminders in the UK national health service: an evaluation of its impact on "no-shows" at hospital out-patient clinics.

The ownership of cell phones and use of short message service (SMS) are sufficiently common in the United Kingdom to be exploited by health services providers. The study evaluates their use to reduce nonattendance at out-patient clinics. The impact is modest, but so also is the cost, about 7.50 pounds (13.13 dollars, 10.88 euros) per "no-show" avoided.

Hidden Markov analysis of mechanosensitive ion channel gating.

Patch clamp data from the large conductance mechanosensitive channel (MscL) in E. coli was studied with the aim of developing a strategy for statistical analysis based on hidden Markov models (HMMs) and determining the number of conductance levels of the channel, together with mean current, mean dwell time and equilibrium probability of occupancy for each level. The models incorporated state-dependent white noise and moving average adjustment for filtering, with maximum likelihood parameter estimates obtained using an EM (expectation-maximisation) based iteration. Adjustment for filtering was included as it could be expected that the electronic filter used in recording would have a major effect on obviously brief intermediate conductance level sojourns. Preliminary data analysis revealed that the brevity of intermediate level sojourns caused difficulties in assignment of data points to levels as a result of over-estimation of noise variances. When reasonable constraints were placed on these variances using the better determined noise variances for the closed and fully open levels, idealisation anomalies were eliminated. Nevertheless, simulations suggested that mean sojourn times for the intermediate levels were still considerably over-estimated, and that recording bandwidth was a major limitation; improved results were obtained with higher bandwidth data (10 kHz sampled at 25 kHz). The simplest model consistent with these data had four open conductance levels, intermediate levels being approximately 20%, 51% and 74% of fully open. The mean lifetime at the fully open level was about 1 ms; estimates for the three intermediate levels were 54-92 micros, probably still over-estimates.

A unified approach to burst properties of multiconductance single ion channels.

Patch clamp recordings from ion channels often show bursting behaviour, that is periods of repetitive activity, which are noticeably separated from each other by periods of inactivity. In this paper, bursting behaviour is considered for a general finite state space continuous-time Markov chain model of channel gating, allowing for one or more non-zero conductance levels. A unified semi-Markov framework, that encompasses both theoretical and empirical bursts, is described for analysing a broad range of properties of bursts, including the total charge transfer, the number of sojourns at distinct conductance levels and the number of openings in a burst, with the results presented when the channel is in equilibrium. When the gating mechanism is time reversible, it is shown that the distribution and autocorrelation function of each of the above properties are necessarily finite linear combinations of exponentially or geometrically decaying components with non-negative coefficients. Three methods for choosing a critical time for empirical bursts are investigated. The theory is illustrated by numerical examples from ryanodine, chloride and nicotinic acetylcholine receptor channels, demonstrating the power and flexibility of the methodology, and permitting comparison between the methods for choosing the critical time.

Financial incentives, competition and a two tier service: lessons from the UK National Health Service internal market.

The experience of General medical practitioner (GP) fundholding is analysed for evidence of the response by family doctors to financial incentives. An analysis of consultant outreach, the local provision of out-patient services, in Scotland finds little evidence of a response, based on comparing the experience of fundholders with non-fundholders. At least in the case of hospital based services, financial incentives seem to be of secondary importance. Financial incentives for such services depend on consultant compliance which, arguably, was missing when it came to creating a two-tier service which deliberately favoured patients from fundholding practices.