Association between requests for supportive care assistance and patients' characteristics, prior to treatment in a comprehensive cancer center.

PURPOSE: Patients with cancer experience a wide array of distress symptoms (emotional, practical, physical, and functional), which often hinders their quality of life and survival. Unfortunately, only a small proportion of these patients request assistance for these problems. This study explored the relationship between requests for supportive care assistance and distress of patients newly diagnosed with cancer. METHODS: This study was conducted at city of hope, an NCI-designated comprehensive cancer center, and included 2658 patients treated between 2009 and 2017. Patients were asked to complete a 30-item biopsychosocial problem-related distress survey via SupportScreen® , prior to any treatment. Correlations between requests for assistance and distress domains were evaluated. Primary types of requests were examined for all patients, and general linear modeling was used to determine the significant predictors of requests for assistance. p-values <0.05 were considered significant. RESULTS: Strong correlations were observed between distress subscales and requests for assistance (r ranging from 0.67 to 0.69). The primary types of requests varied by domain: items such as feeling anxious or fearful, finances, and sleep ranked first within the emotional, practical, and physical-functional domains respectively (∼20% requests for each item). Verbal assistance was generally preferred to the written form of assistance, with the exception of a few items, including finances. Overall, household income of <$100,000 and completing the survey in Spanish were significant predictors of requests for assistance. Regarding the practical and physical-functional domains, having an advanced stage of disease was significantly related to an increase in demands for assistance. Being older was associated to a decrease in requests for assistance vis-à-vis both the emotional and physical functional subscales. CONCLUSION: We demonstrated that distress levels were strongly correlated with requests for assistance. Patients' clinical and demographic characteristics such as age, household income, disease stage and survey language were associated with inquiries for psychosocial support, highlighting the importance of targeting interventions towards those most likely to need them, to better aim patients' needs. Therefore, tailoring supportive care assistance to patients' characteristics could help boost the frequency of requests, reduce distress burden, and improve health outcomes.

Portable air-fed cold atmospheric plasma device for postsurgical cancer treatment.

Surgery represents the major option for treating most solid tumors. Despite continuous improvements in surgical techniques, cancer recurrence after surgical resection remains the most common cause of treatment failure. Here, we report cold atmospheric plasma (CAP)­mediated postsurgical cancer treatment, using a portable air-fed CAP (aCAP) device. The aCAP device we developed uses the local ambient air as the source gas to generate cold plasma discharge with only joule energy level electrical input, thus providing a device that is simple and highly tunable for a wide range of biomedical applications. We demonstrate that local aCAP treatment on residual tumor cells at the surgical cavities effectively induces cancer immunogenic cell death in situ and evokes strong T cell­mediated immune responses to combat the residual tumor cells. In both 4T1 breast tumor and B16F10 melanoma models, aCAP treatment after incomplete tumor resection contributes to inhibiting tumor growth and prolonging survival.

Validation of a biopsychosocial distress screening tool, "You, Your Family and COH Are a Team".

OBJECTIVE: We examined the psychometric properties of a biopsychosocial screening tool "You, Your Family and City of Hope are a Team" implemented via touchpad technology (YYFcore03) at a cancer center in newly diagnosed patients and patients on active treatment, with the primary objective to evaluate concurrent validity with screening criterion measures of depression and anxiety. METHODS: YYFcore03, Patient Health Questionnaire [PHQ-9], and Generalized Anxiety Disorder [GAD-7] were administered to 608 patients in out-patient clinics. A subset of 158 patients responding a second time to YYFcore03 at a subsequent visit were included for assessing reliability. Exploratory factor analysis followed by confirmatory factor analysis were conducted to identify underlying factors. The identified factor of psychological distress (PD) was then correlated with PHQ-9 and GAD-7 for concurrent validity and to estimate sensitivity-specificity. Demographic and clinical variables associated with the PD score were identified. Test-retest reliability of PD score was examined. RESULTS: Factor analysis suggested three factors, including PD. Correlations between PD score and PHQ-9 and GAD-7 were 0.63 and 0.67, respectively. Treating PHQ-9 and GAD-7 as criterion measures, PD score had a sensitivity of 0.77 for identifying depression and 0.86 for identifying anxiety. Younger age, lower household income, and cancer (vs noncancer) diagnosis were independently associated with worse PD score. Omega total for composite reliability was 0.88; intraclass correlation was 0.78. CONCLUSIONS: The YYFcore03 administered via touchpad is a valid instrument for identifying PD in newly diagnosed patients and patients undergoing active treatment.

Biopsychosocial distress and clinical outcome in metastatic renal cell carcinoma.

OBJECTIVE: Limited research exists examining the biopsychosocial experience of patients diagnosed with metastatic renal cell carcinoma (mRCC), a disease commonly associated with a poor prognosis. The purpose of this study was to describe rates and types of distress in mRCC patients and explore the relationship between distress and overall survival. METHOD: A cohort of 102 patients with mRCC treated at a single institution was assessed by a touch screen-based instrument comprising 22 core items spanning physical, practical, functional, and emotional domains. Association between biopsychosocial distress and clinicopathologic criteria was interrogated. Overall survival was compared between patients with low distress versus high distress.ResultHigh rates of distress (20.7%) were found among patients newly diagnosed with mRCC. Among those domains contributing to distress, pain, fatigue, and financial comorbidity were the most commonly reported by patients with mRCC. A trend toward poorer overall survival in those patients with high distress versus low distress was observed among mRCC patients.Significance of resultsBased on data from a relatively large sample of patients, this study provides the first specific insights into the potential impact of biopsychosocial distress and outcomes among patients with mRCC.

Sleepless from the Get Go: Sleep Problems Prior to Initiating Cancer Treatment.

PURPOSE: Cancer patients are likely to experience sleep problems. Understanding their perception of sleep problems is important as subjective symptom experience is associated with treatment-seeking behavior. We explored the prevalence of sleep problems and its correlates in a large sample of cancer patients at an important but understudied stage of their cancer journey: prior to initiating treatment. METHODS: Cancer patients (5702) (67.5% female; 76.9% White; 23.0% Hispanic), following diagnosis and prior to initiating cancer treatment, completed an electronic screening instrument. Patients across eight different cancer diagnoses (breast, gastrointestinal, gynecological, head and neck, hematological, lung, prostate, urinary) rated their sleep problems on a five-point scale, with those reporting "severe" or "very severe" sleep problems classified as having high sleep problems. RESULTS: Overall, 12.5% of patients reported high sleep problems. Across diagnoses, the proportion of patients reporting high sleep problems ranged from 4.3 to 13.8%, with prostate cancer patients least likely and gastrointestinal cancer patients most likely to report high sleep problems. Older age, having a partner, higher education, and higher household income were associated with a lower likelihood of experiencing sleep problems. Being female, Black, Hispanic, and reporting anxiety or depression was associated with an increased likelihood of sleep problems. CONCLUSIONS: A sizeable proportion of cancer patients experience significant problems with their sleep before any treatment has occurred. This clinical issue cannot be ignored as treatment is likely to worsen existing sleep problems. Oncology providers should routinely screen for sleep-related problems. Identifying and treating patients for sleep problems during a vulnerable period early in their cancer trajectory should be an essential component of clinical care.

Biopsychosocial Distress in Young Adult Oncology Patients: Examining Sex Differences in Sources of High Distress and Requests for Assistance.

PURPOSE: This study examines biopsychosocial problem-related distress and requests for assistance with male and female young adult patients by applying a large-scale analysis among individuals diagnosed with a variety of cancers. METHODS: A retrospective study was conducted involving 630 patients of ages 18-39 treated for cancer at City of Hope between 2009 and 2014. Patients were asked to complete a biopsychosocial problem-related distress touch-screen instrument before treatment as part of their routine clinical care. RESULTS: Overall, male patients rated more biopsychosocial problems as highly distressing than female patients. Some problems were consistently endorsed as highly distressing to both male and female patients. In fact, six of the top seven highly distressing problems for each sex were similar: finances, fatigue, sleeping, side effects of treatment, pain, and feeling anxious or fearful. There were differences in the ways male and female patients preferred to ask for assistance from the medical team, as males more often preferred to speak with someone, whereas females more often preferred to receive written information. CONCLUSION: Results indicate that sex may have a significant relationship with biopsychosocial topics of distress, likelihood of reporting distress, and preferred methods of receiving assistance. Tailoring information and resources to specific areas of distress may reduce high distress with common problems (such as finances, treatment side effects, and infertility.).

Breast and gynecological cancer patients' risk factors associated with biopsychosocial problem-related distress.

OBJECTIVES: Inequalities exist between breast and gynecological cancer patients' experiences, leading to high levels of distress throughout the cancer journey. The present study aims to identify differences in source of biopsychosocial problem-related distress between women diagnosed with breast or gynecological cancers. METHODS: From 2009 to 2016, women with breast (n = 2111) and gynecological (n = 641) cancers were screened using the core items of the instrument You, Your Family, and City of Hope are a Team. This is a touch screen-based instrument that assess problem-related distress due to physical, practical, functional, emotional, and other problems and identifies types of assistance requested. Data were analyzed using the linear regression model. RESULTS: A significant difference in overall biopsychosocial problems rated as high distress was found between breast (M = 5.0) and gynecological (M = 6.2) cancer patients (P < .001). Gynecological cancer patients endorsed a greater number of problems to talk with a member of the team (alone or with written information), while both cancer groups requested written information equally. Gynecological cancer was associated with higher physical, functional, emotional, and total distress. Younger patients, non-Asian, and those with lower education and lower household income also reported greater distress. CONCLUSIONS: Gynecological cancer patients represent a high-risk group, reporting greater problem-related distress and higher levels of requested assistance. Age, education, race/ethnicity, and income were found to be potential risk factors. Findings highlight the importance of considering characteristics and special needs related to specific types of cancer to assist in the effective treatment of distress throughout the continuum of care.

Biopsychosocial problem-related distress in cancer: examining the role of sex and age.

BACKGROUND: The current study explores how sex and age relate to biopsychosocial distress by applying a large-scale analysis among individuals diagnosed with a variety of cancers. METHODS: A retrospective study was conducted involving 6462 patients treated for cancer at a National Cancer Institute-designated comprehensive cancer center between 2009 and 2014. Patients were asked to complete the biopsychosocial problem-related distress touchscreen instrument prior to starting treatment as part of their routine clinical care. RESULTS: There was a significant interaction of age and sex on the total number of problems rated as high distress and the total number of problems that prompted a request to talk with a member of the team. Male patients between 18 and 39 reported significantly more problems as high distress than female patients in the same age group (mean = 5.34 and mean = 4.92, respectively; p = 0.005). A similar trend was found where male patients between 18-39 and 40-64 requested to talk with a member of the team significantly more often than female patients in these same age groups (mean = 3.25 and mean = 3.22 vs. mean = 2.70 and mean = 3.07, respectively; p = 0.016). CONCLUSIONS: The results of the current study serve to refute generalizations regarding age or gender demographics and support preferences and thus reinforce the need to offer services in the context of cancer in flexible and varied ways. Copyright © 2016 John Wiley & Sons, Ltd.