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Breast Cancer Survivorship Issues: Age Related Differences Funded by American Cancer Society In Coll

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Breast Cancer Survivorship Issues: Age Related Differences. Funded by American Cancer Society ... Grant. Walther Cancer Institute. American Cancer Society ... – PowerPoint PPT presentation

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Title: Breast Cancer Survivorship Issues: Age Related Differences Funded by American Cancer Society In Coll


1
Breast Cancer Survivorship Issues Age Related
DifferencesFunded by American Cancer SocietyIn
Collaboration with Eastern Cooperative Oncology
Group
  • PI Victoria Champion, RN, DNS, FAAN
  • Co-I George Sledge, MD
  • Co-I David Cella, PhD

2
Significance
  • The concerns of women diagnosed with breast
    cancer before the age of 45 and their partners
    have not been well addressed.
  • Women diagnosed with breast cancer at a younger
    age may have poorer long-term outcomes.
  • The study investigates the quality of life
    (physical functioning, psychological functioning,
    social functioning, and spiritual functioning) of
    younger breast cancer survivors and their
    partners.

3
Aim 1
  • To compare breast cancer survivors who were 45 or
    younger at the time of diagnosis with two groups
    of women
  • Age-matched (to younger group) well females on
    QOL (physical, psychological, social, and
    spiritual functioning), considering type of
    surgical treatment (lumpectomy vs. mastectomy),
    hormonal treatments, and time since diagnosis as
    covariates for the survivors.
  • Breast cancer survivors who were age 55 to 70 at
    time of diagnosis.

4
Aim 2
  • To compare the partners of breast cancer
    survivors who were 45 or younger at time of
    diagnosis with two groups
  • partners of breast cancer survivors who were 55
    to 70 at diagnosis, and
  • partners of age-matched well females on QOL
    (physical, psychological, social, and spiritual
    functioning).

5
Sample
  • Patients considered for study entry will be
    selected from ECOG trials C9741, E1199, and
    E2197 (also recently included NCCTG and SWOG
    patients). In these trials patients received
    adjuvant chemotherapy for Stage I-III disease,
    using a variety of chemotherapy regimens, or
    combined chemotherapy and hormonal therapy. Women
    were selected from each trial using the following
    criteria
  • Received chemotherapy at trial entry
  • Three to eight years of follow-up
  • Disease-free at follow-up

6
Sample, cont.
  • Chemotherapy regimens include anthrocyline,
    taxane, Cytoxan, Methotrexate or 5-FU based chemo
  • (i.e. AC /- Taxol, AC TAM, AC vs., Adria and
    sequential Cytoxan and tamoxifen)

7
Acquaintance Controls
  • Age-matched controls and partners
  • Acquaintance matching will identify control
    participants and their partners. They will be
    women aged 5 years of the younger cancer
    survivors with similar education and race.
  • Matched controls will be ineligible if they have
    a history of breast cancer or are personal
    friends/relatives of the survivor.

8
Framework for Predicting Quality of Life
9
Study Flowchart
10
Consent Procedure Done by IU
  • Mail letter and brochure to interested survivors
  • Call survivors to explain study and obtain verbal
    permission to send informed consent
  • Eligibility /name of partners obtained
  • Call partners to explain study and obtain verbal
    permission to send informed consent
  • Mail informed consent (survivor and partner
    consents will be mailed separately)

11
Data Collection Done by IU
  • Within 7-10 days of receiving the signed informed
    consents
  • Mail out questionnaires
  • Acquaintance control names returned with
    completed questionnaires
  • Contact survivors to schedule and conduct the
    cognitive function telephone assessment
  • Contact acquaintance controls and their partners
    regarding participation interest following the
    same consent procedure as survivors

12
Accrual Overview
13
What have we done so far?
  • Four focus groups have been conducted to test
    study questionnaires and discuss breast cancer
    experiences
  • 2 groups of 7 younger survivors
  • 2 groups of 5 older survivors

14
Focus Group Results
  • We revised study questionnaires to include the
    following
  • Communication with current healthcare providers
  • Current exercise and general health maintenance
  • Relationship changes, especially among the
    younger survivors

15
Where are we at now?
  • Study questionnaires have been finalized
  • Official recruitment has begun and participants
    have are currently being enrolled from IU breast
    clinics
  • NCI approval has been received and ECOG sties
    will begin to refer participants within the
    coming weeks

16
Differences between Younger and Older Breast
Cancer Survivors
  • Younger survivors
  • Have higher fear of recurrence
  • Poorer communication with HCO
  • Higher anxiety
  • Greater scores on impact of events

17
Targeted Enrollment (N1070)
18
Data relationships
  • Communication with HCP correlated with
  • Total fear of recurrence
  • Depression
  • Well being
  • Anxiety
  • Self Efficacy

19
Fear of Recurrence
Preliminary data suggests younger survivors have
significantly increased fear of recurrence
p .001
Unverzagt, F., Monahan, P., Moser, L., Zhao, Q.,
Carpenter, J., Sledge, G., Champion, V.
(Accepted). The Indiana University
Telephone-Based Assessment of Neuropsychological
Status (IU-TBANS) A new method for large scale
neuropsychological assessment. Journal of the
International Neuropsychological Society.
20
Scientific AccomplishmentsTheme 3 (Diagnosis
Survivorship)
p .001
21
Effect of Patient Prompt Sheet on Communication
with Physician
  • Principal Investigators
  • Cleveland Shields, PhD
  • Victoria Champion, DNS
  • George Sledge, MD
  • Supported by Purdue and IU Cancer Centers Grant
  • Walther Cancer Institute
  • American Cancer Society

22
Pilot Intervention
  • Younger survivors have significantly increased
    Fear of recurrence
  • Communication with oncologist significantly
    related to fear of recurrence
  • Younger survivors less satisfied with
    communication with oncologists

23
Aim 1
  • To examine the effect of telephone coaching for
    use of a worries and concern prompt sheet during
    a physician visit versus usual care on patients
    perception of the visit.
  • H1.1 Patients receiving coaching prompt sheet
    will report greater satisfaction with
    communication 1 week and 2 months after the
    physician visit versus usual care.
  • H1.2 Patients receiving coaching prompt sheet
    will report greater autonomy support and patient
    involvement (HCCQ) and less health care provider
    social constraint 1 week and 2 months after the
    physician visit versus usual care.

24
Aim 2
  • To examine the effect of telephone coaching for
    use of a worries and concern prompt sheet during
    a physician visit versus usual care on patient
    distress.
  • H2.1 Patients receiving coaching prompt sheet
    after adjusting for covariates will report lower
    state anxiety and depression 1 week and 2 months
    after the physician visit versus usual care.
  • H2.2 Patients receiving coaching prompt sheet
    after adjusting for covariates will report lower
    state anxiety immediately prior to physician
    visit versus usual care.
  • H2.3 Patients receiving coaching prompt sheet
    after adjusting for covariates will report
    reduced fear of recurrence 1 week and 2 months
    after the physician visit versus usual care.
  • H2.4 Patients receiving coaching prompt sheet
    after adjusting for covariates will report
    greater breast cancer self-efficacy 1 week and 2
    months after the physician visit versus usual
    care.

25
Aim 3
  • To examine the effect of telephone coaching for
    use of a worries and concern prompt sheet versus
    usual care on physician satisfaction with the
    visit.
  • H3.1 Physicians will report greater satisfaction
    immediately following the clinic visit after
    adjusting for covariates with patients in the
    intervention group versus usual care group.

26
Significance
  • This pilot intervention builds addresses a
    significant problem identified in the ACS
    preliminary data-fear of recurrence
  • The intervention builds on current communication
    literature by providing method to coach patients
    to improve communication with their oncologists.
  • Could be easily adapted to clinic or Web format

27
Methods
  • Eligibility-45 years or younger at breast cancer
    diagnosis, 3-8 years from initial diagnosis and
    no recurrence
  • Patients will be followed by Dr. George Sledge at
    Indiana University

28
Methods
  • Sample size of 70
  • 80 power to find a .74 SD difference between
    groups

29
Pilot intervention flowsheet
30
Prompt Sheet Coaching
  • The coach will talk with the patient about each
    item on the sheet, asking them to rate each item,
    and encouraging them to talk about each items
    rating. The items were developed from initial
    results of our prior research (ACS Grant)
  • At the end of each of the two sets of items, the
    coach will ask the patient to put into words what
    she would like to tell her oncologist about her
    worries and concerns about recurrence or other
    emotional issues that are bothering her.

31
Prompt Sheet Coaching (cont.)
  • The coach will input the patient items for
    discussion on the Summary Sheet and mail the
    completed form to the patient for the clinic
    visit.
  • The coach will normalize these concerns, telling
    her that many cancer patients have these concerns
    and that her oncologist wants to hear about them.

32
Patient Visit
  • Patients will be instructed to take the Summary
    Talking Points Sheet to their upcoming visits
    with their oncologists.

33
Data Collection
  • Baseline
  • Day of clinic visit-STAI
  • 1 Week after intervention
  • 2 months after intervention

34
Measures
  • Patient Satisfaction PSQ
  • (Patient) Physician/Pt Communication Autonomy
    Support HCCQ
  • Health Care Provider Social Constraint
  • Anxiety (STAI-State)
  • Depression (CESD)
  • Fear of Recurrence (CARS)
  • Breast Cancer Self Efficacy
  • Physician Satisfaction PSQ
  • (Provider) Intervention Usability
  • Demographic/Disease variables
  • Knowledge of Recurrence of Signs and symptoms
  • Family functioning (FEIES)

35
Outcomes
  • 3 PhD Students using data base-ACS Scholarship,
    NIH predoctoral
  • Students have received ACS scholarship and NRSA
  • One masters student and one undergraduate honors
    student
  • 2 faculty-communication expert and new surgeon
    are involved in team and using data to develop
    research proposals
  • Pilot to test reliability between telephone and
    in-person cognitive testing
  • Unverzagt, F., Monahan, P., Moser, L., Zhao, Q.,
    Carpenter, J., Sledge, G., Champion, V.
    (Accepted). The Indiana University
    Telephone-Based Assessment of Neuropsychological
    Status (IU-TBANS) A new method for large scale
    neuropsychological assessment. Journal of the
    International Neuropsychological Society.

36
Questions?
Thank you
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