Annual Meeting Proceedings Part 1 - American Society of Clinical ...

574s Patient and Survivor Care
9028 Poster Discussion Session (Board #12), Mon, 1:15 PM-5:15 PM and
4:45 PM-5:45 PM
YOCAS yoga for musculoskeletal symptoms in breast cancer patients
receiving aromatase inhibitors: A URCC CCOP randomized, controlled
clinical trial. Presenting Author: Luke Joseph Peppone, University of
Rochester Medical Center, Rochester, NY
Background: Up to 50% of breast cancer patients on aromatase inhibitor
therapy report significant musculoskeletal symptoms such as joint and
muscle pain, which decreases treatment adherence. We conducted a
secondary data analysis of a multi-site, phase III randomized, controlled,
clinical trial examining the efficacy of yoga for improving musculoskeletal
symptoms among breast cancer patients currently receiving hormone
therapy (aromatase inhibitors [AI] or tamoxifen [TAM]) through the University
of Rochester Cancer Center Community Clinical Oncology Program
(CCOP). Methods: The original RCT randomized patients with any type of
non-metastatic cancer without previous yoga participation into 2 arms: 1)
standard care monitoring [controls] or 2) 4-week yoga intervention (2x/wk;
75 min/session) plus standard care. The yoga intervention utilized the UR
Yoga for Cancer Survivors (YOCAS) program consisting of breathing
exercises, 18 Hatha and Restorative yoga postures, and meditation. Only
breast cancer patients currently receiving AI (N�95) or TAM (N�72) were
included in this secondary analysis. Changes in musculoskeletal symptoms
were assessed using ANCOVA with baseline values as covariates between
the yoga and control groups. Results: Compared to TAM users at baseline,
AI users reported higher levels of general pain (1-5 score: AI�2.65 vs.
TAM�2.17; p�0.01), muscle aches (0-4 score: AI�2.14 vs. TAM�1.65;
p�0.01), and total physical discomfort (0-24: AI�8.03 vs. TAM�5.92;
p�0.01). Among AI users only, participants in the yoga group demonstrated
greater reductions in general pain (CS�change score; Yoga CS�
-0.37 vs. Control CS� �0.02; p�0.02), muscle aches (Yoga CS� -0.58
vs. Control CS� -0.15; p�0.03) and total physical discomfort (Yoga CS�
-2.07 vs. Control CS� -0.58; p�0.04) from pre- to post-intervention than
the control group. Conclusions: The severity of musculoskeletal symptoms
was higher for AI users than for TAM users. Among breast cancer patients
on AI therapy, the community-based YOCAS intervention significantly
reduced general pain, muscle aches, and physical discomfort. Funding:
NCI U10CA37420, KL2RR024136-05, K07CA120025.
9030 Poster Discussion Session (Board #14), Mon, 1:15 PM-5:15 PM and
4:45 PM-5:45 PM
Association of screening for psychosocial distress in patients with newly
diagnosed stage IV NSCLC and survival. Presenting Author: William F. Pirl,
Massachusetts General Hospital, Boston, MA
Background: While screening for psychosocial distress has become an
ASCO QOPI indicator of quality cancer care, data has yet to show an
association with improved cancer outcomes. We examined the relationship
between adherence to the QOPI measure for assessment of emotional
well-being and survival in a sample of patients with newly diagnosed stage
IV NSCLC. Methods: From 8/07 to 9/10, we recruited consecutive new
patients in a multidisciplinary thoracic oncology clinic to participate in a
research database for which patients completed self-report instruments for
depression (PHQ-9) and anxiety (GAD-7) at their first oncology visit. We
then performed a QOPI chart audit for patients with stage IV NSCLC who
received care at our institution. To adhere to the QOPI measure, oncologists
were required to document their own assessment of patient emotional
well-being (without access to patient self-report data) within one month of
the first office visit. Survival was calculated from first oncology visit to
death. Cox proportional hazards models were used to test associations with
survival. Results: 243 patients completed baseline assessments and had
follow up. Emotional well-being was assessed in 90 (37%). Median survival
of those with an emotional assessment was 12 months vs. 10 months for
those without (p�.03). Yet, emotional assessment was associated with
younger age (p�.01) and higher depression (p�.05) and anxiety scores
(p�.03). Controlling for age, sex, performance status, smoking, primary
oncology provider, PHQ-9, and GAD-7, having an assessment of emotional
well-being was associated with improved survival (HR .68, 95% CI
.49-.93, p�.02). Although higher PHQ-9 scores were independently
associated with worse survival (HR 1.05, 95% CI 1.02-1.08, p�.004),
neither depression nor anxiety moderated the relationship between clinician
screening and survival. Conclusions: In this large prospective study of
patients with newly diagnosed stage IV NSCLC, adherence to the QOPI
measure for assessment of emotional well-being was associated with a
survival benefit. This benefit appears to extend to all patients, not just those
with depression and anxiety. Randomized trials are needed to confirm these
findings.
9029 Poster Discussion Session (Board #13), Mon, 1:15 PM-5:15 PM and
4:45 PM-5:45 PM
A randomized controlled trial of expressive writing for patients with renal
cell carcinoma (RCC). Presenting Author: Timothy Burnight, University of
Texas M. D. Anderson Cancer Center, Houston, TX
Background: Most previous research examining the efficacy of brief expressive
writing interventions have used small sample sizes and followed people
for no more than 3 months. We conducted a large randomized trial to
examine an expressive writing intervention for patients with renal cell
carcinoma and followed them for 10 months after the end of the writing
sessions. Methods: Two hundred patients with RCC were randomly assigned
to either write their deepest thoughts and feelings about their cancer (EW)
or to write about neutral topics (NW) on four separate occasions over 10
days for a maximum of 20 minutes at each writing session. Patients
completed the MD Anderson Symptom Inventory (MDASI), Brief Fatigue
Inventory, SF-36, IES, CES-D, and PSQI at baseline and then again 1, 4,
and 10 months after the writing sessions. Results: The mean age of the
participants was 58 (range 34-82 years), 41% were women, and staging
data were 39% stage I, 15% stage II, 19% stage III, and 27% stage IV. The
groups were well balanced on all demographic and medical characteristics.
Examination of group differences 1 month after the writing sessions,
controlling for the respective baseline measure, revealed decreased IES
scores for the EW group (intrusive thoughts: EW, 5.0 v NW, 7.2; p�.02;
avoidance behaviors: EW, 6.3 v NW, 8.7; p�.07). By 4 months after the
intervention, the EW group reported higher levels of SF-36 Social Functioning
scores (EW: 52.6 v NW: 49.7; p�.04). At the 10 month time point, the
EW group reported fewer cancer-related symptoms (EW: 20.8 v NW: 30.8;
p�.04), higher levels of SF-36 Role Physical scores (EW: 69.6 v NW: 54.0;
p�.02), and fewer sleep disturbances (subscale of the PSQI; EW: 1.4 v
NW: 1.6; p�.05). Means for the other SF-36 subscales at 10 months were
in the expected, but did not reach statistical significance. There were no
group differences for CES-D or fatigue scores at any time point. Mediation
analyses revealed that IES scores at 1 month mediated the effects of EW on
cancer-related symptoms (F� 1.85, p�.06) at the 10 month follow up.
Conclusions: These findings indicate expressive writing leads to short-term
reduction in intrusive thoughts about the cancer experience and results in
long-term improvement in aspects of quality of life.
9031 Poster Discussion Session (Board #15), Mon, 1:15 PM-5:15 PM and
4:45 PM-5:45 PM
The effect of pretreatment psychosocial factors on immune function and
quality of life after brief presurgical stress management. Presenting Author:
Chelsea D. Gilts, University of Houston, Houston, TX
Background: It is important to identify factors that predict who will benefit
the most from psychosocial interventions in cancer populations. Methods:
We examined the association between pretreatment psychosocial factors
and subjective and objective outcomes from a brief cognitive-behavioral
stress management program. This three-arm randomized clinical trial
investigated the effects of a presurgical stress management (SM; n�53)
compared to supportive attention (SA; n�54) and standard care (SC;
n�52) on quality of life (QOL) and immune outcomes in men with prostate
cancer scheduled for radical prostatectomy. We previously reported improved
QOL 1 year after surgery in the SM and SA groups compared to the
SC group and higher pro-inflammatory cytokines 48h after surgery in the
SM group. We investigated the moderating effects of baseline psychosocial
factors (social support (SS), dyadic adjustment (DA), distress (BSIGSI),
and impact of event (IES)), on QOL (SF-36 physical (PCS) and mental
(MCS) component scores) 1 year after surgery and immune response 48h
after surgery. Results: Baseline SS and BSIGSI interacted with group in
predicting PCS 1 year after surgery (p’s �.05). Men who reported low
baseline SS and were in SM had increased PCS 1 year after surgery
compared to men with low SS in the SC group (b�.36, p�.01). Conversely,
men who reported high BSIGSI at baseline and were in SA had increased
PCS 1 year after surgery compared to those in SM (b�11.14, p�.03), with
SC having an intermediate nonsignificant effect. All four psychosocial
factors (SS, DA, BSIGSI, IES) interacted with group in predicting changes
in pro-inflammatory cytokines (interleukin (IL)-1, IL-6, IL-8, IL-10, tumor
necrosis factor, and interferon) 48h post-surgery (all p’s �.04). In all
significant interactions, men who reported greater psychosocial vulnerability
at baseline and were in SM had increased immune response 48h after
surgery compared to psychosocially vulnerable men in either SC (all p’s
�.02) or SA (all p’s �.02). Conclusions: These findings suggest that
baseline psychosocial factors are important indicators of who may benefit
most from a SM intervention on both subjective and objective outcomes.
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