Integrative Analysis of Clinicopathological Features Defines Novel Prognostic Models for Mantle Cell Lymphoma in the Immunochemotherapy Era: A Report from The North American Mantle Cell Lymphoma Consortium

BACKGROUND: Patients with mantle cell lymphoma (MCL) exhibit a wide variation in clinical presentation and outcome. However, the commonly used prognostic models are outdated and inadequate to address the needs of the current multidisciplinary management of this disease. This study aims to investigate the clinical and pathological features of MCL in the immunochemotherapy era and improve the prognostic models for a more accurate prediction of patient outcomes. METHODS: The North American Mantle Cell Lymphoma Project is a multi-institutional collaboration of 23 institutions across North America to evaluate and refine prognosticators for front-line therapy. A total of 586 MCL cases diagnosed between 2000 and 2012 are included in this study. A comprehensive retrospective analysis was performed on the clinicopathological features, treatment approaches, and outcomes of these cases. The establishment of novel prognostic models was based on in-depth examination of baseline parameters, and subsequent validation in an independent cohort of MCL cases. RESULTS: In front-line strategies, the use of hematopoietic stem cell transplantation was the most significant parameter affecting outcomes, for both overall survival (OS, p \u3c 0.0001) and progression-free survival (PFS, p \u3c 0.0001). P53 positive expression was the most significant pathological parameter correlating with inferior outcomes (p \u3c 0.0001 for OS and p = 0.0021 for PFS). Based on the baseline risk factor profile, we developed a set of prognostic models incorporating clinical, laboratory, and pathological parameters that are specifically tailored for various applications. These models, when tested in the validation cohort, exhibited strong predictive power for survival and showed a stratification resembling the training cohort. CONCLUSIONS: The outcome of patients with MCL has markedly improved over the past two decades, and further enhancement is anticipated with the evolution of clinical management. The innovative prognostic models developed in this study would serve as a valuable tool to guide the selection of more suitable treatment strategies for patients with MCL

Modifiable Characteristics Associated with Fear of Cancer Recurrence among Colorectal Cancer Survivors

Fear of cancer recurrence (FCR) is regarded as one of the most common and distressing issues affecting cancer survivors. Observational studies have identified several modifiable characteristics associated with FCR. However, many of the findings are based on post-hoc analyses and come from studies in which FCR was not identified as a primary outcome. This study sought to overcome these limitations by using a model comprised of cognitive, behavioral, and social characteristics as a framework for examining modifiable characteristics associated with FCR. A sample of 120 patients who had been diagnosed with colorectal cancer and completed cancer treatment in the past 6 to 36 months was recruited during routine outpatient visits or by mail for participation in the study. Medical record reviews were conducted to assess clinical variables, and participants filled out a standard demographic questionnaire as well as self-report measures of characteristics resistant to modification (perceived risk of recurrence, neuroticism, conscientiousness), cognitive modifiable characteristics (self-efficacy, positive beliefs about worry, negative beliefs about worry, misinterpretation of symptoms, intolerance of uncertainty and rumination), behavioral modifiable characteristics (reassurance seeking and health-related reassurance seeking), and social modifiable characteristics (social support and social constraints). As hypothesized, results demonstrated that modifiable characteristics (i.e., self efficacy, positive beliefs about worry, negative beliefs about worry, intolerance of uncertainty, rumination, reassurance seeking, health-related reassurance seeking and social constraints) were associated with FCR (all p’s \u3c .05). Multivariable regression analyses demonstrated that modifiable characteristics accounted for 13% of the variance in FCR beyond that accounted for by non-modifiable characteristics (p \u3c .001), with self-efficacy, rumination and health-related reassurance seeking accounting for unique variance in FCR. This study has identified several modifiable characteristics that should be considered as targets for interventions seeking to reduce FCR among cancer survivors

Modifiable Characteristics Associated with Fear of Cancer Recurrence among Colorectal Cancer Survivors

Fear of cancer recurrence (FCR) is regarded as one of the most common and distressing issues affecting cancer survivors. Observational studies have identified several modifiable characteristics associated with FCR. However, many of the findings are based on post-hoc analyses and come from studies in which FCR was not identified as a primary outcome. This study sought to overcome these limitations by using a model comprised of cognitive, behavioral, and social characteristics as a framework for examining modifiable characteristics associated with FCR. A sample of 120 patients who had been diagnosed with colorectal cancer and completed cancer treatment in the past 6 to 36 months was recruited during routine outpatient visits or by mail for participation in the study. Medical record reviews were conducted to assess clinical variables, and participants filled out a standard demographic questionnaire as well as self-report measures of characteristics resistant to modification (perceived risk of recurrence, neuroticism, conscientiousness), cognitive modifiable characteristics (self-efficacy, positive beliefs about worry, negative beliefs about worry, misinterpretation of symptoms, intolerance of uncertainty and rumination), behavioral modifiable characteristics (reassurance seeking and health-related reassurance seeking), and social modifiable characteristics (social support and social constraints). As hypothesized, results demonstrated that modifiable characteristics (i.e., self efficacy, positive beliefs about worry, negative beliefs about worry, intolerance of uncertainty, rumination, reassurance seeking, health-related reassurance seeking and social constraints) were associated with FCR (all p’s \u3c .05). Multivariable regression analyses demonstrated that modifiable characteristics accounted for 13% of the variance in FCR beyond that accounted for by non-modifiable characteristics (p \u3c .001), with self-efficacy, rumination and health-related reassurance seeking accounting for unique variance in FCR. This study has identified several modifiable characteristics that should be considered as targets for interventions seeking to reduce FCR among cancer survivors

Concealment of Lung Cancer Diagnosis: Prevalence and Correlates

Background: Lung cancer has a commonly understood behavioral etiology. Thus, lung cancer patients are often blamed for their illness and may seek to avoid this blame by concealing their diagnosis from others. This study sought to determine the prevalence of concealment and identify demographic, clinical, and psychosocial correlates of concealment among lung cancer patients. Methods: A sample of 117 lung cancer patients receiving chemotherapy for non-small cell or small cell lung cancer was recruited and completed self-report demographic questionnaires, a measure of diagnosis concealment designed and pilot tested for this study, and standard measures of psychosocial variables. Clinical factors were assessed via a medical chart review. Results: Thirty participants (26%) reported concealing their diagnosis in the previous month, most frequently from casual friends and close friends. Reported reasons for concealment largely reflected concern for others. Univariate analyses indicated that those who concealed their lung cancer diagnosis reported more internalized shame related to their illness and use of positive reappraisal as a coping strategy (ps ≤ 0.02). In addition, those who concealed were more likely to have used alcohol in the previous month and have a more recent recurrence, among those who had a recurrence (ps ≤ 0.04). Multivariate analyses indicated that internalized shame and use of positive reappraisal accounted for significant unique variance in concealment above and beyond that accounted for by use of alcohol (ps \u3c 0.05). Conclusions: Future research should aim to replicate and extend these findings with longitudinal designs to elucidate the directionality of the associations observed in this study. Copyright © 2015 John Wiley & Sons, Ltd

Characteristics and Predictors of Fatigue Among Men Receiving Androgen Deprivation Therapy for Prostate Cancer: A Controlled Comparison

Purpose: Although fatigue is a common problem for men with prostate cancer undergoing androgen deprivation therapy (ADT), there has been little systematic research on this issue. The present study examined changes in fatigue among prostate cancer patients receiving ADT compared to controls and predictors of heightened fatigue in ADT patients. Methods: Prostate cancer patients treated with ADT (ADT+ group, n = 60) completed assessments of fatigue prior to or just after ADT initiation (baseline) and 6 and 12 months later. Prostate cancer patients treated with prostatectomy only (ADT- group, n = 85) and men without cancer (CA- group, n = 86) matched on age and education completed assessments at similar intervals. Results:Group-by-time interactions for fatigue severity, interference, and duration were observed when comparing the ADT+ group to the controls. Groups did not differ at baseline; however, the ADT+ group reported worse fatigue at 6 and 12 months. The same pattern was observed for changes in the prevalence of clinically meaningful fatigue and the extent of clinically meaningful change in fatigue. Within the ADT+ group, higher baseline comorbidity scores were associated with greater increases in fatigue interference, and higher baseline Gleason scores were associated with greater increases in fatigue duration. Conclusions: Prostate cancer patients receiving ADT demonstrate a trajectory of worsened fatigue during the first 12 months following treatment initiation relative to the controls. Greater comorbidities and higher Gleason scores at baseline appear to be risk factors for heightened fatigue during the first year following ADT initiation. Results highlight important time points for implementation of interventions aimed at fatigue reduction

Sleep Disruption among Cancer Patients following Autologous Hematopoietic Cell Transplantation

Despite a high prevalence of sleep disruption among hematopoietic cell transplant (HCT) recipients, relatively little research has investigated its relationships with modifiable cognitive or behavioral factors or used actigraphy to characterize sleep disruption in this population. Autologous HCT recipients who were 6–18 months post transplant completed self-report measures of cancer-related distress, fear of cancer recurrence, dysfunctional sleep cognitions, and inhibitory sleep behaviors upon enrollment. Patients then wore an actigraph for 7 days and completed a self-report measure of sleep disruption on day 7 of the study. Among the 84 participants (age M = 60, 45% female), 41% reported clinically relevant sleep disruption. Examination of actigraph data confirmed that, on average, sleep was disrupted (wake after sleep onset M = 66 min) and sleep efficiency was less than recommended (sleep efficiency M = 78%). Cancer-related distress, fear of recurrence, dysfunctional sleep cognitions, and inhibitory sleep behaviors were related to self-reported sleep disruption (p value

Sleep Disruption among Cancer Patients following Autologous Hematopoietic Cell Transplantation

Despite a high prevalence of sleep disruption among hematopoietic cell transplant (HCT) recipients, relatively little research has investigated its relationships with modifiable cognitive or behavioral factors or used actigraphy to characterize sleep disruption in this population. Autologous HCT recipients who were 6–18 months post transplant completed self-report measures of cancer-related distress, fear of cancer recurrence, dysfunctional sleep cognitions, and inhibitory sleep behaviors upon enrollment. Patients then wore an actigraph for 7 days and completed a self-report measure of sleep disruption on day 7 of the study. Among the 84 participants (age M = 60, 45% female), 41% reported clinically relevant sleep disruption. Examination of actigraph data confirmed that, on average, sleep was disrupted (wake after sleep onset M = 66 min) and sleep efficiency was less than recommended (sleep efficiency M = 78%). Cancer-related distress, fear of recurrence, dysfunctional sleep cognitions, and inhibitory sleep behaviors were related to self-reported sleep disruption (p value