E-mail communication practices and preferences among patients and providers in a large comprehensive cancer center

Purpose: Little is known about how electronic mail (e-mail) is currently used in oncology practice to facilitate patient care. The objective of our study was to understand the current e-mail practices and preferences of patients and physicians in a large comprehensive cancer center. Methods: Separate cross-sectional surveys were administered to patients and physicians (staff physicians and clinical fellows) at the Princess Margaret Cancer Centre. Logistic regression was used to identify factors associated with current e-mail use. Record review was performed to assess the impact of e-mail communication on care. Results: The survey was completed by 833 patients. E-mail contact with a member of the health care team was reported by 41% of respondents. The team members contacted included administrative assistants (52%), nurses (45%), specialist physicians (36%), and family physicians (18%). Patient factors associated with a higher likelihood of e-mail contact with the health care team included younger age, higher education, higher income, enrollment in a clinical trial, and receipt of multiple treatments. Eighty percent of physicians (n = 63 of 79) reported previous contact with a patient via e-mail. Physician factors associated with a greater likelihood of e-mail contact with patients included older age, more senior clinical position, and higher patient volume. Nine hundred sixty-two patient records were reviewed, with e-mail correspondence documented in only 9% of cases. Conclusion: E-mail is commonly used for patient care but is poorly documented. The use of e-mail in this setting can be developed with appropriate guidance; however, there may be concerns about widening the gap between certain groups of patients. </jats:sec

Heterogeneity of circulating tumour cell-associated genomic gains in breast cancer and its association with the host immune response.

Tumor cells that preferentially enter circulation include the precursors of metastatic cancer. Previously, we characterized circulating tumor cells (CTC) from patients with breast cancer and identified a signature of genomic regions with recurrent copy-number gains. Through FISH, we now show that these CTC-associated regions are detected within the matched untreated primary tumors of these patients (21% to 69%, median 55.5%, n = 19). Furthermore, they are more prevalent in the metastases of patients who died from breast cancer after multiple rounds of treatment (70% to 100%, median 93%, samples n = 41). Diversity indices revealed that higher spatial heterogeneity for these regions within primary tumors is associated with increased dissemination and metastasis. An identified subclone with multiple regions gained (MRG clone) was enriched in a posttreatment primary breast carcinoma as well as multiple metastatic tumors and local breast recurrences obtained at autopsy, indicative of a distinct early subclone with the capability to resist multiple lines of treatment and eventually cause death. In addition, multiplex immunofluorescence revealed that tumor heterogeneity is significantly associated with the degree of infiltration of B lymphocytes in triple-negative breast cancer, a subtype with a large immune component. Collectively, these data reveal the functional potential of genetic subclones that comprise heterogeneous primary breast carcinomas and are selected for in CTCs and posttreatment breast cancer metastases. In addition, they uncover a relationship between tumor heterogeneity and host immune response in the tumor microenvironment. SIGNIFICANCE: As breast cancers progress, they become more heterogeneous for multiple regions amplified in circulating tumor cells, and intratumoral spatial heterogeneity is associated with the immune landscape

Clinical outcomes of combined aortic root replacement with mitral valve surgery

ObjectiveThis study was undertaken to examine the operative mortality and morbidity and late outcomes in patients who required combined aortic root replacement with mitral valve surgery.MethodsThese combined procedures were performed in 123 patients with a mean age of 51 ± 16 years; 67% were men. The aortic root pathology was an aneurysm in 76 patients and other disorders in 47 patients. The mitral valve pathology was degenerative disease in 62 patients and other diseases in 61 patients. Sixty-four patients (52%) underwent previous cardiac surgery. The aortic valve was preserved in 21 patients, and the mitral valve was preserved in 67 patients; the remaining patients underwent valve replacement. In addition, 57 patients underwent other procedures. The mean follow-up was 4.9 ± 4.3 years and complete.ResultsThe operative mortality rate was 6.5% (8 patients), and late mortality was 9.7% (12 patients). Reexploration of the mediastinum for bleeding (15%) and implantation of permanent pacemaker (18%) were the most common postoperative complications. Urgent surgery and functional class IV were predictors of operative mortality by univariate analysis. Survival at 1, 5, and 10 years was 90.9% ± 2.6%, 86.1% ± 3.3%, and 79.3 ± 4.9%, respectively. Six patients required reoperation. Freedom from reoperation at 1, 5, and 10 years was 100%, 96.4% ± 2.5%, and 85.7% ± 6.4%, respectively. At the latest follow-up, 98 patients were alive and free from reoperation; 92 patients were in functional classes 1 and 2, and 88 patients were free from any cardiac or valve-related complication.ConclusionAortic root replacement combined with mitral valve surgery is a complex operation associated with high morbidity, but the operative mortality is reasonably low and the long-term outcomes are gratifying

Replacement of the ascending aorta with reduction of the diameter of the sinotubular junction to treat aortic insufficiency in patients with ascending aortic aneurysm

ObjectiveAscending aortic aneurysm often causes dilation of the sinotubular junction with consequent aortic insufficiency despite normal aortic cusps.MethodsReplacement of the ascending aorta with reduction of the diameter of the sinotubular junction to correct aortic insufficiency was performed in 103 consecutive patients. Twenty-nine also needed repair of cusp prolapse. The patients’ mean age was 65 ± 12 years and all had ascending aortic aneurysm; 63 also had arch aneurysm and 21 had aneurysm of the entire aorta. The aortic insufficiency was graded as moderate in 54 patients and severe in 49. Patients were followed up prospectively and had echocardiographic studies annually. The mean follow-up was 5.7 ± 3.4 years.ResultsThere were 2 operative and 30 late deaths. Cardiovascular events were the cause of death in 19 patients. Arch aneurysm and age were the only predictors of late death. Overall survival at 10 years was 54% ± 7%. Seven patients had moderate and 1 had severe aortic insufficiency. The freedom from moderate or severe aortic insufficiency at 10 years was 80% ± 7% and from severe aortic insufficiency, 98% ± 1%. Two patients required aortic valve replacement, 1 because of severe aortic insufficiency and 1 for endocarditis. The freedom from aortic valve replacement at 10 years was 97% ± 1%. At the latest follow-up, 98% of the patients were in functional class I or II.ConclusionsReduction in the diameter of the sinotubular junction restores aortic valve competence in patients with ascending aortic aneurysm and aortic insufficiency with normal aortic cusps. Late survival of these patients is suboptimal because they often have extensive aneurysmal disease

Cooking for Vitality: Pilot Study of an Innovative Culinary Nutrition Intervention for Cancer-Related Fatigue in Cancer Survivors

(1) Background: Cancer-related fatigue (CRF) is one of the most prevalent and distressing side effects experienced by patients with cancer during and after treatment, and this negatively impacts all aspects of quality of life. An increasing body of evidence supports the role of poor nutritional status in the etiology of CRF and of specific diets in mitigating CRF. We designed a group-based two session culinary nutrition intervention for CRF, Cooking for Vitality (C4V), aimed at increasing understanding of how food choices can impact energy levels and establishing basic food preparation and cooking skills as well as the application of culinary techniques that minimize the effort/energy required to prepare meals. The purpose of this pilot mixed-method study was to evaluate: Feasibility of the experimental methods and intervention; acceptability and perceived helpfulness of intervention; and to obtain a preliminary estimate of the effectiveness of the intervention on fatigue (primary outcome), energy, overall disability, and confidence to manage fatigue (secondary outcomes). (2) Methods: Prospective, single arm, embedded mixed-methods feasibility study of cancer survivors with cancer-related fatigue was conducted. Participants completed measures at baseline (T0), immediately following the intervention (T1), and three months after the last session (T2). Qualitative interviews were conducted at T2. (3) Results: Recruitment (70%) and retention (72%) rates along with qualitative findings support the feasibility of the C4V intervention for cancer survivors living with CRF (program length and frequency, ease of implementation, and program flexibility). Acceptability was also high and participants provided useful feedback for program improvements. Fatigue (FACT-F) scores significantly improved from T0&ndash;T1 and T0&ndash;T2 (p &lt; 0.001). There was also a significant decrease in disability scores (WHO-DAS 2.0) from T0&ndash;T2 (p = 0.006) and an increase in POMS-Vigor (Profile of Mood States) from T0&ndash;T1 (p = 0.018) and T0&ndash;T2 (p = 0.013). Confidence in managing fatigue improved significantly from T0&ndash;T1 and T0&ndash;T2 (p &lt; 0.001). (4) Conclusions: The results suggest that the C4V program was acceptable and helpful to patients and may be effective in improving fatigue levels and self-management skills. A randomized controlled trial is required to confirm these findings

The Needs and Experiences of Post-Treatment Adolescent and Young Adult Cancer Survivors

(1) Background: Adolescents and young adults (AYAs) who have been diagnosed with and treated for cancer have unique healthcare needs, but more research is needed to inform developmentally targeted cancer care for this population. The purpose of the current analyses was to describe the physical and psychosocial concerns and experiences of AYA cancer survivors during the post-treatment phase. (2) Methods: A national survey was conducted by the Canadian Partnership Against Cancer to evaluate the experiences and unmet needs of cancer survivors (&ge;18 years) within the first 5 years following cancer treatment. The current analyses were conducted on the AYA survivor population (18&ndash;34 years). (3) Results: A total of 575 surveys were completed by AYAs. Of these, 61% were female, 51% were married/partnered, and 52% were 1&ndash;3 years post treatment. Approximately three-quarters report their physical or emotional health as good/very good. Overall, 88% reported at least one physical concern [mean of 3.98+2.11 physical concerns (range 0&ndash;9)], 90% reported at least one emotional concern [mean of 3.77+1.75 emotional concern (range 0&ndash;6)], and 79% reported at least one practical challenge [mean of 2.39+1.28 practical concerns (range 0&ndash;5)]. The most common concerns were anxiety/worry about cancer returning (83%), fatigue/tiredness (78%), and depression/loss of interest in daily activities (66%). On average, 43% of those reporting a concern sought help. Common reasons for not seeking help included not wanting to ask, being told that it was normal to feel the way they did, or embarrassment. Of those who did seek help, 37% encountered difficulty obtaining assistance. (4) Conclusions: These results suggest that post-treatment AYA cancer survivors have a high rate and number of physical, psychosocial, and practical concerns and are often not seeking or receiving help to address these. Proactive approaches to characterizing and eliminating barriers to obtaining appropriate care are needed