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  • 1
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2023
    In:  Journal of Clinical Oncology Vol. 41, No. 16_suppl ( 2023-06-01), p. 12072-12072
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. 12072-12072
    Abstract: 12072 Background: Treatment with ADT can lead to changes in body composition, including an increase in body fat and a decrease in muscle mass. To minimize the nutritional risks associated with ADT, a nutritional program was developed. Thus, this study sought to determine the benefit of this program among patients with prostate cancer receiving ADT. Methods: Patients were recruited in a cancer center located in Brasilia, Brazil. Patients were eligible if they were diagnosed with prostate cancer, and about to initiate treatment with ADT. They were assessed before starting ADT and at follow-up assessment (3 months). Based on their risk, patients were instructed to follow either a normocaloric (20-25 kcal/kg) or a hypocaloric (18-20 kcal/kg) diet, and both groups were required to consume a hyperproteic diet (1-1.2 g/kg), including the use of whey protein supplementation as needed. Outcomes measures included nutritional risk (Patient-Generated Subjective Global Assessment; PG-SGA), body composition (Medical software Lookin’Body120), and muscle strength (Jamar Hydraulic Hand Dynamometer). Descriptive statistics were generated, and paired T-test, Wilcoxon signed rank on paired samples and ANOVA-RM were used to evaluate changes in variables over time. Results: A total of 62 patients were included in this program. Participants had a median age of 75 years (range from 41-97) and were predominantly married (87%). A great proportion of patients (65%) were diagnosed with a stage IV disease. Notably, 23% were diagnosed with moderate to severe nutritional risk at baseline; 47% were overweight, 13% were obese and 14% were with sarcopenia. The nutritional program resulted in maintenance of total body weight (median 74.1 vs 75.6 kg, P=0.12), lean body weight (median 29.1 vs 29.4 kg, P=0.11), and muscle strength (median 30 vs 30 kg, P=0.62), while a statistically significant loss of body fat weight (median 22.0 vs 20 kg, P=0.003) was found over the 12-week period. Despite no change in the PG-SGA scores were noted overtime, the rate of sarcopenia has decreased (15% vs 13%, P=0.03) and the proportion of eutrophic patients has increased (18% vs 27%, P=0.001), as seen in the contingency table below. Conclusions: These findings suggest that this program may improve body composition and maintain muscle strength in men receiving treatment with ADT after only three months of intervention. Future studies should validate the benefit of this program in randomized trial with a longer follow-up assessment (6 and 12 months after treatment initiation). [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
    detail.hit.zdb_id: 2005181-5
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  • 2
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. 12122-12122
    Abstract: 12122 Background: Exercise has been shown to ameliorate the side effects of cancer therapy, improve quality of life, and may even enhance treatment response. Since immunotherapy is widely used and approved for over 18 indications, studies are needed to determine the effect of exercise on immunotherapy outcomes Additionally, there is a crucial need for understanding how to make such interventions cost-effective and accessible in low- and middle-income countries. We aimed to explore the feasibility and efficacy of a remote exercise program for patients receiving immunotherapy alone or in combination with chemotherapy in Brazil. Methods: This is a 12-week prospective study of a supervised remote exercise program. Patients diagnosed with any solid cancer receiving immunotherapy alone or in combination are eligible. The program is supervised using the WhatsApp and Vedius platforms and consists of resistance and aerobic exercises for 3 to 5 hours per week (4 to 6 days a week). Outcome measures include treatment-related symptoms (FACT-ICM, scale 0-100), fatigue (BFI, scale 0-90), and overall quality of life (FACT-G, scale 0-108). Descriptive statistics were generated, and RM-ANOVA were used to evaluate changes in outcome measures over time. Results: A total of 40 patients have been enrolled to date, with 87.8% of complete adherence. Participants had a mean age of 59 years (SD = 12.2) and were predominantly female (53.7%), white (68.3%), married (68.3%), and had a college degree or higher education (56.0%). Patients were mostly diagnosed with breast (24.4%) or kidney (22.0%) cancers; 63.4% of patients had stage IV disease. Notably, significant improvements in treatment-related symptoms (M 1 = 86.5, M 2 = 96.0, p = 0.001), fatigue (M 1 = 21.4, M 2 = 9.6, p = 0.001) and quality of life (M 1 = 87.5, M 2 = 98.6, p = 0.001) have been observed. Conclusions: To our knowledge, this is the first study to examine the feasibility and efficacy of a supervised remote exercise program among patients with cancer receiving immunotherapy in Latin America. Our findings suggest that this remote program has high adherence and may improve treatment-related symptoms, fatigue, and overall quality of life while providing a practical and easily accessible alternative to patients. This study will be validated in an upcoming randomized clinical trial.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
    detail.hit.zdb_id: 2005181-5
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  • 3
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. 4540-4540
    Abstract: 4540 Background: Given the need to balance both quantity and quality of life among patients with advanced cancer, developing a robust, relevant, and consensus-driven patient-focused measurement strategy is a necessity. Our study expands upon previous findings (Bergerot et al., The Oncologist 2023) in evaluating the perceived relevance of questions on the FKSI-19, EORTC QLQ-C30, and EQ-5D among patients with RCC. Methods: Eligible patients were diagnosed with RCC and asked to evaluate the relevance of each question of the FKSI-19, EORTC QLQ-C30, and EQ-5D (items rated as relevant vs non-relevant). Patients also responded to 2 open-ended questions regarding topics not covered by these measures and their perception of wearable technologies. Questions identified as meaningful required ≥66% “relevant” ratings. Descriptive statistics were collated, and open-ended questions were analyzed by 2 independent reviewers (CB, PB). Results: 116 patients were recruited from Brazil and the US. Most (69%) were male with a median age of 64 (32-88) years. 83% were diagnosed with advanced disease, and 75% received immunotherapy and/or targeted therapy as primary treatment. Few items across surveys were identified as meaningful including 8/19 FKSI-19 questions (lack of energy, fatigue, appetite, sleeping, worry, able to work, enjoyment and quality of life), 3/30 EORTC QLQ-C30 questions (tired, overall health and quality of life), and 0/5 EQ-5D questions. Patients suggested items pertaining to treatment side effects, emotional symptoms, physical function, social/family support, and financial distress should be included. Notably, 58% of patients were open to using wearable devices to assess HRQOL. Conclusions: Our multi-institutional international study confirms findings from our single-institution pilot data suggesting that HRQOL measures for RCC require substantial refinement. These data will inform development of a novel-RCC specific HRQOL tool in a joint effort between experts and patients.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
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  • 4
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 39, No. 28_suppl ( 2021-10-01), p. 313-313
    Abstract: 313 Background: Treatment decisions for patients with cancer have changed during the COVID-19 pandemic due to the increased risk of infection among this population. In recognition of the impact of COVID-19 in Brazil, this study sought to explore the potential consequences of this disruption to oncology care by comparing the prevalence and place of death one year prior to the pandemic (January 2019 to February 2020) and during the pandemic (March 2020 to March 2021). Methods: Consecutive patients with cancer receiving treatment at a single institution located in the capital of Brazil were included in this analysis. Patients’ characteristics were collected via chart review: age, sex, histology, COVID-19, hospital admission and place of death. Chi-square analysis was used to determine differences among this sample of patients (pre-COVID-19 and during COVID-19). Results: We reviewed data from 3,833 patients (53% of patients during the pandemic). Patients’ characteristics were well balanced between both groups of patients. The proportion of patients with breast and prostate cancers increased (P 〈 0.01). Rates of hospital admission were similar between both timepoint, with reasons for hospital admission also similar: surgery (22% vs 19%, respectively) and pulmonary dysfunction (14% vs 19%, respectively); 9% were diagnosed with COVID-19 during the pandemic. Similarly, no differences were found among rates of deaths between samples (7%); 42% of patients pre-COVID were receiving supportive care, while 40% were during pandemic. The proportion of patients dying at home was the same among both groups (12%). A slight increase was observed for those dying in the ICU (45% vs 46%, respectively) or hospital (35% vs 36%, respectively). Pre-COVID-19, no patient has died in the emergency room, and during pandemic, 3% has died). Conclusions: A similar proportion of hospital admission and place of death were found between patients prior and during the COVID-19 pandemic. Most patients died in institutional settings. Future studies are needed to better understand patient’s wishes and preferences and to develop strategies to improve communication surrounding death and dying.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2021
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  • 5
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 27_suppl ( 2019-09-20), p. 63-63
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 27_suppl ( 2019-09-20), p. 63-63
    Abstract: 63 Background: Comprehensive genomic profiling (CGP) has been used to guide treatment selection in metastatic renal cell carcinoma (mRCC). This study sought to determine if genomic alterations guided treatment and contributed to improved outcomes. Methods: From a single institution, patients (pts) diagnosed with mRCC who had CGP in the course of clinical care were identified. Pts were tested on a CLIAA-certified platform (FoundationOne; Cambridge, MA). Pts who died/initiated hospice within the 30 days after the test was performed or who were lost to follow-up were excluded. Duration of therapy (DOT) was measured as months between first and last day of therapy following CGP test. The Kaplan-Meier method was undertaken to estimate the association of CGP-directed therapy with overall survival (OS). Cox regression was also performed and adjusted for histologic subgroup. Results: A total of 64 patients underwent CGP between February 2014 and August 2018. From this group, 15 patients were excluded due to death/hospice within 30 d (n = 10) and lack of follow-up (n = 5). Median age at diagnosis was 60 years (range, 24-84), and 79% were male. Most patients (69%) were diagnosed with clear cell RCC. The median identified genomic alterations (GAs) was 3 (range, 0-7). The most common GAs were VHL (54%), PBRM1 (28%), TERT (21%), TP53 (15%), BAP1 (13%), and SETD2 (13%). Of the 49 patients included in this analysis, 47% had actionable mutations based on their CGP results. Of those, 13 patients received directed-therapy of whom 57% had stable disease, 28% had partial response, and 14% had progressive disease. The median time from CGP test to treatment was 1 month (range, 0-17). The median duration of directed-therapy was 12 months (range, 1-28) and of non-directed therapy was 4 months (range, 1-40) (P = 0.04). Directed-therapy was significantly associated with better OS (adjusted HR, 0.32 [95% CI, 0.13 to 0.82]; P = 0.018) compared to non-directed therapy. Conclusions: This study provides preliminary evidence to justify CGP-guided therapy in mRCC. Forthcoming studies should prospectively explore the use of CGP in treatment allocation for mRCC to validate these findings.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
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  • 6
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 38, No. 6_suppl ( 2020-02-20), p. 649-649
    Abstract: 649 Background: Fear of cancer recurrence (FCR) is considered one of the most pervasive and burdensome sources of distress for patients. Whereas it can be considered an adaptive response to real threats associated with diagnosis, treatment and disease, numerous studies have suggested that elevated levels can be dysfunctional. Despite this extensive body of research, little is known regarding FCR among individuals diagnosed with renal cell carcinoma (RCC). The current study sought to describe the prevalence of FCR among patients with RCC. Methods: Patients with localized RCC participated in an international survey from 07/19 to 09/19, through an online platform devised by a non-profit patient advocacy group (KCCure). Patients were assessed for FCR using the FCR-7, a 7-item measure, ranging from 0 to 28. A cutoff score of 17 indicates a moderate level of FCR, while a cutoff of 27 indicates severe level of FCR. Linear regression was used to determine the association between FCR and patients’ characteristics. Results: A total of 1150 patients participated in this survey, of which 412 had localized disease and were assessed for FCR. The majority were female (79%), with a median age of 54 years old (range, 30-80), and well-educated (58%). Patients were predominantly from US (85%), Canada (4%) and Germany (2%) and lived in suburban (48%) or rural areas (32%). More than half of participants were diagnosed with disease stage I (56%) and the remainder were divided between stage II (19%) and III (24%). More than half of patients (55%) reported a moderate or severe level of FCR. Younger patients (p=0.001) and those of female gender (p=0.004) were more likely to report higher levels of FCR. Conclusions: To our knowledge, this is the first study to quantify the degree of FCR among patients and survivors diagnosed with localized RCC. Importantly, high rates of FCR were associated with female gender and younger age, possibly driven by the fact that women may be more open to disclosing emotional symptoms and younger patients are still to pass through many life milestones and thus fear may be more pronounced. Targeted assessment and interventions are needed to address this highly prevalent form of distress among those diagnosed with RCC.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2020
    detail.hit.zdb_id: 2005181-5
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  • 7
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2018
    In:  Journal of Clinical Oncology Vol. 36, No. 30_suppl ( 2018-10-20), p. 228-228
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 30_suppl ( 2018-10-20), p. 228-228
    Abstract: 228 Background: Genomic profiling (GP) plays an important role in the care of patients diagnosed with advanced cancer, and has been used to guide clinical decision making. As age has been associated with low health literacy, we sought to determine comprehension of the goals and objectives of GP between younger (age 〈 65) and older (age ≥65) with genitourinary cancers. Methods: Eligible patients had agreed to receive somatic GP as a part of routine clinical care through a CLIA-certified commercially available platform. Participating physicians conducted a standardized dialogue with patients pertaining to the rationale for and clinical utility of somatic GP. Patients then received an in-person survey lasting approximately 10-15 min and assessing a broad range of perceptions related to GP. Results: Among 47 patients, 62% were characterized as older adults. Diagnoses encountered included kidney (43%), prostate (32%), and bladder (25%). Only older adults perceived any shortcomings in the description of GP. These shortcomings related to the clarity of the descriptions of genomic data, as well as the accuracy, detail and compassion with which this information was conveyed. Older adults demonstrated a very strong reliance on physician input in their decision to obtain somatic GP - 42% of older adults suggested that trust in their physician was among the top three reasons for which they opted to do genomic testing, in contrast to just 10% of younger patients (P = 0.04). Both older and younger patients demonstrated frequent misconceptions pertaining to the role of GP. For example, the majority of younger (78%) and older (52%) patients suggested the test was being performed for prognostic purposes. Both groups also frequently held the notion that somatic testing could identify hereditary cancer-related disorders (younger: 78% vs older: 66%). Conclusions: Detailed surveys of patients with genitourinary cancers reveal varied comprehension of somatic GP between younger and older patients. Interventions to enhance understanding of the principles of GP may be helpful in facilitating shared decision-making, particularly among older patients.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 2005181-5
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  • 8
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 7_suppl ( 2019-03-01), p. 591-591
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 7_suppl ( 2019-03-01), p. 591-591
    Abstract: 591 Background: Over the past 15 years, considerable progress has been made in systemic therapy options for genitourinary (GU) cancers. In diseases such as metastatic renal cell carcinoma (RCC) and urothelial cancer (UC), immunotherapeutic strategies such as programmed death-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibition have elicited durable responses, albeit in a minority of patients. We examined expectations for clinical outcome with immunotherapy among patients with advanced GU cancers. Methods: A survey study was conducted in patients with advanced GU cancers initiating PD-1/PD-L1 inhibitors from October 2017 to September 2018. Patients were screened prior to initiation of immunotherapy for their expectation of cure (divided into 4 quartiles), symptoms of anxiety and depression (PROMIS-A and PROMIS-D), and quality of life (QOL; FACT-G). For purposes of the survey, cure was equated to a durable complete response. Differences in frequency of anxiety, depression and QOL were compared amongst subsets of patients divided by expectation of cure. Results: Among 60 patients, median age was 67, 72% were male and 81% were married. Types of cancer included RCC (69%), UC (19%) and prostate cancer (12%). The majority were in the 1 st or 2 nd line of therapy (40% and 31%, respectively). Despite extensive counseling from GU medical oncologists, 23% of patients thought that cure was “very likely”, defined as in the range of 76-100%. Approximately 70% of patients estimated cure in the range of 0-25%, in line with clinical counseling. These patients had higher rates of anxiety (P = 0.01), depression (P = 0.002) and poorer QOL (P = 0.003) compared to patients who felt cure was very likely. Conclusions: A considerable proportion of patients with advanced GU malignancies harbor unrealistic expectations around the potential benefit of immunotherapy. Although a first instinct may be to remedy these expectations, it is important to bear in mind that these patients had better emotional well-being and QOL. We will validate these findings and assess these parameters longitudinally in an upcoming SWOG trial for patients with mRCC receiving upfront immunotherapy.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 9
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2018
    In:  Journal of Clinical Oncology Vol. 36, No. 34_suppl ( 2018-12-01), p. 115-115
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 34_suppl ( 2018-12-01), p. 115-115
    Abstract: 115 Background: In Brazil, 60.5% of patients are diagnosed with an advanced stage of cancer. Patients with incurable cancer and their partners experience high rates of distress. This study aimed to assess problem-related distress among patients with stage IV cancer and their partners. Methods: A descriptive study was conducted at a large public hospital. Patients and their partners completed the 33-item SupportScreen-Couples Distress, on a five Likert scale, which contains questions related to emotional and physical symptoms, relationship issues and concerns around diagnosis, treatment, prognosis, and end-of-life. The McNemar’s test was used to compare rates of problem-related distress between patients and their partners. Results: A total of 64 patients (median 56 yrs old; 57.8% male; 51.6% white; 87.5% Eastern Cooperative Oncology Group 〈 2) and 64 partners (median 56 yrs old; 53.1% white; 93.8% primary caregiver) were enrolled. Couples were married for a median of 27.3 yrs. Patients reported higher levels of distress related to fatigue (42.1% vs 29.7%; P = 0.02), worry about the future (28.1% vs 20.3%; P = 0.08), sleep problems (28.1% vs 20.3%; P = 0.07) and feeling depressed (26.6% vs 15.6%; P = 0.03) compared to their associated partners. Partners reported more anxiety (37.5% vs 28.1%) and financial concerns (25.1% vs 17.2%) compared to associated patients (P 〈 0.01 for both). Patients and partners had a similar understanding that curative treatment is unlikely and that the goal of treatment was disease control (51.6% and 56.2%, respectively). Patients (versus their partners) were generally more worried about how their family was coping with their cancer diagnosis (42.2% vs 15.6%) and demonstrated hesitancy in talking about fears related to the end of life (60.9% vs 14.1%) (P 〈 0.001 for both). Conclusions: We identify key differences in psychosocial issues experience by patients and their partners. Furthermore, patients and partners demonstrate unique concerns related to the spectrum of oncology care. Our findings can be used to tailor unique supportive care interventions for patients and partners.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 2005181-5
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  • 10
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 15_suppl ( 2018-05-20), p. 4570-4570
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 2005181-5
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