Survivorship: pain version 1.2014 Denlinger, Crystal S; Ligibel, Jennifer A; Are, Madhuri ...
Journal of the National Comprehensive Cancer Network
12, Issue:
4
Journal Article
Peer reviewed
Open access
Many posttreatment cancer survivors experience chronic pain, often leading to psychological distress; decreased activity, motivation, and personal interactions; and an overall poor quality of life. ...This section of the NCCN Guidelines for Survivorship provides screening and management recommendations for pain in survivors. A multidisciplinary approach is recommended, with a combination of pharmacologic treatments, psychosocial and behavioral interventions, physical therapy and exercise, and interventional procedures.
To determine the strength of evidence supporting an accentuated bleeding risk when patients with CHADS(2) risk factors (chronic heart failure, hypertension, advanced age, diabetes, and prior ...stroke/transient ischemic attack) receive warfarin. A systematic literature search of MEDLINE (January 1, 1950, through December 22, 2009) and Cochrane CENTRAL (through December 22, 2009) was conducted to identify studies that reported multivariate results on the association between CHADS(2) covariates and risk of bleeding in patients receiving warfarin. Each covariate was evaluated for its association with a specific type of bleeding. Individual evaluations were rated as good, fair, or poor using methods consistent with those recommended by the Agency for Healthcare Research and Quality. The strength of the associations between each CHADS(2) covariate and a specific type of bleeding was determined using Grading of Recommendations Assessment, Development and Evaluation criteria as insufficient, very low, low, moderate, or high for the entire body of evidence. Forty-one studies were identified, reporting 127 multivariate evaluations of the association between a CHADS(2) covariate and bleeding risk. No CHADS(2) covariate had a high strength of evidence for association with any bleeding type. For the vast majority of evaluations, the strength of evidence between covariates and bleeding was low. Advanced age was the only covariate that had a moderate strength of evidence for association; this was the strongest independent positive predictor for major bleeding. Similar findings were observed regardless of whether all included studies, or only those evaluating patients with atrial fibrillation, were assessed. The associations between CHADS(2) covariates and increased bleeding risk were weak, with the exception of age. Given the known association of the CHADS(2) score and stroke risk, the decision to prescribe warfarin should be driven more by patients' risk of stroke than by the risk of bleeding.
Healthy lifestyle habits have been associated with improved health outcomes and quality of life and, for some cancers, a reduced risk of recurrence and death. The NCCN Guidelines for Survivorship ...therefore recommend that cancer survivors be encouraged to achieve and maintain a healthy lifestyle, including attention to weight management, physical activity, and dietary habits. This section of the NCCN Guidelines focuses on recommendations regarding nutrition, weight management, and supplement use in survivors. Weight management recommendations are based on the survivor's body mass index and include discussions of nutritional, weight management, and physical activity principles, with referral to community resources, dietitians, and/or weight management programs as needed.
Classroom rules are an integral part of classroom management. Children with Asperger's may require systematic instruction to learn classroom rules, but may be placed in classrooms in which the rules ...are not explicitly taught. A multiple baseline design across students with probes for maintenance after the intervention ceased was used to evaluate the effectiveness of a video self-modeling (VSM) intervention to teach classroom rules to two children with Asperger's. Results indicated that each of the children improved in their ability to recite classroom rules following the VSM intervention. These results were maintained for both students at 12 weeks post-intervention. The findings of this study suggest that VSM is an effective tool for teaching children with Asperger's classroom rules.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Results are presented for suitability screening conducted by the United States Air Force during basic military training. The Lackland Behavioral Questionnaire has been used operationally since 2007, ...and its use has led to an increase in predictive validity. For the prediction of outcomes during the first 4 years of service, one can identify trainees with a 49% likelihood of being separated for unsuitability and a 56% likelihood of being diagnosed with a mental disorder. A formal suitability screening program allows referrals and recommendations to be made using a combination of empirical evidence and clinical judgment.
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BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
Abstract 3818
Although the adherence to recommended preventive care practices in hematopoietic cell transplantation (HCT) survivors is reported to be high, on average 25% of recommended preventive ...care is not delivered to this vulnerable population. We explored factors associated with lower adherence, with particular attention to modifiable factors, in a cross-sectional study of HCT long-term follow up (LTFU) patients. A 45- item supplementary module with questions about adherence to preventive care guidelines and financial concerns was added to the 236- item questionnaire that is mailed annually to LTFU patients who were alive at least 2 years after their first transplant in our center. 1550 (51%) of 3069 mailed questionnaires were returned. We have previously reported that the median adherence to recommended guidelines was 75%. Among other clinical and demographic factors associated with lower adherence, concern about medical costs and lack of knowledge about recommended tests emerged as major modifiable predictors. Of these respondents, 98% had medical insurance coverage, but 26% reported concerns about medical costs which were reflected by attempts to limit medical costs with one or more potentially deleterious avoidance behaviors (e.g., not taking a prescribed medicine, not having a medical test performed). Twenty-six percent worried that medical expenses would reach their lifetime limit. Only 27% of the respondents reported knowing recommended tests for transplant survivors, even though general guidelines are included with each annual questionnaire. 46% of the respondents indicated a desire to acquire this knowledge while 26% indicated that they relied on their treating physicians to be familiar with recommended guidelines. Multivariable logistic regression models were constructed for binary outcomes of “concerns about medical costs” and “lack of knowledge about recommended tests for LTFU patients” (Table). These models showed that concerns about medical costs were associated with lower physical and mental functioning, age less than 65 years, being female and not having chronic GVHD. Males, autologous transplant recipients, allogeneic transplant recipients who did not develop chronic GVHD, and patients surviving more than 15 years after HCT were more likely to report lack of knowledge about recommended tests for LTFU patients. When asked how they wished to receive information about recommended preventive care, patients favored mailed information (64%) over in-person evaluation (24%) or phone calls (27%). These results suggest that provision of comprehensive survivorship care plans might improve adherence to recommended preventive care practices by addressing lack of patient and provider knowledge. The increased support for preventive care by requiring health plans to cover preventive services and eliminating cost-sharing by the recent Affordable Care Act could also improve adherence by addressing financial concerns of this so-called ‘highly insured’ HCT LTFU population.
No relevant conflicts of interest to declare.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives: To determine the function of capsular polysaccharide (CPS)‐specific immunoglobulin‐G (IgG) and neutrophils from older adults in increasing ingestion and killing of type V group B ...Streptococcus (GBS).
Design: Cross‐sectional study.
Setting: Outpatient clinic at Baylor College of Medicine.
Participants: The subjects were 40 healthy, community‐dwelling adults aged 65 and older from Houston, Texas.
Measurements: The serum level of type V GBS CPS‐specific IgG was measured using an enzyme‐linked immunosorbent assay. Functional activity was evaluated using an opsonophagocytosis assay.
Results: Sera from four subjects promoted efficient neutrophil‐mediated phagocytosis and killing of type V GBS (mean log10 reduction±standard deviation in colony‐forming units (cfu)=1.51±0.39). Each had serum CPS‐specific IgG concentrations exceeding 1 μg/mL. Sera from 36 subjects did not promote neutrophil‐mediated functional activity (mean log10 reduction in cfu=−0.09±0.06; P=.025). Only one of these 36 had a CPS‐specific IgG concentration exceeding 1 μg/mL. When pooled sera from young adults given type V GBS conjugate vaccine was added at CPS‐specific IgG concentrations of 4 μg/mL or 0.4 μg/mL, sera from all subjects promoted neutrophil‐mediated killing of type V GBS. No impairment was evident in the neutrophil function of elderly subjects when it was compared with that of young adults.
Conclusion: CPS‐specific IgG and neutrophils from healthy older adults function to ingest and kill type V GBS, but these antibodies are not present in sufficient amounts in most individuals. Further studies should determine whether a type V GBS vaccine induces functionally active antibodies in older people.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Postpubertal male common marmosets, Callithrix jacchus, engage in little or no sexual behaviour while living with their natal families. The social mechanisms underlying this phenomenon have not been ...identified but have been assumed to include reproductive suppression by dominant males and/or avoidance of mating with closely related females. We evaluated these two possible components of male reproductive failure. Seven postpubertal males and their fathers underwent a series of 45-min sex tests, in which the son, the father, or the son and father together were allowed to interact freely with the mother/mate or with an unfamiliar, unrelated adult female. We measured testosterone, luteinizing hormone and cortisol concentrations in blood samples collected from males immediately following each test, and in basal blood samples collected on three different occasions. Sons, but not fathers, engaged in very low rates of sexual behaviour when tested with the mother/mate. When tested with unrelated females, however, sons engaged in significantly more sexual behaviour than they had when tested with their mothers and showed no differences from their fathers. When sons and fathers were tested together, both males performed significantly less sexual behaviour than when tested alone with a female; however, they showed no overt competition for females and engaged in little agonism. Hormone levels did not differ significantly between fathers and sons. These results indicate that avoidance of mating with familiar females and possibly father–son competition, but not specific, rank-related suppression, contribute to reproductive failure among postpubertal male marmosets living with their natal family.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
While numerous studies have implicated copy number variants (CNVs) in a range of neurological phenotypes, the impact relative to disease severity has been difficult to ascertain due to small sample ...sizes, lack of phenotypic details, and heterogeneity in platforms used for discovery. Using a customized microarray enriched for genomic hotspots, we assayed for large CNVs among 1,227 individuals with various neurological deficits including dyslexia (376), sporadic autism (350), and intellectual disability (ID) (501), as well as 337 controls. We show that the frequency of large CNVs (>1 Mbp) is significantly greater for ID-associated phenotypes compared to autism (p = 9.58×10-11, odds ratio = 4.59), dyslexia (p = 3.81×10-18, odds ratio = 14.45), or controls (p = 2.75×10-17, odds ratio = 13.71). There is a striking difference in the frequency of rare CNVs (>50 kbp) in autism (10%, p = 2.4×10-6, odds ratio = 6) or ID (16%, p = 3.55×10-12, odds ratio = 10) compared to dyslexia (2%) with essentially no difference in large CNV burden among dyslexia patients compared to controls. Rare CNVs were more likely to arise de novo (64%) in ID when compared to autism (40%) or dyslexia (0%). We observed a significantly increased large CNV burden in individuals with ID and multiple congenital anomalies (MCA) compared to ID alone (p = 0.001, odds ratio = 2.54). Our data suggest that large CNV burden positively correlates with the severity of childhood disability: ID with MCA being most severely affected and dyslexics being indistinguishable from controls. When autism without ID was considered separately, the increase in CNV burden was modest compared to controls (p = 0.07, odds ratio = 2.33).
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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