Phyllis Butow

A randomized controlled trial (RCT) of a supportive care package (SurvivorCare, SC) for survivors of colorectal cancer (CRC).

79 Background: Colorectal cancer (CRC) and its treatments can cause distressing short and long-term side effects as well as significant functional consequences. Current models of follow-up do not adequately address these issues. We conducted a multi-center RCT of an innovative program (SurvivorCare (SC)); designed to have a beneficial effect on psychological distress, supportive care needs (SCN) and quality of life (QOL). METHODS At the end of active treatment for stage I-III CRC, eligible patients ( =18 years, adequate English) were randomized 1:1 to usual care (UC) or to UC+SC. SC comprised educational materials, needs assessment, an individualized survivorship care plan, nurse-led end-of-treatment session and three follow up (FU) phone calls. Distress (BSI-18), SCN (CaSUN) and QOL (EORTC QLQ-C30, CR29) were assessed at baseline, 2 (FU1) and 6 (FU2) months. Primary hypothesis: SC would have a beneficial effect on distress at FU1. Secondary hypotheses: SC would have a beneficial effect on (1) SCN and QOL at FU1; and (2) distress, SCN and QOL at FU2. 15 items assessed satisfaction with survivorship care. Sample size of 180 (90/arm) was based on 80% power, 2-sided alpha of 0.05, to detect a between groups difference of 3.6 on BSI-18 at FU1. Outcome analysis was ITT. RESULTS Of 221 patients randomized (111 UC, 110 SC), 4 were ineligible and 1 lost to FU, leaving 110 UC, 106 SC. Groups appeared well balanced. Median age was 64, 52% male, 56% colon, 35% rectal cancer, 10% overlap. Stage I 7%, II 22%, III 71%. Intervention fidelity was acceptable. Baseline distress and QOL were similar to population norms. Between groups differences in distress at FU1 (primary outcome), distress at FU2 and SCN and QOL at FU1 and FU2 were small and non-significant. SC patients were more satisfied with survivorship care than UC patients (significant differences on 10 of 15 items). CONCLUSIONS The addition of SC to UC did not have a beneficial effect on distress, SCN or QOL outcomes but SC patients were more satisfied with survivorship care. CLINICAL TRIAL INFORMATION ACTRN12610000207011.

Losing your marble(s): A cross-sectional study of psychosocial outcomes in Australian testicular cancer survivors

The current study aimed to improve the ecological validity of objective cognitive assessment in two ways: (1) by testing prospective memory, a type of cognition that involves remembering to carry out an action when there are distracting ongoing tasks, and (2) by using a virtual reality environment that is more similar to participants’ everyday cognitive challenges than standard neuropsychological tests. The study examined whether prospective memory (PM) performance among breast cancer survivors (BCS) exposed to chemotherapy differed from that seen in a demographically matched control group. Twenty-six female survivors of breast cancer who received chemotherapy that finished 0.5-5 years prior to the time of testing were compared with 25 age- and education-matched women with no history of cancer. Participants completed event-, time- and activity-based PM measures; standardized neuropsychological tests assessing attention and concentration, executive function and verbal memory; and self-report measures of cognitive dysfunction and PM failures. The BCS group showed significantly slower speed of processing on the test of attention and concentration as well as trends towards slower dual task performance. The BCS group reported significantly more cognitive complaints and PM failures than the control group on five of six self-report measures. The groups did not differ on other prospective memory or neuropsychological measures. PM tasks correlated significantly with both standard neuropsychological tasks and with self-reported cognitive function in everyday life. The results provide some evidence for correspondence between more ecologically valid objective measures and self-reported cognitive impairment following chemotherapy treatment. Further research into PM performance in this clinical group appears warranted.