Browsing by Subject "Survivors"
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Item Cancer survivorship care: instructions not included!(2019-08-09) Sadeghi, NavidItem Congruence of Parent-Report, Self-Report, and Performance-Based Neuropsychological Functioning in Pediatric Acute Lymphoblastic Leukemia Survivors(2017-07-28) Clem, Matthew Alan; Holland, Alice A.; Stavinoha, Peter L.; Cullum, C. Munro; Holm, Suzanne; Lampson, ErinAcute Lymphoblastic Leukemia (ALL) is thought to have long-term cognitive effects, and clinicians often rely on parent report to screen for cognitive impairment during survivorship, despite limited congruence with neuropsychological performance and susceptibility to parental factors such as stress. This study was the first to investigate the moderating effect of parental stress on the congruence between reported child functioning and neuropsychological performance in pediatric ALL. Based on prior literature, performance-based, parent-report, and self-report measures were expected to show significantly worse child functioning compared to norms, with parents expected to report elevated stress compared to norms. Parental stress was expected to moderate the congruence between parent report and neuropsychological performance or self-report, with more stressed parents overestimating child impairment. A relatively large (N=107) sample of pediatric ALL survivors treated on chemotherapy-only protocols completed neuropsychological screening and standardized questionnaires on cognitive, behavioral, and emotional functioning at an annual follow-up visit (minimum six months post-treatment completion). Parents completed standardized questionnaires on child cognitive, behavioral, and emotional functioning; and parental stress and mood. Independent t-tests showed average overall cognitive functioning compared with normative data, but higher-than-expected frequencies of impairment (≤ 2nd percentile) in attention and executive functioning. ANOVA/ANCOVA analyses showed greater methotrexate exposure and younger age of diagnosis are associated with worse attention and processing speed performances. Parental stress and depression were lower than expected, likely indicating good parental adjustment. Correlation analyses revealed low to moderate (r = .21 - .41) congruence between parent report and neuropsychological performance; parent- and self-reported behavioral/emotional functioning were weakly associated. Moderation analyses indicated ratings of parents reporting mild stress were more congruent with neuropsychological performance than ratings of parents reporting no stress (ΔR2 = .05, p < .05), suggesting parents reporting at least some stress are more attuned to subtle aspects of child functioning. Contemporary treatment protocols show generally intact child cognitive functioning, though some are vulnerable to late effects. Parental psychological factors may steer clinicians toward performance-based methods of child assessment. Longitudinal studies with healthy and matched controls are necessary to fully understand the variable course and expression of late cognitive effects in pediatric leukemia survivors.Item Functional, Psychological and Community Integration Changes Over Time in Persons With Major Burn Injury(2006-05-15) Grace, Sheila Ann Isom; Cromes, G. FredThe purpose of the present study was to measure prospectively the functional, psychological and community integration status of individuals with major burn injury in order to determine the extent of changes over time and how functional and community integration status relates to emotional distress. This study was part of the North Texas Burn Model System Grant funded by the National Institute on Disability and Rehabilitation Research. Subjects in this study included adults over 14 years of age who met the American Burn Association's criteria for a major burn injury. The Total Body Surface Area burn across the measurement periods in these subjects ranged from 22.4 to 25.2 percent. Data was collected from 356 participants at discharge, 199 participants at 2 months, 255 participants at 6 months, 193 participants at 12 months, 114 participants at 24 months and 41 participants at 36 months. The instruments used in this study were the Brief Symptom Inventory (BSI), the Burn Specific Health Scale (BSHS), The Community Integration Questionnaire (CIQ), the Pain Analog Scale (PAS) and the Functional Assessment Screening Questionnaire (FASQ). It was hypothesized that 1) both areas of functioning and community integration would improve as emotional distress abated and that 2) the functional improvement and community integration as well as the lessening of emotional distress would continue over time. A repeated measures ANOVA was used to measure changes over time and a Bonferroni Multiple Comparison Test was used to compare results at different time intervals. FASQ and CIQ total scores for individuals exhibiting high versus low measures of emotional distress (with median split of BSI global scores) were compared at each measurement period using the Student's T-test. A statistically significant interaction was found between the variables as predicted; however, the participants in this study appeared to reach a plateau at 24 months after which little change in outcomes was noted.Item Longitudinal Changes in Quality of Life and Distress among Cancer Survivors Enrolled in a Community Survivorship Program(2014-07-24) Funk, Rachel Katherine; Hamann, Heidi; Balasubramanian, Bijal; Businelle, Michael; Howe-Martin, Laura; Kendall, JeffreyBACKGROUND: Cancer can be a life-threatening illness with long-term consequences beyond the initial phases of diagnosis and treatment. The post-treatment period presents unique challenges to psychosocial functioning (i.e., psychological distress and quality of life [QOL]), but little is known about the efficacy of psychological and behavioral interventions for cancer survivors, especially in the community setting. OBJECTIVE: This longitudinal study assessed the relationship between participation in a community-based survivorship program and psychosocial functioning among cancer survivors. Aims also addressed how individual characteristics and program participation related to changes in psychosocial functioning over time. METHOD: Participants included 152 cancer survivors receiving psychosocial and behavioral services (e.g., exercise, dietary consult, psychological counseling) through the Fort Worth Program for Community Survivorship at the University of Texas Southwestern Moncrief Cancer Institute. Participants completed measures of psychological distress and QOL at enrollment and at 3, 6, and 12 months post-enrollment. Service attendance was recorded throughout the 12-month study period. ANALYSIS: Linear mixed modeling techniques examined changes in psychosocial functioning over time. RESULTS: Significant improvements in both QOL and distress were noted for participants during the 12-month study period. The largest improvements in QOL and distress occurred during the first 3 months and appeared to level out during the last 6 months of program participation. This pattern mirrored participants’ attendance in program services, which was highest during the first 3 months of enrollment. Participants with low levels of comorbidity displayed a less pronounced improvement in both psychosocial outcomes over time than those with more comorbid symptoms. Individuals attending exercise and dietary services demonstrated a greater rate of improvement in QOL than those not attending these services. DISCUSSION: Results suggest that the cancer survivorship program was effective in addressing the unmet psychosocial needs of cancer survivors, especially during the first few months of program participation. Uptake of exercise and dietary interventions appeared especially impactful for QOL improvement. Future research should expand assessment of survivorship interventions and utilize non-interventional groups to better understand the specific impact of psychosocial and behavioral survivorship care on psychosocial functioning.Item Physical Activity among Cancer Survivors Referred for Exercise Training: A Longitudinal Evaluation(2015-07-23) Cisneros, Cassidy Allyn; Hamann, Heidi; Rethorst, Chad; Roop, Melissa; Germann, Julie; Deschner, MartinBACKGROUND: Physical activity (PA) is a crucial component of cancer survivorship care, but the majority of cancer survivors do not meet National Comprehensive Cancer Network (NCCN) guidelines for weekly activity levels. Supervised exercise training is a growing component of clinical survivorship programs, but little is known about their long-term effects. OBJECTIVE: The primary aim of this study was to examine longitudinal changes (up to 12-months) in self-reported physical activity among cancer survivors enrolled in a community survivorship program and referred for exercise training. A second aim focused on evaluating whether quality of life and session attendance were predictive of these changes, and a third aim identified demographic and clinical predictors of exercise program attendance. METHOD: Participants included 158 cancer survivors referred for supervised exercise training through the Fort Worth Program for Community Survivorship at the University of Texas Southwestern Moncrief Cancer Institute. Self-reported physical activity was measured by the International Physical Activity Questionnaire-Short Form (IPAQ-SF), with data gathered at Baseline, plus 3-, 6- and 12-months post-referral. ANALYSIS: Data related to study aims were analyzed using generalized estimating equations (GEE). RESULTS: Significant increases in self-reported physical activity were noted for participants over the 12-month analysis period; increases were noted at each post-baseline assessment. Participants who had normal BMI at baseline, were married, and had more education reported consistently greater physical activity across timepoints. Baseline global quality of life and exercise session attendance were also positively associated with consistently greater physical activity across timepoints. Emotional well-being at baseline and history of secondary cancer or cancer recurrence were both significant predictors of attending at least 12 exercise sessions. DISCUSSION: Results indicate that in general, the cancer survivorship program was effective in promoting physical activity. A pattern of sustained improvement suggests that even though most participants completed their exercise sessions early in the study period, benefits of the training remained for months afterward. Whether benefits are sustainable in less resource-rich settings and with less intensive exercise interventions should be further explored.Item Solid tumor second malignant neoplasms as a late effect of childhood cancer therapy(2015-09-11) Orlino, Angela M.Item [Southwestern News](2005-10-13) Rian, RussellItem [Southwestern News](2004-12-15) Satyanarayana, Megha; Maier, ScottItem [UT Southwestern Medical Center News](2011-05-19) Bolles, DebbieItem [UT Southwestern Medical Center News](2009-11-03) Stafford, Erin PratherItem [UT Southwestern Medical Center News](2007-08-29) Stafford, Erin Prather