BACKGROUND & AIMS: :We piloted a patient-reported screener in a clinic for survivors of childhood cancers to facilitate detection of late effects, psychosocial needs, and distress. The mean number of patient-reported survivorship concerns endorsed per patient was 3.2; most frequent were difficulties with body weight, sleep, work/school, and fertility. Few individuals reported clinically significant distress or fear of recurrence. Electronic health record data produced an average of 2.3 late effects. Administration of a brief screener was effective in identifying additional current medical and psychosocial care needs among adult survivors of childhood cancers in a survivorship clinic.

背景与目标： : 我们在一家针对儿童癌症幸存者的诊所中试用了患者报告的筛查器，以促进发现晚期影响，社会心理需求和痛苦。每位患者报告的生存关注的平均数量为3.2; 最常见的是体重，睡眠，工作/学校和生育能力方面的困难。很少有人报告临床上有明显的困扰或担心复发。电子健康记录数据平均产生2.3个晚期影响。在生存诊所中，进行简短筛查可以有效地确定儿童癌症成年幸存者中当前的其他医疗和社会心理护理需求。

BACKGROUND & AIMS: BACKGROUND:Recent advances have improved the likelihood of long-term survival for patients with lung cancer. However, little attention has been given to the growing need for dedicated survivorship care for these patients. To address this unmet need, we developed a unique follow-up care model. METHODS:In 2006, we convened a multidisciplinary working group to design a thoracic survivorship program (TSP) that provides follow-up by a nurse practitioner (NP) trained in survivorship care. Patients with early-stage lung cancer who were disease free for at least 1 year after resection were eligible for the program, which incorporates a standardized approach to cancer surveillance. Data on symptoms and outcomes were prospectively collected. Real-time electronic medical documentation was developed to optimize communication with primary physicians. RESULTS:Data were analyzed for the initial phase of the program, which comprised 655 patients. Ninety-two percent of eligible survivors who remained disease free chose to continue their care in the TSP, rather than receive follow-up with their thoracic surgeon. Clinically significant posttreatment symptoms were common, including fatigue (46%), anxiety (32%), chronic pain (25%), dyspnea (14%), and depression (12%). The majority of recurrences (72%) and second primary cancers (91%) in this cohort were identified by scheduled chest computed tomography at TSP visits. CONCLUSIONS:Survivorship care for patients with lung cancer, delivered in our NP-led TSP, is feasible, effective, and well accepted by patients. Through the implementation of a uniform self-sustaining patient-centered system, the TSP model improves on the variation of physician-led follow-up care.

背景与目标：

BACKGROUND & AIMS: :To investigate the effects of increased weight and body mass index (BMI) on total knee arthroplasty (TKA) survivorship and on functional outcomes and quality of life following revision TKA, a prospective cohort study of 291 consecutive revision TKA patients was performed. Average patient BMI was 32.3 +/- 7.7, and 57% of patients were obese (BMI > or = 30). The obese group was not significantly different from the nonobese group regarding reasons for prosthesis failure; however, they were more likely to experience certain comorbidities. Body mass index and weight were both significant predictors of survivorship of primary TKA (regression coefficient BMI = -1.852, P = .004; regression coefficient weight = -0.405, P = .000) in multivariate regression. At 6-month follow-up, improvement of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) stiffness, WOMAC difficulty of function, and Knee Society Score (KSS) function scales at 6 months after revision TKA was significantly lower (at the 0.001 level, two tailed) in patients with higher BMI, weight, or both. In regression analysis, BMI was a significant predictor of Short Form-36, WOMAC difficulty of function, and KSS. Weight and BMI have deleterious effects on the longevity of primary TKA and functional and quality of life outcomes following revision TKA. These findings indicate a need for more effective management of these patients.

背景与目标： : 为了研究体重和体重指数 (BMI) 增加对全膝关节置换术 (TKA) 生存率以及对修订TKA后功能结局和生活质量的影响，进行了291例连续修订TKA患者的前瞻性队列研究。平均患者BMI为32.3 +/- 7.7，57% 患者为肥胖 (BMI> 或 = 30)。在假体失败的原因上，肥胖组与非肥胖组没有显着差异; 但是，他们更有可能出现某些合并症。在多元回归中，体重指数和体重都是原发性TKA存活率的重要预测指标 (回归系数BMI = -1.852，P = 0.004; 回归系数权重 = -0.405，P = .000)。在6个月的随访中，西安大略和麦克马斯特大学骨关节炎指数 (WOMAC) 僵硬度，WOMAC功能难度和修订后6个月的膝关节社会评分 (KSS) 功能量表的改善在BMI较高的患者中，TKA显着降低 (在0.001水平，两尾) 重量，或者两者兼而有之。在回归分析中，BMI是Short Form-36，WOMAC功能困难和KSS的重要预测指标。体重和BMI对原发性TKA的寿命以及修订后TKA后的功能和生活质量结果具有有害影响。这些发现表明需要对这些患者进行更有效的管理。

BACKGROUND & AIMS: BACKGROUND:The aging process is accompanied by several conditions that could affect the outcome of meniscal allograft transplantation (MAT). These conditions have made it difficult for clinicians to determine the effect of chronologic age on survivorship after MAT. HYPOTHESIS:Advanced age does not have an adverse effect on survivorship of MAT when controlling for age-related factors, such as cartilage status and time from previous meniscectomy. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:The records of 264 consecutive patients who underwent primary medial or lateral MAT were reviewed. To check whether there was a difference in MAT survivorship according to age, a cutoff value was calculated from a time-dependent receiver operating characteristic curve. Survival rates, as well as clinical improvement as determined using the Lysholm score, were compared between groups divided by the cutoff value. Patients were matched for cartilage status and elapsed time from previous meniscectomy. Differences in survivorship and clinical outcomes were assessed between the matched groups. RESULTS:A time-dependent receiver operating characteristic curve showed that the difference in MAT survivorship was maximized with a cutoff age of 43 years. Kaplan-Meier analysis showed a significant difference in MAT survivorship between the older and younger groups (log-rank test, P = .01). However, after matching for cartilage status and time from previous meniscectomy, which left 56 patients per group, there was no significant difference in MAT survivorship (log-rank test, P = .10) between the groups. Regarding clinical outcomes, the mean Lysholm scores were not significantly different between the older and younger groups (P = .19, before matching; P = .39, after matching). CONCLUSION:MAT survivorship was more affected by age-related prognostic factors, such as cartilage status and time from previous meniscectomy, than age itself. Clinical outcomes did not show differences according to age, either.

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BACKGROUND & AIMS: BACKGROUND:Uncemented femoral components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the third decade. QUESTIONS/PURPOSES:We evaluated (1) survivorship using femoral revision for any reason as the end point; (2) survivorship using femoral revision for aseptic loosening as the end point; and (3) patient-related and surgical risk factors for aseptic stem loosening at a minimum 20-year followup with an uncemented tapered titanium stem. METHODS:We reviewed the clinical and radiographic results of 354 THAs in 326 patients performed between January 1985 and December 1989 using an uncemented grit-blasted, tapered titanium femoral stem. Mean age at surgery was 57 years (range, 13-81 years). Kaplan-Meier survivorship analysis was used to estimate long-term survival. Minimum followup evaluation was 20 years (mean, 22 years; range, 20-25 years); at that time, 120 patients (127 hips) had died, and four patients (five hips) were lost to followup. Multivariate survival analysis using a Cox regression model was performed. RESULTS:Survivorship at 22 years with revision of the femoral component for any reason as the end point was 86% (95% confidence interval [CI], 81%-90%). Survivorship for femoral revision for aseptic loosening as the end point was 93% at 22 years (95% CI, 90%-96%). Undersized stems (canal fill index≤80%) and stems in hips with cup revision were at higher risk for aseptic loosening (hazard ratio, 4.2 and 4.3, respectively). There was a high rate of acetabular revision in this series (38%), mostly related to smooth-threaded, cementless sockets. CONCLUSIONS:Uncemented femoral fixation was reliable into the third decade. Age, male sex, and diagnosis were not associated with a higher risk of aseptic loosening. LEVEL OF EVIDENCE:Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

背景与目标：

BACKGROUND & AIMS: PURPOSE/OBJECTIVES:To evaluate the feasibility, usability, and satisfaction of a survivorship care plan (SCP) and identify the optimum time for its delivery during the first 12 months after diagnosis. DESIGN:Prospective, descriptive, single-arm study. SETTING:A National Cancer Institute-designated cancer center in the southeastern United States. SAMPLE:28 nonmetastatic colon cancer survivors within the first year of diagnosis and their primary care physicians (PCPs). METHODS:Regular screening identified potential participants who were followed until treatment ended. An oncology certified nurse developed the JourneyForward™ SCP, which then was delivered to the patient by the oncology nurse practitioner (NP) during a routine follow-up visit and mailed to the PCP. MAIN RESEARCH VARIABLES:Time to complete, time to deliver, usability, and satisfaction with the SCP. FINDINGS:During one year, 75 patients were screened for eligibility, 34 SCPs were delivered, and 28 survivors and 15 PCPs participated in the study. It took an average of 49 minutes to complete a surgery SCP and 90 minutes to complete a surgery plus chemotherapy SCP. Most survivors identified that before treatment ended or within the first three months was the preferred time to receive an SCP. CONCLUSIONS:The SCPs were well received by the survivors and their PCPs, but were too time and labor intensive to track and complete. IMPLICATIONS FOR NURSING:More work needs to be done to streamline processes that identify eligible patients and to develop and implement SCPs. Measuring outcomes will be needed to demonstrate whether SCPs are useful or not.

背景与目标：

BACKGROUND & AIMS: :The St. Jude Cloud, an online resource for cancer researchers to download, upload, process, and visualize pediatric cancer data, has announced the release of the St. Jude Survivorship Portal, which contains a wealth of clinical and genomic data about survivors of childhood cancers.

背景与目标： : 圣裘德云 (st.Jude Cloud) 是供癌症研究人员下载，上传，处理和可视化儿科癌症数据的在线资源，已宣布发布圣裘德生存门户网站，其中包含有关儿童癌症幸存者的大量临床和基因组数据。

BACKGROUND & AIMS: BACKGROUND:In a previously reported series of 51 patients with 62 cemented, fixed-bearing unicompartmental knee arthroplasties, we reported a 10-year, 98% survival rate with an average knee score of 92 points. The survivorship and modes of failure past 10 years are incompletely understood. QUESTIONS/PURPOSES:At 15-year followup we sought to determine (1) the overall durability and survivorship of this design; (2) modes of failure; and (3) the progression of arthritis in the nonresurfaced compartments. METHODS:Nineteen knees in 16 patients were available for study with 34 patients lost to death and one lost to followup. At 15 years, we analyzed the Kaplan-Meier survivorship as well as durability with regard to radiographic loosening and knee scores, determined modes of failure, and assessed radiographs for degeneration in the nonresurfaced compartments. RESULTS:Fifteen-year survivorship was 93% and 20-year survivorship was 90%. Four of 62 knees were revised to total knee arthroplasty at a mean of 144 months. One knee was revised for patellofemoral and lateral compartment degeneration, one for lateral compartment degeneration, one for polyethylene disengagement and metallosis, and one for pain of unclear etiology. No patients had aseptic loosening or osteolysis. The mean knee score was 78 at latest followup. Arthritic progression in the nonresurfaced compartments was common although symptomatic in only two patients. CONCLUSIONS:With this cemented, fixed-bearing design, the failure rates were low, there were no cases of failure secondary to wear or loosening, and the survivorship was similar to that reported for total knee arthroplasty.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Balancing the relative advantages and disadvantages of unicompartmental knee arthroplasties (UKAs) against those for TKAs can be challenging. Survivorship is one important end point; arthroplasty registers repeatedly report inferior midterm survival rates, but longer-term data are sparse. Comparing survival directly by using arthroplasty register survival reports also may be inadequate because of differences in indications, implant designs, and patient demographics in patients having UKAs and TKAs. QUESTIONS/PURPOSES:The aims of this study were to assess the survivorship of UKA in the context of one large, northern European registry, and to compare the rates of survivorship with those of cemented TKAs performed for primary knee osteoarthritis during the same 27-year period. METHODS:From the Finnish Arthroplasty Register, we obtained the data for 4713 patients undergoing UKAs for primary osteoarthritis (mean age, 63.5 years; minimum followup, 0 years; mean, 6.0 years; range, 0-24 years) who had surgical revision between 1985 and 2011. From this cohort, we calculated the Kaplan-Meier survivorship for revision performed for any reason and compared it with the survivorship of 83,511 patients (mean age, 69.5 years; minimum followup 0 years; mean, 6.4 years; range, 0-27 years) with TKAs treated for primary osteoarthritis during the same period. Data were adjusted for age and sex in a comparative analysis. RESULTS:Kaplan-Meier survivorship of UKAs was 89.4% at 5 years, 80.6% at 10 years, and 69.6% at 15 years; the corresponding rates for TKAs were 96.3%, 93.3%, and 88.7%, respectively. UKAs had inferior long-term survivorship compared with cemented TKAs, even after adjusting for the age and sex of the patients (hazard ratio 2.2, p < 0.001). CONCLUSIONS:A UKA offers tempting advantages compared with a TKA; however, the revision frequency for UKAs in widespread use, as measured in a large, national registry, was poorer than that of TKAs. When choosing between a UKA and a TKA, patients should be informed of advantages of both procedures, but they also should be advised about the generally higher revision risk after UKA. LEVEL OF EVIDENCE:Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

背景与目标：

BACKGROUND & AIMS: :As more and more people are successfully treated for and live longer with cancer, greater attention is being directed toward the survivorship needs of this population. Women treated for cancer often experience issues related to sexual health and intimacy, which are frequently cited as areas of concern, even among long-term survivors. Unfortunately, data suggest that providers infrequently discuss these issues. We reviewed a contemporary understanding of sexual health of women and the impact of treatment on both sexual function and intimacy. We also provide a review of the diagnosis using the newest classification put forth by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and potential treatments, including both endocrine and nonendocrine treatments that the general oncologist may be asked about when discussing sexual health with his or her patients.

背景与目标： : 随着越来越多的人成功接受癌症治疗并寿命更长，人们越来越关注该人群的生存需求。接受癌症治疗的妇女经常遇到与性健康和亲密有关的问题，即使在长期幸存者中，这些问题也经常被视为关注的领域。不幸的是，数据表明提供商很少讨论这些问题。我们回顾了当代对女性性健康以及治疗对性功能和亲密关系的影响的理解。我们还使用美国精神病学协会在《精神疾病诊断和统计手册》第五版中提出的最新分类对诊断进行了回顾，并提供了潜在的治疗方法，包括一般肿瘤学家可能会询问的内分泌和非内分泌治疗与他或她的患者讨论性健康时。

BACKGROUND & AIMS: BACKGROUND:Overall, the survival rate for cancer patients has continued to improve over the past several decades. However, those aged 15 to 29 years have not experienced the same improvements in survival. This review explores some of the challenges faced by adolescent and young adult (AYA) cancer patients and their survivorship needs. METHODS:Using the OVID Medline database from 1966 to present, a variety of search terms including "adolescent," "young adult," and "cancer survivorship" were entered. Articles related to those obtained by the search were also collected. Additional data were obtained from the SEER database AYA monograph, the Childhood Cancer Survivorship Study, the Report of the Adolescent and Young Adult Oncology Progress Review Group, and the Long-Term Follow-Up Recommendations of the Children's Oncology Group. RESULTS:Cancer patients in this age-group are at increased risk for second malignancies, cardiotoxicity, and reproductive difficulties. Few data exist concerning intellectual and other psychosocial issues for this specific patient population. CONCLUSIONS:More research is needed to develop accurate data on treatment and survivorship for AYA patients. A separate cancer discipline focusing on improving outcomes in treatment and survivorship among AYA patients should be developed in major academic cancer centers.

背景与目标：

BACKGROUND & AIMS: :Social reintegration is an important part of young adult cancer patients' transition to survivorship care. As part of a mixed methods study exploring the social functioning of young adult cancer patients during this transition process, participants (N = 13) completed four selected measures from the Patient-Reported Outcomes Measurement Information System (PROMIS) social and mental health domains within ∼6 months of completion of active treatment and 3 months later. The majority of participants (n = 10) had T-scores within normal limits on all measures. Three participants had T-scores in the mild or moderate impairment range across time points. No significant differences were found between groups at Time 1 and Time 2 on any of the four measures.

背景与目标： : 社会重返社会是年轻成人癌症患者向生存护理过渡的重要组成部分。作为一项混合方法研究的一部分，该研究探索了年轻成年癌症患者在此过渡过程中的社会功能，参与者 (n   =   13) 在积极治疗完成后的6个月和3个月后完成了患者报告的结果测量信息系统 (PROMIS) 社会和精神卫生领域的四项选定测量。大多数参与者 (n   =   10) 的所有指标的T评分均在正常范围内。三名参与者在不同时间点的轻度或中度损伤范围内有T评分。在四项测量中，在时间1和时间2两组之间没有发现显着差异。

BACKGROUND & AIMS: :Long term results of joint replacement are frequently expressed as survivorship; it therefore becomes increasingly important to have the ability to make valid comparisons between survivorship tables in order to determine accurately the statistical significance of published differences. We present a statistical method for direct comparison of survivorship tables. We have applied this technique to evaluate the survivorship of the unconstrained, uncemented Ring total knee replacement first implanted in 1975 and compare this to contemporaneous constrained prostheses. There is a significant improvement in survival, which suggests a beneficial long-term effect on the bone/implant interface of this changing design concept.

背景与目标： : 关节置换的长期结果通常表示为生存能力; 因此，具有在生存能力表之间进行有效比较以准确确定已发布差异的统计意义的能力变得越来越重要。我们提出了一种直接比较幸存者表的统计方法。我们已应用此技术来评估首次植入1975年的无约束，无约束环全膝关节置换术的存活率，并将其与同期的约束假体进行比较。存活率有了显着改善，这表明这种不断变化的设计概念对骨骼/植入物界面产生了有益的长期影响。

BACKGROUND & AIMS: :This study investigates economic differentials in cancer survival in a sample of 1180 white men, focusing in particular on the relationship between income level and survivorship in the various subsites comprising the digestive system cancer category. Using the Cox proportional hazards model to control for confounding variables, the economic status-survivorship relationship is estimated for several subgroupings of primary malignancies. The results show significant variation in this relationship across different cancer sites, with a pronounced effect observed in carcinomas of the small intestine, peritoneum and, especially, colon and rectum. High-income patients with these malignancies had a significantly lower risk of dying from the disease (P less than 0.05) than either their middle- or lower-income counterparts, controlling for age, stage, and initial course of treatment. Differences in immunologic status, tumor characteristics, and follow-up treatment may account for these economic effects.

背景与目标： : 这项研究调查了1180名白人男性样本中癌症生存的经济差异，特别关注消化系统癌症类别的各个子位点的收入水平与生存率之间的关系。使用Cox比例风险模型控制混杂变量，估算了原发性恶性肿瘤几个亚组的经济状况-生存关系。结果表明，这种关系在不同癌症部位之间存在显着差异，在小肠，腹膜，尤其是结肠和直肠癌中观察到明显的作用。这些恶性肿瘤的高收入患者死于该疾病的风险 (P小于0.05) 明显低于中等或低收入患者，控制了年龄，阶段和初始治疗过程。免疫状态，肿瘤特征和后续治疗的差异可能是这些经济影响的原因。

BACKGROUND & AIMS: INTRODUCTION:The optimal structure for survivorship care plan (SCP) programs and methodology for generating treatment summaries (TSs) has not yet been defined, but the Commission on Cancer and the National Accreditation Program for Breast Centers both mandate that participating oncology programs implement SCP-TS processes for patients that have completed treatment. METHODS:We used the Institute for Healthcare Improvement's Plan-Do-Study-Act model for conducting a quality improvement project evaluating two different SCP-TS programs implemented at the Henry Ford Health System/Henry Ford Cancer Institute's Breast Oncology Program in Detroit, Michigan. System I involved TSs drafted by nonspecialist breast clinic staff; System II involved TSs vetted through a multidisciplinary breast specialist conference approach. Accuracy of basic documentation entries related to dates and components of treatment were compared for the two approaches. RESULTS:Seventy-one System I and 93 System II documents were reviewed. Documentation was accurate in at least 90% of documents for both systems regarding delivery of chemotherapy and/or endocrine therapy and for documenting the identity of the various members of the cancer treatment team. Both systems had notable inaccuracies in documenting type of surgery performed, but System II had fewer inaccuracies than System I (33.78% v 51.67%, respectively; P = .05). System II, compared with System I, had fewer inaccuracies in documenting date of diagnosis (9.68% v 25.35%, respectively; P = .01) and had less missing information for dose of radiation delivered (9.33% v 33.9%, respectively; P < .01). CONCLUSION:A multidisciplinary team approach to drafting and reviewing SCP-TS documents improved content accuracy for our program, but ongoing education regarding documentation of various surgical procedures is warranted.

背景与目标：