Supplemental Table 2 shows associations of baseline continuous participant characteristics with past 30-day tobacco product use

The use of multigene panels in clinical practice has created an increasing likelihood that cancer genetic testing will leave many patients with uncertainties regarding test interpretation, implications and recommendations, which will change over time. We lack effective longitudinal clinical care models to provide updated information to patients regarding genetic test results or medical recommendations and to obtain personal and medical history updates. To bridge this gap in genetic medicine, we developed a patient and provider informed digital genetic health portal, "MyCancerGene," to improve longitudinal patient understanding and responses to genetic testing, especially in an evolving landscape of evidence and risk information. We used a 5-step process to develop the MyCancerGene digital tool. To better understand interest in and willingness to utilize a digital genetic health portal, we first surveyed 307 patients who completed genetic testing (Step 1). We completed qualitative interviews with 10 patients and a focus group with 17 providers to inform the content and function of MyCancerGene (Step 2). Next, we developed initial intervention content (Step 3) and completed user testing of intervention content with 25 providers and 28 patients (Step 4). After the prototype intervention was developed, we completed usability testing with eight patients for feedback on the final content, functions and ease of use (Step 5). Patient and provider interviews identified high interest in a patient-centered digital genetic health portal to support longitudinal care. Potential advantages of MyCancerGene, according to patients and providers, included: increased accessibility, convenience and efficiency of accessing their genetic reports and documentation, and increasing and maintaining patient understanding through patient-centered content and educational resources. Both patients and providers endorsed the benefit of the tool for updating personal and family history and for providers to share new risk information, test interpretation or other medical changes. Patient and provider input informed eight key components of the tool: Landing Page, Summary of Care, My Genetic Test Results, My Family History, Provide an Update, Review an Update, Resources and a Screenings Tracker. They also recommended key functions, including the ability to download and print materials and the inclusion of reminders and engagement functions. Potential challenges identified included privacy/security concerns, the potential for electronic information to generate distress, and the need to integrate with existing health portals. While patients were comfortable with updates (even variant reclassification upgrades or clinically significant results), genetic providers had mixed feelings on the appropriateness of sharing variant reclassification upgrades through MyCancerGene MyCancerGene, a patient-centered digital genetic health portal, was developed with extensive patient and provider feedback and designed to enhance longitudinal patient understanding of and affective and behavioral responses to genetic testing, particularly in the era of evolving evidence and risk information. NCT04774445

Adolescent and young adult cancer survivors (AYAs) experience clinically significant distress and have limited access to supportive care services. Interventions to enhance psychological well-being have improved positive affect and reduced depression in clinical and healthy populations and have not been routinely tested in AYA survivors. We are optimizing a web-based positive skills intervention for AYA cancer survivors called Enhancing Management of Psychological Outcomes With Emotion Regulation (EMPOWER) by: (1) determining which intervention components have the strongest effects on well-being and (2) identifying demographic and individual difference variables that mediate and moderate EMPOWER's efficacy. EMPOWER is a five-session online intervention that teaches behavioral and cognitive skills for increasing psychological well-being. Guided by the Multiphase Optimization Strategy (MOST), we assign two levels (yes, no) to each of five intervention components (positive events, capitalizing, & gratitude; mindfulness; positive reappraisal; personal strengths & goal-setting; acts of kindness), allowing us to evaluate the effects of individual and combined intervention components on positive affect in a full factorial design. Post-treatment AYA cancer survivors (N = 352) are recruited from participating NCI-designated comprehensive cancer centers and randomized to one of 32 experimental conditions. Our primary outcome is positive affect; potential mediating and moderating variables include coping self-efficacy and emotional support, respectively. Upon trial completion, we will have an optimized, digital health intervention to enhance psychological well-being among AYA cancer survivors. EMPOWER will be scalable and primed for a large, multi-site trial among AYAs who would otherwise not have access to supportive care interventions to manage distress and enhance well-being.

5014 Background: Chemohormonal therapy with androgen deprivation therapy and docetaxel (ADT+D) improves overall survival (OS) and quality of life (QOL) at 12 months compared to ADT alone in metastatic hormone sensitive prostate cancer (mHSPC). However, the prognostic relationship between QOL, disease characteristics, and OS has not been described in this population. Methods: In this post-hoc exploratory analysis of the CHAARTED trial, the QOL instrument Functional Assessment of Cancer Therapy-Prostate (FACT-P) was completed by patients treated with ADT and ADT+D. Log-rank test and Cox proportional hazards models were used to test the association between QOL and OS by clinical and disease characteristics. Results: 790 men were included in the study (ADT+D, n = 397; ADT, n = 393). Baseline higher QOL by FACT-P (n = 790) was associated with better OS in univariate regression (HR 0.70 [0.55,0.90], p = 0.005), however the association was not significant in multivariate analysis (HR 0.80 [0.62-1.04], p = 0.09). There was a trend towards improved survival for patients with the lowest baseline QOL (lowest quartile) treated with ADT+D compared to ADT (HR 0.75 [0.53, 1.05], p = 0.09). In contrast, patients with the highest baseline QOL (highest quartile, 63% high volume disease) had similar survival regardless of treatment arm (HR 0.92 [0.63-1.36], p=0.69). Higher 3-month QOL by FACT-P (n = 654) was associated with survival in the multivariate analysis independently of treatment arm (HR 0.76 [0.58, 1.0], p = 0.05). Patients with the highest 3-month QOL had comparable survival regardless of treatment arm (HR 1.11 [0.73, 1.67], p = 0.63), while patients with the lowest 3-month QOL experienced a survival benefit with ADT+D compared to ADT (HR 0.69 [0.48, 0.99], p = 0.047). Conclusions: In this analysis, 3-month QOL by FACT-P was significantly associated with survival for patients with mHSPC. Patients with the poorest QOL ("most symptomatic”) appeared to experience survival benefit from ADT+D regardless of disease volume. Conversely, patients reporting the highest QOL (“least symptomatic”) did not seem to benefit from ADT+D despite a predominance of patients with high volume disease in that cohort. These findings suggest that consideration of QOL may enhance decision making and patient selection when considering chemohormonal treatment for mHSPC. [Table: see text]

Background: Being an oncologist means accepting that some patients will have disease recurrence despite the most expert treatments. The universality of that experience, however, does not negate the potential for decisional regret and emotional distress on the part of the physician. The broad scale movement towards treatment optimization in medicine likely complicates this experience, as enrollment in de-escalation clinical trials inevitably means that the patient will receive less than the current standard of care. The objective of this study was to assess physician perceptions of potential emotional distress and decisional regret following patient recurrence through exploring the broad range of factors that either moderate or exacerbate those experiences. Methods: Physicians who treat breast cancer in academic and community settings across the United States participated in a qualitative interview designed to assess physician perspectives regarding patient enrollment in de-escalation clinical trials. Purposive sampling techniques were utilized to construct a balanced sample (sex, time in practice) of 39 participants. A subsection of the interview schedule centered on the experiences of decisional regret and distress surrounding patient recurrence. Interviews were recorded, transcribed, and analyzed in order to identify shared themes. Two independent coders performed a content analysis, identifying and recording factors that impact the level of distress that the physician may feel. Results: Thirty-six physicians provided in depth responses regarding their experience when a patient recurs. A total of 21 factors that affected recurrence stress were identified and spanned broad categories including patient features, disease biology, the design of the clinical trial, and characteristics of the physician. All participants expressed willingness to enroll patients in de-escalation-focused clinical trials. However, approximately half of the sample indicated that the experience would be worse after enrollment in a de-escalation trial than after a traditional intensification trial, and a quarter admitted that patient recurrence after a de-escalation trial would impact their decision making regarding future patient enrollment. Individuals not likely to experience distress emphasized having a strong trial rationale, informed patient consent, and engaging in shared decision-making, while greater distress centered on the fear of “not doing enough” and the patient missing out on necessary treatment. Conclusions: Many factors contribute to the experience of physician decisional regret and emotional distress after patient recurrence. Although most physicians recognize the importance of de-escalation focused clinical trials, a significant proportion indicated a greater potential for distress following patient recurrence in such trials and offered insight into how trial design and the process of patient enrollment can be improved to minimize potential distress. Citation Format: Nicole L. Henderson, Andrews Courtney, Lawhon Valerie, Stacey A. Ingram, Lisa Zubkoff, Nadine Tung, Lynne Wagner, Lauren P. Wallner, Antonio C. Wolff, Gabrielle B. Rocque. "Clinical Trials are Space Travel": Moderators of Recurrence Stress among Breast Cancer Oncologists [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-54.

Approximately 66% of patients diagnosed with colorectal cancer will survive for at least 5 years and engaging patients in an active role to optimize their health will improve outcomes. Clinical guidelines recommend patients receive a comprehensive care plan (CP) when transitioning from active treatment to survivorship that includes support for ongoing symptoms and recommended healthy behaviors. Yet cancer care providers find this guideline difficult to implement due to the additional time and resources required. Future directions for survivorship care planning include enhancing information technology support for developing personalized CPs, using CPs to facilitate self-management, and assessing CPs in clinical settings. To develop an electronic tool for colorectal cancer follow-up care planning. Incorporating healthcare professional and patient stakeholder input is fundamental to the successful integration of any tool into the clinical workflow. Thus, we followed the Integrate, Design, Assess and Share (IDEAS) framework to adapt an existing application for stroke care planning (COMPASS-CP) to meet the needs of colorectal cancer survivors (COMPASS-CP CFC). Constructs from the Consolidated Framework for Implementation Research (CFIR) guided our approach. We completed this work in three phases: (1) gathered qualitative feedback from stakeholders about the follow-up CP generation design and workflow; (2) adapted algorithms and resource data sources needed to generate a follow-up CP; and (3) optimized the usability of the adapted prototype of COMPASS-CP CFC. We also quantitatively measured usability (target average score of ≥70; range=0-100), acceptability, appropriateness, and feasibility. In the first phase, healthcare professionals (n=7) and patients and caregivers (n=7) provided qualitative feedback on COMPASS-CP CFC that informed design elements such as selection, interpretation and clinical usefulness of patient-reported measures. In phase 2, we built a minimal viable product of COMPASS-CP CFC. This tool generated CPs based on needs identified by patient-completed measures (including validated patient-reported outcomes) and EHR data, which were then matched with resources by zip code and preference to support patients’ self-management. Elements of CFIR assessed revealed that most healthcare professionals believed the tool would serve patients’ needs and had advantages (e.g., providing local community resources). In phase 3, the average System Usability Score was above our target score for healthcare professionals (n=5; M=71.0, SD=15.2) and patients (n=5; M=95.5, SD=2.1). Participants also reported high levels of acceptability, appropriateness, and feasibility. Additional CFIR-informed feedback such as desired format for training will inform future studies. Data collected in this study supports initial usability of COMPASS-CP CFC and will inform next steps toward implementation in clinical care. COMPASS-CP CFC has the potential to streamline the implementation of personalized cancer follow-up care planning to enable systematic access to resources that will support self-management. Future research is needed to test the impact of COMPASS-CP CFC on health outcomes.

Purpose/Objective(s)E3311 was a Phase II randomized trial that demonstrated excellent disease control (95% PFS) after primary transoral surgery (TOS) with de-escalated postoperative radiotherapy (RT) for intermediate risk HPV associated oropharyngeal cancer (OPC). De-escalation of postoperative RT to 50 Gy was largely motivated by the need to improve functional outcomes. Our objective was to explore over time and across arms: 1) aspiration rates per modified barium swallow (MBS) studies as reported by site clinicians, and 2) accuracy of site reporting against central review of MBS images.Materials/Methods495 patients underwent TOS. MBS was included as an optional procedure in 316 patients from 50 of 59 sites at baseline, post-TOS, 6- and 24-months. Aspiration by site clinicians’ MBS reading was logged in the trial database. MBS images were also centrally reviewed at MD Anderson Cancer Center using Penetration-Aspiration Scale criteria. Exploratory post hoc analyses compared aspiration rates baseline to post-TOS in all patients using McNemar's test, and between all arms at the post-TOS time point and between the two randomized arms at 6 and 24 months using Fisher's exact test. Kappa assessed agreement of site clinicians and central review.ResultsPooling all arms, aspiration was reported at baseline in 2.4% of MBS studies increasing to 13.3% after TOS (p < 0.01), then decreasing to 10.8% and 9.0% at 6-months and 24-months, respectively. Post-TOS aspiration rates did not significantly differ between all arms (p = 0.97). After RT, aspiration rates were significantly different at 6 months (p=0.04) but not at 24 months between randomized arms. In a subset of 62 MBS, site clinicians demonstrated substantial reliability grading aspiration on MBS in comparison to central review (92% exact agreement; k = 0.62, 95% CI: 0.32-0.92).ConclusionUsing a standardized MBS protocol, site clinicians reported aspiration with high accuracy relative to central image review. Aspiration rates were low overall, increasing significantly after TOS. De-escalated radiotherapy was associated with significantly lower aspiration rates at 6 months, not maintained at 24 months.

Objectives: Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores >= 10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 >= 10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. Study Design and Setting: Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. Results: A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 >= 10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 >= 10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 >= 14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 >= 14 (95% prediction interval: -13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: -16.4%, 15.0%). Conclusion: PHQ-9 >= 10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies. (C) 2020 Elsevier Inc. All rights reserved.

Background and Purpose Cancer survivors continue to cope with significant stressors after completing treatment. The Brief COPE (Carver, 1997) is frequently used to measure coping; however, its factor structure remains unclear. The purpose of this study was to determine the best factor conceptualization of the Brief COPE for use among breast cancer survivors. Methods Breast cancer survivors ( N = 1,127) completed the Brief COPE. We conducted confirmatory factor analyses comparing several a priori models based on research in cancer-relevant populations. Results Of the eight models examined, the 14-factor model of the Brief COPE showed the best fit. Conclusions Despite efforts to simplify the structure of the Brief COPE, our results suggest coping among breast cancer survivors is best assessed using Carver's (1997) original 14-factor conceptualization.

Abstract Background: TAILORx patient-reported outcomes (PRO) quantify symptoms and health-related quality of life (HRQL) from C+E beyond E alone from the patient's perspective, thus can inform decision-making for women in the intermediate risk group for whom chemotherapy may still be considered. Methods: TAILORx participants with OncoType DX Recurrence Scores 11-25 were randomly assigned to E or C+E. All TAILORx participants enrolled 1/2010-10/2010 (N=612) completed PROs measuring fatigue, endocrine symptoms, cognitive impairments (PCI), and fear of recurrence at baseline, 3, 6, 12, 24 and 36 months. HRQL was assessed at baseline, 12, and 36 months. Linear regression (LR) examined PRO scores among the per-protocol sample. Results: Overall, participants reported significantly more fatigue, endocrine symptoms and PCI at 3, 6, 12, 24 and 36 months compared to baseline and those randomized to C+E reported a greater magnitude of change baseline-3 months compared to those randomized to E alone (Table 1). Overall, by 12 months symptoms were comparable between groups. Pre-menopausal women had comparable symptoms at 24 and 36 months. Post-menopausal women randomized to C+E had greater endocrine symptoms at 24 and 36 months and greater fatigue at 6 and 24 months. Fear of recurrence was comparable between arms during treatment and follow-up. Multiple linear regression identified increased fatigue (LR slope β=0.67), endocrine symptoms (β =0.14), and PCI (β=0.11) as significant predictors of decreased HRQL across arms (p< 0.001). HRQL was comparable between E and C+E at 12- and 36-months. Mean PRO change scores from baseline by treatment arm and menopausal status in per protocol population Months 36122436N=Overall454469458384343n=Pre-menopausal153151150118103n=Post-menopausal301318308266240FACIT-Fatigue Overall sample C+E-8.77-4.37-4.01-4.27-3.67E-2.48-1.97-2.14-1.49-1.83LMED-5.32***-1.55-1.01-1.76-0.90Pre-M C+E-8.01-3.26-2.99-2.45-1.60E-3.87-1.66-1.32-2.52-2.11LMED-3.11-0.82-1.121.021.46Post-M C+E-9.22-4.97-4.55-5.14-4.67E-1.87-2.10-2.52-1.09-1.71LMED-6.42***-1.99*-1.16-3.02*-2.01FACT-Endocrine Symptoms Overall sample C+E-5.56-5.63-6.96-6.81-7.14E-3.61-4.24-5.62-5.31-5.17LMED-1.62*-0.97-1.08-1.05-1.69Pre-M C+E-7.62-8.34-7.94-8.29-8.96E-5.96-6.19-8.95-10.39-10.84LMED-1.44-1.631.062.272.18Post-M C+E-4.39-4.19-6.45-6.10-6.28E-2.55-3.41-4.10-3.23-2.87LMED-1.49-0.45-2.04-2.39*-3.17**Significance between mean change scores *p<0.05;**p<0.01;***p<0.001. LMED=estimated tx difference using linear model regressing score on baseline value and tx Conclusions: TAILORx is the first trial to examine patient-reported fatigue, endocrine symptoms, PCI and HRQL among breast cancer patients randomized to endocrine therapy alone vs chemoendocrine therapy, thus allowing us to quantify acute and long-term symptoms uniquely attributable to chemotherapy. As expected, chemotherapy is associated with greater fatigue, endocrine symptoms and PCI acutely during treatment, and for post-menopausal women with greater long-term endocrine symptoms. Increased symptoms were associated with poorer HRQL. Long-term HRQL was comparable between groups. Citation Format: Wagner LI, Gray RJ, Garcia S, Whelan TJ, Tevarweerk A, Yanez B, Carlos R, Gareen I, McCaskill-Stevens W, Cella D, Sparano JA, Sledge, Jr. GW, On behalf of the TAILORx Study Team. Symptoms and health-related quality of life on endocrine therapy alone (E) versus chemoendocrine therapy (C+E): TAILORx patient-reported outcomes results [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS6-03.

Abstract Background: Black race is associated with worse outcomes in localized hormone receptor (HR)-positive breast cancer in population-based and in clinical trial cohorts, whether using self-identified race (Albain et al. JNCI 2009 [PMID: 19584328; Sparano et al. JNCI 2012 [PMID: 22250182) or genetically-identified race (Schneider et al. J Precision Oncol 2017 [PMID: 29333527]). This disparity persists after adjustment for treatment delivery parameters (Hershman et al. JCO 2009 [PMID:19307504]). We evaluated clinicopathologic characteristics, treatment delivered and clinical outcomes in the Trial Assigning Individualized Options for Treatment (TAILORx) by race and ethnicity (Sparano et al. NEJM 2018 [PMID: 29860917]). Methods: The analysis included 9719 evaluable TAILORx participants. The association between clinical outcomes and race (white, black, Asian, other/unknown) and ethnicity (Hispanic vs. non-Hispanic) was examined, including invasive disease-free survival (iDFS), distant relapse-free interval (DRFI), relapse-free interval (RFI), and overall survival (OS). Proportional hazards models were fit including age (5 categories), tumor size (>2 cm vs. <=2 cm), histologic grade (high vs. medium vs. low vs. unknown), continuous recurrence score (RS), race, and ethnicity in the overall population and randomized treatment arms in the RS 11-25 cohort. Results: The study population included 8189 (84%) whites, 693 (7%) blacks, 405 (4%) Asians, and 432 (4%) with other/unknown race. Regarding ethnicity, 7635 (79%) were non-Hispanic, 889 (9%) Hispanic, and 1195 (12%) unknown. There was no significant difference in RS distribution (p=0.22) in blacks compared with whites, or in median (17 vs. 17) or mean RS (19.1 vs. 18.2). There was likewise no difference in Hispanic vs. non-Hispanic ethnicity for RS distribution (p=0.72) or median (17 vs. 17) or mean RS (18.5 vs. 18.0). Black race (39% vs. 30%) and Hispanic ethnicity (39% vs. 30%) were both associated with younger age (=50 years) at diagnosis. The use and type of adjuvant chemotherapy and endocrine therapy, and duration of endocrine therapy, were similar in black (vs. white) and Hispanic (vs. non-Hispanic) populations. In proportional hazards models, black race (compared with white race) was associated with worse clinical outcomes in the entire population and in those with a RS 11-25 (see table). Hispanic ethnicity was generally associated with better outcomes (compared with non-Hispanic ethnicity). For the cohort with a RS of 11-25, there was no evidence for chemotherapy benefit for any racial or ethnic group. Race (black vs.white) and clinical outcomes in proportional hazards modelsClinical endpointEntire Population (N=693 black) Hazard ratio for eventRS 11-25 (N=471 black) Hazard ratio for eveniDFS1.33 (p=0.005)1.49 (p=0.001)DRFI1.21 (p=0.28)1.60 (p=0.02)RFI1.39 (p=0.02)1.80 (p<0.001)OS1.52 (p=0.005)1.67 (p=0.003 Conclusions: In patients eligible and selected for participation in TAILORx, black women had worse clinical outcomes despite similar 21-gene assay RS results and comparable systemic therapy. This adds to an emerging body of evidence suggesting a biologic basis or other factors contributing to racial disparities in HR-positive breast cancer that requires further evaluation. Citation Format: Albain K, Gray RJ, Sparano JA, Makower DF, Pritchard KI, Hayes DF, Geyer, Jr. CE, Dees EC, Goetz MP, Olson, Jr. JA, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge, Jr. GW. Race, ethnicity and clinical outcomes in hormone receptor-positive, HER2-negative, node-negative breast cancer: results from the TAILORx trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS4-07.

BACKGROUND The recurrence score based on the 21-gene breast cancer assay predicts chemotherapy benefit if it is high and a low risk of recurrence in the absence of chemotherapy if it is low; however, there is uncertainty about the benefit of chemotherapy for most patients, who have a midrange score. METHODS We performed a prospective trial involving 10,273 women with hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, axillary node-negative breast cancer. Of the 9719 eligible patients with follow-up information, 6711 (69%) had a midrange recurrence score of 11 to 25 and were randomly assigned to receive either chemoendocrine therapy or endocrine therapy alone. The trial was designed to show noninferiority of endocrine therapy alone for invasive disease-free survival (defined as freedom from invasive disease recurrence, second primary cancer, or death). RESULTS Endocrine therapy was noninferior to chemoendocrine therapy in the analysis of invasive disease-free survival (hazard ratio for invasive disease recurrence, second primary cancer, or death [endocrine vs. chemoendocrine therapy], 1.08; 95% confidence interval, 0.94 to 1.24; P = 0.26). At 9 years, the two treatment groups had similar rates of invasive disease-free survival (83.3% in the endocrine-therapy group and 84.3% in the chemoendocrine-therapy group), freedom from disease recurrence at a distant site (94.5% and 95.0%) or at a distant or local-regional site (92.2% and 92.9%), and overall survival (93.9% and 93.8%). The chemotherapy benefit for invasive disease-free survival varied with the combination of recurrence score and age (P = 0.004), with some benefit of chemotherapy found in women 50 years of age or younger with a recurrence score of 16 to 25. CONCLUSIONS Adjuvant endocrine therapy and chemoendocrine therapy had similar efficacy in women with hormone-receptor-positive, HER2-negative, axillary node-negative breast cancer who had a midrange 21-gene recurrence score, although some benefit of chemotherapy was found in some women 50 years of age or younger.

Fear of recurrence has been well documented among cancer survivors, yet there have been few publications on strategies for coping with this fear. This report describes 3 coping strategies tailored to the management of fear of recurrence and the delivery of these coping strategies through FoRtitude, a targeted e‐health intervention designed to teach breast cancer survivors coping strategies targeted at fear of recurrence with a Web‐ and text messaging–based approach.

188 Background: Although breast cancer is more commonly diagnosed in post-menopausal women, there are a significant number of survivors diagnosed at age 45 or younger. Compared to older survivors, younger survivors have significantly more problems with depression sexual functioning, marital satisfaction, and overall well-being, but there is little research on the partners of these younger survivors. The purpose of this study is to determine if the partners of young survivors experience more problems with depression, sexual functioning, marital satisfaction, and overall well-being than partners of age-matched controls. Methods: Survivors and partners (n=227) were enrolled in a large cross-sectional study, executed through the ECOG-ACRIN Cancer Research Group. Eligibility for survivors included being 45 or under at diagnosis, 3 to 8 years from treatment without a breast cancer recurrence, and with similar chemotherapy treatment regimens. Survivors identified age-matched acquaintance controls without breast cancer. These age matched controls and their partners (n=170) were also included. All groups completed a survey assessing demographic characteristics, depression, sexual functioning (enjoyment and difficulty), marital satisfaction, and overall well-being. The partners of both young survivors and acquaintance controls were compared on all study variables adjusting for demographic variables. Results: Partners of young survivors reported significantly more depression (effect size [ES] = -0.23, p=.0199), worse sexual functioning as indicated by lower enjoyment (ES= 0.32, p=.0019) and more sexual difficulty (ES= -0.24, p=.0164), lower marital satisfaction (ES=0.24, p=.0189), and lower overall well-being (ES= 0.40, p=.0001). Conclusions: Partners of breast cancer survivors suffer from problems similar to breast cancer survivors. Further research is needed to fully understand the impact of a breast cancer diagnosis on both the partner as well as the survivor, especially when problems exist that are related to the dyadic relationship.

Each year, 70,000 adolescents and young adults (AYAs) between ages 15 and 39 years in the United States are diagnosed with cancer. In 2006, a National Cancer Institute (NCI) Progress Review Group (PRG) examined the state of science associated with cancer among AYAs. To assess the impact of the PRG and examine the current state of AYA oncology research, the NCI, with support from the LIVESTRONG Foundation, sponsored a workshop entitled “Next Steps in Adolescent and Young Adult Oncology” on September 16 and 17, 2013, in Bethesda, Maryland. This report summarizes the findings from the workshop, opportunities to leverage existing data, and suggestions for future research priorities. Multidisciplinary teams that include basic scientists, epidemiologists, trialists, biostatisticians, clinicians, behavioral scientists, and health services researchers will be essential for future advances for AYAs with cancer. Cancer 2016;122:988–999. © 2016 American Cancer Society