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  1. Article ; Online: Treatment patterns and burden of myelosuppression for patients with small cell lung cancer: A SEER-medicare study.

    Epstein, Robert S / Nelms, Jerrod / Moran, Donald / Girman, Cynthia / Huang, Huan / Chioda, Marc

    Cancer treatment and research communications

    2022  Volume 31, Page(s) 100555

    Abstract: Purpose: To depict the treatment journey for patients with small cell lung cancer (SCLC) and evaluate health care resource utilization (HCRU) associated with myelosuppression, a complication induced by chemotherapy or chemotherapy plus radiation therapy. ...

    Abstract Purpose: To depict the treatment journey for patients with small cell lung cancer (SCLC) and evaluate health care resource utilization (HCRU) associated with myelosuppression, a complication induced by chemotherapy or chemotherapy plus radiation therapy.
    Patients and methods: This was a descriptive, retrospective study of patients with SCLC aged ≥65 years, identified from linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data curated between January 2012 and December 2015. Treatment types (chemotherapy, radiation therapy, surgery) were classified as first, second, or third line, depending on the temporal sequence in which regimens were prescribed. For each year, the proportions of patients completing 4- or 6-cycle chemotherapy regimens, with hospital admissions associated with myelosuppression, or who used granulocyte colony-stimulating factors (G-CSFs), blood/platelet transfusions, or erythropoiesis-stimulating agents (ESAs), were calculated.
    Results: Chemotherapy was administered as initial treatment in 7,807/11,907 (65.6%) patients whose treatment journey was recorded. Approximately one-third (n = 3,985) subsequently received radiation therapy. In total, 5,791 (57.8%) patients completed the guideline-recommended 4-6 cycles of chemotherapy. Among all chemotherapy-treated patients, 10,370 (74.3%) experienced ≥1 inpatient admission associated with myelosuppression (anemia, 7,366 [52.8%]; neutropenia, 4,642 [33.3%]; thrombocytopenia, 2,375 [17.0%]; pancytopenia, 1,983 [14.2%]). Supportive care interventions included G-CSF (6,756 [48.4%] patients), ESAs (1,534 [11.0%]), and transfusions (3,674 [26.3%]).
    Conclusion: Chemotherapy remains a cornerstone of care for patients with SCLC. Slightly over half of patients completed the recommended number of cycles, underscoring the frailty of patients and aggressiveness of SCLC. HCRU associated with myelosuppression was prominent, suggesting a substantial burden on older patients with SCLC.
    MeSH term(s) Aged ; Granulocyte Colony-Stimulating Factor/adverse effects ; Humans ; Lung Neoplasms/drug therapy ; Medicare ; Neutropenia/chemically induced ; Neutropenia/drug therapy ; Retrospective Studies ; Small Cell Lung Carcinoma/drug therapy ; United States/epidemiology
    Chemical Substances Granulocyte Colony-Stimulating Factor (143011-72-7)
    Language English
    Publishing date 2022-04-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2468-2942
    ISSN (online) 2468-2942
    DOI 10.1016/j.ctarc.2022.100555
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  2. Article ; Online: The Effectiveness of Emotional Freedom Techniques in the Treatment of Posttraumatic Stress Disorder: A Meta-Analysis.

    Sebastian, Brenda / Nelms, Jerrod

    Explore (New York, N.Y.)

    2017  Volume 13, Issue 1, Page(s) 16–25

    Abstract: Background: Over the past two decades, growing numbers of clinicians have been utilizing emotional freedom techniques (EFT) in the treatment of posttraumatic stress disorder (PTSD), anxiety, and depression. Randomized controlled trials (RCTs) have shown ...

    Abstract Background: Over the past two decades, growing numbers of clinicians have been utilizing emotional freedom techniques (EFT) in the treatment of posttraumatic stress disorder (PTSD), anxiety, and depression. Randomized controlled trials (RCTs) have shown encouraging outcomes for all three conditions.
    Objective: To assess the efficacy of EFT in treating PTSD by conducting a meta-analysis of existing RCTs.
    Methods: A systematic review of databases was undertaken to identify RCTs investigating EFT in the treatment of PTSD. The RCTs were evaluated for quality using evidence-based standards published by the American Psychological Association Division 12 Task Force on Empirically Validated Therapies. Those meeting the criteria were assessed using a meta-analysis that synthesized the data to determine effect sizes. While uncontrolled outcome studies were excluded, they were examined for clinical implications of treatment that can extend knowledge of this condition.
    Results: Seven randomized controlled trials were found to meet the criteria and were included in the meta-analysis. A large treatment effect was found, with a weighted Cohen׳s d = 2.96 (95% CI: 1.96-3.97, P < .001) for the studies that compared EFT to usual care or a waitlist. No treatment effect differences were found in studies comparing EFT to other evidence-based therapies such as eye movement desensitization and reprocessing (EMDR; 1 study) and cognitive behavior therapy (CBT; 1 study).
    Conclusions: The analysis of existing studies showed that a series of 4-10 EFT sessions is an efficacious treatment for PTSD with a variety of populations. The studies examined reported no adverse effects from EFT interventions and showed that it can be used both on a self-help basis and as a primary evidence-based treatment for PTSD.
    MeSH term(s) Cognitive Therapy/methods ; Emotions ; Freedom ; Humans ; Mind-Body Therapies/methods ; Psychotherapy/methods ; Stress Disorders, Post-Traumatic/complications ; Stress Disorders, Post-Traumatic/therapy
    Language English
    Publishing date 2017-01
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Review
    ZDB-ID 2183945-1
    ISSN 1878-7541 ; 1550-8307
    ISSN (online) 1878-7541
    ISSN 1550-8307
    DOI 10.1016/j.explore.2016.10.001
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  3. Article ; Online: A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Trials of Clinical Emotional Freedom Techniques (EFT) for the Treatment of Depression.

    Nelms, Jerrod A / Castel, Liana

    Explore (New York, N.Y.)

    2016  Volume 12, Issue 6, Page(s) 416–426

    Abstract: Background: Among a group of therapies collectively known as energy psychology (EP), emotional freedom techniques (EFT) is the most widely practiced. Clinical EFT is an evidence-based practice combining elements of cognitive and exposure therapies with ... ...

    Abstract Background: Among a group of therapies collectively known as energy psychology (EP), emotional freedom techniques (EFT) is the most widely practiced. Clinical EFT is an evidence-based practice combining elements of cognitive and exposure therapies with the manual stimulation of acupuncture points (acupoints). Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of outcomes after clinical EFT treatment in reducing depression.
    Methods: All studies (2005-2015) evaluating EFT for sufferers of depression were identified by electronic search; these included both outcome studies and randomized controlled trials (RCTs). Our focus was depressive symptoms as measured by a variety of psychometric questionnaires and scales. We used meta-analysis to calculate effect sizes at three time points including posttest, follow-ups less than 90 days, and follow-ups more than 90 days.
    Results: In total, 20 studies were qualified for inclusion, 12 RCTs and 8 outcome studies. The number of participants treated with EFT included N = 461 in outcome studies and N = 398 in RCTs. Clinical EFT showed a large effect size in the treatment of depression in RCTs. At posttest, Cohen׳s d for RCTs was 1.85 and for outcome studies was 0.70. Effect sizes for follow-ups less than 90 days were 1.21, and for ≥ 90 days were 1.11. EFT were more efficacious than diaphragmatic breathing (DB) and supportive interview (SI) in posttest measurements (P = .06 versus DB, P < .001 versus SI), and sleep hygiene education (SHE) at follow-up (P = .036). No significant treatment effect difference between EFT and eye movement desensitization and reprocessing (EMDR) was found. EFT were superior to treatment as usual (TAU), and efficacious in treatment time frames ranging from 1 to 10 sessions. The mean of symptom reductions across all studies was -41%.
    Conclusions: The results show that Clinical EFT were highly effective in reducing depressive symptoms in a variety of populations and settings. EFT were equal or superior to TAU and other active treatment controls. The posttest effect size for EFT (d = 1.31) was larger than that measured in meta-analyses of antidepressant drug trials and psychotherapy studies. EFT produced large treatment effects whether delivered in group or individual format, and participants maintained their gains over time. This meta-analysis extends the existing literature through facilitation of a better understanding of the variability and clinical significance of depression improvement subsequent to EFT treatment.
    MeSH term(s) Acupressure/methods ; Cognitive Therapy/methods ; Depression/therapy ; Depressive Disorder/therapy ; Emotions ; Humans ; Implosive Therapy/methods ; Randomized Controlled Trials as Topic ; Treatment Outcome
    Language English
    Publishing date 2016-11
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2183945-1
    ISSN 1878-7541 ; 1550-8307
    ISSN (online) 1878-7541
    ISSN 1550-8307
    DOI 10.1016/j.explore.2016.08.001
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  4. Article ; Online: The Risk of Subclinical Breast Cancer-Related Lymphedema by the Extent of Axillary Surgery and Regional Node Irradiation: A Randomized Controlled Trial.

    Boyages, John / Vicini, Frank A / Shah, Chirag / Koelmeyer, Louise A / Nelms, Jerrod A / Ridner, Sheila H

    International journal of radiation oncology, biology, physics

    2020  Volume 109, Issue 4, Page(s) 987–997

    Abstract: Purpose: To compare the risk of subclinical breast cancer-related lymphedema (sBCRL) using bioimpedance spectroscopy (BIS) or tape measure (TM) by the extent of axillary surgery and regional nodal irradiation (RNI).: Methods and materials: Patients ... ...

    Abstract Purpose: To compare the risk of subclinical breast cancer-related lymphedema (sBCRL) using bioimpedance spectroscopy (BIS) or tape measure (TM) by the extent of axillary surgery and regional nodal irradiation (RNI).
    Methods and materials: Patients were randomized to surveillance with TM or BIS. A BIS ≥6.5 L-Dex units or TM volume change ≥5 and <10% above presurgical baselines "triggered" sBCRL. The incidence of sBCRL by sentinel node biopsy or axillary lymph node dissection (ALND) with or without RNI was examined for 484 patients. Radiation was categorized as "limited RNI" (axilla level I/II only) or "extensive RNI" (axilla level III or supraclavicular fossa with or without level I/II).
    Results: At a median follow-up of 20.5 months, 109 of 498 patients (21.9%) triggered sBCRL (BIS 13.5% vs TM 25.6%; P <.001). In patients not receiving RNI, BIS triggered 12.9% of patients undergoing SNB and 25.0% undergoing ALND (P = .18). Extensive RNI significantly increased triggering with BIS versus no RNI after sentinel node biopsy (SNB; 33.3% vs 12.9%; P = .03) but not ALND (30.8% vs 25.0%; P = .69). Triggering by TM was greater than 25% for most subgroups and was inferior to BIS in discriminating the risk of sBCRL by utilization of RNI or axillary surgery.
    Conclusions: The lower triggering rates with BIS and its better discrimination of the risk of sBCRL by receipt and type of RNI compared with TM support its use for posttreatment surveillance to detect sBCRL and to initiate early intervention. The risk of sBCRL increased with more extensive axillary treatment. Patients having ALND or extensive RNI require close surveillance for BCRL. Longer follow-up is required to determine rates of progression to clinical lymphedema.
    MeSH term(s) Aged ; Axilla/surgery ; Breast Neoplasms/therapy ; Combined Modality Therapy ; Female ; Humans ; Lymph Node Excision/adverse effects ; Lymph Nodes/radiation effects ; Lymphedema/etiology ; Middle Aged
    Language English
    Publishing date 2020-10-27
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2020.10.024
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    Zs.A 1218: Show issues Location:
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  5. Article ; Online: The impact of monitoring techniques on progression to chronic breast cancer-related lymphedema: a meta-analysis comparing bioimpedance spectroscopy versus circumferential measurements.

    Shah, Chirag / Zambelli-Weiner, April / Delgado, Nicole / Sier, Ashley / Bauserman, Robert / Nelms, Jerrod

    Breast cancer research and treatment

    2020  Volume 185, Issue 3, Page(s) 709–740

    Abstract: Background: Chronic breast cancer-related lymphedema (BCRL) is a potentially serious complication following treatment. Monitoring for progression to BCRL may allow for earlier detection and intervention, reducing the rate of progression to chronic BCRL. ...

    Abstract Background: Chronic breast cancer-related lymphedema (BCRL) is a potentially serious complication following treatment. Monitoring for progression to BCRL may allow for earlier detection and intervention, reducing the rate of progression to chronic BCRL. Therefore, the purpose of this meta-analysis is to evaluate the impact of monitoring techniques on the incidence of chronic BCRL among patients monitored by bioimpedance spectroscopy (BIS) and circumference as compared to background rates.
    Methods: Eligible peer-reviewed studies from PubMed, CINHAL, or Google Scholar that were published in English from 2013 onward and conducted in North America, Europe, or Oceania. Incidence rates abstracted from studies were classified by BCRL monitoring method: background (no standardized BIS or circumference assessments), BIS or circumference. A random-effects model was used to calculate a pooled annualized estimate of BCRL incidence while accounting for clinical and methodological heterogeneity. Subgroup analyses examined differences in duration of follow-up as well as breast and axillary surgery.
    Results: 50 studies were included, representing over 67,000 women. The annualized incidence of BCRL was 4.9% (95% CI: 4.3-5.5) for background studies (n = 35), 1.5% (95% CI: 0.6-2.4) for BIS-monitored studies (n = 7), and 7.7% (95% CI: 5.6-9.8) for circumference-monitored studies (n = 11). The cumulative BCRL incidence rate in BIS-monitored patients was 3.1% as compared to 12.9% with background monitoring (69% reduction) and 17.0% with circumference-monitored patients (81% reduction).
    Conclusions: Evidence suggests that monitoring with BIS allowing for early intervention significantly reduces the relative risk of chronic BCRL with a 69% and 81% reduction compared to background and circumference, respectively. Circumference monitoring did not appear to provide a benefit with respect to chronic BCRL incidence. Based on these results, BIS should be considered for BCRL screening in order to detect subclinical BCRL and reduce rates of chronic BCRL, particularly in high-risk patients.
    MeSH term(s) Axilla ; Breast Cancer Lymphedema/diagnosis ; Breast Cancer Lymphedema/epidemiology ; Breast Cancer Lymphedema/etiology ; Breast Neoplasms/complications ; Breast Neoplasms/epidemiology ; Europe ; Female ; Humans ; Lymphedema/diagnosis ; Lymphedema/epidemiology ; Lymphedema/etiology ; Spectrum Analysis
    Language English
    Publishing date 2020-11-27
    Publishing country Netherlands
    Document type Journal Article ; Meta-Analysis
    ZDB-ID 604563-7
    ISSN 1573-7217 ; 0167-6806
    ISSN (online) 1573-7217
    ISSN 0167-6806
    DOI 10.1007/s10549-020-05988-6
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    Zs.A 1655: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  6. Article ; Online: Epigenetic Effects of PTSD Remediation in Veterans Using Clinical Emotional Freedom Techniques: A Randomized Controlled Pilot Study.

    Church, Dawson / Yount, Garret / Rachlin, Kenneth / Fox, Louis / Nelms, Jerrod

    American journal of health promotion : AJHP

    2016  Volume 32, Issue 1, Page(s) 112–122

    Abstract: Purpose: To assess the feasibility of measuring changes in gene expression associated with post-traumatic stress disorder (PTSD) treatment using emotional freedom techniques (EFT).: Design: Participants were randomized into an EFT group receiving EFT ...

    Abstract Purpose: To assess the feasibility of measuring changes in gene expression associated with post-traumatic stress disorder (PTSD) treatment using emotional freedom techniques (EFT).
    Design: Participants were randomized into an EFT group receiving EFT and treatment as usual (TAU) throughout a 10-week intervention period and a group receiving only TAU during the intervention period and then receiving EFT.
    Setting: A community clinic and a research institute in California.
    Participants: Sixteen veterans with clinical levels of PTSD symptoms.
    Intervention: Ten hour-long sessions of EFT.
    Measures: Messenger RNA levels for a focused panel of 93 genes related to PTSD. The Symptom Assessment 45 questionnaire, Hospital Anxiety and Depression Scale, Insomnia Severity Scale, SF-12v2 for physical impairments, and Rivermead Postconcussion Symptoms Questionnaire.
    Analysis: Pre-, posttreatment, and follow-up mean scores on questionnaires were assessed using repeated measures 1-way analysis of variance. A Student t test and post hoc analyses were performed on gene expression data.
    Results: Post-traumatic stress disorder symptoms declined significantly in the EFT group (-53%, P < .0001). Participants maintained their gains on follow-up. Significant differential expression of 6 genes was found ( P < .05) when comparing the expression levels before and after the intervention period in participants receiving EFT.
    Conclusion: Study results identify candidate gene expression correlates of successful PTSD treatment, providing guidelines for the design of further studies aimed at exploring the epigenetic effects of EFT.
    MeSH term(s) Adult ; Aged ; California ; Cognitive Behavioral Therapy/methods ; Epigenesis, Genetic ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Stress Disorders, Post-Traumatic/genetics ; Stress Disorders, Post-Traumatic/rehabilitation ; Veterans/psychology
    Language English
    Publishing date 2016-08-12
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 645160-3
    ISSN 2168-6602 ; 0890-1171
    ISSN (online) 2168-6602
    ISSN 0890-1171
    DOI 10.1177/0890117116661154
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    Zs.A 2531: Show issues Location:
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  7. Article ; Online: Implementing a prospective surveillance and early intervention model of care for breast cancer-related lymphedema into clinical practice: application of the RE-AIM framework.

    Koelmeyer, Louise / Gaitatzis, Katrina / Ridner, Sheila H / Boyages, John / Nelms, Jerrod / Hughes, T Michael / Elder, Elisabeth / French, James / Ngui, Nicholas / Hsu, Jeremy / Stolldorf, Deonni

    Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

    2020  Volume 29, Issue 2, Page(s) 1081–1089

    Abstract: Purpose: Chronic lymphedema following breast cancer (BC) affects individuals physically, functionally, psychologically, and financially. Despite national guidelines and evidence-based research supporting a prospective surveillance and early intervention ...

    Abstract Purpose: Chronic lymphedema following breast cancer (BC) affects individuals physically, functionally, psychologically, and financially. Despite national guidelines and evidence-based research supporting a prospective surveillance and early intervention model of care (PSM), bridging the gap between research and clinical practice has been difficult.
    Method: As part of an international randomized controlled trial (RCT), Australian women with BC from four hospitals were recruited, monitored for lymphedema at regular intervals over a 3-year period, and were provided a compression garment if intervention was triggered. The reach, effectiveness, adoption, implementation and maintenance (RE-AIM) evaluation framework was used retrospectively to assess a PSM at the individual and organizational level for those who had completed at least 2-year follow-up (N = 219) in the RCT.
    Results: The application of the RE-AIM framework retrospectively demonstrated an extensive reach to patients across public and private settings; the effectiveness of prospective surveillance and early intervention was achieved through low progression rates to clinical lymphedema (1.8%), and all hospital sites initially approached adopted the research study. Key implementation strategies necessary for effectiveness of this model of care included education to health professionals and patients, staff acceptability, and development of a referral and care pathway. Maintenance dimensions were evaluated both at the individual level with 92-100% adherence rates for all nonoptional study appointments over the 2-year period, and at the organizational-level, PSM was sustained after recruitment ceased for the research study.
    Conclusion: The PSM for lymphedema in BC can be successfully implemented using the RE-AIM framework applied retrospectively. The implementation of the PSM used in the RCT has assisted in changing clinical practices and improving the quality and effectiveness of the health care system.
    MeSH term(s) Adult ; Australia ; Breast Cancer Lymphedema/diagnosis ; Breast Cancer Lymphedema/therapy ; Breast Neoplasms/pathology ; Female ; Health Personnel ; Humans ; Middle Aged ; National Health Programs ; Prospective Studies ; Randomized Controlled Trials as Topic ; Referral and Consultation ; Retrospective Studies ; Watchful Waiting
    Language English
    Publishing date 2020-06-29
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1134446-5
    ISSN 1433-7339 ; 0941-4355
    ISSN (online) 1433-7339
    ISSN 0941-4355
    DOI 10.1007/s00520-020-05597-5
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