Depression, anxiety, & loneliness among cancer survivors during the COVID-19 pandemic.

PURPOSE: To assess the impact of the COVID-19 pandemic on depression, anxiety, and loneliness between those with and without a history of cancer. DESIGN: This prospective observational study used a quantitative approach. PARTICIPANTS: Adult members of the Kaiser Permanente Research Bank (N = 104,640). METHODS: Participants completed a series of surveys from May to December 2020. The difference in score of depression, anxiety, and loneliness were estimated using linear mixed regression. FINDINGS: Among cancer survivors, 21% and 19% met the thresholds for increased risk of depression and anxiety. Among cancer survivors, younger age groups and females reported increased depression, anxiety, and loneliness scores. CONCLUSIONS: This study highlights the continued necessity of addressing mental health needs and social support in cancer survivors during and after a public health emergency. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: Cancer survivors may need particular resources after cancer treatment to strengthen resilience and improve quality of life.

Social risk factors among individuals with a history of cancer during the COVID-19 pandemic.

PURPOSE: The coronavirus disease (COVID-19) pandemic and its economic consequences may disproportionately impact cancer survivors and their overall health-related quality of life. The objective of this study was to examine whether cancer survivors experienced higher levels of financial strain or food insecurity compared to those without a history of cancer. METHODS: Kaiser Permanente Research Bank (KPRB) study participants were invited to complete a series of electronic surveys starting April 2020 to assess the impact of the COVID-19 pandemic. Participants who completed the initial survey and one follow-up survey were included. The odds of financial strain and food insecurity in those with and without a history of cancer were estimated using multinomial logistic regression. RESULTS: Cancer survivors (n = 16,231) had lower odds of reporting "somewhat hard" (AOR = 0.77) and "very hard" (AOR = 0.67) financial strain, and food insecurity "sometimes" (AOR = 0.70) and "often" (AOR = 0.55) compared to those with no history of cancer (n = 88,409). Non-Hispanic (NH) Black and Hispanic cancer survivors had higher odds compared to NH Whites of reporting financial strain and food insecurity. Smokers and those with multiple comorbidities had higher odds of reporting financial strain and food insecurity among cancer survivors. CONCLUSIONS: While cancer survivors overall did not report greater financial strain or food insecurity than individuals without a history of cancer, subsets of cancer survivors are experiencing greater social risks during the pandemic and should be prioritized for screening for social risk factors. IMPLICATIONS FOR CANCER SURVIVORS: Incorporating screening for social risk factors into care coordination workflows for subsets of cancer survivors should be a priority.

Immediate Unrestricted Weightbearing With Simple Stirrup Brace Following Single Anchor Lateral Ankle Ligament Stabilization.

OBJECTIVE: To report on a series of patients treated with immediate unrestricted weightbearing with limited protection following single anchor lateral ligament stabilization. METHODS: Patients with chronic lateral ankle ligament instability who underwent modified Broström-Gould lateral ligament reconstruction with a single double-loaded anchor were identified. Immediate unrestricted full weightbearing in a stirrup brace was allowed the first postoperative day and accelerated physical therapy was initiated from 2 weeks. Subsequent assessment was performed at a minimum of 1-year follow-up. RESULTS: Thirteen patients with a mean age at final follow-up of 49 years (range 21-70 years). Average follow-up was 21 months (16 to 26). American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and visual analogue scale (VAS) score improved significantly (P < .05) from preoperative to postoperative, respectively (57 to 91, 5.7 to 1.5). Average postoperative Foot and Ankle Outcome Score (FAOS) was 82 (range 52-100). Short Form-12 (SF-12) scores averaged 55 and 49 on mental component and physical components, respectively, consistent with US age-matched averages. No measurable differences in range of motion, ligamentous stability, or Star Excursion Balance Test in the anterior, posterolateral, or posteromedial planes compared to the contralateral side (P > .05) were observed. No recurrence was reported. CONCLUSION: Immediate unrestricted weightbearing in a stirrup brace following single anchor lateral ligament reconstruction is a successful protocol for the treatment of chronic lateral ankle instability. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case series.

Feasibility of a Traceback Approach for Using Pathology Specimens to Facilitate Genetic Testing in the Genetic Risk Analysis in Ovarian Cancer (GRACE) Study Protocol.

Guidelines currently state that genetic testing is clinically indicated for all individuals diagnosed with ovarian cancer. Individuals with a prior diagnosis of ovarian cancer who have not received genetic testing represent missed opportunities to identify individuals with inherited high-risk cancer variants. For deceased individuals, post-mortem genetic testing of pathology specimens allows surviving family members to receive important genetic risk information. The Genetic Risk Assessment in Ovarian Cancer (GRACE) study aims to address this significant healthcare gap using a "traceback testing" approach to identify individuals with a prior diagnosis of ovarian cancer and offer genetic risk information to them and their family members. This study will assess the potential ethical and privacy concerns related to an ovarian cancer traceback testing approach in the context of patients who are deceased, followed by implementation and evaluation of the feasibility of an ovarian cancer traceback testing approach using tumor registries and archived pathology tissue. Descriptive and statistical analyses will assess health system and patient characteristics associated with the availability of pathology tissue and compare the ability to contact and uptake of genetic testing between patients who are living and deceased. The results of this study will inform the implementation of future traceback programs.