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IMPORTANCE: Older patients with cancer and their caregivers worry about the effects of cancer treatment on aging-related domains (eg, function and cognition). Quality conversations with oncologists about aging-related concerns could improve patient-centered outcomes. A geriatric assessment (GA) can capture evidence-based aging-related conditions associated with poor clinical outcomes (eg, toxic effects) for older patients with cancer. OBJECTIVE: To determine whether providing a GA summary and GA-guided recommendations to oncologists can improve communication about aging-related concerns. DESIGN, SETTING, AND PARTICIPANTS: This cluster-randomized clinical trial enrolled 541 participants from 31 community oncology practices within the University of Rochester National Cancer Institute Community Oncology Research Program from October 29, 2014, to April 28, 2017. Patients were aged 70 years or older with an advanced solid malignant tumor or lymphoma who had at least 1 impaired GA domain; patients chose 1 caregiver to participate. The primary outcome was assessed on an intent-to-treat basis. INTERVENTIONS: Oncology practices were randomized to receive either a tailored GA summary with recommendations for each enrolled patient (intervention) or alerts only for patients meeting criteria for depression or cognitive impairment (usual care). MAIN OUTCOMES AND MEASURES: The predetermined primary outcome was patient satisfaction with communication about aging-related concerns (modified Health Care Climate Questionnaire [score range, 0-28; higher scores indicate greater satisfaction]), measured after the first oncology visit after the GA. Secondary outcomes included the number of aging-related concerns discussed during the visit (from content analysis of audiorecordings), quality of life (measured with the Functional Assessment of Cancer Therapy scale for patients and the 12-Item Short Form Health Survey for caregivers), and caregiver satisfaction with communication about aging-related patient concerns. RESULTS: A total of 541 eligible patients (264 women, 276 men, and 1 patient did not provide data; mean [SD] age, 76.6 [5.2] years) and 414 caregivers (310 women, 101 men, and 3 caregivers did not provide data; mean age, 66.5 [12.5] years) were enrolled. Patients in the intervention group were more satisfied after the visit with communication about aging-related concerns (difference in mean score, 1.09 points; 95% CI, 0.05-2.13 points; P = .04); satisfaction with communication about aging-related concerns remained higher in the intervention group over 6 months (difference in mean score, 1.10; 95% CI, 0.04-2.16; P = .04). There were more aging-related conversations in the intervention group’s visits (difference, 3.59; 95% CI, 2.22-4.95; P < .001). Caregivers in the intervention group were more satisfied with communication after the visit (difference, 1.05; 95% CI, 0.12-1.98; P = .03). Quality of life outcomes did not differ between groups. CONCLUSIONS AND RELEVANCE: Including GA in oncology clinical visits for older adults with advanced cancer improves patient-centered and caregiver-centered communication about aging-related concerns. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02107443

Cancer patients often report impaired sleep quality. Impaired sleep quality may be due to increased levels of sleep-mediating cytokines resulting from cancer treatment. Exercise may have a positive influence on sleep-mediating cytokines, such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a), and soluble tumor necrosis factor-alpha receptor (sTNF-R), which may improve sleep quality. This two-arm pilot study compared the influence of a home-based exercise intervention with standard care/control on sleep quality and mediators of sleep. Breast and prostate cancer patients (n = 38) beginning radiation therapy were randomized to a 4-week exercise program or no exercise arm. Global sleep quality, subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction were assessed with the Pittsburgh Sleep Quality Index. IL-6, TNF-a, and sTNF-R were measured before and after intervention. There was a greater improvement in sleep quality in the exercise group from pre- to postintervention, although the difference was not significant. Additionally, there were associations between IL-6 and sleep efficiency and duration, suggesting that regulation of sleep-mediating cytokines by exercise may mediate improvements in sleep-quality components.

DECRA (direct exponential curve resolution algorithm) is a fast multivariate method used to resolve spectral data with concentration profiles that are linear combinations of exponential functions. DECRA has been previously applied to a wide variety of spectroscopies. Results are presented in this paper for two new application areas: solid state nuclear magnetic resonance spectra of polymorphic crystal mixtures and mid‐infrared spectroscopy of chemical reactions. Furthermore, the paper will show the effect of the way the data set is split, which is a part of the algorithm, on the results. Copyright © 2000 John Wiley & Sons, Ltd.

DECRA (direct exponential curve resolution algorithm) is a fast multivariate method used to resolve spectral data with concentration profiles that are linear combinations of exponential functions. DECRA has been previously applied to a wide variety of spectroscopies. Results are presented in this paper for two new application areas: solid state nuclear magnetic resonance spectra of polymorphic crystal mixtures and mid-infrared spectroscopy of chemical reactions. Furthermore, the paper will show the effect of the way the data set is split, which is a part of the algorithm, on the results. Copyright © 2000 John Wiley & Sons, Ltd.

SYNOPTIC ABSTRACTEstimation of the variance and covariance matrices of the random effects and the residuals is considered. The Multivariate Analysis of Variance (MANOVA) and the Restricted Maximum Likelihood (REML) estimators are examined. A simple procedure for adjusting the MANOVA estimator for nonnegativeness is suggested. For both balanced and unbalanced designs, biases and mean square errors (MSEs) of the different procedures are compared through simulation studies.