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Objective: Survivorship care plans (SCPs) are recommended to promote appropriate follow-up care, but implementation has been limited. We conducted a randomized controlled trial comparing three SCP delivery models in two health systems. We utilize mixed methods to compare the feasibility and participants' perceived value of the three models., Methods: Patients completing treatment for stage I-III breast, prostate, or colorectal cancer from one urban-academic and one rural community cancer center were randomized to (1) mailed SCP, (2) SCP delivered during an in-person survivorship visit, or (3) SCP delivered during an in-person survivorship visit plus 6-month follow-up. Clinics had flexibility in intervention implementation. Quantitative data summarize intervention fidelity and protocol deviations. Qualitative interview data provide patients' perspectives on feasibility and intervention value., Results: Of 475 eligible participants approached, 378 (79%) were randomized. Of 345 SCPs delivered, 265 (76.8%) were by protocol. Protocol deviations were more common at the urban-academic center. In post-study qualitative interviews, participants recalled little about the SCP document or visit(s). SCPs were valued for information and care coordination, although their static nature was limiting, and sometimes SCP information differed from that provided elsewhere. Visits were opportunities for care and reassurance, but time and distance to the clinic were barriers., Conclusions: SCP provision was challenging. Patients were interested in SCP, but not necessarily additional survivorship visits, particularly at the urban-academic hospital., Implications for Cancer Survivors: These findings suggest that patients value careful consideration of health care needs during the transition out of treatment; SCP documents are one element of this. For many patients, models without additional visits and dynamic SCPs may be preferred., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Spinal injuries (SIs) can pose a significant burden to patients and family; delayed surgical intervention, associated with interhospital transfer, results in worse outcomes., Objective: This study aimed to identify early patient-centered factors associated with risk for near-shore SIs to assist clinicians with expeditious medical decision-making., Methods: We performed a multicenter retrospective study of all adults transported from Ocean City, Maryland to two emergency departments (EDs) and one regional trauma center for evaluation of suspected SIs from 2006 to 2017. Outcomes were any SI and any spinal cord injury (SCI). Multivariable logistic regression was performed for association of environmental and clinical factors with outcomes., Results: We analyzed 278 records, 102 patients (37%) were diagnosed with any SI and 41 (15%) were diagnosed with SCIs. Compared with patients without SI, patients with SI were more likely to be older (48 vs. 39 years), male (90% vs. 70%), with pre-existing spinal condition (62% vs. 33%), and injury caused by diving (11% vs. 2%). Multivariable logistic regression showed age (odd ratio [OR] 1.07; 95% confidence interval [CI] 1.04-1.11), diving (OR 3.5; 95% CI 3-100+), and wave height (OR 4.5; 95% CI 1.35-15.2) were associated with any SI, and a chief complaint of extremity numbness or tingling (OR 5.73; 95% CI 1.2-27.9) was associated with SCI., Conclusions: We identified older age, diving, and higher wave height as risk factors for any SI and symptoms of numbness and tingling were associated with SCIs. Clinicians should consider expediting these patients' transfers to a trauma center with neurosurgical capability., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Low-dose total-body irradiation, 150 rad given in 10 fractions over 5 weeks, is a useful treatment modality for favorable-prognosis lymphomas. Little is known, however, about the effects of this regimen on normal bone marrow. Six healthy beagle dogs and 5 dogs of various breeds with lymphoma were treated with total-body irradiation. Three of the 5 lymphomatous dogs achieved remissions of limited duration. No changes in hemograms or in bone marrow cellularity (as assessed by needle marrow biopsies) could be detected during or after treatment. Bone marrow progenitor cells were studied weekly during treatment and for 4 weeks thereafter using in vitro growth assays for GM-CFC and M-CFC. These studies demonstrated significant reductions (P less than 0.001) of granulocyte and macrophage progenitor cells with subsequent recovery toward normal pre-irradiation and sham irradiation values. Two additional dogs were injected with sublethal doses of Salmonella typhosa endotoxin 2 weeks after completion of the irradiation regimen. Their bone marrow GM-CFC responses were dramatically blunted compared to nonirradiated controls whereas their peripheral leukocyte responses and serum CSF levels were comparable to nonirradiated controls. These studies suggest that total-body irradiation may induce bone marrow injury that may be clinically significant if patients so treated are further stressed by infections or myelosuppressive drugs.

Progressive thrombocytopenia developed in a patient following the completion of total lymphoid irradiation and combination chemotherapy for Hodgkin's disease. Thorough evaluation eventually yielded a diagnosis of acute myelogenous leukemia (AML). Previous workers have suggested that the development of thrombocytopenia with a hypoplastic marrow following total lymphoid irradiation indicated recurrent Hodgkin's disease. When the combination cytopenias and hypoplastic marrow is recognized these workers have recommended early combination chemotherapy. Recent data suggest a 1300-fold increase in the risk of AML following multimodality therapy for Hodgkin's disease. We feel that a careful search for AML should be conducted in patients with deteriorating hematologic parameters following therapy for Hodgkin's disease and that this search should include sampling bone marrow outside irradiated areas.