bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term follow-up results of the effects of chronotherapy and conventional chemotherapy combined with intensity modulated radiotherapy on dendritic cells and lymphocyte subsets in nasopharyngeal carcinoma.
Authors: Minghui Yang
Published: June 2022

e18066

Background: In this study, we compared the effects of chronotherapy with conventional chemotherapy plus intensity modulated radiotherapy (IMRT)on dendritic cells and lymphocyte subsets in locoregionally advanced NPC. Methods: Analysis of 136 patients with treatment locoregionally advanced nasopharyngeal carcinoma enrolled, 68 patients were randomly assigned to the chronotherapy group and 68 patients to the conventional chemotherapy group, and all patients received 2-3 cycles of TPF induction chemotherapy plus 2-3 cycles of cisplatin concurrent chemoradiotherapy with the following schedules: docetaxel (DOC): 60mg / m2, ivgtt, D1 (03:30-04:30); Cisplatin (DDP): 60mg / m2, civ, d1-d5 (10:00-22:00); 5-fluorouracil (5-FU): 600mg / m2 / D 1, civ, d1-d5 (22:00-10:00); Synchronized DDP 100mg / m2, civ, D1 (10:00-22:00). Conventional group: Doc 60 mg / m2, ivgtt, D1; DDP 60mg/m2, ivgtt, d1; 5-FU 600mg/m2 /d 1, civ, d1-d5(120h); Synchronized DDP 100mg / m2, IVGTT, D1. Both groups were treated with IMRT at the same dose。 Lymphocyte and lymphocyte subsets were measured by flow cytometry before induction chemotherapy and 1 year versus 3 years after the end of concurrent chemoradiotherapy in patients, and changes in immune parameters, survival, and long-term toxicities were compared between the two groups. Results: One year after induction chemotherapy and concurrent chemoradiotherapy, the chronotherapy group showed higher plasma dendritic cells (PDC) than the conventional group (P < 0.05). At 1 year after induction chemotherapy and concurrent chemoradiotherapy, CD4 +, activated CD4 +, activated CD8 +, CD3-CD16 +, PDC, and MDC were significantly higher (P < 0.05) in both pre - and post-treatment groups, and at 1 year after induction chemotherapy and concurrent chemoradiotherapy in the conventional group (P < 0.05). At 3 years after induction chemotherapy and concurrent chemoradiotherapy, CD4 +, activated CD4 +, activated CD8 +, CD4 + CD25 +, cd3-cd19 +, and CD3-CD16 + were significantly increased in the chronic group (P < 0.05), and CD4 +, activated CD4 +, activated CD8 +, and CD4 + CD25 + were significantly increased in the conventional group (P < 0.05). In the comparison of toxic effects between the two groups, the incidences of xerostomia and dysphagia in the group at 3 years after treatment were significantly lower than those in the conventional group (P < 0.05). There were no significant differences in PFS, OS, DMFS, LRRFS between the two groups at 3 years (P > 0.05). Conclusions: Chronotherapy with intensity-modulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma more than conventional chemoradiotherapy reduces damage to dendritic cells and lymphocytes and alleviates toxic effects such as xerostomia and dysphagia at the same survival rate.
Novel algorithm for assigning risk/disease-directed treatment (DDT) choice in locally advanced primary squamous cell carcinoma head and neck (SCCHN): Using pretreatment data only.
Authors: Talor Eyal , Lavin Philip T , Markovic Dusan
Published: June 2022

e18070

Background: Locally advanced primary SCCHN, DDT options (radiotherapy (RTx) or concurrent Chemoradiotherapy (CRTx)) is performed only following surgery (National Comprehensive Cancer Network [NCCN] Guidelines). A novel 2-step exclusion algorithm was developed, based only on N classification and imaging (CT; MRI +/- PET) to detect clinical features only from screening/entry findings. The algorithm was developed using the IT-MATTERS SCCHN pivotal study (Clinical trials.gov NCT01265849) data to identify treatment naïve lower risk (LR) for recurrence subjects receiving neoadjuvant immunotherapy prior to surgery to optimize long-term overall survival (OS). Methods: SCCHN patients are routinely examined and imaged at entry/screening to establish TNM classification and disease stage. Imaging is performed using CT, MRI, and/or PET-CT/PET-MRI per NCCN Guidelines. These imaging techniques can reliably detect extracapsular cervical lymph node spread before surgery, allowing the algorithm to be constructed and validated. Algorithm rules target CRTx bound (“High-Risk”) patients leaving RTx bound (“Low-Risk”) locally advanced primary disease patients at entry. The 2-step exclusions are: (1) exclude all N2 leaving only those with N0-N1, (2) further exclude those exhibiting extra capsular spread (PET-CT or PET-MRI). We retained those determined by study physicians to receive CRTx for the algorithm validation exercise only. The n = 923 pivotal study intent to treat (ITT) population was used to validate the algorithm. Results: Overall algorithm coverage was 99.9% (922/923 ITT except one missing N case) with 24.6% having N2 and 75.3% N0/N1. Among algorithm exclusions, 81.3% (282/347) were High-Risk; among algorithm inclusions, 60.6% (349/576) were Low-Risk. Algorithm validation: Among all Low-Risk cases in the study (n = 380), 91.8% (349/380) met the algorithm criteria; among all High-Risk cases, 60.4% (282/467) were correctly excluded by the algorithm. Remaining were physician choice. Overall, algorithm alone predicted 74.5% (631/847) risk group (combined low and high) accurately. Significant OS advantage (2-sided log rank p = 0.0376) to Immunotherapy regimen + standard of care (SOC) surgery + RTx vs SOC alone was seen for Low-Risk cases selected only by the 2-step algorithm. Conclusions: The algorithm provided near perfect (99.9%) ITT population coverage, achieved near 75% overall accuracy, with 91.8% accurate predictive value for the low-risk group demonstrating significant OS. Thus, risk group can be inferred at screening consistent with clinical practice and NCCN Guidelines. The algorithm can be used to help identify low risk SCCHN patients at entry to receive neoadjuvant immunotherapy before surgery.
VEGF expression in cetuximab resistance development in patients with squamous cell carcinoma of the tongue and oral mucosa.
Authors: Lyanova Aza A. , Vladimirova Liubov Yu , Ulianova Elena P. , Abramova Natalia A. , Popova Irina L. , Storozhakova Anna E. , Tikhanovskaya Natalia M. , Ryadinskaya Ludmila A. , Teplyakova Maria A. , Kabanov Sergey N. , Kalabanova Elena A. , Udalenkova Irina A. , Engibaryan Marina A. , Pustovaya Irina V. , Cherkes Maria A. , Sergeeva Marina M.
Published: June 2022

e18072

Background: Clinical course and aggressiveness of a tumor, as well as the subtle mechanisms of its pathogenesis are related to vascularization, which in turn is determined by the ability of transformed cells to synthesize a wide range of biologically active substances. Among modern approaches to cancer treatment, special attention is paid to anti-EGFR agents reducing tumor vascularization. The purpose of this study was to analyze VEGF expression in tumor vessels in patients with squamous cell carcinoma of the tongue and oral mucosa developing cetuximab resistance. Methods: The study included 45 patients with squamous cell carcinoma of the tongue and oral mucosa T3-4N0-1M0. The patients were divided into 3 groups: group 1 – all patients before treatment; group 2 – patients after standard chemotherapy with cisplatin and fluorouracil; group 3 – patients after chemotherapy in combination with targeted therapy with cetuximab. Immunohistochemical study was performed on sections from paraffin blocks of tumors using monoclonal murine anti-VEGF antibodies (clone VG1, Thermo Scientific) diluted 1:150. The Reveal Polyvalent HRP-DAB Detection System was used. The significance of differences was assessed using the Mann Whitney and Wilcoxon tests calculated using the STATISTICA 10.0 program (StatSoftInc., USA). Results: Changes in the density of vessels stained with the VEGF marker were studied in tumor cells of patients in all groups. Patients in group 1 had from 3 to 10 vessels in one field of view; in group 2 – from 2 to 6 vessels in 70% of cases (21) and up to 15 vessels in 30% of cases (9); in group 3 – only solitary vessels. The average numbers of microvessels stained with the VEGF marker per field of view were 6.5±1.52; 4.5±1.71; 1.0±0.28, respectively. Quantification of intratumoral microvascular density showed that the minimum number of microvasculature vessels in the field of view was observed in patients who received chemotherapy and targeted therapy with cetuximab. The value was 5 times lower compared to initial values, and 4 times lower than in patients who received only standard chemotherapy (the Mann Whitney test, p < 0.05). The statistical analysis according to the Wilcoxon test on the effect of targeted therapy (comparison between groups 2 and 3) revealed a statistically significant effect of cetuximab for this marker (p = 0.028). Conclusions: Immunohistochemical analysis of the VEGF neoangiogenesis factor in squamous cell carcinoma of the tongue and oral mucosa confirmed the effectiveness of targeted therapy with cetuximab.
Facility type and late-stage Thyroid Hürthle Cell Adenocarcinoma: A NCDB Review.
Authors: Keirns Darby , Silberstein Peter T. , Eaton Vincent
Published: June 2022

e18074

Background: Hürthle cell adenocarcinoma, or oxyphilic adenocarcinoma, is a rare and invasive cancer accounting for 3-4% of all thyroid malignancies. Surgical removal is the most common treatment. Survival differences based on treatment facility have been identified in other cancers, but this has not yet been studied in Hürthle cell adenocarcinoma. This study utilizes the National Cancer Database (NCDB) to investigate facility survival differences. Methods: Using the NCDB, 2,900 patients with stage III or IV oxyphilic adenocarcinoma of the thyroid were identified with ICD-O-3 histology code 8290/3 and primary site C739 between years 2004 and 2016. Facility types included community cancer, comprehensive community cancer, academic/research, and integrated network cancer programs. Between-facility type survival differences were estimated by the Kaplan-Meier method and associated log-rank tests. Descriptive statistics of race, sex, stage, facility location, urban/rural 2013, primary payer, median income quartile, and Charlson-Deyo score were used. All analysis was conducted using SPSS statistical software version 27. Results: Survival data was available for 2,017 stage III patients and 644 stage IV patients. In stage III, survival was lower in community programs when compared to academic/research (p = .011) and integrated network programs (p = .017). In stage IV, survival was also lower in community programs when compared to academic/research (p = .007) and integrated network programs (p = .011). No significant difference was seen within other comparisons. In both stages, the highest percentage of patients were white, had a Charlson-Deyo score of 0, and were treated in an urban metro area. Sex and facility location were variable among all stages and facilities. In stage III, private insurance was most common overall and for academic/research programs, but Medicare was the majority for other facility types. In stage IV, Medicare was most common overall and for each facility. The median income quartile was > $63,000 across all facility types for stage III and overall for stage IV, although stage IV treated in community and integrated network programs were most commonly between $48,000-$62,999. Conclusions: Patients with late-stage Hürthle cell adenocarcinoma have worse survival when treated in a community program than other facility types. Most demographics were consistent across stage and facility type, except for sex, primary insurance, median income, and facility location. This data contributes to a developing understanding of differences in cancer survival.[Table: see text]
Real-world analysis of use of lenvatinib in differentiated thyroid cancers.
Authors: Peelay Zoya , Pathak Shruti , Patil Vijay Maruti , Prabhash Kumar , Noronha Vanita , Menon Nandini Sharrel
Published: June 2022

e18075

Background: Lenvatinib is one of the approved treatments for radioiodine refractory differentiated thyroid cancers. However, there is very limited data from India on real-world efficacy and adverse events of Lenvatinib and hence this analysis was performed. Methods: This was a retrospective analysis in which patients of radioiodine refractory differentiated thyroid cancer as per the select study criteria who received lenvatinib were selected for the study over the last 4 years. The baseline demographic characteristics, adverse events of lenvatinib, the date of progression and the date of overall survival (OS) were extracted from the electronic medical records (EMR) of the Tata Memorial Hospital. SPSS version 20 was used for analysis. Results: Thirty patients were identified. The median age was 54.5 years (25-77). The male: female ratio was1:1. The Eastern Cooperative Oncology Group (ECOG) performance status (PS) was 0-1 in 21(70%), 2 in 4(13.3%) and 3 in 5(16.7%). The thyroid status was hypothyroid in 10 patients (33.3%), euthyroid in 12(40%) and hyperthyroid in 8(26.7%). In 5 patients it had to be stopped because of toxicity, these were proteinuria in 2, a hand-foot syndrome in 2 and diarrhoea in 1. The response rate was 56.7% (n = 17). The median progression-free survival (PFS) on lenvatinib was 366 days(95%CI 170.3-561.67) and the 2 year PFS was 29.3% (standard error 12.1) The median overall survival (OS) on lenvatinib was 411 days (95%CI 95.5-726.6). The 2 year OS was 38.8% (standard error -12.5%) and 5 year OS was 14.6% (standard error 12.1). Conclusions: In the real world lenvatinib provides a 2 year PFS and OS of 29.3% and 38.8% which is lower than that reported in the pivotal SELECT study.
Mammary analog secretory carcinoma in adults: A systematic review.
Authors: Findakly Dawood , Beedupalli Kavitha
Published: June 2022

e18076

Background: Mammary analog secretory carcinoma (MASC) is a rare malignant salivary gland tumor of the head and neck region that was first described by Skálová et al. in 2010. It histologically mimics breast secretory carcinoma and parotid acinic cell carcinoma, and characterized by ETV6-NTRK3 fusion gene. This review aims to investigate the clinicopathologic features, treatment, and outcomes of MASC in adults. Methods: PubMed search for MASC adults (18+ years) from data inception through 2021, pooled with a case from our institution. Kaplan-Meier analysis was used to plot survival curves. Results: Of the 254 included cases, female:male ratio 1.02:1 with a mean age at diagnosis (±SD, range) of 50.1 (±16.7, 18–86) years. In terms of location, 143 (56.3%) occurred in the parotid gland, 21 (8.3%) in the submandibular gland, 21 (8.3%) in the lip, 15 (5.9%) in the thyroid gland–all (100%) had a component of classical type papillary carcinoma, 15 (5.9%) were cutaneous, 13 (5.1%) in the buccal mucosa, 12 (4.7%) split between hard and soft palate, 4 (1.6%) in the nasal mucosa, 2 (0.8%) in the lung, and remaining 8 (3.1%) each in the conjunctiva, tongue, minor salivary gland, submaxillary gland, maxillary sinus, ethmoid sinus, upper esophagus, and mandible. Patients mostly presented with swelling or growing mass in 95.4% (out of which, 93.3% were painless), followed by a painful ulcer in 1.8%. Median tumor size was 1.9 cm (range 0.3cm–8.5cm). Median duration of symptoms at time of presentation was 12 (range 1-360) months. Tumors were T1 (49.7%), T2 (23.9%), T3 (20.3%), and T4 (6.1%), N0 (81.9%), N1 (10.7%), N2 (7.4%), M0 (97.4%), and M1 (2.6%). Most patients (70.7%) presented as early stage (I or II) which was associated with a high survival probability based on a log-rank test (p-value: 0.0007). All patients had surgical resection, mostly combined with neck dissection (ND) in11.4%, radiation (RT) in 7.8%, ND+RT in 4.7%, ND with platinum-based chemoradiation in 1.0%, and one case reported use of Crizotinib followed by Entrectinib with disease progression at 4.5 and 7 months, respectively. Among patients with reported outcomes, 92.2% were alive with a median follow-up of 26 (range 1-228) months, and 7.8% deceased with a median time-to-death of 29 (range 1-107) months. Eleven (4.3%) reported a high-grade MASC and 18.5% of patients lived for over five years after their diagnosis. Conclusions: Early stage was a notable predictor of higher survival probability in MASC patients. Its rarity, heterogeneity of clinical behaviors, and variable outcomes make it even more challenging. This review serves as real-world evidence to further our understanding of this rare entity and shed light on prospective clinical trial design.
An audit of anaplastic carcinoma of thyroid from a single institution.
Authors: Kanteti Aditya pavan kumar , Ghose Joy , Patil Vijay Maruti , Tamhankar Anup Sunil , Abraham George , Noronha Vanita , Laskar Sarbani , Menon Nandini Sharrel , Pai P. S. , Prabash Kumar
Published: June 2022

e18084

Background: Anaplastic thyroid carcinoma (ATC) is a rare thyroid malignancy with a dire prognosis, nearly 100% disease specific mortality and a median overall survival of less than 6 months. In view of the limited data from India on anaplastic thyroid cancer we conducted this audit to analyze the treatment pattern, outcomes and factors influencing it. Methods: This is a retrospective analysis of outcomes of patients treated in a single institution between Jan 2008- Dec 2020. Baseline characteristics, treatment received and outcomes among adult patients with ATC were collected. Progression free survival (PFS) and Overall survival (OS) were analyzed. SPSS version 20 and R Studio version 3.1.1 were used for analysis. Results: In this cohort of 134 patients, the median age at diagnosis was 59 years, with 63.4% of them being females. At presentation, 70.9% of them had good performance status (PS 0-1). Only 38.8% received treatment with radical intent (either surgery f.b adjuvant or NACT f.b surgery f.b adjuvant or definitive CTRT) while 61.2% patients received palliative treatment (either palliation alone or palliative chemotherapy or palliative surgery or palliative RT). Predominant pattern of progression was local progression (79.8%). Median PFS and OS of the overall cohort was 58 days and 80 days respectively. PFS and OS was significantly better in patients treated with radical intent vs. palliative intent (116 and 134 days Vs 45 and 50 days; p = 0.00 and 0.00 respectively). Among patients treated with radical intent, OS was significantly better in patients undergoing surgery Vs CTRT (155 Vs 76days; p = 0.03). Among patients treated with upfront surgery, both PFS and OS were better with the addition of adjuvant CTRT/RT Vs no adjuvant (332 and 540 days vs 55 and 91 days; p = 0.00 and 0.003 respectively). Conclusions: ATC is a rare cancer with dismal prognosis. Local therapy with surgery followed adjuvant seems to be associated with the better outcomes. Systemic therapy seems to be a better option for palliation. However the outcomes are far from satisfactory and research is required for development of affordable therapies.
Characterization of URST1 as a biomarker and therapeutic target for oral cancer.
Authors: Takano Atsushi , Yoshitake Yoshihiro , Shinohara Masanori , Daigo Yataro
Published: June 2022

e18092

Background: Cancer-specific oncoproteins are expected to be useful for the development of novel biomarkers and therapeutic targets for oral cancers. Methods: We screened candidate oncoproteins as follows: i) Identification of up-regulated genes in oral cancers by gene microarray, ii) Validation of clinicopathological significance of their protein expression by tissue microarray, iii) Examination of their growth effect on cancer cells by siRNA/small molecule compounds, iv) Elucidation of their tumor promoting effects by enforced gene expression. Results: Using above mentioned approach, we identified URST1 (Up-regulated solid tumor 1) as a candidate. Immunohistochemical staining showed that URST1 protein expression was observed in 110 (71.0%) of 155 oral cancers that had undergone curative surgery. In addition, high level of URST1 expression was associated with poor prognosis for oral cancer patients ( P = 0.0021, by log-rank test) and it was an independent prognostic factor. Reduction of URST1 expression by siRNA specific for URST1 significantly suppressed the growth of oral cancer cell lines and induced G2/M arrest as detected by flowcytometry and time lapse imaging. In contrast, enforced expression of URST1 enhanced the growth of oral cancer cells. The growth of oral cancer cells were inhibited by the URST1 inhibitor. Microarray analysis coupled with siRNAs for URST1 suggested various URST1-related oncogenic pathways in oral cancer cells. Conclusions: URST1 is a possible prognostic biomarker and therapeutic target for oral cancer.
Results of an online, globally-available survey to determine modes of cancer treatment education used by patients with cancer.
Authors: Gilreath Jeffrey A , Goewey Daphne D , Lo Mimi , McCabe Colleen , Greenly Anthony , Wilds Brandon , Stenehjem David D.
Published: June 2022

e18523

Background: Many patients with cancer (PwC) possess a suboptimal understanding of their chemotherapy treatment plan.1 Accordingly, PwC may seek information regarding both the disease and its treatment from other resources. Purpose: A freely-accessible website was curated by oncology pharmacists to provide evidence-based educational material on chemotherapy treatment plans. Objective: To use the website to deploy an online survey assessing other modes of education routinely accessed by PwC. Methods: Between February 2020 and January 2021, PwC completed an anonymous, English language survey via www.chemoexperts.com. Results: A total of 1,036 self-identified patient users began the survey. The majority were from North America (75%). Most respondents (65%) were female. PwC were asked: “If you received education from a health care professional (HCP), what type of education did you receive?” Multiple responses were allowed. Of the 820 patients who responded to this question, 77.4% (n = 635) were given printed material, 52.3% (n = 429) were taught in clinic, 8% (n = 66) were shown videos, 5.7% (n = 47) participated in an educational class outside of clinic, and 4% (n = 33) were given magazines. Roughly 37% were directed to an internet site (n = 304; 92 to chemoexperts.com, 212 to other internet sites) by a HCP. Patients also reported using blogs (12.7%; n = 111/873 respondents), websites other than chemoexperts (85%; n = 742/873), support groups (28.4%; n = 248/873), and YouTube (15.1%; n = 132/873). Discussion: In-person teaching sessions are vital to understanding treatment plans. While the ongoing COVID-19 pandemic may have lowered the percentage of PwC who are offered teaching, some PwC may still not absorb or retain all there is to know during in-person sessions and seek other resources to bolster their understanding of treatment. Although the majority of users reported receiving printed material, this too may be limited in its ability to meet the needs of all individuals. Knowing PwC may seek varying modes of education, HCPs should direct patients to resources they are familiar with. Conclusions: To our knowledge, this is the first global survey to examine modes of education utilized by PwC. Although PwC may receive teaching in person, many still seek a variety of educational resources outside of clinic. Relying solely on printed material will not meet the needs of some PwC. When educating PwC in clinic, HCPs concerned about the validity of outside materials should direct patients to resources they are familiar with and trust. Reference: Almalki H, Absi A, Alghamdi A, Alsalmi M, Khan M. Analysis of Patient-Physician Concordance in the Understanding of Chemotherapy Treatment Plans Among Patients With Cancer. JAMA Netw Open. 2020 Mar 2;3(3):e200341.
Ethnic disparities in adverse events of chemotherapy for breast cancer: A scoping review.
Authors: Hegde Siddhi , Carlos Ruth C
Published: June 2022

e18524

Background: Ethnic disparities may contribute to a higher symptom burden of adverse events following chemotherapy and poorer response to treatment for breast cancer. The objective was to examine the intra-group and inter-group ethnic differences in adverse effects experienced by Asian breast cancer patients undergoing chemotherapy with aromatase inhibitors or tamoxifen. Methods: A scoping review involving the Pubmed database was conducted. The search strategy included a combination of keywords and index terms related to Asians, breast cancer, CTCAE and treatment. Title, abstract and then full-text screening was performed by two reviewers. Primary research studies and systematic review articles involving female adults in peer-reviewed articles or grey literature records, of any design or date and published in English, were included. Descriptive statistics and charting was used to summarize the results. Results: Of 1765 abstracts retrieved and screened, 56 articles were ultimately included for analysis. Most articles (58.9%) studied the adverse events of tamoxifen. The majority of the studies involved Japanese patients (35.7%) followed by Chinese patients (19.6%) with an average of 8515 patients being studied per study. Only 2 studies were conducted in the US. Half the studies (50%) involved patients with TNM stage I breast cancer, postoperatively enrolled after BCS or mastectomy (71.4%). ER/PR status was reported in 58.9% of studies with an average of 494 patients being positive for either hormone receptor. HER-2 status was reported in 10 studies with an average of 53 positive HER-2 patients. 28.5% of studies involved patients with musculoskeletal adverse events following chemotherapy with aromatase inhibitors, commonly grade 3 or above (31.2%). These adverse events were arthralgia, fractures, osteoporosis or myalgia, affecting an average of 33.9% of patients in each study. 35.7% of studies involved patients with endocrinological adverse events following chemotherapy with tamoxifen. These adverse events involved menopausal symptoms, gynecological complications or endometrial cancer, affecting an average of 36.1% of patients in each study. Conclusions: Multi-level differences may contribute to the adverse events affecting Asian breast cancer patients undergoing chemotherapy with aromatase inhibitors or tamoxifen. Improving physician knowledge of ethnic disparities in adverse events occurring in Asian ethnic subgroups can help improve overall outcomes and patient adherence through a patient-centered approach.
Mental health care for oncology patients in community settings.
Authors: Gentile Danielle , Klink Andrew J. , Jeune-Smith Yolaine , Gajra Ajeet , Feinberg Bruce A.
Published: June 2022

e18525

Background: Research suggests that between thirty and fifty percent of patients with cancer experience psychiatric disorders across the cancer trajectory. As part of standard cancer care, mental health care can reduce distress and psychological morbidity for patients and improve their quality of life. Mental health treatment may even improve cancer survival rates.Considering the mental health issues relevant to cancer, implementation of mental health care into routine clinical care remains a challenge among community-based hematologists/oncologists (cH/O). Methods: Practicing U.S. cH/O completed a cross-sectional, web-based survey from September through November 2021. The survey collected demographic information and assessed physicians’ experiences and awareness regarding mental health diagnosis, frequency, severity, and management among their patients. Data were summarized using descriptive statistics. Results: Participants (N = 243) specialized in hematology/oncology (63%), medical oncology (36%) (1% other). The majority practiced in community-based settings unaffiliated with an academic center or hospital (73%). The majority (92%) agreed that mental health can significantly impact the health outcomes of patients with cancer. The majority (80%) frequently see patients coping with mental illness or distress. More than a quarter of the participants reported that their practice has clinical psychologists (27%), and nearly half (46%) have social workers on staff. About half (51%) occasionally refer patients for mental health services/treatment while 15% rarely or never refer. Nearly half (49%) indicated they do not have adequate resources to support the mental health needs of their patients with cancer. Conclusions: Our findings that oncologists have high levels of awareness about mental health issues among their patients with cancer is encouraging as is their incorporation of professionals on the care team to address this need. However, oncologists indicated that their available mental health resources are inadequate to meet patients’ needs and external referrals are limited. These findings suggest that additional resources and referrals are needed to ensure that patients will consistently receive the mental health care they need. Future research to assess the impact of mental health care on clinical outcomes including quality of life in patients with cancer is warranted.
Factors associated with default of treatment and follow-up among cancer patients.
Authors: Kumar Parmod , Sehrawat Amit , Gupta Sweety , sundriyal Deepak
Published: June 2022

e18528

Background: Default during treatment or follow-up is a major area of concern in oncology. Default leads to disease progression, treatment failure, and drug resistance ultimately resulting in increased morbidities and mortality. Default also serves as a mode of confusion and burden to the treating physician who has to re-tailor the treatment. We carried out this study to look for the characteristics and reasons associated with the default during among patients with cancer. Methods: Patients registered with a histologically confirmed diagnosis of solid organ cancer and default during evaluation, treatment, and follow-up were included. Default was defined as skipping a scheduled visit during evaluation by a duration of more than 2 weeks, skipping a scheduled session of chemotherapy by a period of more than the duration between chemo-sessions (week or 2-weeks or 3-weeks), or lost to follow -up (skipped 2 or more scheduled consecutive visits with no further intention of continuing treatment). Information regarding performance status, stage, phase of the treatment, reason for default, educational status of the patient, and demographic profile were noted. Lost to follow-up patients were interviewed telephonically. Results: One hundred seven patients with default were interviewed. Sixty-five percent were males. Thirty-six percent of the patient were of geriatric age-group. Eighty-four percent patients had an ECOG-PS of 0,1 or 2 immediately prior to default. Thirty-three percent of the patient had an early-staged disease. Fifty-four percent of the patients were illiterate. The intent of the treatment was curative in 36 % of the patient. Close to 92% of the patients defaulted during the treatment phase while the rest during evaluation or follow-up. The most common reasons for default were lack of social support (32%), financial distress (22%), difficulty in finding transport (16%), and too sick to come (15%). The lack of social support was evident due to the fear of the loss of daily wages by the family members. The average distance traveled by each patient from home to the cancer center was 131.5 kilometers. Other reasons included poor follow-up counseling by the healthcare staff, demise at home, shifting to alternative treatment (fear of chemo-toxicities), concomitant illness, religious reasons, and general well-being. Thirty-one percent of the patients reported more than one reason for non-compliance. Conclusions: The study reveals illiteracy, lack of social support, and financial distress as major causes of default. Although more than 90% of the patients are covered under PMJAY scheme, which provides free-of-cost treatment, the cost of transportation and the time consumed in commuting to a far-off center adds to the misery. These issues need to be addressed at national levels. Appropriate counselling regarding insight of the disease and adherence to the treatment is desired at the healthcare provider level.
Cost-related medication nonadherence and cost-saving strategies among Native Hawaiian and Pacific Islander cancer survivors.
Authors: Lee Min Jee , Adjei Boakye Eric , Salloum Ramzi
Published: June 2022

e18531

Background: Although cost-related medication nonadherence resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about cost-related medication nonadherence among Native Hawaiian and Pacific Islander cancer survivors. This study compared cost-related medication nonadherence among Native Hawaiian and Pacific Islander adults diagnosed with and without cancer and described the strategies cancer survivors used to offset the costs of medications. Methods: Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey, we compared self-reported cost-related medication nonadherence, shifting spending from basic needs to afford medications, and cost reduction strategies among Native Hawaiian and Pacific Islanders diagnosed with and without cancer. Cancer survivors were those with a history of cancer (excluding nonmelanoma/unknown type of skin cancer). Descriptive statistics and logistic regression models were used to characterize (age, sex, sexual orientation, marital status, household income, educational attainment, health insurance status, comorbidities, self-rated health, activity limitation, and cancer type) and compare these populations. Results: Of 2,593 adults were included in the study, 151 (5.8%) reported a history of cancer, and 2,442 (94.2%) did not. Although 13.6% of cancer survivors and 7.7% without cancer reported cost-related medication nonadherence (p = 0.065), about 9.9% and 11.7% of those with and without cancer, respectively, reported delays in filling a prescription to save money. In addition, about 8.0% and 9.9% of those with and without cancer, respectively, reported taking less medication to save money. In weighted adjusted analyses, the rate of cost-related non-adherence among the two groups was similar, but with some subgroup differences noted by sex and household income. The use of cost reduction strategies was mostly similar among cancer survivors and those without cancer. Conclusions: Cost-related medication nonadherence is common among Native Hawaiian and Pacific Islanders, but appears at similar prevalence among those diagnosed with and without cancer.
Training community health workers to increase advanced care planning in African American women with breast cancer.
Authors: Villamar Dario Martin , Huard Clarissa , Nicholson Lian Ariel , Moreno Patricia , Tan Marcia
Published: June 2022

e18549

Background: Black women are more likely to be diagnosed with more aggressive subtypes of breast cancer, at more advanced stages, and have worse outcomes than white women. Rates of advanced care planning (ACP) discussions are lower among black patients with advanced cancer, and they are less likely to receive care concordant with their wishes at end of life. Community health workers (CHW) play a versatile role in bridging social barriers to care and offer a unique mechanism to improve ACP discussions in this population. The aim of our study was to use a mixed methods approach to examine current practices and strategies to facilitate integration of CHW in ACP with black women with breast cancer. Methods: Participants completed a 22-item questionnaire to assess prior training in ACP and experience serving cancer patients. Focus groups were conducted with CHW (N = 5) and providers (i.e., oncologists, radiation oncologists, and palliative medicine physicians; N = 6) to discuss knowledge of ACP, barriers to ACP discussions, strategies to integrate CHW into ACP, and components of an effective ACP training curriculum for CHW. Focus groups were transcribed and two independent coders analyzed the data using the Framework method to extract themes and components of an ACP training curriculum for CHW. Results: Approximately 60% of CHW reported having received prior training in ACP. All providers reported primarily serving Black patients, and 66% self-reported low rates of ACP documentation (10-25%) among their patients. In the focus groups, CHW and providers described elements of effective ACP discussions as patient value-focused, multidisciplinary, timely, and empowering. Common barriers to ACP discussions identified by CHW included inexperience with ACP, unclear responsibility to initiate the discussion, and patient factors such as reluctance and complex social dynamics; providers identified issues of mistrust, historic injustice and power dynamics with their patients. Both CHW and providers viewed the role of CHW in ACP as a longitudinal process to empower, educate and reinforce patients’ values via a non-judgmental member of the community. For both groups, an ideal training curriculum teaches about key oncologic concepts, assesses patient readiness, and increases familiarity with ACP documentation. Conclusions: CHW serve a vital role in bridging care gaps for vulnerable patients and provide an opportunity to improve rates of ACP discussions in Black women with breast cancer. A training curriculum designed to help CHW assess a patient’s understanding of ACP and reinforce a longitudinal conversation is feasible, straightforward and can be incorporated into CHW workflow. One such training curriculum could expose CHW to different ACP documents, provide simulated patient encounters, and educate CHW on verbal and non-verbal cues from providers that may signal an ACP discussion is needed.
Association between platelets and in-hospital mortality in critically ill patients with tumors: A retrospective cohort study.
Authors: Chaofen Zhao
Published: June 2022

e18552

Background: Platelet count is an independent predictor of mortality in cancer patients. It remains unknown whether the platelet count is related to in-hospital mortality in severely ill patients with tumours. Methods: A retrospective study based on a dataset from a multicentre cohort. Setting This was a secondary analysis of data from one Electronic Intensive Care Unit (eICU) Collaborative Research Database (eICU- CRD) survey cycle (2014-2015). Participants The data pertaining to severely ill patients with tumours were collected from 208 hospitals located across the United States. This study initially a total of 200859 participants. After the population was limited to patients with combined tumours and platelet deficiencies, the remaining 2628 people were included in the final data analysis. Primary and secondary outcome measures The main measure was the platelet count, and the main outcome was in-hospital mortality. Results: After adjustment for the covariates, the platelet count had a curvilinear relationship with in-hospital mortality (P < 0.001). The first inflection point was 18.4 (per 10 change). On the left side of the first inflection point (platelet count ≤ 184 K/mcL), an increase of 10 in the platelet count was negatively associated with in-hospital mortality [OR = 0.92, 95% CI = 0.89 to 0.95, P < 0.001]. The second inflection point was 44.5 (per 10 change). Additional increases of 10 in the platelet count thereafter were positively associated with hospital mortality [OR = 1.13, 95% CI = 1.00 to 1.28, P = 0.0454]. The baseline platelet count was in the range of 184 K/mcL to 445 K/mcL(P = 0.0525), and the hospital mortality was lower than the baseline platelet count in other ranges. Conclusions: The relationship between platelet count and in-hospital mortality in critically ill patients with tumours was curvilinear. The lowest in-hospital mortality was associated with platelet count between 184 K/mcL and 445 K/mcL. This indicates that both high and low platelet count should receive attention in clinical practice.
Primary language, race, and location of care as main determining factors of decision to opt out of personalized breast cancer risk assessment.
Authors: Rutkowski Angela , Paul Shirlene , Lieberenz Jordan , Stempel Lisa , Levy Mia Alyce , Alvarado Rosalinda
Published: June 2022

e18567

Background: Personalized breast cancer risk assessment (CRA) and genetic counseling/testing for women have been shown to improve interventional and clinical outcomes. However, despite CRA being routinely offered to all women at our institution, not all women choose to opt into the program. This study evaluated the demographic distribution of patients that opted out of the CRA to identify potential components influencing this substantial decision. Methods: Our medical center, located in four urban and suburban locations, piloted a clinical framework to provide CRA to all women between the ages of 25 and 75 with a qualifying mammogram. In this single institution retrospective study, we analyzed differences among patients who opted out of the program between July 20, 2020 and July 19, 2021. Data elements extracted from the electronic medical record include race, primary language, location of care, and decision to partake in CRA. Overall Chi-square tests and all pairwise comparisons with Bonferroni correction were used to statistically determine the impact of various demographics on opting out. Results: 18726 women met criteria for inclusion and 2717 (14.5%) declined CRA. Within their respective racial groups, 122 (17.6%) Asian, 1175 (16.3%) Black, 455 (14.2%) Hispanic, 112 (15%) Other, and 853 (12.4%) White opted out. Within their identified primary language, 2370 (13.7%) English, 231 (23.1%) Spanish, 35 (19.7%) Bilingual, and 81 (35.2%) Other opted out. Based on their setting of care, 837 (16.8%) Location A, 1436 (14.2%) Location B, 270 (13.8%) Location C, and 174 (10.6%) Location D opted out. The differences between demographics and opting out were statistically significant for all analyses (p < .0001). Results shown in Table below. Conclusions: The main variables mediating the decision to opt out of CRA are a non-English primary language, non-White race, and location of care, potentially due to inadequate interpretation services, barriers to education, and staffing shortages. Thus, these women are less likely to receive genetic counseling/testing or supplemental screening. Our study is the first to investigate the factors contributing to the uptake of risk assessment. Further study is needed to determine the clinical impact of this striking disparity.[Table: see text]
Racial disparities in stage 3 lung cancer treatment.
Authors: Powell Adam C. , Pickerell Jeremy T. , Long James W. , Loy Bryan A. , Mirhadi Amin J.
Published: June 2022

e18574

Background: In the 1990s, it was demonstrated that Black patients were less likely to receive timely treatment for Stage 3 lung cancer than White patients. While contemporary work has found racial disparities in accessing insurance, diagnostics, and treatments, we wished to explore whether patients faced disparities once in treatment. To do this, we examined whether racial disparities were observable in a 2019 cohort of Medicare Advantage beneficiaries receiving treatment for lung cancer. Methods: This retrospective, observational study used health plan claims data to identify Black and White patients aged 18 to 89 years with a Medicare Advantage health plan in calendar year 2019 who received diagnostic imaging (computed tomography or positron emission tomography) followed by lung cancer treatment (radiation therapy [RT] or surgery claims mentioning a diagnosis of lung cancer) within 90 days. Only patients treated in 2019 were considered so that the findings would reflect the state of care immediately preceding the COVID-19 pandemic. Patients were excluded if they had a history of RT or lung surgery in the year prior to the diagnostic imaging date. Other databases were used to determine cancer stage, patient demographics, comorbidities, the urbanicity and median income of patients’ home ZIP code, and whether treatment was ordered by a hospital-based physician. A multivariate logistic model was used to examine the association between race and surgery, and a multivariate negative binomial model was used to examine the association between race and days to treatment (surgery or RT). Results: We identified 823 patients, 83.8% White (690), and 16.2% (133) Black. Surgery was received by 3.1% [4/133] of Black patients and 9.7% [61/690]) of White patients. Black patients received treatment on average 36.9 days after diagnosis, versus 35.1 days for White patients. Adjusted analysis did not find a significant association between race and receipt of surgery (P = 0.07) or race and days to treatment (P = 0.77). No covariate was significantly associated with receipt of surgery. Residence in a state with a higher obesity rate was associated with fewer days to treatment (P = 0.02). Conclusions: In a uniformly insured population that successfully received treatment, adjusted analysis found no evidence of a Black / White racial disparity in use of lung surgery for Stage 3 lung cancer or in timeliness of treatment. Given the directionality of the findings, they could potentially have been significant if the sample size had been increased by extending the enrollment period. The implication of these findings is that it may be most fruitful to address racial disparities at the frontend of the care process; working to ensure that patients have access to insurance, diagnostics, and treatments, as disparities were not observed in a population that had accessed treatment. Further research is needed to assess whether racial disparities in lung cancer treatment have dissipated over time.