bluuebunny/crossref_metadata_2025 huggingface dataset:
Complementary and alternative medicine use and recommendations for discontinuation of supplements in an integrative oncology clinic.
Authors: D'Andre Stacy D. , Bauer Brent D. , Hofmann Maggie D. , Burckhard Jenna D. , Montane Heather D. , Loprinzi Charles L.
Published: June 2022

12058

Background: It is well established that many patients with cancer are taking dietary supplements (DS) and alternative medicines and often do not disclose such to their care teams. There is potential for harm in several ways: 1) interactions with their medications that may increase side effects, 2) interactions with their treatment that may lead to decreased efficacy, 3) direct toxicity from the supplement 4) financial toxicity. We have recently started a new Integrative Oncology service to help counsel patients about improving lifestyle factors and assist patients with safe and evidence-based integrative treatments and supplements. Methods: Patient data (N=100) were collected prospectively from an Integrative Oncology Clinic. The number and type of DS were documented. Using the Natural Medicines Database (NMD), we determined whether supplements interacted with the patients’ other medications or cancer therapies. We calculated the percentage of patients in which a recommendation for discontinuation of DS was recommended, along with the supporting reasons. We calculated the most common DS being taken and other alternative therapies beyond supplements. Results: Ninety-one percent of patients took DS, with an average of 5.5 per patient (range 0-20). The most common DS patients reported taking (%): Vit D (52), Vit C (41), Multivitamin (34), probiotic (27), B Vitamins (26), Ca (20), zinc (20), fish oil (18), cannabis (18), mushrooms (18), turmeric (17), magnesium (15), melatonin (14), biotin (11), coq10 (7), iron (8), VIT E (5), and glucosamine (5). Eighty-nine percent of patients using DS were on active cancer therapy. In thirty-five percent of patients, we recommended stopping some of their DS or other therapies. Number of patients using alternative therapies beyond DS: IV Vitamin C (5), Rick Simpson oil (high dose THC) (4), extreme diets (4), mistletoe (2), re-purposed meds (2); and one each was using hyperbaric O2, ozone, homeopathic, ayurvedic, insulin-potentiated chemo, miracle mineral cure, chelation, low dose naltrexone Conclusions: Cancer patients both on and off active treatment are using large numbers of DS with potential for adverse effects and/or decreasing efficacy of treatments. This study highlights the prevalence of DS and alternative medicine usage in cancer patients referred to an integrative oncology clinic and demonstrates the need for counseling about safe supplement use; in 35% of patients, discontinuation of DS was recommended. [Table: see text]
Symptom monitoring with patient-reported outcomes using a web app with alerting algorithms among patients with lung cancer (SYMPRO-Lung).
Authors: Becker-Commissaris Annemarie , Billingy Nicole Erica , Hoek Rianne , Tromp Vashti , van den Hurk Corina , Walraven Iris
Published: June 2022

12060

Background: The use of patient reported outcomes (PROs) to monitor symptoms during and after cancer treatment can improve symptom management, health-related quality of life (HRQoL), and overall survival, especially when linked to an alert system. Previous studies used alerts to the health care provider (HCP), but will this also work when patients receive the alerts? The aim is to compare a reactive (patient receives alert) and an active (HCP receives alert) method of PRO symptom monitoring on symptom incidence and management during the first 15 weeks of treatment. Methods: SYMPRO-Lung is a Dutch multicenter stepped wedge RCT performed among lung cancer (LC) patients to monitor symptoms, using a PRO-CTCAE LC subset. The NCI scoring algorithm assessed the symptom severity. If symptoms exceeded a predefined threshold an alert was sent by email to the HCP (active arm) or to the patient (reactive arm). Differences between both study arms in baseline characteristics, symptom incidence and management, were assessed using chi-square tests. Results: In total, 244 patients (active arm n = 155, 64%, reactive arm n = 89, 37%) completed 2412 symptom checklists during the first 15 weeks of treatment, with a mean of 10 per patient (pp) (SD 4.3). A total of 673 alerts (28%) were triggered, with a mean of 3 (SD 2.1) pp in both arms. The top 3 symptoms that caused the app to send an alert were fatigue (n = 231, 19%), pain (n = 188, 16%), and constipation (n = 144, 12%). Decreased appetite, diarrhea, and nausea were significantly higher in the reactive arm compared to the active arm (see table). For 313 alerts (74%), telephone contact with a HCP was the only intervention needed. 57 Alerts (13%) were discussed during a planned outpatient’s consultation in the week of the alert. For 39 alerts (9%) the patients were referred to another specialty (see table). However, ‘no need to follow-up’ (FU) was requested after 237 alerts (35%). For all symptoms, the no FU request was significantly higher in the reactive arm (n = 135, 32% vs n = 102, 40%), compared to the active arm (p-values between 0.02 and < 0.001). Conclusions: In both arms an average of 3 alerts pp were triggered. In the reactive arm, significantly more patients chose not to contact their HCP compared to the active arm. Future research needs to unravel the underlying mechanisms and the potential consequences of this observed difference between study arms. Clinical trial information: Trial NL7897. [Table: see text]
Evaluation of social connectedness, loneliness, and anxiety among cancer survivors during the 2020-2021 winter surge of COVID-19 pandemic.
Authors: Poghosyan Hermine , Yu James B.
Published: June 2022

12061

Background: Limited research is available about cancer survivors’ level of stress, social connectedness and loneliness during the COVID-19 that can put them at increased risk for poor physical and mental health. We estimated relative decreased rate of social connectedness and increased rates of loneliness/sadness and stress/anxiety among cancer survivors during the 2020-2021 winter surge of COVID-19 and investigated whether decreased social connectedness is associated with increased feelings of loneliness/sadness and stress/anxiety. Methods: This cross-sectional study used data from Medicare Current Beneficiary Survey COVID-19 Winter 2021 Supplement, nationally representative phone survey of Medicare beneficiaries living in community, conducted in March-April 2021. We included 1,836 respondents who self-reported cancer history (other than skin cancer). Outcomes were self-reported feelings of loneliness/sadness and stress/anxiety over the past 4 months. The independent variable was social connectedness defined as feeling less socially connected to family/friends over the past 4 months. We used weighted descriptive statistics and multivariable logistic regression adjusting for self-reported socio-demographics (age, sex, race, income), region, metropolitan residency, Medicaid eligibility, living alone, depression, having access to internet and health care. We applied sample weights to account for complex survey design with results generalizable to 9.5 million cancer survivors. Results: Out of 9505626 cancer survivors, 6.8% self-reported as Black, 7.1% Hispanic, 80.4% White, 59% women, 42.7% reported decreased social connectedness, 20.3% increased feeling of loneliness/sadness, and 40.0% increased feeling of stress/anxiety in the past 4 months. Women had higher rates of reporting increased feelings of loneliness/sadness (12.0% vs. 26.1%, P = <.001), stress/anxiety (30.0% vs. 46.6%, P = <.001), and decreased social connectedness (38.7% vs. 45.5% P =.028) than men in the past 4 months. Among self-reported racial and ethnic groups, Hispanics had the highest rates of reporting increased feelings of loneliness/sadness (31.2% vs. 20.5% of Whites vs. 10.2% of Blacks, P =.008) and stress/anxiety (54.0% vs. 39.4% of Whites vs. 31.2% of Blacks, P =.034). No statistically significant difference was found in social connectedness by self-reported race and ethnicity. Survivors who reported decreased social connectedness had higher odds of feeling more lonely/sad (adjusted OR = 3.67, 95%CI 2.85-4.72, P = <.001) and more stressed/anxious (adjusted OR = 2.63, 95%CI 2.1- 3.26, p = <.001) over the past 4 months. Conclusions: Increased feelings of loneliness/sadness and anxiety/stress in the past 4 months were prevalent among cancer survivors. Also, almost half of them reported decreased social connectedness at the end of the second year of COVID-19.
Prevalence of pain symptoms among U.S. adult cancer survivors.
Authors: Hu Xinwen , Cao Chao , Han Yunan , Jiang Shu , Yang Lin , Colditz Graham A.
Published: June 2022

12062

Background: Pain symptoms are common in cancer survivors. The life expectancy of US cancer survivors continues to raise. To date, the comprehensive pattern of pain symptoms in US cancer survivors by cancer history remains unknown. Methods: Data on pain symptoms and correlates were derived from a nationally representative sample of cancer survivors (n = 55,716, weighted population = 17,352,886) in the 1997-2018 National Health Interview Survey. Individuals who answered “yes” to the questions “During the past three months, did you have headache/facial/neck/low back pain/low back pain radiating to the leg” were considered as having pain symptoms at respective anatomical regions. The US national prevalence of pain overall and by anatomical regions were estimated. Correlates of pain symptoms were examined using multivariable logistic regression. Results: The prevalence of overall pain symptoms was persistently high (48.5%, 95% CI: 48.0-49.0) in cancer survivors from 1997-2018 ( P for trend =.58), driven by low back (37.6%, 95% CI: 37.1-38.0) and neck pain (20.9%, 95% CI: 20.5-21.3), and was leading in survivors of bone (63.1%, 95% CI: 57.9-68.4), soft tissue (58.1%, 95% CI: 50.6-65.6), and brain (58.2%, 95% CI: 52.3-64.0) cancers. Considerable pain symptoms were reported by survivors of commonly diagnosed cancers: lung (48.5%), breast (46.7%), colon (52.2%) and prostate (38.4%) cancers. The prevalence of pain is higher in females (52.9%) than males (42.6%) across all anatomical regions (OR, 1.50 [95% CI, 1.38-1.63]), particularly headache (19.8% vs. 8.6%) and facial pain (8.6% vs. 3.9%). Of note, females with reproductive system cancers, cervical (66.3%), uterine (60.0%) and ovarian (59.4%) cancers, have a higher prevalence in all types of pain than those with other cancers. Cancer survivors aged ≥65 years were less likely to report pain symptoms than younger survivors (OR, 0.71 [95% CI, 0.64-0.79]). Despite no racial disparity in the prevalence of overall pain, Non-Hispanic Blacks (18.6%, 95% CI: 17.2-20.0) and Hispanics (21.2%, 95% CI: 19.5-22.9) were more likely to report headache than Non-Hispanic Whites (14.4%, 95% CI: 14.0-14.8). A higher prevalence of pain symptoms was consistently observed in cancer survivors with low income, smoking history, low physical activity levels, diabetes, and cardiovascular diseases (all P <.05). Age at cancer diagnosis ( P for trend <.001), but not the time since, affected pain symptoms. Cancer survivors diagnosed at age 0-14 (53.0%, 95% CI: 49.1-56.9) and 15-39 years (58.6%, 95% CI: 57.5-59.7) had a significantly higher prevalence of pain across all anatomical regions than those at ≥40 years (45.5%, 95% CI: 44.9-46.1). Conclusions: Half of US cancer survivors experienced pain symptoms, driven by low back and neck pain. Higher prevalence of pain was noted in cancer survivors with younger age, female sex, low income and suboptimal lifestyle behaviors, calling for adequate pain management in cancer survivorship.
Analysis of incidence/mortality/cost for thrombotic events in hospitalized patients with lung cancer using the National Inpatient Sample database.
Authors: Atodaria Kuldeepsinh , Fidler Christian
Published: June 2022

12073

Background: Thrombotic events are a common complication of lung cancer. We performed a retrospective analysis of an inpatient adult population (age ≥18) using the National Inpatient Sample (NIS) database from the years 2003-2014. Methods: The analysis was performed on the NIS database, using IBM SPSS Statistics 28.0.0.0 software. The cases for lung cancer were selected based on ICD-9(International Classification of Disease) codes for lung cancer. The cases were weighted by Weight to discharges in the universe. These cases were checked for a diagnosis of acute lower extremity Deep Vein thrombosis (DVT) and acute Pulmonary Embolism (PE) again using ICD-9 codes. Chi square tests were utilized to check the significance of association between mortality and DVT/PE. Independent T-tests were utilized to check the association of cost of hospitalization and length of stay with DVT/PE. Results: There were a total of 4,940,262 cases (53.0% male) of lung cancer from the years 2003-2014. 112,569 (2.3%) cases had a diagnosis of acute lower extremity DVT, and 164,208 (3.3%) cases had a diagnosis of acute PE. Overall, death for lung cancer cases was 516,070(10.5%). Death rate in patients with DVT was 12.4%(frequency = 13,943). DVT and death during hospitalization were positively associated, X 2 (1, N = 4,936,702) = 578.792, p <.001. Rate of death for PE was 15.5% (25,360). PE and death during hospitalization were positively associated as well, X 2 (1, N = 4,936,702) = 4540.012, p.000. DVT was associated with a prolonged length of stay ( M = 8.66 days, SD = 8.8.624), compared to cases without DVT ( M = 6.42 days, SD = 6.42), t(4,940,122) = 115.02, p =.000. DVT was also associated with increased total charges of hospitalization ( M = $ 62,950, SD = 85,105), compared to cases without DVT ( M = $ 41,764, SD = 55,410), t(4,864,517) = 124.09, p =.000. PE was associated with a prolonged length of stay ( M = 8.01 days, SD = 8.13), compared to cases without PE ( M = 6.42 days, SD = 6.41), t(4,940,122) = 97.89, p =.000. PE was also associated with increased total charges of hospitalization ( M = $ 56,161, SD = 76,585), compared to cases without PE ( M = $ 41,772, SD = 55,468), t(4,864,517) = 100.85, p =.000. Conclusions: DVT and PE are common complications of Lung Cancer. They are associated with increased mortality in these patients. DVT increases the mean LOS by 2.24 days, and mean charges by $21,186. PE increases the mean LOS by 1.59 days, and the mean charges by $14,389. Prevention of DVT and PE could help bring down the mortality, LOS and charges of hospitalization. This data provides support to the usage of prophylactic anticoagulation in patients with lung cancer as shown in recent trails with Direct Acting Oral Anticoagulants(DOACs), and further study of DVT/PE in Lung cancer patients would be warranted.
Effects of exercise during adjuvant chemotherapy for breast cancer on long-term cardiotoxicity.
Authors: Naaktgeboren Willeke , Stuiver Martijn M. , van Harten Wim H. , Aaronson Neil K , Scott Jessica , Sonke Gabe S. , Van Der Wall Elsken , Velthuis Miranda , Leiner Tim , Teske Arco J. , May Anne Maria , Groen Wim G
Published: June 2022

12081

Background: A common conception is that exercise training is cardioprotective for patients with breast cancer receiving adjuvant chemotherapy, but evidence to support this assertion is limited. This study aims to evaluate the effect of exercise training during adjuvant chemotherapy for breast cancer on long-term structural and functional cardiac outcomes. Methods: This is a follow-up study of two previously performed randomized studies in breast cancer patients; the PACT (N = 204) and PACES (N = 230) study. Cardiac outcomes, including extracellular volume fraction (ECV), left ventricular ejection fraction (LVEF) on cardiac MRI and global longitudinal strain (GLS) on echocardiography, were evaluated in patients allocated to moderate-to high-intensity exercise and non-exercise controls using linear and logistic regression models, adjusted for relevant confounders. Additionally, we explored the influence of self-reported PA during chemotherapy on cardiac outcomes, regardless of treatment allocation. Results: In total, 185 breast cancer survivors were included (mean age 58.9±7.8 years, mean time since treatment 8.5±1.1 years). Mean ECV was 25.3±2.5 in the control group and 24.6±2.8 in the exercise group. Mean LVEF was borderline normal in both (54.6±4.9 and 53.0±7.8) with an LVEF < 50% of 17.1% and 27.8% in control and exercise group, respectively. Compared to control, no significant effect of exercise during chemotherapy on ECV (β = -0.61, 95%CI: -1.55;0.32) or on abnormal ECV (OR = 0.80, 95%CI: 0.26;2.45) was found. Native T1 was statistically significantly lower in the exercise group compared to control (β = -16.75%CI: -31.5 ;-1.93). The odds of having an abnormal native T1 appeared lower in the exercise group (OR 0.58, 95%CI: 0.28;1.17). We found no benefit of exercise for LVEF or GLS (β = -1.82, 95%CI: -4.06;0.42 and β = 0.21, 95%CI: -0.87;1.28), nor on the likelihood of having an abnormal LVEF or GLS (OR = 1.78, 95%CI: 0.79;4.16); OR = 1.21, 95%CI: 0.56;2.63), respectively. Higher self-reported physical activity levels during chemotherapy tended to be associated with better cardiac outcomes. Conclusions: Exercise training during chemotherapy was not associated with long-term cardioprotection in patients with early-stage breast cancer. The high prevalence of cardiac abnormalities years post-chemotherapy suggests the need to include cardiac assessment in long-term follow-up programs for breast cancer survivors and calls for more research on cardioprotective measures during adjuvant chemotherapy, including alternative exercise dosing regimens and pharmacological adjuncts. Clinical trial information: NTR7247.
Thromboembolism (TE) and association with survival in patients (pts) with melanoma receiving chemo– or immunotherapy.
Authors: Sussman Tamara A. , Vu Long , Buchbinder Elizabeth Iannotti , Ott Patrick Alexander , Markt Sarah C. , Koroukian Siran M. , Hodi F. Stephen , Khorana Alok A.
Published: June 2022

12082

Background: Emerging reports suggest high rates of venous thromboembolism (VTE) and arterial thromboembolism (ATE) with immune checkpoint inhibitors (ICI) in pts with melanoma, but it is unclear whether these are truly increased compared to older systemic therapy approaches. We assessed the incidence of TE in melanoma pts on ICI, cytokine therapy (CY), and chemotherapy (chemo), and evaluated its impact on survival. Methods: We conducted a cohort study using the SEER-Medicare database to evaluate rates of TE in pts with melanoma treated from 2008-2019 with ICI (ipilimumab, nivolumab, pembrolizumab), CY (IL2, IFN), and/or chemo (antineoplastic agents, BRAF/MEK inhibitors) within two years of treatment initiation. TE including VTE events of deep venous thrombosis, pulmonary embolism, and ATE of MI, ischemic stroke, and transient ischemic attack were identified by at least two outpatient claims or one inpatient claim. Overall survival (OS) from treatment start was analyzed by time-varying Cox analysis. Results: The cohort comprised 13,124 pts with median age 75 (24-101) years and 68% male. Of these, 14.8% received ICI, 48.9% chemo, 1.7% CY, 31.8% chemo+ICI, and 2.8% chemo+CY. At treatment start, comorbidities included 72% of pts with hypertension, 33% cerebrovascular disease, 17% atrial fibrillation, 7.3% history of VTE, and 13.0% history of ATE. Overall, 11.4% were on anticoagulation and 5.2% on antiplatelet agents. Incidence rates of ATE and VTE after treatment start are shown (Table). VTE was highest at 3 months after starting therapy with 19.6 events per 100 person-years in those receiving chemo+ICI, 17.1 events with chemo, 15.4 events with ICI, 10.1 events with chemo+CY, and 7.7 events with CY. In multivariable analysis, VTE and ATE were associated with worse OS compared to patients without (HR 2.77 [95%CI, 2.50-3.08], and HR 2.53 [95%CI, 2.23-2.86], respectively). Conclusions: Systemic therapy with ICI and chemo, especially when exposed to both sequentially or concurrently, demonstrates a high incidence of TE in pts with melanoma. TE is associated with substantial worsening of survival. TE rates are not substantially increased with ICI in comparison to chemo. Further studies are needed to identify benefit of thromboprophylaxis.[Table: see text]
Association of metabolic risk factors with breast cancer survival in a population-based cohort.
Authors: Feliciano Elizabeth , Zimbalist Alexa , Caan Bette Jane , Mittendorf Elizabeth A. , Dillon Deborah , Quesenberry Charles P. , Chen Wendy Y.
Published: June 2022

12089

Background: Metabolic abnormalities may impact breast cancer prognosis, but research has been limited by small samples and assessment of laboratory values at a single time point, often prior to cancer diagnosis and treatment. In a population based cohort, we utilized time-updated laboratory values and adjusted for cancer treatment to assess the association between metabolic risk factors (glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides) and breast cancer survival. Methods: 13,434 women diagnosed with stage I-III breast cancer from 2005-15 at Kaiser Permanente were included. All outpatient fasting glucose, HDL, LDL, and triglyceride values from diagnosis through 2019 or death were extracted from electronic medical records. Lab values were updated a median of 5 times between 1-7 years post-diagnosis. Risk of breast cancer-specific mortality was evaluated with Cox proportional hazards models adjusted for metabolic labs, demographics, body mass index, and diabetes, and then for dyslipidemia and anti-hypertensive medications, tumor characteristics (stage, ER and HER2 receptor status) and cancer treatment (use of chemotherapy, and tamoxifen v. aromatase inhibitors). Results: Mean (SD) age at diagnosis was 62.3 (11.8) years. Over median follow-up of 9 years, 2,876 patients died (1,080 of breast cancer). Patients with low HDL (≤45 vs. >45 mg/dL) had higher breast cancer-specific mortality (HR, 1.87; 95% CI, 1.62-2.16); high levels of glucose, triglycerides, and LDL were not associated. The increased risk associated with low HDL persisted after adjusting for tumor characteristics, cancer treatment, and medications. Conclusions: Low HDL evaluated over time after cancer diagnosis is associated with higher breast cancer mortality independent of cancer treatments and changes in other metabolic risk factors. Cholesterol may play a role in breast cancer due to its role in cell membrane structure, signaling pathways, and steroid hormone synthesis. Future studies should address whether pharmacologic or lifestyle treatment of lipids after breast cancer diagnosis can optimize survival outcomes.[Table: see text]
Patient-reported hope, quality of life (QOL), symptom burden, and coping mechanisms in early phase clinical trial participants.
Authors: Lundquist Debra , Pelletier Andrea , Durbin Sienna , Bame Viola , Turbini Victoria , Healy Megan , Lynch Kaitlyn , McIntyre Casandra , Juric Dejan , Ferrell Betty R. , Jimenez Rachel , Nipp Ryan David
Published: June 2022

12114

Background: Early phase clinical trials (EP-CTs) investigate novel treatment options in oncology, with recent advances in personalized therapy leading to improved outcomes and offering hope to patients with cancer. However, little research has sought to understand associations of patient-reported hope with QOL, symptom burden, and coping mechanisms in EP-CT participants. Methods: We prospectively enrolled consecutive adults with cancer participating in EP-CTs at Massachusetts General Hospital from 04/2021-01/2022. Participants completed baseline surveys prior to treatment initiation that assessed hope (Herth Hope Index [HHI], higher scores indicate greater hope), QOL (Functional Assessment of Cancer Therapy-General), symptom burden (physical: Edmonton Symptom Assessment System [ESAS]; psychological: Patient Health Questionaire-4 [PHQ4]), and coping mechanisms (Brief COPE). We used independent samples t-test to test for mean differences between groups and regression models to explore associations of hope with patient characteristics as well as patient-reported QOL, symptom burden, and coping mechanisms. Results: Of 92 eligible patients, we enrolled 85 (enrollment rate 92.4%, median age = 61.4 years [range 54.7-68.9]; 56.5% female, and 95.3% metastatic cancer). Most common cancer types were gastrointestinal (41.2%), breast (21.2%), lung (7.1%), and gynecologic (7.1%). Patients had an average HHI score of 28.2 (range 12.0-36.0), with 32.9% reporting high levels of hope. We found that married patients had higher mean hope score compared with non-married patients (28.9 versus 26.1, p = 0.024), those with children had higher mean hope scores than those without (28.9 versus 25.9, p = 0.013), and those who had received 3 or more lines of prior therapy compared with 1-2 (29.3 versus 27.2, p = 0.045) had higher hope scores. We also found associations of hope with patients’ QOL (B = 0.24, p < 0.001), symptom burden (ESAS-physical: B = -0.13, p = 0.001; PHQ4-depression: B = -2.26 p = < 0.001; PHQ4-anxiety: B = -0.94, p = 0.008), and coping (self-blame [B = -1.39, p = 0.003]; acceptance [B = 1.23, p = 0.002], denial [B = -1.09, p = 0.009], support [B = 1.06, p = 0.002], active [B = 0.73. p = 0.034], disengage [B = -3.24, p < 0.001]). Conclusions: In this prospective cohort study, we demonstrated that a substantial proportion of EP-CT participants had high baseline hope, and we identified several patient factors associated with their hope scores. We also found novel associations of higher hope scores with better QOL, lower symptom burden, and more adaptive coping mechanisms. Collectively, our findings highlight the potential for patient-reported hope to represent a key factor to consider when seeking to improve outcomes in EP-CT participants.
Prevalence and perceptions of cannabis use among racially diverse patients with cancer pain: Results from a multi-site survey.
Authors: Worster Brooke , Ashare Rebecca , Meghani Salimah H. , Smith Danielle , Case Amy Allen , Selvan Preethi , Shimada Ayako , Garber Greg D. , Leader Amy
Published: June 2022

12125

Background: While access to cannabis is prevalent among cancer patients1, unknowns persist about real-time use, perceived effectiveness in cancer pain management and impact on other medication use, including opioids. Moreover, racial disparities in cancer pain management persist2-3 with Black patients more likely to have undiagnosed pain.4 Studies on the intersection of cannabis, opioids, race and cancer pain are needed. As part of an NCI-funded initiative, we assessed the perceived effectiveness of cannabis vs. opioids for pain control by race. Methods: A survey was created by three Mid-Atlantic, cancer centers to examine self-reported cannabis use and knowledge, barriers and perceptions about cannabis among cancer patients. All sites assessed common core questions and included additional questions assessing cannabis and opioid use. Patients were eligible to participate if they were treated for cancer within the prior year. Surveys were distributed both by mail and electronically via REDCap. Results are compared separately by site. Results: In all, 2,734 patients are included in this analysis. Rates of cannabis use since diagnosis ranged from 32-41% of respondents, with similar rates of use between gender and race. Patients under age 65 more frequently reported cannabis use. Across sites, only 7-8% of patients reported currently using opioids. A sizable number patients who use cannabis reported using cannabis instead of opioids to treat pain. Of those using cannabis, most felt that cannabis was better in managing their pain than opioids, with Black patients reporting this much more frequently than White patients across two sites (Site A 62.2% vs 43.2%, Site B 77.78 vs 48.96%, Site C 50.0% vs. 65.5%). The most common reasons patients reported using cannabis instead of opioids included the perception that: “cannabis is safer” (80-82%), “cannabis is less addictive” (70-73%), and “cannabis has fewer side effects” (68-74%). Conclusions: Cannabis is frequently used by cancer patients, with many reporting use instead of opioids for pain management. Of those using cannabis for pain management, a significant majority felt that it is more effective than opioids. Black patients report cannabis as more effective than opioids for pain control more frequently than other races. Given the ongoing under-treatment of cancer pain in Black patients, more data is needed to understand whether cannabis is an effective tool to reduce disparities in cancer pain management. [Table: see text]
Delayed versus immediate start of chemotherapy in asymptomatic patients with metastatic cancer: A systematic review and meta-analysis.
Authors: Augustinus Simone , Thurairajah Gajanan , Besselink Marc G , Van Laarhoven Hanneke W.M. , van Oijen Martijn G.H. , Mackay Tara , Wilmink Johanna
Published: June 2022

12126

Background: The number of asymptomatic patients diagnosed with metastatic cancer is increasing. This is mostly due to increased used of imaging, especially for screening and during follow-up. Traditionally, chemotherapy is started immediately in these patients, but some argue that withholding chemotherapy until symptoms occur may be beneficial for patients, especially in terms of quality of life. However, the impact on survival and quality of life is unknown. The aim of this study is to give an overview of delayed versus immediate chemotherapy in asymptomatic patients with metastatic cancer. Methods: We systematically searched PubMed, EMBASE (Ovid), and Cochrane for studies investigating the timing of start of chemotherapy in asymptomatic patients with metastatic cancer. Primary outcome was overall survival (OS). Secondary outcomes included quality of life (QOL) and toxicity. A meta-analysis was performed on OS, including all studies that compared direct versus delayed chemotherapy. Quality of life was described using the global health status derived from the EORTC-QLQ-C30 questionnaire evaluated in the studies. Results: Four randomized controlled trials and one retrospective study with overall 919 patients were included. The studies considered colorectal cancer (n = 3), ovarian cancer (n = 1), and gastric cancer (n = 1). The median OS varied from 11.9 to 25.7 months in the immediate treatment group versus 9.0 to 27.1 months in the delayed group. A pooled analysis demonstrated no significant differences in OS between the groups (pooled HR 1.05, 95% CI 0.90-1.22, p = 0.52). Quality of life was evaluated in three studies and suggested a better QOL in the delayed treatment group. In two studies including colorectal cancer patients the global health status in the immediate treatment group was lower at all time-points compared to the delayed treatment group, with no significant differences in any of the separate domains. In the study evaluating ovarian cancer patients, among others, the time median time spent in good global health score was lower in the immediate treatment group. Toxicity was compared between the two groups in one study, and this showed no significant differences. Conclusions: This systematic review with meta-analysis on timing of start of chemotherapy in asymptomatic patients with metastatic cancer suggests that a delayed start of chemotherapy, as compared to immediate start, does not result in worse OS, while it may better preserve QOL. Future randomized trials, with specific emphasis on quality adjusted life years are needed.
Effects of a yoga intervention on distress indicators among diverse women with gynecologic, gastrointestinal, and thoracic cancers.
Authors: Hanvey Grace Ann , Padron Adaixa , Kacel Elizabeth L. , Bacharz Kelsey C. , Jones Dennie V. , Kaye Frederic J. , Markham Merry Jennifer , Estores Irene M. , Mesa Sonia , Pereira Deidre B.
Published: June 2022

12129

Background: Depression, anxiety, and fear of cancer recurrence (FCR) constitute prevalent psychological concerns necessitating further attention in developing supportive care interventions for women with gynecologic, gastrointestinal, and thoracic cancers. Recent evidence indicates that such concerns may be especially severe among underserved women of color and women affected by low-socioeconomic status (SES). The purpose of the present study is to evaluate the magnitude of changes in depression, anxiety, and FCR associated with a mindfulness-based yoga intervention among a diverse sample of women with these cancers. A second aim is to identify how changes in these concerns may differ across sociodemographic groups. Methods: Women with gynecologic ( n=86), gastrointestinal ( n=17), or thoracic ( n=20) cancers were enrolled in a group-based 10-week yoga intervention utilizing mindfulness meditation, relaxation, and gentle yoga. Prior to and following intervention, participants were administered assessments, including the Beck Depression Inventory – Second Edition (BDI-II) to measure depression, the State-Trait Anxiety Inventory (STAI) to assess anxiety, and the Fear of Cancer Recurrence Inventory (FCRI) to evaluate aspects of FCR. Mixed-linear models evaluated change in outcomes from pre- to post-intervention, with conditional models assessing the effects of age, race/ethnicity, and SES on change. Analyses were conducted prior to trial completion due to approaching accrual period termination. Results: The sample demonstrated a mean age of 58.46 ( SD=10.82) and mean SES score of 3.98 ( SD=1.55) using a 1 to 7 composite scale. Twenty-six percent of participants were of racial and/or ethnic minority status ( n=32). Significant declines in total depressive symptoms, somatic depressive symptoms, state anxiety, and psychological distress due to FCR were observed across the sample. Higher SES was associated with significantly greater reductions in total depressive symptoms and affective depressive symptoms, specifically. Women of color experienced significantly greater declines in somatic symptoms compared to non-Hispanic White women. Conclusions: This mindfulness-based yoga intervention was associated with significant reductions in depressive symptoms, state anxiety, and psychological distress related to FCR among women with gynecologic, gastrointestinal, and thoracic cancers. Higher SES and underserved race/ethnicity status moderated some of these effects. Future research should explore the efficacy of this intervention among diverse women in a randomized clinical trial context. Clinical trial information: NCT03385577.
A comparative study of unmet information needs of patients with lymphoma and CLL: North America and Europe.
Authors: Bamigbola Olufunmilayo (Funmi) , Warwick Lorna
Published: June 2022

12135

Background: Informed patients are consistently associated with better outcomes and overall patient experiences. However, there are still unknowns about the information needs of patients. This study uses the Lymphoma Coalition (LC) 2020 Global Patient Survey (GPS) on Lymphomas and CLL to describe the differences in the unmet information needs among patients with lymphoma and CLL in North America and Europe. Methods: Globally, 9,179 patients from 90+ countries took part in the LC 2020 GPS. The countries were grouped into regions, and the North American (NA) (n=1543) and European (EU) (n=4343) regions were used for this analysis (Table). The demographics of the regions were examined, and univariate, bivariate and multivariate analyses of questions relating to patients’ information needs, were performed in IBM SPSS v27. Results: When compared, the regions differed significantly in patients’ age distribution, lymphoma subtype, highest educational level completed, and area of residence. The top three areas of unmet information need for patients with lymphoma and CLL in both regions were: diagnosis and what it means, treatment options, and side effects from treatment. Compared to patients in the EU, patients in NA were 27% more likely to need more information about treatment options, 51% more likely to need more information about support for self-care, and 18% less likely to need more information about their diagnosis and what it means. These differences were statistically significant (Table). Patients from NA were 26% more likely to report that they had no informational needs compared to patients from EU (p=0.02) (Table). There was no significant difference between patients in both regions in their need for more information in the following areas: psychological support, support for their families, side effects from treatment and fertility (Table). Conclusions: Regardless of region, patients with lymphoma need more information about certain areas of their care than is currently provided. LC advocates for increased access to appropriate and adequate medical information for patients, and that this information be contextualized to the patient’s needs.[Table: see text]
Impact of oncology clinical pharmacist intervention on clinical trial enrollment in The U.S. Oncology Network’s MYLUNG Consortium.
Authors: Koselke Elizabeth , Hough Shannon , Howell Josh , Robert Nicholas J. , Neubauer Marcus A. , Bullock Susie A. , Walberg Jennifer M. , Rammage Melissa , Butrynski James E. , Hakimian David , Jotte Robert M. , Meshad Michael W. , Ali Kashif , Waterhouse David Michael , Coleman Robert L. , Evangelist Makenzi Colleen
Published: June 2022

1503

Background: The Molecularly Informed Lung Cancer Treatment in a Community Cancer Network: A Pragmatic Consortium (MYLUNG) clinical trial platform aims to advance the use of precision medicine in non-small cell lung cancer patients through a series of prospective and iterative clinic trials. “Protocol 2” is evaluating the patient and tissue journey of newly diagnosed lung cancer patients presenting for care. Timely patient accrual to oncology clinical trials is a known practice challenge. The US Oncology Network recently implemented a clinical pharmacist (ClinReview) to provide remote clinical services to support Protocol 2 enrollment. Methods: An oncology-trained clinical pharmacist remotely reviewed chemotherapy regimen orders and a weekly custom recruitment report within six community network practices (n = 149 physicians). The ClinReview pharmacist identified, screened, and assisted with recruitment of eligible patients for enrollment in the MYLUNG study. Relevant and concise patient data were provided to the on-site research team to facilitate ease of enrollment. Enrollments and intervention data were tracked to monitor the impact of the pharmacist intervention. The primary outcome of monthly enrollment was evaluated using a paired t-test. Results: Over a 6-month period, the ClinReview pharmacist screened 367 potentially eligible patients, 325 patients were recommended for enrollment, and 103 patients (32%) were consented and enrolled. Enrollment due to this ClinReview intervention increased monthly and ranged from 5 in first month to 33 enrollments in month 6. Average monthly enrollment was significantly greater after ClinReview intervention (3.4 patients/month vs. 6.8 patients/month; p = 0.008). Of the 154 patients recommended for enrollment that were not enrolled, 104 (68%) exceeded their eligibility window allowed by the trial, 15 (10%) were deceased or enrolled into hospice care, 10 (6%) declined trial participation, and 25 (16%) transferred care or were treated at outside facilities. Conclusions: We demonstrate that incorporation of an oncology clinical pharmacist in clinical research teams significantly enhanced clinical trial enrollment. The remote pharmacist easily adapted into clinic workflows in community practices. Validation across a broader spectrum of differentially resourced oncology practices will be conducted as the MYLUNG clinical trials platform is executed. [Table: see text]
Time to biopsy of screening mammography-detected abnormalities: Evaluating the impact of same-day services implemented during the COVID-19 pandemic.
Authors: Klinger Kimberly , Dontchos Brian , Mercaldo Sarah , Achibiri Janeiro , Wang Gary , Miles Randy , Lamb Leslie , Lehman Constance Dobbins
Published: June 2022

1511

Background: Screening mammography programs often require patients undergo multiple visits (screening exam, diagnostic exam, and biopsy) before tissue diagnoisis of screen-detected abnormalities. During the COVID-19 pandemic, same-day breast imaging services were leveraged to decrease the number of visits following abnormal screening exams. Specifically, in May 2020, we implemented an immediate-read screening mammography program to synergize with our pre-existing same-day breast biopsy program, such that every effort was made to perform diagnostic imaging during the same visit after an abnormal screening mammogram. This study aims to evaluate the impact of these same-day breast imaging services on time and number of patient visits to undergo breast biopsy after an abnormal screening mammogram. Methods: Consecutive screening mammograms performed during normal business hours pre- (6/1/16 to 5/30/17) and post-implementation (6/1/20 to 5/30/21) of same-day services were identified. Patient demographics, imaging and biopsy results, and visit dates were extracted from the medical record. Multivariable logistic, linear, and ordinal regression models estimated with generalized estimating equations were fit to assess the association of period (pre- versus post-implementation), patient age, and race and ethnicity (White versus races other than White) with having a same-day biopsy (biopsy on the same day as the abnormal screening exam), number of days to biopsy, and number of visits. Adjusted odds ratios (aOR) and beta estimates (aBeta) of each covariate and corresponding 95% confidence intervals (CI) were estimated. Results: A total of 409/25,922 (1.6%) of patients (median age 61, IQR 50-70) pre-implementation and 221/20,452 (1.1%) patients (median age 62, IQR 49-71) post-implementation had screen-detected abnormalities leading to diagnostic breast imaging and biopsy. Median number of days from screening to biopsy decreased from 16 days pre-implementation to 5 days post-implementation (p < 0.001). Pre-implementation, 86.8% of patients required 3 visits between screening and biopsy, while post-implementation only 23.1% required 3 visits (p < 0.001). Compared to pre-implementation, the post-implementation period was associated with increased odds of undergoing same-day biopsy (aOR 20.7, 95% CI 8.3-51.7), p < 0.001), fewer days from abnormal screening mammogram to biopsy (aBeta -13.3, 95% CI -15.7 to -10.9, p < 0.001), and fewer visits (aOR 0.05, 95% CI 0.02-0.09), p < 0.001), controlling for age and race and ethnicity. Conclusions: Same-day breast imaging services decreased time and patient visits between abnormal screening mammogram and breast biopsy. Same-day services implemented out of necessity during the COVID-19 pandemic should be continued after the pandemic has subsided to improve timeliness of care.
Preliminary analysis of an expanded access study of the fixed-dose combination of pertuzumab (P) and trastuzumab (H) for subcutaneous injection (PH FDC SC) for at-home administration (admin) in patients (pts) with HER2-positive (HER2+) breast cancer (BC) during the COVID-19 pandemic.
Authors: Dang Chau T. , Tolaney Sara M. , Riaz Fauzia , Tan Antoinette R. , Tkaczuk Katherine H. R. , Yu Anthony Francis , Liu Jennifer , Fung Anita M. , Yang Anna , Day Bann-mo , Rugo Hope S.
Published: June 2022

1515

Background: Standard of care for HER2+ early/first-line metastatic BC (EBC/MBC) is P + H and concurrent chemotherapy (CT); PH FDC SC offers faster, more convenient admin vs intravenous (IV) P + H. COVID-19 has caused unprecedented strain on healthcare systems and disruption to cancer care; treatment (Tx) at home may: enable pts to continue cancer Tx; reduce exposure to COVID-19; free up hospital resources. This study’s main objectives: to enable continuity of care during COVID-19; to assess safety of PH FDC SC given at home. Methods: This is an ongoing single-arm, hybrid, decentralized clinical trial (NCT04395508). Pts with HER2+ EBC/MBC who completed concurrent CT with P + H IV and are receiving/about to receive maintenance P + H IV, PH FDC SC, or H SC are switched to PH FDC SC given at home by a home health nursing provider (HHNP) until disease progression, unacceptable toxicity, pt withdrawal, or physician recommendation (pts with EBC will complete ≤18 cycles). The study endpoint is safety. A subset of pts took part in HARRIET, a substudy of at-home cardiac surveillance with artificial intelligence-guided cardiac ultrasound and optional 6L ECG acquired by an HHNP. Results: Data for 114 pts (1 male) were available at cutoff (Jan 19, 2022): 18 (16%) completed Tx; 20 (18%) discontinued; 76 (67%) remain on study; 79 (69%) had a COVID-19 vaccine while on study. Median age was 49 years; pts were balanced between EBC (n = 55, 48%) and MBC (n = 59, 52%); received a median of 6 (EBC) and 8 (MBC) cycles; and were from metropolitan (n = 109), urban (n = 4), and rural (n = 1) areas. 11 pts tested COVID-19-positive during the Tx phase: 8 continued Tx after appropriate COVID-19 Tx and/or quarantine. Safety is summarized in the table. No new adverse events (AEs) emerged due to home admin. AEs of special interest were grade (gr) 1–2: admin-related reactions (n = 76, 67%), hypersensitivity (n = 5, 4%), cardiac dysfunction (n = 4, 4%), except 1 case of gr ≥3 diarrhea. AEs leading to study Tx discontinuation or interruption/dose reduction occurred in 3 (3%) and 15 (13%) pts. A subset of 7 pts completed at-home cardiac surveillance testing; quantitative assessment of left ventricular ejection fraction was feasible in 3 (43%); 5 (71%) preferred at-home surveillance to clinic. Conclusions: In this preliminary analysis, safety of PH FDC SC at home was consistent with the established P + H safety profile, indicating that PH FDC SC at home is a viable option for continuing BC care during and beyond COVID-19. Clinical trial information: NCT04395508. [Table: see text]
Reducing inpatient mortality in patients with cancer through multidisciplinary review and targeted interventions.
Authors: Shah Manan P , Garrigues Sarah K. , Khaki Ali Raza , Hansen Jennifer , Divi Vasu , Blayney Douglas W.
Published: June 2022

1524

Background: Excess inpatient mortality is a marker of poor quality in cancer care. We developed a multidisciplinary mortality review committee to review each inpatient death to determine key drivers of mortality and develop targeted interventions to reduce our inpatient mortality index. Methods: Through retrospective review, inpatient deaths were identified at Stanford Health Care for patients with an ICD10 cancer diagnosis regardless of inpatient service. Details of each hospitalization were reviewed by a quality consultant and subsequently reviewed by a physician quality team member to identify opportunities for improvement. Most cases were then discussed in a monthly multidisciplinary committee meeting. The committee analyzed key drivers of inpatient mortality, communicated suggestions to the patient’s outpatient and inpatient attending physicians, and/or identified opportunities for systemic change. The resulting targeted interventions were tracked using the observed versus expected mortality ratio for inpatient deaths over time. Results: From May 2017 through August 2021 we reviewed 528 inpatient oncology deaths. Patients’ median age was 65 years, and the median length of stay was 8 days. 73% of patients had metastatic cancer, and 28% received chemotherapy within 14 days of death. 25% of patients had a prior ED visit, and 35% had a prior hospitalization within 30 days of admission. Only 26% of patients had an advanced directive on record at time of death. Opportunities for improvement were identified for 60% of cases (Table). Interventions have aimed to increase advance care planning conversations and documentation, develop predictive models for cancer-related readmissions and mortality, expand outpatient services for urgent symptoms, and expedite transitions to hospice. Conclusions: Understanding key drivers for preventable inpatient mortality through a multidisciplinary review process identified targeted interventions that have successfully contributed to reduction of the inpatient cancer mortality index.[Table: see text]