bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse health effects of opioids in survivors of breast cancer after active cancer treatment.
Authors: Haque Reina , Chen Lie H. , Shi Jiaxiao , Gu Zheng , Brady-Rogers Moira , Chlebowski Rowan T. , Hechter Rulin 
Published: June 2023

e24145 Background: Limited data exists about the effects of opioid use in breast cancer survivors post-treatment. Thus, we examined the risk of adverse events associated with opioid use among breast cancers survivors after active cancer treatment. Methods: We assembled a cohort of women diagnosed with in situ, localized, and regional breast cancer 2009-2019 within a large integrated healthcare system in southern California. Data were captured from the tumor registry, electronic health records, and pharmacy database. We examined opioids use in women with breast cancer after one-year post survival and followed them through December 2021. Opioid use after the first prescription was considered. We examined the risk of incident cardiovascular events (stroke, acute myocardial infarction, arrhythmia); lung problems (COPD, pneumonia); fractures; and falls requiring medical attention. Follow-up was censored at membership disenrollment, death, or study’s end (12/31/2021). We calculated the maximum daily morphine milligrams equivalent (MME) dose during follow-up. Incidence rates (per 1000 person-years, PY) of adverse events were calculated, and multivariable analyses were conducted to estimate hazard ratios (HR) associated with time-dependent opioid use based on Cox proportional hazards models. We adjusted for age; breast cancer surgery; adjuvant cancer therapies; BMI; comorbidity; demographics; and psychiatric drugs. Results: The cohort included 33,989 breast cancer survivors (mean age: 62 years, range: 22-106), followed a maximum of 12 years (median: 5.6 years). The cohort was diverse: 12% African American/Black; 14% Asian/Pacific Islander; 22% Latine; 51% White, and 1% other/mixed. A total of 20,311 women (60%) used opioids during follow-up. The median MME during follow-up was 43.0 (IQR: 30.0-75.0). Falls were the most common event, with a dramatically higher rate for opioid user (47.0/1,000 PY) than non-use (21.8/1,000 PY), corresponding to nearly a doubled risk of falls (adjusted HR = 1.8, 95% CI:1.6-1.9). Similarly, adjusted HRs (95% CIs) for lung problems (HR = 1.6, 1.4-1.7); fractures (HR = 2.1, 2.0-2.3); and CV events (HR = 1.6, 1.3-2.0) were all higher for opioid use. Conclusions: Over 60% of breast cancer survivors used opioids post active treatment. We found statistically significant 1.6-2.1-fold increased risks of adverse events (falls, lung problems, fractures and CV events) associated with opioid use. Clinicians must weigh the risk and benefits of treating pain with opioids post-treatment.
D-CRSE: Diminishing chemotherapy related side effects through patient education.
Authors: Dailey Hannah , Labe Shelby A. , Jones Gavin , Bhasker Joanna , Kanwar Rhea , Hafiz Sonia , Crago Madison , Fitzgerald Britney , Mikhail Daniella , Zhu Junjia , Vasekar Monali K. 
Published: June 2023

e24148 Background: Patient (pt) education materials regarding self-management of cytotoxic chemotherapy related side effects are lacking at Penn State Cancer Institute (PSCI), resulting in patients using disreputable sources. We created a brochure that educates patients on common side effects, tools to address the problems themselves, information on when to contact their oncologist, and guidance on when to visit the ED. The aim of our pilot study is to evaluate the feasibility at PSCI and subsequently improve pt related outcomes and quality of life through pt education. Methods: Chemotherapy naïve pts with breast or gastrointestinal (GI) cancer were enrolled from November 2021-December 2022. At the baseline visit, pts were consented, given the brochure and asked to complete surveys. The Emotional Thermometer Scale (ETS) evaluates mental health, measuring distress, anxiety, depression, and anger while the Memorial Symptom Assessment Scale (MSAS) evaluates symptoms commonly seen with chemotherapy. MSAS means were also broken down into physical, psychological, and global distress index (GDI) subsets. Pts filled out the same surveys at their 6 and 12 week visits to assess change over time. Results: 40 pts completed the baseline surveys, and 36 of them had at least one additional visit. Some key demographics were: 82.2% female, 17.8% male, 22.2% GI cancer (71.4% colonic adenocarcinoma, 14.3% rectal adenocarcinoma, 14.3% anal squamous cell carcinoma), 77.8% breast cancer (81.8% ductal carcinomas, 9.1% lobular carcinomas, 9.1% invasive metaplastic carcinoma, 52.5% ER+, 42.5% PR+, 22.5% HER2+), and 27.5% of patients underwent concurrent therapies with chemotherapy. Table 1 summarizes the mean score comparisons from baseline to 6 and 12 weeks for the ETS and MSAS. We observed significantly decreased psychological symptoms at week 12 compared to baseline (p = 0.023), while physical symptoms did not change significantly (p = 0.21). Conclusions: We successfully conducted a pilot study distributing a standardized educational brochure, thus demonstrating feasibility of this intervention. Measured psychological symptoms decreased over time, while physical symptoms did not, which aligns with side effect progression from cumulative chemotherapy burden. We plan to expand standardized pt education materials to other cancer types, incorporate digital educational tools, and further explore pt education barriers. Clinical trial information: NCT04694794 .[Table: see text]
Symptom burdens in long-term survivors of gynecologic cancer receiving acupuncture care.
Authors: Daugherty Christopher K. , Hanold Kathleen J. , Hlubocky Fay J. 
Published: June 2023

e24152 Background: Gynecologic cancer survivors (GCS) experience physical and emotional symptom burdens (SB) due to advanced, recurrent disease and intensive treatment often requiring supportive, complementary/integrative therapies. Yet, limited evidence exists on which specific SB require attention and intervention. This study aimed to identify demographics and SB of GCS referred for outpatient acupuncture services at a U.S. cancer center. Methods: A retrospective analysis was conducted of GCS actively receiving outpatient acupuncture services at the University of Chicago Supportive Oncology Program between March 2021 and June 2022. A brief self-reported SB assessment using a 0-10 Likert rating scale was completed at each acupuncture treatment. Socio-demographic (age, religion), disease information (stage) and SB (pain, insomnia) information was obtained from the medical record. Descriptive statistics were analyzed and paired sample t-tests evaluated SB differences prior to first and final treatment. Results: Eighty-three percent (54 of 65 referred) GCS received outpatient acupuncture care. Seventeen percent (11 of 65 referred) were unable to seek acupuncture due to disease progression leading to referral for end-of-life care (e.g. hospice, home palliative care). The mean age of GCS receiving acupuncture was 60y (range 30-81); 97% Non Hispanic, 65% White; 32% African American; 58% married; 53% with children; 65% Christian; 59% retired/on disability. Fifty percent of GCS had endometrial dx, 47% ovarian; 95% Stage IV; mean 7y since dx (range = .6-20y); 88% lacked advanced directives (e.g. DNR). Seventy percent completed at least four weekly acupuncture treatments. Prevalent SB were fatigue (94.1%), sleep disturbance (88.3%), pain (88.2%), anxiety (82.6%); and neuropathy (52.9%). On average, elevated SB mean scores were fatigue, numbness, anxiety, and hot flashes. Neuropathy was scored as the most severe (≥8 of 10). No significant improvement in SB was identified at the third treatment (p = 0.10). At the sixth session, GCS reported significantly less pain (p = 0.02). SB change was both statistically and clinically significant in 61-73% GCS at last session, except nausea. Only 0-5% of GCS reported worsening SB after acupuncture. Conclusions: Our results suggest acupuncture may aid in GCS SB control serving as a useful adjunct during cancer treatment and beyond. Early acupuncture referral may benefit GCS coping with SB during the cancer trajectory and is warranted. Future research should use a longitudinal prospective cohort design with validated SB measures.
Incidence patterns and clinical implications of venous thromboembolisms (VTE) in patients (p) with neuroendocrine tumors (NET).
Authors: Hernando Jorge , Roca Maria , Garcia-Alvarez Alejandro , Serradell Sonia , Garcia-Burillo Amparo , Casteras Anna , Molero Xavier , Merino-Casabiel Xavier , Landolfi Stefania , Blanco Laia , Navales Ignacio , Diez Iratxe , Salcedo Maria Teresa , Simo Marc , Sanchez Jose Luis , Castro Sandra , Eremiev Simeon , Alvarez Raquel , Vazquez Anna , Capdevila Jaume 
Published: June 2023

e24155 Background: Venous Thromboembolisms (VTE) is a common complication in cancer patients (p) and one of the lead causes of cancer-related death. Digestive neoplasms have specific characteristics in VTE incidence and treatment. There is a lack of data regarding VTE impact in p with neuroendocrine tumors (NET). Currently few studies have addressed VTE in NET, with an estimated incidence of 7.5%. Nevertheless, there is no evidence from large datasets to address specific implications of thrombosis in NET p. In the present study, we review incidence and treatment of VTE in NET in a large unicentric cohort. Methods: Consecutive p with gastroenteropancreatic (GEP) and thoracic NET treated in our institution were reviewed to study incidence of VTE including deep vein thrombosis (DVT), pulmonary embolisms (PE) and splanchnic venous thrombosis (SVT). Information regarding clinical characteristics and VTE treatment were collected. Results: 212 p were included in the analysis (38% Female; 42% Pancreatic, 35% Small Intestine, 6.5% lung). 50p presented any kind of thrombotic event (23.5%), and 23 were directly related to TNE (10.8%). Considering 23p with TNE-related VTE (82.3% Male; 82.3% Pancreatic), main origins included: SVT 11p (47.8%) and PE 7p (30.4%). Leading cause of SVT was splenic vein thrombosis. 80.9% of VTE cases received anticoagulant therapy, most of them with low-molecular weight heparin (82.6%) and indefinitely duration (58.8%). All cases that did not started anticoagulant therapy were splenic vein thrombosis due to physician decision. Any complication related to anticoagulant therapy was described in 5p (26.3%). No cases of VTE-related death were found. Conclusions: Patients with NET have a moderate risk of VTE events. Splenic thrombosis is the most common location but need of anticoagulant therapy in those cases remains controversial. Specific studies regarding VTE in NET population are needed.
A retrospective chart review of palliative care consultation during curative-intent chemoradiation for head and neck cancer.
Authors: Rizwan Farsha , Davella Christopher , Albert Madeline , King Traci , Egleston Brian L. , Galloway Thomas James , Chwistek Marcin , Fang Carolyn Y , El-Jawahri Areej , Bauman Jessica R 
Published: June 2023

e24165 Background: Head and neck cancer (HNC) treatment with chemoradiation therapy (CRT) is highly morbid. Patients develop significant symptoms including severe pain, dysphagia, and malnutrition resulting in poor quality of life (QOL), frequent hospitalizations, and high rates of depression. Although integration of palliative care (PC) teams into the care of incurable cancers has resulted in improved QOL, less is known about its integration into the care of patients receiving curative-intent treatments. We sought to characterize the use of PC during HNC CRT at a single cancer center. Methods: We performed a retrospective chart review of patients who received curative-intent CRT for HNC from 1/2008 to 1/2019 at Fox Chase Cancer Center. We excluded patients with metastatic disease or who participated in a PC intervention study. Data extracted included: demographics, comorbidities, cancer subtypes, human papilloma virus (HPV) status, inpatient admissions, feeding tube use, pain medication usage, and PC referrals throughout CRT. We used parametric and non-parametric statistics for hypothesis testing. Results: A total of 332 patients were included; median age was 60, 73% were male, 57.8% had oropharynx HNC, 10.2% had a history of chronic pain, and 18.9% had a psychiatric diagnosis. At the start of treatment, 38.5% of patients were on opioids for cancer pain or chronic pain, which increased to 90.7% of patients by the end of CRT. Six months after CRT, 30% of patients remained on opioids. 44.7% of patients required a feeding tube and 51.4% were admitted to the hospital. Despite the significant symptomatology, only 64 patients (19.2%) were referred to PC during treatment. The patients referred to PC were more likely to be younger (p=0.002), have an inpatient admission during treatment (p=0.001), a history of a psychiatric disorder (p=0.001) or substance abuse (p=0.003), and less likely to have HPV-related HNC. Conclusions: A large majority of patients receiving CRT for HNC faced significant pain with a high hospitalization rate, yet few had the expertise of PC involved in their care. Those who were referred to PC were more likely to have pre-existing substance use or chronic pain. These data provide strong rationale for the development of standardized, PC-based interventions to help with the symptomatology of HNC treatment to better serve this high needs population. [Table: see text]
Timing of specialized palliative care integration and its impact on quality of end-of-life care indicators among Latin American cancer patients.
Authors: Dias e Silva Douglas , Melo Ferreira Vanessa , Swerts Diego Belandrino , Eleoterio Giulia Nicolucci , Takahashi LIlian Tamy , Nogueira Camila Viale , de Souza Polianna Rodrigues , Moura Fernando , Araujo Sergio Eduardo Alonso , Uson Junior Pedro Luiz Serrano , Prado Bernard Lobato ,   Oncology and Hematology Department
Published: June 2023

e24168 Background: Prior studies have shown that specialized palliative care (SPC), when integrated early during the disease trajectory, improves the quality of end-of-life care among advanced cancer patients. However, those studies were conducted in large academic cancer centers in developed countries, where the availability of human and structural SPC resources is extensive. Little is known about how the timing of SPC may affect end-of-life quality care indicators in other settings of the globe. We aimed to examine the timing of SPC over a 4-year period and how it was associated with ASCO end-of-life quality care indicators. Methods: Retrospective cohort study of all adult cancer patients referred to the SPC team and who died at Hospital Israelita Albert Einstein, Sao Paulo, Brazil, between April 2017 and April 2021.Data onpatient demographics, clinical characteristics, timing of SPC integration as measured as the median interval between first SPC consult to death (SPC1-D), and ASCO end-of-life quality care indicators were retrieved. Results: Among 292 deceased cancer patients (52% female; median age = 67; 70% ECOG ≥3), the median SPC1-D interval was 24 days. There was a decrease in SPC1-D interval in the pandemic years (April 2017 through March 2018 = 27 days; April 2018 through March 2019 = 39 days; April 2019 through March 2020 = 23 days; April 2020 through April 2021 = 15 days; p = .02). 164 (56%) had an SPC1 < 30 days before death. Patients who had an SPC1 > 30 days before death were less likely to receive chemo and targeted therapy within the last 30 days of life (Table 1). Conclusions: Integration of SPC occurred late, especially during the pandemic years. Nevertheless, earlier SPC1 improved treatment aggressiveness in end-of-life. Further efforts are needed to enhance early SPC referrals in resource-limited settings.[Table: see text]
Use of medical cannabis in cancer-related symptons: A systematic review.
Authors: Sette Claudia Vaz De Melo , Schoueri Jean Henri , Cubero Daniel De Iracema Gomes , Del Giglio Auro 
Published: June 2023

e24170 Background: Medical cannabis’ (MC) use is increasing due to its alleged potencial effects amongst various diseases. In this sense, there are many papers trying to demonstrate its benefits in cancer-related symptoms (CRS). However, few randomised controlled trials (RCT) were done to date. This systematic review (SR) aimed to evaluate the eficacy of MC in CRS. Methods: We performed a SR acordding to PRISMA guidelines based on PUBMED, EMBASE, LILACS and WEBScience platforms seaching for RCTs using the following terms: medical cannabis OR cannabinoids OR dronabinol OR tetrahydrocannabinol OR AND nausea OR vomiting OR chemotherapy OR cancer OR pain OR cachexia OR anorexia. We included trials from January 2010 to January 2023 that evaluated the association between MC and CRS. Results: We found 2097 abstracts, of which 304 were RCTs. After excluding the ones that did not meet the inclusion criteria, repeated articles and non-published trials, we ended up with 9 papers. Most of these studies used oral sprays combination of CBD/THC and the results are heterogeneous as displayed in table 1. Conclusions: MC may have a potencial effect in CRS, however more RCTs are needed for current literature presentes low quality evidence for its use. Up to now, there is no clear data to encourage its use.[Table: see text]
Exploring the reproductive and sexual health concerns of young adults with cancer.
Authors: Menon Surabhi , Levine Jennifer 
Published: June 2023

e24176 Background: Young adults (YA) with cancer face unique challenges due to their developmental stage at the time of diagnosis/treatment. In the limited number of studies that have looked at reproductive and sexual health among YA being treated for cancer, YA expressed a need for increased communication and guidance in these areas. There is inadequate insight into the extent of sexual and reproductive concerns YA have and the substance of related counseling patients have received in the past, if any. As survivorship rates improve in this age group the need to address reproductive and sexual health as a part of comprehensive cancer care increases. Methods: This was a cross sectional study via a one time survey created on REDCap. Eligibility included diagnosis of malignancy (lymphoma, leukemia, breast cancer, or testicular cancer) between ages 18-39, less than 5 years from therapy completion. Eligible participants were identified via an i2b2 filter on Epic. Enrolled participants completed an online survey that focused on their concerns surrounding sexual health, fertility, contraception, the HPV vaccine, and any counseling they received in those areas. Questions regarding patient demographics, diagnostic, and treatment information were included. Results: The survey was completed by 23 patients (126 eligible, 52 contacted after permission given by the primary oncologist). Patients were 52% female, 73% non-Hispanic/Latino. 57% were between ages 18-24 at diagnosis and the most common cancer for females and males were lymphoma and testicular cancer respectively. 57% of patients stated they had questions about sexual activity during their cancer diagnosis and treatment, 35% recalled having a discussion with a provider. 60% of patients said cancer affected their sex life, with over 80% of those stating it was a net negative effect. 82% of patients had questions about fertility, and 87% had a discussion with a provider. 24% had questions about contraception with 43% having a discussion. 43% of patients were unsure if there was any conversation about the HPV vaccine. Conclusions: YA cancer patients seem to have many questions surrounding sexual and reproductive health. The biggest discrepancy between questions had and conversations had was specifically in the area of sexual health. Future research should delve into the content of the questions and how providers can better address sexual health in a standard manner. Most patients who had questions concerning fertility report they did have some discussion, although satisfaction varies. The majority of patients said cancer negatively affected their sex life, but it is yet to be determined if this affects overall quality of life and if providers can help. The lack of HPV vaccine counseling should be further explored.[Table: see text]
Types of work young adults perform to adjust to a cancer diagnosis and treatment.
Authors: Ghazal Lauren Victoria , Iannarino Nicholas , Cyers Josephine 
Published: June 2023

e24179 Background: Patients and their caregivers perform work (i.e., demanding and arduous labor that takes resources and coordination to address) to manage their illness, relationships, and lives. A growing body of psychosocial research has investigated the communication work performed by young adults (18-39 years old at diagnosis; YAs) and their caregivers as they adjust to cancer treatment and survivorship. However, to our knowledge, no studies have examined how the four types of work identified through Theory of Illness Trajectories (i.e., everyday, illness-related, biographical, and communication) interact within cancer survivorship. Thus, the study purpose was to investigate how and why YAs describe their efforts to manage life along the cancer trajectory as work or labor. Methods: We conducted a qualitative secondary analysis leveraging three separate qualitative interview datasets that sought to describe and explain similar psychosocial aspects of the YA cancer experience. Two specific interview questions: 1) “What advice would you give to another person your age who received a similar diagnosis?” and 2) “What did you learn from your cancer experience that you wish you knew when you were diagnosed?” shaped our thematic analysis. We applied the Theory of Illness Trajectories in the open coding phase, where everyday-life work referred to recurring existing responsibilities (e.g., employment, childcare); illness work related to cancer-management tasks like taking medication and seeing physicians; biographical work involved one’s cognitive efforts to reconstruct their identity, and communication work involved the demanding use of communication to manage identities, share information, or solicit support. During axial coding, each author reviewed one-third of the data individually, making note of units that could be classified as themes related to each type of work. Results: A total of 112 participants completed qualitative interviews across the three studies. Most (71%) were female, and mean age was 26 years. Most received a diagnosis of lymphoma (33.0%), leukemia (17.9%), and breast cancer (11.6%). Data analyses are still ongoing; we are currently meeting regularly to reach consensus on our axial codes. Our final abstract will include findings from our selective coding phase, which will allow us to examine comparisons and interactions between types of work. Conclusions: Additional goals of our innovative qualitative secondary analysis are to a) to identify the most salient subtypes of biographical, illness-related, everyday, and communication work in the YA cancer context and b) to better understand how the four types of work described by theory of illness trajectories interact and whether they facilitate or hinder the performance of additional types of work.