tbuckley/cabot-search huggingface dataset:
Differences in rural versus urban cancer patients’ perception of care coordination.
Authors: Izumi Okado, Michelle Hashimoto, Randall F. Holcombe
Journal: Journal of Clinical Oncology (2020)

114 Background: Although advances in anticancer treatment have improved survival of patients with cancer overall, cancer mortality rates remain disproportionately high in rural areas. Disparities in rural cancer health outcomes are partially attributed to challenges with care coordination in rural areas. However, little is known about rural-urban differences in patients’ perception of cancer care coordination. In this exploratory study, we compared rural and urban cancer patients’ perception of care coordination (CC) using a Care Coordination Instrument (CCI), a validated self-report measure. Methods: We conducted a secondary analysis of cross-sectional survey data from two community-based cancer care delivery studies from 2018 and 2019 focused on cancer patients’ perception of CC. Patients receiving active therapy for any cancer completed a 29-item CCI. The CCI assesses overall perceptions of CC (Total) and across 3 domains: Communication, Navigation, and Operational. The rural patient cohort was derived from the American Cancer Society Hope Lodge Hawaii, which provides lodging for patients from neighbor islands (rural) receiving cancer care on Oahu (urban). The urban comparison group included patients residing on Oahu. Multivariate regression analyses were conducted to compare rural and urban patients’ perception of CC with adjustment for age, gender, and cancer type. Results: Data from 243 patients were analyzed; 23 (9.5%) were rural and 220 (90.5%) were urban. The rural and urban groups were similar with respect to patient demographics (age, gender) and clinical status. Rural patients reported significantly lower overall mean CCI scores than urban patients (54.7 vs 61.6; p = .02). Rural-urban differences in patients’ perception of CC were found for Communication (29.5 vs 35.1; p = .004) and Operational (19.7 vs 22.0; p = .02) domains. There were no rural-urban differences for Navigation. Conclusions: Our results demonstrate that rural patients had significantly poorer perception of care coordination overall than urban patients. Specifically, the observed rural vs urban differences in patients’ perception of care coordination were related to communication and operational challenges. Required coordination with a patient navigator to facilitate access to Hope Lodge may have confounded analysis in the Navigation domain. These findings highlight the need for interventions to address communication and operational CC challenges for rural patients in order to improve the quality of cancer care and reduce health disparities for rural cancer patients.
Association of State Medicaid Expansion With Racial/Ethnic Disparities in Liver Transplant Wait-listing in the United States
Authors: Lauren D. Nephew, Kelly Mosesso, Archita Desai, Marwan Ghabril, Eric S. Orman, Kavish R. Patidar, Chandrashekhar Kubal, Mazen Noureddin, Naga Chalasani
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Millions of Americans gained insurance through the state expansion of Medicaid, but several states with large populations of racial/ethnic minorities did not expand their programs. <h3>Objective</h3> To investigate the implications of Medicaid expansion for liver transplant (LT) wait-listing trends for racial/ethnic minorities. <h3>Design, Setting, and Participants</h3> A cohort study was performed of adults wait-listed for LT using the United Network of Organ Sharing database between January 1, 2010, and December 31, 2017. Poisson regression and a controlled, interrupted time series analysis were used to model trends in wait-listing rates by race/ethnicity. The setting was LT centers in the United States. <h3>Main Outcomes and Measures</h3> (1) Wait-listing rates by race/ethnicity in states that expanded Medicaid (expansion states) compared with those that did not (nonexpansion states) and (2) actual vs predicted rates of LT wait-listing by race/ethnicity after Medicaid expansion. <h3>Results</h3> There were 75 748 patients (median age, 57.0 [interquartile range, 50.0-62.0] years; 48 566 [64.1%] male) wait-listed for LT during the study period. The cohort was 8.9% Black and 16.4% Hispanic. Black patients and Hispanic patients were statistically significantly more likely to be wait-listed in expansion states than in nonexpansion states (incidence rate ratio [IRR], 1.54 [95% CI, 1.44-1.64] for Black patients and 1.21 [95% CI, 1.15-1.28] for Hispanic patients). After Medicaid expansion, there was a decrease in the wait-listing rate of Black patients in expansion states (annual percentage change [APC], −4.4%; 95% CI, −8.2% to −0.6%) but not in nonexpansion states (APC, 0.5%; 95% CI, −4.0% to 5.2%). This decrease was not seen when Black patients with hepatitis C virus (HCV) were excluded from the analysis (APC, 3.1%; 95% CI, −2.4% to 8.9%), suggesting that they may be responsible for this expansion state trend. Hispanic Medicaid patients without HCV were statistically significantly more likely to be wait-listed in the post–Medicaid expansion era than would have been predicted without Medicaid expansion (APC, 13.2%; 95% CI, 4.0%-23.2%). <h3>Conclusions and Relevance</h3> This cohort study found that LT wait-listing rates have decreased for Black patients with HCV in states that expanded Medicaid. Conversely, wait-listing rates have increased for Hispanic patients without HCV. Black patients and Hispanic patients may have benefited differently from Medicaid expansion.
A rare cause of dyspeptic symptoms and anaemia in a young man
Authors: Hareem Rehman, Shahab Abid, Naila Kayani, Ali Haroon
Journal: Gut (2020)

A 33-year-old male patient presented to our gastroenterology clinic, in January 2020, with complains of early satiety, regurgitation, heartburn and weakness for the past several months. He denied any complains of nausea, vomiting or weight loss. His past medical history was significant for a Heineke-Mikulicz pyloroplasty secondary to gastric outlet obstruction in 2004 at the age of 17 years, after which he remained relatively asymptomatic for 10 years. He had an unremarkable family history for autoimmune disease or gastric cancer.

In 2014, he developed anorexia, weight loss, weakness and numbness in the fingers, and was diagnosed with megaloblastic anaemia secondary to vitamin B12 deficiency. An endoscopy performed at that time revealed moderate-to-severe gastritis (figure 1A), and biopsy revealed atrophic gastritis. …
COVID-19: Staging of a New Disease
Authors: Carlos Cordon-Cardo, Elisabet Pujadas, Ania Wajnberg, Robert Sebra, Gopi Patel, Adolfo Firpo-Betancourt, Mary Fowkes, Emilia Sordillo, Alberto Paniz-Mondolfi, Jill Gregory, Florian Krammer, Viviana Simon, Luis Isola, Patrick Soon-Shiong, Judith A. Aberg, Valentin Fuster, David L. Reich
Journal: Cancer Cell (2020)
Trends in short-term, long-term, and high-risk opioid use among older cancer patients.
Authors: Mia A Salans, Paul Riviere, Lucas Vitzthum, Vinit Nalawade, James Don Murphy
Journal: Journal of Clinical Oncology (2020)

187 Background: While opioids represent a cornerstone of cancer pain management, the timing and patterns of persistent and high-risk opioid use in the context of the ongoing opioid epidemic are not well studied. This study sought to explore longitudinal trends in short-term, long-term, and high-risk opioid use among older cancer patients. Methods: Within a cohort of 84,994 Medicare beneficiaries ≥ 65 years old diagnosed with cancer between 2007 and 2013, we determined the likelihood of being prescribed an opioid after cancer diagnosis (0-6 months, 6-12 months, and 1-2 years post-diagnosis) and of receiving a daily morphine equivalent dose (MED) ≥ 200 mg, a dose associated with higher opioid-related mortality. Multivariable logistic regression models were used to identify patient and cancer risk factors associated with outcomes. Results: The rates of opioid prescription at 0 to 6 months, 6 to 12 months, and 1 to 2 years after diagnosis were 60.7%, 32.7%, and 38.2% respectively. Among patients who were prescribed an opioid, 4.0% received a MED ≥ 200 mg within 2 years of diagnosis. The likelihood of opioid prescription 0 to 6 months after diagnosis increased over the study period (OR = 1.05 per year, CI = 1.04 to 1.06), while the likelihood of opioid prescription 6 to 12 months (OR = 0.98 per year, CI = 0.97 to 0.99) and 1 to 2 years (OR = 0.98 per year, CI = 0.97 to 0.99) after diagnosis decreased over the study period. The probability of receiving a MED ≥ 200 mg decreased over the study period (OR = 0.98 per year, CI = 0.96 to 0.99). On multivariable analysis, Black (OR = 1.14, CI = 1.06 to 1.23) and American Indian/Native Alaskan (OR = 1.46, CI = 1.06 to 2.02) patients were more likely to receive opioids 1 to 2 years after diagnosis. Patients living in areas with higher rates of poverty (OR = 1.40, CI = 1.32 to 1.48) were also more likely to receive an opioid 1 to 2 years after diagnosis. Black (OR = 1.72, CI = 1.59 to 1.86), Asian (OR = 1.46, CI = 1.19 to 1.80), and Hispanic (OR = 1.36, CI = 1.23 to 1.51) patients were more likely to receive a MED ≥ 200 mg. Conclusions: While the rate of short-term opioid use is rising, rates of persistent and high-risk opioid use are declining among cancer patients. This may reflect growing awareness of the dangers of opioid misuse among clinicians treating patients with cancer. Nevertheless, racial and socioeconomic disparities in patterns of opioid use are persistent in the cancer population.
Moving palliative care upstream for patients diagnosed with head and neck cancers.
Authors: Tamara M Day
Journal: Journal of Clinical Oncology (2020)

227 Background: Adults with cancer face complex treatment choices and symptom burden that impact their quality of life. Goals of palliative care (PC) are to reduce symptom burden and improve quality of life. Strong evidence exists that PC helps reduce symptom burden, decreases hospital utilization, and improve quality of life. Yet, PC remains underutilized, especially in the context of cancer care. Methods: This descriptive longitudinal study evaluated whether use of a psychosocial distress screening tool would help identify patients eligible for PC. A convenience sample of adults with diagnosis of head and neck cancers presenting to an otolaryngology clinic, located in the cancer center of a Midwestern academic health system, were screened for eligibility for PC referral. If eligible, the provider was notified and introduced PC to the patient. Upon acceptance, a PC referral was ordered. The project consisted of baseline (n = 61) and follow-up chart reviews (n = 60) of patients seen in clinic during over a 3-month period. Results: We found an increase in PC referrals from 14.6% at baseline to 30.8% in follow-up, a 227% increase. Psychosocial distress screenings increased from 5% at baseline to 45% in follow-up, an increase of 200%. Of patients who received a PC referral, 85.6% accepted. There were statistically significant differences found between the pre- and post-intervention groups for marital status, χ2 (3) = 9.67, ( p = .02); and cancer stage χ2 (4) = 21.35, ( p = .00) with increased referrals for married patients at higher cancer stages in the prospective group. Conclusions: This study has shown physicians maybe more likely to offer PC referrals based on cancer stages, and not based on psychosocial distress symptoms. Potential barriers to early referral to PC were identified and could serve as useful information for future studies.
Effect of Tropisetron on Prevention of Emergence Delirium in Patients After Noncardiac Surgery
Authors: Yi Sun, Dandan Lin, Jing Wang, Mengwen Geng, Mei Xue, Yayun Lang, Lina Cui, Yanan Hao, Shanshan Mu, Dan Wu, Lirong Liang, Anshi Wu
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Postoperative delirium is a frequent disorder for patients undergoing surgery and is associated with poor outcomes. Delirium may occur in the immediate period after anesthesia administration and surgery. Tropisetron, which is frequently administrated for postoperative nausea and vomiting, is also a partial agonist of α7 nicotinic acetylcholine receptors associated with neuroprotective effects. Tropisetron may be the potential pharmacological treatment to decrease delirium after noncardiac surgery. <h3>Objective</h3> To perform a randomized clinical trial to determine the efficacy and safety of tropisetron for prevention of emergence delirium in patients undergoing noncardiac surgery. <h3>Design, Setting, and Participants</h3> This single-center, 2-arm randomized, double-blind, placebo-controlled trial will include 1508 patients undergoing noncardiac surgery. The intervention group will receive 5 mg of intravenous tropisetron before anesthesia induction, and patients in the control group will receive a placebo. The primary end point is the incidence of emergence delirium within 1 hour after tracheal tube removal, measured by the Confusion Assessment Method for the Intensive Care Unit score. The main secondary outcome is the incidence of postoperative delirium measured at 3 days of follow-up. An intention-to-treat principle will be used for all analyses. <h3>Discussion</h3> Delirium remains the most common neuropsychiatric complication for patients after surgery. This will be the first randomized clinical study to evaluate whether tropisetron is effective in preventing emergence delirium. Results from this study will provide evidence for alteration of daily practice. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT04027751
Psychosocial impacts of COVID-19 on oncology workforces: Metro versus regional Australia.
Authors: Elizabeth Stephanie Ahern, Harry Michael Gasper, Bryan Chan, Natasha Anne Roberts, Brett Gordon Maxwell Hughes, David Wyld, Glen Kennedy, Melissa A. Eastgate, Zarnie Lwin
Journal: Journal of Clinical Oncology (2020)

111 Background: The COVID-19 pandemic poses psychosocial challenges to the oncology workforce. We postulate that these impacts may affect the entire patient-facing workforce. Whether distress is different in varying settings (metro vs regional hospitals) is unknown. Methods: Cancer Care staff were approached via all-staff email for a weekly online survey administered at two hospital sites, Royal Brisbane and Women’s Hospital (RBWH) (metro) and Sunshine Coast Hospital and Health System (SCHHS) (regional). Surveys included Likert-scale items exploring perceptions of departmental preparation, COVID-19 related query burden and staff well-being, and distress thermometer derived from NCCN. Mean and 95% confidence interval were calculated, with non-parametric t-tests adjusted for multiple comparisons (Holm-Sidak); significance was deemed p &lt; 0.05. Results: 117 participants at RBWH and 59 at SCHHS consented. The survey opened April 3, 2020. Data is presented for the initial 6 weeks (COVID-19 preparation phase). Highest survey response was noted in week 1 (87%) and lowest at week 6 (36%). 65% unique responses were from RBWH. 60% participants worked in an outpatient setting, while 37% had inpatient care role. The remainder worked in either community-based or mixed settings. Significant heterogeneity was detected between sites (RBWH vs SCHHS) for some occupational roles: RBWH had more representation of administrative (19% vs 8%, p &lt; 0.001) and ancillary staff (2% vs 0%, p = 0.005) but SCHHS had more allied health (28% vs 17%, p = 0.005). Nursing and medical staff proportions at SCHHS and RBWH were similar (50% vs 45%, and 14% vs 18% respectively). Higher levels of distress were noted early; mean (95% CI) distress thermometer result (0-10) during week 1 was 4.7 (4.3-5.2) at RBWH and 4.9 (4.2-5.5) at SCHHS. Mean distress scores significantly reduced over time: correlative scores during week 6 were 3.2 (2.3-4.1) at RBWH and 2.5 (1.6-3.4) at SCHHS. Distress levels comparing RBWH with SCHHS were similar (p = 0.22-0.76). No significant difference was noted in staff perception of self-support comparing RBWH with SCHHS, and over 80% responders felt well-supported at work most, or all of the time. Concurrently, participants perceived that the Cancer Care department of their site was either “well” or “very well” prepared for COVID-19 over 85% of the time, with no difference between sites. Conclusions: High perceptions of support and preparedness were evident, with no regional difference. Distress scores reduced over time during the COVID-19 preparation phase, in the context of low COVID-19 rates.
MYD88 L265P elicits mutation-specific ubiquitination to drive NF-κB activation and lymphomagenesis
Authors: Xinfang Yu, Wei Li, Qipan Deng, Haidan Liu, Xu Wang, Hui Hu, Ya Cao, Zijun Y. Xu-Monette, Ling Li, Mingzhi Zhang, Zhongxin Lu, Ken H. Young, Yong Li
Journal: Blood (2020)

Myeloid differentiation primary response protein 88 (MYD88) is a critical universal adapter that transduces signaling from Toll-like and interleukin receptors to downstream nuclear factor-κB (NF-κB). MYD88L265P (leucine changed to proline at position 265) is a gain-of-function mutation that occurs frequently in B-cell malignancies such as Waldenstrom macroglobulinemia. In this study, E3 ligase RING finger protein family 138 (RNF138) catalyzed K63-linked nonproteolytic polyubiquitination of MYD88L265P, resulting in enhanced recruitment of interleukin-1 receptor-associated kinases and elevated NF-κB activation. However, RNF138 had little effect on wild-type MYD88 (MYD88WT). With either RNF138 knockdown or mutation on MYD88 ubiquitination sites, MYD88L265P did not constitutively activate NF-κB. A20, a negative regulator of NF-κB signaling, mediated K48-linked polyubiquitination of RNF138 for proteasomal degradation. Depletion of A20 further augmented MYD88L265P-mediated NF-κB activation and lymphoma growth. Furthermore, A20 expression correlated negatively with RNF138 expression and NF-κB activation in lymphomas with MYD88L265P and in those without. Strikingly, RNF138 expression correlated positively with NF-κB activation in lymphomas with MYD88L265P, but not in those without it. Our study revealed a novel mutation-specific biochemical reaction that drives B-cell oncogenesis, providing a therapeutic opportunity for targeting oncogenic MYD88L265P, while sparing MYD88WT, which is critical to innate immunity.
A geriatric assessment (GA) intervention for older patients with advanced cancer: Secondary outcomes from a University of Rochester cancer center NCI community oncology research program cluster randomized controlled trial (CRCT).
Authors: Supriya Gupta Mohile, Mostafa Mohamed, Huiwen Xu, Amita Patil, Eva Culakova, Erika E. Ramsdale, Kah Poh Loh, Allison Magnuson, Marie Anne Flannery, Nikesha Gilmore, Richard Francis Dunne, Spencer Obrecht, Sandy Plumb, Lisa M Lowenstein, Karen Michelle Mustian, Gary R. Morrow, Judith O. Hopkins, Rakesh Gaur, Jeffrey L. Berenberg, William Dale
Journal: Journal of Clinical Oncology (2020)

33 Background: GA evaluates aging-related domains (e.g., function) known to be associated with cancer treatment toxicity. We found that providing a GA summary with management recommendations to oncologists reduces clinician-rated toxicity in older patients (pts) with advanced cancer receiving high risk treatment (presented @ASCO2020). Herein, we report secondary outcomes on the effects of the GA intervention on aging-related outcomes. Methods: Pts aged ≥ 70 with incurable solid tumors or lymphoma and ≥ 1 impaired GA domain starting a new treatment regimen were enrolled. Community oncology practices were randomized to intervention (oncologists received GA summary/recommendations) or usual care (none given). Secondary analyses examined effects of the intervention on functional outcomes (patient-reported falls, instrumental activities of daily living (IADL), short physical performance battery (SPPB), geriatric depression scale (GDS), and medications [total and prescription]). Outcomes were analyzed using linear mixed effects model, logistic or Poisson regression adjusted for baseline values, time, and site effects as appropriate. Results: From 2013-19, 718 pts were enrolled from 41 practices. Age (mean 77 yrs), sex (43% women), number of impaired GA domains (median 4/8), and treatment type (chemotherapy 88%) were not different by arm. More pts in intervention were black (12% vs 3%, p&lt;0.01), had GI cancer (38% vs 31%, p&lt;0.01), and had prior chemotherapy (31% vs 23%, p=0.02). Overall, 16.4% of all pts had one new fall over 3 months; patients in the intervention arm were significantly less like to fall over 3 months (11.7% vs 20.7%; Risk Ratio 0.58; 95% CI 0.40-0.84, p=0.004). There was no difference in the total number of medications (mean 5.86 vs 5.79, p=0.80) and prescriptions (mean 4.26 vs 4.20, p=0.70) at baseline. More medications (adjusted mean 0.23 vs 0.09, p=0.03) and prescriptions (0.19 vs 0.07, p=0.05) were discontinued during intervention, although there was no difference at 3 month follow up. There were no significant between-arms differences in IADL, SPPB, and GDS. Conclusions: Providing GA information to oncologists reduces the proportion of older pts who experience a fall over 3 months and improves polypharmacy; both of these endpoints are of clinical importance to older adults with aging-related conditions and advanced cancer undergoing palliative treatment. Funding: R01CA177592, U01CA233167, UG1CA189961. Clinical trial information: NCT02054741 .
RELEVANT study: Patient (Pt) and physician (PI) perspectives on meaningful outcomes in advanced pancreatic ductal adenocarcinoma (PDAC).
Authors: Rille Pihlak, Melissa Frizziero, Soo Yit Gustin Mak, Christina Nuttall, Angela Lamarca, Richard Hubner, Janelle Yorke, Juan W. Valle, Mairead Geraldine McNamara
Journal: Journal of Clinical Oncology (2020)

150 Background: PDAC is an aggressive cancer with median overall survival (OS) ~6 months (m). Methods: Pts with advanced PDAC due to start first-line chemo (Chx) completed 1 study survey and 2 quality of life (QoL) questionnaires (QLQ-C30 and PAN26) on 3 time-points: baseline (T1), before (T2) and after (T3) their 1st on-treatment CT scan, PIs filled in paired surveys T1/2/3. Results: 71 Pts and 12 PIs were recruited. 4% Pts died/deteriorated between consent and T1, 28% between T1 - T2 (~2.3m later), 13% between T2 - T3 (~1.3m), only 55% reached T3. 49% Pts preferred to share decision making with their PI, 31% Pts preferred to make the final decision about treatment after considering PI opinion. 86% Pts had personal goals to reach (12% PIs knew of these). 70% Pts were aware that Chx was unlikely to cure cancer however, they had much higher expectations than PIs (%, Table). Choosing between treatment options Pts prioritised: 54% OS, 26% balance between side-effects (SEs) and OS, 15% could not choose and 5% symptom control. These did not match with PIs (p&lt;0.001). Pts who prioritised OS had higher symptom burden (p=0.03). OS was different in these Pts: who prioritised symptom control- OS 2.8m from T1, OS priority- 6.4m, could not choose- 8.7m and balance priority- 9.2m (p=0.01). At T1 Pts had low QoL (57/100, higher better). ‘Future worries’ and ‘planning of activities’ were scored the worst (58 and 56/100, lower better). Clinically significant (+/- 10p) worsening between T1/2/3 were: PF (10p), nausea/vomiting (NV, 12p), body image (18p p=0.01), taste (25p p=0.002). Financially 29% Pts were “a little/ lot” out of pocket at T1, 41% at T2 (p=0.036), 42% at T3 (p=0.034). Acceptability of SEs showed that least acceptable SEs (ranked 1-10, 10-least) were the ones Pts were already struggling with: NV (ranked 9/10, 46p/100 on QLQ), diarrhoea (8/10, 45/100); fatigue (less acceptable T3 (p=0.05), 46/100); appetite loss (7-8/10, 47/100). In contrast, most Pts (97%) were willing to take few/medium and around 50% large amount of SEs as a trade-off for extra time, whilst 9% PIs thought that Pts would accept excess SEs (p&lt;0.001). Conclusions: Pts worry about future, have high symptom burden and high expectations of Chx. Pts want to be involved in decisions, but the contrasting views between Pts and PI show differing aims. [Table: see text]