Cancer Patients Receiving Radiation Therapy Research Articles

Development of a question prompt list for Indian cancer patients receiving radiation therapy treatment and their primary family caregivers.

We aimed to develop two question prompt lists (QPLs), one for Indian cancer patients undergoing radiation therapy and the second for their primary family caregivers. The study comprised three phases: (1) qualitative interviews with patients (n=65) and PFCs (n=39) to identify their information needs, queries and concerns regarding RT; (2) development of draft QPLs using conventional content analysis and translation into Hindi and Marathi using European Organisation Research and Treatment of Cancer guidelines; and, (3) A readability analysis, and acceptability study with patients (n=22), PFCs (n=26) and Radiation Oncology (RO) staff (n=20) exploring barriers to QPL implementation. Analysis in Phase I identified questions patients and PFCs asked or wanted to ask their physician. A list of 125 and 136 questions were generated for patients and PFCs, respectively. After five iterations, the draft QPLs were finalised, translated, and back-translated from English into Hindi and Marathi (Phase II). In Phase III, most patients and PFCs reported the QPLs were easy to read, they did not find it difficult to ask the questions, and the questions were not emotionally upsetting. Conversely, RO staff reported concerns that patients may find it difficult to discuss the questions with their physician. The study highlights the need to empower patients and PFCs to ask questions and for staff to feel comfortable answering them. Implementing physician-endorsed QPLs could achieve these aims.

The practical significance of using Canephron N medication for radiation cystitis prevention in patients undergoing radiation/chemoradiation therapy

Background. With increasing life expectancy in cervical cancer patients, new medical and social problems associated with radiation therapy become apparent.  The combination of radiation therapy and chemotherapy is an important therapeutic component in treatment of malignant neoplasms of the genital area in women, but the frequency and severity of side effects has been increasing. Radiation complications occur in 20–50 % of patients.  In 5 % of patients, they can represent a severe and potentially life-threatening condition. Prevention of negative effects on the genitourinary system in cervical cancer patients receiving radiation therapy on the pelvis is a matter of importance.Aim. To evaluate the clinical efficacy of a phytotherapeutic  preparation Canephron  N containing centaury, lovage root, rosemary leaves in the prevention of radiation cystitis during chemoradiotherapy in patients with advanced cervical cancer.Materials and methods. The study included 60 patients with locally advanced cervical cancer receiving radical chemoradiotherapy. The patients were divided into 2 groups: treatment  group consisting of patients receiving phytotherapeutic preparation Canephron N for prevention of radiation complications, and control group consisting of patients not receiving symptomatic treatment.  The treatment results were evaluated using questionnaires, clinical, laboratory and instrumental studies. The obtained data were compared with the results of treatment of the control group which were not prescribed a medication for prevention of urological complications.Results and conclusion. The use of Canephron N in accompanying therapy had significantly decreased the risk and incidence of radiation cystitis.

RNA N6-methyladenosine modification-based biomarkers for absorbed ionizing radiation dose estimation

Radiation triage and biological dosimetry are critical for the medical management of massive potentially exposed individuals following radiological accidents. Here, we performed a genome-wide screening of radiation-responding mRNAs, whose N6-methyladenosine (m6A) levels showed significant alteration after acute irradiation. The m6A levels of three genes, Ncoa4, Ate1 and Fgf22, in peripheral blood mononuclear cells (PBMCs) of mice showed excellent dose-response relationships and could serve as biomarkers of radiation exposure. Especially, the RNA m6A of Ncoa4 maintained a high level as long as 28 days after irradiation. We demonstrated its responsive specificity to radiation, conservation across the mice, monkeys and humans, and the dose-response relationship in PBMCs from cancer patients receiving radiation therapy. Finally, NOCA4 m6A-based biodosimetric models were constructed for estimating absorbed radiation doses in mice or humans. Collectively, this study demonstrated the potential feasibility of RNA m6A in radiation accidents management and clinical applications.

Analysis of Artificial Intelligence-Based Automated Phenotyping of Coronary Artery Disease Diagnoses for Patients who Received Radiotherapy for Thoracic Malignancies.

Coronary artery disease (CAD) is a critical risk factor and toxicity endpoint in thoracic radiation oncology. The recent advent of artificial intelligence (AI) algorithms - specifically natural language processing (NLP) - allows for automated extraction of this data from electronic health records (EHR) more efficiently and at scale. We report on the application and performance characteristics of an EHR-based automated phenotyping tool to a cohort of lung cancer patients receiving radiation therapy (RT). We applied to this radiation oncology use-case an AI-based disease phenotyping tool developed by other researchers for phenotyping CAD from the EHR. The CAD model was trained on 191,187 patients with at least one ICD code and validated with 158 gold-standard patients (Sensitivity: 73%, Specificity: 93%, PPV: 90%). NLP disease definitions were determined by UMLS and were employed with ICD codes through PheNorm classification method to create the phenotype algorithm (Yue et al., J Am Med Inform Assoc. 2018 Jan 1; 25(1):54-60). We applied the CAD phenotyping tool to two independent cohorts of RT treated lung cancer patients: 1) an annotated set of 677 patients who received RT from 1998 to 2014 and were studied in prior cardiac toxicity research; 2) an independent set of 209 patients who received RT from 1998 to 2018 and were annotated separately. Only 7.7% of the AI training population had a CAD diagnosis code, compared to 32.5% and 65.0% in the 677 patient and 209 patient cohorts, respectively. Validation of the AI predicted CAD is shown in the table below. Performance on the 209 patient cohort best matched the AI training set. The 677-patient cohort differed from the 209-patient cohort in that its CAD definition included patients with radiographic coronary artery calcifications, which accounted for the difference in cohort sensitivities, F-scores, and NPVs. The AI calculated CAD was somewhat accurate in detecting whether a patient had CAD and was very accurate in confirming no CAD. The differences in sensitivity and NPV reflect differences in defining CAD, but this study demonstrates the potential for automated AI-phenotyping to detect pre-treatment risk factors and cardiac toxicity events from the EHR.

Comparison and Breakdown of Cost in Head and Neck Cancer Radiation Therapy and Adaptive Replanning

Head and neck cancers pose a significant challenge to radiation oncologists due to several factors, including rapid shrinkage during radiation and patient weight loss. As the target and patient anatomy change, re-simulation and re-planning are often necessary, which precipitates additional time, resources, and cost. However, the true added cost of providing adaptive replanning for head and neck cancer patients receiving radiation therapy (RT) is often unknown. We hypothesize that adaptive replanning adds significant cost to treatment, primarily driven by the additional personnel time in the replanning process. The total costs of providing standard radiation therapy and treatment with adaptive replanning for head and neck cancer were calculated using time-driven activity-based costing. We created process maps for each step from consultation to end of treatment, utilizing data that included the space, personnel involved, equipment and supplies used, and time spent. Capacity cost rates were calculated for all resources using a combination of publicly accessible cost data, financial data from our institution, and time averages for each activity obtained from personnel interviews and clinical measurements. We included the following domains in our process maps: consultation, CT simulation, treatment planning, new treatment start, daily beam treatments, weekly on-treatment visits, CT Re-simulation, treatment replanning, and new start for replanned treatment. We found that the total cost for providing standard therapy was $12,216.39 US Dollars (USD), while the total cost of adaptive replanning was $14,705.14 USD, for a relative increase in cost of 20.4%. The most expensive factor for both treatment arms was the cost of daily treatments on the linear accelerator, representing 66.1% and 53.3% of the standard and adaptive replanning, respectively. The second largest driver of cost for both was weekly on-treatment visits with a physician, representing 11.37% and 9.45% of the total cost, respectively. Of the total cost difference between standard therapy and adaptive replanning, 64% was due to personnel costs, 27.9% was due to space/equipment costs, and 8.1% was attributable to material costs. We found that adaptive replanning increased the overall cost of radiotherapy for head and neck cancers by a significant amount. The additional personnel time with resim and replanning, as well as machine time on the CT simulator are the primary reasons for this increase. In addition, use of these resources represents an opportunity cost in the clinic. Opportunities to make adaptive replanning more cost-effective include incorporation of AI tools for volume delineation and/or treatment planning to reduce personnel time, as well as using daily cone beam CT images instead of a new CT simulation, when feasible.

PO-2303 Evaluation of physical activity in cancer patients receiving radiation therapy

PO-2303 Evaluation of physical activity in cancer patients receiving radiation therapy

Potential Benefits of Aloe vera and Raphanus sativus var. longipinnatus Gel for Prevention of Radiation-Induced Dermatitis in Head and Neck Cancer Patients.

The main therapy for head and neck cancer is radiation, and one of the toxic effects of radiation is radiation dermatitis. Aloe vera is a species of succulent plant of the genus Aloe, widely used in cosmetic and skin care products, as well as daikon (Raphanus sativus var. longipinnatus), which is high in antioxidants. The present study aims to evaluate the potential benefits of Aloe vera and daikon gel combination in head and neck cancer patients to prevent radiation-induced dermatitis. A cohort study was conducted with eligible subjects, all head and neck cancer patients receiving radiation therapy selected in consecutive sampling. Samples were divided into two groups; either received Aloe vera and daikon combination gel (study group) or baby oil (control induced dermatitis (RID) were observed. A total of 44 patients were grouped into intervention (Aloe vera-daikon gel) and control (baby oil) groups. After ten radiotherapies (RT) sessions, the intervention group had a lower percentage of grade 1 RID (35% vs. 91.7%, control: 65% grade 2 RID, P < 0.001). After 20 RT sessions, 40% had no dermatitis, while all patients had RID in the control group (P = 0.061). After 30 RT sessions, the intervention group had a lower RID grade overall (gr 0: 5%, gr 1: 85%, gr 2: 10%) compared to the control group (gr 1: 33.3%, gr 2: 54.3%, gr 3: 8.3%, P = 0.002). After 35 RT sessions, the intervention group also had a lower RID grade overall (gr 0: 5%, gr 1: 65%, gr 2: 20%, gr 3: 10%) compared to the control group (gr 1: 8.3%, gr 2: 37.5%, gr 3: 45.8%, gr 4: 8.3%, P < 0.001). The combination of Aloe vera and daikon gel showed promising results in reducing the severity of radiation-induced dermatitis for head and neck cancer patients.

Nomogram to Predict Radiation Enteritis in Cervical Squamous Cell Carcinoma.

To investigate the risk factors of radiation enteritis in patients with cervical cancer after radiotherapy. Retrospective analysis 90 cervical cancer patients receiving radiation therapy from January 2019 to May 2021 in Hefei Cancer Hospital, Chinese Academy of Sciences. The patients were divided into radiation enteritis group and control group according to the radiation enteritis, the continuous variable were analyzed by ROC to obtain the best truncation value, and univariate and multifactorial logistic regression models analyzed the independent risk factors for radiation enteritis in cervical cancer patients. Nomogram was constructed and evaluated based on independent risk factors. The radiation enteritis incidence rate was 35.56%. Univariate analysis found that hemoglobin (OR=4.25, 95% CI=1.43~13.73), albumin (OR=2.33, 95% CI=0.95~5.83), hypertension (OR=3.57, 95% CI=1.24~10.90), sigmoid colon V45(OR=0.41, 95% CI=0.15~1.03), external radiation dose (OR=0.45, 95% CI=0.18~1.08), age (OR=2.27, 95% CI=0.90~6.18), total T lymphocyte count (OR=2.4, 95% CI=0.97~6.29)(p<0.1) are risk factors for radiation enteritis. Multivariate logistic regression analysis found that hemoglobin (p=0.001, OR=13.22, 95% CI=3.03~72.65), albumin (p=0.003, OR=6.76, 95% CI=2.08~25.67), total T lymphocyte count (p=0.015, OR=4.79, 95% CI=1.45~13.38) were independent risk factors for radiation enteritis. Based on the above predictors, a nomogram model is established, and the area under the model fit, C-index, and ROC curve indicates that the model has good prediction efficiency and differentiation. Hemoglobin, albumin, and total T lymphocyte count are risk factors for radiation enteritis in cervical cancer patients under radiotherapy, the nomogram model based on the above risk factors has good predictive efficacy and can provide a reference for radiation enteritis prediction.

Fatigue among Cancer Patients Receiving Radiation Therapy in a Selected Hospital, Mangalore

Abstract Introduction Cancer is a group of diseases characterized by the uncontrolled proliferation of aberrant cells. Radiation therapy is one of the cancer treatments options. It uses high-energy waves to attack tumor cells, as well as adjacent cells. The majority of cancer patients report feeling tired at the start of treatment or after a few weeks of radiation therapy. It is one of the most disabling and ongoing side effects of anticancer therapy among cancer patients. As a result, cancer-related fatigue can be a troubling symptom for most people getting anticancer treatment which is commonly underdiagnosed by the health care team. This research study aids us in assessing fatigue in cancer patients who receive radiation therapy as a treatment. Materials and Methods A quantitative descriptive research design was used in this study to collect data from 138 cancer patients who were undergoing radiation therapy both inpatient and outpatient departments of the selected Medical College Hospital in Mangaluru. The samples for this study were chosen using a purposive sampling technique. Data were collected by administering baseline proforma and Fatigue Assessment Scale. Results Majority of the patients were experiencing substantial fatigue, that is, 105 (76.08%) of patients were experiencing fatigue, 8 (5.79%) were experiencing extreme fatigue. and only 25 (18.11%) were experiencing no fatigue. Mean percentage shows that the majority, that is, 57%, of the patients with cancer experience physical fatigue and 50.25% experience mental fatigue. There is no significant association found between fatigue and selected demographic variables except for marital status (p = 0.015). Hence H0 is accepted at 0.05 level of significance, except for one selected variable. Conclusion The present study concluded that fatigue is one of the common symptoms and adverse effects experienced among cancer patients who receive radiation therapy. Health care professionals should consider the impact of fatigue on the individual and effective fatigue management to be provided to improve the quality of life

Racial and Treatment Center Differences on Time to Treatment Initiation for Nonsmall Cell Lung Cancer Patients Receiving Radiation Therapy As an Initial Treatment.

Objective:Because time to treatment has been shown to be associated with increase in the risk of death for Non Small Cell Lung Cancer (NSCLC) patients, we examined the prevalence and magnitude of racial disparities in mean time to radiation therapy (TTRT) for Stage I-III non-small cell lung cancer patients across a variety of treatment facilities.Methods:Utilizing the United States National Cancer Database (NCDB), we determined differences in TTRT between different races and different treatment facilities.Results:Concordant with past research, we found that non-White patients and patients treated at academic facilities, regardless of race, have longer mean TTRT, and that racial disparities in TTRT extend across all treatment facilities (all p<0.05).Conclusions:These findings shed light on the potential presence of and impact of structural racism on patients seeking cancer treatment, and the need for further investigation behind the reasonings behind longer TTI for non-White patients. To elucidate the real-world applicability of these results, further investigation into the societal determinants that perpetuate disparity in time to radiation therapy, and potential interventions in the clinical setting to improve cultural and racial sensitivity among healthcare professionals is recommended.

Patients' Preferences for Androgen Deprivation Therapy in the Treatment of Intermediate-Risk Prostate Cancer.

This study demonstrates that prostate cancer patients receiving radiation therapy are reluctant to receive androgen deprivation therapy (ADT) most commonly due to anticipated fatigue and loss of libido/erectile dysfunction.Men who had received ADT reported they would require an average 8% absolute increase in survival to tolerate its side effects, whereas those who declined ADT would require an average 16% increase.Required thresholds are well above the estimated absolute survival benefit for ADT demonstrated in recent clinical trials, suggesting an unmet need for improved patient education regarding the risks and benefits of ADT.

A Comparison of Three Different Breath Hold Techniques Used for Reducing Cardiac Dose for Patients Receiving Left-Sided Breast Cancer Radiation Therapy

Purpose: Cardiac toxicity is a major concern for left-sided breast cancer patients receiving radiation therapy (RT). Different breath-hold techniques may be used to reduce cardiac dose including voluntary deep inspiration breath hold (vDIBH), the Elekta Active Breathing Coordinator (ABC), and the AlignRT system from VisionRT. The purpose of this study is to evaluate the differences in heart position and mean heart dose for these three techniques during RT of left-sided breast cancer patients.

Treatment-related communication experiences and expectations among Indian cancer patients receiving radiation therapy and their family members: A qualitative study

ObjectiveTo explore Indian cancer patients’ and their primary family caregivers’ (PFC) experiences and expectations of treatment-related communication with their physician while undergoing radiation therapy. MethodsParticipants, comprising patient-PFC dyads (n = 32), patients only (n = 33) and PFC only (n = 7), were recruited from one hospital in Mumbai, India. Semi-structured interviews explored participants’ perceived role in cancer-related decision-making, diagnosis and prognosis communication experiences with the physician, communication expectations of their treating physician, and information needs. Interviews were audio-recorded, transcribed verbatim, and analysed using the framework approach. ResultsMain themes included: (i) patients’ passive role in treatment communication, (ii) family as an integral part of the medical consultation, and (iii) dyads’ expectations and beliefs about the role of the physician. ConclusionIndian cancer patients played a passive role in treatment decision-making while physicians were seen as primary medical decision-makers. Further, PFCs provided the final consent for the treatment plan and acted as a mediator/moderator between the patient-physician. Practice implicationsThese findings suggest the need for (i) interventions such as question prompt lists that may improve patient activation and caregiver preparedness, and (ii) triadic communication training interventions for optimal communication between the three stakeholders (i.e., patient, physician and PFC).

Effectiveness of Gabapentin in Reducing Opioid Requirements after Radiation in Head and Neck Cancer in a Single Institution

<h3>Purpose/Objective(s)</h3> The national opioid epidemic has been an increasing health crisis over the last 3 decades. Head and neck cancer patients are at risk for chronic opioid use due to pain from their disease or treatment. Studies have evaluated the effectiveness of gabapentin to mitigate opioid use in this population. In this study, we aim to examine the efficacy of prophylactic gabapentin at our institution to reduce opioid use in head and neck cancer patients receiving radiation therapy. <h3>Materials/Methods</h3> A prospective cohort study of patients receiving radiation therapy (RT) for head and neck cancer was performed. Patients from a previous publication from our institution not treated with gabapentin were used as controls. Sociodemographic and clinical information was recorded, including if patients were taking opioids at 3 and 6-months after therapy, which was the primary endpoint of the study. Factors related to chronic opioid use were evaluated with univariate and multivariate analyses. <h3>Results</h3> In total, 185 patients met inclusion criteria, 53 being treated with gabapentin. Overall, 39.6% of patients taking gabapentin were using opioids at 3 months post-treatment vs. 58.3% in the non-gabapentin cohort (p= 0.021). There was no statistical difference between cohorts at 6 months. Gabapentin use was independently associated with less opioid use on multivariate analysis at 3 months, but not at 6 months (p=0.049, 95% CI 0.01-0.62). Gabapentin patients were 47% as likely to use opioids at 3 months (OR 0.47, 95% CI 0.24-0.9) than those not treated with gabapentin. Perineural invasion on pathology specimens was not significantly associated with opioid use in the gabapentin cohort. Gastrostomy tube dependence and pre-treatment opioid use were associated with chronic opioid use despite gabapentin treatment on both univariate and multivariate analyses. <h3>Conclusion</h3> Gabapentin is an effective medication at expediting opioid tapering in head and neck cancer patients who were not taking opioids pre-treatment or gastrostomy tube dependent. These patients are particularly high risk for chronic opioid use, and gabapentin treatment should be approached with caution as it is less likely to be effective, and these patients are at higher risk for medication abuse.

Effect of Radiation Treatment at a High-Volume Center on Outcomes in Intermediate-Risk Prostate Cancer: An Analysis of the National Cancer Database

ObjectiveTo investigate the effect of radiation treatment at a high-volume center on overall survival in men with intermediate-risk prostate cancer. MethodsFrom 2004 to 2015, 430,347 patients with intermediate-risk prostate cancer were identified in the National Cancer Database. Radiation case volume (RCV) of each hospital was calculated based on number of patients treated. After excluding certain patients including those with metastatic disease, our final analysis population included 116,091 intermediate-risk prostate cancer patients receiving radiation therapy or radiation with androgen deprivation therapy. Characteristics analyzed include age, race, distance to treatment facility, Charlson-Deyo Score, and socioeconomic factors. Primary outcome was overall survival (OS). Five-year survival rates were estimated using the Kaplan-Meier method. Adjusted hazard ratios with 95% confidence intervals were computed using multivariate analysis. Cox regression and propensity score-matched analysis was performed. ResultsMedian follow up was 63.5 months and estimated 5-year OS was 90.1% at high RCV centers and 88.2% at low RCV centers (P <.0001). Treatment at high RCV facility was associated with significantly lower mortality compared to treatment at a low RCV facility on multivariate analysis and propensity score matching analysis. The survival benefit of treatment at a high RCV facility remained when high RCV facilities were defined as those above the 80th, 90th, and 95th percentile in patient volume (P <.05). ConclusionTreatment at a high radiation case volume facility is associated with improved OS in patients with radiation-treated intermediate-risk prostate cancer. This survival benefit is important to consider when choosing a treatment center for radiation therapy.

Patient-reported outcomes version of the common terminology criteria for adverse events and quality-of-life linear analogue self-assessment in breast cancer patients receiving radiation therapy: single-institution prospective registry

Purpose/objectivesWe sought to investigate the impact of patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE) on overall quality-of-life (QOL) employing linear analogue self-assessment (LASA) in breast cancer (BC) patients undergoing radiation therapy (RT).Materials/methodsAll patients treated with RT for BC with curative intent from 2015 to 2019 at our institution were included. Breast specific PRO-CTCAE and overall QOL LASA questionnaires were administered at baseline, end-of-treatment, 3, 6, 12 months, and then annually. Minimal clinically important difference in overall QOL was a 10-point change in LASA. Hypofractionation was any treatment > 2 Gy per fraction. Mixed models for repeated measures were used to determine the association of PRO-CTCAE and overall QOL LASA.ResultsThree hundred thirty-one (331) patients with a median follow-up of 3.1 years (range 0.4–4.9) were included. Average overall QOL LASA scores were 78.5 at baseline, 79.8 at end-of-treatment, 79.8 at 3 months, 77.1 at 6 months, 79.4 at 12 months, and 79.7 at 24 months. On univariate analysis, patients reporting a grade ≥ 3 PRO-CTCAE had, on average, a 10.4-point reduction in overall LASA QOL (p < 0.0001). On multivariate analysis, not being treated with hypofractionation and higher BMI were predictive for worse overall LASA QOL with a 10-point reduction in LASA for patients reporting a grade ≥ 3 PRO-CTCAE (p < 0.0001).ConclusionsPatients reporting a grade ≥ 3 PRO-CTCAE experienced statistically significant and clinically meaningful deterioration in overall QOL LASA. Hypofractionation improved QOL while higher BMI predicted for worse QOL. PRO-CTCAE should be integrated into future clinical trials.

Effectiveness of Progressive Muscle Relaxaion Technique on Pain among Cancer Patients Receiving Radiation Therapy

Background: Pain in cancer may arise from a tumor compressing or infiltrating nearby body parts; from treatments and diagnostic procedures; or from skin, nerve, and other changes caused by a hormone imbalance or immune response. Progressive muscle relaxation technique, a complementary approach to pain relief, is a form of body work that focuses primarily on the feet. Methodology: A quasi-experimental study was conducted to evaluate the effectiveness of progressive muscle relaxation technique on pain among cancer patients receiving radiation therapy. Totally, 60 samples were selected by non-probability purposive sampling technique, among them, 30 were in the experimental group and 30 samples were in the control group. The investigator implemented progressive muscle relaxation technique for 15 days with the duration of 20–30 min. The level of pain was assessed using numerical pain intensity rating scale. The data gathered were analyzed by descriptive and inferential statistical method. Results: The finding revealed that, in the experimental group, the post-test mean score was 4.10 ± 1.63 and, in the control group, the mean score was 7.13 ± 2.11 with the mean difference of 3.03. The independent “t”-test value (t = 6.23) is highly significant. The paired “t”-test value (t = 8.24) revealed that progressive muscle relaxation technique was effective in reducing the pain. In the experimental group, there is a significant association found between the post-test level of pain and the variables such as age (χ² = 9.47), occupational status (χ² = 12.44), and stage of cancer (χ² = 9.83). Conclusion: The progressive muscle relaxation technique was effective in reduction of pain among cancer patients receiving radiation therapy

Predicting Feeding Tube Placement in Head and Neck Cancer Patients Receiving Radiation Therapy With Machine Learning

During radiation therapy (RT) for head and neck malignancies, patients often experience weight loss secondary to odynophagia, dysphagia, and dysgeusia, which may necessitate enteral nutrition. Prophylactic feeding tube (FT) placement in every patient is not cost effective, and the procedure is not without complications. Additionally, FT placement has been associated with significant delay in a return to a normal diet. Machine learning models may help facilitate early identification of patients requiring early FT placement, augmenting outcomes and quality of life in these patients.A retrospective cohort of 283 patients from a single institution were included that received definitive or adjuvant RT for head and neck cancer from 2016-2020, and that did not receive > 3 Gy/fraction or FT < 10 days after start of RT. The outcome predicted was FT placement or > 10% weight loss after start of RT if a patient declined FT recommendation. The majority of patients were ECOG 0-1 (51.5%), former/current smokers (67.5%), white (65.7%) and had oropharyngeal/nasopharyngeal disease (60.4%). Definitive chemoRT or RT was received by 91.5% of patients. One hundred twenty-seven patients either had a FT placed (majority) or had > 10% weight loss following the start of RT. Sixty percent of patients were used as training; 20% and 20% were used for validation and testing. Over 50 clinical features were obtained for each patient. Recursive feature analysis was performed to select top performing features in the validation dataset. Hyperparameters were selected for logistic regression (LR), support vector machine (SVM), and explainable boosting machine (EBM) models using Optuna. Separate models were created that used five, six, seven, and eight selected clinical features.The top performing 5-8 feature models for LR, SVM, and EBM are reported using test data as follows. The LR models obtained areas under the receiver operating curve (AUCs) of 0.653-0.685 with the following clinical variables: chemotherapy regimen, ECOG status, RT laterality (unilateral vs bilateral), ethnicity, T stage, smoking status, and pre-RT weight. The SVM models obtained AUCs of 0.530-0.669 with T/N stage, ethnicity, RT laterality, pre-RT pain medications, RT regimen, chemotherapy regimen, primary site, ECOG status, pre-RT weight. The EBM models obtained AUCs of 0.630-0.723 with chemotherapy regimen, T/N stage, RT laterality, RT regimen, gender, age, and ethnicity.The explainable EBM models outperformed LR and SVM models on the test set with consistent use of similar features within the 5-8 feature models. Clinical features most commonly utilized in the models were chemotherapy regimen, RT laterality, and ethnicity.

A Survey of Breast Cancer Patients’ Use of Cannabis During Radiation Therapy

Cannabis use is rapidly expanding and cancer is a qualifying condition in all 33 states allowing medical cannabis. However, the patterns of cannabis use among breast cancer patients receiving radiation therapy is unknown. The goal of this study was to better understand how and why cannabis is used among breast cancer patients undergoing adjuvant and palliative radiation therapy.Between 12/16/2019 and 1/19/2020, U.S.-based members of the Breastcancer.org Community (a nonprofit organization providing medical information and peer support) and Healthline, ≥ age 18 and diagnosed with breast cancer within 5 years, were invited to participate in a cannabis survey. After informed consent, anonymous data were collected and analyzed in aggregate. The study was led by Socanna (advancing the science of cannabis), conducted by Outcomes Insights, and supported by a grant from Ananda Health/Ecofibre.A total of 725 were screened and met eligibility criteria, of whom 612 subjects completed the survey. Overall, 42% (257/612) of participants had used medical cannabis products to relieve breast cancer symptoms or treatment side effects. Of the 120 respondents who received adjuvant radiation, 49% (59/120) used cannabis during breast radiotherapy; and 47% (14/30) used cannabis during palliative radiotherapy. Methods of cannabis product delivery were similar during adjuvant vs palliative radiation: edibles (75% vs 67%), liquids/tinctures (71% vs 83%), smoking (46% vs 47%), vaping (43% vs 43%), and pills/capsules/gel caps (18% vs 23%). Pain was the most common reason for using cannabis during adjuvant vs. palliative radiation treatment groups (77% vs 87%). Except for chronic pain (43% vs 67%, P < 0.05), no other pain subtype was statistically significantly different between adjuvant vs palliative care groups: acute pain (37% vs 47%), nerve pain (43% vs 57%), and joint/muscle aches/stiffness/pain (56% vs 60%). Pain was rarely the only reason for cannabis use, however. Other common symptoms for cannabis use during adjuvant vs palliative radiation included: insomnia (69% vs 77%), anxiety (58% vs 50%), stress (50% vs 43%), nausea/vomiting (47% vs 43%), and anorexia (38% vs 47%).Almost half of all participants reported using cannabis during adjuvant or palliative radiation to relieve breast cancer symptoms or treatment side effects, most commonly: pain, insomnia, anxiety, stress, nausea/vomiting, and anorexia. Patients undergoing palliative radiation were more likely to use cannabis to relieve chronic pain compared to patients undergoing adjuvant radiation. Both oral and inhalational methods of cannabis delivery were commonly utilized, regardless of stage. Although preliminary research shows that cannabis helps to relieve pain, nausea, insomnia and anxiety, safety studies are needed regarding the use of inhalational cannabis products during breast radiation, given the known risk of pulmonary toxicity from cigarette smoking during breast radiation.

Trends in Health Insurance Among Cancer Patients Receiving Radiation Therapy From 2008-2017

In 2010, the Affordable Care Act (ACA) was enacted, which allowed for increased access to health insurance in the US. Since then, there was a decrease in uninsured patients including those with cancer receiving radiation therapy. In 2017, federal policy was changed in regards to the ACA including a shortened enrollment period and significantly reduced funding. We aimed to determine trends in rates of uninsured patients receiving radiation therapy within this time period in order to identify correlations of these policy changes.We obtained data from the National Cancer Database (NCDB) Public Benchmark Reports from 2008-2017 to investigate trends in uninsured cancer patients who received radiation therapy. This data was stratified by all patients who received radiation therapy, and calculated percentages of those without insurance from the years 2008 to 2017. We then identified trends of uninsured status by race including White, Black, Hispanic, Asian/Pacific, Native American, and unknown.According to the data, the percentage of patients receiving any kind of radiotherapy without health insurance declined over the years of 2008 to 2016 (2.3% to 1.76%). In 2017, the trend reversed with 1.78% of patients without health insurance. The percentage of patients who were uninsured that identified as White was lower than the entire population, and also declined from 2008 to 2016 (1.73% to 1.12%). In 2017, the trend reversed to 1.18%. The percentage of patients who were uninsured that identified as Black was higher than the entire population, but also declined from 2008 to 2016 (4.2% to 2.92%). In 2017, this trend continued to decline to 2.69%. The percentage of patients who were uninsured that identified as Hispanic was the highest of any group at any year. This group had an initial increase in uninsured patients from 2008 to 2012 (7.35% to 10%), then decrease by 2016 (7.78%). By 2017, this trend reversed again with 8% of the Hispanic population to be reported as uninsured.In the last decade, there has been an overall trend towards less uninsured patients receiving radiation therapy in the United States, with the exception of 2017, which saw a slight increase, disproportionately affecting the Hispanic population. While it is uncertain as to whether federal policy changes in the promotion and administration of ACA affected these trends, this data mirrors observations in other series looking at un-insurance in cancer survivors. Further work is indicated to determine if this trend continues throughout the remainder of the past federal administration. In the meantime, it is essential to acknowledge the continued racial health disparities increase efforts in making access to cancer care more equitable.