Diagnosed Cancer Patients Research Articles

Trajectories of Cognitive Function Prior to Cancer Diagnosis: A Population-Based Study.

An emerging body of research suggests that noncentral nervous system cancer may negatively impact the brain apart from effects of cancer treatment. However, studies assessing cognitive function in newly diagnosed cancer patients cannot exclude selection bias and psychological effects of cancer diagnosis. To overcome these limitations, we investigated trajectories of cognitive function of patients before cancer diagnosis. Between 1989 and 2013, a total of 2059 participants from the population-based Rotterdam Study were diagnosed with noncentral nervous system cancer. Cognitive assessments were performed every 3 to 5 years using a neuropsychological battery. The general cognitive factor was composed of individual cognitive tests to assess global cognition. Using linear mixed models, we compared change in cognitive function of cancer case patients before diagnosis with cognitive change of age-matched cancer-free control subjects (1:2). In addition, we performed sensitivity analyses by discarding assessments of control subjects 5 years before the end of follow-up to exclude effects from potential undiagnosed cancer. All statistical tests were two-sided. The Word Learning Test immediate recall declined faster among case patients than among control subjects (-0.05, 95% confidence interval = -0.09 to -0.01 vs 0.01, 95% confidence interval = -0.01 to 0.03; P for difference = .003). However, this difference was not statistically significant in sensitivity analyses. Furthermore, no statistically significant differences were observed in change of other individual cognitive tests and of the general cognitive factor. In this study, we evaluated cognitive function in a large group of cancer patients prior to diagnosis, thereby excluding the psychological impact of cancer diagnosis and biased patient selection. In contrast to previous studies shortly after cancer diagnosis, we found no difference in change of cognitive function between cancer patients and control subjects.

Self-reported and objective taste and smell evaluation in treatment-naive solid tumour patients.

Taste and smell abnormalities (TSA) commonly occur in cancer and are associated with anorexia, early satiety, malnutrition, weight loss and reduced quality of life. A recent study found a high TSA prevalence in newly diagnosed cancer patients before treatment. This suggests that TSA may originate from the tumour itself. No previous study has examined TSA, both subjectively and objectively, in newly diagnosed, treatment-naïve cancer patients. This study aimed to address this gap. This prospective observational study recruited consecutive, newly diagnosed, treatment-naïve patients with solid tumours at Radiation Oncology Out-patients. Self-reported taste and smell changes since becoming ill were evaluated using modifiedTaste and Smell Survey, and objective taste and smell tests were conducted using 'Sniffin' Sticks Olfactory Test® and Burghart Taste Strips®. Nutritional status was assessed with abridged Patient-Generated Subjective Global Assessment. Thirty completed the study. Seventy-four per cent had at least one TSA. Taste changes and/or abnormalities were more prevalent than smell, and subjective taste changes more common than objective abnormalities. Although less common, smell abnormalities impacted quality of life more. TSA characteristics were heterogeneous. Forty-seven per cent were at malnutrition risk. No association was found between TSA and nutritional status. Over two thirds had at least one TSA and almost half were at malnutrition risk. Self-reported TSA included changes in taste and smell perception, and most commonly persistent bad taste. This study demonstrated the complexity of TSA assessment and the prevalence, severity and impact of these and related symptoms in treatment-naïve cancer patients.

＜Editors' Choice＞ Renewed Japanese spirometric reference variables and risk stratification for postoperative outcomes in COPD patients with resected lung cancer.

ABSTRACTAlthough the lower limit of normal (LLN) of FEV1/FVC detects at-risk patients for postoperative outcomes among Japanese chronic obstructive pulmonary disease (COPD) patients with resected lung cancer, there was a lack of a Japanese reference equation to calculate the LLN of FEV1/FVC. Renewed Japanese spirometric reference variables might enable us to verify clinical impact of the LLN of FEV1/FVC among the Japanese population. To evaluate the clinical impact of the LLN of FEV1/FVC by using this renewed reference, data were retrospectively analyzed from 609 newly diagnosed lung cancer patients who had undergone thoracic surgery between 2006 and 2011. The combined assessment of the 0.70 fixed ratio and the LLN of the FEV1/FVC ratio classified the 609 subjects into the COPD (214 subjects), non-COPD (337 subjects), and in-between (58 subjects) groups, respectively. All of the relative odds ratios (ORs) of postoperative outcomes for the comparison between the in-between and non-COPD groups did not show significant confidence intervals (CIs). On the other hand, the adjusted ORs of postoperative outcomes for the COPD group versus the non-COPD group were 2.840 (95% CI: 1.824–4.421) for prolonged oxygen therapy (POT), 1.836 (95% CI: 1.166–2.890) for prolonged postoperative stays, and 1.637 (95% CI: 1.007–2.663) for combined complications. Adjusted comparisons of POT between the in-between and COPD groups also showed a significant relative OR of 2.984 (95% CI: 1.447–6.153). A standardized assessment of the LLN of FEV1/FVC by a renewed Japanese spirometric reference provides risk stratification for postoperative outcomes in the population.

Patient–physician relationship and use of gut feeling in cancer diagnosis in primary care: a cross-sectional survey of patients and their general practitioners

ObjectivesTo examine whether the quality of the patient–physician relationship, assessed by the general practitioner (GP) and the patient, associates with GPs’ use of gut feeling (GF) in cancer diagnosis.DesignCross-sectional questionnaire...

Prevalence and related factors of sarcopenia in newly diagnosed cancer patients.

Sarcopenia is defined as the loss of muscle mass and muscular functioning. Although sarcopenia prevalence is highly variable in the literature, pre-chemotherapy sarcopenia prevalence was not well studied in newly diagnosed cancer patients. In this context, the present study aims to determine the prevalence of sarcopenia and its related factors in this population. Prospectively, newly diagnosed cancer patients were evaluated for body composition measurement and muscle strength by employing the bioelectric impedance analysis method and handgrip dynamometer tool. A total of 461 patients were included in the study. The median age of patients was 59years (range 18-83) and 258 patients (56%) were women. Sarcopenia was present in 77 patients (16.7%) and was at significantly higher frequencies in men (p = 0.015), advanced age (≥ 65years, p = 0.014), lower body mass index (BMI < 25, p = < 0.001), and poor performance status (ECOG status > 0, p = 0.026). In multivariate analyses, advanced age (over 65years), gender (men), and lower body mass index (BMI < 25) were significantly associated with sarcopenia (p values 0.033, < 0.001, and < 0.001, respectively). Our study is the first prevalence study conducted with bioelectric impedance analysis on Turkish cancer patients and sarcopenia was detected to be notably prevalent among our patients with newly diagnosed cancer. Given the likely negative outcomes of sarcopenia reported in the literature (treatment failure, increased complications, and impaired survival), it is important to know the presence of sarcopenia before treatment and take preventive precautions.

Supportive oncofertility care, psychological health and reproductive concerns: a qualitative study.

Impaired fertility in cancer patients and survivors of reproductive age (15-45years) may lead to psychological distress and poor mental health outcomes, and may negatively impact quality of life. Limited research has focused on the fertility experiences of those who have had access to supportive oncofertility care. This study aims to explore the fertility-care experiences and reproductive concerns of reproductive age cancer patients at the time of their cancer diagnosis who have had access to oncofertility care. The qualitative data from a larger mixed method study is presented, comprising 30 semi-structured telephone interviews with newly diagnosed cancer patients across Australia and New Zealand, undertaken between April 2016 and April 2018. Interviews were undertaken with 9 male patients and 21 female patients aged between 15 and 44years. All patients recalled a discussion about fertility and majority underwent some form of fertility preservation. Thematic analysis identified five main themes: (i) satisfaction with oncofertility care, (ii) a need for individualised treatment and support, (iii) desire for parenthood, (iv) fertility treatment can be challenging, and (v) fertility preservation provides a safety net for the future. Participants who access supportive oncofertility care report low emotional impact of threatened future infertility at the time of cancer diagnosis. These results suggest that such services may assist in lowering the emotional burden of potential infertility in survivors. Long-term research is needed to assess the longitudinal benefits for different models of care.

PS1582 DECREASED PLATELET REACTIVITY IS ASSOCIATED WITH AN INFLAMMATORY STATUS IN PATIENTS WITH CANCER

Background:Decreased platelet reactivity was observed in cancer patients at high risk of venous thromboembolism (VTE) and death. Prothrombotic and inflammatory mechanisms have been suggested to cooperate in the development of VTE, representing represent the hallmark of thromboinflammation.Aims:To assess whether platelet reactivity is associated with inflammatory parameters in cancer patients.Methods:Platelet reactivity was determined by whole blood flow cytometry in 62 newly diagnosed cancer patients (median age [interquartile range, IQR]: 63 [54–70] years, 48 % female) at several time points during the first 6 months of chemotherapy (total number of samples analyzed: 179). We measured platelet surface P‐selectin and activated glycoprotein (GP) IIb/IIIa expression in vivo and upon ex vivo stimulation with agonists of protease‐activated receptor (PAR) −1, −4, and GPVI. C‐reactive protein (CRP) and fibrinogen levels were analyzed in plasma samples from the corresponding blood draws.Results:Platelet reactivity, as determined by percentage of platelets expressing activated GPIIb/IIIa on the surface, upon stimulation with different agonists, correlated with significantly lower levels of CRP and fibrinogen (Table 1). Platelet surface P‐selectin expression upon stimulation of the GPVI receptor also showed a significant inverse correlation with CRP and fibrinogen (Table 1). Platelet activation in vivo (i.e. without ex vivo agonist activation) did not correlate with CRP and fibrinogen levels (Table 1).Summary/Conclusion:Our data indicate that there is an inverse relationship between platelet reactivity and inflammatory status in cancer patients, whereby platelets of patients with increased inflammatory parameters are less reactive to stimulation with platelet agonists. Further research is needed to better understand underlying pathophysiological mechanisms.image

Patients preference in receiving phone call from oncologist after cancer diagnosis and before in person consultation.

e18044 Background: Diagnosis of cancer creates an emotionally challenging time for patients. Waiting period between receiving diagnosis, and formal consultation with an Oncologist is associated with fear, shock, and uncertainty. Understanding patients’ preferences during this sensitive period is essential in providing high quality care. We hypothesized that receiving a call from an Oncologist, while waiting for a formal consultation, would help patients cope with cancer diagnosis. Methods: To assess our hypothesis, we surveyed 171 patients across five Kaiser Permanente medical centers. All patients received a call from an Oncology navigator to onboard them, and assure completion of necessary tests before in-person consultation with Oncologist. Of the 171 patients surveyed, 61 patients received an additional call from their assigned Oncologist before a formal in-person consultation. To understand the impact of the call made by the Oncologist, a survey was administered to patients within a few weeks of consultation. The remaining 110 patients who only received a call from an Oncology navigator were also surveyed to determine if a call from an Oncologist before their consultation could have helped them cope better with their cancer diagnosis. Results: Approximately 45 % of surveyed patients (n = 171) preferred a call from an Oncologist before the formal consultation. Conclusions: Brief telephone contact by Oncologist before in-person consultation supports newly diagnosed cancer patients with high-levels of uncertainty and shock. A substantial portion of newly diagnosed cancer patients prefers to speak with an Oncologists in the days after receiving a cancer diagnosis, and those who do receive an Oncologist call, find it beneficial in coping with their diagnosis.[Table: see text]

Trends in the use of proton beam therapy among newly diagnosed cancer patients in the United States.

6551 Background: Proton Beam Therapy (PBT) is a potentially superior radiotherapy technology for tumors with complex anatomy surrounded by sensitive tissues and for childhood cancers where sparing surrounding normal tissue is better achieved than with photon radiotherapy. The first conditions for payment of PBT claims went into effect in 2009. In 2014, the American Society of Radiation Oncology categorized PBT clinical indications into Group 1, for which health insurance coverage is recommended, and Group 2, for which coverage is recommended only if additional requirements are met. Methods: We evaluated 21,920 newly diagnosed patients in the National Cancer Database (NCDB) who received PBT between 2004 and 2016. Joinpoint analyses were used to evaluate the Annual Percent Change (APC) in the number and characteristics of patients treated with PBT. Results: The number of patients treated with PBT in NCDB facilities increased from 1,114 in 2004 to 3,173 in 2016 (APC = 8.78, p &lt; .001), due mainly to increases in Group 1 cancers after 2010 (from 271 patients in 2010 to 1,124 in 2016, APC = 26.4, p &lt; .001). The number of Group 2 patients treated with PBT increased slower (from 937 in 2004 to 2,049 in 2016, APC = 6.1, p &lt; .05). Breast and prostate cancers were most common, although trends varied substantially by cancer site. Between 2010 and 2016, receipt of PBT increased for breast cancer patients from 40 in 2010 to 405 in 2016 (APC = 48.5, p &lt; .001), but decreased for prostate cancer patients from 1,205 in 2011 to 680 in 2016 (APC = -14.06, p &lt; .001). While most of Group 1 patients had private insurance coverage (59.3% of patients treated in 2016), Medicare was the most common primary insurance type among Group 2 patients (50% of patients treated in 2016). Conclusions: The number of newly diagnosed cancer patients treated with PBT has increased between 2004 to 2016 in the US, with a sharp increase for cancers with clinical indications for health insurance coverage since 2010. While most of these patients have private insurance coverage, the steady increase in the number of patients being treated with PBT for cancers with additional requirements for health insurance coverage is primarily in those with Medicare coverage.

Rising thyroid cancer incidence in Kerala: Is it real or over diagnosis?

e17589 Background: There has been an increase in the incidence of thyroid cancer in India and in high income countries. One of the reasons for this has been attributed to the large number of screening programs. Kerala state ranks second highest in the incidence of thyroid cancer in India. Screening provides the advantage of early detection of cancer and successful treatment but also tends to over diagnose. Methods: To study the trend of incidence of primary thyroid cancer among newly diagnosed cancer patients and its association with the mode of detection, we retrospectively reviewed hospital based cancer registry data of patients with thyroid cancer who were treated at AIMS (Amrita Institute of Medical Sciences), Kochi between 2004-2014. All patients who were newly diagnosed with primary thyroid cancer at our center or referred to us after initial surgery were included in this analysis. Patients with recurrent cancer/metastases were excluded. Results: We analyzed the records of 2,315 newly diagnosed thyroid cancer patients. Median age was 44.1yrs (range 13-90yrs). There were 619 males and 1696 females. Papillary type was the most common 85.8% followed by follicular type 7.4%. 1235 cases were operated at AIMS. 74 cases (3.2%) were diagnosed incidentally by Ultrasonography/PET scan/CT scan. All others (97% n = 2,245) presented with neck swelling. It was seen that the proportion of new cases of thyroid cancer among all new cancer cases was increasing serially from 4.6 % (n = 106, 95% 2004) to 7.4% (n = 195) to13.7% (n = 317, 2014). There was a significant increase in the number of cases of T1a and T1b at the time of diagnosis during the study period (n = 1235, p value &lt; 0.001 and p value for trend &lt; 0.001 respectively) which indicates that there was early diagnosis. 97% of the cases presented with thyroid related symptoms indicating that clinical presentation has still been the main mode of detection in our series. Conclusions: Our data shows that there may be a true increase in the number of cases of thyroid cancer as majority presented with clinical symptoms, except few detected incidentally. As it is a single institution based data we need further studies to see if over use of USG based imaging for any thyroid swelling is responsible for an apparent increase in the number of thyroid cancer cases.

Implementing smoking cessation within cancer treatment centres and potential economic impacts.

Although the health benefits of smoking cessation in newly diagnosed cancer patients are well established, systematic efforts to help cancer patients stop smoking have rarely been implemented in cancer centres. Starting in 2012, the 14 regional cancer centres overseen by Cancer Care Ontario in the province of Ontario, Canada began to screen ambulatory cancer patients for their smoking status, to provide smokers with advice on the health benefits of quitting and to offer referral to smoking cessation services. Multiple initiatives were undertaken to educate healthcare providers and patients on the health benefits of cessation. Critical to the success of the initiative was strong leadership from Cancer Care Ontario executives and regional vice presidents, advice from an advisory committee of smoking cessation experts, engagement of regional champions and support from a provincial secretariat. The quarterly review of performance metrics was an important driver of change. Most cancer centres now screen in excess of 75% of ambulatory patients but rates for the acceptance of a referral to smoking cessation services remain low (less than 25%). Introduction of an opt-out referral process appears to increase referral acceptance. Economic analyses suggest that smoking cessation is cost-effective in a cancer centre environment. Although there are barriers to the implementation of smoking cessation in cancer centres, it is possible to change the culture to one in which smoking cessation is considered part of high-quality treatment.

PCN164 BRCA MUTATION EPIDEMIOLOGY IN BREAST AND OVARIAN CANCER. IN PROSTATE AND PANCREATIC CANCER TOO?

Mutations in the breast cancer (BRCA) 1 and/or BRCA 2 tumor suppressor genes are risk factors for hereditary breast-ovarian cancer syndrome and are typically associated with these cancers. There is evidence of these mutations in two other cancer sites: prostate cancer and exocrine pancreatic cancer. BRCA 1/2 genes are drug targets for poly ADP ribose polymerase (PARP) inhibitors. This study aims to estimate the number of newly diagnosed cases of breast, exocrine pancreatic, ovarian, and prostate cancer with BRCA mutation. Medline was systematically searched for studies reporting the prevalence of deleterious germline or somatic BRCA 1/2 mutation in unselected breast, exocrine pancreatic, ovarian, and prostate cancer patients in seven countries. The prevalence of BRCA 1/2 mutations was determined in the newly diagnosed incident population, and in the early and advanced/metastatic stages. These BRCA 1/2 prevalence estimates were applied to Decision Resources Group’s (DRG) incident, early stage, advanced, and recurrent case estimates for each cancer site to determine the number of incident cases and first line drug-treatable patients with BRCA 1/2 mutation. In 2018, there were 62,000 newly diagnosed incident cases of breast, exocrine pancreatic, ovarian, and prostate cancer with BRCA 1/2 mutation. The average BRCA 1/2 mutation prevalence across the seven countries ranged from 3% in breast cancer to 12% in ovarian cancer. Prostate cancer accounted for nearly 50% of the incident cases. With screening in prostate cancer leading to a large proportion of cases diagnosed with early disease thus reducing the risk of recurrence, ovarian cancer cancers form the majority (30%) of the 22,000 first-line drug treatable opportunities. The BRCA 1/2 mutations are not just restricted to breast and ovarian cancer, and due to the high risk of prostate cancer, the majority of newly diagnosed cancer patients with this mutation are in fact prostate cancer patients.

PCN272 HUMANISTIC BURDEN OF BREAST, PROSTATE AND COLORECTAL CANCER IN JAPAN AND CHINA: A POPULATION BASED NHWS SURVEY

Recent GLOBOCAN statistics suggest breast, colorectal and prostate cancer among the top 5 most commonly diagnosed cancers worldwide. The objective of this study was to examine the humanistic burden of these cancers in Japan and China, especially, in terms of health-related quality of life (HRQoL) and work productivity and activity impairment (WPAI). This analysis utilized population-based Japan’s National Health and Wellness Survey (NHWS) for 2018 (n=30,000) and 2017 (n=30,001), as well as the China’s NHWS for 2017 (n=19,994) and 2015 (n=26,004). Demographic characteristics, HRQoL measured by SF-12v2/SF-36v2 and WPAI were assessed for the three cancer types (breast, colorectal and prostate) in China and Japan. Proportion of diagnosed cancer patients among self-reported patients were >80% in Japan and <55% in China for the three cancer types. Both in China and Japan, respondents without cancer had similar mental component score (MCS: 48.43 vs. 48.71), physical component score (PCS: 52.56 vs. 50.95) and WPAI (work productivity impairment: 20.09 vs. 22.47; activity impairment: 20.49 vs. 19.74). Interestingly, in China after adjustment of potential confounders, the differences in MCS and PCS between cancer and non-cancer respondents were clinically significant (greater than 3). The differences were greater than six for PCS for colorectal cancer patients and, MCS and PCS for prostate cancer patients. Ergo, the differences in MCS and PCS between cancer patients and non-cancer respondents were not clinically significant in Japan. However, cancer patients in China also had much lower HRQoL and higher WPAI, compared to cancer patients in Japan. Despite lower rate of self-reported diagnosis of breast, colorectal and prostate cancer, these 3 cancers caused significant humanistic burden in terms of the HRQoL and WPAI in China compared to Japan. Thus, compared to Japan, in China, there is a gap in the awareness of cancer and patient support, which needs to be addressed.

PCN318 REAL WORLD TREATMENT DATA BASED PROJECTION OF PATIENT NUMBER ELIGIBLE FOR IMMUNO-ONCOLOGY THERAPIES IN TAIWAN AND ESTIMATION OF TOTAL LIFE YEARS GAINED

PD1/PD-L1 blockers are regarded as new SoC for certain cancer types. We aimed to project the potential national number of cancer patients who would be eligible for PD1/PD-L1 inhibitors in Taiwan and also to estimate additional total life years gained with these therapies. The indications of PD1/PD-L1 inhibitors approved by Taiwan FDA as 07-09-2018 were reviewed to finalize the scope of projection. Newly diagnosed cancer patients were identified in the 2012-14 dataset of National Cancer Registry for these indications. Using the ID codes of these patients, their individual treatment history data was extracted from the 2012-15 dataset of National Health Insurance Database. Patient level data was analyzed to estimate the number of patients remained in each treatment line. The population census and historical growth rate of patient number was estimated and applied together with PDL1 prevalence rate for projection of eligible patient numbers. The reported incremental median overall survival gain for PD-1/PD-L1 inhibitors was applied accordingly to each projected patient number by indication to estimate the additional total life years gained. Based on the real world datasets, the annual number of patients who are eligible for PD1/PD-L1 inhibitors from 2019 to 2023 were projected to be 101 to 115 for MEL 1L; 1,200 to 1,520 for NSCLC 1L with TPS≥50%; 1,556 to 1,849 for NSCLC 2L; 1,440 to 1,574 for HNSCC 2L, 285 for GC 3L; and 152 to 193 for UC 2L. A total gain of additional 2,499 to 3,073 life-years was estimated for treatment with PD-1/PD-L1 inhibitors instead of chemotherapies for eligible patients in Taiwan. This study informs an annual total of 4,734 to 5,536 cancer patients who were estimated to be eligible for PD-1/PD-L1 inhibitors in Taiwan. This projection will be useful in future related research and policy planning such as resource and budget allocation.

Perceived cancer-related benefits of quitting smoking and associations with quit intentions among recently diagnosed cancer patients

One third of smokers diagnosed with cancer continue smoking, perhaps due to low perceived cancer-related benefits of cessation. To examine perceived cancer-related benefits of quitting among newly diagnosed cancer patients who smoke and associations with quit intentions, baseline measures from patients (N = 303) enrolled in a randomized controlled trial were analyzed using hierarchical regression models and bootstrapping. Higher perceived cancer-related benefits of quitting were associated with having a smoking-related cancer and less education. Perceived cancer-related benefits of quitting and quit intentions were positively correlated, particularly among patients with smoking-related cancers. For smokers with smoking-related cancers, perceived cancer-related benefits of quitting are correlated with quit intentions.

Giving Voice to Patient Values Throughout Cancer: A Novel Nurse-Led Intervention

ContextOptimal advance care planning allows patients to articulate their values as a touchstone for medical decision making. Ideally, this occurs when patients are clinically stable, and with opportunities for iteration as the clinical situation unfolds. ObjectivesTesting feasibility and acceptability in busy outpatient oncology clinics of a novel program of systematic, oncology nurse-led values discussions with all new cancer patients. MethodsWithin an institutional initiative integrating primary and specialist palliative care from diagnosis for all cancer patients, oncology nurses were trained to use specific questions and an empathic communication framework to discuss health-related values during outpatient clinic visits. Nurses summarized discussions on a template for patient verification, oncologist review, and electronic medical record documentation. Summaries were reviewed with the patient at least quarterly. Feasibility and acceptability were evaluated in three clinics for patients with hematologic or gastrointestinal malignancies. ResultsOncology nurses conducted 177 total discussions with 67 newly diagnosed cancer patients (17 with hematologic and 50 with gastrointestinal malignancies) over two years. No patient declined participation. Discussions averaged eight minutes, and all patients verified values summaries. Clinic patient volume was maintained. Of 31 patients surveyed, 30 (97%) reported feeling comfortable with the process, considered it helpful, and would recommend it to others. Clinicians strongly endorsed the values discussion process. ConclusionNurse-led discussions of patient values soon after diagnosis are feasible and acceptable in busy oncology clinics. Further research will evaluate the impact of this novel approach on additional patient-oriented outcomes after broader dissemination of this initiative throughout our institution.

Development and Psychometric Evaluation of the Cancer Health Literacy Scale in Newly Diagnosed Cancer Patients.

Health literacy (HL) influences a patient's comprehension and judgment of health-related information. A rigorous assessment tool is needed to screen for low HL in order to improve it. The aim of this study was to develop and validate the Cancer Health Literacy Scale (C-HLS). The framework of the C-HLS is based on the Levels of Prevention model. The scale items were developed according to Nutbeam's 3 constructs of HL. We employed several procedures to develop the C-HLS, including focus group interviews, item generation, the expert Delphi process, and face validity. Various types of analysis, including reliability and split-half reliability testing, confirmatory factor analysis, and criterion-related validity testing, were performed; receiver operating characteristic curve analysis was also performed to confirm sensitivity and specificity. There were 33 items included in the C-HLS for validation; 360 newly diagnosed cancer patients completed the survey. The administration time is only 10 to 15 minutes. Results showed that C-HLS had good reliability, split-half reliability, and validity. All confirmatory factor analysis model fit indices reached acceptable thresholds. The receiver operating characteristic curve analyses suggested that the C-HLS had an adequate combination of sensitivity and specificity to distinguish between high and low HL. The C-HLS is a reliable, valid tool capable of discriminating levels of HL in the assessment of cancer patients and does not have an excessive administration time. This scale can aid our understanding of HL in newly diagnosed cancer patients and can serve as a basis for providing individual care interventions.

Duration of anticoagulant therapy and VTE recurrence in patients with cancer

PurposeAnticoagulant therapy for at least 3–6 months is currently recommended for treatment of venous thromboembolism (VTE) in patients with cancer, but the optimal duration of treatment is unknown. This study examines the association between the duration of anticoagulation treatment and VTE recurrence in cancer patients.MethodsThe Humana claims database was used to identify newly diagnosed cancer patients who had their first VTE diagnosis between January 1, 2013, and May 31, 2015, and initiated injectable or oral anticoagulant therapy. Follow-up was calculated from the index treatment initiation to the end of eligibility or end of data (June 2015). VTE recurrence was defined as a hospitalization with a primary diagnosis of VTE. Cox proportional hazards models were used to evaluate the risk of VTE recurrence by duration of therapy in patients who discontinued therapy.ResultsThe study included 1158 patients. Compared to patients treated for 0 to 3 months, VTE recurrences were significantly lower among patients treated for 3 to 6, or over 6 months. After adjustment for baseline characteristics, patients treated for 3 to 6 months (HR [95%CI], 0.53; 0.37–0.76) and more than 6 months (HR [95%CI], 0.48; 0.34–0.68) were still significantly less likely to have VTE recurrences compared to patients treated for 0 to 3 months (both p < 0.01). Findings were similar using a VTE event definition that included outpatient visits.ConclusionsAmong newly diagnosed cancer patients with VTE, anticoagulant therapy lasting more than 3 months was associated with a lower risk of VTE recurrence.

Moving into the mainstream: healthcare professionals\u2019 views of implementing treatment focussed genetic testing in breast cancer care

A proportion of breast cancers are attributable to BRCA1 or BRCA2 mutations. Technological advances has meant that mutation testing in newly diagnosed cancer patients can be used to inform treatment plans. Although oncologists increasingly deliver treatment-focused genetic testing (TFGT) as part of mainstream ovarian cancer care, we know little about non-genetics specialists’ views about offering genetic testing to newly diagnosed breast cancer patients. This study sought to determine genetics and non-genetics specialists’ views of a proposal to mainstream BRCA1 and 2 testing in newly diagnosed breast cancer patients. Qualitative interview study. Nineteen healthcare professionals currently responsible for offering TFGT in a standard (triage + referral) pathway (breast surgeons + clinical genetics team) and oncologists preparing to offer TFGT to breast cancer patients in a mainstreamed pathway participated in in-depth interviews. Genetics and non-genetics professionals’ perceptions of mainstreaming are influenced by their views of: their clinical roles and responsibilities, the impact of TFGT on their workload and the patient pathway and the perceived relevance of genetic testing for patient care in the short-term. Perceived barriers to mainstreaming may be overcome by: more effective communication between specialities, clearer guidelines/patient pathways and the recruitment of mainstreaming champions.

Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infection Among Patients With Newly Diagnosed Cancer From Academic and Community Oncology Practices

Universal screening of patients with newly diagnosed cancer for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV is not routine in oncology practice, and experts disagree about whether universal screening should be performed. To estimate the prevalence of HBV, HCV, and HIV infection among persons with newly diagnosed cancer. Multicenter prospective cohort study of patients with newly diagnosed cancer (ie, identified within 120 days of cancer diagnosis) at 9 academic and 9 community oncology institutions affiliated with SWOG (formerly the Southwest Oncology Group) Cancer Research Network, a member of the National Clinical Trials Network, with enrollment from August 29, 2013, through February 15, 2017. The data analysis was conducted using data available through August 17, 2017. The accrual goal was 3000 patients and the primary end point was the presence of HBV infection (previous or chronic), HCV infection, or HIV infection at enrollment. Patients with previous knowledge of infection as well as patients with unknown viral viral status were evaluated. Of 3092 registered patients, 3051 were eligible and evaluable. Median (range) age was 60.6 (18.2-93.7) years, 1842 (60.4%) were female, 553 (18.1%) were black, and 558 (18.3%) were Hispanic ethnicity. Screened patients had similar clinical and demographic characteristics compared with those registered. The observed infection rate for previous HBV infection was 6.5% (95% CI, 5.6%-7.4%; n = 197 of 3050 patients); chronic HBV, 0.6% (95% CI, 0.4%-1.0%; n = 19 of 3050 patients); HCV, 2.4% (95% CI, 1.9%-3.0%; n = 71 of 2990 patients); and HIV, 1.1% (95% CI, 0.8%-1.6%; n = 34 of 3045). Among those with viral infections, 8 patients with chronic HBV (42.1%; 95% CI, 20.3%-66.5%), 22 patients with HCV (31.0%; 95% CI, 20.5%-43.1%), and 2 patients with HIV (5.9%; 95% CI, 0.7%-19.7%) were newly diagnosed through the study. Among patients with infections, 4 patients with chronic HBV (21.1%; 95% CI, 6.1%-45.6%), 23 patients with HCV (32.4%; 95% CI, 21.8%-44.5%), and 7 patients with HIV (20.6%; 95% CI, 8.7%-37.9%) had no identifiable risk factors. Results of this study found that a substantial proportion of patients with newly diagnosed cancer and concurrent HBV or HCV are unaware of their viral infection at the time of cancer diagnosis, and many had no identifiable risk factors for infection. Screening patients with cancer to identify HBV and HCV infection before starting treatment may be warranted to prevent viral reactivation and adverse clinical outcomes. The low rate of undiagnosed HIV infection may not support universal screening of newly diagnosed cancer patients.