Diagnosed Cancer Patients Research Articles

Diagnostic values of microRNA 27a in breast cancer patients

Breast cancer is one of the most malignant tumors in women across the globe. Diagnosis of breast cancer at early stages is essential to improve treatment outcomes and decrease mortality rates. There is a pressing need for new non-invasive biomarkers to improve early diagnosis of breast cancer. This study aims to assess plasma miR-27a for the early diagnosis of breast cancer. miR-27a was evaluated in a total of 95 blood samples, 40 newly diagnosed cancer patients, 20 patients with benign breast lesions, 20 females with positive family history for breast cancer and 15 apparently healthy controls, using quantitative real time polymerase chain reaction. Our results exhibited significantly higher expression level of plasma miR-27a in breast cancer patients (median= 8.3 and 19 fold change for early and late stages respectively) compared to controls, high risk group and benign group with (P <0.001) for each. Plasma miR-27a was significantly higher in late breast cancer (median=19 fold change) compared to early breast cancer (median= 8.3) with (P <0.001). There was no statistically significant difference of plasmamiR-27a levels in benign group (median=1.8 fold change) compared to both control group and high risk group. There was no statistically significant difference of plasma miR-27a levels in high risk group (median= 1.2 fold change) compared to control group (median= 1 fold change). We performed Receiver Operating Characteristic (ROC) analysis for discriminating malignant from non-malignant cases. Plasma miR-27a yielded an area under the curve (AUC) of 0.983 with sensitivity 97.5%, specificity 91% and accuracy 94%.We concluded that miR-27a expression level represents sensitive and specific non-invasive molecular biomarkers for diagnosis of breast cancer.

Healthcare Costs Associated with Venous Thromboembolism in Cancer Patients Treated with Anticoagulants

Introduction: Venous thromboembolism (VTE) is highly prevalent in patients with active cancer and is associated with higher healthcare costs. Although LMWH is currently recommended for the treatment of VTE in cancer patients, oral anticoagulants warfarin and rivaroxaban are commonly used for treatment. Recent evidence among Medicare cancer patients with VTE showed that rivaroxaban is associated with lower healthcare costs than LMWH and similar costs to warfarin. This study compares healthcare costs of cancer patients treated with rivaroxaban or warfarin and LMWH in younger patients from a commercial insurance claims database.Methods: Medical and pharmacy claims from the Truven Health Analytics MarketScan databases in 1/1/2013 - 9/30/2016 were analyzed. Newly diagnosed cancer patients aged ≥18 were selected if they had a first VTE (deep vein thrombosis (DVT) or pulmonary embolism (PE); excluding upper VTE) diagnosis occurring within 30 days prior to or any time after their first cancer diagnosis and ≥1 dispensing of an anticoagulant agent within 7 days after their VTE diagnosis. Based on the first anticoagulant agent received, patients were classified into one of the following cohorts: LMWH, warfarin, or rivaroxaban. The warfarin cohort included patients who started LMWH and warfarin within 7 days of their first VTE. Inverse probability of treatment weights (IPTW) based on propensity score were used to adjust for differences between treatment cohorts. Baseline characteristics were evaluated during the 6-month period prior to the index VTE. VTE-related costs were identified with a primary or secondary diagnosis of DVT or PE, and were evaluated for the entire follow-up period, starting from the initiation of the anticoagulant therapy until end of eligibility or end of data, whichever was earlier. Healthcare costs per-patient-per-year (PPPY) were evaluated and compared using mean cost differences (CD). Significance in cost differences between cohorts and 95% confidence intervals (CI) were estimated using nonparametric bootstrap procedures.Results: A total of 12,457 patients (LMWH: N=4,313; warfarin: N=4,774; rivaroxaban: N=3,370) were included. After weighting the cohorts, baseline demographic and clinical characteristics were well balanced. The mean age of patients ranged from 61.3 to 63.6 years and approximately half of all patients were women. Across cohorts, 25%-28% of patients were diagnosed with PE, 47%-48% were diagnosed with DVT, and 24%-27% were diagnosed with both PE and DVT. Between 71% and 76% of patients had their first VTE within one year of their cancer diagnosis. At first cancer diagnosis, 80%-82% of patients had solid tumors. The percent with cancers at high-risk for VTE (stomach, pancreas, brain) varied from 7%-14%. The mean Charlson comorbidity index ranged from 2.9-3.0. During the 6-month baseline period, healthcare costs were similar across cohorts. Over the follow-up period, patients treated with rivaroxaban had significantly lower VTE-related healthcare costs when compared with patients in the LMWH cohort (Table 1). VTE-related hospitalization, emergency room (ER) visit, outpatient visit, pharmacy, imaging, and other costs were all significantly lower for patients treated with rivaroxaban than for patients treated with LMWH (all P <0.03). VTE-related healthcare costs were $17,847 for the rivaroxaban cohort and $28,273 for the LMWH cohort (CD= -$10,426 [-$13,461; -$7,981]). VTE-related healthcare costs were similar between the rivaroxaban cohort and the warfarin cohort at $14,880 for the rivaroxaban cohort and $14,911 for the warfarin cohort (CD [95% CI] = -$32 [-$2,618; $2,417] (Table 1)). Higher VTE-related pharmacy costs in the rivaroxaban cohort (CD= $832 [$630; $1,082]) were offset by lower VTE-related outpatient visit costs (CD= -$1,370 [-$1,977; -$915]).Conclusion: This real-world analysis based on a commercial claims database showed that cancer patients treated with rivaroxaban after an initial VTE incurred significantly lower VTE-related healthcare costs than patients treated with LMWH and similar costs to patients treated with warfarin. [Display omitted] DisclosuresStreiff:CSL Behring: Consultancy, Research Funding; Janssen Scientific Affairs, LLC: Consultancy, Research Funding; Portola: Research Funding; Roche: Research Funding. Milentijevic:Janssen Scientific Affairs, LLC: Employment, Equity Ownership. McCormick:Janssen Scientific Affairs, LLC: Research Funding. Laliberté:Janssen Scientific Affairs, LLC: Research Funding. Crivera:Janssen Scientific Affairs, LLC: Employment, Equity Ownership. Lefebvre:Janssen Scientific Affairs, LLC: Research Funding. Lejeune:Janssen Scientific Affairs, LLC: Research Funding. Rozjabek:Janssen Scientific Affairs, LLC: Other: Fellowship supported by Janssen Scientific Affairs, LLC. Schein:Janssen Scientific Affairs, LLC: Employment, Equity Ownership, Other: Own in excess of $10,000 of J&J stock. Khorana:Pfizer: Consultancy, Honoraria; Halozyme: Consultancy, Honoraria; Janssen Scientific Affairs, LLC: Consultancy, Honoraria, Research Funding; Sanofi: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; Amgen: Consultancy, Research Funding; Leo: Consultancy, Honoraria, Research Funding.

Fluorescence Liquid Biopsy for Cancer Detection Is Improved by Using Cationic Dendronized Hyperbranched Polymer.

(1) Background: Biophysical techniques applied to serum samples characterization could promote the development of new diagnostic tools. Fluorescence spectroscopy has been previously applied to biological samples from cancer patients and differences from healthy individuals were observed. Dendronized hyperbranched polymers (DHP) based on bis(hydroxymethyl)propionic acid (bis-MPA) were developed in our group and their potential biomedical applications explored. (2) Methods: A total of 94 serum samples from diagnosed cancer patients and healthy individuals were studied (20 pancreatic ductal adenocarcinoma, 25 blood donor, 24 ovarian cancer, and 25 benign ovarian cyst samples). (3) Results: Fluorescence spectra of serum samples (fluorescence liquid biopsy, FLB) in the presence and the absence of DHP-bMPA were recorded and two parameters from the signal curves obtained. A secondary parameter, the fluorescence spectrum score (FSscore), was calculated, and the diagnostic model assessed. For pancreatic ductal adenocarcinoma (PDAC) and ovarian cancer, the classification performance was improved when including DHP-bMPA, achieving high values of statistical sensitivity and specificity (over 85% for both pathologies). (4) Conclusions: We have applied FLB as a quick, simple, and minimally invasive promising technique in cancer diagnosis. The classification performance of the diagnostic method was further improved by using DHP-bMPA, which interacted differentially with serum samples from healthy and diseased subjects. These preliminary results set the basis for a larger study and move FLB closer to its clinical application, providing useful information for the oncologist during patient diagnosis.

Association of state Medicaid income eligibility limits and long-term survival after cancer diagnosis in the United States.

6512 Background: Income eligibility limits for Medicaid, the health insurance programs for low-income populations in the United States, vary substantially by state for the non-elderly population. This study examined associations between state Medicaid income eligibility limits and long-term survival among newly diagnosed cancer patients. Methods: 1,426,657 adults aged 18-64 years newly diagnosed with 17 common cancers between 2010 to 2013 were identified from the National Cancer Database. States’ Medicaid income eligibility limits were categorized as &lt; = 50%, 51%-137%, and &gt; = 138% of Federal Poverty Level (FPL). Survival time was measured from diagnosis date through December 31, 2017, for up to 8 years of follow-up. Multivariable Cox proportional hazard models with age as time scale were used to assess associations of eligibility limits and stage-specific survival, controlling for age group, sex, race/ethnicity, metropolitan statistical area, number of health conditions other than cancer, year of diagnosis, facility type, and the random effect of state of residence. Results: Among newly diagnosed cancer patients aged 18-64 years, 22.0%, 43.5%, and 34.5% resided in states with Medicaid income eligibility limits ≤50%, 51%-137%, and ≥138% FPL, respectively. Compared to patients living in states with Medicaid income eligibility limits ≥138% FPL, patients living in states with Medicaid income eligibility limits ≤50% and 51-137% FPL were more likely to have worse survival for most cancers in both early and late stage. The highest hazard ratios (HRs) were observed among patients living in states eligibility limits ≤50% FPL (p trend &lt; 0.05). For example, for early stage female breast cancer patients, the HRs were 1.31 (95% confidence interval [95% CI]: 1.18 – 1.46) and 1.17 (95% CI: 1.06 – 1.30) for patients living in states with Medicaid income eligibility limits ≤50% and 51%-137% compared to those living in states with Medicaid income eligibility limits ≥138% FPL. Conclusions: Lower Medicaid income eligibility limits were associated with worse long-term survival within stage, with variation below the Medicaid eligibility threshold as part of the Affordable Care Act. States that have not expanded Medicaid income eligibility limits should expand them to help improve survival among cancer patients.

Plasma hPG80 circulating prograstin levels in cancer patients in Nigeria: Prolevcan study.

3029 Background: Progastrin is a tumor-promoting peptide which is detectable in the blood of patients with different cancers. hPG80 (circulating progastrin) is produced by cancer cells. Recently it was reported that hPG80 is detected in the blood of cancer patients, suggesting its potential utility for cancer detection. In this Nigerian study, we assessed the performance of hPG80 in diagnosed cancer patients versus healthy volunteers. Methods: Plasma samples of 50 patients with breast (n = 41) and colorectal (n = 9) cancer, aged from 26 to 70 years, were assayed for hPG80 levels with the DxPG80 kit from ECS-Progastrin. The diagnostic performance (ROC AUC) of hPG80 was assessed compared to 50 healthy volunteers aged from 21 to 38 years. Results: Plasma hPG80 levels were significantly higher in cancer patients compared to controls (median values: 4.59 pM (IQR: 2.02-8.27 pM) vs 1.37 pM (IQR: 0-3.11 pM), p &lt; 0.0001). The median value of hPG80level was 3.96 pM (IQR: 1.61-7.89 pM) for breast cancers and 6.43 pM (IQR: 2.80-15.86 pM) for colorectal cancer patients. ROC AUC for all cancers, breast cancer and colorectal cancer were 0.75, 0.74 and 0.82 respectively. There was no correlation between hPG80 blood levels with age or CA15.3 levels. Conclusions: Plasma hPG80 is a simple and relatively affordable blood test, it shows potential utility as a biomarker for cancer detection, monitoring and treatment assessment. Further prospective studies are needed to explore and confirm its potential.

Association between Medicaid expansion under the Affordable Care Act and survival among newly diagnosed cancer patients.

1502 Background: Medicaid expansion under the Affordable Care Act (ACA) is associated with increased insurance coverage and early stage at diagnosis among patients with cancer. Whether these gains translate to improved survival is largely unknown, however. This study examines changes in one-year survival rates among persons newly diagnosed with cancer following the ACA Medicaid expansion. Methods: Patients aged 18-62 years from 41 population-based state cancer registries diagnosed pre-(2010-2012) and post-(2014-2016) ACA Medicaid expansion were followed through October 1, 2013 and December 31, 2016, respectively. Difference-in-differences (DD) analysis was conducted to estimate changes in one-year overall and cause-specific survival rates associated with Medicaid expansion, adjusting for age group, sex, race/ethnicity, area-level poverty, urban/rural status and region. Stratified analysis was conducted by cancer type, sex and area-level poverty. Results: A total of 2,537,818 patients diagnosed with cancer were included from Medicaid expansion (N = 1,492,729) and non-expansion (N = 1,045,089) states. During follow-up, 291,854 patients died including 246,660 deaths from cancer. The one-year overall survival rate (%) increased from 88.1 pre-ACA to 89.1 post-ACA in Medicaid expansion states and from 85.6 to 86.4 in non-expansion states for both sexes combined, resulting in a net increase of 0.4 (95%CI = 0.3-0.6) in expansion states after adjusting for sociodemographic factors. By cancer site and for both sexes combined, the increase in adjusted one-year overall survival in expansion states versus non-expansion states was greater for cancers of lung (DD = 1.6; 95%CI = 0.8-2.5), pancreas (DD = 2.2; 95%CI = 0.5-3.9) and liver (DD = 3.4; 95%CI = 1.7-5.1); as were the increases for cervix (DD = 1.3; 95%CI = 0.1-2.5), melanoma (DD = 0.4;95%CI = 0.04-0.9), non-Hodgkin lymphoma (DD = 1.2; 95%CI = 0.1-2.2) and esophagus (DD = 7.1; 95%CI = 0.5-13.7) among women. The improvement in one-year overall survival was larger among patients residing in the poorest areas (DD = 0.7; 95%CI = 0.3-1.1) compared to those in the richest areas (DD = 0.2; 95%CI = -0.2 to 0.5), leading to a narrowing survival disparity by area-level poverty. Patterns in one-year cause-specific survival were similar. Conclusions: Medicaid expansion was associated with greater increase in one-year overall survival rates, largely driven by the improvements in survival for cancer types with poor prognosis, suggesting improved access to timely and effective treatments. Furthermore, the increase was largest in poorest areas, highlighting the promising role of Medicaid expansion in reducing health disparities. Future studies should monitor changes in longer-term health outcomes following the ACA.

Propping up the parents: An environmental scan of childcare programs available to cancer patients in North America.

e18805 Background: Approximately 20% of newly diagnosed cancer patients are between the ages of 20 and 54, and many of these patients are also the primary caregivers of children. Qualitative studies focusing on this demographic indicate that patients who are parents struggle to balance their own care needs with those of their children. Further, a lack of childcare support during cancer treatments can negatively impact compliance and increase existing psychological stress for patients. In the efforts to establish a child-minding program at a major Canadian cancer centre, we carried out an environmental scan to evaluate the current state of childcare support for cancer patients. Methods: Firstly, a literature scan was conducted in order to assess current knowledge about childcare and cancer patients, which included the use of search engines, directed internet searches, a review of oncology conference proceedings and websites of oncology associations. Literature was selected based on pre-determined criteria. Secondly, 12 representatives from major Canadian cancer centres (CCC) completed a questionnaire assessing current childcare strategies at their respective institutions. Finally, a broad scan of the grey literature was conducted by investigating 161 Canadian and American hospitals for on-site childcare services, using lay-accessible searching techniques (hand-searching hospital websites, phone and email correspondences). Results: The literature scan identified seventeen primary articles, which focused largely on exploring the role strain faced by patients who are also parents. A single study explored the instrumental challenges of being a parent with cancer, and formally assessed the childcare needs of these patients. The questionnaire results indicated that only two of the twelve investigated CCCs had established an approach to child-minding for patients. The grey literature scan identified twenty-six on-site, patient-accessible child-minding centres at hospitals in Canada and the US based on pre-determined inclusion criteria. Of these, 76.9% of centres were associated with pediatric hospitals, and 69.2% were located in the United States. Most centres (76.9%) were open for over 30 hours per week, and 88.5% of centres were free of charge to users. Conclusions: These findings generally indicate that a minority of Canadian and American hospitals and cancer centres have formal childcare services in place to support patients who are also parents. As cancer patients are at increased risk for financial toxicity, they may be particularly in need of this kind of instrumental support. This highlights the importance of carrying out a targeted needs assessment in order to fully elucidate the need for patient-accessible childcare services at CCCs.

Examining the effects of stress and psychological distress on smoking abstinence in cancer patients.

Cancer patients who smoke report more stress and psychological distress than patients who do not smoke. It is unclear how these emotional symptoms may modify smoking behavior in cancer patients. We examined the influence of a smoking cessation intervention for cancer patients on stress and distress, and the effects of these symptoms on smoking abstinence. Mixed-methods secondary analysis of data from the Smokefree Support Study, a two-site randomized controlled trial examining the efficacy of Intensive (IT; n=153) vs. Standard Treatment (ST; n=150) for smoking cessation in newly diagnosed cancer patients. Stress coping, perceived stress, distress, and anxiety were self-reported at baseline, 3, and 6months. Abstinence was biochemically-confirmed at 6months. A subset of patients (n=72) completed qualitative exit-interviews. Patients were on average, 58years old, 56% female, and smoked a median of 10 cigarettes/day. There were no significant treatment group×time interactions or main effects of treatment group on stress or distress measures (p's>0.05), however there were significant main effects of time suggesting symptom improvements on each measure in both study groups (p's<0.05). In adjusted logistic regression models, lower levels anxiety at 3months predicted confirmed smoking abstinence at 6months (p=.03). Qualitatively, at 6months, patients reported their stress and smoking were connected and that the cessation counseling was helpful. Cancer patients enrolled in a smoking cessation trial report decreases in stress, distress and anxiety over time, and anxiety symptoms may impact smoking cessation success at follow-up resulting in an important intervention target.

Greater preferences for death in hospital and mechanical ventilation at the end of life among non-whites recently diagnosed with cancer.

PurposeNon-white cancer patients receive more aggressive care at the end-of-life (EOL). This may indicate low quality EOL care if discordant with patient preferences. We investigated preferred potential place of death and preferences regarding use of mechanical ventilation in a cohort of Texas cancer patients.MethodsA population-based convenience sample of recently diagnosed cancer patients from the Texas Cancer Registry was surveyed using a multi-scale inventory between March 2018 and June 2020. Item responses to questions about preferences regarding location of death and mechanical ventilation were the outcome measures of this investigation. Inverse probability weighting analysis was used to construct multivariable logistic regression examining the associations of covariates.ResultsOf the 1460 respondents, a majority (82%) preferred to die at home compared to 8% who preferred dying at the hospital. In total, 25% of respondents expressed a preference for undergoing mechanical ventilation at the EOL. Adjusted analysis showed increased preference among Black (OR = 1.81; 95% CI: 1.19–2.73) and other non-white, non-Hispanic race individuals (OR = 3.53; 95% CI: 1.99–6.27) for dying at a hospital. Males, married individuals, those of higher education and poor self-reported health showed significantly higher preference for dying at home. Non-white respondents of all races were more likely to prefer mechanical ventilation at the EOL as were individuals who lived with another person at home.ConclusionNon-white cancer patients were more likely to express preferences coinciding with aggressive EOL care including dying at the hospital and utilizing mechanical ventilation. These findings were independent of other sociodemographic characteristics, including decisional self-efficacy.

Longitudinal observation of anxiety and depression among palliative care cancer patients.

Anxiety and depressive symptoms are commonly reported to have a high prevalence in advanced cancer patients. However, whether the severity of the symptoms change during a stay in a palliative care unit (PCU) and after discharge home has not been studied thus far. This prospective, longitudinal, single-center study screened for anxiety and depression as measured on the German version of Hospital Anxiety and Depression Scale (HADS-D) in a palliative care (PC) cancer cohort at three different time points. Consecutive patients (N=206) admitted to a PCU were evaluated of whom N=102 could be enrolled. Patients were screened for anxiety and depression using the HADS-D questionnaire: 24 h after admittance (P1), within 24 h before discharge (P2) and 2 weeks after discharge (P3). Longitudinal changes and influencing factors were determined. Nearly 80% of all patients had at least at one time point a HADS score ≥8 indicating a clinically meaningful symptom burden. The P1 mean scores were 7.1±3.3 (anxiety) and 8.9±4.6 (depression). Depression was associated with underlying cancer type (P<0.05). Anxiety and depression stabilized during hospitalization (P2). However, a significant deterioration after discharge (P3) was observed (anxiety P=0.046; depression P=0.003), in particular in older patients (>65 years) and higher ECOG status (≥3). Patients with a short time since first diagnosis (<1 year) had significantly higher symptom burden compared to patients with a longer disease course. Participation was 50% emphasizing the difficulty to study PC patients. Most patients had advanced cancers (99%). Underlying cancer types consisted of a broad variety of solid tumors including 15% hematological cases. Median survival was 1.1 months. The high prevalence of anxiety and depressive symptoms points to the need for psychological support. All PC patients should be screened for psychological distress to identify those in need of further assessment and treatment. The deterioration at home suggests the need for improved outpatient management, including home-based psychological support. Caregivers should be aware of the psychological vulnerability of newly diagnosed cancer patients, patients with lower functional status and higher age.

Increasing trends in the prevalence of prior cancer in newly diagnosed lung, stomach, colorectal, breast, cervical, and corpus uterine cancer patients: a population-based study

BackgroundCancer survivors are frequently excluded from clinical research, resulting in their omission from the development of many cancer treatment strategies. Quantifying the prevalence of prior cancer in newly diagnosed cancer patients can inform research and clinical practice. This study aimed to describe the prevalence, characteristics, and trends of prior cancer in newly diagnosed cancer patients in Japan.MethodsUsing Osaka Cancer Registry data, we examined the prevalence, characteristics, and temporal trends of prior cancer in patients who received new diagnoses of lung, stomach, colorectal, female breast, cervical, and corpus uterine cancer between 2004 and 2015. Site-specific prior cancers were examined for a maximum of 15 years before the new cancer was diagnosed. Temporal trends were evaluated using the Cochran-Armitage trend test.ResultsAmong 275,720 newly diagnosed cancer patients, 21,784 (7.9%) had prior cancer. The prevalence of prior cancer ranged from 3.3% (breast cancer) to 11.1% (lung cancer). In both sexes, the age-adjusted prevalence of prior cancer had increased in recent years (P values for trend < 0.001), especially in newly diagnosed lung cancer patients. The proportion of smoking-related prior cancers exceeded 50% in patients with newly diagnosed lung, stomach, colorectal, breast, and cervical cancer.ConclusionsThe prevalence of prior cancer in newly diagnosed cancer patients is relatively high, and has increased in recent years. Our findings suggest that a deeper understanding of the prevalence and characteristics of prior cancer in cancer patients is needed to promote more inclusive clinical research and support the expansion of treatment options.

Major impact of COVID-19 national containment on activities in the French northern comprehensive cancer center.

The SARS-CoV-2 pandemic has significantly impacted cancer patient management. National and local recommendations to reduce SARS-CoV-2 transmission have been applied in a comprehensive cancer center located in Northern France. We prospectively measured key indicators for three successive eight-week periods: directly before, during, and right after the containment (from 16 March to 10 May 2020). Overall, the number of newly diagnosed and referred cancer patients in our hospital steadily increased (1027; 1135 and then 1704; +11% during containment and +50% just after). To reduce patient transportation, teleconsultations were implemented. Teleconsulting activity steadily increased during the three periods (5, 2025, and 2351). However, a marked decrease in the number of surgical procedures was observed (448; 330 and 288; −26% during containment and −13% just after). We observed a slight decrease in the number of radiation therapy sessions (7761; 7328 and 7075; −6% during containment and −3% just after) and in day-hospital cycles of IV systemic treatment (2891; 2736 and 2717; −5% during containment and −1% just after). We observed an increase in the number of patients admitted to palliative care and a dramatic reduction in clinical trial enrollment. During this 24-week period, organizational changes were mainly characterized by an increase in newly diagnosed cancer patient referral and the implementation of protective measures, such as teleconsultations. Activities in cancer surgery have decreased while radiotherapy and chemotherapy activities were stable.

A Novel Patient Values Tab for the Electronic Health Record: A User-Centered Design Approach.

BackgroundThe COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients’ values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient’s wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care.ObjectiveTo provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center’s EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation.MethodsWe first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab’s main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted.ResultsWe have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content.ConclusionsIt is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.

A Systematic Review and Scoping Analysis of Smoking Cessation after a Urological Cancer Diagnosis

Smoking cessation after a urologic cancer diagnosis significantly benefits patients. It is not well known how often patients quit after diagnosis or how urologists intervene to support patients' smoking cessation efforts. To examine rates of smoking cessation after diagnosis among patients with urologic cancers and to assess how often patients are given advice and support to quit smoking in the urology setting. Following the PRISMA guidelines, a systematic review was conducted of the available studies on smoking cessation after a urologic cancer diagnosis during April 2020 by a trained medical librarian using the MEDLINE, PsycInfo, Embase, and Cochrane CENTRAL databases. Studies were included based on three independent reviews and if they met a priori inclusion/exclusion criteria. In total, 2568 records were identified, 31 of which were included for final analysis. Four studies (patient n=587) reported outcomes related to the prospective implementation of a smoking cessation program with patient-level quit rates ranging from 3.2% to 47.3%. Twenty one studies reported outcomes of passive (no directed, active intervention) smoking cessation after the diagnosis of a urologic cancer (patient n=3669) with widely varying quit rates. In general, the quality of included studies was poor. There was no standardization of the measurement or timing of outcomes and few studies included validated survey instruments or biochemical confirmation of cessation. Seventeen studies included data on whether patients received advice to quit smoking after diagnosis. The proportion of patients in each study who were told to quit ranged from 2.8-78.3%. There are few smoking cessation interventions that have been prospectively implemented and reported in the urology literature and studies on quit rates after diagnosis are limited. The paucity of quality data and lack of smoking cessation interventions being used in routine urologic oncology care underscores the need for more rigorous study and implementation of evidence-based practices in this area.

Preferences for More Aggressive End-of-life Pharmacologic Care Among Racial Minorities in a Large Population-Based Cohort of Cancer Patients

ContextMinority patients receive more aggressive and potentially suboptimal care at the end of life (EOL). We investigated preferences about pharmacologic interventions at the EOL and their potential variation by sociodemographic factors among recently diagnosed cancer patients. MethodsA population-based cross-sectional survey of cancer patients identified through the Texas Cancer registry was conducted using a multi-scale inventory between March 2018 and June 2020. Item responses to questions about potential pharmacologic interventions at the EOL were the focus of this investigation. Inverse probability weighted multivariate analysis examined associations of sociodemographic characteristics, health literacy, and trust in medical professionals with pharmacologic preferences. ResultsOf the 1480 included responses, 13.3% stated they would take a medication that may prolong life at the cost of feeling worse. Adjusted analyses showed Black or Hispanic race/ethnicity, living with another person, and having a higher trust score were more likely to express this preference. In contrast, 41–65 years (vs. 21–40 years), living in a rural area, and adequate or unknown health literacy were less likely to express this preference. Overall 16% of respondents were opposed to potentially life shortening palliative drugs. In adjusted analysis Black or Hispanic respondents were more likely to be opposed to potentially life shortening drugs although age 65–79 and ≥college education were associated with a decreased likelihood of opposition to this item. ConclusionBlack and Hispanic cancer patients were more likely to express preferences toward more aggressive EOL pharmacologic care. These findings were independent of other sociodemographic characteristics, health literacy and trust in the medical profession.

Comparing the Ability of Physician-Reported Versus Patient-Reported Performance Status to Predict Survival in a Population-Based Cohort of Newly Diagnosed Cancer Patients

AimsPerformance status is an important prognostic tool in cancer. In oncology, the Eastern Cooperative Oncology Group (ECOG) measure is commonly used. Patient-reported functional status (PRFS) is an emerging method that allows patients to provide an estimate of their function; however, there is limited information about its prognostic significance. The aim of this study was to compare the predictive validity of functional status as reported by patients and physicians in relation to the observed survival after a new cancer diagnosis. Materials and methodsThis was a retrospective, population-based study using observational data of newly diagnosed patients in Ontario, Canada. We included patients who had both PRFS and ECOG recorded on the same day during an outpatient cancer clinic visit between March 2013 and March 2018. The dataset was randomly divided into 60% training and 40% validation cohorts. One-year survival was estimated by modelling clinical characteristics with PRFS, with ECOG, and alone. ResultsIn total, 13 045 patients met the inclusion criteria. Covariates were similar at baseline for both training and validation datasets. PRFS and ECOG scores were statistically significant predictors of overall survival. Higher PRFS and ECOG scores were both associated with inferior survival, hazard ratio = 1.71 (P < 0.0001) and hazard ratio = 1.90 (P < 0.0001), respectively. Models that included either PRFS or ECOG scores outperformed the model with clinical characteristics only. C statistics were 0.836, 0.839 and 0.811, respectively. ConclusionsPRFS adds to survival modelling and is equally predictive as the ECOG scale. PRFS may be used instead of ECOG in clinical or research settings for survival estimation.

Exploring the lengthiest ambulatory breast surgery clinic appointments: is the patient the problem?

Prolonged outpatient clinic appointments can disrupt schedules, impacting patients and providers. We sought to define features of the longest ambulatory appointments in a breast surgery clinic, and to ascertain whether patients attending these appointments consistently have protracted appointments. A single-institution retrospective cohort study was conducted of breast surgery clinic patients, January 2017 to May 2019, and the longest 1% of appointments identified using a real-time patient tracking system. A primary chart review was performed, and data abstracted. Other appointments attended by these patients were identified, and the ratio of appointments >75th percentile duration (protracted appointments) to the total appointments during the study period was calculated, enabling comparison for patients with consistently protracted (ratio >50%) vs. sporadically protracted appointments (≤50%). Descriptive analysis was performed, and results reported as medians with inter-quartile ranges. A total of 15,265 clinic appointments were identified, and the longest 148 (exceeding 244 minutes) analyzed. Median appointment length was 264 minutes (inter-quartile range: 253-290). 70% were new patient appointments, and 54% of patients underwent a test/investigation that day. A minority were obese (39%), smokers (41%), diagnosed with a psychiatric comorbidity (34%), had a genetic cancer syndrome (22%), or received unexpected news at their appointment (16%). Of 118 patients with multiple appointments, 26% had consistently protracted appointments and 74% sporadically protracted appointments. The lengthiest appointments are usually newly diagnosed cancer patients. Only a minority of patients have consistently protracted appointments, implying that a patient's previously prolonged appointment may not predict future long appointments.

COVID-19 Pandemisi Döneminde Geciken Tümör Cerrahileri; Evre T1b’den T3b’ye İlerleyen Renal Hücreli Karsinom: Olgu Sunumu

COVID-19 is a highly contagious disease. This condition affects the decision of both the patient and the surgeon about the surgery of newly diagnosed cancer patients and it may also result in delays in cancer surgeries because of the limitations in healthcare applications. In our particular case, it was aimed to present the transition of the cancer from the localized stage to distant spread stage cancer since the patient who was pre-diagnosed with RCC and who was recommended surgery, did not want to undergo surgery due to COVID-19 pandemic and its risks. Our case was a 49-year-old female patient. In her computed tomography, a 58x70 mm heterogeneously enhancing solid lesion which showed exophytic extension from the middle zone of the right kidney to the lower pole was observed. Surgery was recommended for the patient but the patient claimed that she did not want to undergo surgery due to the risk of COVID-19 pandemic. The patient made an application for the surgery 8 months later. The new magnetic resonance imaging of the patient showed that there was a mass lesion of approximately 76x76x80 mm in size, which involved middle-lower part of the right kidney and extended into the opening of the renal vein VCI by invading the renal vein. Radical nephrectomy and thrombectomy procedure was applied to the patient with RCC? tumor. Due to psychosocial problems caused by the pandemic, surgeries are delayed and an acceleration of the cancer progression from the localized stage to the distant spread stage occurs indispensably.

Examining the effects of problematic alcohol use on cigarette abstinence in recently diagnosed cancer patients enrolled in a cessation trial: A secondary analysis

AimsAmong people with cancer, dual alcohol and tobacco use increases risk for morbidity and mortality. Most smoking cessation clinical trials with this patient population have excluded individuals with problematic alcohol use. This investigation examined whether problematic alcohol use affects smoking cessation in cancer patients. MethodsMixed-methods secondary analysis of data from the Smokefree Support Study, a randomized-controlled trial examining the efficacy of Intensive (IT; n = 153) vs. Standard Treatment (ST; n = 150) for smoking cessation in newly diagnosed cancer patients. Problematic alcohol use was assessed at enrollment using the Cut-Down-Annoyed-Guilty-Eye-Opener (CAGE), weekly frequency of alcohol use and binge drinking measures. Alcohol use was categorized as: no current alcohol use, moderate and problematic use. The primary outcome was biochemically-confirmed cigarette abstinence at 6-months. A subset of patients (n = 72) completed qualitative exit-interviews. ResultsAmong all participants, biochemically-confirmed cigarette abstinence rates were 25% (n = 32), 28% (n = 27), and 36% (n = 20) for participants reporting no current alcohol use, moderate use, and problematic use, respectively (p = 0.33). In logistic regression analysis, neither problematic alcohol use (AOR = 0.96, 95% CI = 0.35–2.67, p = .94) nor the problematic use by study arm interaction (AOR = 2.22, 95% CI = 0.59–8.39, p = .24) were associated with biochemically-confirmed 6-month abstinence. Qualitatively, participants reported that drinking alcohol triggers urges to smoke. ConclusionNewly diagnosed cancer patients reporting problematic alcohol use were not less likely to quit smoking than those without. Additional research is needed to investigate whether problematic alcohol users may benefit from smoking and alcohol behavior change interventions at the time of cancer diagnosis.

“Door to Treatment” Outcomes of Cancer Patients during the COVID-19 Pandemic

Background: The novel coronavirus disease 2019 has become a worldwide threat. We aimed to explore reflections of these unexpected changes to newly diagnosed cancer patients. Method: We searched the 2 months after the index case of our country. The first admission day and the first day of intravenous treatment of newly diagnosed patients were recorded. Results: In the 60 days measured during the pandemic, the total number of patients on polyclinics was 159/weekdays, and the total applied chemotherapy cycles were 276/week. For comparison, the total numbers in the previous year were 267/weekday and 363/week for polyclinic and applied chemotherapy cycles, respectively. The total number of newly admitted patients in 2020 was 283. For comparison, the number of new patients in the same 60-day period in 2019 was 495. Patients who were admitted for adjuvant treatment required a median of 8 days for the first course, those who were admitted for neoadjuvant treatment required 12 days, and metastatic patients required 14 days; there were no significant differences between treatment types (p = 0.233). However, the median treatment time was 11.5 and 17 days, in 2020 and in 2019, respectively. A significant difference was observed between the 2 groups (p < 0.001). Conclusion: The effective shift of workers and accurate regulations have not resulted in apparent delays in patient care. While a decrease in the number of patients has detected, faster healthcare service was introduced to newly diagnosed patients. The reason for the decrease in the number of patients should be investigated with new studies.