Health Outcomes In Cancer Patients Research Articles

Evaluating the impact of PD-1 inhibitor treatment on key health outcomes for cancer patients in China.

There is a lack of studies examining the influence of programmed cell death protein 1 (PD-1) inhibitors on the health outcomes of cancer patients in China. This study aimed to evaluate prospective health outcomes associated with introducing PD-1 inhibitor treatment in China over five years. We constructed a partitioned survival model to assess disparities in health outcomes over a 5-year time frame between two scenarios: one involving the availability of PD-1 inhibitor class with standard of care and the other involving standard of care alone. The impact on various health outcomes were assessed, including life years (LYs) gained, quality-adjusted life years (QALYs) gained, progression-free survival (PFS) years gained, the reduction in the number of grade 3-5 adverse events (AEs), and the improvement in objective remission rates (ORR). A sensitivity analysis was conducted to assess the robustness and reliability of the model. From 2023 to 2027, the incorporation of PD-1 inhibitor class treatments was anticipated to yield substantial improvements in health outcomes, with an estimated increase of 1,336,332 LYs (+ 24.7%), 1,065,359 QALYs (+ 30.3%), and 1,177,564 PFS years (+ 57.4%) compared to standard of care alone. Simultaneously, the number of grade 3-5 AEs decreased by 334,976 (- 13.0%), and the ORR saw a 19.1% increase (+ 105.6%) relative to standard of care treatment alone. This study provides a analysis of the potential beneficial effects on health outcomes in the Chinese population after introducing PD-1 inhibitor class treatment. The findings suggest the PD-1 inhibitor class will significantly improve patient survival.

Effects of traditional Chinese culture-based bibliotherapy on the spiritual health of patients with liver cancer

BackgroundLiver cancer is a serious global health problem and is associated with poor spiritual health. Bibliotherapy is beneficial in improving health outcomes in cancer patients, yet there is a lack of empirical evidence of its effect on the spiritual health of liver cancer patients in China. The study aimed to investigate the effects of bibliotherapy based on Chinese traditional culture on the spiritual health of patients with liver cancer in China. This study was approved by the Ethics Committee of Hunan Normal University School of Medicine and registered with the Chinese Clinical Trial Registry with the registration (No: 2021260), which registration in June 30th 2021.MethodsA total of 60 patients with liver cancer were divided into the intervention group (n = 30) and the control group (n = 30) through WeChat. The intervention group received bibliotherapy therapy based on traditional Chinese culture, while the control group received routine care. Spiritual health was assessed using the Spiritual Attitude and Involvement List (SAIL) and compared before and after the intervention between the two groups. The chi-square test and t-test were used to analyze the intervention effects.ResultsThe two groups were comparable in all baseline characteristics including the SAIL score. After 5 weeks of intervention, the score of SAIL increased significantly from 96.76 ± 15.08 to 106.93 ± 13.82 in the intervention group (t = − 29.380, p < 0.001), while no significant difference in SAIL score was observed in the control group (from 95.27 ± 16.40 to 95.31 ± 16.24, t = − 0.189, p = 0.852). Similar patterns were also observed in its three dimensions of connecting with oneself, connecting with the environment, and connecting with transcendence.ConclusionsOur study showed that bibliotherapy based on traditional Chinese culture using the WeChat platform can greatly improve the spiritual health of patients with liver cancer and has the potential to be widely applied to cancer patients to improve their well-being.

Evaluating the health and health economic impact of the COVID-19 pandemic on delayed cancer care in Belgium: A Markov model study protocol.

Cancer causes a substantial burden to our society, both from a health and an economic perspective. To improve cancer patient outcomes and lower society expenses, early diagnosis and timely treatment are essential. The recent COVID-19 crisis has disrupted the care trajectory of cancer patients, which may affect their prognosis in a potentially negative way. The purpose of this paper is to present a flexible decision-analytic Markov model methodology allowing the evaluation of the impact of delayed cancer care caused by the COVID-19 pandemic in Belgium which can be used by researchers to respond to diverse research questions in a variety of disruptive events, contexts and settings. A decision-analytic Markov model was developed for 4 selected cancer types (i.e. breast, colorectal, lung, and head and neck), comparing the estimated costs and quality-adjusted life year losses between the pre-COVID-19 situation and the COVID-19 pandemic in Belgium. Input parameters were derived from published studies (transition probabilities, utilities and indirect costs) and administrative databases (epidemiological data and direct medical costs). One-way and probabilistic sensitivity analyses are proposed to consider uncertainty in the input parameters and to assess the robustness of the model's results. Scenario analyses are suggested to evaluate methodological and structural assumptions. The results that such decision-analytic Markov model can provide are of interest to decision makers because they help them to effectively allocate resources to improve the health outcomes of cancer patients and to reduce the costs of care for both patients and healthcare systems. Our study provides insights into methodological aspects of conducting a health economic evaluation of cancer care and COVID-19 including insights on cancer type selection, the elaboration of a Markov model, data inputs and analysis.

An eHealth symptom and complication management program for cancer patients with newly created ostomies and their caregivers (Alliance): a pilot feasibility randomized trial

BackgroundCancer patients with newly created ostomies face complications that reduce quality of life (QOL) and increase morbidity and mortality. This proof-of-concept study examined the feasibility, usability, acceptability, and initial efficacy of an eHealth program titled the “Patient Reported Outcomes-Informed Symptom Management System” (PRISMS) during post-ostomy creation care transition.MethodsWe conducted a 2-arm pilot randomized controlled trial among 23 patients who received surgical treatment with curative intent for bladder and colorectal cancer and their caregivers. After assessing QOL, general symptoms, and caregiver burden at baseline, participants were randomly assigned to PRISMS (n = 16 dyads) or usual care (UC) (n = 7 dyads). After a 60-day intervention period, participants completed a follow-up survey and post-exit interview. We used descriptive statistics and t-tests to analyze the data.ResultsWe achieved an 86.21% recruitment rate and a 73.91% retention rate. Among the PRISMS participants who used the system and biometric devices (n = 14, 87.50%), 46.43% used the devices for ≥ 50 days during the study period. Participants reported PRISMS as useful and acceptable. Compared to their UC counterparts, PRISMS patient social well-being scores decreased over time and had an increased trend of physical and emotional well-being; PRISMS caregivers experienced a greater decrease in caregiver burden.ConclusionsPRISMS recruitment and retention rates were comparable to existing family-based intervention studies. PRISMS is a useful and acceptable multilevel intervention with the potential to improve the health outcomes of cancer patients needing ostomy care and their caregivers during post-surgery care transition. A sufficiently powered RCT is needed to test its effects.Trial registrationClinicalTrial.gov ID: NCT04492007. Registration date: 30/07/2020.

THE POTENTIAL OF TELECOMMUNICATIONS IN CANCER CLINICAL TRIALS: AN OVERVIEW

This review article explores the potential benets and challenges of using telecommunications technology, including telemedicine and mobile health apps, in cancer clinical trials. The author conducted a search of four electronic databases for studies published in English between 2010 and 2021 that evaluated the use of telecommunications technology in adult cancer patients and reported patient outcomes. The studies were grouped based on the type of telecommunications technology used, and the outcomes were synthesized to provide an overview of the potential impact of telecommunications technology on cancer clinical trials. Telecommunications technologies were found to improve patient access and recruitment, data collection, management, and analysis, and enable real-time monitoring of patients' health and adherence to treatment. Telecommunications technologies can also reduce trial costs by minimizing the need for inperson visits and other expenses. However, the implementation of telecommunications technologies in clinical trials is not without challenges, including technical issues, patient acceptance and adherence, regulatory and legal approvals, and variability in healthcare systems. The author suggests that addressing these challenges could lead to improved patient outcomes and better overall health outcomes for cancer patients.

The effects of expressive writing intervention in cancer patients and survivors: A rapid umbrella review

Objectives: Numerous primary studies and systematic reviews, both with and without meta-analyses, examined the effects of expressive writing intervention (EWI), yielding mixed and inconsistent findings. The purpose of this review was to assess the effects of EWI on health outcomes in cancer patients using systematic reviews with or without meta-analyses. Materials and Methods: Google Scholar, Google, and Yahoo search engines and the Cochrane databases of systematic reviews published between 1986 and October 2019 were used to conduct the searches. Five studies met all of the criteria for inclusion. According to the AMSTAR tool, 80% of the included studies achieved a moderate level of methodological quality, while the remaining 20% achieved a low level of methodological quality. Results: There were no consistent or robust findings regarding expressive writing effects, with some studies (40%, n = 2) indicating that expressive writing has no general effectiveness. In comparison, others (40%, n = 2) indicated that expressive writing affects only physical health outcomes, and only one study (20%, n = 1) indicated that expressive writing has a general effect. In addition, several studies (40%, n = 2) discovered a moderating effect. Conclusion: In summary, the findings of this narrative overview indicate that there are mixed or inconsistent findings and several moderators regarding expressive writing effects in the cancer population, implying that substantial clinical heterogeneity and deviation from Pennebaker and Beal’s, 1986, initial experiment, as well as some moderating variables, may account for this finding. Thus, future primary and review studies should employ a more rigorous methodology and greater homogeneity, notably similar to that of Pennebaker and Beal’s original study in 1986, to replicate their initial findings.

Life forms after cancer remission following treatment and disposal of medical waste

Our research discusses the life forms after the remission of cancer following treatment and disposal of medical waste. The semi-structured interviews conducted with the surveyed individuals who are sick and in remission help us understand their perception of themselves and the future of their family relationships during the illness process. The data collected through faceto-face interviews, WhatsApp, and questionnaires reveal that the surveyed individuals acquire new identities. The majority of respondents declare that their personalities have evolved positively, while others have a negative outlook on their cancer experience. This could be attributed to various factors influencing the development of this perception. We observe a certain intertwining and unraveling of our surveyed individuals’ relationships with their surroundings. There is a weakening of sibling bonds, whereas marital bonds are strengthened, and new connections are formed with strangers throughout the care process for our surveyed individuals. Family relationships contribute to the health outcomes of cancer patients, including their remission or recurrence. The data from our research unveil the respondents’ reactions to medical waste as a sign of remission.

Abstract C113: Mediation of race/ethnicity disparities in physical patient reported outcomes (PROS) by socioeconomic position, comorbidities, and tumor biology among elderly female breast cancer (BC) patients in the SEER-MHOS database

Abstract Objective: Variations in physical PROs between Non-Hispanic Black (NHB) and Hispanic compared to Non-Hispanic White (NHW) elderly women with BC may be attributable to differences in socioeconomic position (SEP), comorbidities, and tumor biology (TB). We examine the extent to which the race/ethnicity disparity in patient reported physical component score (PCS) is transmitted through these domains. Methods: Data is from the Surveillance, Epidemiology, and End Results- Medicare Health Outcomes Survey dataset (SEER-MHOS) which is used to research health outcomes in cancer patients. The analytic sample (n=19,857) included 14,936 NHW, 2,897 NHB, and 2,024 Hispanic women with newly diagnosed BC between 2010-2017. PCS were calculated using the SF-36/V linear transformation of 0-100 versions of the scale that yield a population mean of 50 and standard deviation of 10 based on 1990 population means. We estimated average controlled direct associations (ACDA) using regression models with predictive margins to evaluate crude and age/body mass index (BMI)-adjusted PCS by race/ethnicity and performed a series of ACDA [with comparison of rescaled coefficients (RC)] controlling for the domains of SEP [household income (&amp;lt; 30K, 30K-80K, &amp;gt;80K) and education attainment [&amp;lt;High School (HS), HS, &amp;gt;HS)], comorbidities [smoking status (current smoker/current non-smoker), diabetic (yes/no), and hypertensive (yes/no)], and tumor biology [stage(1-3), grade (well/moderate/poor), and subtype (luminal A/triple negative)]. Results: Overall, NHB and Hispanic women were younger and had a higher BMI than NHW women. In baseline age/BMI adjusted models, NHWs had PCSs 3.4 points significantly higher than both NHWs and Hispanics (95% CI: 2.8, 3.9 and 2.8, 4.1, respectively). Adjusting for SEP reduced the observed disparity: NHB (1.6; 95% CI: 0.90, 2.3) and Hispanics (0.76; 95% CI: 0.04, 1.6) compared to NHW. Inclusion of all three domains highly attenuated the observed PCS disparities between the minority populations and NHWs (0.20; 95%CI: -1.1, 1.5) for NHB and (0.54; 95%CI: -0.90, 1.99) for Hispanics compared to NHWs]. Based on the method of RC, we determined the SEP accounted for the largest fraction of mediated effects, followed by comorbidities, with TB having the smallest effect. Conclusion: Our findings support the hypothesis that observed racial/ethnicity differences in physical PROs in elderly BC patients are largely mediated by differences in SEP and comorbidity, rather than TB. Citation Format: Kristen E. Champion, Kendra Krebsbach, Chloe Stallion, Keith A. Dookeran. Mediation of race/ethnicity disparities in physical patient reported outcomes (PROS) by socioeconomic position, comorbidities, and tumor biology among elderly female breast cancer (BC) patients in the SEER-MHOS database [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C113.

Abstract C127: Mental health and quality of care levels associated with race and socioeconomic status among cancer patients

Abstract Mental health and quality of cancer care are factors that significantly impact a cancer patient’s health outcomes. It is imperative that all patients, regardless of race or socio-economic status (SES), have equitable opportunities for optimal cancer survival. Recent reports suggest, African American (AA) cancer patients have the highest cancer mortality rates and lowest survival rates of any racial and ethnic group in the United States (U.S.). (cite) These alarming statistics, attributed in part to disparities in healthcare, can be linked to individual level stressors, modifiable risk factors, and structural characteristics of the health system. Recent studies suggest, AA’s and individuals of low SES in the U.S., are more likely to suffer disproportionately from social determinants of health (SDOH) that may contribute to chronic stress over the lifespan. Chronic stress is shown to have a negative impact on the mental health of a patient which can potentially contribute to progression of disease and effectiveness of cancer treatments. Quality of cancer care may even contribute to lower or higher rates of cancer patient stress. The complex interplay of mental health and quality of cancer care with race and SES can have a significant impact on the health outcomes of cancer patients. Methods Data for this study will be obtained from the National Cancer Institute’s Health Informational National Trends Survey (HINTS 5, CYCLE 4), a nationally representative cross sectional survey of American adults using telephone and postal mail. Secondary analysis of the dataset will be conducted using respondents. Participant characteristics and behaviors will be examined using weighted descriptive statistics. Bivariate chi square analyses will be conducted to examine the association between each independent variable (gender, race/ethnicity, age, level of education, level of income, and can afford treatment without it effecting finances) and the dependent variable as stress and distress scores and quality of care Multivariable logistic regression analyses will be used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (95% Cis) to determine whether race and socioeconomic status factors affect stress, distress scores, and quality of care. Results We will report findings relative to African American cancer patients of the same socio-economic status as White cancer patients and the association with lower quality of care and higher stress scores. Additional we will present findings relative to the association of African American cancer patients of lower socio-economic status with have higher stress scores and lower quality of care than African Americans of higher socio-economic status. Lastly, we will present data on the association of financial toxicity, race, SES, and stress score and quality of cancer care. Conclusion It is anticipated the findings from this study will inform future intervention strategies to address social determinants of health in clinical and non-clinical settings. Citation Format: Jamirah Y. Chevrin, Brian Rivers. Mental health and quality of care levels associated with race and socioeconomic status among cancer patients [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C127.

DGKα, Bridging Membrane Shape Changes with Specific Molecular Species of DAG/PA: Implications in Cancer and Immunosurveillance.

Cancer immunotherapy has revolutionized the oncology field. Despite the success, new molecular targets are needed to increase the percentage of patients that benefits from this therapy. Diacylglycerol kinase α (DGKα) has gathered great attention as a potential molecular target in immunotherapy because of its role in cancer proliferation and immunosuppression. DGKα catalyzes the ATP-dependent phosphorylation of diacylglycerol (DAG) to produce phosphatidic acid (PA). Since both lipids are potent signaling messengers, DGKα acts as a switch between different signaling pathways. Its role in cancer and immunosuppression has long been ascribed to the regulation of DAG/PA levels. However, this paradigm has been challenged with the identification of DGKα substrate acyl chain specificity, which suggests its role in signaling could be specific to DAG/PA molecular species. In several biological processes where DGKα plays a role, large membrane morphological changes take place. DGKα substrate specificity depends on the shape of the membrane that the enzyme binds to. Hence, DGKα can act as a bridge between large membrane morphological changes and the regulation of specific molecular species of DAG/PA. Bearing in mind the potential therapeutic benefits of targeting DGKα, here, the role of DGKα in cancer and T cell biology with a focus on the modulation of its enzymatic properties by membrane shape is reviewed. The goal is to contribute to a global understanding of the molecular mechanisms governing DGKα biology. This will pave the way for future experimentation and, consequently, the design of better, more potent therapeutic strategies aiming at improving the health outcomes of cancer patients.

The effectiveness of case management for cancer patients: an umbrella review

BackgroundCase management (CM) is widely utilized to improve health outcomes of cancer patients, enhance their experience of health care, and reduce the cost of care. While numbers of systematic reviews are available on the effectiveness of CM for cancer patients, they often arrive at discordant conclusions that may confuse or mislead the future case management development for cancer patients and relevant policy making. We aimed to summarize the existing systematic reviews on the effectiveness of CM in health-related outcomes and health care utilization outcomes for cancer patient care, and highlight the consistent and contradictory findings.MethodsAn umbrella review was conducted followed the Joanna Briggs Institute (JBI) Umbrella Review methodology. We searched MEDLINE (Ovid), EMBASE (Ovid), PsycINFO, CINAHL, and Scopus for reviews published up to July 8th, 2022. Quality of each review was appraised with the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. A narrative synthesis was performed, the corrected covered area was calculated as a measure of overlap for the primary studies in each review. The results were reported followed the Preferred reporting items for overviews of systematic reviews checklist.ResultsEight systematic reviews were included. Average quality of the reviews was high. Overall, primary studies had a slight overlap across the eight reviews (corrected covered area = 4.5%). No universal tools were used to measure the effect of CM on each outcome. Summarized results revealed that CM were more likely to improve symptom management, cognitive function, hospital (re)admission, treatment received compliance, and provision of timely treatment for cancer patients. Overall equivocal effect was reported on cancer patients’ quality of life, self-efficacy, survivor status, and satisfaction. Rare significant effect was reported on cost and length of stay.ConclusionsCM showed mixed effects in cancer patient care. Future research should use standard guidelines to clearly describe details of CM intervention and its implementation. More primary studies are needed using high-quality well-powered designs to provide solid evidence on the effectiveness of CM. Case managers should consider applying validated and reliable tools to evaluate effect of CM in multifaced outcomes of cancer patient care.

Identification of Immuno-Targeted Combination Therapies Using Explanatory Subgroup Discovery for Cancer Patients with EGFR Wild-Type Gene.

Simple SummaryCancer immunotherapy is a form of cancer treatment that uses a person’s own immune system to prevent, control, and eliminate cancer. However, immunotherapy alone may not be effective, especially in patients with limited treatment options. Immuno-targeted combination therapies have a potential to create synergetic effects with improved health outcomes. Therefore, there is a growing interest in searching for therapeutic combinations that could extend the benefits of immunotherapy. In this study, we designed a computational method that facilitated the identification of effective combination therapies for cancer patients with few treatment options. We determined several specific drug targets that substantially increased the odds of stable disease versus progressive disease for head and neck cancer, lung cancer, and melanoma. The identified treatment combinations were targets in several clinical trials. Moreover, our approach has the potential to improve the selection of patients for immuno-targeted combination therapies and lead to an overall improvement in health outcomes for cancer patients with limited treatment options.(1) Background: Phenotypic and genotypic heterogeneity are characteristic features of cancer patients. To tackle patients’ heterogeneity, immune checkpoint inhibitors (ICIs) represent some the most promising therapeutic approaches. However, approximately 50% of cancer patients that are eligible for treatment with ICIs do not respond well, especially patients with no targetable mutations. Over the years, multiple patient stratification techniques have been developed to identify homogenous patient subgroups, although matching a patient subgroup to a treatment option that can improve patients’ health outcomes remains a challenging task. (2) Methods: We extended our Subgroup Discovery algorithm to identify patient subpopulations that could potentially benefit from immuno-targeted combination therapies in four cancer types: head and neck squamous carcinoma (HNSC), lung adenocarcinoma (LUAD), lung squamous carcinoma (LUSC), and skin cutaneous melanoma (SKCM). We employed the proportional odds model to identify significant drug targets and the corresponding compounds that increased the likelihood of stable disease versus progressive disease in cancer patients with the EGFR wild-type (WT) gene. (3) Results: Our pipeline identified six significant drug targets and thirteen specific compounds for cancer patients with the EGFR WT gene. Three out of six drug targets—FCGR2B, IGF1R, and KIT—substantially increased the odds of having stable disease versus progressive disease. Progression-free survival (PFS) of more than 6 months was a common feature among the investigated subgroups. (4) Conclusions: Our approach could help to better select responders for immuno-targeted combination therapies and improve health outcomes for cancer patients with no targetable mutations.

Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors.

Cancer diagnosis and treatment constitute profoundly stressful experiences involving unique and common challenges that generate uncertainty, fear, and emotional distress. Individuals with cancer must cope with multiple stressors, from the point of diagnosis through surgical and adjuvant treatments and into survivorship, that require substantial psychological and physiological adaptation. This can take a toll on quality of life and well-being and may also promote cellular and molecular changes that can exacerbate physical symptoms and facilitate tumor growth and metastasis, thereby contributing to negative long-term health outcomes. Since modifying responses tostressors might improve psychological and physiological adaptation, quality of life, and clinical health outcomes, several randomized controlled trials have tested interventions that aim to facilitate stress management. We review evidence for the effects of stress management interventions on psychological and physiological adaptation and health outcomes in cancer patients and survivors and summarize emerging research in the field to address unanswered questions.

Role of Peace of Mind for Mental Health Outcomes in Cancer Patients

Role of Peace of Mind for Mental Health Outcomes in Cancer Patients

Pro-Inflammatory Signalling PRRopels Cisplatin-Induced Toxicity.

Cisplatin is a platinum-based chemotherapeutic that has long since been effective against a variety of solid-cancers, substantially improving the five-year survival rates for cancer patients. Its use has also historically been limited by its adverse drug reactions, or cisplatin-induced toxicities (CITs). Of these reactions, cisplatin-induced nephrotoxicity (CIN), cisplatin-induced peripheral neuropathy (CIPN), and cisplatin-induced ototoxicity (CIO) are the three most common of several CITs recognised thus far. While the anti-cancer activity of cisplatin is well understood, the mechanisms driving its toxicities have only begun to be defined. Most of the literature pertains to damage caused by oxidative stress that occurs downstream of cisplatin treatment, but recent evidence suggests that the instigator of CIT development is inflammation. Cisplatin has been shown to induce pro-inflammatory signalling in CIN, CIPN, and CIO, all of which are associated with persisting markers of inflammation, particularly from the innate immune system. This review covered the hallmarks of inflammation common and distinct between different CITs, the role of innate immune components in development of CITs, as well as current treatments targeting pro-inflammatory signalling pathways to conserve the use of cisplatin in chemotherapy and improve long-term health outcomes of cancer patients.

The Relevance of Epigenetic Biomarkers for Breast Cancer and Obesity for Personalised Treatment in Public Healthcare: A Systematic Review

Background: Personalised medicine has gained attention as a result of the advances of genomic research in the last decade. This includes the rise in epigenetic research, which focuses on the environmental influences on the genome and examines biomarkers that might be useful for cancer therapy. This study investigates the epigenetic biomarkers for breast cancer and its risk factor, obesity, and evaluates their relevance for global public health.&#x0D; Methods: A systematic search of articles published from 2005 to May 2015 was performed in PubMed for epigenetic breast cancer marker. An additional literature search was carried out on the epigenetic markers of obesity.&#x0D; Results: The search resulted in 84 articles on breast cancer, which demonstrate the various applications of epigenetic markers for breast cancer diagnostics, prognostics and treatment. Particularly, non-invasive blood-based diagnostic biomarkers and epigenetic therapy could improve the health outcomes of cancer patients using a personalised approach. The 14 obesity-related articles highlight the epigenetic link of disease and risk factors and emphasise the relevance of nutritional influences.&#x0D; Conclusions: Although epigenetics offers many opportunities, new discoveries have to be confirmed first in clinical settings to ensure advantages over traditional methods. Furthermore, before personalised epigenetic therapy can be applied in public health it is crucial to ensure a fair implementation in both high and low-income settings globally.

Patient-reported outcomes and digital literacy of patients treated in an oncology day hospital unit.

Patient-reported outcomes (PROs) use, via a computer registry, allows patients to report their symptoms enabling the detection of early signs of progression of the disease. For such a record, the patient needs to show certain skills in new technologies use. The present study aimed to analyse the perception and degree of digital literacy of patients undergoing oncological treatment in an Oncology Day Hospital (ODH). A cross-sectional descriptive study was performed, where the degree of literacy of patients attending antineoplastic treatment at the ODH was examined by means of an anonymous survey. A total of 122 patients have been included in the study. The proportion of subjects who use the electronic mail (TM) and the Internet on a daily basis was 45.1% and 70.5%, respectively, and up to 77.9% from the subjects considered that the use of digital 2.0 strategies could help improve communication between healthcare professional and patient.The TM was determined by the age, educational level and employment status of the individual. Furthermore, the age of the patients conditioned their perception of the usefulness of the web 2.0 tools (T2.0). This study allowed us to establish a target patient profile to conduct the efficient monitoring of cancer progression by PROs. The results have shown that approximately 60% of the patients in our population could be potential candidates to receive PROs-based health care. This approach enables earlier detection of symptoms and signs of progression and consequently, improves health outcomes for cancer patients.

Effect of Treatment with the PD-1/PD-L1 Inhibitors on Key Health Outcomes of Cancer Patients.

Recent studies have shown that treatment with the programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitor class could significantly improve survival outcomes in several oncology indications. However, there is some clinical uncertainty. This study aimed to obtain high-level estimates of the impact of treatment with PD-1/PD-L1 inhibitor class to oncology treatment on key health outcomes in real-world situations and to inform public health policy decisions about cancer care after reducing uncertainties around new immuno-oncology therapy options in South Korea. A model was developed to estimate the impact of PD-1/PD-L1 inhibitors on outcomes in situations wherein both anti-PD-1/PD-L1s and standard of care (SOC) were available versus SOC only. A partitioned survival model was utilized to estimate the impact of introducing anti-PD-1/PD-L1s on outcomes, including life-years gained, quality-adjusted life-years gained, progression-free survival-years obtained, and grade 3 or higher adverse events avoided for six indications over 5 years. An exponential distribution was fitted to the survival function of the SOC based on visual inspection. Outcomes associated with anti-PD-1/PD-L1s were estimated using a piecewise modeling approach with Kaplan-Meier analysis followed by best-fitting survival analysis. The incident number of patients and market share of anti-PD-1/PD-L1s during 2020-2024 were projected using published literature and Korean market survey data. Sensitivity analyses were performed to test the uncertainty of input parameters. During the next 5-year period (2020-2024), introducing the anti-PD-1/PD-L1 class led to a gain of 22,001 life-years (+ 31%), 19,073 quality-adjusted life-years (+ 38%), and 22,893 progression-free survival-years (+ 82%); it also avoided 3610 adverse events (- 11%) compared with SOC alone. Most adverse events associated with anti-PD-1/PD-L1s were attributed to combination therapy with cytotoxic chemotherapy (91%). In a scenario wherein the time to reimbursement of the anti-PD-1/PD-L1s was accelerated by 1 year, the life-years gained increased by 14% compared with the base-case scenario. Anti-PD-1/PD-L1 therapy is expected to provide marked survival benefits for patients with cancer. This study demonstrated the potentially beneficial health impacts of utilizing the anti-PD-1/PD-L1 class at the population level. The findings could inform health policy decision makers about cancer care and ultimately enhance population health through rapid access to innovative cancer drugs.

Utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) to measure primary health outcomes in cancer patients: a systematic review.

To systematically review the literature on how the Patient-Reported Outcomes Measurement Information System (PROMIS) measure system is used to assess patient-reported outcomes (PROs) in cancer patients. We conducted a systematic review following the PRISMA guidelines. Articles were identified through searches of PubMed, EMBASE, and additional manual review of the publications listed on the PROMIS website. We included studies measuring outcomes, including physical function, fatigue, pain, anxiety, and depression in cancer patients. Eligible articles included interventional and observational studies published in English between 2009 and 2019. A total of 1789 records were identified and screened by three reviewers, 118 articles were reviewed in full text, and 42 articles met the inclusion criteria. The majority of studies used the PROMIS measure system to prospectively assess longitudinal changes in PROs; the number of measurements ranges from 2 to 4with the time points of follow-up set at 3, 6, and 12 months after the baseline assessment. Depression and fatigue were the most frequently measured outcomes. Fixed-length short forms with four items were the most common measure types. A transition toward utilizing a web- or smartphone-based electronic tool was observed to limit the burden of the conventional paper-based survey to collect and store PROs. The PROMIS measure system is increasingly popular to measure PROs in cancer patients with acceptance of its various short forms and electronic-based systems to administer data electronically. Findings from this review highlight various aspects of PROMIS and may help health professionals in their choice of PRO tools for optimizing care and support for cancer patients.

Screening for health literacy at an urban academic cancer center.

e19034 Background: Low health literacy is more prevalent among older adults and minority populations, and it has been linked to excess health care utilization and poor health outcomes in cancer patients. Screening for health literacy may improve communication and care, such that discussions and information can be tailored to patient need. The purpose of this study was to describe health literacy levels and correlates among patients at an urban, NCI-designated cancer center. Methods: In September 2019, we began health literacy screening for each newly diagnosed, English-speaking cancer patient. Patients were categorized as having low, medium, or high health literacy using the BRIEF health literacy screener; results are visible in the EMR. For this analysis, we included patient age, gender, insurance type, race/ethnicity, and socio-economic status (SES), which was calculated using an Area Deprivation Index (ADI) ranging from 0 (no deprivation) to 100 (extreme deprivation). Data was summarized using descriptive statistics; ANOVA and Chi-squared tests investigated associations between patient’s health literacy levels and potential correlates. Results: Among 284 patients, 68%, (n = 195) were Caucasian, 25% (n = 70) were African American and 7%, (n = 19) identified as Hispanic, Asian American or some other race. Seventy-five percent (n = 211) were male; the mean age was 63 years (SD: 12). The mean ADI was 42 (SD: 28), indicating a low to moderate SES. Seventy percent (n = 200) had a high health literacy score, 20% (n = 57) had a medium score, and 10% (n = 27) had a low health literacy score. Only a patient’s race/ethnicity and the ADI were significantly associated with their health literacy score. Seventy-seven percent of Caucasian patients had high health literacy scores compared to 59% of African American patients and 48% patients of Hispanic, Asian or some other origin (P &lt; .001). Patients with low health literacy had an ADI score (65.1) that was almost double the score of patients with high health literacy scores (38.5) (p &lt; .001). Conclusions: Roughly one-third of patients seen at this urban cancer center did not have a high health literacy score. Socio-economic status was a stronger correlate to health literacy than patient age, marital status, or insurance type. EMRs should capture a patient’s SES in some manner, as this is strongly associated with health literacy.