Health Outcomes In Cancer Patients Research Articles

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.
 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.
 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.
 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 < .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 < .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.

HSR20-092: “Write to Recover”: The Impact of Group Led Creative Writing on Physical Health Outcomes in Cancer Patients

HSR20-092: “Write to Recover”: The Impact of Group Led Creative Writing on Physical Health Outcomes in Cancer Patients

Primary Care-Led Transition Clinics Hold Promise in Improving Care Transitions for Cancer Patients Facing Social Disparities: A Commentary.

Transitions in care are key junctions during which care coordination, communication, and individualized support are required to ensure optimal health outcomes for patients. This is particularly true for patients who face social disparities, such as poverty, limited health literacy, or belonging to a racial or ethnic minority, who are particularly at risk for experiencing poor care transitions. Interdisciplinary primary care-led transition clinics are an intervention that have shown promise in improving care transitions for diverse patient populations, including those that face social disparities, but their role in improving transitions in cancer care remains largely untapped. In this commentary we highlight why the time-limited support of an interdisciplinary primary care-led transition clinic that targets socially vulnerable cancer patients holds the promise of achieving more equitable healthcare access, healthcare quality, and ultimately more equitable health outcomes for cancer patients.

Muscle alterations in the development and progression of cancer-induced muscle atrophy: a review.

Cancer cachexia-cancer-associated body weight and muscle loss-is a significant predictor of mortality and morbidity in cancer patients across a variety of cancer types. However, despite the negative prognosis associated with cachexia onset, there are no clinical therapies approved to treat or prevent cachexia. This lack of treatment may be partially due to the relative dearth of literature on mechanisms occurring within the muscle before the onset of muscle wasting. Therefore, the purpose of this review is to compile the current scientific literature on mechanisms contributing to the development and progression of cancer cachexia, including protein turnover, inflammatory signaling, and mitochondrial dysfunction. We define "development" as changes in cell function occurring before the onset of cachexia and "progression" as alterations to cell function that coincide with the exacerbation of muscle wasting. Overall, the current literature suggests that multiple aspects of cellular function, such as protein turnover, inflammatory signaling, and mitochondrial quality, are altered before the onset of muscle loss during cancer cachexia and clearly highlights the need to study more thoroughly the developmental stages of cachexia. The studying of these early aberrations will allow for the development of effective therapeutics to prevent the onset of cachexia and improve health outcomes in cancer patients.

137 - Quality of Diabetes Care Among Cancer Survivors

As cancer survivorship continues to improve, management of comorbid diabetes has become an increasingly important determinant of health outcomes for cancer patients. This study aimed to compare indicators of diabetes quality of care between diabetes patients with and without a history of cancer.

Mindfulness‐based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta‐analysis of randomized controlled trials

ObjectiveMindfulness‐based interventions (MBIs) are increasingly used within psycho‐oncology. Since the publication of the most recent comprehensive meta‐analysis on MBIs in cancer in 2012, the number of published trials has more than doubled. We therefore conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs), testing the efficacy of MBIs on measures of psychological distress (primary outcome) and other health outcomes in cancer patients and survivors.MethodsTwo authors conducted independent literature searches in electronic databases from first available date to 10 October 2018, selected eligible studies, extracted data for meta‐analysis, and evaluated risk of bias.ResultsTwenty‐nine independent RCTs (reported in 38 papers) with 3274 participants were included. Small and statistically significant pooled effects of MBIs on combined measures of psychological distress were found at post‐intervention (Hedges's g = 0.32; 95%CI: 0.22‐0.41; P < .001) and follow‐up (g = 0.19; 95%CI: 0.07‐0.30; P < .002). Statistically significant effects were also found at either post‐intervention or follow‐up for a range of self‐reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain (g: 0.20 to 0.51; p: <.001 to.047). Larger effects of MBIs on psychological distress were found in studies (a) adhering to the original MBI manuals, (b) with younger patients, (c) with passive control conditions, and (d) shorter time to follow‐up. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post‐intervention.ConclusionsMBIs appear efficacious in reducing psychological distress and other symptoms in cancer patients and survivors. However, many of the effects were of small magnitude, suggesting a need for intervention optimization research.

Write to recover: The impact of group led creative writing on behavioral health outcomes in cancer patients.

11536 Background: The diagnosis of cancer can adversely affect mental wellbeing. In addition to treating cancer, the emotional wellbeing of patients must simultaneously be addressed. A previous pilot exploring the feasibility of creative writing workshop (CWW) in cancer patients showed apositive effect on patients’ mental health. Methods: To longitudinally evaluate the efficacy of CWW on mood, we conducted a phase II study with cancer patients (any stage, any cancer type); randomized 2:1 to CWW vs. active control (AC). Patients in the CWW arm attended at least 4, 1.5-hour bi-monthly CWW x 8 wks, whereas AC patients completed independent writing at home with the help of a book (bi-monthly x 8wks). We used validated tools, [Emotional Thermometer Scales (ETS), PHQ-9, GAD-7] to assess changes in overall mood, depression, and anxiety. Primary end point: a) ETS scores before and after intervention b) Changes in depression and anxiety based on PHQ-9 and GAD-7 scores. We present results from ETS scores. Descriptive statistics were generated for these quantitative scales measured in each group, pre and post intervention. Comparisons between groups (gp) were made using Wilcoxon Rank-sum tests. All tests were two sided and the statistical significance level used was 0.05. Results: Amongst evaluable patients, N of 50 (demographics in table below), twenty-six patients in the CWW gp attended at least one class and 19 attended at least 4 classes. Patients in CWW showed significant mood improvement vs. AC when comparing the final overall ETS (p=0.0063). Three of the five sub-scale ETS scores were significantly lower for the CWW vs. AC gp: anxiety (p=0.0027), depression (p=0.0009), and anger (p=0.0027). Conclusions: Group led CWW have a positive effect on mood. Our results suggest potential therapeutic benefit of this intervention on the emotional wellbeing of cancer patients. Larger studies are needed to evaluate the effect of CWW in cancer patients. Clinical trial information: NCT03536702. [Table: see text]

Early Cancer detection in the Pacific

Abstract Cancer is now the second leading cause of death across the South Pacific Region, and leading cause of death in at least two Pacific nations. As Pacific countries are also operating health systems with constrictive budgets and constrained resourcing, it can be difficult to quantify and obtain precise cancer measures and estimates such as incidence, morbidity, survival and mortality figures over time. It is acknowledged that within this resource constrained environment, the diagnosis, treatment and management of cancer patients is fraught with challenges and difficulties where routine tests and equipment may be unavailable and even vary from hospital to hospital. Circulating tumour DNA (ctDNA) refers to tumour DNA fragments found in the blood circulation. Using a simple blood test, these fragments can be identified by the presence of mutations in cancer genes and can be isolated and quantified to provide information concerning cancer’s size and progression. It is anticipated this simple method of detecting and monitoring cancer will enhance the precision of cancer diagnostics and surveillance and also lead to improved cancer health outcomes for Pacific Peoples in the Region. Preliminary engagement efforts with clinical and research persons were undertaken in order to understand the local context and explore the potential utility of ctDNA technology for early cancer detection to support and improve the diagnostics, care and health outcomes of cancer patients in the Solomon Islands. Interest was expressed in the possibility of utilizing a simple blood sample to allow detection and monitoring of cancer growth. The potential utility of ctDNA for early cancer detection remains a promising approach for cancer diagnostics.

Development of a Prehabilitation Multimodal Supportive Care Interventions for Men and Their Partners Before Radical Prostatectomy for Localized Prostate Cancer.

An important question revolves around when the most opportune time is to introduce recovery-optimizing behaviors for men opting for radical prostatectomy (RP) for localized prostate cancer (PCa). An emerging field of research describes the role of preoperative strategies to improve treatment tolerance and overall physical and psychological recovery. The aim of this study was to explore the perceptions of a multimodal prehabilitation intervention for men and their partners before RP for localized PCa. Thirty-four patients who opted for RP for localized PCa and their partners (19) were identified and recruited into the study. The multimodal intervention was composed of educational materials, physiotherapy instruction, and a self-management group-based seminar. The multimodal prehabilitation intervention was perceived as overall helpful with demonstrated acceptability (91.9%). Beneficial themes related to the quality of the information provided to support self-management, open forum questions with multidisciplinary healthcare professionals, and increased knowledge among partners to help with their understanding of how to look after their partners. The intervention was feasible and beneficial for the PCa dyad. A future pilot randomized controlled trial study is needed to provide sufficient evidence on the long-term physical and psychological outcomes and cost-effectiveness. Oncology nurses play a key role in the development of prehabilitation care delivery. Prehabilitation interventions can have a positive effect on improving health outcomes for cancer patients and their partners after surgery and into survivorship.

Budget impact model for oncopharmacogenetics from the perspective of mandatory basic health insurance in Switzerland using the example of breast cancer.

Single-nucleotide polymorphisms (SNPs) can severely impact individual drug response and health outcomes in cancer patients. Genetic tests to screen for marker SNPs are available to adjust the drug dose of oncologicals to the patient’s needs. However, it is unclear whether the positive effects outbalance the increased costs or even lead to an overall cost reduction. This very pragmatic analysis used three frequently used oncologicals for the treatment of breast cancer to evaluate whether preemptive pharmacogenetic testing may have a cost-reducing impact on health care spending in the Swiss health care system. Our results indicate that oncopharmacogenetics might help to reduce health care costs (ie, by avoiding adverse drug effects) and to increase efficiency of drugs in oncologic patients.

Research progress of expressive writing in cancer patients

Interventions of expressive writing in cancer patients are mainly implemented in foreign countries. This paper reviews the proposal and development, implementation methods and mechanisms of expressive writing, and its effect on health outcomes of cancer patients, which indicates the population sensitivity and cultural sensitivity. In recent years, more and more attention has been paid to the intermediary variables, objective index and the analysis of the writing text in order to fully explain the mechanism and identify the social psychological needs of cancer patients at different stages. Future research can focus on sensitive populations, explore intermediary variables, incorporate objective indicators, optimize intervention methods, and explore the best intervention model for localization. Key words: Neoplasms; Psychological health; Physical health; Expressive writing

Health Literacy Is an Independent Predictor of Cancer Patients' Hospitalizations.

Background:Lower levels of health literacy predict higher hospitalization rates. Hospitalization is expensive and many admissions are potentially avoidable. Research examining the relationship between health literacy and health outcomes for cancer patients is limited, and no published studies to date have focused on hospitalization and health literacy in cancer patients.Objective:This study examined the ability of health literacy to predict hospitalization of cancer patients.Methods:This secondary data analysis investigated the relationship between health literacy and hospitalization rates of adult cancer patients in the first 5 years after their diagnosis. The sample included a diverse selection of cancer diagnoses and all stages of cancer were represented. Health literacy was assessed using the Cancer Health Literacy Test 30 (CHLT-30), a psychometrically sound measure of health literacy validated in a cancer patient population. Health literacy's ability to predict the number of times hospitalized, total days spent hospitalized, and number of 30-day readmissions was examined using multivariate negative binomial multiple regression to control for the outcomes and potentially confounding variables.Key Results:When controlling for potentially confounding variables, a negative relationship was found between health literacy and the number of inpatient hospitalizations (β = −0.041, p = .009) and the total number of days spent hospitalized (β = −0.028, p = .023) independently, whereas the relationship between health literacy and the number of 30-day readmissions failed to reach significance (β = −0.002, p = .903).Conclusions:Patients with lower health literacy need additional assistance to avoid unplanned hospitalizations. [Health Literacy Research and Practice. 2017;1(4):e153–e162.]Plain Language Summary:Results from this study found that as cancer patients' health literacy scores decreased, the number of times hospitalized and the total number of days spent in the hospital increased. This relationship was significant when controlling for diagnosis, stage at diagnosis, receipt of chemotherapy, number of comorbidities, death, education, and race. Cancer patients with low health literacy are at a higher risk of being hospitalized.

The Cancer Loneliness Scale and Cancer-related Negative Social Expectations Scale: development and validation.

Loneliness is a known risk factor for poor mental and physical health outcomes and quality of life in the general population, and preliminary research suggests that loneliness is linked to poorer health outcomes in cancer patients as well. Various aspects of the cancer experience contribute to patients feeling alone and misunderstood. Furthermore, loneliness theory suggests that negative social expectations, which may specifically relate to the cancer experience, precipitate and sustain loneliness. Cancer-specific tools are needed to assess key constructs of this theory. In the current study, we developed and tested measures of (1) loneliness attributed to cancer (i.e., cancer-related loneliness) and (2) negative social expectations related to cancer. First, we developed the items for the measures based on theory, prior research, and expert feedback. Next, we assessed the measures' psychometric properties (i.e., internal consistency and construct validity) in a diverse sample of cancer patients. The final products included a 7-item unidimensional Cancer Loneliness Scale and a 5-item unidimensional Cancer-related Negative Social Expectations Scale. Evidence of excellent reliability and validity was found for both measures. The resulting measures have both clinical and research utility.

Validation of biomarkers to predict response to immunotherapy in cancer: Volume II — clinical validation and regulatory considerations

There is growing recognition that immunotherapy is likely to significantly improve health outcomes for cancer patients in the coming years. Currently, while a subset of patients experience substantial clinical benefit...

Oral antidiabetic drug use and associated health outcomes in cancer patients.

To assess oral antidiabetic drug use and associated health outcomes in American non-elderly adults with cancer A retrospective study was conducted by analysing the Marketscan(®) Commercial Claims and Encounters Database from 2008 to 2009. Individuals 18-64years with concomitant diagnoses of cancer (breast, prostate, colon or lung) and type 2 diabetes, and treated with oral antidiabetic medications were included. Medication adherence was assessed using the Medication Possession Ratio (MPR); logistic regression was used to analyse factors associated with non-adherence. Adherence was compared between patients with cancer and non-cancer controls matched by propensity scores. Negative binomial regression was utilized to examine the effect of antidiabetic drug adherence on all-cause hospitalizations and emergency room visits. The impact of adherence on total medical costs was then evaluated using the generalized linear model (GLM) with the log-link function and gamma error distribution. Of 1918 diabetic, cancer patients who newly initiated oral diabetic drugs, only 37·6% were adherent to oral diabetic medications; a similar proportion of adherence was found in the non-cancer control population (35·8%, P=0·24). Younger age, living in the southern region, using combination therapy vs. monotherapy, and using retail pharmacy vs. mail order pharmacy were significantly associated with non-adherence in patients with cancer. Adherence to oral antidiabetic drugs was associated with 24% fewer all-cause hospitalizations (P=0·02). We identified high prevalence of non-adherence to oral antidiabetic medications as well as negative consequences associated with non-adherence, among patients with cancer. These findings may underscore the importance of developing relevant intervention strategies for improving diabetes management and treatment outcomes among cancer patients with diabetes.

Healthcare access for cancer patients in the era of economic crisis. Results from the HOPE III study

Abstract Background: Despite the documentation of addressing healthcare disparities in detection and treatment of cancer and health outcomes for cancer patients, the inequalities persist. Cancer patients of several vulnerable groups suffer disproportionally the effect of economic crisis on health and healthcare. Patients &amp; Methods: A cross sectional survey was carried out between July and October 2014 in order to assess the cancer patients’ barriers to healthcare access. A total of 426 cancer patients, members of cancer patient organization participated in the study. Data were collected by using an online, self reported questionnaire evaluating three main areas: healthcare access (7 items), economic status and financial burden of the disease (17 items) and the alteration on several aspects related to the disease (8 items) from 2009 to 2014. Results: Approximately 31% of cancer patients reported that they faced barriers to healthcare access for cancer treatment during the last 12 months. The main barriers included long waiting time for a medical appointment (51%) and inability to visit a private physician due to the incapability to pay the out of pocket cost (44%). One in four patient encountered obstacles in medication access which resulted to treatment delay (46%), worsened health status (96%) and increased out of pocket costs (39%). Conclusions: Results suggest that there are vulnerable groups among cancer patients in Greece who suffer disproportionally more the impact of economic crisis on health and healthcare. Healthcare reforms and targeted interventions should be implemented in order to effectively address the inequities in access for cancer patients.