New Diagnosis Of Cancer Research Articles

Cancer Risk in Inflammatory Bowel Disease: A 6-Year Prospective Multicenter Nested Case–Control IG-IBD Study

In a 6-year, multicenter, prospective nested case-control study, we aimed to evaluate risk factors for incident cancer in inflammatory bowel disease (IBD), when considering clinical characteristics of IBD and immunomodulator use. The secondary end point was to provide characterization of incident cancer types. All incident cases of cancer occurring in IBD patients from December 2011-2017 were prospectively recorded in 16 Italian Group for the Study of Inflammatory Bowel Disease units. Each of the IBD patients with a new diagnosis of cancer was matched with 2 IBD patients without cancer, according to IBD phenotype (ulcerative colitis [UC] vs Crohn's disease [CD]), age (±5 years), sex. Risk factors were assessed by multivariate logistic regression analysis. Cancer occurred in 403 IBD patients: 204 CD (CD cases), 199 UC (UC cases). The study population included 1209 patients (403 IBD cases, 806 IBD controls). Cancer (n = 403) more frequently involved the digestive system (DS; 32%), followed by skin (14.9%), urinary tract (9.7%), lung (6.9%), genital tract (6.5%), breast (5.5%), thyroid (1.9%), lymphoma (2.7%, only in CD), adenocarcinoma of the small bowel (SBA; 3.9%, 15 CD, 1 pouch in UC), other cancers (15.9%). Among cancers of the DS, colorectal cancer (CRC) more frequently occurred in UC (29% vs 17%; P < 0.005), whereas SBA more frequently occurred in CD (13% vs 6.3% P = 0.039). In CD, perforating (B3) vs non-stricturing non-perforating (B1) behavior represented the only risk factor for any cancer (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.33-4.11). In CD, risk factors for extracolonic cancer (ECC) were a B3 vs B1 and a stricturing (B2) vs B1 behavior (OR, 2.95; 95% CI, 1.62-5.43; OR, 1.79; 95% CI, 1.09-2.98). In UC, risk factors for ECC and for overall cancer were abdominal surgery for UC (OR, 4.63; 95% CI, 2.62-8.42; OR, 3.34; 95% CI, 1.88-5.92) and extensive vs distal UC (OR, 1.73; 95% CI, 1.10-2.75; OR, 1.99; 95% CI, 1.16-3.47). Another risk factor for ECC was left-sided vs distal UC (OR, 1.68; 95% CI, 1.00-2.86). Inflammatory bowel disease duration was a risk factor for skin and urinary tract cancers. Perforating CD, extensive UC, and abdominal surgery for UC were identified as risk factors for overall incident cancer and for ECC. The clinical characteristics associated with severe IBD may increase cancer risk.

Job loss and return to work of patients with cancer. A prospective observational study on 416 cancer patients.

A prospective observational study started at the Medical oncology unit, Hospital of Piacenza (North Italy). All the patients between 18 and 65 years of age, diagnosed with early or metastatic cancer, admitted to the outpatient clinic, were analyzed for employment and work-related issues (job interruption, returning to work, job loss). A questionnaire with socio-demographic and job related information was submitted to each patient. From January 2015 to June 2017, 2,187 patients with a new diagnosis of cancer were admitted to the outpatient clinic, 550 patients (25.15%) were be-tween 18 and 65 year old, and 416 patients (75.64%) participated to the study. 278 (66.83%) women and 138 (33.17%) men, mean age 50.32±7.90 years (range 18-65), 39.18% were employees, 29.81% workers, 328 (78.85%) with subordinate job, the majority of patients had an high school or academic degree (63.46%). 196 (47.12%) patients had breast cancer, 85 (20.43%) gas-trointestinal cancer, 41 (9.86%) lung cancer, and 94 pa-tients (22.59%) had other cancer; 105 patients (25.24%) showed metastatic cancer and 134 (32.21%) had comor-bidity. After 6 months 178 patients (42.79%) interrupted their work, of these, 99 were women, 35.61% of the 278 female and 79 men, 57.25% of the 138 males, 69 worker (38.76%), 94 with low level of education (52.81%). The majority of patients (86.67%) with metastatic cancer, or treated with chemotherapy (61.60%), or with comorbidity (50.75%), left their work after 6 months from diagnosis. Only 22 of 178 patients (12.36%) in our series returned to work, of these, 20 (90.90%) were women, 17 with breast cancer (85%). Our findings suggest that there is a significant association between job loss and gender (male), low level of education/heavy works, advanced stage of cancer, chemotherapy and comorbidity. It is important that clinicians and institutions consider work-related issue in cancer patients and perform adequate organizational and normative interventions.

Omega 3 fatty acid supplementation after myocardial infarction: a systematic review and meta-analysis

BackgroundThe purpose of this review is to examine the effect of Omega-3 Fatty acids on mortality, morbidity, and adverse events in patients with acute myocardial infarction (AMI).MethodsData Sources: MEDLINE, EMBASE, and the Cochrane Library through May 2018. Study Selection: Randomized Controlled trials (RCT). Certainty of evidence was assessed with the GRADE system. Interventions: omega 3 fatty acids against placebo or no treatment. Primary and secondary outcomes: All-cause death, cardiovascular death, new AMI, stroke, need for therapeutic angioplasty or By-pass, new diagnosis of cancer and incidence of adverse events.ResultsFor the efficacy endpoints we included 10 RCT (24,414 patients). Omega 3 fatty acids probably make little or no difference to all-cause mortality (4 studies 9141 patients RR 1.06 - CI95% 0.90 to 1.27, moderate certainty), cardiovascular mortality (3 studies 4304 patients RR 0.93 - CI95% 0.63 to 1.37, moderate certainty), new AMI (RR 1.24 CI95% 0.71 to 2.14 - moderate certainty), any cardiovascular event (RR 0.95 95%CI 0.86 to 1.05; low certainty due to risk of bias and imprecision), and stroke (RR 1.2 95%CCI 0,66–2,19 - moderate certainty). Regarding adverse events, we are uncertain if Omega 3 fatty acids improve/reduce non severe adverse events (RR 1.39 95% CI 0.36 to 5.34; very low certainty). There is probably little or no difference in the outcome suspension due to adverse events (RR 1.19 CI 95% 0.97 to 1.47; moderate certainty).ConclusionsFor adult patients with AMI, omega 3 fatty-acids probably yield no benefit to patient important outcomes.

How are caregivers involved in treatment decision making for older people with dementia and a new diagnosis of cancer?

ObjectiveTo explore how caregivers are involved in making treatment decisions for older people living with dementia and a new diagnosis of cancer.MethodA systematic review of PubMed, CINAHL, PsycINFO, Web of Science, and Scopus databases was conducted. Studies recruiting formal or informal caregivers for older people with dementia and a diagnosis of cancer were considered for inclusion.ResultsOf 1761 articles screened, 36 full texts were assessed for eligibility, and six were included in the review. This review has identified that health care professionals (HCPs) are often unaware of the coexistence or severity of dementia in cancer patients, and therefore fail to properly address care needs as a result. While caregivers are relied on to help make decisions, they have unmet information needs and feel excluded from decision‐making.ConclusionTreatment decision making in the context of older adults with dementia and a new diagnosis of cancer needs further research. This will help HCPs to understand their needs and improve the experience of decision making for both caregivers and the people that they care for.

MON-170 Low Plasma Glucose Results from Primary Care Are Not Associated with Morbidity, Mortality, or Underlying Hypoglycemic Disorders

Background: Low glucose is a relatively common primary care referral to specialist endocrine services. However the prevalence of endocrine disease causing endogenous hypoglycemia is extremely rare. We sought to determine whether low plasma glucose in primary care was associated with adverse clinical outcomes or underlying hypoglycemic disorders. Methods: We obtained all plasma glucose results <72mg/dl originating from primary care within our catchment population (n = 800,00), in non-diabetic individuals (20,145 people [77.6% female]) aged 18 - 40 years, between 2002 and 2017. These data were linked to national admission, mortality, cancer and diabetes registers to assess associations with mortality and morbidity. Results: Median follow-up was 4.8 years (IQR 2.6 - 7.8). Median age was 29 years (24 - 34). Glucose was marginally higher in women 65 mg/dl vs. 63 mg/dl, P < 0.0001. Only 0.3% of patients were assessed in an endocrine clinic for evaluation of hypoglycaemia. Glucose concentration was < 40 mg/dl in 0.63% (category A), 40 - <54 mg/dl in 8.7% (category B), 54 - <63 mg/dl in 28.0% (category C) and ≥63 mg/dl in 62.6% (category D). A history of eating disorder was present in 2.4% (A), 1.1% (B), 0.4% (C) and 0.3% (D), P < 0.0001. Likelihood of admission to hospital with hypoglycaemia (P < 0.001) and electrolyte disturbance (P < 0.001) was also greater in those in the lower glucose categories. Increasing age (HR 1.03, P < 0.001) and male gender (HR 4.20, P < 0.001), but not glucose < 54 mg/dl (HR 0.89, P = 0.79), were associated with mortality (n = 72). The risk of a subsequent new diagnosis of cancer or hospital admission with incident cardiovascular, renal or liver disease was not related to glucose category. Hospital admission with infectious disease was more likely (3.3%) in those with glucose ≥ 54mg/dl compared to those with lower glucose (2.2%), P = 0.01. Incident diabetes was observed in 0.2% of those with glucose < 54 mg/dl and in 0.6% of those with glucose ≥ 54mg/dl (OR 3.0, P = 0.009). No cases of insulinoma were detected based on the results of these tests. Conclusion: Low plasma glucose results from primary care are almost never indicative of an endogenous hyperinsulinemic disorder and are not associated with adverse outcomes in adults up to 40 years of age. Underlying eating disorder should be considered in this context. Assessment by an endocrinologist should be limited to cases where Whipple’s triad is present.

An Exploratory Needs Analysis of Parents Diagnosed with Cancer

ABSTRACTThe purpose of this study was to explore the experiences of parents and co-parents where one parent was diagnosed with cancer with specific interest in the impact of the disease on their role as a parent and the supports that were found to be useful in managing the ongoing care of their children. A qualitative research method using semi-structured interviews and thematic network analysis techniques was used. Participants included adult English-speaking parents receiving treatment for a new diagnosis of cancer at a major tertiary oncology research and treatment centre, with prior social work involvement. Participants reported multiple, complex layers of need. Four salient themes were evident: (a) emotional impact of a cancer diagnosis on the patient, (b) accessing professional supports, (c) children’s understanding, and (d) meeting children’s needs. Parents described difficulties in managing emotionally, physically, and existentially. Accessing supports within the healthcare service and community was paramount, as was guidance around communicating with children. Receiving a proactive service from a social worker was highly regarded. The results demonstrate that it is essential to respond to the needs of parents with cancer in order to minimise prolonged emotional distress.

Unidentified cachexia patients in the oncologic setting: Cachexia UFOs do exist.

Cachexia is an important outcome-modulating parameter in patients with cancer. In the context of a randomized controlled trial on cachexia and nutritional therapy, the TiCaCONCO (Tight Caloric Control in the Cachectic Oncologic Patient) trial, the contacts between patients with cancer and health care practitioners and oncologists were screened. The aim of this retrospective study was to identify in the charts the input of data on body weight (necessary to identify cachexia stage), relevant nutritional data, and nutritional interventions triggered or implemented by oncologists and dietitians. In a tertiary, university oncology setting, over a time span of 8 mo (34 wk), the charts of patients admitted to an oncology, gastroenterology, or abdominal surgery unit were screened for the presence of information contributing to a cancer cachexia diagnosis. Data (patient characteristics, tumor type, and location) was gathered. We analyzed 9694 files. Data on body weight was present for >90% of patients. Of the 9694 screening, 118 new diagnoses of cancer were present (1.22% of patient contacts). Information on weight evolution or nutritional status was absent for 54 patients (46%). In contacts between oncologists and patients with cancer, at the time of diagnosis, cachexia was present in 50 patients (42%). In 7 of these patients (14%), no nutritional information was present in the notes. Of the 50 patients with cachexia, only 8 (16%) had a nutritional intervention initiated by the physician. Nutritional interventions were documented in the medical note in 11 patients (9%) in the overall study population. Dietitians made notes regarding nutrition and weight for 49 patients (42%). We could not demonstrate a difference in mortality between cachectic and non-cachectic patients, although numbers are small for analysis. Patients newly diagnosed with cancer are not systematically identified as being cachectic and if they are, interventions in the field of nutrition therapy are largely lacking. Important barriers exist between oncologists and dietitians, the former being mandatory to the success of a nutrition trial in cancer.

Engagement in HIV Care and Access to Cancer Treatment Among Patients With HIV-Associated Malignancies in Uganda.

PURPOSEHealth system constraints limit access to HIV and cancer treatment programs in sub-Saharan Africa. Limited access and continuity of care affect morbidity and mortality of patients with cancer and HIV. We assessed barriers in the care cascade of comorbid HIV and cancer.PATIENTS AND METHODSStructured interviews were conducted with 100 adult patients with HIV infection and new diagnoses of cancer at the Uganda Cancer Institute. Participants completed follow-up questionnaires after 1 year to assess ongoing engagement with and barriers to care.RESULTSThe median time from new-onset cancer symptoms to initiation of cancer care at the Uganda Cancer Institute was 209 days (interquartile range, 113 to 384 days). Persons previously established in HIV care waited less overall to initiate cancer care (P = .04). Patients established in HIV care experienced shorter times from initial symptoms to seeking of cancer care (P = .02) and from seeking of care to cancer diagnosis (P = .048). Barriers to receiving care for HIV and cancer included difficulty traveling to multiple clinics/hospitals (46%), conflicts between HIV and cancer appointments (23%), prohibitive costs (21%), and difficulty adhering to medications (15%). Reporting of any barriers to care was associated with premature discontinuation of cancer treatment (P = .003).CONCLUSIONPatients with HIV-associated malignancies reported multiple barriers to receiving care for both conditions, although knowledge of HIV status and engagement in HIV care before presentation with malignancy reduced subsequent time to the start of cancer treatment. This study provides evidence to support creation and evaluation of integrated HIV and cancer care models.

HBV, HCV, and HIV Infection in People with New Diagnoses of Cancer

Hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV can significantly affect the care of a person with newly diagnosed cancer, yet universal

Second primary cancers in long-term survivors of glioblastoma.

Overall survival (OS) in glioblastoma (GBM) is poor at an average of 14 to 18 months, and long-term survivors (LTS) of GBM are rare. LTS of GBM, defined as surviving >5 years postdiagnosis, represent only 2% to 10% of all GBM patients. LTS of cancer are at high risk of developing second primary neoplasms. This study looks at occurrences of second primary neoplasms in LTS of GBM. Records from adult patients newly diagnosed with GBM between January 1, 1998 and February 8, 2010, were retrospectively reviewed to identify LTS, defined as patients who survived ≥5 years. We focused on the identification of a new diagnosis of cancer occurring at least 2 years after the initial GBM diagnosis. We identified 155 LTS of GBM, with a median OS of 11.0 years (95% CI: 9.0 to 13.1 years) and a median follow-up of 9.6 years (95% CI: 8.7 to 10.7 years). In this cohort of patients, 13 (8.4%) LTS of GBM developed 17 secondary cancers. Eight could potentially be attributed to previous radiation and chemotherapy (skin cancer in radiation field [n = 4], leukemia [n = 2], low-grade glioma [n = 1], and sarcoma of the scalp [n = 1]). The other 9 cases included melanoma (n = 2), prostate cancer (n = 2), bladder cancer (n = 1), endometrioid adenocarcinoma (n = 1), basal cell carcinoma (n = 1), and renal cell carcinoma (n = 1). Although second primary cancers are rare in GBM LTS, providers should continue close monitoring with appropriate oncologic care. Moreover, this highlights the need for survivorship care of patients with GBM.

Abstract WMP53: New Diagnosis of Cancer and the Risk of Subsequent Arterial Thromboembolic Events

Background: Retrospective studies have reported an association between cancer and arterial thromboembolism risk. We sought to confirm this in a prospective cohort with adjudicated cardiovascular outcomes. Methods: We analyzed data from participants enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who had Medicare coverage for 365 days before their baseline study visit in 2003-2007. Participants with prevalent cancer, coronary heart disease, or cerebrovascular disease were excluded. Medicare claims were used to identify new cancer diagnoses during follow-up. Using incidence-density sampling, participants who developed cancer were matched by age, sex, race, and education level 1:4 to participants who hadn’t developed cancer. Participants were prospectively followed through September 30, 2015 for an adjudicated arterial thromboembolic event, defined as fatal or nonfatal acute myocardial infarction or ischemic stroke. Cox regression was performed to evaluate the association between incident cancer and subsequent arterial thromboembolic events. To fulfill the proportional hazard assumption, follow-up time was modeled in discrete time periods. Results: In this analysis, 836 REGARDS participants with incident cancer were matched to 3,339 participants without cancer. During median follow-up of 3 years, 63 (7.5%) participants with cancer and 216 (6.5%) participants without cancer had an arterial thromboembolic event. Compared to non-cancer controls, participants with incident cancer had an increased risk of arterial thromboembolic events in the first 30 days after diagnosis (HR, 5.2; 95% CI, 2.1-12.7). This association persisted after adjustment for demographics, region of residence, and cardiovascular risk factors (HR, 5.8; 95% CI, 2.1-15.9). Cancers with known metastases and types considered high-risk for venous thromboembolism had the strongest associations with arterial thromboembolic events. There was no association between cancer diagnosis and arterial thromboembolic event risk beyond 30 days. Conclusions: Incident cancer, particularly when metastatic, is associated with an increased short-term risk of arterial thromboembolic events independent of vascular risk factors.

Incidence and relative risk for developing cancers in women with gestational diabetes mellitus: a nationwide cohort study in Taiwan

ObjectivesTo evaluate the risk of developing cancers, particularly site-specific cancers, in women with gestational diabetes mellitus (GDM) in Taiwan.SettingThe National Health Insurance Research Database (NHIRD) of Taiwan.ParticipantsThis study was conducted...

Enhancing well-being and building resilience in people living with cancer part 2: a central role for nurses

Receiving a new diagnosis of cancer or of its recurrence is distressing and there are increasing numbers of people living with the disease, some taking continuous treatment, as well as others who have been cured. Living with cancer and the possibility of recurrence requires psychological strength to deal with the treatment, effects of the illness and uncertainty about the future. The attributes of self-efficacy and psychological well-being can reduce the effects of chronic stress. Excellent symptom control is essential and fatigue, the most prevalent and often most distressing symptom for those with cancer, requires targeted support. Well-being and psychological resilience may be improved by specific actions and psychological approaches, some of which are encompassed by Foresight Mental Capital and Well-being Project’s (2008) five ways to well-being framework, which can be used to deliver personalised care. This is the second of a two-part article that reviews interventions promoting well-being and resilience in patients living with cancer. It describes the framework and suggests practical ways in which clinicians can integrate it and other interventions into clinical practice. It also offers time out exercises and a multiple choice quiz to aid readers’ learning and test their knowledge.

Enhancing well-being and resilience in people living with cancer. Part 1

Receiving a new diagnosis of cancer or recurrent disease is distressing. Increasing numbers of people are living with cancer, as well as those who have been cured. Living with cancer and the possibility of recurrence requires psychological strength to deal with the treatment, effects of the illness and uncertainty about the future. Self-efficacy and psychological well-being can reduce the effects of chronic stress.Excellent symptom control is essential and fatigue, the most prevalent symptom for those with cancer, requires targeted support. Well-being and psychological resilience may be improved by specific actions and psychological approaches, some of which are encompassed by the ‘five ways to well-being’ framework, which can be used to deliver personalised care.The first of this two-part article reviews interventions that promote well-being and resilience in patients living with cancer. Part two describes the ‘five ways to well-being’ framework and suggests practical ways in which clinicians can integrate this and other interventions into clinical practice.

Cancer survivorship care plans time and effort.

146 Background: The Lifespan Cancer Institute (LCI) is one program based at three hospitals in the Lifespan healthcare system, a main teaching affiliate of Brown Medical School. All sites are ASCO QOPI certified. In 2017, 1,742 patients from radiation, surgical, and medical oncology were diagnosed and/or treated for cancer. The Commission on Cancer guidelines specify patients with a new diagnosis of cancer treated with curative intent receive a survivorship care plan (SCP) within one year of diagnosis extended to 18 months for those receiving hormone therapy. Methods: The LCI Quality team is a multidisciplinary group comprised of nursing, leadership, physicians, midlevel providers, administrative assistants, and tumor registry staff. Our Quality Improvement Project for 2017 was generation and distribution of survivorship care plans to 50% of eligible patients. Our project underwent 5 plan/do/study/act cycles (PDSA). Prior to the intervention only 271 care plans were prepared and delivered for 2016 diagnoses. Results: For the total 2017 diagnoses, 843 eligible patients were treated within the LCI (medical and radiation oncology). Survivorship Care plans completed by midlevel providers were generated and distributed to 100% of LCI patients during January -April 2018 (244 in total), a 37% increase compared to the same timeframe, one year previous. The electronic medical record provides tools for SCP preparation including auto population of demographics and chemotherapy plan. Staging, radiation, and surgery are manually entered. On average, each SCP required 1 hour to complete for approximately 244 hours of midlevel provider time for January -April 2018. This abstract’s time and effort does not include the time for patient calls, survivorship visits or administrative monitoring. Conclusions: Survivorship care plans provide patients and primary care providers a summary of the treatment plan and recommendations for follow up/survivorship goals in transitions of care. Significant time and effort is required to generate an individual SCP therefore the goal should be to increase electronic efficiencies within the medical record, and focus on the clinically relevant patient population who are most likely to survive 5 years and be impacted by diagnosis and treatment.

Providing oncologic care with access to clinical trials to an underserved and minority population: The Mayo Clinic/Indian Health Service experience.

79 Background: Novel mechanisms are needed to provide high quality oncologic clinical care and clinical trial access to underserved and minority populations (UMP). UMP are underrepresented in cancer clinical trials, thus limiting the generalizability of the research. As a National Cancer Institute-Comprehensive Cancer Center, Mayo Clinic has the responsibility to ensure that its cancer care reaches a diverse patient population. Mayo Clinic in Arizona developed a clinical oncology practice in collaboration with the US Indian Health Service at Phoenix Indian Medical Center (PIMC), in part to address these needs. The relationship between Mayo and PIMC is invaluable and serves a crucial need in the community. The Mayo consultants serve as staff physicians in the “Oncology Center of Excellence” at PIMC and see 100 – 200 tribal members annually with new diagnoses of cancer or blood disorders. Being onsite at PIMC allows Mayo consultants to integrate seamlessly into the wider PIMC practice. Methods: Descriptive demographic data from the MCA-PIMC clinical practice were obtained from the PIMC practice database 2008 - 2017. Enrollment of MCA-PIMC patients into MCA cancer clinical trials were prospectively enumerated. Results: Between the time period of 2008-2017, 356 breast cancer patients and 259 colorectal cancer patients were seen by Mayo Clinic oncologists and the PIMC nurse practitioner. During the period of 2016-2017, there were 13 clinical trial referrals from PIMC with 8 of those patients being enrolled in Mayo cancer clinical trials. Conclusions: High quality oncologic clinical care can be provided via unique collaborations between academic oncology program and UMP-focused care provider. This mechanism allows access to cancer clinical trial opportunities for UMP. Prior to the established partnership, there were no Native American patients referred to clinical trials from PIMC, showing the critical pathway that has been forged. Importantly, this is the only known program of its kind in the country. By imbedding the cancer provider in the community, we are able to build trust with the underserved community and create a pathway to a quality care and clinical research.

Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Metastases: A Retrospective Study

Introduction: Metastatic lesions to the pancreas are an uncommon but increasingly prevalent problem, accounting for 2% of pancreatic malignancies. Surgical resection is often recommended for medically fit patients with a single lesion, but in an era with rapid emergence of new chemotherapies and biologic agents, it has not been well established which modality offers the best survival. Lung, breast, renal, skin, and gastrointestinal origins are the most common metastatic origins. It is postulated that the pancreatic metastases may directly invade the ductal epithelium, causing patients to present similarly to pancreatic adenocarcinoma. We report a cohort of cases at a single medical center that utilizes endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of metastatic lesions to the pancreas. Methods: Medical records were abstracted for patients who underwent EUS-FNA with a diagnosis of pancreatic mass. Data regarding demographics, history, diagnosis, mass characteristics, and outcomes were recorded from patients with metastatic primaries. Results: There were a total number of 1,472 EUS-FNA procedures performed for evaluation of pancreatic mass from 2007-2017. Twenty-two (1.5%) of the masses were found to be from metastatic primaries. Twenty-one were diagnosed with immunocytology after EUS-FNA. Small cell carcinoma of the lung was the most common histopathology (7 of 22; 32%). In the remaining patients, the primary histopathology was lung adenocarcinoma (n=5), renal cell carcinoma (n=4), adenocarcinoma of the breast (n=1), liposarcoma (n=1), neuroendocrine tumor of the rectum (n=1), melanoma (n=1), osteosarcoma (n=1), and squamous cell carcinoma of the lung (n=1). EUS-FNA generated seven new diagnoses of cancer including small cell carcinoma of the lung and adenocarcinoma of the lung. The most common location for metastatic lesions was the pancreatic head (8 of 22; 36%). Four masses were found in the tail of the pancreas, and all were found to be small cell carcinoma of the lung. Four of the patients have documented one year survival. Surgery was performed in three patients. Hospice was pursued by nine of the patients, all with metastases from the lung. Conclusion: Pretherapeutic diagnosis of pancreatic masses due to metastatic primaries is necessary for proper management by the multimodal treatment team. As the treatment of cancer continues to rapidly evolve, EUS-FNA with immunocytology can assist with the diagnosis of pancreatic metastases and have a major clinical role.97_A Figure 1. No Caption available.97_B Figure 2. EUS of pancreatic head with metastatic mass found to be small cell carcinoma of the lung.

Children's experiences of being diagnosed with cancer at the early stages of treatment; an interpretive phenomenological analysis.

Being given a diagnosis of cancer is a significant and highly distressing event for both children and their families, but little research has been done to explore and understand children's feelings. This study aims to understand from the child's perspective what it feels like to be told you have cancer, with the hope that increased understanding can lead to improved communication and support for children and families. The study uses qualitative methodology. Six children aged 8-12 years with a new diagnosis of cancer took part in two semi-structured interviews at least one week apart. The interviews were conducted using the draw and write technique. The results were analysed using interpretative phenomenological analysis. The report describes the five super-ordinate themes that were identified; initially I felt shocked and scared, chemo is an awful thing, please talk to me; the more I know the better I feel, I will accept treatment and quickly get used to it because I know I will get better and, finally, my family are vital. Implications for clinical practice are discussed. The report highlights the research limitations and areas for future studies.

Getting New Test Results to Patients.

We surveyed 100 patients and our clinic personnel to assess opinions regarding methods of communication in common scenarios. Response rate was 79% from patients and 75% from clinic personnel. Most patients thought letters were an appropriate way to receive normal test results (83%). They also felt medical-technician calls were appropriate for normal results (88%), medication dose changes (75%), or need for additional studies (71%). Respondents considered nurse calls acceptable in most scenarios except for new diagnoses of cancer or need for surgery; the consensus was that physicians should directly communicate to patients in these situations. Providers should take the time to discuss results with patients that lead to significant interventions, but employ support staff to disseminate information about normal results, medication dose changes, and need for additional diagnostic testing.

Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer

The purpose of this study was to evaluate the impact of cancer upon a patient's net worth and debt in the US. This longitudinal study used the Health and Retirement Study from 1998-2014. Persons ≥50years with newly-diagnosed malignancies were included, excluding minor skin cancers. Multivariable generalized linear models assessed changes in net worth and debt (consumer, mortgage, home equity) at 2 and 4 years after diagnosis (year+2, year+4), controlling for demographic and clinically-related variables, cancer-specific attributes, economic factors, and mortality. A 2-year period before cancer diagnosis served as a historical control. Across 9.5 million estimated new diagnoses of cancer from 2000-2012, individuals averaged 68.6±9.4 years with slight majorities being married (54.7%), not retired (51.1%), and Medicare beneficiaries (56.6%). At year+2, 42.4% depleted their entire life's assets, with higher adjusted odds associated with worsening cancer, requirement of continued treatment, demographic and socioeconomic factors (ie, female, Medicaid, uninsured, retired, increasing age, income, and household size), and clinical characteristics (ie, current smoker, worse self-reported health, hypertension, diabetes, lung disease) (P<.05); average losses were $92,098. At year+4, financial insolvency extended to 38.2%, with several consistent socioeconomic, cancer-related, and clinical characteristics remaining significant predictors of complete asset depletion. This nationally-representative investigation of an initially-estimated 9.5 million newly-diagnosed persons with cancer who were ≥50 years of age found a substantial proportion incurring financial toxicity. As large financial burdens have been found to adversely affect access to care and outcomes among cancer patients, the active development of approaches to mitigate these effects among already vulnerable groups remains of key importance.