Quality Of Life In Patients Research Articles

Effect of probiotics on quality of life for patients with cancer undergoing immunotherapy.

e24148 Background: Probiotics are crucial in oncology for enhancing gut health, boosting immune response, potentially improving immunotherapy efficacy, and reducing side effects of cancer treatments. Research links a healthy gut microbiome with better immunotherapy outcomes, however, more studies in this area are required to validate this hypothesis. Methods: Oncological patients at Hospital Ángeles Puebla's Comprehensive Cancer Center undergoing immunotherapy were invited to participate and provided their consent to receive a daily probiotic and prebiotic mix (including Lactobacillus rhamnosus, Bifidobacterium longum, Pediococcus pentosaceus, and others) for three months. Their health was closely monitored, and quality of life assessed using the EORTC-QLQ-C30 questionnaire at the start, day 45, and day 90. A Kruskal-Wallis H-test was conducted to correlate the EORTC-QLQ-C30 scores with their diagnosis, clinical stage, presence of comorbidities, and use of ancillary treatments, as well as a Spearman's test to associate these scores with their age. Results: 22 patients were included. Average age was 64.5 years, with 77% being male and 23% female. 68.18% were in stage IV, 4.55% in stage III, 18.18% in stage II, and 9.09% in stage I. Comorbidities included: diabetes in 31.82%, hypertension in 40.91%, and other diseases in 22.73%. Treatment regimens involved 81.81% receiving Anti-PD-L1 and 18.18% receiving Anti-PD-1. Additionally, 40.91% were on corticosteroids and another 40.91% on proton pump inhibitors as ancillary treatments. Median follow-up was 3.13 months, during which 23% of the patients experienced adverse events. Of these, 9.09% were grade 4 according to the CTCAE v.5, and 13.63% were grade 1. Significant differences were found between patients with hepatocellular carcinoma versus renal carcinoma in the overall score on day 1 (KW: 4.47, p-value: 0.0344), with no differences in the rest of the scores. Significant differences were also identified between patients with advanced-stage versus early or locally advanced-stage cancer in terms of pain (KWS: 4.091, p-value: 0.043), dyspnea (KWS: 4.355, p-value: 0.037), loss of appetite (KWS: 4.091, p-value: 0.043), constipation (KWS: 3.971, p-value: 0.046), and diarrhea (KWS: 4.355, p-value: 0.037). A negative correlation was found between age and social functioning (Spearman: -0.73, p-value: 0.03), as well as with the presence of pain (Spearman: -0.73, p-value: 0.04). Conclusions: In this study, we observed a decrease in symptoms and an increase in functionality and overall quality of life scores among the patients. This suggests that patients undergoing active immunotherapy treatment may benefit from the use of probiotics and prebiotics as an ancillary treatment. However, further extended studies with larger populations are necessary to corroborate our findings.

Impact of Migraine and Vestibular Migraine on Audiometric Profiles and Quality of Life in Patients With Tinnitus.

To investigate the clinical manifestations and complete auditory function in primary tinnitus patients with and without migraine or vestibular migraine. Retrospective case-control study. A tertiary referral center. This study enrolled 298 patients from the Kaohsiung Veterans General Hospital. All patients were diagnosed with primary tinnitus by a neurotologist between April 2020 and August 2021. Patients were excluded if they had histories of chronic otitis media, idiopathic sudden sensorineural hearing loss, Ménière's disease, skull base neoplasm, or temporal bone trauma. Twenty-five-item Tinnitus Handicap Inventory (THI), speech audiometry including speech recognition threshold, most comfortable level, uncomfortable loudness levels, dynamic range, and pure-tone audiometry. Objective hearing loss is defined as a mean threshold greater than 25 dB. Extremely elevated THI is defined as a score greater than 1 standard deviation above the mean THI. Among the 298 patients with tinnitus, 149 were women and 149 were men, with a mean age of 57.06 (range, 19.22-94.58) years.A total of 125 patients completed the THI questionnaire during their initial visit. The median THI score was 32 (95% confidence interval: 13.98-56.00), and the mean score was 34.99 with a standard deviation of 21.01. The sole contributing factor significantly associated with higher total THI score was the diagnosis of migraine or vestibular migraine (p < 0.001, odds ratio = 19.41).Tinnitus patients with migraine or vestibular migraine exhibited significantly lower mean pure-tone auditory thresholds (right 22.2 versus 29.5, p = 0.002; left 22.5 versus 30.4, p < 0.001), speech recognition threshold (right 20.0 versus 25.2, p = 0.016; left 20.2 versus 25.5, p = 0.019), and most comfortable levels values (right 46.1 versus 51.4, p = 0.007; left 46.9 versus 51.4, p = 0.021) compared with the tinnitus patients without migraine. In this population-based study, patients with primary tinnitus experienced significantly higher THI scores and exhibited concurrent symptoms, including dizziness/vertigo, cervicalgia, and migraine or vestibular migraine. Among these parameters, the diagnosis of migraine or vestibular migraine was the sole contributor to significant higher THI score.

Results of neoadjuvant therapy for patients with triple negative breast cancer in a public hospital in Brazil (Federal District).

e12660 Background: Breast cancer is the neoplasm with the highest number of deaths among women in Brazil. Triple negative breast cancer contributes to the worsening of this condition, considering that it is more aggressive, accounting for 15% of deaths. Furthermore, more aggressive treatments and new medications have recently been added to neoadjuvant protocols, improving the complete pathological response, but with more side effects. In this way, it is predictive to understand the profile and treatment of choice for patients diagnosed with triple negative breast cancer, contributing to a better understanding of the treatment outcome, survival and quality of life in patients with this health condition. Methods: observational and cross-sectional study with retrospective data collection, in the electronic medical record of the TrakCare system. Patients diagnosed with triple-negative breast cancer between January 2020 and December 2021 and who underwent neoadjuvant treatment were included. Information was collected regarding the date of treatment, age, color/race, comorbidity, staging, type of chemotherapy used, postoperative response rate, and patient evolution during follow-up. Results: 78 patients with triple-negative breast cancer were included. The average age of patients was 56.3 years (26 – 83 years) and approximately 38.5% of patients were under 50 years of age. Around 42.3% of patients had hypertension and 33.3% were obese. Only 28.2% of patients did not have associated comorbidities. Approximately 59% of patients were staged T4 and 35.9% staged T3. Pathological complete response (cPR) was achieved in 56.4%, but progression was recorded in 13% of cases. In 88.5% of patients, the AC-T protocol was used (doxorubicin and cyclophosphamide followed by weekly paclitaxel) and 52% obtained CPR. On the other hand, only 11.5% (9 patients) used the AC-TC protocol (doxorubicin and cyclophosphamide followed by paclitaxel and carboplatin) with a CPR of 89% (p=0.016), with no record of progression or death. Conclusions: Triple negative patients were young and tended to have at least one comorbidity in addition to a highest rate of locally advanced tumor. The more aggressive protocol (AC-TC) was used less often, but has a higher rate of cRP and should be used more frequently in this scenario despite the greater complexity of these patients.

Incontinence Is an Independent Risk Factor for Total Hip and Knee Arthroplasty

BackgroundUrinary incontinence has been linked to worse postoperative pain, decreased physical function, and reduced quality of life in patients following total joint arthroplasty. The purpose of this study was to analyze whether incontinence is associated with increased postoperative medical and joint complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsA retrospective cohort study was conducted using a national insurance database. Thirty-two thousand eight hundred eleven patients with incontinence who underwent primary THA were identified and matched 1:4 with 129,073 patients without incontinence. Ninety-one thousand nine hundred thirty-five patients with incontinence who underwent primary TKA were matched 1:4 with 367,285 patients without incontinence. Medical and joint complication rates at 90 days and 2 years, respectively, were then compared for patient cohorts using multivariable logistic regressions. ResultsPatients who underwent primary THA with incontinence had statistically higher rates of dislocation, periprosthetic fracture, aseptic revisions, and overall joint complications compared to controls. Patients who underwent primary TKA with incontinence had higher rates of mechanical failure, aseptic revision, and all-cause revision compared to controls. ConclusionsThis study demonstrated an association between patients with incontinence and higher rates of dislocation, periprosthetic fractures, aseptic revisions, and overall joint complications following primary THA compared to controls. Patients with incontinence experience higher rates of mechanical failure, aseptic revision, and all-cause revision following TKA compared to controls. As such, perioperative management of urinary incontinence may help mitigate the risk of postoperative complications.

Access to palliative care in patients with multiple myeloma in the USA: A National Cancer Database (NCDB) analysis of years 2004-2020.

7563 Background: Palliative care (PC) can improve the quality of life for patients with multiple myeloma (MM). Despite its recognized importance, research gaps persist in understanding factors influencing PC accessibility and utilization, particularly in the diverse MM patient landscape in the real-world setting. This study explores potential associations between race, ethnicity, socioeconomic factors, and PC access for MM patients in the USA. Methods: Utilizing the NCDB, we identified 202,949 MM patients diagnosed from 2004 to 2020. Multivariate logistic regression analysis was conducted with SAS version 9.4, to determine independent factors predicting PC access. Results: Analysis of 202,949 MM patients revealed notable disparities for access to PC. Female patients exhibited lower PC odds (OR: 0.94, p &lt; 0.0001) compared to male patients, as did Black patients (OR: 0.80, p &lt; 0.0001) and other racial groups (OR: 0.84, p &lt; 0.0001) compared to White patients. Hispanic ethnicity was associated with lower PC utilization odds (OR: 0.84, p &lt; 0.0001) compared to non-Hispanics. Earlier years (2004-2007) showed higher PC odds (OR: 1.12, p &lt; 0.0001), while subsequent years (2008-2011, 2012-2015) exhibited lower odds (OR: 0.93, p = 0.0009; OR: 0.87, p &lt; 0.0001, respectively) compared to the most recent years (2016-2020). Academic settings had lower PC odds than non-academic facilities (OR: 0.78, p &lt; 0.0001). Insurance status varied, with no insurance (OR: 1.40, p &lt; 0.0001), Medicaid (OR: 1.17, p &lt; 0.0001), and other government insurance (OR: 1.38, p &lt; 0.0001) linked to higher PC odds compared to private insurance. Lower annual household incomes (&lt;$38,000, $38,000-$47,999, $48,000-$62,999) had increased PC odds compared to higher incomes (&gt;$63,000) (all p &lt; 0.0001). Areas with a higher percentage of individuals without a high school degree exhibited lower PC odds, notably 21% (OR: 0.83, p &lt; 0.0001) and 13.0%-20.9% (OR: 0.94, p = 0.0222) compared to &lt;7.0% without a high school degree. Greater distance (&gt;30 miles) reduced PC odds compared to shorter distance (&lt;10 miles) to treatment facility (OR: 0.83, p &lt; 0.0001). A Charlson-Deyo score of 1 increased PC odds compared to a score of 0 (OR: 1.12, p &lt; 0.0001). Conclusions: Our real-world analysis reveals substantial disparities in MM patients’ PC access and utilization. Female patients and minority groups (Blacks and Hispanics) face significant challenges. The dynamic trends over time and socioeconomic impacts underscore the need for integrating PC and targeted interventions for overall MM patient well-being. Our findings pave grounds for future prospective studies.

Results from METIS (EF-25), an international, multicenter phase III randomized study evaluating the efficacy and safety of tumor treating fields (TTFields) therapy in NSCLC patients with brain metastases.

2008 Background: For non-small cell lung cancer (NSCLC) with brain metastases (BM) stereotactic radiosurgery (SRS) is the current preferred therapy. Due to frequent intracranial failures, there is a high unmet need for salvage therapies. Whole brain radiotherapy (WBRT) reduces intracranial failure but used less frequently due to cognitive consequences. Tumor Treating Fields (TTFields) are electric fields that disrupt cancer cell division and have shown improved survival and safety in patients with glioblastoma and metastatic NSCLC. Phase 3 METIS trial [NCT02831959] aimed to evaluate the efficacy and safety of TTFields therapy in NSCLC patients with BM treated with SRS, specifically in terms of lengthening time to intracranial progression without cognitive decline. Methods: Mutation negative (M-) NSCLC patients with 1–10 BM were randomized 1:1 to receive stereotactic radiosurgery (SRS) followed by Tumor Treating Fields (TTFields; 150 kHz) therapy with best supportive care (BSC) or SRS followed by BSC. Patients with Karnofsky Performance Status (KPS) ≥70, newly diagnosed with one inoperable or 2–10 supra-/infratentorial brain metastases suitable for SRS and receiving optimal extracranial disease therapy were included. Exclusions were prior WBRT and single operable or recurrent brain metastases. Primary endpoint was time to first intracranial progression (RANO-BM) based on cumulative risk. Patients were followed every two months until second intracranial progression. Cognition and patient quality of life (QoL) were evaluated. Results: Between July 2016 and September 2022, 298 patients were randomized. Baseline characteristics were balanced: median age was 63.5 (range 37-84) years, 37.6% females, majority of patients had a KPS ≥ 80, median time from initial NSCLC diagnosis was 1.8 months (range: 0.2-55.7), 77% had adenocarcinoma. Median treatment duration of TTFields was 16 weeks, with a median usage time of 67%. Primary endpoint, time to intracranial progression from SRS, was significantly prolonged with SRS followed by TTFields therapy with BSC vs. TTFields plus BSC arm (median of 21.9 vs. 11.3 months); HR=0.67 [0.48-0.93], p=0.02. TTFields-related AEs were mainly dermatological, and Grade ≤2. TTFields therapy also improved deterioration-free survival of global health status, physical functioning, and fatigue according to QoL, and did not negatively impact cognition. Conclusions: METIS study met its primary endpoint, demonstrating that TTFields therapy following SRS in mutation negative NSCLC patients with BM, significantly prolongs time to intracranial progression and could postpone WBRT, without QoL and cognition decline. Clinical trial information: NCT02831959 .

Resilience and related factors in caregivers of adult cancer patients: a systematic review

Background: This systematic review aimed to investigate resilience and its related factors in caregivers of adult patients with cancer. Materials and methods: A systematic search of online electronic databases including Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) was performed using keywords extracted from Medical Subject Headings such as “Psychological Resilience”, “Caregiver”, and “Cancer” from the earliest to 6 June 2023. The quality of the studies included in this review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). Results: A total of 2735 caregivers of cancer patients participated in 15 studies. The majority of the studies found that caregivers of cancer patients had high levels of resilience. Factors related to the resilience of cancer patients’ caregivers included caregivers’ social support, caregivers’ quality of life, patients’ resilience, caregivers’ family function, patients’ performance, caregivers’ age, caregivers’ health status, caregivers’ self-esteem, caregivers post-traumatic growth, caregivers religious, caregivers hope, caregivers positive affect, patients age, patients social support, patients resilience support, patients quality of life, caregivers’ anxiety, caregivers’ depression, caregivers’ burden, caregivers level of education, caregivers financial problem, caregivers memory, caregivers negative affect, caregivers post-traumatic stress disorder, maternal distress, and patients post-traumatic stress disorder. Conclusion: Therefore, healthcare administrators and policymakers can enhance the resilience of caregivers and the quality of care they provide by instituting ongoing training initiatives focused on evaluating mental well-being and implementing coping strategies for managing stress and depression.

The epidemiology and demographic statistics of serrated adenocarcinoma.

e15645 Background: Serrated adenocarcinoma (SAC) is a recently-recognized variant of colorectal cancer (CRC) arising from precursor lesions of the serrated neoplastic pathway. Despite its novelty, SAC makes up around 10% of all CRCs and demonstrates worse patient prognosis than other forms. As rates of CRC, one of the most common cancers worldwide, continue to rise, further investigation must be done into new variants like SAC to improve its survivability and patient quality of life. This National Cancer Database (NCDB) analysis aims to evaluate the epidemiological factors and clinical characteristics of patients diagnosed with SAC. Methods: The 2004-2020 NCDB records were searched for patients with histologic diagnosis of SAC (N = 171) with the ICD-O-3 code 8213. This study utilized descriptive statistics to analyze demographics factors including age, sex, race, Hispanic status, educational attainment, insurance status, facility type, and Charlson-Deyo score. Results: From 2005-2020, 171 patients with an average age at diagnosis of 70.5 ± 11.3 years were diagnosed with serrated adenocarcinoma, with most (88%) cases demonstrating invasive behavior in the ascending colon (37%) or cecum (21%). The size of the tumors ranged from 1 - 200 mm, with an average size of 30.0 mm. The overwhelming majority of patients were white (93%) women (60%) living on average no more than 20 miles away from a hospital in metropolitan areas with populations over a million (49%). More patients were insured through Medicare (66%), receiving treatment at comprehensive community cancer (37%) or academic research programs (30%). Nearly all patients (95%) underwent surgery at the primary site, with a ninety-day survival rate of 88%. Among these, the most common procedure was subtotal colectomy or hemicolectomy (43%) followed by partial colectomy with segmental resection (22%), with 84% of patients showing no residual tumor after surgery. Alternate treatments included were chemotherapy (19%) and radiation therapy (8%). After five years, 68% of patients were alive, with the number falling to 35% after ten years. Conclusions: This study is the first on SAC to analyze NCDB data, presenting a larger sample than prior literature. With the commonality of colorectal cancer, the lack of research on SAC represents a significant knowledge gap. Interestingly, the data suggests that SAC predominantly develops in the ascending colon and cecum, conflicting with prior literature which suggested its tumors were more evenly distributed. Demographically, its diagnosed patients are mostly elderly, non-Hispanic whites insured by Medicare living in dense metropolitan areas near hospitals. These findings implicate that rural, aging communities could be impacted more severely by SAC, as they lack the healthcare infrastructure to obtain a proper diagnosis. To better define the link between demographic factors and effective diagnosis and treatment, further research is needed.

Ten-year outcomes of targeted axillary surgery after neoadjuvant chemotherapy in breast cancer.

600 Background: When pathological complete response (pCR) is achieved in node-positive breast cancer after neoadjuvant chemotherapy (NAC), identifying traces of the previous lesion becomes challenging which makes accurate surgery difficult. We conducted targeted axillary surgery (TAS) in node-positive breast cancer after NAC, which involves accurately targeting the lymph nodes where metastasis occurred and performing surgery using a less extensive method. The 10-year outcomes were compared with those of patients who underwent conventional axillary lymph node dissection (ALND). Methods: We conducted a retrospective analysis of 235 patients with cT1-3N1-2 breast cancer who received NAC from 2012 to 2017. In this cohort, 78 patients underwent TAS only, and 157 underwent conventional ALND, including 31 patients who initially received TAS followed by additional ALND. Oncologic results, including locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS), were assessed over a 10-year follow-up period. Survival outcomes for all patients and each subtype were analyzed using Kaplan-Meier survival methods. Results: The TAS group had significantly more postmenopausal patients (p=0.022), and the most common type of breast cancer was invasive ductal carcinoma [TAS: 75 (96.2%); ALND: 157 (100.0%)]. There was no statistical difference in the T stage and the number of lymph nodes suspected of metastasis at diagnosis (p=0.062, 0.985). Mastectomy was performed in 60.3% of patients in the TAS group and 93.0% in the ALND group (p&lt;0.001), and 68 (87.2%) of the TAS group and 41 (26.1%) of the ALND group received additional axillary radiotherapy (p=0.019). There was no significant difference in oncologic outcomes between the TAS and ALND groups in all patients (LRFS, p=0.673; DMFS, p=0.729; OS, p=0.396) and based on subtypes, including hormone receptor (HR)-positive, HER2-positive, and triple-negative breast cancer (TNBC). In the HR-positive breast cancer group, the TAS and ALND groups showed very similar trends (LRFS, p=0.954; DMFS, p=0.993; OS, p=0.617). In HER2-positive breast cancer, although not statistically significant, the survival outcomes were better in the TAS group than in the ALND group (LRFS, p=0.967; DMFS, p=0.999; OS, p=0.423). However, the OS in the TAS group for TNBC was lower than that in the ALND group, though not significantly (LRFS, p=0.411; DMFS, p=0.697; OS, p=0.210). Conclusions: This study demonstrates that TAS is comparable to ALND in terms of 10-year oncological outcomes across different types of node-positive breast cancer, suggesting its potential as a viable alternative. However, further research focusing on patient quality of life and postoperative complications is essential to establish TAS as a superior surgical option to ALND.

Efficacy of treatment with traditional Chinese patent medicine (Fufang E'jiao Syrup) for cancer-related fatigue in patients with advanced cancer: A randomized, double-blinded, placebo-controlled, multicenter trial.

12053 Background: There is ongoing interest in finding effective drugs for cancer-related fatigue (CRF) in advanced cancer patients, although studies have had mixed results. Fufang E'jiao Syrup (FFEJS), a traditional Chinese patent medicine, has shown promise in alleviating CRF. This trial aims to investigate whether FFEJS could reduce fatigue and improve quality of life in advanced cancer patients. Methods: This prospective, multicenter, double-blinded, placebo-controlled trial was implemented at 29 hospitals in China, enrolling 611 advanced non-small cell lung cancer, colorectal cancer, and gastric cancer patients with Visual Analogue Scale for Fatigue ≥ 4 points. The study was conducted between September 23, 2019 and April 7, 2022, with a final follow-up on May 25, 2022. Participants were randomized to receive FFEJS (20 ml, 3 times per day) or a matching placebo orally for six weeks. The safety assessments were extended until the fourth week after the trial ended. The primary outcome was the change in total mean score (range: 0 [no fatigue] to 10 [extreme fatigue] points) on the Revised Piper Fatigue Scale-Chinese Version (RPFS-CV) from baseline to week 6. Secondary outcomes include quality of life (Functional Assessment of Chronic Illness Therapy-Fatigue, FACIT-F) and adverse events. FFEJS were compared with the placebo group using a linear mixed model. Results: Among 611 patients randomized (FFEJS: 303 and placebo: 308; 210 non-small cell lung cancer [34.4%], 201 colorectal cancer [32.9%], 200 gastric cancer [32.7%]; mean [SD] age, 62.8 [9.3] years; 413 [68.3%] man; mean [SD] baseline RPFS-CV total mean score, 4.86 [1.30] points), 503 (82.3%) completed the primary end point. By the end of week 6, the FFEJS group achieved normal fatigue levels (RPFS-CV &lt; 4) compared to the placebo group (FFEJS: 3.78 vs Placebo: 4.39, adjusted mean difference 0.59 points [95% CI, 0.45 to 0.76 points]; P &lt; .001). The adjusted mean difference for a favorable shift to a higher FACIT-F total score at week 6 comparing FFEJS with placebo was 2.77 points (97.36 vs 94.23 points; [95% CI, 0.56-4.96 points]; P = .02). There was no difference in adverse events occurrence between FFEJS and the placebo groups (110 [20%] vs 122 [18%], P = .38). Conclusions: In this randomized clinical trial among advanced cancer patients with CRF, FFEJS reducedfatigue severity and improved quality of life compared to placebo. Research is needed to assess the mechanism, clinical effect, and long-term safety of FFEJS for CRF in advanced cancer patients. Clinical trial information: NCT04147312 .

Pain, palliation, and opioid use patterns: A nationwide analysis of neoplasm-related pain admissions and trends (2016-2020).

e24068 Background: Neoplasm-related pain (NRP) remains a significant contributor to the diminished quality of life in cancer patients. We aimed to study the epidemiological characteristics and trends among patients hospitalized for NRP from 2016 to 2020. Methods: A retrospective study of patients hospitalized for primary or secondary diagnosis of NRP from 2016-2020 was conducted using the National Inpatient Sample (NIS) database. Temporal trends in the prevalence, mortality rate (MR), length of stay (LOS), hospitalization cost, palliative care consults, and opioid use/dependence/abuse (OUD) were assessed using linear regression or the Cochran-Armitage test. Further, the NIS database was searched to identify all patients admitted with a diagnosis of OUD. Amongst them, the proportion of patients with a coexisting diagnosis of NRP was calculated. Analysis was done using R 4.3.2 and SAS 9.4. Results: 174,530 cases with NRP were identified from 2016-2020, with a median age at hospitalization of 61(IQR: 52,70). The number of hospitalizations increased from 28,036 in 2016 to 41,013 in 2019 and then dropped to 38,040 in 2020 (p &lt; 0.001). The total inpatient MR was 7.8%, decreasing from 8.5 % in 2017 to 7.0% in 2020 (p &lt; 0.0001). The mean cost of hospitalization increased significantly from $64,162.5 in 2016 to $82,943.8 in 2020 (p &lt; 0.001). There was no significant change in the mean LOS. The number of palliative care consults increased from 29.8% in 2016 to 31.5% in 2019 and then dropped to 31.3% in 2020 (p &lt; 0.001). Among 174,530 NRP patients, 5,844 (3.4%) had a coexisting diagnosis of OUD, which increased from 832 (3.0%) in 2016 to 1419 (3.7%) in 2020 (p &lt; 0.001). A total of 737,971 patients with a diagnosis of OUD were admitted from 2016-2020, of which 5844 (0.79%) had a coexisting diagnosis of NRP. Conclusions: We observed increased hospitalizations for NRP and related palliative care consults from 2016 to 2019, with a subsequent decline in 2020. This drop could be related to the impact of the COVID-19 pandemic. Despite the rise in the cost of hospitalizations, there has been a declining trend in MR, potentially due to improved quality of care. The gradual rise in the coexistence of OUD among NRP patients is notable. Yet, NRP patients remain a minority within the broader context of OUD-related admissions, underscoring the need for nuanced, patient-centered approaches in NRP management. [Table: see text]

Sociodemographic differences in suicide/intentional self-harm among cancer survivors versus the general United States population.

11097 Background: Suicide is a national public health crisis, and one of the leading causes of death in the United States. Worse yet, the suicide mortality rate is at least double among cancer survivors compared to the general population. Suicide rates vary across the population, but it is unclear how sociodemographic factors explain differences in suicide rates among cancer survivors versus the general United States population. Methods: We analyzed two sets of population-based data. First, we retrieved suicide/self-harm mortality rates for the general population from the National Vital Statistics System. Next, we accessed cancer case data from the Surveillance, Epidemiology, End Results (SEER) program to estimate number of deaths due to suicide/self-harm among cancer patients, per 100,000 persons, with a 95% confidence interval. All analyses were restricted to contiguous states with full state representation in SEER (CA, CT, GA, ID, IA, KY, LA, NJ, NM, NY, TX, UT). We then compared subgroup differences by sex, race/ethnicity, age, and state. Results: In 2020, there were 15,813 deaths in the general population (12.1 suicide/100,000 persons; 95% CI: 11.9, 12.3), and 1,127 among cancer survivors (22.1 suicide/100,000 persons; 95% CI: 22.0, 22.1) due to suicide/intentional self-harm. Among racial/ethnic groups, the largest difference was found in the non-Hispanic White cancer survivors, with 10.4 more suicide/100,000 persons vs. White individuals in the general population. In contrast, two racial minority groups had higher suicide mortality rate in the general population vs. cancer survivors: Non-Hispanic Black individuals (general population = 7.4 suicide/100,000 persons vs cancer survivors = 6.9 suicide/100,000 persons), and Native American Indian (general population = 16.6 suicide/100,000 persons vs. cancer survivors = 11.3 suicide/100,000 persons). Among females, suicide mortality rate was slightly higher by 1.3 suicide/100,000 persons in cancer survivors vs. general population, and much higher among male cancer survivors vs. general population (19.9 suicide/100,000 persons more). For age groups, the lowest difference in suicide mortality between cancer survivors vs. general population was in the 65-84 age group (5.1 more suicide/100,000 persons). Across all other age groups, suicide rates were 11.9 to 14.4 higher in cancer survivors vs. the general population. Across the 12 states in our analysis, the smallest difference was in Iowa (1.9 more suicide/100,000 persons), and the largest difference was in Idaho (27.0 more suicide/100,000 persons). Conclusions: In most subgroups, people diagnosed with cancer appear to be at greater risk of death from suicide/intentional self-harm than the general population. As the number of people living with cancer continues to grow, policies increasing the quality of life for cancer patients are warranted.

Adherence to fertility preservation guidelines in young patients with breast cancer: A retrospective analysis.

e23255 Background: Breast cancer affects a considerable proportion of women of childbearing age making it important to provide options for fertility preservation. At Chihuahua's State Cancer Center, a state-federal-funded institution providing free oncological care, and ensuring access to fertility preservation measures is integral to the multidisciplinary approach for young cancer survivors. Recognizing chemotherapy's impact on fertility, implementing fertility preservation measures is key. Assessing adherence to these guidelines is essential for comprehensive care and holistic well-being in young breast cancer patients at our center. Methods: In this retrospective study at the Chihuahua´s State Cancer Center, we examined adherence to fertility preservation guidelines among breast cancer patients aged 18 to 40 years. The primary method used for fertility preservation was the administration of GnRH analogs, such as triptorelin and goserelin. Data on GnRH analog use, chemotherapy regimens, and patient demographics were collected from medical records. The study aimed to assess the integration of fertility preservation measures, particularly GnRH analogs, into treatment plans for young breast cancer patients. Additionally, we aimed to identify barriers to accessing fertility preservation services in this population. Results: The study findings revealed that out of the 749 registered breast cancer patients, 95 (12.6%) were 40 years old or younger. Among these, 75 (79%) received adjuvant and/or neoadjuvant chemotherapy, with 58 (77.3%) being in locally advanced clinical stages. Of the 75 patients who underwent chemotherapy, 20 (26.7%) also received GnRH analogs, while 55 (73.3%) did not. Among the 75 chemotherapy recipients, 16 (p = 0.046) were estrogen receptor-positive and received analogs. Furthermore, out of the 20 patients with triple-negative breast cancer, only 1 (1.3%) received an analog. Conclusions: The study indicates that GnRH analogs usage in breast cancer patients is significantly associated with estrogen receptor positivity. While estrogen receptor status is crucial for determining treatment suitability, GnRH analog utilization was notably low among triple-negative breast cancer patients. This suggests that triple-negative status alone should not preclude GnRH analog use. The findings underscore the need to raise awareness and improve adherence to ovarian suppression recommendations to enhance clinical outcomes and quality of life for breast cancer patients.

Real-world data of cancer-associated venous thromboembolism in a tertiary-care hospital in India.

e23298 Background: Cancer-associated venous thromboembolism (VTE) is a leading cause of morbidity and mortality in patients with various malignancies. Anticoagulation is crucial for preventing and treating thrombosis associated with cancer. However, its use faces challenges due to increased risks of bleeding, recurrent thrombosis and complexities in dosing, particularly in patients with concurrent comorbidities. Prophylactic anticoagulation is under-utilized and the cost of low- molecular-weight heparin (LMWH) and direct oral anticoagulants is a major barrier in developing countries. Methods: It was an ambispective observational study. All the cancer-associated thrombosis patients attending the thrombosis clinic at a tertiary-level referral hospital based in north India between 2018 and 2023 were analysed. Patient demographics, disease-related and treatment-related parameters were collected and analysed. The study was approved by the Institute Ethics Committee. Results: A total of 1312 patients attended the thrombosis clinic during study period, of which 139 (10.59%) cases were Cancer-associated VTE. The median age was 48 years and 61.2% were female. Most of VTE (54.6%) occurred within 6 months of cancer diagnosis and only 7% occurred after 3 years. Gynaecological malignancies (25.18%) and adenocarcinomas (21.58%) were the most common site and histological type of cancer respectively. Common risk factors observed for VTE development were: active cancer (80.3%), active chemotherapy (36.7%), cancer surgery (15.1%). Lower limb thrombosis was the most commonly seen type (46%), while abdominal and pulmonary thrombosis were seen in 17% and 7.9% respectively. Out of total patients, 124 (89.2%) patients received anticoagulation. Low molecular weight heparin (LMWH) was used as an initial anticoagulation in majority (52.41%) and direct oral anticoagulant (DOACs) was used as long term anticoagulation in 54% of patients. In 26 patients, anticoagulation was interrupted, the major reasons being bleeding and thrombocytopenia. There was no significant difference in frequency of bleeding with use of different anticoagulants (P = 0.48). Conclusions: Most cases of cancer associated VTE occur shortly after cancer diagnosis. Prophylactic anticoagulation is still underutilized in our patients with cancer. Early suspicion and prompt treatment can improve quality of life in such patients.

Health-related quality of life (HRQoL) and symptoms in LIBRETTO-431 patients with RET fusion-positive advanced non-small-cell lung cancer (NSCLC).

11068 Background: LIBRETTO-431 (NCT04194944), a randomized phase 3 trial, compared first-line selpercatinib to platinum-based chemotherapy +/- pembrolizumab (pembro). Selpercatinib, a highly selective and potent CNS penetrant RET inhibitor, is approved for the treatment of advanced RET fusion+ NSCLC. This analysis reported NSCLC symptoms and HRQoL from LIBRETTO-431. Methods: This analysis used data (cut-off date: May 01, 2023) from the intent-to-treat (ITT) pembro subpopulation [selpercatinib (n=129); chemotherapy + pembro (control, n=83)] to assess time to confirmed deterioration (TTCD) of NSCLC symptoms (cough, dyspnea, pain, fatigue, poor appetite using NSCLC-Symptom Assessment Questionnaire [SAQ]). TTCD of NSCLC symptoms were defined as time from randomization to the first score that met the pre-specified meaningful within-patient change thresholds, confirmed at next assessment. TTCD was compared between treatment arms using log-rank test and Cox proportional hazards model. Changes of NSCLC-SAQ total score (meaningful important difference [MID] ≥2 points) and HRQoL (using EORTC QLQ-C30 Physical Function (MID ≥6 points) and Global Health Status (GHS)/QoL (MID ≥5 points)) up to 1 year were evaluated and compared between the arms using a growth curve model and mixed model for repeated measures. Results: Selpercatinib significantly (p &lt;.05) delayed TTCD of all individual symptoms with hazard ratio ranging from 0.41 (cough and pain) to 0.57 (dyspnea), compared to control (Table). Selpercatinib also showed a significant and clinically meaningful difference in the mean NSCLC-SAQ total score (difference = -2.0, p &lt;.001) and physical function (difference = 8.1, p =.003) at 1 year, compared to control. GHS/QoL was improved in both arms with no difference in the mean scores between the arms at 1 year. Conclusions: Selpercatinib significantly delayed TTCD of NSCLC symptoms and improved physical function compared to control in this patient population after 1 year of treatment. The findings were consistent with the favorable efficacy of selpercatinib compared with platinum-based chemotherapy + pembro and further support 1L use of selpercatinib in this population. [Table: see text]

Quality of life for older patients with metastatic cancer in Brazil: A telehealth-based geriatric assessment and supportive care intervention (GAIN-S).

1514 Background: Older adults with cancer often present unique geriatric and supportive care needs. We sought to evaluate the impact of a telehealth-based multimodal geriatric assessment (GA)-guided supportive care interventions (GAIN-S) program among older patients with metastatic cancer in a Brazilian cancer center. Methods: This is a randomized trial. Patients aged 65+ years with metastatic cancer, undergoing treatment, regardless of ECOG status, were enrolled. Following the baseline assessment, patients were randomized 1:1 to receive usual care or GAIN-S. The GAIN-S intervention provided remote, telehealth-based consultations with a nutritionist, psychologist, psychiatrist, and certified fitness trainer. At baseline and 3-months, patients were assessed for emotional symptoms (Geriatric Depression Scale), functional status (Instrumental Activities of Daily Living), coping (BriefCope), and quality of life (Functional Assessment of Cancer Therapy-General). Independent t-tests and linear mixed model were used. Results: Out of 86 approached patients, 80 were enrolled (40 per arm), with 3 deceased during treatment (usual care: 2, GAIN-S: 1). Most patients were female (56%), with a median age of 73 years (range, 65-68). Most common cancers were genitourinary (28%) and breast (23%). At baseline, there were no differences in the outcome measures between arms. However, from baseline to 3-months, patients assigned to GAIN-S had improvements in emotional symptoms, functional status, and quality of life compared to usual care (Table). Additionally, those assigned to GAIN-S reported increased utilization of active coping, acceptance, and positive reframing at 3-months. Conclusions: GAIN-S demonstrated significant improvements in emotional well-being, functional status, and quality of life among older patients with metastatic cancer. These findings underscore the potential of such telehealth-driven approaches to enhance the supportive care experience in diverse healthcare settings. [Table: see text]

EHR documentation of cost discussions and financial interventions for a cohort of patients with advanced cancer: Findings from a retrospective chart review-based study.

e23150 Background: Financial Toxicity (FT), the adverse impact of high medical costs on quality of life, notably affects many oncology patients. In a prior initiative to improve quality of life for advanced cancer patients, a palliative care-trained nurse practitioner (PCNP) was embedded in an academic oncology practice. Patients completed the Edmonton Symptom Assessment System (ESAS) and Canadian Problem Checklist (CPC) to gauge physical symptoms, psychosocial issues, and financial concerns. However, the incidence of self-reported financial issues and electronic health record (EHR) documentation of cost discussions and interventions remain unclear for this patient group. Methods: The study included adult oncology patients with advanced cancer seen by the PCNP from January 1, 2020, to January 1, 2022. We assessed incidence of self-reported financial concerns via CPC checklists in this cohort. Ten charts underwent detailed manual review for evidence of cost discussions or referral to finance-related interventions for up to 1 year from the initial consult with the PCNP or until death. During the review, we identified keywords in documentation of cost discussions and finance-related interventions to create a keyword library. We iteratively compared the library to our reference standard manual chart review to ensure 100% sensitivity. We then employed this keyword library to evaluate the remaining charts. Descriptive statistics were employed to assess correlations between self-reported financial concerns, chart documentation of cost discussions or financial interventions, and patient demographics. Results: Out of 109 eligible patients, 71% (77) completed pre-visit questionnaires, with 30% (23) reporting financial issues. Of this group, 43% (10) died during the study period. Average follow-up was 5.0 months among the decedents. Among those reporting financial concerns, 65% (15) had documented cost discussions or financial assistance referrals in the EHR, involving physicians, social workers, and other clinic staff. Most interventions addressed medication costs and referrals to financial assistance as indicated. Patient demographics (age, sex, insurance type) showed no apparent association with chart documentation of cost discussions or financial assistance. Conclusions: We used retrospective chart review to evaluate the extent of documentation of cost discussions and finance-related intervention in a cohort of patients with advanced cancer. In our patient cohort, 30% self-reported financial concerns, a proportion consistent with previously reported incidence of FT among oncology patients. Notably, 35% of the patients with known financial concerns had no other relevant documentation in the EHR. More work is needed to establish best practices for systematic screening for FT and interventions to support patients.

Understanding the relationship between obesity and in-hospital outcomes in gastric cancer patients : A nationwide analysis.

e16050 Background: Gastric cancer is the fifth most common form of cancer and the third leading cause of cancer-related deaths worldwide. Obesity has been identified as a significant risk factor for gastric cancer, associated with increased incidence and heightened complications in hospitalized patients. Our analysis comprehensively evaluates obesity's impact on hospital-admitted gastric cancer patients. Methods: Using the National Inpatient Sample (NIS) 2020, we identified gastric cancer patients with regional and advanced metastatic disease, and they were stratified into patients with and without obesity. The primary outcome was mortality, and secondary outcomes included length of stay, the total cost of hospitalization, and other in-hospital adverse outcomes. Multivariate logistic regression analysis was used to calculate the outcomes after adjusting for confounding variables. Results: A total of 17560 patients were hospitalized with gastric cancer, among which 1720(9.8%) had the concurrent diagnosis of Obesity. The mean age of patients with and without Obesity was 63 (+/- 13.88) and 66 (+/- 12.93),p&lt;0.001 respectively. The obese category had the greater percentage of male patients as compared to females (58.14% vs 44.85% respectively, p&lt;0.001). After adjusting for confounding variables, Obesity was not considered as an independent predictor of mortality in patients with gastric cancer (OR=1.06(0.59-1.92); p=0.90). However, patients with Obesity had prolonged length of stay (+ 1.52 days(1.49-2.26); p=0.004) and total cost of hospitalization (+ $30977(12320-49633); p=0.001). Similarly, obese patients had an increased likelihood of Acute kidney injury (OR=1.47(1.09-1.96); p=0.01), ICU admission (OR=2.01(1.30-3.09); p=0.002), invasive (OR=2.14(1.29-3.54); p=0.003) Noninvasive mechanical ventilation (OR=5.36(2.17-13.14); p&lt;0.001) and Heart failure (OR=1.68(1.09-2.57); p=0.02). No difference was noted in the risk of cardiac arrest (OR=1.26(0.28-5.68); p=0.76), and sepsis(OR=1.76(0.99-3.13); p=0.05). Conclusions: Obesity in patients with gastric cancer is not an independent predictor of mortality but is associated with increased length of stay, the total cost of hospitalization, increased risk of mechanical ventilation, and ICU admissions. Management of obesity can prove crucial in averting a wide range of potential health complications and significantly enhancing the overall quality of life in gastric cancer patients. [Table: see text]

Assessment of health-related quality of life and health utility in patients on home parenteral nutrition

Assessment of health-related quality of life and health utility in patients on home parenteral nutrition

Combined Aerobic and Resistance Training Improves Body Composition, Alters Cardiometabolic Risk, and Ameliorates Cancer-Related Indicators in Breast Cancer Patients and Survivors with Overweight/Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Breast cancer survivors with obesity are at a high risk of cancer recurrence, comorbidity, and mortality. This review aims to systematically evaluate the effects of combined aerobic and resistance training (CART) on body composition, lipid homeostasis, inflammation, adipokines, cancer-related fatigue, sleep, and quality of life in breast cancer patients and survivors with overweight/obesity. An electronic search was conducted in PubMed, Web of Science, Scopus, Science Direct, Cochrane, and Google Scholar databases from inception up to January 8, 2024. Randomized controlled trials (RCTs) meeting the inclusion criteria were selected for the analysis. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the quality of evidence. A random-effects model was used, and data were analyzed using mean (MD) and standardized mean differences (SMD) for continuous variables with 95% confidence intervals (CI). We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence. A total of 17 randomized controlled trials were included in the systematic review involving 1,148 female patients and survivors (mean age: 54.0 ± 3.4 years). The primary outcomes showed significant improvements in body mass index (SMD -0.57 kg/m2, p = 0.04), body fat (SMD -0.50%, p = 0.02), fat mass (SMD -0.63 kg, p = 0.04), hip circumference (MD -3.14 cm, p = 0.02), and fat-free mass (SMD 1.03 kg, p < 0.001). The secondary outcomes indicated significant increases in high-density lipoprotein cholesterol (MD -0.05 mmol/L, p = 0.008), natural killer cells (SMD 0.42%, p = 0.04), reductions in triglycerides (MD -81.90 mg/dL, p < 0.01), total cholesterol (SMD -0.95 mmol/L, p < 0.01), tumor necrosis factor α (SMD -0.89 pg/mL, p = 0.03), and leptin (SMD -0.63 ng/mL, p = 0.03). Also, beneficial alterations were found in cancer-related fatigue (SMD -0.98, p = 0.03), sleep (SMD -1.17, p < 0.001), and quality of life (SMD 2.94, p = 0.02) scores. There was very low to low confidence in the estimated effect of most of the outcomes. The present findings reveal that CART could be considered an adjunct therapy in supporting the conventional clinical approach observed following exercise. However, further high-quality research is needed to evaluate whether CART would be a valuable intervention to lower aggressive pharmacologic use in breast cancer patients with overweight/obesity.