Patients Receiving Radiation Treatment Research Articles

Schwannomas: Experience from a single center reference in Peru.

e14043 Background: Schwannomas are nerve sheath tumors that originate in Schwann cells. They are usually solitary and sporadic and manifest on peripheral, spinal or cranial nerves. It is the most common type of benign peripheral nerve tumor in adults. These tumors represent a diagnostic challenge due to their rarity and difficult differential diagnosis. Our objective was to determine the clinical and pathological characteristics, as well as the therapeutic management of patients with Schwannoma admitted to our institution over a period of time. Methods: A retrospective, cross-sectional and descriptive study was carried out on the cases of patients with Schwannoma over 14 years of age, diagnosed at the National Institute of Neoplastic Diseases from 2009 to 2023. Medical records and pathology reports were reviewed. Results: A total of 225 patients were diagnosed with schwannoma on anatomopathology. Median age was 44 years, with a range of 15 to 92 years. 135 (60%) patients were female and 90 (40%) male, with a ratio of 1.5:1. 19 (8.4%) patients had a second cancer before or after the diagnosis of schwannoma. 6 (2.66%) patients were previously diagnosed with neurofibromatosis. According to anatomical origin: 27 (12%) patients had schwanommas of the abdominal region, 36 (16%) of the head and neck, 42 (18.66%) of the spinal cord, 17 (7.55%) of the extremities, 83 ( 36.88%) of the intracranial region and 20 (8.88%) of the thorax. At the intracranial level, 71 patients had location at the cerebellopontine angle, 5 at the orbital level, 2 at the level of the cerebellum and 5 in another location. At the abdominal level, 13 patients had a retroperitoneal location, 8 at the gastric level, 2 at the renal level and 4 in another location. In 130 patients we can obtain the ki67, median score was 2% (1-50%). Regarding treatment, 156 (69.33%) patients underwent surgery, and 42 (18.66%) patients received radiation treatment. During their follow-up, only 5 (2.22%) patients had local recurrence. Conclusions: Schwannomas are rare benign tumors. In many cases, its suspected diagnosis is difficult due to its similarity to other tumors that must be part of the differential diagnosis. Its treatment is surgical, with the objective of complete macroscopic resection. Radiotherapy is a complementary treatment in case of residual disease.

Head and Neck Paragangliomas: Overview of Institutional Experience.

Head and neck paragangliomas (HNPGLs) are rare and have high rates of genetic mutations. We conducted a retrospective review of 187 patients with 296 PGLs diagnosed between 1974 and 2023. The mean age of diagnosis was 48.8 years (range 10 to 82) with 69.0% female and 26.5% patients with multiple PGLs. Among 119 patients undergoing genetic testing, 70 (58.8%) patients had mutations, with SDHB (30) and SDHD (26) being the most common. The rates of metastasis and recurrence were higher among patients with SDHB mutations or SDHD mutations associated with multiple PGLs. Metabolic evaluation showed elevated plasma dopamine levels were the most common derangements in HNPGL. MRI and CT were the most common anatomic imaging modalities and DOTATATE was the most common functional scan used in this cohort. Most patients (81.5%) received surgery as the primary definitive treatment, while 22.5% patients received radiation treatment, mostly as an adjuvant therapy or for surgically challenging or inoperable cases. Systemic treatment was rarely used in our cohort. Our single-center experience highlights the need for referral for genetic testing and metabolic evaluation and for a team-based approach to improve the clinical outcomes of patients with HNPGLs.

Effectiveness of Comprehensive Intervention Programme on Quality of life, fatigue, self-efficacy, and psychosocial distress among head and neck cancer patients receiving radiotherapy

PurposeThe study aimed at evaluating the Effectiveness of Comprehensive Intervention Programme (CIP) on Quality of life (QOL), fatigue, self-efficacy, and psychosocial distress among Head and Neck Cancer (HNC) patients receiving radiotherapy treatment.MethodsSingle-centre non-RCT time series study was conducted among 134 HNC patients (67 observed, followed by 67 subjected to CIP). FACT- H&N, FACT-F, Cancer Behavior Inventory and psychosocial distress scales were used to assess QOL, fatigue, self-efficacy, and psychosocial distress respectively. CIP was provided to the intervention arm twice a week during the course of radiation therapy along with the standard care; the control arm received only standard care. Data were collected before commencing radiotherapy, and post-test assessments were carried out at the end of radiotherapy treatment, and at 3 and 6 months after completion of radiotherapy.ResultsRepeated measures ANOVA revealed a statistically significant improvement with CIP in QOL (F (1.917) = 454.103, p = 0.001), fatigue (F (2.106) = 183.775, p = 0.001), self-efficacy (F (2.429) = 190.861, p = 0.001), and psychosocial distress (F (2.288) = 290.105, p = 0.001) in the intervention arm.ConclusionThe CIP implemented to address multitude of issues in HNC patients receiving radiotherapy, proved to be effective in reducing the impact of treatment on QOL, fatigue, self-efficacy and psychosocial distress in HNC patients receiving radiotherapy.

Perception and Utilization of Cannabinoids in Patients Undergoing Radiation Treatment: Our Patients Are Curious

PurposeLimited studies have described the utilization of cannabinoids among cancer patients. This survey study aimed to characterize utilization patterns and perceptions of cannabinoid use for treatment-related side effects among patients receiving radiation treatment. MethodsThis was an anonymous survey study of patients who were undergoing or recently completed radiation treatment at a comprehensive cancer center. Data on cannabinoid use during cancer treatment, reasons for the use of cannabinoids, perceived effects of cannabinoids, and formulations of usage were collected and summarized using descriptive statistics. ResultsOf the 431 respondents, 111 (25.8%) patients reported cannabinoid use since their cancer diagnosis. Among the cannabinoid users, a majority (73.9%) experienced improvement in symptoms. 38.7% had better relief of cancer-treatment symptoms from cannabinoids in comparison to their prescription medications, and 16.2% lowered the amount of prescription pain medications needed after using cannabinoids. Cannabinoids appeared to be most effective in helping patients manage sleep (76.6%) and anxiety (72.1%). When asked about whether physicians should be discussing cannabinoid use, 45.1% of cannabinoid users wanted to speak with their doctors regarding its utilization. For patients who did not report cannabinoid use, a large majority (83.1%) never had discussions with their doctors regarding its utilization as part of their cancer care, and 34.8% wanted to learn more about cannabinoids from their doctors. ConclusionsAbout one in four cancer patients reported cannabinoid use to assist in symptom control. A majority had subjective alleviation of treatment-related symptoms from cannabinoid use. Regardless of cannabinoid use, a sizable percentage of patients never had any discussions about cannabinoids with their oncologists, with some expressing interest in learning more. Guidelines are needed to assist radiation oncologists on how cannabinoids may play a role in caring for patients.

Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation treatment.

302 Background: In recent years, the frequency and severity of climate-driven disasters, including wildfires, have posed significant challenges to the delivery of oncology care. Among various treatment modalities, radiotherapy stands is particularly vulnerable due to its reliance on consistent electrical power and daily treatment sessions. For patients receiving radiation treatment for locally advanced non-small cell lung cancer (NSCLC), even minor disruptions in treatment continuity have been shown to have a detrimental impact on overall survival. Methods: Patients undergoing definitive radiotherapy for nonoperative locally advanced NSCLC between 2004 and 2019 were selected from the hospital-based National Cancer Database, which captures approximately 70% of all cases in the United States. Disaster declarations were identified from the Federal Emergency Management Agency from 2004 to 2019. Exposed patients (n = 1,419) were defined as those who had a wildfire disaster declared in the county of the treatment facility during the exposure window (within 12 weeks of radiotherapy start date), while unexposed patients (n = 226,719) had no disasters declared within the same timeframe. Overall survival was defined as age when radiation therapy started and age of death, last contact, or study end. Cox proportional hazards was used for estimating hazard ratios (HRs) adjusted for sex, region, health insurance, comorbidities, facility type, lymph node involvement and concomitant chemotherapy. Survival estimates were weighted by the inverse of the probability of remaining uncensored at the end of the exposure window. Results: A total of 228,138 individuals were included in the study. Our preliminary data shows that exposed individuals were more likely to receive treatment in facilities located in western states, have no comorbidities, and have private health insurance coverage. Individuals whose facility had a wildfire disaster declared within 12 weeks of the radiation start date had worse overall survival (HR = 1.03; 95% Confidence Interval = 1.01, 1.06) compared to unexposed individuals with sensitivity analyses pending. Conclusions: Our study highlights the vulnerability of individuals undergoing radiotherapy for NSCLC to the hazards posed by wildfires. These findings underscore the urgent need for oncology institutions to prioritize the climate adaptation efforts aimed at safeguarding the needs of this vulnerable population.

Development and Validation of a Convolutional Neural Network Model to Predict a Pathologic Fracture in the Proximal Femur Using Abdomen and Pelvis CT Images of Patients With Advanced Cancer.

Development and Validation of a Convolutional Neural Network Model to Predict a Pathologic Fracture in the Proximal Femur Using Abdomen and Pelvis CT Images of Patients With Advanced Cancer.

Radiotherapy for Geriatric Cancer Patients: Five-year Experience at a North Indian Tertiary Care Hospital

Background: The incidence of malignancy in elderly population in India has risen due to increased life expectancy, health awareness, and access to tertiary health care. Radiotherapy is the primary treatment modality in elderly cancer patients due to morbidity of surgery. We reviewed and analyzed clinical, disease and treatment profiles of geriatric population treated with conventional radiotherapy at our institute. Methodology: The clinical records of patients aged 70 years or more, treated from January 2015 to December 2019 were analyzed for patient characteristics (age, sex & co-morbidities), disease characteristics (site, histology & stage) and treatment characteristics (modality & intent of treatment, radiation dose). Results: A total of 289 patients aged 70 years and above were treated during the study period. 69% were treated with curative intent, of which, 72.4% received definitive, 24.6% received adjuvant, and 3% received neoadjuvant radiotherapy. 31% were given palliative radiotherapy. The median age was 74.6 years with male: female ratio of 4.25:1. 21.4% of the study patients had co-morbidities. 14% patients were of early stage, 57% locally advanced and 29% had metastatic disease. 51% of the study population received concurrent chemotherapy along with Radiotherapy. 87.1% of those treated with curative intent & 93.3% of patients treated with palliative intent, completed the planned radiotherapy regimen. Out of total 200 patients treated at our institute with Radiotherapy, 187 were prescribed concurrent chemotherapy, while it was exhibited to only 103 patients due to various factors like old age, poor performance status and co-morbidities. Conclusion: Our study showed a high degree of compliance amongst geriatric patients receiving radiotherapy treatment. Toxicity rates in geriatric population were not significantly higher than the overall population treated at our centre. Various factors like disease biology and stage and patient’s performance status, co-morbidities and life expectancy affect the decision making in deciding radiotherapy intent and schedules in cancer patients of geriatric age group. Combined decision making between patients, caregivers and oncologists is crucial in geriatric age group keeping in mind above mentioned factors.

MAGNETIC RESONANCE IMAGING EVALUATION OF INCIDENTAL CARDIAC IRRADIATION DURING LEFT BREAST CANCER RADIOTHERAPY: A SYSTEMATIC REVIEW

Breast cancer is one of the most common malignant tumours among women. Radiotherapy plays a key role in the management of breast cancer patients. However, radiotherapy results in incidental exposure of the heart. This work systematically reviewed articles on magnetic resonance imaging (MRI) evaluation of cardiac changes due to incidental cardiac irradiation during left breast radiotherapy and also to identify the MRI sequences used during evaluation. A systematic literature search was conducted in the following three selected databases: PubMed, ScienceDirect and Scopus using carefully defined search terms related to the left breast, MRI and cardiac irradiation. The quality of the included papers was determined using the critical appraisal skills programme for qualitative studies. The review had a total of six articles that were screened and graded for quality. Articles graded as high and moderate in terms of quality assessment were included and characterised based on the sample size, type of cancer treated, treatment methods employed, and period MRI was performed after radiotherapy. The review showed that breast cancer patients who had radiotherapy also developed radiation-induced heart disease (RIHD) few months post treatment. The review noted that breast cancer patients receiving radiation treatment are at high risk of RIHD which may affect their quality of life after completion of treatment. Cardiac MRI facilitates early detection of RIHD, hence better patient management.

Abstract A006: Loss of PMEPA1 gene isoform facilitates the development of hormone and radiation therapies resistance in prostate cancer cells

Abstract Introduction: Nearly all the patients receiving hormone treatment eventually progress into castration resistance stage. In addition, approximately 30% to 40% of patients receiving radiation treatment will develop resistance. The aberrant alterations of androgen receptor (AR) and transforming growth factor-β (TGF-β) signaling play critical roles in such processes. Our studies identified five PMEPA1 (Prostate Transmembrane Protein Androgen Induced 1) gene isoforms in prostate cancer cells. PMEPA1-b isoform was androgen responsive and inhibited androgen signaling. In contrast, PMEPA1 isoforms a and d were TGF-β inducible and suppressed TGF-β signaling. Loss or reduced expressions of PMEPA1 was detected in over 60% of prostate cancer samples. In this study, we investigated the impacts of PMEPA1 isoforms (a, b and d) on the development of hormone and radiation therapies resistance in prostate cancer. Methods: RNA-seq data of unmatched 50 benign and 499 malignant prostate samples from The Cancer Genome Atlas (TCGA) dataset, as well as 101 metastatic castration resistant prostate cancer (mCRPC) biopsy samples from Quigley lab at UCSF (WCDT dataset) were used to study the transcript levels of PMEPA1 isoforms (a, b and d) and their correlations to disease progression. Hormone dependent LNCaP cells and androgen independent PC-3, DU-145 cells were utilized to investigate the impacts of PMEPA1 isoforms (a, b and d) on the responses to of androgen inhibitors (enzalutamide and bicalutamide, 0, 5.0 and 25.0 nM) and radiation (0, 1.0 and 5.0 Gy). The vectors of pcDNA3.1-PMEPA1-a, -b and -d were transfected into prostate cancer cells via Lipofectamine, and endogenous PMEPA1 isoforms were knocked down by isoforms specific siRNAs. The cell growth was assessed by cell counting, BrdU incorporation and cell plating efficiency assays. The protein levels of AR and PSA were evaluated by immunoblotting. The transcript levels of PSA, NKX3.1, NEDD9 and THBS1 were assessed by RT-PCR technology. Results: The reduced transcript levels of PMEPA1 isoforms (a, b and d) were detected in mCRPC group. Lower expression of PMEPA1-b was significantly associated with earlier biochemical recurrence. The growth inhibition and androgen signaling blockage mediated by androgen inhibitors were explicitly reversed by depletion of PMEPA1-b in LNCaP cells. Ectopic PMEPA1-b in isoform b depleted LNCaP cells reinstituted the growth inhibition induced by androgen inhibitors. Knockdown of isoforms a and d conspicuously rescued the decreased cell proliferation and suppressed TGF-β signaling resulted from radiation treatment in PC-3 and DU-145 cells. Similarly, over-expression of PMEPA1-a and -d in siRNA treated cells recapitulated the growth inhibitory effects of radiation treatments. Conclusion: Loss of PMEPA1 gene isoforms (a, b and d) induced the development of resistance to hormone ablation and radiation treatments in prostate cancer cells in vitro through activating androgen and TGF-β signaling. Our research provided a new insight into treatment resistance mechanism of prostate cancer cells. Citation Format: Shashwat Sharad, Hua Li. Loss of PMEPA1 gene isoform facilitates the development of hormone and radiation therapies resistance in prostate cancer cells [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr A006.

Patient views on the implementation of artificial intelligence in radiotherapy

Purpose/objectiveTo date there has been limited research looking at patient views on the implementation of artificial intelligence (AI) in radiotherapy. The aim of this study is to adapt and utilise a validated patient questionnaire to develop an understanding of current patient views on the use of AI in radiotherapy. Materials/methodsAn existing questionnaire, developed to assess understanding of patients’ views on the implementation of AI in radiology, was adapted to the field of radiotherapy. The questionnaire was distributed to cancer patients receiving radiotherapy treatment between November 2021 and March 2022. Completed questionnaires were analysed to assess patient levels of positivity or negativity towards AI. Results were grouped into five factors, representing underlying patient perspectives, and correlation of factors with demographic variables was assessed. ResultsIn total, 95 patients participated. Overall, there was a moderately negative patient view towards the use of AI in radiotherapy. Certain factors drew a more negative response than others, for example patients desire significant personal interaction with healthcare professionals during the course of their treatment. No significant correlation was found between the demographics of age and gender and the strength of views towards the use of AI in radiotherapy. ConclusionThis study has found that there are clear patient concerns around the use of AI in radiotherapy. As the use of AI in this field increases in future years, it will therefore be extremely important to educate and involve patients in the future direction of this technology.

Health-Related Quality of Life of Prostate Cancer Patients on Radiotherapy Treatment at Cancer Diseases Hospital in Lusaka, Zambia

Prostate Cancer is a major Public Health problem because of its high incidence and mortality. It is feared by men due to negative stigma brought by its diagnosis and its psychological effects, which affect the perception of sexuality and their own personal image and thereby affect the quality of life. The aim of the study was to investigate the health-related quality of life and associated factors of patients receiving radiotherapy treatment for prostate cancer at the Cancer Diseases Hospital in Lusaka, Zambia.

Perception and Utilization of Cannabinoids in Patients Undergoing Radiation Treatment: Our Patients are Curious

<h3>Purpose/Objective(s)</h3> There has been growing interest in the use of cannabinoid products as medical treatments, particularly for cancer care. With the legalization of marijuana for recreational use in many states in the United States, patients are increasingly using these substances at their own discretion. Limited studies have described the utilization of cannabinoids among cancer patients. This study aimed to characterize utilization patterns and perceptions of cannabinoid use for treatment-related side effects among patients receiving radiation treatment. <h3>Materials/Methods</h3> This was a single-institution study conducted at a comprehensive cancer center in a state with legalized medical and recreational use of cannabinoids. An anonymous survey was administered using a tablet and distributed to patients who were undergoing or recently completed radiation treatment. Patient demographics were recorded, including age, gender, race and ethnicity, marital status, education, household income, and cancer diagnosis. Two surveys were designed, one for those who used or are using cannabinoids during treatment and one for those who were not. The survey also included Likert-scale items regarding perceived effects of cannabinoids. Survey results were calculated using descriptive summary statistics. <h3>Results</h3> Of the 165 respondents, 45 (27.7%) patients reported cannabinoid use since their original cancer diagnosis. Of those who reported use, the majority (66.7%) experienced improvement of symptoms with cannabinoids. Much of this subset (66.7%) had better relief of symptoms from cannabinoid than from prescription medications, and 46.7% lowered the amount of pain medications required after using cannabinoid. More than half of cannabinoid users reported some degree of effectiveness of cannabinoid in managing pain (64.4%), sleep (62.2%), and anxiety/stress (57.8%), with more patients citing benefits while undergoing chemo- or immunotherapy (35.6%) than while undergoing radiation treatment (17.8%). Additionally, 44.4% of patients who reported cannabinoid use wanted more discussions with their doctors regarding their cannabinoid use. For patients who did not report cannabinoid use, a large majority (89.2%) never had discussions with their doctors regarding using cannabinoid as part of their cancer care, and 43.4% would like to learn about cannabinoids from their doctors. <h3>Conclusion</h3> About one in four cancer patients reported cannabinoid use since their cancer diagnosis. A majority had subjective alleviation of symptoms associated with cancer treatments, and some reported improved symptom relief from cannabinoid compared to prescription medications. A large proportion of patients, regardless of their cannabinoid use, were interested in discussing cannabinoid use with their radiation oncologists during their treatment. Guidelines are needed to assist radiation oncologists on how cannabinoid may play a role in their patients' care.

Total Pain and Illness Acceptance in Pelvic Cancer Patients: Exploring Self-Efficacy and Stress in a Moderated Mediation Model.

Cancer patients experience pain not only in its physical dimension, but also in a broader context that includes psychological, social, and spiritual aspects due to a higher level of anxiety and stress. The present prospective, longitudinal study examined the relationship between total pain and illness acceptance among pelvic cancer patients, taking into consideration the moderated mediation effects of self-efficacy and stress. The study involved a sample of pelvic cancer patients receiving radiotherapy treatment. Assessments were completed at T1 (before radiotherapy), T2 (after 3–4 weeks), and T3 (after radiotherapy) to assess the psychosocial dynamics of illness acceptance (N = 267). The more physical, psychological, social, and spiritual pain symptoms the patients experienced, the less they accepted negative health conditions and the effects of their illness. Stress moderated the indirect effect between total pain dimensions and illness acceptance through self-efficacy, but it did not moderate the relationship between total pain and illness acceptance. The relationships between total pain dimensions and illness acceptance thus depend on both the mediating effect of self-efficacy and the moderating effect of stress. This highlights the need to control one’s motivation and behavior and manage emotional strain or tension.

The Role of TGF-β in Cognitive Decline Associated with Radiotherapy in Brain Tumor

Cognitive decline is a late adverse event in brain tumor survivors. The patients receiving radiation treatment exhibit a wide range of damage and impairment in attention, memory, and executive function compared to the untreated group. After radiation treatment, various changes are observed in astrocytes, oligodendrocytes, white matter, and vasculature. The major affected areas are the hippocampus and prefrontal cortex. Neurogenesis impairment is one of the primary mechanisms responsible for cognitive dysfunction. Various cytokines and growth factors are responsible for inducing apoptosis of neural cells, which results in impaired neurogenesis in response to radiotherapy. Transforming growth factor (TGF-β) is one of the key cytokines released in response to radiation. TGF-β plays a major role in neuronal apoptosis through various pathways such as the MAP kinase pathway, JAK/STAT pathway, and protein kinase pathway. In contrast, activation of the ALK5 pathway via TGF-β improves neurogenesis. So, the current review article focuses on the detailed effects of TGF-β on neuronal cells concerning radiation exposure. This in-depth knowledge will help researchers focus more on the TGF-β pathway and come up with new treatment schedules which will help reduce cognitive dysfunctions in brain tumor patients produced as a result of radiation therapy.

Impact of radiation treatment on immediate direct to implant reconstruction with ADM

Introduction: This study looks into complications and revision procedures performed in patients receiving radiation treatment and compares it with those not receiving radiation treatment in immediate direct to implant reconstruction (IDTIR) with ADM.

Validation of an MRI-only planning workflow for definitive pelvic radiotherapy

PurposePrevious work on Magnetic Resonance Imaging (MRI) only planning has been applied to limited treatment regions with a focus on male anatomy. This research aimed to validate the use of a hybrid multi-atlas synthetic computed tomography (sCT) generation technique from a MRI, using a female and male atlas, for MRI only radiation therapy treatment planning of rectum, anal canal, cervix and endometrial malignancies.Patients and methodsForty patients receiving radiation treatment for a range of pelvic malignancies, were separated into male (n = 20) and female (n = 20) cohorts for the creation of gender specific atlases. A multi-atlas local weighted voting method was used to generate a sCT from a T1-weighted VIBE DIXON MRI sequence. The original treatment plans were copied from the CT scan to the corresponding sCT for dosimetric validation.ResultsThe median percentage dose difference between the treatment plan on the CT and sCT at the ICRU reference point for the male cohort was − 0.4% (IQR of 0 to − 0.6), and − 0.3% (IQR of 0 to − 0.6) for the female cohort. The mean gamma agreement for both cohorts was > 99% for criteria of 3%/2 mm and 2%/2 mm. With dose criteria of 1%/1 mm, the pass rate was higher for the male cohort at 96.3% than the female cohort at 93.4%. MRI to sCT anatomical agreement for bone and body delineated contours was assessed, with a resulting Dice score of 0.91 ± 0.2 (mean ± 1 SD) and 0.97 ± 0.0 for the male cohort respectively; and 0.96 ± 0.0 and 0.98 ± 0.0 for the female cohort respectively. The mean absolute error in Hounsfield units (HUs) within the entire body for the male and female cohorts was 59.1 HU ± 7.2 HU and 53.3 HU ± 8.9 HU respectively.ConclusionsA multi-atlas based method for sCT generation can be applied to a standard T1-weighted MRI sequence for male and female pelvic patients. The implications of this study support MRI only planning being applied more broadly for both male and female pelvic sites.Trial registration This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) (www.anzctr.org.au) on 04/10/2017. Trial identifier ACTRN12617001406392.

Clinical Characteristics and Mortality in Patients With Cancer and COVID-19 From the Epicenter in New York City

Purpose/Objective(s)The COVID-19 pandemic has resulted in over 2 million deaths worldwide and numerous studies demonstrate cancer patients are at increased risk of mortality. In this current study, the authors seek to investigate patient characteristics, clinical course, and predictors of COVID-19 diagnosis, severity and mortality in patients with active cancer at Elmhurst Hospital.Materials/MethodsA retrospective analysis of patients presenting to our institution with an active cancer diagnosis between January-June 2020 was performed. Inclusion criteria consisted of diagnosis of cancer or active cancer-directed treatment including surgery, radiation, and systemic therapy during this time period. Demographic, clinical characteristics, treatment, SARS-CoV-2 laboratory results, and outcomes were evaluated. Statistical analysis was performed using students t-test, chi-square, and Fisher's exact test. COVID-confirmed death required confirmatory laboratory evidence for SARS-CoV-2 using RT-PCR testing. Severe events were defined as patients requiring hospitalization, oxygen supplementation, mechanical ventilation, or death.Results266 patients met inclusion criteria for this study. 108 patients were tested for COVID-19 with 21 testing positive. Only 7.9% of cancer patients tested positive for SARS-CoV-2 with a test-positive rate of 19.4%. Median age of entire cohort was 61 years old (IQR 52-69) and 55 years old (IQR 46-70) in COVID positive cohort. There was a male preponderance in COVID positive cohort (66.7%, P = 0.07) and COVID-confirmed deaths (83.3%, P = 0.09) that trended toward statistical significance. A higher proportion of COVID positive patients (66.7%) and COVID-confirmed deaths (83.3%) were of Hispanic ethnicity compared to patients without COVID diagnosis (53.0%, P = 0.23) and patients who died without COVID (31.6%, P = 0.06); however, this was not statistically significant. Furthermore, there was a statistically significant higher proportion of COVID positive patients that were receiving cytotoxic chemotherapy compared non-COVID patients (P = 0.02). The overall 30-day mortality in this cohort of cancer patients was 2.3%, with 3% of patients having severe events. Of the cancer patients who tested positive, 9 had severe events (42.9%) and 6 had confirmed COVID-related deaths (28.6%). There were no significant predictors for diagnosis of COVID nor were there significant predictors of severity or mortality.ConclusionThe incidence of laboratory confirmed SARS-CoV-2 infection in cancer patients during the height of the COVID-19 pandemic in New York City was low suggesting safety procedures implemented were effective. Patients receiving radiation treatment were not at increased risk of COVID diagnosis but patients receiving cytotoxic chemotherapy were. Based on our analysis, patients with cancer seem to be at increased risk for mortality (case-fatality rate of 29%) and severe events (43%) due to the SARS-CoV-2 infection compared to general population.

Factors associated with increased financial toxicity after the completion of radiation treatment for gynecologic cancer

<h3>Objectives:</h3> Financial toxicity is estimated to impact up to 50% of patients with gynecologic malignancies, but little is known about the factors that may predispose patients receiving radiation treatment for gynecologic cancer to increased financial distress. <h3>Methods:</h3> Patients from an urban academic gynecologic radiation oncology practice completed a financial toxicity survey at their 1-month follow-up visit after completion of radiation treatment from August 2019-March 2020. The survey was modified from our prior study and included basic demographic questions, the Comprehensive Score for Financial Toxicity (COST) tool and the EQ-5D to measure quality of life. Consistent with our prior work, high financial toxicity was defined as COST score ≤23. We assessed correlation of COST scores with QOL. Demographic and disease characteristics between high and low financial toxicity groups were compared using Chi-square or Fisher's exact test for categorical variables and Wilcoxon rank sum test for continuous variables. We used log-binomial regression to examine associations between high financial toxicity and cost-coping strategies. <h3>Results:</h3> The response rate was 88%. Of the 49 patients surveyed, 71% were White, 14% Black and 10% Asian. The majority of patients had uterine cancer (65%), followed by cervical (23%) and vaginal (8%) cancer. Two-thirds (63%) received external beam radiation with or without brachytherapy; the remaining (37%) received brachytherapy alone. Median COST score was 13 (IQR 5-19) in the high financial toxicity group (n=18) and 32 (IQR 27-36) in the low toxicity group (n=31). Greater financial toxicity was significantly correlated with worse QOL (R=-0.36, P=0.02). No demographic, disease or treatment characteristics were associated with high financial toxicity aside from employment status (p=0.03), though income was borderline significant (p=0.053). Compared with the low financial toxicity group, patients with high financial toxicity were more likely to move from full-time to part-time employment since diagnosis (22% vs 0%, p=0.01) and reported that difficulty paying for transportation or parking was a consideration in making medical decisions (33.3 vs 3.2%, p=0.01). Patients with high financial toxicity were more likely to report delaying or avoiding medical care (22% vs 0%, P=0.01), 13.8 (95% CI 1.9-101.4, P<0.001) times more likely to borrow money, and 10.3 (95% CI 1.3-79.1, p=0.01) times more likely to report reduced spending on basic goods. <h3>Conclusions:</h3> Financial toxicity correlated with worse quality of life in patients who received radiation for their gynecologic cancer diagnosis and was associated with delays or avoidance of medical care and use of economic cost-coping strategies. A larger survey cohort may improve our ability to meaningfully detect other associations with high financial toxicity. Moreover, transportation and parking costs should be considered in the design of any future intervention study in this population.

Utilizing a Radiation Therapist Champion Model to Improve ESAS-r/EPIC Completion Rates During the COVID-19 Pandemic

Purpose: Patient-reported outcome measures through ESAS-r and EPIC, branded as Your Symptoms Matter (YSM), are an important tool for patients to report symptoms related to their treatment and to improve their quality of care. During the COVID-19 pandemic, the rate of YSM completion decreased due to the need to minimize the use of high touch surfaces (kiosks), and reduce the number of people in the Cancer Centre, such as supporting volunteers. The aim of this initiative was to implement a Radiation Therapist champion model to improve the completion rate of YSM among patients receiving radiation treatment during the COVID-19 pandemic.

Recommendation for the contouring of limbic system in patients receiving radiation treatment: A pictorial review for the everyday practice and education

The limbic circuit (LC) is devoted to linking emotion to behavior and cognition. The injury this system results in post-RT cognitive dysfunction. The aim of this study is to create the first radiation oncologist's practical MR-based contouring guide for the delineation of the LC for the everyday clinical practice and education. An anonymized diagnostic 3.0 T T1-weighted BRAVO MRI sequence from a healthy patient with typical brain anatomy was used to delineate LC. For each structure key anatomical contours were completed by radiation oncologists, along with a neuro-radiologist to generate the final version of the LC atlas. a step-by-step MR-based atlas of LC was created. Key structures of the LC, such as, cingulate gyrus, fornix, septal region, mammillary bodies, thalamus and the hippocampal-amygdala formation were contoured. This article provides the recommendations for the first contouring atlas of LC in the setting of patients receiving RT and education.