Patients Undergoing Cancer Treatment Research Articles

Systemic Anti-Inflammatory Agents in the Prevention of Chemoradiation-Induced Mucositis: A Review of Randomised Controlled Trials.

Mucositis is a pathological condition characterised by inflammation and ulceration of the mucous membranes lining the alimentary canal, particularly in the mouth (oral mucositis) and the gastrointestinal tract. It is a common side effect of cancer treatments, including chemotherapy and radiotherapy, and it is sometimes responsible for treatment interruptions. Preventing mucositis throughout the alimentary tract is therefore crucial. However, current interventions mainly target either oral or gastrointestinal side effects. This review aimed to investigate the use of systemically administered anti-inflammatory agents to prevent mucositis in cancer patients undergoing cancer treatment. PubMed, Ovid, Scopus, Web of Science, WHO ICTRP and ClinicalTrials.gov were screened to identify eligible randomised controlled trials (RCTs). The published literature on anti-inflammatory agents provides mixed evidence regarding the degree of efficacy in preventing/reducing the severity of mucositis in most anticancer treatments; however, sample size continued to be a significant limitation, alongside others discussed. Our review yielded a list of several anti-inflammatory agents that exhibit potential mucositis-preventive effects in cancer patients undergoing cancer treatment, which can be used to inform clinical practice.

Monitoring Adolescent and Young Adult Patients With Cancer via a Smart T-Shirt: Prospective, Single-Cohort, Mixed Methods Feasibility Study (OncoSmartShirt Study).

Wearables that measure vital parameters can be potential tools for monitoring patients at home during cancer treatment. One type of wearable is a smart T-shirt with embedded sensors. Initially, smart T-shirts were designed to aid athletes in their performance analyses. Recently however, researchers have been investigating the use of smart T-shirts as supportive tools in health care. In general, the knowledge on the use of wearables for symptom monitoring during cancer treatment is limited, and consensus and awareness about compliance or adherence are lacking. The aim of this study was to evaluate adherence to and experiences with using a smart T-shirt for the home monitoring of biometric sensor data among adolescent and young adult patients undergoing cancer treatment during a 2-week period. This study was a prospective, single-cohort, mixed methods feasibility study. The inclusion criteria were patients aged 18 to 39 years and those who were receiving treatment at Copenhagen University Hospital - Rigshospitalet, Denmark. Consenting patients were asked to wear the Chronolife smart T-shirt for a period of 2 weeks. The smart T-shirt had multiple sensors and electrodes, which engendered the following six measurements: electrocardiogram (ECG) measurements, thoracic respiration, abdominal respiration, thoracic impedance, physical activity (steps), and skin temperature. The primary end point was adherence, which was defined as a wear time of >8 hours per day. The patient experience was investigated via individual, semistructured telephone interviews and a paper questionnaire. A total of 10 patients were included. The number of days with wear times of >8 hours during the study period (14 d) varied from 0 to 6 (mean 2 d). Further, 3 patients had a mean wear time of >8 hours during each of their days with data registration. The number of days with any data registration ranged from 0 to 10 (mean 6.4 d). The thematic analysis of interviews pointed to the following three main themes: (1) the smart T-shirt is cool but does not fit patients with cancer, (2) the technology limits the use of the smart T-shirt, and (3) the monitoring of data increases the feeling of safety. Results from the questionnaire showed that the patients generally had confidence in the device. Although the primary end point was not reached, the patients' experiences with using the smart T-shirt resulted in the knowledge that patients acknowledged the need for new technologies that improve supportive cancer care. The patients were positive when asked to wear the smart T-shirt. However, technical and practical challenges in using the device resulted in low adherence. Although wearables might have potential for home monitoring, the present technology is immature for clinical use.

Association of opioid use with survival in patients with cancer treated with immune checkpoint inhibitors: it is time for evidence-based behaviors.

Cancer is a leading cause of morbidity and mortality worldwide, with pain experienced by most patients undergoing cancer treatment. Opioids are the recommended treatment for cancer pain management, but recent studies suggest a negative association between opioid use and survival rates among patients undergoing immunotherapy. However, conclusions cannot be drawn regarding causality from these observational data. Immunotherapy, which boosts the body's immune system to fight cancer cells, has emerged as a promising treatment option for all types of cancer. Immune checkpoint inhibitors (ICIs) can activate the anticancer function of exhausted T cells and have shown remarkable survival benefits in patients with multiple malignancies. However, a recent systematic review and meta-analysis suggested that the use of opioids during ICI treatment has an adverse effect on patient prognosis, while the use of NSAIDs is not significantly associated with the prognosis in patients treated with ICIs. These reviews have major limitations due to the retrospective nature of the studies and the multiple factors that can influence the phenomenon. Therefore, caution is required when interpreting results from retrospective data on drug interactions. The findings of this study are alarming and potentially harmful to patients with cancer suffering from pain or other symptoms requiring opioid drugs.

Changes in hospital mortality in patients with cancer during the COVID-19 pandemic (ISARIC-CCP-UK): a prospective, multicentre cohort study

Patients with cancer are at greater risk of dying from COVID-19 than many other patient groups. However, how this risk evolved during the pandemic remains unclear. We aimed to determine, on the basis of the UK national pandemic protocol, how factors influencing hospital mortality from COVID-19 could differentially affect patients undergoing cancer treatment. We also examined changes in hospital mortality and escalation of care in patients on cancer treatment during the first 2 years of the COVID-19 pandemic in the UK. We conducted a prospective cohort study of patients aged older than 19 years and admitted to 306 health-care facilities in the UK with confirmed SARS-CoV-2 infection, who were enrolled in the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol (CCP) across the UK from April 23, 2020, to Feb 28, 2022; this analysis included all patients in the complete dataset when the study closed. The primary outcome was 30-day in-hospital mortality, comparing patients on cancer treatment and those without cancer. The study was approved by the South Central-Oxford C Research Ethics Committee in England (Ref: 13/SC/0149) and the Scotland A Research Ethics Committee (Ref 20/SS/0028), and is registered on the ISRCTN Registry (ISRCTN66726260). 177 871 eligible adult patients either with no history of cancer (n=171 303) or on cancer treatment (n=6568) were enrolled; 93 205 (52·4%) were male, 84 418 (47·5%) were female, and in 248 (13·9%) sex or gender details were not specified or data were missing. Patients were followed up for a median of 13 (IQR 6-21) days. Of the 6568 patients receiving cancer treatment, 2080 (31·7%) died at 30 days, compared with 30 901 (18·0%) of 171 303 patients without cancer. Patients aged younger than 50 years on cancer treatment had the highest age-adjusted relative risk (hazard ratio [HR] 5·2 [95% CI 4·0-6·6], p<0·0001; vs 50-69 years 2·4 [2·2-2·6], p<0·0001; 70-79 years 1·8 [1·6-2·0], p<0·0001; and >80 years 1·5 [1·3-1·6], p<0·0001) but a lower absolute risk (51 [6·7%] of 763 patients <50 years died compared with 459 [30·2%] of 1522 patients aged >80 years). In-hospital mortality decreased for all patients during the pandemic but was higher for patients on cancer treatment than for those without cancer throughout the study period. People with cancer have a higher risk of mortality from COVID-19 than those without cancer. Patients younger than 50 years with cancer treatment have the highest relative risk of death. Continued action is needed to mitigate the poor outcomes in patients with cancer, such as through optimising vaccination, long-acting passive immunisation, and early access to therapeutics. These findings underscore the importance of the ISARIC-WHO pandemic preparedness initiative. National Institute for Health Research and the Medical Research Council.

“Accepting Unexpected Health Realities”: Exploring the Life Experiences of Ovarian Cancer Patients – A Qualitative Study

Introduction: Among women, ovarian cancer is the eighth most frequent cancer globally and the fifth leading cause of cancer-related deaths in women. Ovarian cancer is termed the "silent killer" because of its slow onset and unclear symptoms. Most of the advanced cases of ovarian cancer were found due to poor screening. The main objective of this study was to understand the emotional experiences, coping and resilience of patients undergoing ovarian cancer treatment. Methods: This qualitative study employs a phenomenological approach to explore the life experiences of ovarian cancer patients. An in-depth interview was conducted among patients undergoing cancer treatment. A total of 11 participants were included in this study. Thematic analysis was done. Results: The analysis of the data revealed eight main themes and 32 sub-themes that were characterized based on the experiences of cancer patients: 1) Misconceptions about symptoms, 2) Barriers in accessing healthcare, 3) Physical struggles, 4) Emotional turmoil, 5) Social issues, 6) Hope giving factors, 7) Sacrifice for family well-being, and 8) Emotional resilience. Conclusion: One of the key findings of this study is the importance of accepting unexpected health realities. This study shows the emotional journey of accepting difficult realities and mainly trusting medical professionals to guide one through treatment. Develop targeted educational campaigns to raise awareness about the symptoms of ovarian cancer and dispel common misconceptions.

An initiative to implement a triage and referral system to make exercise and rehabilitation referrals standard of care in oncology

BackgroundClinical guidelines suggest that patients should be referred to exercise while undergoing cancer treatment. Oncology clinicians report being supportive of exercise referrals but not having the time to make referrals. Toward the goal of making exercise referrals standard of care, we implemented and evaluated a novel clinical workflow.MethodsFor this QI project, a rehabilitation navigator was inserted in chemotherapy infusion clinics. Patients were offered a validated electronic triage survey. Exercise or rehabilitation recommendations were communicated to patients during a brief counseling visit by the rehabilitation navigator. The implementation approach was guided by the EPIS framework. Acceptability and feasibility were assessed.ResultsInitial meetings with nursing and cancer center leadership ensured buy-in (exploration). The education of medical assistants contributed to the adoption of the triage process (preparation). Audit and feedback ensured leadership was aware of medical assistants’ performance (implementation). 100% of medical assistants participated in implementing the triage tool. A total of 587 patients visited the infusion clinics during the 6-month period when this QI project was conducted. Of these, 501 (85.3%) were offered the triage survey and 391 (78%) completed the survey (acceptability). A total of 176 (45%) of triaged patients accepted a referral to exercise or rehabilitation interventions (feasibility).ConclusionsImplementation of a validated triage tool by medical assistants and brief counseling by a rehabilitation navigator resulted in 45% of infusion patients accepting a referral to exercise or rehabilitation. The triage process showed promise for making exercise referrals standard of care for patients undergoing cancer treatment.

Oral Complications and Management Strategies for Cancer Patients: Principles of Supportive Oncology in Dentistry.

It is recognized that patients undergoing cancer treatment experience different adverse effects depending on the type of therapy they received. The objective of this work is to provide a scientific evidence-based protocol for oral care in cancer patients. Cancer resection surgery, chemotherapy, and radiotherapy can cause important complications that impact patients' quality of life. Cancer patients, from the moment of diagnosis to the end of treatment and subsequent follow-up, have diverse care needs, both from a systemic and local point of view. The implementation of oral care protocols before, during, and after cancer therapy is essential because it helps to identify risk factors for the development of predictable oral complications. It is essential to establish that all cancer patients, before starting treatment, undergo a systematic dental check-up to avoid limitations during treatment and also alter their quality of life. Regular professional oral care maintenance and follow-up programs are essential to maintaining a patient's long-term oral health.

O100: A novel bedside assessment of skeletal muscle wasting predicts treatment-related toxicity prior to major surgery – The Muscle Ultrasound in Esophagogastric Cancer (MUSEC) study

Abstract Sarcopenia is an important prognosticator during treatment for Oesophagogastric (OG) cancer. Despite this, sarcopenia is not routinely measured in clinical practice due to resource availability. Ultrasound is emerging as a potential tool to quantify muscle mass and quality and might predict treatment-related complications. Skeletal muscle ultrasound has not been investigated in patients undergoing cancer treatment. Patients receiving treatment for OG cancer (chemotherapy plus surgery) were prospectively recruited. Ultrasound was performed at 4 time points during treatment. Primary outcome was a measurable change in skeletal muscle. Secondary outcome measures included correlation with gold-standard measures of muscle mass (CT skeletal muscle index (SMI)), and the association between sarcopenia on ultrasound and treatment-related complications. Fifty patients were recruited. Significant deterioration in quadriceps muscle thickness, cross sectional area, rectus femoris echointensity, and ultrasound sarcopenia index (USI) was observed during chemotherapy. USI showed moderate correlation with CT SMI (r = -.511, p=0.001) with ultrasound classifying more patients as sarcopenic (37% vs 18%, p=0.001), plus detecting a greater magnitude of muscle loss during chemotherapy (-20.2 ±18% vs -6.5 ±7.4%, p=&amp;lt;0.001). USI correlated better with physical function (1-minute sit to stand) compared to CT SMI (r .589, p=&amp;lt;0.001 versus r .149, p=0.169). Ultrasound-defined sarcopenia at baseline was associated with a higher incidence of dose limiting chemotoxicity and severe chemotoxicity but did not post-operative complications. Further validation studies are required, but bedside muscle ultrasound could provide an effective bedside assessment of muscle health and identifies a higher proportion of patients at risk of chemotoxicity prior to major surgery.

Evaluation of Contractile Function Using Human iPS Cell-derived Cardiomyocytes

Cardiotoxicity induced by anti-cancer drugs is a significant concern for patients undergoing cancer treatment. Some anti-cancer drugs can damage cardiac muscle cells directly or indirectly, potentially leading to severe heart failure. Various risk factors, including the type and dosage of chemotherapy agents as well as patient background, contribute to the development of cardiotoxicity. Human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs), which enable patient-specific toxicity prediction, hold great promise in this regard. However, the practical implementation of hiPSC-CMs-based prediction of anti-cancer drug-induced cardiotoxicity still faces hurdles. One major challenge involves establishing and optimizing experimental systems for evaluating contractile dysfunction, the ultimate output of heart failure, using hiPSC-CMs. Such efforts are currently underway globally, focusing on tailoring functional evaluation systems to the characteristics of hiPSC-CMs. In this paper, we provide an overview of the contraction mechanisms of cardiac cells and introduce a method of measuring contraction that we have developed, and discuss the current status of contractile function evaluation methods using hiPSC-CMs.

Tumor Response Evaluation Using iRECIST: Feasibility and Reliability of Manual Versus Software-Assisted Assessments.

To compare the feasibility and reliability of manual versus software-assisted assessments of computed tomography scans according to iRECIST in patients undergoing immune-based cancer treatment. Computed tomography scans of 30 tumor patients undergoing cancer treatment were evaluated by four independent radiologists at baseline (BL) and two follow-ups (FU), resulting in a total of 360 tumor assessments (120 each at BL/FU1/FU2). After image interpretation, tumor burden and response status were either calculated manually or semi-automatically as defined by software, respectively. The reading time, calculated sum of longest diameter (SLD), and tumor response (e.g., "iStable Disease") were determined for each assessment. After complete data collection, a consensus reading among the four readers was performed to establish a reference standard for the correct response assignments. The reading times, error rates, and inter-reader agreement on SLDs were statistically compared between the manual versus software-assisted approaches. The reading time was significantly longer for the manual versus software-assisted assessments at both follow-ups (median [interquartile range] FU1: 4.00 min [2.17 min] vs. 2.50 min [1.00 min]; FU2: 3.75 min [1.88 min] vs. 2.00 min [1.50 min]; both p < 0.001). Regarding reliability, 2.5% of all the response assessments were incorrect at FU1 (3.3% manual; 0% software-assisted), which increased to 5.8% at FU2 (10% manual; 1.7% software-assisted), demonstrating higher error rates for manual readings. Quantitative SLD inter-reader agreement was inferior for the manual compared to the software-assisted assessments at both FUs (FU1: ICC = 0.91 vs. 0.93; FU2: ICC = 0.75 vs. 0.86). Software-assisted assessments may facilitate the iRECIST response evaluation of cancer patients in clinical routine by decreasing the reading time and reducing response misclassifications.

Real-world use and clinical impact of an electronic patient-reported outcome tool in patients with solid tumors treated with immuno-oncology therapy

BackgroundUtilization of electronic patient-reported outcome (ePRO) tools to monitor symptoms in patients undergoing cancer treatment has shown clinical benefits. Tennessee Oncology (TO) implemented an ePRO platform in 2019, allowing patients to report their health status online. We conducted a real-world, multicenter, observational, non-interventional cohort study to evaluate utilization of this platform in adults with solid tumors who initiated immuno-oncology (IO) therapy as monotherapy or in combination at TO clinics.MethodsPatients initiating IO therapy prior to platform implementation were included in a historical control (HC) cohort; those initiating treatment after implementation were included in the ePRO cohort, which was further divided into ePRO users (platform enrollment ≤ 45 days from IO initiation) and non-users. Data were extracted from electronic medical records; patients were followed for up to 6 months (no minimum follow up). Outcomes included patient characteristics, treatment patterns, duration of therapy (DoT), and overall survival (OS).ResultsData were collected for 538 patients in the HC and 1014 in the ePRO cohort; 319 in the ePRO cohort were ePRO users (uptake rate 31%). Baseline age was higher, more patients had stage IV disease at diagnosis, and more received monotherapy (82 vs 52%, respectively) in the HC vs the ePRO cohort. Median follow-up was 181.0 days (range 0.0–182.6) in the HC and 175.0 (0.0–184.0) in the ePRO cohort. Median DoT of index IO regimen was 5.1 months (95% confidence interval [CI], 4.4–NE) in the HC cohort vs not estimable (NE) in the ePRO cohort. Multivariable regression adjusting for baseline differences confirmed lower risk of treatment discontinuation in the ePRO vs HC cohort: hazard ratio (HR) 0.83 (95% CI, 0.71–0.97); p < 0.05. The estimated 6-month OS rate was 65.5% in the HC vs 72.4% in the ePRO cohort (p < 0 .01). Within the ePRO cohort, DoT of index IO regimen and OS did not differ between users and non-users. In ePRO users, patient platform use was durable over 6 months.ConclusionImprovements in DoT and OS were seen after ePRO platform implementation. Conclusions are limited by challenges in separating the impact of platform implementation from other changes affecting outcomes.

Survey of the association between tooth extraction and development of medication-related osteonecrosis of the jaw in patients undergoing cancer treatment with bone-modifying agents.

This study aimed to verify whether tooth extraction before the administration of bone-modifying agents (BMA) was effective in preventing the onset of medication-related osteonecrosis of the jaw (MRONJ). This retrospective study included patients with a history of receiving BMA for cancer treatment. The patients were classified into three groups based on the timing of tooth extraction: no tooth extraction before the onset of MRONJ, tooth extraction before the administration of BMA, and tooth extraction after the administration of BMA. The incidence of MRONJ was compared between the groups. Fisher's exact test and Bonferroni correction were used to test for differences in proportions between the three groups. The total number of subjects was 123. Twenty-four patients (19.5%) developed MRONJ. The incidence rates were 12.3% (10/81), 17.9% (5/28), and 64.3% (9/14) in the non-extraction group, the extraction before BMA administration group, and the extraction after BMA administration group, respectively, showing statistically significant differences between the extraction after BMA administration group and the non-extraction groups and between the extraction after BMA administration group and the extraction before BMA administration group (p < 0.001, p = 0.0049). On the other hand, there was no statistically significant difference in incidence between the non-extraction and the extraction before BMA administration group (p = 0.5274). Tooth extraction before the administration of BMA is effective in preventing the onset of MRONJ in patients receiving BMA for cancer treatment. Prevention of MRONJ development in patients receiving BMA for cancer treatment contributes to the maintenance of patients' quality of life.

Evidence of validity of the Brazilian version of the Cancer Behavior Inventory - Brief Version.

To analyze the validity evidence of the Brazilian version of the Cancer Behavior Inventory - Brief Version. Methodological study, conducted between November and December 2021, with 140 patients undergoing hospital cancer treatment in João Pessoa, Paraíba, Brazil. Psychometric analyses were performed in the adapted version, using exploratory factor analysis and correlation with correlated constructs. A two-factor and 10-item model was evidenced. The cumulative variance explained about 61% the shared variance of the items. Satisfactory values were observed for the factors in the analyses of composite reliability (0.89 and 0.91, respectively), internal consistency (0.86 and 0.91, respectively) and ORION (0.89 and 0.85, respectively). The expected correlations of self-efficacy with quality of life (convergent) and with anxiety and depression (divergent) were evident. The Brazilian version of the instrument showed evidence of validity, being considered reliable to assess the self-efficacy of patients undergoing cancer treatment.

Risk of Sudden Cardiac Death in Patients Undergoing Cancer Treatment

The risk of sudden cardiac death (SCD) in patients with cancer receiving cancer therapies is not well defined. In this study we aimed to (1) evaluate the risk of SCD during the first 6months of cancer treatment and (2) identify risk factors (RFs) for SCD in patients who underwent active cancer treatment. The study population comprised 8,356 patients who received any cancer treatment at the University of Rochester Medical Center from 2011 to 2020. The primary end point was the occurrence of SCD within 6months of cancer treatment. SCD was defined by using the modified Hinkle-Thaler classification. The mean age at the time of cancer treatment was 64 ± 14years and 49% were women. All-cause mortality occurred in 834 patients (10%), of whom 51 (6%) were identified as SCD. The cumulative probability of SCD at 6months was 0.6%. Age <74 years (0.042) and history of congestive heart failure (0.058) and lung cancer (0.004) were identified as independent RFs for SCD in the multivariate Cox regression models. The cumulative probability of SCD at 6months from cancer treatment initiation was significantly higher in patients with ≥2 RFs (1.6%) than in patients with 0 or 1 RF (0.5%) (log-rank p <0.001). In conclusion, our findings suggest that active cancer treatment is associated with SCD risk that is more pronounced in younger patients, patients with cancer with a history of heart failure, and those who underwent treatment for lung cancer. Future studies should address appropriate modalities for prevention and protection in this high-risk population.

Establishing Innovative Complex Services: Learning from the Active Together Cancer Prehabilitation and Rehabilitation Service

Prehabilitation and rehabilitation will be essential services in an ageing population to support patients with cancer to live well through their life spans. Active Together is a novel evidence-based service embedded within existing healthcare pathways in an innovative collaboration between health, academic, and charity organisations. Designed to improve outcomes for cancer patients and reduce the demand on healthcare resources, it offers physical, nutritional, and psychological prehabilitation and rehabilitation support to patients undergoing cancer treatment. The service is underpinned by behaviour change theories and an individualised and personalised approach to care, addressing the health inequalities that might come about through age, poverty, ethnicity, or culture. Meeting the challenge of delivering high-quality services across multiple stakeholders, while addressing the complexity of patient need, has required skilled leadership, flexibility, and innovation. To support patients equally, regardless of geography or demographics, future services will need to be scaled regionally and be available in locations amenable to the populations they serve. To deliver these services across wide geographic regions, involving multiple providers and complex patient pathways, will require a systems approach. This means embracing and addressing the complexity of the contexts within which these services are delivered, to ensure efficient, high-quality provision of care, while supporting staff well-being and meeting the needs of patients.

Impaired microvascular reactivity in patients treated with 5-fluorouracil chemotherapy regimens: Potential role of endothelial dysfunction

Background5-fluorouracil (5-FU) is the second most common cancer chemotherapy associated with short- and long-term cardiotoxicity. Although the mechanisms mediating these toxicities are not well understood, patients often present with symptoms suggestive of microvascular dysfunction. We tested the hypotheses that patients undergoing cancer treatment with 5-FU based chemotherapy regimens would present with impaired microvascular reactivity and that these findings would be substantiated by decrements in endothelial nitric oxide synthase (eNOS) gene expression in 5-FU treated human coronary artery endothelial cells (HCAEC). MethodsWe first performed a cross-sectional analysis of 30 patients undergoing 5-FU based chemotherapy treatment for cancer (5-FU) and 32 controls (CON) matched for age, sex, body mass index, and prior health history (excluding cancer). Cutaneous microvascular reactivity was evaluated by laser Doppler flowmetry in response to endothelium-dependent (local skin heating; acetylcholine iontophoresis, ACh) and -independent (sodium nitroprusside iontophoresis, SNP) stimuli. In vitro experiments in HCAEC were completed to assess the effects of 5-FU on eNOS gene expression. Results5-FU presented with diminished microvascular reactivity following eNOS-dependent local heating compared to CON (P = 0.001). Iontophoresis of the eNOS inhibitor L-NAME failed to alter the heating response in 5-FU (P = 0.95), despite significant reductions in CON (P = 0.03). These findings were corroborated by lower eNOS gene expression in 5-FU treated HCAEC (P < 0.01) compared to control. Peak vasodilation to ACh (P = 0.58) nor SNP (P = 0.39) were different between groups. ConclusionsThe present findings suggest diminished microvascular function along the eNOS-NO vasodilatory pathway in patients with cancer undergoing treatment with 5-FU-based chemotherapy regimens and thus, may provide insight into the underlying mechanisms of 5-FU cardiotoxicity.

Fast timing detectors with applications in cosmic ray physics and medical science

We discuss the use of Low Gain Avalanche (LGAD) silicon detectors for two specific applications, namely measuring cosmic rays in space in collaboration with NASA] and beam properties and received doses for patients undergoing cancer treatment in flash beam therapy.

Prospective validation of machine learning-based approaches to predict potentially preventable emergency visits and hospitalizations.

404 Background: Patients undergoing cancer treatment are at risk for unplanned acute care. Early identification of at-risk patients could enable preventative interventions, reducing costs and treatment delays. To address this, the Centers for Medicare &amp; Medicaid Services developed the Chemotherapy Measure (OP-35) to monitor potentially preventable acute care utilization during outpatient treatment. We previously developed machine-learning (ML) models using three approaches: least absolute shrinkage selection operator (LASSO), random forest (RF), and gradient boosted trees (GBT). The models predict risk of an OP-35 qualifying acute care event in the 30-days following a systemic therapy infusion and had good performance in the internal validation cohort, with GBT demonstrating the best predictive ability (receiver operating characteristic area under the curve (ROC-AUC) = 0.805). The aim of this study was to prospectively validate these models in patients undergoing systemic therapy at a single institution. Methods: All three models are being prospectively validated on systemic therapy infusions, including chemo, immuno, biologic, hormone, research and targeted therapies. Assuming a 2% event rate based on our prior data, with an alpha = 0.05 and 84% power, to detect an ROC-AUC of 0.75, validation will run for a total of 8000 infusions, from May 1 to August 21, 2023. We present early findings from May 1 to May 14, 2023 for this prospective validation. Model performance was assessed for calibration based on brier score and predictive ability based on ROC-AUC. Sensitivity and specificity were calculated for the model with the highest ROC-AUC based on a previously determined Youden’s J statistic. Results: This study included 1096 systemic therapy treatments across 957 patients. 21 (1.9%) infusions resulted in an OP-35 qualifying acute care event (3 emergency department visits and 18 hospitalizations). Most events were due to pain, anemia, sepsis, and/or dehydration. All models had good performance, with GBT demonstrating the greatest predictive ability (ROC-AUC = 0.78 [0.67 - 0.88], compared to LASSO (0.76 [0.65-0.85]) and RF (0.70 [0.56-0.81]). GBT also had good calibration (brier score = 0.017 [0.011 - 0.025]) followed closely by LASSO (0.018 [0.011-0.026]) and RF (0.019 [0.012-0.026]). Youden-based cut-off of 0.0249 corresponded to a validation sensitivity of 77.6% and specificity of 61.9%. Conclusions: Early prospective validation of ML models demonstrates accurate predictions of OP-35 qualifying acute care events on a per-infusion basis. The use of computational tools to identify patients at risk for unplanned acute care would enable preventative interventions, reducing costs and treatment disruptions. Prospective validation is ongoing and more comprehensive results will be presented at the meeting.

ALCANCE Food for Health Equity: Community-driven development of a food insecurity intervention for patients with cancer.

208 Background: Food insecurity is prevalent among patients undergoing cancer treatment and has been associated with decreased adherence to cancer therapies, malnutrition risk, and poor quality of life. While food insecurity disproportionately impacts low-income, immigrant and non-English speaking populations, few studies have assessed the needs and preferences for these populations as it relates to interventions that can address this growing problem. In previous work, we identified that 50% of populations in our partner clinic screened positive for food insecurity. This study aimed to assess the needs and preferences of low-income, culturally diverse patients with cancer who screened positive for food insecurity and to co-develop an intervention to address these needs. Methods: Participants were recruited among low-income and immigrant adults ≥18 years of age who screened positive for food insecurity using the 2-item Hunger Vital Sign as part of an ongoing parent randomized controlled trial evaluating a precision medicine intervention. 1:1 semi-structured interviews were conducted in English or Spanish to assess dietary habits, barriers to obtaining healthy food, and preferences regarding intervention assistance options, including on-site food pantry, home delivery of food boxes, food vouchers, and cash transfers. Interviews responses were transcribed and thematically analyzed. Results: Of the 110 patients screened for food insecurity as part of the parent trial, 40 (36.4%) screened positive for food insecurity. Among these patients, 31 identified as Hispanic or Latinx (77.5%), and 26 (65%) indicated Spanish as their primary language. Nineteen (47.5%) reported a household income of &lt;$34,000, 24 (60%) were on Medicaid, and 14 (35%) identified as disabled. A total of 10 participants were randomly selected and consented to participate in interviews. Three main themes emerged from interviews: 1) cancer diagnoses necessitated changes to food behaviors including emphasis on nutrient dense and symptomatically tolerated foods; 2) contributors to food insecurity included higher costs of healthy food options, lack of employment during treatment, limited support, and coexisting expenses including financial toxicity from cancer treatment; 3) priorities for assistance included limiting sense of reliance on charity, autonomy in choosing desired food items that are culturally preferent, and timing assistance with other expenses to maximally relieve financial strain. Conclusions: Food insecurity is a critical issue among patients with cancer with disproportionate impact on low-income and immigrant populations. Various opportunities for intervention are well-received by patients and have the potential to reduce the burden of food insecurity among these populations.

Management of Cancer Therapy-Induced Oral Mucositis Using Photobiomodulation Therapy: An Overview of Systematic Reviews.

Objective: To systematically summarize the evidence for photobiomodulation therapy (PBMT) in the prevention and treatment of oral mucositis (OM) in patients undergoing cancer treatment. An electronic search was conducted in 8 databases and grey literature. Background: PBMT is recommended for the management of OM resulting from cancer treatment, with several systematic reviews (SRs) being published in recent years on this topic. Methods: Only SRs with outcomes from clinical trials were included, with no language or year restriction. The AMSTAR 2 tool was used to assess the methodological quality of the SRs. Results: Five thousand eight hundred fifty-six references were found, and 16 were selected for this review. OM prevention and treatment were favorable for PBMT in most studies, with a significant reduction in OM severity. Most studies obtained moderate confidence. Conclusions: PBMT represents an effective strategy in the management of OM, and this evidence is supported by studies with acceptable methodological quality.