Receiving Cancer Treatment Research Articles

Association of immune checkpoint inhibitors (ICI) and venous thromboembolism (VTE) in non–small-cell lung cancer (NSCLC): A single healthcare system experience.

e14680 Background: NSCLC and chemotherapy are well-known predisposing factors for VTE. There are conflicting data regarding the association between ICI and VTE in patients with NSCLC. In a retrospective study by Khorana et al. in 2299 NSCLC patients, VTE incidence was numerically lower for patients receiving ICI than chemotherapy. In another study by Attia et al., in 514 patients with lung cancer, there was an increased incidence of VTE with ICI. We conducted a retrospective chart review to further assess the relationship between VTE and ICI in patients with NSCLC who were treated at our facility. Methods: All adult patients >18 years of age with NSCLC who received cancer treatment in our academic health system between January 2011- January 2021 were extracted from the tumor registry. Information was obtained about the type of cancer treatment, deep venous thrombosis (DVT) or pulmonary embolism (PE) occurrence, and associated comorbidities. Patients were divided into two groups – chemotherapy and combined ICI-chemotherapy. Fisher exact tests were used to compare categorical covariates by VTE status, while Wilcoxon rank-sum tests were used for continuous covariates. Multivariable logistic regression was performed to adjust for potential confounding. Results: 370 patients with NSCLC were included in the study. No statistically significant difference was found between VTE incidence and race, histology, or gender. There was a decreased VTE rate among non-advanced cancer (6.2% vs. 18.1%, p=.015) and squamous cell histology (7.5% vs. 28.1%, p=.009). Although the rate of VTE increases slightly in ICI/chemotherapy (17.4%, CI: 11.2%-25.8%) when compared to chemotherapy (15.3% %, CI: 11.2%-20.4%), this was not statistically significant (p=.645). After adjusting for sex, histology, and race, ICI/chemotherapy group had a statistically insignificant increase in odds of VTE events (adjusted OR = 1.24 95% CI = 0.67-2.3, p=.498) compared to the chemotherapy group. The odds of death were significantly lower in patients with ICI/chemotherapy (aOR=.33, 95% CI = .2-.54, p=.001). The median time between ICI use and VTE was 21 days (CI: 12.5-65), while the median time between chemotherapy and VTE was 65.5 days (CI=36.5-146.5). Conclusions: In patients with NSCLC who were treated at our facility, there was no significant VTE difference in patients related to race or gender identity. Likewise, there was no statistical difference in the incidence of VTE in the ICI/chemotherapy and chemotherapy groups. Multivariable logistic regression of various groups to the vital status of the patients shows a statistically significant decrease in death in ICI/chemotherapy group, which is a potential censoring event for VTE. Further studies, including meta-analyses, are required to evaluate the association further, given conflicting results on prior retrospective studies.

Cancer-Related Fatigue Is Associated With Objective Measures of Physical Function in Survivors of Cancer

Purpose: Cancer-related fatigue (CRF) is a common and limiting symptom reported by survivors of cancer and may have a negative impact on functional activities. The purpose of this study was to investigate the relationships between CRF and objective measures of physical function in survivors. Methods: A retrospective analysis was performed on 428 survivors initiating a clinical exercise oncology program. A physical assessment was performed prior to program start and included a six-minute walk test (6MWT), handgrip strength assessment, and a 10 m walk test to measure both usual and fast gait speed. CRF was measured with the Functional Assessment of Chronic Illness Therapy Fatigue scale (FACIT-Fatigue), a commonly used 13-item questionnaire, with scores ranging from 0–52. Lower scores indicate greater CRF. Participant demographics, cancer diagnosis, and treatment information were self-reported at program start. Four multiple linear regression analyses were performed, with 6MWT, handgrip strength, usual gait speed, and fast gait speed as the dependent variables. In each model, FACIT-Fatigue was entered as a predictor and covariates were age, gender, cancer diagnosis, and cancer treatment (currently receiving chemotherapy or radiation or not). Results: Participants were on average 55.2 (SD = 14.1) years old, majority women (64%) and breast cancer survivors (30.5%). Approximately half were currently receiving cancer treatment (48%). The means (SD) of measures of physical function were: 6MWT = 582 (120) m; grip strength = 32.7 (10.5) kg; usual gait speed = 1.36 (0.25) m/s; and fast gait speed = 1.9 (0.38) m/s. The mean (SD) FACIT-Fatigue score was 33.7 (10.8). All regression models were significant (P < 0.01). FACIT-Fatigue was significantly associated with 6MWT (Î2 = 3.39, P < 0.01), handgrip strength (Î2 = 0.13, P < 0.01), usual gait speed (Î2 = 0.005, P < 0.01), and fast gait speed (Î2 = 0.009, P < 0.01). Conclusions: Findings demonstrated that higher CRF was significantly associated with reduced performance on objective measures of physical function, providing insight on how CRF may contribute to limitations of functional day-to-day activities. Future studies should investigate whether reductions in CRF mediate the improvements in physical function seen after participation in exercise programs.

Quality of care in the oncological outpatient setting: Individual interviews with people receiving cancer treatment.

To describe how patients receiving cancer treatment perceive quality of care in the oncological outpatient settings. A strategic sample of 20 adult patients with cancer treated in four oncological outpatient settings in four hospitals in Sweden participated in the study. Participants were interviewed using a semi-structured interview guide with open-ended questions. The interviews were audio-recorded, and the transcripts were analysed using a phenomenographic approach. Three descriptive categories emerged from the data: The patient's care is designed to meet individual needs, The patient's dignity is respected, and The patient feels safe and secure with the care. Overall, quality of care in the oncological outpatient setting is perceived as something positive and described in normative terms by the participants. The results emphasises that in order to achieve quality of care it is important to the patients that they are able to meet with the same well-educated, professional, caring and sensible health care professionals every time.

Patterns, perceptions, and experience with cannabidiol (CBD) after cancer diagnosis.

e18829 Background: CBD is derived from cannabis and has minimal psychoactive effect. We sought to evaluate factors associated with CBD use among patients who received cancer treatment and elucidate the reasons for use, and perceived benefits of CBD. Methods: An anonymous online or phone survey was administered to patients treated for cancer between 3/2021-8/2021 at a comprehensive cancer center; only patients residing in states where cannabis is legal were contacted. Surveys were completed 8/2021-4/2022. Patient-reported use of cannabis and CBD products was assessed, as well as beliefs and perceptions regarding CBD. Unadjusted and weighted multivariable logistic regression (MVA) was used to assess factors associated with CBD use after diagnosis. Results: Among 1258 patients (35% response rate), 41% knew either “a lot” or “some” about CBD, 44% knew “a little”, 15% knew nothing or were unsure. Of those who had heard about CBD, 69% felt there were no risks of taking CBD. 370 patients (29%) both knew of CBD and endorsed cannabis use after diagnosis; 61% of that group, 226 (18% of all surveyed) specifically reported CBD use. Those who reported CBD use were 54% women, 83% white, and 88% non-Hispanic, with a median age of 63 (IQR 52-71). 75% of CBD users had used any cannabis product at least once prior to diagnosis and 40% of CBD users had used cannabis in the year prior to diagnosis. Among the 150 patients who used CBD during treatment, 54% used it several times a week or more; 49% used CBD after treatment completion. Among CBD users, common reasons for CBD use were pain (56%, n = 125), sleep (48%, n = 107), mood (36%, n = 80), or neuropathy (18%, n = 40). Symptom benefit from CBD (improved “somewhat” or “quite a bit”) was reported for pain (71%), sleep (71%), mood (74%), and neuropathy (60%). Only 1% reported worsening of non-target symptoms or side effects with CBD; 3% felt it worsened neuropathy. Overall, 47% either stopped using CBD or used it less than they would prefer due to no benefit (30%), high cost (25%), or lack of insurance coverage (21%). On weighted MVA, patients who were ≤45 (OR 1.16, 95%CI 1.06-1.26, p < 0.01) or 46-64 (OR 1.10, 95%CI 1.04-1.27, p < 0.01) were more likely to use CBD after diagnosis than those ≥65. Prior cannabis use, compared to no prior cannabis use, was associated with CBD use after diagnosis (OR 1.13, 95%CI 1.08-1.19, p < 0.01). Compared to patients with lung cancer, patients with gastrointestinal cancer were more likely to use CBD after diagnosis (OR 1.11, 95%CI 1.00-1.22, p = 0.04). Conclusions: Fewer than half of surveyed patients treated for cancer had good knowledge of CBD, however most felt it was safe to use without any risks. Almost one in five surveyed had used CBD after diagnosis for a variety of symptoms. Patient-reported benefits were high and negative side effects were rare except for cost. Additional research is needed to help guide patient use of CBD given weak evidence of benefits.

Associations among anesthesia-induced brain biomarkers during surgery, preoperative exposure to cancer therapeutics, and clinical outcomes.

12095 Background: Cognitive impairment represents a key concern in oncology, as issues with memory and concentration can be a debilitating side effect of cancer and its treatment. Prior work demonstrates that the power of the alpha wave, a pattern of electroencephalographic (EEG) signals in the brain in patients under general anesthesia, correlates with cognitive function. In this study, we sought to investigate the associations among anesthesia-induced alpha power, preoperative exposure to cancer therapeutics, and clinical outcomes in a large cohort of patients undergoing surgery. Methods: We analyzed intra-operative EEG recordings of a retrospective cohort of patients with and without cancer who underwent surgery with general anesthesia at a single institution between 4/2016 - 12/2019. We used multivariable regression models (adjusted for age, sex, history of dementia) to determine associations of cancer-related covariates with patients’ alpha power (measured in decibels [dB]), and to determine associations of alpha power with clinical outcomes, such as hospital length of stay, discharge location, hospital readmission, and survival. Results: Among 1,084 total patients included in this study, 377 (35%) had a preoperative diagnosis of cancer. The most common cancer diagnoses were breast (87, 23% of those with cancer), gastrointestinal (85, 23%), genitourinary (73, 19%), and lung (47, 12%). We found that a cancer diagnosis alone was not associated with alpha power (-0.015 dB, p = 0.95). However, among patients with cancer, receiving chemotherapy within 3 months before surgery was associated with a 1.6dB drop in alpha power (p < 0.001). By comparison, having a preoperative diagnosis of dementia was associated with a drop of 2.86dB (p < 0.001). Decreased alpha power was associated with longer hospital stays (1.03 times longer per dB drop, p < 0.001), higher rates of discharge to a rehab facility (odds ratio [OR] = 1.22 per dB drop, p < 0.001), and higher mortality (hazard ratio = 1.085 per dB drop, p < 0.001). We found no association between alpha power and 30-day readmission (OR = 1.04, p = 0.24). Conclusions: In this large cohort of patients undergoing surgery, we found that alpha power correlated with several important clinical outcomes, and that recent receipt of chemotherapy was associated with a decrease in alpha power. Of note, the observed drop of 1.6 dB among those with recent chemotherapy is roughly equivalent to aging 10-15 years, while a diagnosis of dementia was associated with a nearly 3dB drop in alpha power. As evidence suggests that alpha power corresponds with patients’ cognitive function, our findings highlight the need to prospectively monitor and track longitudinal alpha power in patients receiving cancer treatment to determine if early detection of changes in alpha power may predict for future treatment-related cognitive decline.

Association of nutrition with psychological health and quality of life among older adults with advanced cancer.

12043 Background: Impaired nutrition is associated with greater treatment toxicity and reduced overall survival in patients with advanced cancer. We aimed to evaluate the association of impaired nutrition with psychological health and quality of life among older adults with advanced cancer who were starting cancer treatment with palliative intent. Methods: This secondary analysis was performed on baseline data from a nationwide cluster randomized clinical trial (ClinicalTrials.gov identifier: NCT02107443; PI: Mohile; funding NCI UG1CA189961). Adults age ≥70 with advanced cancer and≥1 geriatric assessment impairment were enrolled from 2014 to 2017. Patients with BMI < 21 kg/m2, > 10% involuntary weight loss in the past 6 months, or Mini Nutritional Assessment Short Form (MNA-SF) score of ≤11 were considered to have impaired nutrition. We used separate multivariable linear regressions to evaluate the association of impaired nutrition with each measure of psychological health and quality of life, which included Geriatric Depression Scale (GDS-15, range 0-15), Generalized Anxiety Disorder-7 (GAD-7, range 0-21), NCCN Distress Thermometer (NCCN DT, range 0-10) and Functional Assessment of Cancer Therapy-General (FACT-G, range 0-108). Analyses were adjusted for baseline patient demographics, clinical characteristics, and geriatric assessment. Results: Among 541 patients, mean age was 77 (range 70-96) and 60% had impaired nutrition. Among the 326 patients with impaired nutrition, 95% had MNA-SF ≤11, 23% had > 10% weight loss in the last six months, and 20% had BMI < 21 kg/m2. Mean baseline GDS-15 was 3.1 (standard deviation [SD] 2.7), GAD-7 was 2.9 (SD 4.0), NCCN DT was 2.9 (SD 2.7), and FACT-G was 80 (SD 14). In the adjusted model, compared to those with normal nutrition, older adults with impaired nutrition had greater depression (mean 0.65 points higher on the GDS-15, p < 0.01) and lower quality of life (mean 6.0 points lower on the FACT-G, p < 0.01). There was insufficient evidence of an association between nutrition and anxiety (β = 0.67, p = 0.06) or distress (β = 0.26, p = 0.28). Conclusions: Recognition of malnutrition by oncology providers is crucial for older adults with advanced cancer. Impaired nutrition is associated with greater depression and lower quality of life among older adults with advanced cancer. Tailored resources to improve psychological health and quality of life are needed to support older adults with impaired nutrition receiving cancer treatment.

Developing machine learning algorithms incorporating patient reported outcome measures to predict acute care events among patients with cancer.

1516 Background: Clinical trials have shown that collecting patient-reported outcome measures (PROMs) can improve outcomes among oncology patients. However, there remains uncertainty about how to best collect and use PROMs in routine clinical care. Since 2016 we have collected PROMs for patients receiving cancer treatment within a large health system containing academic and community sites. We sought to examine whether combining PROMs with electronic health record (EHR) data improves the performance of machine learning algorithms predicting patients’ risk of 30-day acute care events. Methods: The sample included patients with solid tumors receiving curative- or palliative-intent systemic therapy between 9/1/20 and 7/31/22 who completed at least one PROMs survey. PROMs were collected via a 12-item questionnaire based on the Common Terminology Criteria for Adverse Events measurement system. Patients completed questionnaires via the EHR’s patient portal or on tablets in waiting rooms. EHR data included 176 variables describing demographics, laboratory values, vital signs, diagnoses, medications, and prior healthcare encounters. A binomial outcome was calculated for each patient encounter to indicate whether the patient had an acute care event (ED visit or hospitalization) in the subsequent 30 days. Data were randomly assigned to training (70%) and test (30%) sets and were used to train and test four models: EHR + PROMs, EHR alone, PROMs alone, and ‘PROMs plus,’ which included PROMs and minimal EHR data such as age, sex, and site of cancer treatment, which served as an accessible proxy for cancer type. For each model, we compared multiple architectures and selected the best-performing model for comparison. Results: Between September 2020 and June 2022, 4,193 patients completed 20,359 PROM surveys during outpatient encounters. There were 2,118 30-day acute care events within the cohort. The area under the receiver operating curves (AUCs) were 0.84 (95% CI 0.81 to 0.86) for the EHR + PROMs model, 0.82 (95% CI 0.80 to 0.84) for the EHR alone model, 0.67 (95% CI 0.65 to 0.69) for the PROMs alone model, and 0.79 (95% CI 0.77 to 0.82) for the PROMs plus model. In the EHR alone and EHR + PROMs models, the most important variables were last albumin, white blood cell count and hemoglobin. In the PROMs plus model, the most important variables were age, treatment site, patient-reported pain, and patient-reported fatigue. Conclusions: Incorporating PROMs into machine learning models to predict risk of acute care events can improve model performance. Notably, the model combining PROMs with a small number of easily accessible EHR variables performed nearly as well as models including all EHR data. These models demonstrate the predictive value of PROMs in oncology patients and they lay the foundation for future interventions aiming to reduce acute care events among high-risk patients.

Abstract 85: The Social and Economic Impact of a Cervical Cancer Diagnosis on Women and Children in Uganda

Abstract Purpose: Cervical cancer is the second most common cancer for women living in low- and middle-income countries (LMIC). In Uganda 40% of all female cancer cases are cervical cancer. There is a need for more research on the social and economic impacts of cervical cancer in LMICs in order to provide evidence for expanded cervical cancer screening programs. The goal of this study is the understand the economic impact of cervical cancer on women and children in Uganda. Methods: Data collection for this study began in September and will continue until December 2022. Participants were recruited by nurses at two clinics at the Uganda Cancer Institute in Kampala and Jinja. Participants were eligible if they are being treated for cervical cancer and speak either English, Lusoga, Luo, Runyankore, or Luganda. Each participant completed a 45-minute orally administered survey on REDCap. Descriptive statistics using counts and frequencies were used to describe primary outcomes which include changes in a child’s education and a family’s economic status. Ethical approval was obtained from the University of British Columbia, Uganda Cancer Institute, and Uganda National Council for Science & Technology. Results: To date 67 participants have completed the survey and 57 indicated that they had children living in their household. The mean age of participants is 49 years. The majority of participants are married, have a primary school education or less, and were diagnosed with stage II or stage III cancer. Women reported traveling up to 14 hours to receive cancer treatment and 28% (n=19) brought their child with them to the clinic because they could not find childcare. In all, 93% (n=62) of women indicated that they have paid out of pocket for some type of medical care with 15% (n=9) of women noting that they stopped at least one treatment because of the cost. Approximately 15% of women reported that they cut down on food consumed and withdrew their child from school to help pay for cancer care. Conclusion: We found that a cervical cancer diagnosis has not only on women, but their children as well, confirming that while largely preventable, cervical cancer has far-reaching impact beyond the woman diagnosed. The results of this study can be used to provide further evidence of the urgent need expand cervical cancer screening programs not only in Uganda, but similar countries as well. This in turn will help contribute to the eventual global elimination of cervical cancer. Citation Format: Hallie Dau, Shamim Nakyazze, Priscilla Naguti, Avery McNair, Beth Payne, Marianne Vidler, Joel Singer, Laurie Smith, Jackson Orem, Carolyn Nakisige, Gina Ogilvie. The Social and Economic Impact of a Cervical Cancer Diagnosis on Women and Children in Uganda [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 85.

Beyond Medical Care: How Different National Models of Care Impact the Experience of Adolescent and Young Adult Cancer Patients.

Patient experience is positively associated with clinical effectiveness, quality care, and patient safety. This study examines the experience of care of adolescents and young adult (AYA) cancer patients from Australia and the United States, allowing a comparison of patient experiences in the context of different national models of cancer care delivery. Participants (n = 190) were aged 15-29 years and received cancer treatment from 2014 to 2019. Australians (n = 118) were recruited nationally by health care professionals. U.S. participants (n = 72) were recruited nationally via social media. The survey included demographic and disease variables, and questions regarding medical treatment, information and support provision, care coordination, and satisfaction across the treatment pathway. Sensitivity analyses examined the possible contribution of age and gender. Most patients from both countries were satisfied or very satisfied with their medical treatment (chemotherapy, radiotherapy, and surgery). There were significant differences between countries in the provision of fertility preservation services, age-appropriate communication, and psychosocial support. Our findings suggest when a national system of oversight with both state and federal funding is implemented, as is the case in Australia but not in the United States, significantly more AYAs with cancer receive age-appropriate information and support services, and improved access to specialist services such as fertility care. A national approach with government funding and centralized accountability appears to be associated with substantial benefits for the well-being of AYAs undergoing cancer treatment.

Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.

To examine geospatial patterns of cancer care utilization across diverse populations in New Jersey-a state where most residents live in urban areas. We used data from the New Jersey State Cancer Registry from 2012 to 2014. We examined the location of cancer treatment among patients 20-65 years of age diagnosed with breast, colorectal, or invasive cervical cancer and investigated differences in geospatial patterns of care by individual and area-level (e.g., census tract-level) characteristics. Multivariate generalized estimating equation models were used to determine factors associated with receiving cancer treatment within residential counties, residential hospital service areas, and in-state (versus out-of-state) care. We observed significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area-level factors. Even after adjusting for tumor characteristics, insurance type, and other demographic factors, non-Hispanic Black patients had a 5.6% higher likelihood of receiving care within their own residential county compared to non-Hispanic White patients (95% CI: 2.80-8.41). Patients insured with Medicaid and those without insurance had higher likelihoods of receiving care within their residential county compared to privately insured individuals. Patients living in census tracts with the highest quintile of social vulnerability were 4.6% more likely to receive treatment within their residential county (95% CI: 0.00-9.30) and were 2.7% less likely to seek out-of-state care (95% CI: -4.85 to -0.61). Urban populations are not homogenous in their geospatial patterns of cancer care utilization, and individuals living in areas with greater social vulnerability may have limited opportunities to access care outside of their immediate residential county. Geographically tailored efforts, along with socioculturally tailored efforts, are needed to help improve equity in cancer care access.

Experiences of patients on cancer treatment regarding decentralization of oncology services at a tertiary hospital in the Eastern Cape

BackgroundThe cancer burden is a global public health concern associated with high morbidities and mortalities. Low and middle-income countries are more affected including South Africa. Limited access to oncology services contributes to the late presentation, late diagnosis, and treatment of cancer. In the Eastern Cape, oncology services were previously centralized with negative effects on the quality of life of the already compromised health status of the oncology patients. To mitigate the situation, a new oncology unit was opened to decentralize oncology services in the province. Little is known about the experiences of patients after this transformation. That prompted this inquiry.AimThis study aims to explore the experiences of cancer patients regarding the decentralization of oncology services at a tertiary hospital in the Eastern Cape.MethodologyA qualitative approach with a descriptive, explorative, and contextual design was undertaken, to obtain the perspective of oncology recipients following the decentralization of oncology services at a selected public tertiary hospital in the Eastern Cape. After obtaining ethical clearance and permission to conduct the study, interviews were conducted with 19 participants. All interviews were transcribed verbatim against their audio recordings. Field notes were taken by the primary researcher. The concept of trustworthiness was used to ensure rigour throughout this study. Thematic analysis was done using Tesch’s approach to open coding in qualitative research.ResultsThree themes emerged from the data analysis: 1) Access to oncology services; 2) Oncology services provided; and 3) Need for improved infrastructural facilities.ConclusionThe majority of patients had positive experiences with the unit. The waiting time was acceptable, and medication was available. Access to services was improved. The staff had a positive attitude towards patients receiving cancer treatment.

Scale Validation of the Mandarin-Language Supportive Care Needs Survey–Adolescent Form

To (1) modify the Mandarin-language 34-item Supportive Care Needs Survey-Adult Form into the Adolescent Form and (2) examine the psychometric properties of the Adolescent Form. A multiphase, iterative scale validation process was used in this methodological study. Participants who were 13 to 18 years old and receiving cancer treatment in inpatient or outpatient settings, or receiving follow-up care in outpatient settings, were recruited using a convenience sampling method. Confirmatory factor analysis demonstrated good fitness of indices, and all factor loadings for the 18-item Adolescent Form were >0.50, which supported the scale's construct validity. The Adolescent Form score was significantly correlated with the symptom distress score (r = 0.56, P < .01) and quality of life score (r = -0.65, P < .01), which indicated the scale's convergent validity. The correlated item-total correlations (0.30-0.78), Cronbach's alpha (.93), and test-retest reliability coefficient (0.79) confirmed the scale's stability. This study successfully modified the 34-item Adult Form into the 18-item Adolescent Form. Given its adequate psychometric properties, this concise scale has great promise as a useful, feasible, and age-appropriate tool for evaluating care needs among adolescents with cancer who speak Mandarin. This scale can screen for unmet care needs in busy pediatric oncology settings or large-scale clinical trials. It allows for cross-sectional comparison of unmet care needs between adolescent and adult populations and for longitudinal follow-up into how unmet care needs change from adolescence into adulthood.

Quality of Life of Caregivers of Women Receiving Cancer Treatment in Turkey.

The study aims to explore the predictors of the quality of life of caregivers of women receiving cancer treatment in Turkey. This study was conducted in a Medical-Oncology inpatient clinic of a University Hospital in Istanbul, Turkey, between February and June 2020. Descriptive data were collected from 128 family caregivers using caregiver and patient identification forms and the quality of life scale- family version. Bivariate analyses and multiple regression were used to analyze the data. The mean score of the quality of life was 4.41 (standard deviation=0.63). A backward multiple regression revealed that being female caregivers, increased time spent for care per day, and caring for women with metastatic cancer were factors associated with poor quality of life. Although caregiving responsibilities bring challenges to every caregiver, those who are at high risk for impaired quality of life during caregiving need further support in their caregiving to maintain quality of life. Further research should focus on finding solutions to better support caregivers who are experiencing impairment in their quality of life.

Patterns of health-promoting behaviors and associated factors in family caregivers of people receiving cancer treatment: A latent class profile analysis.

Family caregivers tend to neglect their health while prioritizing the needs of their care recipients. Identifying subgroups of caregivers based on the patterns of health-promoting behaviors (HPBs) may help develop tailored interventions for them, yet little is known. The purpose of this study was: (1) to identify latent classes with distinct patterns of HPBs in family caregivers of people with cancer; and (2) to investigate factors associated with the latent class membership. We performed a cross-sectional data analysis using the baseline dataset from a longitudinal survey study that assessed HPBs of family caregivers of individuals who received cancer treatment at a national research hospital (N=124). Latent class profile analysis was conducted to identify latent classes based on the subdomains of the Health-Promoting Lifestyle Profile II, followed by multinomial logistic regression analysis to investigate factors associated with the latent class membership. Three latent classes were identified: a high level of HPB (Class 1, 25.8%); a moderate level of HPB (Class 2, 53.2%); and a low level of HPB (Class 3, 21.0%) of HPBs. Controlling for caregiver age and sex, caregiver burden due to lack of family support, perceived stress, self-efficacy and body mass index were factors associated with the latent class membership. HPBs of our caregiver sample appeared in relatively stable patterns at different levels. Higher caregiver burden and perceived stress and lower self-efficacy were associated with the lower practice of HPBs overall. Our findings may serve as a reference for screening caregivers who need support and developing person-centered interventions.

Can Nurses' Training and Documentation Audit Improve the Oral Care Practice among Patients Receiving Cancer Treatment? Results from the Pretest-Post-Pest Study.

Oral complications arising out of radiation therapy and chemotherapy significantly affect the oral health status of patients leading to severe distress. Poor oral health can impair nutritional intake and patient recovery. Trained nurses lack knowledge of oral care of patients receiving cancer treatment. The study is aimed at training the nurses and conducting a documentation audit to assess the effect of the training on their clinical practice. Methods: A quantitative research approach was adopted using one group pretest-post-test design to train 72 nurses on oral care of cancer patients working in radiation oncology wards of a tertiary care setting in the southern part of India. After the training program, 80 head and neck cancer patient records were audited to monitor the implementation of oral care. After completing the training program, the knowledge score increased to 13.54 with a mean difference of 4.15 at a p-value <0.001, which indicates that the training was effective, resulting in a gain in knowledge scores. Nurses reported usage of evidence-based intervention, and patient education materials helped them in the clinical practice and a few barriers to oral care practice were identified while implementing the oral care i.e increased frequency of oral care, increased documentation, and time issues. There was poor adherence to the implementation of oral care for cancer patients after the training program, as monitored by a documentation audit. Capacity building of the nurses in providing effective oral care of cancer patients will help in improving the standards of cancer nursing practice. An implementation audit of the records would help check adherence to the new oral care practice. A hospital-instituted protocol can result in the effective implementation of the practice change rather than a researcher-introduced protocol.

Association of polypharmacy with all-cause mortality and adverse events among elderly colorectal cancer survivors.

The risk of inappropriate drug exposure in elderly colorectal cancer (CRC) survivors after the initial cancer treatment has not been well studied. This study investigated the association of polypharmacy (PP) with overall survival, hospitalization, and emergency room (ER) visits among older CRC survivors. A retrospective cohort study was conducted using the Korean National Health Insurance claims data follow-up from 2002 to 2017. Participants comprised those aged ≥65years who were hospitalized with a diagnosis of CRC received cancer treatment and survived at least 2years from the initial CRC diagnosis between 2003 and 2012. PP was defined based on the number of individual drugs during the third year, after 2years of survival since the initial cancer treatment. PP was categorized as follows: non-PP (zero to four prescribed drugs); PP (five to nine drugs), and excessive PP (≥10 drugs). Main outcomes are all-cause mortality, hospitalization, and ER visits. Of the 55,228 participants, 44.5% died, 83.1% were hospitalized, and 46.1% visited the ER. The PP and excess PP groups showed increased risk of all-cause mortality, hospitalization, and ER visit compared with the low PP group, and was highly associated among groups including patients aged 65 to 74years and those in low-level frailty groups. These risks can be minimized by increasing awareness and enhancing behaviors among health care professionals, especially clinician and pharmacists, to be aware of potential drug interactions, review, and ongoing monitoring. The risk of inappropriate drug exposure in older colorectal cancer (CRC) survivors after the initial cancer treatment has not been well studied. Polypharmacy was associated with adverse outcomes, including all-cause mortality, hospitalization, and emergency room visits among older CRC survivors and it was particularly associated with those who were 65 to 75years and those with low risk of frailty. When prescribing drugs, physicians should be mindful of finding a balance between adequate treatment of diseases and avoiding adverse drug effects in survivors of CRC.

Patient experiences through head and neck cancer: Information delivery combatting psychological distress

As part of a larger study investigating the utility of electronic decision support tools for patients with head and neck cancer (HNC), this article describes the patient experience of receiving cancer treatment in British Columbia, Canada. It aims to give voice to the patient experience and recommend a model of psychological adjustment for clinicians and clinical service management to consider to refine patient centric care pathways for HNC. Based in phenomenology, semi-structured interviews were conducted with 12 survivors of HNC, audio-video recorded, and thematically analyzed. Three themes were identified: (1) patients have high, though varying information needs; (2) an emotional experience; and (3) coping, strength, and resiliency. These themes arose from six concepts: (1) information needs; (2) fear of the unknown; (3) desire for personalized information; (4) varying degrees of information needs; (5) fear as a motivator versus stressor; and (6) high information needs on life after treatment. Conclusions: The patient experience must be considered through the full care trajectory and into survivorship to provide the right information to the correct patient at the optimal time. Patient journey mapping may be a novel approach to exploring the temporal relationship between information needs and the patient experience along the cancer continuum to uncover opportune moments, from the patient perspective, for knowledge and supportive care intervention. The model of psychological adjustment by Calver et al. (2019) can be considered to inform the delivery of cancer care information in a method recognizing the patient as the ultimate knowledge holder.

Does the preoperative neutrophil-to-lymphocyte ratio have a prognostic value in aneurysmal bone cysts?

The aim of this study was to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-tomonocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in aneurysmal bone cysts (ABCs). Between February 2001 and August 2019, a total of 86 patients (44 males, 42 females; mean age: 21.5±15.2 years; range, 2 to 73 years) with a histologically confirmed diagnosis of ABCs who did not receive cancer treatment previously and had a minimum follow-up period of 24 months were retrospectively analyzed. Data including age, sex, side, tumor location, pre-treatment complete blood count analysis results, preferred surgical method, follow-up period, presence of recurrence, and date of recurrence were recorded. Preoperative NLR, LMR and PLR values were calculated in all patients. The mean follow-up was 56.7±13.5 (range, 24 to 179) months. Forty-one (47.7%) ABCs were located in the lower extremities, 36 (41.8%) in the upper extremities, and nine (10.4%) in the pelvic girdle. A statistically significant difference was detected in the NLR values according to recurrence status (p=0.023). The PLR and LMR values were not significant for area under the curve, while NLR values were significant for recurrence. The cut-off value was determined as 2.054. Those with an NLR of ≥2.054 were found to have a 4.561-fold higher risk of recurrence than those with an NLR of <2.054 (odds ratio [OR]=4.561). Our study results suggest that NLR, which is the pre-treatment inflammatory index, is a prognostic factor in patients with ABCs. Although NLR alone is not decisive in patients with elevated NLR, it can be used to evaluate the clinical prognosis and recommend an appropriate treatment strategy.

Cardiovascular outcomes of cancer patients in rural Australia.

Cancer and heart disease are the two most common health conditions in the world, associated with high morbidity and mortality, with even worse outcomes in regional areas. Cardiovascular disease is the leading cause of death in cancer survivors. We aimed to evaluate the cardiovascular outcomes of patients receiving cancer treatment (CT) in a regional hospital. This was an observational retrospective cohort study in a single rural hospital over a ten-year period (17th February 2010 to 19th March 2019). Outcomes of all patients receiving CT during this period were compared to those who were admitted to the hospital without a cancer diagnosis. 268 patients received CT during the study period. High rates of cardiovascular risk factors: hypertension (52.2%), smoking (54.9%), and dyslipidaemia (38.4%) were observed in the CT group. Patients who had CT were more likely to be readmitted with ACS (5.9% vs. 2.8% p = 0.005) and AF (8.2% vs. 4.5% p = 0.006) when compared to the general admission cohort. There was a statistically significant difference observed for all cause cardiac readmission, with a higher rate observed in the CT group (17.1% vs. 13.2% p = 0.042). Patients undergoing CT had a higher rate of mortality (49.5% vs. 10.2%, p ≤ 0.001) and shorter time (days) from first admission to death (401.06 vs. 994.91, p ≤ 0.001) when compared to the general admission cohort, acknowledging this reduction in survival may be driven at least in part by the cancer itself. There is an increased incidence of adverse cardiovascular outcomes, including higher readmission rate, higher mortality rate and shorter survival in people undergoing cancer treatment in rural environments. Rural cancer patients demonstrated a high burden of cardiovascular risk factors.

Impact of Social Isolation, Physician-Patient Communication, and Self-perception on the Mental Health of Patients With Cancer and Cancer Survivors: National Survey Analysis.

Cancer is perceived as a life-threatening, fear-inducing, and stigmatized disease. Most patients with cancer and cancer survivors commonly experience social isolation, negative self-perception, and psychological distress. The heavy toll that cancer takes on patients continues even after treatment. It is common for many patients with cancer to feel uncertain about their future. Some undergo anxiety, loneliness, and fear of getting cancer again. This study examined the impact of social isolation, self-perception, and physician-patient communication on the mental health of patients with cancer and cancer survivors. The study also explored the impact of social isolation and physician-patient communication on self-perception. This retrospective study used restricted data from the 2021 Health Information National Trends Survey (HINTS), which collected data from January 11, 2021, to August 20, 2021. We used the partial least squares structural equation modeling (PLS-SEM) method for data analysis. We checked for quadratic effects among all the paths connecting social isolation, poor physician-patient communication, mental health (measured using the 4-item Patient Health Questionnaire [PHQ-4]), and negative self-perception. The model was controlled for confounding factors such as respondents' annual income, education level, and age. Bias-corrected and accelerated (BCA) bootstrap methods were used to estimate nonparametric CIs. Statistical significance was tested at 95% CI (2-tailed). We also conducted a multigroup analysis in which we created 2 groups. Group A consisted of newly diagnosed patients with cancer who were undergoing cancer treatment during the survey or had received cancer treatment within the last 12 months (receipt of cancer treatment during the COVID-19 pandemic). Group B consisted of respondents who had received cancer treatment between 5 and 10 years previously (receipt of cancer treatment before the COVID-19 pandemic). The analysis indicated that social isolation had a quadratic effect on mental health, with higher levels of social isolation associated with worse mental health outcomes up to a certain point. Self-perception positively affected mental health, with higher self-perception associated with better mental health outcomes. In addition, physician-patient communication significantly indirectly affected mental health via self-perception. The findings of this study provide important insights into the factors that affect the mental health of patients with cancer. Our results suggest that social isolation, negative self-perception, and communication with care providers are significantly related to mental health in patients with cancer.