Prevalence and Predictors of Palliative Care Utilization among Hospitalized Patients with Diffuse Large B-Cell Lymphoma.

Objective: Research has shown that palliative care improves the quality of life of cancer patients; however, there is no literature on specific factors that predict its use in diffuse large b-cell lymphoma (DLBCL) patients. Therefore, the prevalence of palliative care utilization and predictors of palliative care utilization among patients with DLBCL were examined. Methods: Data from the National Inpatient Sample (NIS) collected between 2016 to 2018 were used for all analyses. Multivariable logistic regression models were used to examine the predictors of palliative care utilization among hospitalized patients with DLBCL. Descriptive analyses were used to explore the overall prevalence of palliative care receipt in this population. Results: Of the 41,789 hospitalizations, 7.1% of patients used palliative care during hospitalization, while 4.8% utilized palliative care and were discharged alive. DLBCL patients aged 70 and older had 1.3 times (95% CI: 1.14-1.41) higher odds of utilizing palliative care compared to those less than 70 years. Relative to Medicare/Medicaid patients, those with other types of insurance were 1.7 times (95% CI: 1.34-2.05) more likely to receive palliative care. Those who were either transferred to a facility/discharged with home health (AOR: 6.23; 95% CI: 5.21-7.44) or died during hospitalization (AOR: 45.17; 95% CI: 36.98-55.17) had higher odds of receiving palliative care when relative to those with a routine hospital discharge. Other associated factors were type of admission, length of stay, chemotherapy receipt, and number of comorbidities. Conclusions: The prevalence of palliative care utilization was low and factors predicting utilization in our population were identified. Our findings highlight the need to increase awareness among medical oncologists on the need to involve the palliative care team early in the management of hospitalized patients with DLBCL.

Arrhythmia prevalence, predictors, and impact on hospital-associated outcomes among patients with diffuse large B-cell lymphoma.

INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) patients have been reported to have cardiac manifestations, however, arrhythmias have not been characterized in this population. We examined the predictors of arrhythmias and assessed the impact of arrhythmias on inpatient outcomes among DLBCL patients. METHODS: Retrospective cohort analysis was performed using the National Inpatient Sample data collected between 2016 and 2018. Multivariable logistic and linear regression models were used to examine the predictors of arrhythmias and inpatient outcomes among DLBCL patients. RESULTS: 11% of DLBCL patients had a diagnosis of arrhythmias. Patients aged 70 years or older had 2.6 times higher odds (95% CI: 2.37-2.78) of having arrhythmias compared to patients younger than 70 years. Females were 23% (AOR: 0.77; 95% CI: 0.71-0.83) less likely to have a diagnosis of arrhythmias relative to their male counterparts. Compared to non-Hispanic whites, patients who were non-Hispanic blacks (AOR: 0.69; 95% CI: 0.60-0.81), Hispanics (AOR: 0.60; 95% CI: 0.52-0.69) or in the non-Hispanic other category (AOR: 0.80; 95% CI: 0.70-0.91) were significantly less likely to be diagnosed with arrhythmias. Other factors that predicted arrhythmias were patient disposition and comorbidity index. Additionally, arrhythmias were associated with higher inpatient mortality, length of stay and hospital costs. CONCLUSIONS: Older male patients were more likely to be diagnosed with arrhythmias while non-Hispanic blacks and Hispanics were less likely to have arrhythmias. These findings highlight the need for surveillance to enable early detection of arrhythmias in this population.

Prevalence and Factors Associated with Palliative Care Utilization among Hospitalized Patients with Esophageal Cancer in the United States.

Objective: Due to poor 5-year survival and high symptom burden, esophageal cancer (EC) patients benefit markedly from palliative care utilization. However, there is scant literature exploring factors associated with receipt of palliative care in this population. The prevalence of palliative care consultations among hospitalized EC patients was assessed. Furthermore, we examined the factors associated with palliative care utilization among hospitalized patients with EC. Methods: Retrospective analyses were conducted using the National Inpatient Sample data collected between 2016 and 2018. Descriptive analyses were used to explore the overall prevalence of palliative care utilization. Univariate and multivariable regression models were used to examine factors associated with palliative care utilization among hospitalized EC patients. Results: The overall prevalence of palliative care utilization was 15.97%. Non-Hispanic Blacks had 1.16 times (95% CI: 1.00-1.34) higher odds of palliative care utilization compared to non-Hispanic Whites. Compared to patients on Medicare, those on Medicaid (AOR: 1.21; 95% CI: 1.02-1.45), private (AOR: 1.19; 95% CI: 1.06-1.35) and other insurance types (AOR: 1.68; 95% CI: 1.39-2.02) were more likely to utilize palliative care. Relative to patients hospitalized in the Northeast, those in Midwest (AOR: 1.34; 95% CI: 1.17-1.53), south (AOR: 1.28; 95% CI: 1.12-1.45), and west (AOR: 1.41; 95% CI: 1.22-1.61) were more likely to receive palliative care. Patients admitted to urban teaching hospitals (AOR: 1.28; 95% CI: 1.07-1.52) had higher odds of having palliative care consultations when compared to their counterparts in rural hospitals. Also, patients who were either discharged to a facility/with home health (OR: 5.39; 95% CI: 4.76-6.10) or died during hospitalization (OR: 26.93; 95% CI: 23.31-31.11) had higher odds of utilizing palliative care when compared to those with a routine discharge. Other factors identified were median household income quartiles, admission type, chemotherapy receipt, and the number of comorbidities. Conclusions: Our findings highlight the need to further analyze and address factors that may hinder palliative care utilization among hospitalized EC patients to decrease disparities and improve their quality of life. Hospital physicians and health systems need to be more proactive about palliative care consultations to maximize the benefits to these sick cancer patients.

Fulminant Myocarditis and Cardiogenic Shock Following COVID-19 Infection Versus COVID-19 Vaccination: A Systematic Literature Review.

BACKGROUND: Myocarditis, diagnosed by symptoms and troponin elevation, has been well-described with COVID-19 infection, as well as shortly after COVID-19 vaccination. The literature has characterized the outcomes of myocarditis following COVID-19 infection and vaccination, but clinicopathologic, hemodynamic, and pathologic features following fulminant myocarditis have not been well-characterized. We aimed to compare clinical and pathological features of fulminant myocarditis requiring hemodynamic support with vasopressors/inotropes and mechanical circulatory support (MCS), in these two conditions. METHODS: We analyzed the literature on fulminant myocarditis and cardiogenic shock associated with COVID-19 and COVID-19 vaccination and systematically reviewed all cases and case series where individual patient data were presented. We searched PubMed, EMBASE, and Google Scholar for "COVID", "COVID-19", and "coronavirus" in combination with "vaccine", "fulminant myocarditis", "acute heart failure", and "cardiogenic shock". The Student's t-test was used for continuous variables and the χ2 statistic was used for categorical variables. For non-normal data distributions, the Wilcoxon Rank Sum Test was used for statistical comparisons. RESULTS: We identified 73 cases and 27 cases of fulminant myocarditis associated with COVID-19 infection (COVID-19 FM) and COVID-19 vaccination (COVID-19 vaccine FM), respectively. Fever, shortness of breath, and chest pain were common presentations, but shortness of breath and pulmonary infiltrates were more often present in COVID-19 FM. Tachycardia, hypotension, leukocytosis, and lactic acidosis were seen in both cohorts, but patients with COVID-19 FM were more tachycardic and hypotensive. Histologically, lymphocytic myocarditis dominated both subsets, with some cases of eosinophilic myocarditis in both cohorts. Cellular necrosis was seen in 44.0% and 47.8% of COVID-19 FM and COVID-19 vaccine FM, respectively. Vasopressors and inotropes were used in 69.9% of COVID-19 FM and in 63.0% of the COVID-19 vaccine FM. Cardiac arrest was observed more in COVID-19 FM (p = 0.008). Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for cardiogenic shock was also used more commonly in the COVID-19 fulminant myocarditis group (p = 0.0293). Reported mortality was similar (27.7%) and 27.8%, respectively) but was likely worse for COVID-19 FM as the outcome was still unknown in 11% of cases. CONCLUSIONS: In the first series to retrospectively assess fulminant myocarditis associated with COVID-19 infection versus COVID-19 vaccination, we found that both conditions had a similarly high mortality rate, while COVID-19 FM had a more malignant course with more symptoms on presentation, more profound hemodynamic decompensation (higher heart rate, lower blood pressure), more cardiac arrests, and higher temporary MCS requirements including VA-ECMO. In terms of pathology, there was no difference in most biopsies/autopsies that demonstrated lymphocytic infiltrates and some eosinophilic or mixed infiltrates. There was no predominance of young males in COVID-19 vaccine FM cases, with male patients representing only 40.9% of the cohort.

Atypical Takotsubo Cardiomyopathy Precipitated by Gastrointestinal Bleeding: Review of the Pathophysiology.

Stress-induced cardiomyopathy, otherwise known as takotsubo cardiomyopathy, typically presents with chest pain and acute left ventricular failure with unobstructed coronary arteries. There is an increase in disease incidence as clinicians are becoming more aware of this clinical entity. An atypical variant exists where there is left ventricular dysfunction with apical sparing. Various precipitants have been described in the literature, however, there has not been any documented case following massive gastrointestinal bleeding. We report an atypical variant of takotsubo cardiomyopathy following a gastrointestinal bleed with review of the pathophysiologic mechanisms behind the disease process.

Thoracic Aortic Rupture Post Cardiopulmonary Resuscitation in a Patient With Previous Thoracic Aneurysm Repair.

Aortic dissection is characterized by a tear or rupture in the intimal layer of the aorta causing blood to flow between the layers of the arterial wall, thus separating them. While cardiopulmonary resuscitation (CPR) is a life-saving intervention, it can unintentionally contribute to the development or worsening of aortic dissection. The forceful chest compressions involved in CPR can put significant pressure on the fragile aortic wall, potentially leading to a tear or rupture. This highlights the delicate balance between life-saving measures and the potential risks they carry. Though studies have been done on the effects of CPR on the thoracic wall, few reports have studied the effects on the structures that lie in the thoracic cavity. The authors present a 63-year-old with a history of thoracic aneurysm repair who experienced a cardiac arrest while choking on food at home. The patient received CPR and a CT scan done thereafter revealed thoracic dissection and rupture. The patient received medical management in the Intensive Care Unit but eventually expired due to irreversible neurological damage. This highlights the importance of recognizing that CPR can pose a risk for aortic dissection and rupture, particularly in individuals with prior aortic repairs. It emphasizes the need for developing protocols to monitor patients who have undergone aneurysmal repair and adjusting CPR techniques to suit their specific needs. Additionally, further studies are needed to understand how often aortic complications occur after CPR and to provide guidance for follow-up care in patients who have had aortic repairs. By implementing these measures, we can improve outcomes and safety during resuscitation.

Incidental Finding of Thoracic Aortic Dissection in a Patient Post-Coronary Artery Bypass Graft Surgery.

Thoracic aortic dissection (TAD) is an uncommon but potentially fatal complication of coronary artery bypass graft (CABG). Most patients present to the emergency room with severe chest pain, shortness of breath, or after a syncopal episode. Asymptomatic patients pose a challenge to diagnosis. The authors present a case of an 82-year-old male, who was found to have an incidental finding of a 5-cm ascending aortic aneurysm with an intimal dissection flap four months after CABG. Extensive workup on possible risk factors such as underlying aortic diseases, genetic conditions, and hypertensive crisis proved noncontributory. Aggressive blood pressure control was achieved, and the patient was observed in the intensive care unit before discharge with follow-up. The purpose of this case report is to alert clinicians of TAD after CABG and highlight the importance of developing a protocol for follow-up and monitoring of patients who have undergone CABG, as complications can be asymptomatic. Early and accurate diagnosis of TAD as a complication of CABG is essential to improving survival rates.

Cardiovascular complications of sickle cell disease: A primer for the general clinician.

Sickle cell disease (SCD) is the most common hereditary hemoglobinopathy and mainly affects individuals of African ancestry. As survival has improved especially in high-income countries, increased rates of cardiopulmonary complications such as pulmonary hypertension, heart failure with diastolic dysfunction, and sudden death are encountered in clinical practice. These complications are the leading causes of morbidity and mortality as these individuals survive into adulthood. Understanding the need for, early identification, timely intervention, and implementation of preventive strategies are critical in reversing this trend and improving quality of life and survival rates. This manuscript aims to provide a comprehensive review of the pathogenesis of cardiovascular complications associated with sickle cell disease and equip the clinician with tools to facilitate the early diagnosis and management of patients with SCD as increasing numbers survive into adulthood.

A Rare Case of Myocarditis After the First Dose of Moderna Vaccine in a Patient With Two Previous COVID-19 Infections.

Myocarditis is the inflammation of the cardiac muscle caused by a variety of factors ranging from infections to autoimmune diseases. Most cases of vaccine-induced myocarditis occur after the second dose of vaccination; however, a few cases have been reported following the first dose of vaccination with or without previous coronavirus disease 2019 (COVID-19) infection. A case of myocarditis occurring about three weeks after the first dose of the Moderna vaccine has been reported in a patient with one previous COVID-19 infection. However, there have not been any documented cases of myocarditis after the first dose of the Moderna vaccine in a patient with two prior COVID-19 infections. Our index patient had already experienced two COVID-19 infections in the past and was diagnosed with myocarditis eight hours after receiving the first dose of the Moderna vaccine. The susceptibility to developing this likely stems from the possible production of antibodies to the viral antigen from previous COVID-19 infections. Furthermore, the fact that our patient developed symptoms eight hours after receiving the vaccine suggests a possible additive effect of antibodies produced from the two previous COVID-19 infections. This case report suggests that individuals repeatedly infected with COVID-19 may be at increased risk of myocarditis following the administration of the Moderna vaccine.

Impact of Atrial Fibrillation on Inpatient Outcomes Among Hospitalized Patients With Multiple Myeloma.

Background Though multiple myeloma (MM) patients have been reported to have the highest risk of atrial fibrillation compared to other cancer patients, studies are lacking on the impact of atrial fibrillation on health outcomes in this population. In this study, we examined the impact of atrial fibrillation on inpatient outcomes among hospitalized patients with MM. Methodology Retrospective cohort analyses were conducted using National Inpatient Sample data from 2016 to 2018. Descriptive analyses were performed to explore the prevalence of atrial fibrillation among MM patients. Multivariable logistic and linear regression models were used to examine the association between atrial fibrillation and inpatient all-cause mortality, length of stay, and total hospital charges among hospitalized patients with MM. Results Overall, 13.1% of the patients reported having atrial fibrillation. MM patients with atrial fibrillation had 1.2 times (adjusted odds ratio (AOR) = 1.16; 95% confidence interval (CI) = 1.05-1.29) higher odds of inpatient all-cause mortality when compared to those without atrial fibrillation. They were also 1.3 times (AOR = 1.29; 95% CI = 1.23-1.35) more likely to have a length of stay of more than five days relative to five days or less. Additionally, MM patients with atrial fibrillation had $8,020 (95% CI = $5,495.2-$10,546.3) higher hospital costs when compared to their counterparts without atrial fibrillation. Stratified results by the use of anticoagulation further showed that MM patients who were not using anticoagulation had bad health outcomes, reporting higher odds of inpatient all-cause mortality (AOR = 1.40; 95% CI = 1.25-1.57), a longer length of hospital stay of more than five days (AOR = 1.44; 95% CI = 1.36-1.53), and total hospital charges (ß = $14,772.5; 95% CI = $11,467.8-$18,077.3). Conclusions Our findings stress the need for monitoring and possible screening to detect atrial fibrillation in MM patients as anticoagulation helps improve mortality in these patients. Medication reconciliation remains a key component of hospital admissions/discharges and may help in decreasing the length of stay and healthcare costs.

Trends, Sociodemographic and Hospital-Level Factors Associated With Palliative Care Utilization Among Multiple Myeloma Patients Using the National Inpatient Sample (2016-2018).

BACKGROUND: Several factors are reported to be associated with palliative care utilization among patients with various cancers, but literature is lacking on multiple myeloma (MM) specific factors. MM patients have a high symptom burden and early involvement of palliative could increase their quality of life. We examined factors associated with palliative care utilization among MM patients and explored prevalence trends in palliative care utilization among patients with MM. METHODS: Cross-sectional analyses were conducted using the National Inpatient Sample data collected between 2016 and 2018. Descriptive analyses were used to explore prevalence trends in palliative care utilization over time. Multivariable logistic regression models were used to examine sociodemographic and hospital-level factors associated with palliative care utilization in MM patients. RESULTS: Overall prevalence of palliative care utilization in our population was 7.7% with a trend of increasing use of palliative care from 7.3% in 2016 to 8.2% in 2018. MM patients aged 70 years and above had 1.30 times higher odds (95% CI: 1.20-1.42) of receiving palliative care relative to those younger than 70 years. Compared to non-Hispanic whites, non-Hispanic blacks (Adjusted odds ratio (AOR): 0.86; 95% CI: 0.79-0.94) were less likely to utilize palliative care. Patients on Medicaid (AOR: 1.27; 95% CI: 1.08-1.49), private insurance (AOR: 1.27; 95% CI: 1.16-1.39) and other insurance types (AOR: 2.10; 95% CI: 1.79-2.47) had significantly higher odds of receiving palliative care when compared to those on Medicare. Other factors identified were hospital region, location, patient disposition, admission type, length of stay, and number of comorbidities. CONCLUSION: Our findings highlight the urgent need for education of hospital physicians on the need for early palliative care involvement in the care of hospitalized MM patients. Messaging interventions such as the delivery of pop-up messages in electronic medical records to serve as reminders for physicians can be explored as a potential way to increase palliative care consultations for patients who need them.

Percutaneous Coronary Intervention With Dual Antiplatelet Therapy in a Patient With Chronic Subdural Hematoma: Novel Approach.

Subdural hematoma is a type of brain bleed characterized by the accumulation of blood beneath the dura matter. It usually occurs as a sequela of a traumatic event or following the use of antiplatelets and/or anticoagulants. The clinical presentation may include symptoms like headache, confusion, ataxia, and hemiparesis. However, it may even be asymptomatic, especially in the elderly population. The presence of subdural hematoma is a relative contraindication to antiplatelet therapy because of the associated risk of worsening bleeding. Hence, acute coronary syndrome or conditions requiring antiplatelet therapy presents a management dilemma when they coexist with subdural hematoma. This paper reports a case of successful use of dual antiplatelets post percutaneous coronary intervention in a patient with spontaneous chronic subdural hematoma. Our patient had a history of coronary artery disease six months prior to stent placement and was on dual antiplatelet therapy. He developed a headache some months later and his neurologist, on evaluating him, made a diagnosis of subdural hematoma, evident on magnetic resonance imaging of the brain. His antiplatelet therapy was discontinued, and he subsequently had a bilateral middle meningeal artery embolization. Following the procedure, a left heart catheterization was done with appropriate interventions for acute coronary syndrome diagnosed at the time of presentation. He was later discharged on dual antiplatelet therapy, followed up on outpatient at scheduled intervals, and was found stable. This case report suggests that individuals with chronic subdural hematoma who may require antiplatelet therapy can still go on to receive the medication after undergoing a bilateral middle meningeal artery embolization. More observational studies are needed to make this the standard of care.

Burden of arrhythmias and predictors of mortality among multiple myeloma patients with arrhythmias.

Arrhythmias are a major cardiac complication reported among patients with multiple myeloma (MM), but these have not been further characterized in this population. We explored the prevalence of arrhythmias and examined the predictors of mortality among patients with MM with arrhythmias. The National Inpatient Sample data collected between 2016 and 2018 were used to conduct retrospective analyses. Multivariable logistic regression analyses were done to examine the predictors of mortality among patients with MM with arrhythmias. 16.9% of patients with MM reported a diagnosis of any arrhythmias and 70.7% of these were atrial fibrillation. Patients aged 70 years and above had 21% lower odds (adjusted OR (AOR): 0.79; 95% CI: 0.68 to 0.92) of inpatient mortality relative to younger patients. Those in the non-Hispanic black, Hispanic, and non-Hispanic other category were 1.38 (95% CI: 1.16 to 1.64), 1.53 (95% CI: 1.19 to 1.97), and 1.69 (95% CI: 1.29 to 2.21) times more likely to die during hospitalization compared with their counterparts who were non-Hispanic whites. Relative to patients with MM who were on Medicare, those on private (AOR: 1.28; 95% CI: 1.06 to 1.54) and other insurance types (AOR: 1.78; 95% CI: 1.23 to 2.58) had higher odds of mortality. Other predictors of inpatient mortality were elective admission (AOR: 0.67; 95% CI: 0.52 to 0.85) and Charlson comorbidity indices between 5-7 (AOR: 1.23; 95% CI: 1.07 to 1.41) and ≥8 (AOR: 1.45; 95% CI: 1.21 to 1.73) compared with comorbidity indices between 0 and 4. Our study adds to the body of knowledge on the need for proper diagnosis and management of cardiac arrhythmias in patients with MM. Research is needed to further assess the time of arrhythmia diagnosis and its impact on health outcomes among patients with MM.

Retrospective analyses of factors influencing arrhythmias and the impact of arrhythmias on inpatient outcomes among hospitalized patients with hemochromatosis.

BACKGROUND: Though hemochromatosis is described as an infiltrative cardiomyopathy that can result in arrhythmias, studies are lacking on the impact of arrhythmias in this population. We examined the prevalence, factors influencing arrhythmias, and impact of arrhythmias on inpatient outcomes among hospitalized patients with hemochromatosis. METHODS: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS) collected between 2016 and 2018. Descriptive analyses were done to assess the prevalence of arrhythmias in patients with hemochromatosis. Univariate and multivariable logistic and linear regression models were used to examine the factors associated with arrhythmias and hospital-associated outcomes among patients with hemochromatosis. RESULTS: 11.7% of hemochromatosis patients were diagnosed with arrhythmias. Compared to hemochromatosis patients less than 40 years old, those between 40 and 59 years had 2.3 times higher odds (Adjusted Odds Ratio (AOR): 2.35; 95% Confidence Interval (CI): 1.81-3.05) of having arrhythmias relative to no arrhythmias while patients aged 60 and above had 5 times higher odds (AOR: 4.96; 95% CI: 3.74-6.58) of arrhythmias. Compared to male patients, females were significantly less likely to be diagnosed with arrhythmias. Hispanics were 36% (AOR: 0.64; 95% CI: 0.47-0.86) less likely to have arrhythmias when compared to their non-Hispanic white counterparts. Other factors associated with arrhythmias were income, insurance type, and patient disposition. Furthermore, arrhythmias were related to higher hospital mortality, longer hospital stays, and total hospital charges. CONCLUSION: Our findings accentuate the need for close monitoring and early detection of arrhythmias in patients with hemochromatosis to improve their health outcomes. Patients need to be continually educated on their medical diagnoses and the need for treatment adherence, while hospitalist physicians need to ensure good continuity of care between the hospital and primary care setting to drive hospital costs down while keeping patients healthy.

Prevalence and Factors Associated with Electronic Cigarette Use Among Young Adult Cancer Survivors Using Behavioral Risk Factor Surveillance System, 2016-2018.

Purpose: This study describes the prevalence trends of electronic cigarette (e-cigarette) use in young adult cancer survivors and compares these to the prevalence among young adults without a cancer history. It also examines the association between conventional cigarette use, binge drinking, depression, and other sociodemographic factors, and e-cigarette use in young adult cancer survivors. Methods: Cross-sectional analyses, using the Behavioral Risk Factor Surveillance System, 2016-2018, were done. Multivariable logistic regression was used to examine the associations between conventional cigarette use, binge drinking, and depression as well as other factors associated with e-cigarette use in young adult cancer survivors. Results: Lifetime e-cigarette use increased from 40.1% in 2016 to 47.4% in 2018. Former smokers were 5.47 times (95% confidence interval [CI]: 3.48-8.61) more likely to be lifetime e-cigarette users and 1.9 times (95% CI: 1.12-3.23) more likely to be current e-cigarette users compared to never smokers. Current smokers were over sixteen folds more likely (adjusted odds ratio: 16.50, 95% CI: 11.59-23.57) to be lifetime e-cigarette users and 2.1 times (95% CI: 1.24-3.57) more likely to be current e-cigarette users relative to never smokers. Furthermore, binge drinking and depression were associated with higher odds of lifetime e-cigarette use, while increasing age was associated with lower odds of e-cigarette use. Compared to females, males were significantly more likely to be current users of e-cigarettes relative to former users. Conclusion: Conventional cigarette use, binge drinking, depression, age, and gender were found to be associated with e-cigarette use among young adult cancer survivors. Policies targeted at e-cigarette control among young adult cancer survivors need to be multipronged, simultaneously addressing other harmful practices such as binge drinking and the use of conventional cigarettes.

Sources of health information among U.S. cancer survivors: results from the health information national trends survey (HINTS).

BACKGROUND: Health information is crucial for preservation of health and maintenance of healthy practices among cancer survivors. This study examines the sources and factors associated with choice of health information source among cancer survivors and those without a cancer history. METHODS: We examined health information sources utilized by cancer history between 2011-2014 and 2017-2018 using the Health Information National Trends Survey (HINTS). Factors associated with seeking health information were examined using multinomial logistic regression. Data from HINTS 4, cycles 1-4 (2011-2014) and HINTS 5, cycles 1-2 (2017-2018) were combined and used for all analyses. HINTS-FDA, cycles 1-2 (2015-2017) were excluded from this study because the question about a cancer history was not asked. RESULTS: Over half of cancer survivors (52.7%) and those without a cancer history (60.9%) obtained their health information through the media. Among cancer survivors, factors associated with health information seeking either through the media or interpersonal communication relative to not seeking information were age, gender, level of education, income, marital status and having a regular healthcare provider. Male survivors were 39% less likely to seek health information from the media (aOR: 0.61; 95% CI: 0.38-0.99) while those with a regular health provider had significantly higher odds of seeking health information via interpersonal communication (aOR: 1.92; 95% CI: 1.09-3.38). In addition, widowed cancer survivors had lower odds of seeking health information from either interpersonal communication (aOR: 0.28; 95% CI: 0.13-0.60) or the media (aOR: 0.30; 95% CI: 0.13-0.69). In the study population without a cancer history, compared to non-Hispanic whites, non-Hispanic blacks, Hispanics and non-Hispanic other categories were significantly less likely to seek health information from the media rather than not seek health information. CONCLUSION: Socioeconomic status, marital status, gender and age are important correlates of choice of health information source among cancer survivors in the US. These factors may be useful in guiding interventions aimed at various groups of cancer surviving populations to ensure that they improve their health seeking behaviors.