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2.
Psychooncology ; 31(1): 107-115, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34425036

RESUMEN

OBJECTIVE: CanCope is an internet-delivered, cognitive-behavioural intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. Four separate pilot studies evaluated each of CanCope's modules for (1) feasibility and participant satisfaction, and changes in (2) module-specific outcomes, and (3) global measures of emotion dysregulation and anxiety and depressive symptoms, from pre-to-post module delivery. METHODS: Eligible cancer survivors self-selected into one two-week online module designed to improve a specific aspect of emotion regulation ([1] understanding emotions, [2] mindfulness of emotions, [3] cognitive reappraisals, [4] challenging emotion-driven behaviours). RESULTS: Across modules, post-intervention surveys were completed by 17-19 participants, (58.1%-90.5% completion rate for participants who received the intervention). Each module was feasible and participants reported high satisfaction. Moderate-to-large pre-to-post effect sizes in mean differences were observed in module-specific target outcomes (p's < 0.05). Emotion dysregulation significantly decreased across modules 1 to 3 (p's < 0.05) with a non-significant decrease for module 4 (p = 0.13). Anxiety symptoms significantly decreased across all modules (p's < 0.05). Depressive symptoms significantly decreased across modules 1 and 3 (p's < 0.05), with non-significant decreases across modules 2 (p = 0.08) and 4 (p = 0.06). CONCLUSIONS: Each CanCope module demonstrated promise in targeting emotion regulation skills and supporting the mental health of cancer survivors. Randomised controlled trials are required to test the efficacy of CanCope as an intervention in its entirety.


Asunto(s)
Supervivientes de Cáncer , Terapia Cognitivo-Conductual , Intervención basada en la Internet , Neoplasias , Trastornos de Ansiedad/terapia , Supervivientes de Cáncer/psicología , Terapia Cognitivo-Conductual/métodos , Humanos , Salud Mental , Neoplasias/terapia
3.
In Vivo ; 36(2): 898-906, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35241548

RESUMEN

BACKGROUND/AIM: An early evaluation concerning the effectiveness of supportive oligonucleotide therapy (SOT) in cancer as a monotherapy and in combination with other types of treatment. PATIENTS AND METHODS: This study evaluated the clinical condition and performance status (Karnofsky-Index) of 95 patients, post-SOT administration. Furthermore, circulating tumor cells (CTCs) from 47 patients' pre- and post-SOT administration were measured and analyzed by repeated-measures ANOVA. RESULTS: Improvement of the clinical condition was observed in all patients who used SOT (77.89%), SOT in combination with other therapy (69.77%) and SOT as a monotherapy or no information was given concerning another therapy (84.31%). Positive results for Karnofsky-Index were also observed in 71.58%, 61.36%, and 80.39%, respectively. Finally, statistically significant reductions in CTCs were observed for both SOT as a monotherapy and SOT as an adjunctive therapy. CONCLUSION: The preliminary results indicate that SOT therapy can be used both as monotherapy as well as in combination with other therapies for cancer.


Asunto(s)
Neoplasias , Oligonucleótidos , Humanos , Neoplasias/terapia , Oligonucleótidos/uso terapéutico
4.
Am Soc Clin Oncol Educ Book ; 42: 1-8, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35503982

RESUMEN

The rise of digital technologies such as telehealth, mobile apps, electronic medical records, and telementoring for rural primary care providers could provide opportunities for improving equity in cancer care delivery and outcomes. Benefitting from new technologies requires access to broadband internet, appropriate devices (smartphones, computers, etc.) along with basic digital literacy skills to use the devices. When these requirements are not met, the likelihood of widening existing inequities in access to care increases. This article introduces opportunities for improving cancer care using health informatics systems for engaging patients and flagging bias and existing videoconferencing technology to build workforce capacity. Policy recommendations for expanding evidence-based interventions are also highlighted, with the aim of mitigating the effects of workforce shortages and reducing persistent inequities in access to and quality of care.


Asunto(s)
Neoplasias , Telemedicina , Atención a la Salud , Tecnología Digital , Registros Electrónicos de Salud , Humanos , Neoplasias/epidemiología , Neoplasias/terapia , Tecnología
5.
BMJ Open ; 12(5): e059563, 2022 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-35504641

RESUMEN

INTRODUCTION: Cancer symptom monitoring and management interventions can address concerns that may otherwise go undertreated. However, such programmes and their evaluations remain largely limited to trials versus healthcare systemwide applications. We previously developed and piloted an electronic patient-reported symptom and need assessment ('cPRO' for cancer patient-reported outcomes) within the electronic health record (EHR). This study will expand cPRO implementation to medical oncology clinics across a large healthcare system. We will conduct a formal evaluation via a stepped wedge trial with a type 2 hybrid effectiveness-implementation design. METHODS AND ANALYSIS: Aim 1 comprises a mixed method evaluation of cPRO implementation. Adult outpatients will complete cPRO assessments (pain, fatigue, physical function, depression, anxiety and supportive care needs) before medical oncology visits. Results are available in the EHR; severe symptoms and endorsed needs trigger clinician notifications. We will track implementation strategies using the Longitudinal Implementation Strategy Tracking System. Aim 2 will evaluate cPRO's impact on patient and system outcomes over 12 months via (a) a quality improvement study (n=4000 cases) and (b) a human subjects substudy (n=1000 patients). Aim 2a will evaluate EHR-documented healthcare usage and patient satisfaction. In aim 2b, participating patients will complete patient-reported healthcare utilisation and quality, symptoms and health-related quality of life measures at baseline, 6 and 12 months. We will analyse data using generalised linear mixed models and estimate individual trajectories of patient-reported symptom scores at baseline, 6 and 12 months. Using growth mixture modelling, we will characterise the overall trajectories of each symptom. Aim 3 will identify cPRO implementation facilitators and barriers via mixed methods research gathering feedback from stakeholders. Patients (n=50) will participate in focus groups or interviews. Clinicians and administrators (n=40) will complete surveys to evaluate implementation. We will graphically depict longitudinal implementation survey results and code qualitative data using directed content analysis. ETHICS AND DISSEMINATION: This study was approved by the Northwestern University Institutional Review Board (STU00207807). Findings will be disseminated via local and conference presentations and peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04014751; ClinicalTrials.gov.


Asunto(s)
Registros Electrónicos de Salud , Neoplasias , Adulto , Humanos , Oncología Médica , Neoplasias/terapia , Medición de Resultados Informados por el Paciente , Calidad de Vida , Encuestas y Cuestionarios
6.
Oncologist ; 27(5): 363-370, 2022 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-35522559

RESUMEN

BACKGROUND: Adolescent and young adult (AYA) patients with cancer are underrepresented on cancer clinical trials (CCTs), and most AYAs are treated in the community setting. Past research has focused on individual academic institutions, but factors impacting enrollment vary across institutions. Therefore, we examined the patterns of barriers and facilitators between high- and low-AYA enrolling community-based clinics to identify targets for intervention. MATERIALS AND METHODS: We conducted 34 semi-structured interviews with stakeholders employed used at National Cancer Institute Community Oncology Research Program (NCORP) affiliate sites ("clinics"). Stakeholders (eg, clinical research associates, patient advocates) were recruited from high- and low-AYA enrolling clinics. We conducted a content analysis and calculated the percentage of stakeholders from each clinic type that reported the barrier or facilitator. A 10% gap between high- and low-enrollers was considered the threshold for differences. RESULTS: Both high- and low-enrollers highlighted insufficient resources as a barrier and the presence of a patient eligibility screening process as a facilitator to AYA enrollment. High-enrolling clinics reported physician gatekeeping as a barrier and the improvement of departmental collaboration as a facilitator. Low-enrollers reported AYAs' uncertainty regarding the CCT process as a barrier and the need for increased physician endorsement of CCTs as a facilitator. CONCLUSIONS: High-enrolling clinics reported more barriers downstream in the enrollment process, such as physician gatekeeping. In contrast, low-enrolling clinics struggled with the earlier steps in the CCT enrollment process, such as identifying eligible trials. These findings highlight the need for multi-level, tailored interventions rather than a "one-size-fits-all" approach to improve AYA enrollment in the community setting.


Asunto(s)
Neoplasias , Médicos , Adolescente , Instituciones de Atención Ambulatoria , Humanos , Neoplasias/terapia , Selección de Paciente , Incertidumbre , Adulto Joven
8.
Am Soc Clin Oncol Educ Book ; 42: 1-6, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35522911

RESUMEN

Conducting clinical research in low- and middle-income countries is essential to address the global impact of cancer. In 2017, ASCO convened an Academic Global Oncology Task Force that recommended an increase in global oncology research to enhance the field of oncology through research and education. The emerging crisis of cancer in Africa demands a similar global commitment to workforce development, infrastructure building, and access to care that will provide a platform for impactful and relevant research efforts. In the words of the African Organisation for Research and Training in Cancer, it is time to "transform cancer control in Africa through collaboration in education, research, (and) delivery of equitable and timely interventions to minimize the impact of cancer." Although there are some initiatives aimed at developing research capacity to host trials in Africa, there is now a need to establish strategic partnerships with the aim of achieving harmonized, accredited clinical trial units capable of running trials according to Good Clinical Practice standards.


Asunto(s)
Oncología Médica , Neoplasias , Humanos , Neoplasias/epidemiología , Neoplasias/terapia
9.
Sci Rep ; 12(1): 7429, 2022 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-35523855

RESUMEN

Febrile neutropenia (FN) is a common condition in children receiving chemotherapy. Our goal in this study was to develop a model for predicting blood stream infection (BSI) and transfer to intensive care (TIC) at time of presentation in pediatric cancer patients with FN. We conducted an observational cohort analysis of pediatric and adolescent cancer patients younger than 24 years admitted for fever and chemotherapy-induced neutropenia over a 7-year period. We excluded stem cell transplant recipients who developed FN after transplant and febrile non-neutropenic episodes. The primary outcome was onset of BSI, as determined by positive blood culture within 7 days of onset of FN. The secondary outcome was transfer to intensive care (TIC) within 14 days of FN onset. Predictor variables include demographics, clinical, and laboratory measures on initial presentation for FN. Data were divided into independent derivation (2009-2014) and prospective validation (2015-2016) cohorts. Prediction models were built for both outcomes using logistic regression and random forest and compared with Hakim model. Performance was assessed using area under the receiver operating characteristic curve (AUC) metrics. A total of 505 FN episodes (FNEs) were identified in 230 patients. BSI was diagnosed in 106 (21%) and TIC occurred in 56 (10.6%) episodes. The most common oncologic diagnosis with FN was acute lymphoblastic leukemia (ALL), and the highest rate of BSI was in patients with AML. Patients who had BSI had higher maximum temperature, higher rates of prior BSI and higher incidence of hypotension at time of presentation compared with patients who did not have BSI. FN patients who were transferred to the intensive care (TIC) had higher temperature and higher incidence of hypotension at presentation compared to FN patients who didn't have TIC. We compared 3 models: (1) random forest (2) logistic regression and (3) Hakim model. The areas under the curve for BSI prediction were (0.79, 0.65, and 0.64, P < 0.05) for models 1, 2, and 3, respectively. And for TIC prediction were (0.88, 0.76, and 0.65, P < 0.05) respectively. The random forest model demonstrated higher accuracy in predicting BSI and TIC and showed a negative predictive value (NPV) of 0.91 and 0.97 for BSI and TIC respectively at the best cutoff point as determined by Youden's Index. Likelihood ratios (LRs) (post-test probability) for RF model have potential utility of identifying low risk for BSI and TIC (0.24 and 0.12) and high-risk patients (3.5 and 6.8) respectively. Our prediction model has a very good diagnostic performance in clinical practices for both BSI and TIC in FN patients at the time of presentation. The model can be used to identify a group of individuals at low risk for BSI who may benefit from early discharge and reduced length of stay, also it can identify FN patients at high risk of complications who might benefit from more intensive therapies at presentation.


Asunto(s)
Bacteriemia , Neutropenia Febril , Hipotensión , Neoplasias , Sepsis , Adolescente , Bacteriemia/diagnóstico , Niño , Cuidados Críticos , Neutropenia Febril/epidemiología , Fiebre/complicaciones , Humanos , Hipotensión/complicaciones , Modelos Logísticos , Neoplasias/complicaciones , Neoplasias/terapia , Estudios Retrospectivos , Sepsis/complicaciones
10.
Sci Rep ; 12(1): 7477, 2022 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-35523935

RESUMEN

Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death are limited and have inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. From 2012 to 2018, this cohort study included adult cancer patients, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects received life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR] 0.87; 95% confidence interval [CI] 0.85-0.89). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.45, 95% CI 0.43-0.47), endotracheal intubation (AOR = 0.92, 95%CI 0.90-0.95), and defibrillation (AOR = 0.54, 95%CI 0.49-0.59). Since EOL discussions are associated with less aggressive care, our study supports the importance of providing these discussions to cancer patients during the EOL treatment.


Asunto(s)
Neoplasias , Cuidado Terminal , Adulto , Anciano , Estudios de Cohortes , Muerte , Humanos , Modelos Logísticos , Neoplasias/terapia
12.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 47(3): 358-363, 2022 Mar 28.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-35545329

RESUMEN

B lymphocyte is an important component of the human immune system and it has a role in the process of the body's specific immunity. In recent years, the research on B cells and tumor immune escape has rapidly progressed. Studies have shown that different types of B cells play different roles in tumor microenvironment through a variety of mechanisms. B cells in the tertiary lymphatic structure promote anti-tumor immunity, while regulatory B cells promote tumor immune escape. Antibody drugs targeting B cells are a promising direction for tumor immunotherapy.


Asunto(s)
Neoplasias , Escape del Tumor , Linfocitos B/patología , Humanos , Inmunoterapia , Neoplasias/patología , Neoplasias/terapia , Microambiente Tumoral
13.
Neoplasia ; 29: 100800, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35500546

RESUMEN

Dietary patterns contribute to cancer risk. Separately, microbial factors influence the development of several cancers. However, the interaction of diet and the microbiome and their joint contribution to cancer treatment response needs more research. The microbiome significantly impacts drug metabolism, immune activation, and response to immunotherapy. One of the critical factors affecting the microbiome structure and function is diet. Data demonstrate that the diet and microbiome composition affects the immune response. Moreover, malnutrition is a significant confounder to cancer therapy response. There is little understanding of the interaction of malnutrition with the microbiome in the context of cancer. This review aims to address the current knowledge of dietary intake patterns and malnutrition among cancer patients and the impact on treatment outcomes. Second, this review will provide evidence linking the microbiome to cancer treatment response and provide evidence of the potentially strong effect that diet could have on this interaction. This review will formulate critical questions that will need further research to understand the diet-microbiome relationship in cancer treatment response and directions for future research to guide us to precision nutrition therapy to improve cancer outcomes.


Asunto(s)
Microbioma Gastrointestinal , Desnutrición , Microbiota , Neoplasias , Dieta , Microbioma Gastrointestinal/fisiología , Humanos , Neoplasias/tratamiento farmacológico , Neoplasias/terapia , Estado Nutricional
14.
Sci Rep ; 12(1): 7169, 2022 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-35504918

RESUMEN

Cancer immunotherapies are highly potent and are gaining wide clinical usage. However, severe side effects require focusing effector immune cell activities on the tumor microenvironment (TME). We recently developed a chimeric antigen receptor tumor-induced vector (CARTIV), a synthetic promoter activated by TME factors. To improve CARTIV functions including background, activation levels, and synergism, we screened a library of promoters with variations in key positions. Here, we present a screening method involving turning ON/OFF stimulating TNFα and IFNγ cytokines, followed by sequential cell sorting. Sequencing of enriched promoters identified seventeen candidates, which were cloned and whose activities were then validated, leading to the identification of two CARTIVs with lower background and higher induction. We further combined a third hypoxia element with the two-factor CARTIV, demonstrating additional modular improvement. Our study presents a method of fine-tuning synthetic promoters for desired immunotherapy needs.


Asunto(s)
Inmunoterapia , Neoplasias , Microambiente Tumoral , Biblioteca de Genes , Humanos , Neoplasias/terapia , Regiones Promotoras Genéticas
15.
Nat Commun ; 13(1): 2506, 2022 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-35523809

RESUMEN

Immune checkpoint molecules play critical roles in regulating the anti-tumor immune response, and tumor cells often exploit these pathways to inhibit and evade the immune system. The B7-family immune checkpoint B7x is widely expressed in a broad variety of cancer types, and is generally associated with advanced disease progression and poorer clinical outcomes, but the underlying mechanisms are unclear. Here, we show that transduction and stable expression of B7x in multiple syngeneic tumor models leads to the expansion of immunosuppressive regulatory T cells (Tregs). Mechanistically, B7x does not cause increased proliferation of Tregs in tumors, but instead promotes the conversion of conventional CD4+ T cells into Tregs. Further, we find that B7x induces global transcriptomic changes in Tregs, driving these cells to adopt an activated and suppressive phenotype. B7x increases the expression of the Treg-specific transcription factor Foxp3 in CD4+ T cells by modulating the Akt/Foxo pathway. B7x-mediated regulation of Tregs reduces the efficacy of anti-CTLA-4 treatment, a therapeutic that partially relies on Treg-depletion. However, combination treatment of anti-B7x and anti-CTLA-4 leads to synergistic therapeutic efficacy and overcomes the B7x-mediated resistance to anti-CTLA-4. Altogether, B7x mediates an immunosuppressive Treg-promoting pathway within tumors and is a promising candidate for combination immunotherapy.


Asunto(s)
Antígenos B7/inmunología , Neoplasias , Humanos , Inmunoterapia , Neoplasias/tratamiento farmacológico , Neoplasias/terapia , Linfocitos T Reguladores
17.
Cell Rep Med ; 3(4): 100595, 2022 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-35522096

RESUMEN

John Maher has worked on CAR T cell immunotherapy with a primary focus on solid tumors for over 20 years. In this Q&A, Cell Reports Medicine interviewed him about his journey in this arena and next steps.


Asunto(s)
Inmunoterapia Adoptiva , Neoplasias , Humanos , Inmunoterapia , Neoplasias/terapia
19.
BMC Palliat Care ; 21(1): 61, 2022 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-35501797

RESUMEN

BACKGROUND: Spending time at home and dying at home is advocated to be a desirable outcome in palliative care (PC). In Norway, home deaths among cancer patients are rare compared to other European countries. Advance care planning (ACP) conversations enable patients to define goals and preferences, reflecting a person's wishes and current medical condition. METHOD: The study included 250 cancer patients in the Romsdal region with or without an ACP conversation in primary health care who died between September 2018 and August 2020. The patients were identified through their contact with the local hospital, cancer outpatient clinic or hospital-based PC team. RESULTS: During the last 90 days of life, patients who had an ACP conversation in primary health care (N=125) were mean 9.8 more days at home, 4.5 less days in nursing home and 5.3 less days in hospital. Having an ACP conversation in primary health care, being male or having a lower age significantly predicted more days at home at the end of life (p< .001). Patients with an ACP conversation in primary health care where significantly more likely to die at home (p< .001) with a four times higher probability (RR=4.5). Contact with the hospital-based PC team was not associated with more days at home or death at home. Patients with contact with the hospital-based PC team were more likely to have an ACP conversation in primary health care. CONCLUSION: Palliative cancer patients with an ACP conversation in primary health care spent more days at home and more frequently died at home. Data suggest it is important that ACP conversations are conducted in primary health care setting.


Asunto(s)
Planificación Anticipada de Atención , Neoplasias , Cuidado Terminal , Femenino , Humanos , Masculino , Neoplasias/terapia , Atención Primaria de Salud , Estudios Retrospectivos
20.
Cancer Epidemiol Biomarkers Prev ; 31(5): 1043-1051, 2022 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-35506248

RESUMEN

BACKGROUND: Financial hardship among adolescents and young adults (AYA) with cancer who receive gonadotoxic treatments may be exacerbated by the use of fertility services. This study examined whether AYA women with cancer who used fertility preservation had increased financial hardship. METHODS: AYA women with cancer in North Carolina and California completed a survey in 2018-2019. Cancer-related financial hardship was compared between women who cryopreserved oocytes or embryos for fertility preservation after cancer diagnosis (n = 65) and women who received gonadotoxic treatment and reported discussing fertility with their provider, but did not use fertility preservation (n = 491). Multivariable log-binomial regression was used to estimate prevalence ratios and 95% confidence intervals (CI). RESULTS: Women were a median age of 33 years at diagnosis and 7 years from diagnosis at the time of survey. Women who used fertility preservation were primarily ages 25 to 34 years at diagnosis (65%), non-Hispanic White (72%), and had at least a Bachelor's degree (85%). In adjusted analysis, use of fertility preservation was associated with 1.50 times the prevalence of material financial hardship (95% CI: 1.08-2.09). The magnitude of hardship was also substantially higher among women who used fertility preservation: 12% reported debt of ≥$25,000 versus 5% in the referent group. CONCLUSIONS: This study provides new evidence that cryopreserving oocytes or embryos after cancer diagnosis for future family building is associated with increased financial vulnerability. IMPACT: More legislation that mandates insurance coverage to mitigate hardships stemming from iatrogenic infertility could improve access to fertility preservation for young women with cancer.


Asunto(s)
Preservación de la Fertilidad , Neoplasias , Adolescente , Femenino , Estrés Financiero , Humanos , Cobertura del Seguro , Masculino , Neoplasias/terapia , Encuestas y Cuestionarios , Adulto Joven
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