Tobacco Use in Human Papillomavirus-Positive Advanced Oropharynx Cancer Patients Related to Increased Risk of Distant Metastases and Tumor Recurrence

4004 Background: Despite recent advances in the treatment of metastatic colorectal cancer, tailoring adjuvant treatment of stage II and III colon cancer patients remains controversial. Identifying a reliable panel of prognostic and predictive markers for tumor recurrence is critical in selecting an individualized and tailored chemotherapy. Tumor angiogenesis plays an important role in tumor development, progression and metastasis. In this retrospective study, we tested whether a specific pattern of 40 functionally significant polymorphisms in 37 genes involved in angiogenesis and tumor microenvironment will predict the risk of tumor recurrence in stage II and III colon cancer patients treated with adjuvant chemotherapy. Methods: Between 1999 and 2006 blood specimens from 140 patients (69 females and 71 males with a median age of 59 years; range=28–86) were obtained at the University of Southern California/Norris Comprehensive Cancer Center (USC/NCCC). Sixty-three patients had stage II and 77 had stage III colon cancer. The median follow-up was 5.4 years (range=2.0–16.8). 51 of 140 patients (36.4%) developed tumor recurrence with a 5-year probability of 0.28 ± 0.06 for stage II and 0.40 ± 0.06 for stage III colon cancer patients. Genomic DNA was extracted from peripheral blood and genotypes were determined using PCR based RFLP. Results: Polymorphisms in VEGF (C936T; p=0.009, log-rank) and VEGFR2 (+4422 AC- repeat; p=0.04, log-rank and +1416 T/A; p=0.0009, log-rank) were associated with risk of tumor recurrence in stage III colon cancer patients (n=77). VEGFR2 AC-repeat polymorphisms were additionally associated with risk of recurrence in Stage II colon cancer patients (n=63, p=0.02, log-rank). Conclusion: VEGF C936T and VEGFR2 (+4422 AC-repeat and +1416 T/A) polymorphisms may help to identify Stage II and III colon cancer patients who are at increased risk for developing tumor recurrence. Angiogenesis seems to play a crucial role in tumor recurrence, thus targeting VEGF and VEGFR2 may be of clinical benefit for stage II and stage III colon cancer patients. Large prospective trials are needed to validate these preliminary data. No significant financial relationships to disclose.

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Association between tobacco use, pain expression, and maladaptive coping among patients with advanced cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.65 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 65-65

Author(s):

Rony Dev ◽

Yu Jung Kim ◽

Akhila Sunkepally Reddy ◽

David Hui ◽

Kimberson Cochien Tanco ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Tobacco Use ◽

Symptom Expression ◽

Advanced Cancer Patients ◽

Maladaptive Coping ◽

Increased Risk ◽

Pain Expression ◽

Former Smokers ◽

Never Smokers

65 Background: Cancer patients who smoke have been reported to have higher pain expression and increased risk for opioid abuse. The purpose of our study is to evaluate the association between tobacco use, symptom expression, and maladaptive coping in advanced cancer patients. Methods: We prospectively enrolled advanced cancer patients evaluated in an outpatient Supportive Care Center and collected data on patient demographics, cancer diagnosis, morphine equivalent daily dose (MEDD), cigarette smoking status using Behavioral Risk Factor Surveillance System, symptom expression as measured by Edmonton Symptom Assessment Scale, Cut down/Annoyed/Guilty/Eye opener (CAGE alcoholism questionnaire), short form Screener and Opioid Assessment for Patients with Pain (SOAP-SF) survey, and Brief COPE Questionnaire. Results: Among399 patients, 195 (49%) were never smokers, 158 (40%) former smokers, and 46 (11%) current smokers. The most common malignancies were gastrointestinal (21.1%) and breast (19.5%). Never smokers were more likely to be female (p = 0.005). Current smokers expressed significantly higher pain scores at consultation than former or never smokers [median 7 vs. 6 vs. 5, respectively (p = 0.015)], increased MEDD (median 90 vs. 60 vs. 50, p = 0.002), and more likely to screen CAGE positive (33% vs. 24% vs. 8.7%, p < 0.0001). Compared with former and never smokers, current smokers were significantly more likely to cope with substance use (p = 0.02), denial (p = 0.007), and self-blame (< 0.0001), while both current and former smokers significantly more likely to use venting (p = 0.04). In addition, current smokers compared with former and never smokers were significantly more likely screen positive (≥ 4) on the SOAP-SF survey (74% vs. 13% vs. 9.3%, p = < 0.0001) and clinicians rated patients to be at higher risk for maladaptive coping (6.5% vs 2.5% vs. 1.5%, p = 0.003). Conclusions: In advanced cancer, current and former smokers were significantly more likely to have higher pain expression, CAGE positivity, and increased MEDD at consultation. In addition, a history of current or past tobacco use in advanced cancer patients was associated with increased risk of maladaptive coping.

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CEASE: A novel patient directed electronic smoking cessation platform for cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6584 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6584-6584

Author(s):

Jennifer M. Jones ◽

Geoffrey Liu ◽

Peter Selby ◽

Lawson Eng ◽

David Paul Goldstein ◽

...

Keyword(s):

Time Series ◽

Smoking Cessation ◽

Cancer Patients ◽

Tobacco Use ◽

Self Report ◽

Process Of Care ◽

Referral Rates ◽

Increased Risk ◽

Patient Reported ◽

The Impact

6584 Background: Continued smoking in cancer patients receiving treatment results in decreased efficacy, reduced survival, amd increased risk of recurrence. Despite ASCO and AACR policy statements, routine tobacco use screening and provision of smoking cessation treatment has not been widely implemented in the cancer setting. A paper-based tobacco use screening and clinician-dependent referral program for new ambulatory cancer patients was initiated at Princess Margaret Cancer Centre in 2013 resulting in moderate screen rates but low referral rates. In response, we developed and implemented a tailored patient directed electronic smoking cessation platform (CEASE) which included three elements:1) tobacco use assessment tool; 2) patient education on benefits of cessation; 3) a patient directed automatic referral system to smoking cessation programs. Methods: Interrupted time series design to examine the impact of CEASE on process of care (screening rates, referrals offered and accepted) and patient reported (quit attempts, smoking status, uptake of cessation programs) outcomes. Included 20 monthly intervals: 6 pre implementation (Apr-Sept 2015) (PRE), 8 gradual implementation across all tumour sites (Oct 2015-May 2016), and 6 postb implementation (Jun 2016-Nov 2016) (POST). A time series segmented linear regression was conducted to evaluate changes in process of care outcomes (excluding the implementation period). Pre-post self-report patient outcome data was also compared. Results: We assessed data from n = 3785 (PRE) and n = 4726 (POST) new patients. Screening rates increased from 44% using the paper-based approach to 65% with CEASE (p = 0.0019). Referrals offered to smokers who were willing to quit increased from 24% to 100% (p < 0.0001). Accepted referrals decreased from 45% to 26%; though the overall referral rate increased from 11% to 26% (p = 0.0001). The proportion of those using tobacco or attempting to quit did not differ at 3-months. However, engagement with the referral source increased from 4% to 62.5% (p < 0.001). Conclusions: CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services.

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Short-term Mortality Risks Among Oropharynx Cancer Patients by Human Papillomavirus Status

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2019.11.187 ◽

2020 ◽

Vol 106 (5) ◽

pp. 1163

Author(s):

Z.H. Fullerton ◽

S.S. Butler ◽

B.A. Mahal ◽

V. Muralidhar ◽

J.D. Schoenfeld ◽

...

Keyword(s):

Human Papillomavirus ◽

Cancer Patients ◽

Short Term ◽

Mortality Risks ◽

Oropharynx Cancer ◽

Short Term Mortality

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Comparison and impact of COVID-19 for patients with cancer: a survival analysis of fatality rate controlling for age, sex and cancer type

BMJ Health & Care Informatics ◽

10.1136/bmjhci-2021-100341 ◽

2021 ◽

Vol 28 (1) ◽

pp. e100341

Author(s):

Haiquan Li ◽

Edwin Baldwin ◽

Xiang Zhang ◽

Colleen Kenost ◽

Wenting Luo ◽

...

Keyword(s):

Cancer Patients ◽

Uterine Cancer ◽

Fold Increase ◽

Distant Metastases ◽

Cancer Type ◽

Fatality Rate ◽

Patients With Cancer ◽

Increased Risk ◽

Cancer Types ◽

Stratified Analysis

ObjectivesPrior research has reported an increased risk of fatality for patients with cancer, but most studies investigated the risk by comparing cancer to non-cancer patients among COVID-19 infections, where cancer might have contributed to the increased risk. This study is to understand COVID-19’s imposed HR of fatality while controlling for covariates, such as age, sex, metastasis status and cancer type.MethodsWe conducted survival analyses of 4606 cancer patients with COVID-19 test results from 16 March to 11 October 2020 in UK Biobank and estimated the overall HR of fatality with and without COVID-19 infection. We also examined the HRs of 13 specific cancer types with at least 100 patients using a stratified analysis.ResultsCOVID-19 resulted in an overall HR of 7.76 (95% CI 5.78 to 10.40, p<10−10) by following 4606 patients with cancer for 21 days after the tests. The HR varied among cancer type, with over a 10-fold increase in fatality rate (false discovery rate ≤0.02) for melanoma, haematological malignancies, uterine cancer and kidney cancer. Although COVID-19 imposed a higher risk for localised versus distant metastasis cancers, those of distant metastases yielded higher overall fatality rates due to their multiplicative effects.DiscussionThe results confirmed prior reports for the increased risk of fatality for patients with COVID-19 plus hematological malignancies and demonstrated similar findings of COVID-19 on melanoma, uterine, and kidney cancers.ConclusionThe results highlight the heightened risk that COVID-19 imposes on localised and haematological cancer patients and the necessity to vaccinate uninfected patients with cancer promptly, particularly for the cancer types most influenced by COVID-19. Results also suggest the importance of timely care for patients with localised cancer, whether they are infected by COVID-19 or not.

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Bone health in prostate cancer patients: A survivorship issue requiring intervention.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.247 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 247-247

Author(s):

George A. Dawson ◽

Anne Greener ◽

Dalila Reyes-Dawson ◽

Sheetal Malhotra ◽

Sarah Weinbrom ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Vitamin D ◽

Alcohol Abuse ◽

Cancer Patients ◽

Tobacco Use ◽

Bone Disease ◽

Bone Health ◽

Increased Risk ◽

Vitamin D Levels

247 Background: In general, men are not routinely screened for bone health. Prostate cancer patients are at an increased risk because of treatment with androgen deprivation therapy (ADT). Unlike other patients diagnosed with a malignancy, they may survive a long time. Some risk factors include inadequate calcium, vitamin D deficiency, tobacco use and alcohol abuse. We implemented a pre-ADT program to mitigate the effects of ADT on bone health. This study evaluates the pre-existing risk factors and bone health by baseline DEXA scans pre-ADT initiation. Methods: We completed a chart review of 182 veterans referred to Radiation Oncology for curative treatment of prostate cancer from 2009 to 2013. Of those, 160 patients underwent baseline DEXA scans. Clinical variables analyzed were demographics, tobacco and alcohol use, vitamin D levels, incidence of AODM (adult onset diabetes mellitus), and calcium or vitamin D intervention. Descriptive statistics and bivariate analysis including Chi Square tests and odds ratios were carried out. Results: The mean age of the study participants was 66.6 years (range 47-82.8 years). Baseline DEXA scans were abnormal in 63% of patients, showing osteoporosis and/or osteopenia. Vitamin D levels were abnormal in 61% of patients- 26% of whom had normal DEXA scans. Twenty percent had a history of alcohol abuse, and 56% used tobacco; 33% had AODM. Smokers with an abnormal Vitamin D level were at increased risk of bone disease as compared to non smokers (OR 3.23, 95% CI 1.35-7.69 p<0.01). Variables significantly impacting bone health were age (OR 1.087, p=0.012, 95% CI 1.018-1.161) and Tobacco use (OR 0.424, p=0.045, 95% CI 0.183-0.980). Almost 90% of the patients in this study had intermediate risk prostate cancer with an expected cancer specific survival of 85 to 90% at 5 to 10 years. Conclusions: Pre-ADT screening confirms the risk of underlying bone disease in this veteran population with an expectation of long term survival. Guidelines for treatment and prevention of bone disease should be implemented in all patients over age of 50. Particular attention should be paid to patients who underwent ADT. This can affect the quality of life in this group of cancer survivors.

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