A population-based study of medical cannabis utilization in patients with cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 124-124
Author(s):  
Safiya Karim ◽  
Jingyu Bu ◽  
Ed Jess ◽  
Winson Y. Cheung ◽  
Marc Kerba
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Systemic Therapy ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Regulatory Framework ◽  
Medical Cannabis ◽  
Logistic Regression Models ◽  
Utilization Patterns ◽  
One Year

124 Background: Between 2014 and 2018, access to cannabis for medical purposes was regulated by Health Canada. Surveys have demonstrated that cancer patients use cannabis to manage symptoms and side effects. Medical cannabis utilization patterns in cancer patients under Canada’s regulatory framework have not been well-described. We aimed to determine the proportion of cancer patients who used medical cannabis, timing of use in relation to cancer treatment and sociodemographic factors predicting use. Methods: The Alberta Cancer Registry was used to identify all patients age ≥ 18 diagnosed with invasive cancer in the province from April 01, 2014 to December 31, 2016. These cases were linked to records from the College of Physicians and Surgeons of Alberta database which collects data on patients who received an authorization for medical cannabis. Authorization was used as a surrogate for medical cannabis utilization. Univariate and multivariate logistic regression models were constructed to determine factors associated with medical cannabis utilization. Results: We identified 41,889 patients between April 1, 2014 and December 31, 2016. Median age at cancer diagnosis was 65 and 50% were female. Among these patients, 1,070 (2.5%) used medical cannabis. Of these patients, 541 (51%) used medical cannabis within 1 year of diagnosis, 248 (52%) within one year of the start of systemic therapy and 128 (41%) within one year of the start of radiation therapy. On multivariate analysis, patients aged 18-29 (OR 12.4, 95% CI 7.8-19.7) and those receiving systemic therapy (OR 2.0, 95% CI 1.7-2.4) were more likely to use medical cannabis (p < 0.001). There were 171 unique physicians who authorized medical cannabis of which only 3.5% (6/171) were oncologists. Conclusions: A small proportion of cancer patients used medical cannabis under Health Canada’s regulatory framework. Utilization was associated with a cancer diagnosis and receiving treatment. Younger patients and those undergoing systemic treatment were predictors of medical cannabis use. Further study is required to understand utilization patterns after cannabis legalization and how to incorporate these findings into patient-centered cancer care.

A population-based study of medical cannabis utilization in patients with cancer in the pre-legalization era.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18297-e18297
Author(s):  
Safiya Karim ◽  
Jingyu Bu ◽  
Ed Jess ◽  
Winson Y. Cheung ◽  
Marc Kerba
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Systemic Therapy ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Regulatory Framework ◽  
Medical Cannabis ◽  
Logistic Regression Models ◽  
Utilization Patterns ◽  
One Year

e18297 Background: Between April 1, 2014 and October 17, 2018, access to cannabis for medical purposes was regulated by Health Canada. Surveys have demonstrated that cancer patients use cannabis to manage symptoms and side effects. However, medical cannabis utilization patterns in cancer patients under Health Canada’s regulatory framework have not been well-described. We aimed to determine the proportion of cancer patients who used medical cannabis, timing of use in relation to cancer treatment and sociodemographic factors predicting use in a large Canadian province. Methods: The Alberta Cancer Registry was used to identify all patients age ≥ 18 diagnosed with invasive cancer in the province from April 01, 2014 to December 31, 2016. These cases were linked to records from the College of Physicians and Surgeons of Alberta database which collects data on patients who received authorization to access medical cannabis as well as on physicians that provided the authorization. Authorization was used as a surrogate for medical cannabis utilization. Univariate and multivariate logistic regression models were constructed to determine factors associated with medical cannabis utilization. Results: We identified 41,889 patients between April 1, 2014 and December 31, 2016. Median age at cancer diagnosis was 65 and 50% were female. Among these patients, 1,070 (2.5%) used medical cannabis. Of these patients, 541 (51%) used medical cannabis within 1 year of diagnosis, 248 (52%) within one year of the start of systemic therapy and 128 (41%) within one year of the start of radiation therapy. On multivariate analysis, patients aged 18-29 (OR 12.4, 95% CI 7.8-19.7) and those receiving systemic therapy (OR 2.0, 95% CI 1.7-2.4) were more likely to use medical cannabis (p < 0.001). There were 171 unique physicians who authorized medical cannabis of which only 3.5% (6/171) were oncologists. Conclusions: A small proportion of cancer patients used medical cannabis under Health Canada’s regulatory framework. Utilization was associated with a cancer diagnosis and receiving treatment. Younger patients and those undergoing systemic treatment were predictors of medical cannabis use. Further study is required to understand utilization patterns after cannabis legalization and how to incorporate these findings into patient-centered cancer care.

scholarly journals Distributions of Usage and the Costs of Conventional Medicine and Traditional Chinese Medicine for Lung Cancer Patients in Taiwan

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Yueh-Hsiang Liao ◽  
Jaung-Geng Lin ◽  
Cheng-Chieh Lin ◽  
Tsai-Chung Li
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Conventional Medicine ◽  
Outpatient Services ◽  
Lung Cancer Patients ◽  
Lung Cancer Diagnosis ◽  
Before And After ◽  
Utilization Patterns ◽  
One Year

Background. This study aims to analyze the utilization patterns of patients with lung cancer stratified by surgery status.Methods. A retrospective cohort study was conducted from 1996 to 2010 by using the Longitudinal Health Insurance Database 2005.Results. Among the 7,677 lung cancer patients, 230 (31.17%) and 1,826 (26.32%) who have and have not undergone surgery have used TCM outpatient services, respectively. For lung cancer patients who have not undergone surgery, patients who are aged 70 years and older, males, occupational members, and farmers and fishermen are less likely to avail of TCM services. For lung cancer patients who have undergone surgery, the likelihood of TCM users is higher in residents who used TCM one year prior to lung cancer diagnosis and in patients with insurance amounts ranging from ≥NT$60,000. The total amount paid per visit for WM is higher than that for one year of TCM outpatient care before and after lung cancer diagnosis.Conclusion. The factors associated with TCM use varied according to surgery status. The costs of insurance covering TCM were consistently lower than those covering WM for lung cancer patients. These findings would be useful for health policy makers who are considering TCM and WM integration.

Impact of cancer on the risk of unplanned 30-day readmissions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6581-6581
Author(s):  
Alexander Qian ◽  
Edmund Qiao ◽  
Vinit Nalawade ◽  
Nikhil V. Kotha ◽  
Rohith S. Voora ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Hospital Admissions ◽  
Reference Group ◽  
Cancer Site ◽  
Cancer Type ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Initial Hospitalization ◽  
The Impact

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.

Disparities in end-of-life inpatient care received by patients with metastatic cancer, 2010 to 2017.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12008-12008
Author(s):  
Stephanie Deeb ◽  
Fumiko Chino ◽  
Lisa Diamond ◽  
Anna Tao ◽  
Abraham Aragones ◽  
...  
Keyword(s):  
End Of Life ◽  
Systemic Therapy ◽  
Minority Groups ◽  
Metastatic Cancer ◽  
Cohort Analysis ◽  
Population Based ◽  
Teaching Hospitals ◽  
Patients Âgés ◽  
Logistic Regression Models ◽  
Total Charges

12008 Background: Many patients with metastatic cancer receive high-cost, low-value care near the end of life. We examined interventions during terminal hospitalizations for patients with metastatic cancer to identify those with high likelihood of receiving futile care. Methods: A retrospective population-based cohort analysis of encounter-level data from the National Inpatient Sample was conducted, including records from 2010-2017 for patients ages ≥18 with metastatic cancer who died during hospitalization. We fit multivariable binomial logistic regression models to examine associations between exposures, including patient demographics, and the main outcome of aggressive, low-value, and high-cost medical care (Table). Results: Out of 321,898 hospitalizations among patients with metastatic cancer, 21,335 (6.6%) were terminal. Of these, 65.9% were white, 14.1% Black, 7.5% Hispanic, 58.2% were insured by Medicare or Medicaid, and 33.2% were privately insured. Overall, 63.2% were admitted from the Emergency Department (ED), 4.6% received systemic therapy, and 19.2% received invasive ventilation. Median total charges were $43,681. Black patients and publicly insured patients had higher likelihoods of admission from the ED and receiving ventilation, as well as higher total charges; similar trends emerged among patients of Asian race and Hispanic ethnicity. Patients hospitalized at urban teaching hospitals had higher likelihoods of receiving systemic therapy, ventilation, and incurring higher total charges (Table). Conclusions: Metastatic cancer patients of racial and ethnic minority groups and those with Medicare or Medicaid were more likely to receive low-value, aggressive interventions at the end of life. Further studies are needed to determine the underlying causes of these disparities in order to implement prospective interventions and advance appropriate end-of-life care.[Table: see text]

scholarly journals Trajectories of Cognitive Function Prior to Cancer Diagnosis: A Population-Based Study

2019 ◽  
Vol 112 (5) ◽  
pp. 480-488 ◽  
Author(s):  
Kimberly D van der Willik ◽  
Michael Hauptmann ◽  
Katarzyna Jóźwiak ◽  
Elisabeth J Vinke ◽  
Rikje Ruiter ◽  
...  
Keyword(s):  
Nervous System ◽  
Cognitive Function ◽  
Confidence Interval ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Cognitive Tests ◽  
Control Subjects ◽  
Nervous System Cancer

Abstract Background An emerging body of research suggests that noncentral nervous system cancer may negatively impact the brain apart from effects of cancer treatment. However, studies assessing cognitive function in newly diagnosed cancer patients cannot exclude selection bias and psychological effects of cancer diagnosis. To overcome these limitations, we investigated trajectories of cognitive function of patients before cancer diagnosis. Methods Between 1989 and 2013, a total of 2059 participants from the population-based Rotterdam Study were diagnosed with noncentral nervous system cancer. Cognitive assessments were performed every 3 to 5 years using a neuropsychological battery. The general cognitive factor was composed of individual cognitive tests to assess global cognition. Using linear mixed models, we compared change in cognitive function of cancer case patients before diagnosis with cognitive change of age-matched cancer-free control subjects (1:2). In addition, we performed sensitivity analyses by discarding assessments of control subjects 5 years before the end of follow-up to exclude effects from potential undiagnosed cancer. All statistical tests were two-sided. Results The Word Learning Test immediate recall declined faster among case patients than among control subjects (−0.05, 95% confidence interval = −0.09 to −0.01 vs 0.01, 95% confidence interval = −0.01 to 0.03; P for difference = .003). However, this difference was not statistically significant in sensitivity analyses. Furthermore, no statistically significant differences were observed in change of other individual cognitive tests and of the general cognitive factor. Conclusions In this study, we evaluated cognitive function in a large group of cancer patients prior to diagnosis, thereby excluding the psychological impact of cancer diagnosis and biased patient selection. In contrast to previous studies shortly after cancer diagnosis, we found no difference in change of cognitive function between cancer patients and control subjects.

Change in Working Time in a Population-Based Cohort of Patients With Breast Cancer

2012 ◽  
Vol 30 (23) ◽  
pp. 2853-2860 ◽  
Author(s):  
Marie Høyer ◽  
Karin Nordin ◽  
Johan Ahlgren ◽  
Leif Bergkvist ◽  
Mats Lambe ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Diagnosis ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Working Time ◽  
Full Time ◽  
Logistic Regression Models ◽  
Work Limitations ◽  
Quality Register

Purpose We examined changes in working time 16 months after a breast cancer diagnosis and identified factors associated with job discontinuation and/or decreased working time. Patients and Methods This was a population-based cohort study with 735 patients identified in the Regional Breast Cancer Quality Register of Central Sweden. The study sample consisted of 505 women (age < 63 years at diagnosis) who completed questionnaires at baseline and at follow-up (on average 4 and 16 months after diagnosis, respectively). Clinical register data and questionnaire data on sociodemographic factors were obtained at baseline. Self-reported work-related data were obtained at follow-up. Odds ratios were estimated by using logistic regression models. Results Compared with prediagnosis working time, 72% reported no change in working time, 2% reported an increase, 15% reported a decrease, and 11% did not work at follow-up. Chemotherapy increased the likelihood (odds ratio [OR], 2.45; 95% CI, 1.38 to 4.34) of job discontinuation/decreased working time. Among chemotherapy recipients, associated factors included full-time work prediagnosis (OR, 3.25; 95% CI, 1.51 to 7.01), cancer-related work limitations (OR, 5.26; 95% CI, 2.30 to 12.03), and less value attached to work (OR, 3.69; 95% CI, 1.80 to 7.54). In the nonchemotherapy group, older age (OR, 1.09; 95% CI, 1.02 to 1.17) and less value attached to work (OR, 5.00; 95% CI, 2.01 to 12.45) were associated with the outcome. Conclusion The majority of women treated for breast cancer returned to their prediagnosis working time. Chemotherapy and cancer-related work limitations are important factors to take into account in identifying women in need of support. Moreover, it is important to consider the woman's own valuation of labor market participation.

Incidence of acute kidney injury in cancer patients: A population-based cohort study in Denmark

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9570-9570
Author(s):  
C. F. Christiansen ◽  
M. B. Johansen ◽  
S. Christensen ◽  
W. Langeberg ◽  
J. P. Fryzek ◽  
...  
Keyword(s):  
At Risk ◽  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Kidney Injury ◽  
Population Based ◽  
First Year ◽  
Increased Risk

9570 Background: Although cancer patients may be at increased risk for acute kidney injury (AKI), which could then reduce their likelihood of receiving optimal therapeutic management and supportive care, the occurrence of AKI among newly diagnosed cancer patients has not been well-described. Therefore, we examined the incidence of AKI within the first year after cancer diagnosis to estimate the magnitude of this risk and better understand which patients are at greatest risk. Methods: Using the population-based Danish Cancer Registry, we conducted a retrospective cohort study of 4,427 men and women from North Jutland, Denmark (population 500,000) diagnosed with cancer from 2002 to 2003 (non-melanoma skin cancer excluded). AKI was defined according to the Risk/ Injury/ Failure/ Loss/ End-stage-renal-disease (RIFLE) criteria. We included Risk or worse: at least a 1.5 times increase in serum creatinine (sCr) from baseline. SCr levels were obtained from the Regional Laboratory Database, which collects all biochemical analyses for hospital laboratories. Baseline sCr was defined as the lowest sCr in the year before cancer diagnosis. We compared this value to the highest sCr on record during the first year following cancer diagnosis to identify those who experienced an AKI. Results: Median age for the cohort was 68.6 years, 50.9% were men, and the most common cancer sites were lung (14.2%), breast (13.7%), prostate (9.8%), colon (9.6%), rectum (5.1%), and bladder (6.3%). During the first year, 973 (22.0%) members of the cohort experienced an AKI, corresponding to an overall incidence rate of 326 per 1,000 person-years (95% confidence interval (CI) 306–347). Incidence was highest among patients aged 80 years or older (531 per 1,000 person-years, 95% CI 464–606) and in those with cancer of the liver (1,221, 95%CI 676–2,205), pancreas (1,472, 95%CI 1,130–1,917), or kidney (1,254, 95%CI 974–1,616), or with multiple myeloma (855, 95%CI 538–1,356). Conclusions: To protect against AKI, we must first identify those at risk. Our study showed that over 20% of cancer patients may experience acute kidney injury in the first year after diagnosis. Older patients and those with cancer of the liver, pancreas, or kidney, or with multiple myeloma are especially at risk for AKI. [Table: see text]

scholarly journals Pregnancy-associated breast cancer: nationwide Dutch study confirms a discriminatory aggressive histopathologic profile

2021 ◽  
Vol 186 (3) ◽  
pp. 699-704
Author(s):  
B. B. M. Suelmann ◽  
C. van Dooijeweert ◽  
E. van der Wall ◽  
S. Linn ◽  
P. J. van Diest
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Large Population ◽  
Population Based ◽  
Intrinsic Subtype ◽  
Receptor Expression ◽  
Breast Cancers ◽  
Breast Cancer Patients ◽  
Dutch Study ◽  
One Year

Abstract Purpose Breast cancer is the most common type of malignancy in pregnant women, occurring approximately once in every 3000 pregnancies. Pregnancy-associated breast cancer (PABC) is commonly defined as breast cancer diagnosed during or within one year after pregnancy, and it accounts for up to 6.9% of all breast cancers in women younger than 45 years old. Whether these cancers arise before or during pregnancy, and whether they are stimulated by the high hormonal environment of pregnancy, is currently unknown. This study assesses the histopathological profile of PABC in a large Dutch population-based cohort. Methods We identified 744 patients with PABC (in this cohort defined as breast cancer diagnosed during or within 6 months after pregnancy) diagnosed between 1988 and 2019, in the nationwide Dutch Pathology Registry (PALGA). An age-matched PALGA cohort of unselected breast cancer patients (≤ 45 years), diagnosed between 2013 and 2016, was used as a control. Histopathologic features of both cohorts were compared. Results The median age of PABC patients was 34.3 years old (range 19–45 years) and most breast cancers were diagnosed during pregnancy (74.2%). As compared to age-matched controls, PABC patients had tumors of higher Bloom–Richardson grade (grade I: 1.5% vs. 12.4%, grade II: 16.9% vs. 31.3%, grade III: 80.3% vs. 39.5%, p < 0.0001). Furthermore, estrogen (ER)- and progesterone (PR)-receptor expression was less frequently reported positive (ER: 38.9% vs. 68.2% and PR: 33.9% vs. 59.0%, p < 0.0001), while a higher percentage of PABC tumors overexpressed HER2 (20.0% vs. 10.0%, p < 0.0001). The most observed intrinsic subtype in PABC was triple-negative breast cancer (38.3% vs. 22.0%, p < 0.0001), whereas hormone-driven cancers were significantly less diagnosed (37.9% vs. 67.3%, p < 0.0001). Conclusion This study, based on a large population-based cohort of 744 PABC Dutch patients, underlines the more aggressive histopathologic profile compared to age-matched breast cancer patients ≤ 45 years. Further in-depth genetic analysis will be performed to unravel the origin of this discriminating phenotype. It definitely calls for timely detection and optimal treatment of this small but delicate subgroup of breast cancer patients.

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