Citations

Abstract Purpose: This multicenter, single-arm, phase II trial evaluated the safety and efficacy of cabazitaxel and carboplatin followed by abiraterone, plus androgen deprivation therapy (ADT), in patients with high-volume metastatic castration-sensitive prostate cancer (mCSPC). Patients and Methods: Eligible patients had high-volume mCSPC and ≤3 months of prior ADT. Patients received six 21-day cycles of cabazitaxel (20 mg/m2) and carboplatin (AUC 4) with continuous ADT, followed by maintenance abiraterone (1,000 mg daily) and prednisone (5 mg daily). The primary endpoint was the proportion of patients free of prostate-specific antigen (PSA) or radiographic progression at 12 months. Secondary endpoints included complete PSA response (≤0.2 ng/mL), objective response, progression-free survival (PFS), and safety. Overall survival (OS) was also reported. Results: Sixty-one participants were enrolled at eight sites. The median age was 64 years, median baseline PSA was 6.6 ng/mL (0.07–745.7 ng/mL), 73.3% had Gleason grade group 5, 69.5% had 10 or more metastases, and 19.6% had a homologous recombination repair (HRR) mutation. PSA PFS at 12 months was 84.6% [95% confidence interval (CI), 72.5%–91.7%], and OS at 12 months was 94.8% (84.7%–98.3%). Complete PSA response was 66.7%, and complete objective response was 30.7%. Contrary to our hypothesis, relative to HRR wild-type patients, HRR-mutated patients (19.6%) had numerically fewer complete PSA responses (33.3% vs. 70.3%) and inferior PFS (HR, 2.43; 95% CI, 0.93–6.39). Common side effects of this quadruplet regimen included fatigue, nausea, and diarrhea. Conclusions: Cabazitaxel and carboplatin followed by abiraterone, together with ADT, were feasible, safe, and efficacious in patients with high-volume mCSPC and warrant further study in larger randomized trials.

Epilepsy-related mortality, including Sudden Unexpected Death in Epilepsy and suicide, is a crucial topic within the interdisciplinary scope of caring for people with epilepsy (PWE). This review highlights best practices that emphasize proactive education for patients, caregivers, and communities, as well as evidence-based strategies and interventions for seizure management aimed at reducing mortality risk. It further underscores the essential contribution of the multidisciplinary care team in managing epilepsy-related mortality, highlighting considerations such as comorbid behavioral health conditions, challenges with treatment adherence, the use of the ketogenic diet, and the impact of social determinants of health and health disparities on historically marginalized populations. The authors provide actionable insights to address these challenges and barriers and enhance the outcomes and quality of life for PWE and their loved ones.

ABSTRACT Background Postoperative venous thromboembolism (VTE) is a major source of morbidity and mortality. Real‐time risk stratification for VTE is important to guide measures for thromboprophylaxis. We sought to compare the discrimination of three VTE predictive systems in classifying 90‐day postoperative VTE among cancer patients undergoing pancreas and liver surgery using administrative data. Methods We conducted a retrospective analysis of the 2001–2015 SEER‐Medicare data for patients with newly diagnosed primary pancreatic or liver malignancies who underwent surgery. The primary outcome was 90‐day postoperative VTE (including deep venous thrombosis and pulmonary embolism [PE]). We used the 2001–2010 dataset to create a new VTE predictive model using multivariable logistic regression. We then compared the discrimination of the Caprini score (adapted for claims data), the Elixhauser comorbidity score, and the new predictive model using the 2011–2015 dataset. Results Our sample included 15 479 patients (12 005 pancreas and 3474 liver surgery). Median age was 74 years (interquartile range: 69–78) and 7619 were female (49%). The overall incidence of 90‐day VTE was 10.0% (90‐day PE: 4.5%). The new VTE model included age, race, history of VTE, cancer stage, preoperative chemotherapy, and Elixhauser score. The discrimination of all predictive models was modest for both VTE ( c ‐statistic 63.0%, 59.4%, and 67.8%) and PE (61.5%, 59.7%, 65.6% for Caprini, Elixhauser, and new score respectively). Conclusions The existing tools for predicting postoperative VTE show poor performance using claims data. Future research should supplement administrative data with additional data sources to better predict patients at high risk for postoperative VTE.

Background Medication nonadherence has been associated with poor outcomes in transplant recipients yet identifying these behaviors pre-transplant remains challenging. The simplified medication adherence questionnaire (SMAQ) is a brief, reliable instrument to assess medication adherence. The aim of this study was to perform SMAQ testing on thoracic organ candidates and examine correlations between these scores and individual patient factors predicting medication nonadherence. Methods Consenting waitlisted lung, heart, and heart-lung transplant candidates from six thoracic transplant centers were mailed a survey that included demographic information and the Simplified Medication Adherence Questionnaire (SMAQ). Univariate logistic regression analysis was performed to assess association between pre-transplant medication adherence and demographic characteristics, psychosocial factors, and mortality. Results Among 298 participants, 60.7% were medication nonadherent. Nonadherence was associated with some college education (OR: 1.73; CI: 1.06, 2.81), lower positive affect (OR: 0.95; CI: 0.92, 0.99), and higher uncertainty (OR: 1.02; CI: 1.01, 1.04). Higher positivity ratio predicted adherence. Conclusion Identifiable patient-specific characteristics associated with medication nonadherence can be screened for during thoracic transplant evaluation. Interventions aimed at improving these factors during the pre-transplant period may improve clinical post-transplant outcomes, however, larger studies are needed to validate these findings.

Background: Sharing of family cancer history (FCH) in Black families has been documented as lower than in other populations. There has been limited exploration as to the factors and circumstances that facilitate or hinder FCH communication in these communities. Objective: To explore intersecting factors influencing FCH discussion in Black families with a breast or ovarian cancer diagnosis. Interventions/Methods: We conducted qualitative interviews with socioeconomically diverse breast and ovarian cancer patients or family members. Interviews were thematically analyzed for iterative themes on FCH. Results: A total of 107 participants completed an interview. Discussion of FCH was reported as being influenced by several factors, including relationship and family dynamics, personality of family members, involvement in caregiving and support, and perceived importance and responsibility of communicating FCH for cancer prevention. Participants also described how inequitable access to medical care influenced disclosure of a cancer diagnosis, and socioeconomic concerns can influence family communication and documentation of FCH in the medical record. Conclusion: Our analysis indicates that disclosure of FCH is improving over time as access to healthcare has increased for Black families. Implications for Oncology Nursing Practice: Strategies to collect FCH outside of clinic settings, such as digital tools or chatbots, should be considered for increased capture of cancer pedigrees in families where discussion is limited. Patient education on options for preventative care and communications tools may assist patients with family discussions, although patients with adverse social determinants of health are likely to experience additional barriers to genetic screening based on FCH alone.

Purpose Survivors of critical illness often acquire significant physical, cognitive, and psychological burdens following their intensive care unit (ICU) stay, termed “post-intensive care syndrome” (PICS). Screening for PICS is generally not performed outside of research settings largely due to lack of a simple assessment tool and time constraints. Methods This was a prospective cohort study at a single academic medical center in the USA. We included adults (18 years or older) who spent greater than 48 h in any ICU within the medical center. Following transfer out of the ICU and at 3 months, psychological, cognitive, and physical functioning were assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, Montreal Cognitive Assessment-blind, and Barthel Index. We compared these validated questionnaires to a brief, 15-item PICS screening tool (5 questions/domain) that was developed by our multidisciplinary study team and administered to study participants after ICU discharge to general care. The primary objectives of this study were to assess the ability of validated screening tools administered at ICU discharge to predict PICS at 3 months and develop a novel screening tool for identifying patients at risk of PICS. Major Findings 191 participants completed the initial questionnaire, and 109 (56%) completed the 3-month follow-up. PICS tool scores were compared to 3-month follow-up data from validated questionnaires to evaluate predictive performance. Overall, the screening tool weakly-to-moderately correlated with continuous outcomes of the validated measures at 3-month follow-up. When evaluating sensitivity and specificity for individual domains, the screening tool had an area under curve of >0.7 for all three domains, indicating moderate-to-good sensitivity and specificity. Conclusions We developed a brief PICS screening tool that is feasible to use without prior training that modestly predicted the development of PICS following ICU stay.

Objective: To survey critical areas of variation in published research methodology with a primary aim of highlighting fundamental aspects that contribute to ongoing controversy surrounding optimal management of patients with sporadic vestibular schwannoma. Interventions: Observation, stereotactic radiosurgery (SRS), and microsurgery. Main outcome measures: Variation in reported outcomes surrounding facial function, useful hearing, tumor pseudoprogression following SRS, and tumor growth/natural history. Results: Published research defines “good” post-treatment facial function as anything ranging from HB I, ≤HB II, to ≤HB III. While most studies define serviceable hearing as AAO Class A/B, others include Class C in published post-treatment hearing preservation results; meanwhile, patients report their greatest decrement in quality-of-life at a threshold around 75% in word recognition scores. Heterogeneously defined as post-SRS tumor growth 6 months after SRS to 5 years after SRS, the reported incidence of tumor pseudoprogression ranges from 7% to 77% within the published literature. Natural history studies that employ linear tumor measurements consistently suggest most tumors do not grow following diagnosis, whereas volumetric studies of natural history suggest the exact opposite is true. Limited follow-up and absent time-to-event analyses undermine many outcomes surrounding vestibular schwannoma that are inherently time-dependent. Conclusions: Disparate definitions used in vestibular schwannoma research beget variable outcome reporting and confuse interpretation of optimal management, particularly for the increasingly common scenario of a small tumor in a minimally symptomatic patient. Progress towards optimizing management requires re-evaluation and alignment on key outcome measures to improve consistency in reporting with renewed emphasis on clinically significant, patient-driven outcomes that often exceed the thresholds most frequently studied to date.