Jatoi, Aminah

Hiccups occur in 15-40% of cancer patients, but previous research has not sought the perspectives of cancer healthcare providers. The objective of this research is to report on United States cancer healthcare providers’ awareness of their patients’ hiccups and these healthcare providers' perceived need for further palliation options. A survey was developed and then distributed throughout the United States via email to cancer healthcare providers; results are reported descriptively. Six hundred eighty-four cancer healthcare providers completed 2 eligibility screening questions which required them to have cared for an adequate number of patients (> 10 in the past 6 months) with “clinically significant” hiccups (defined as hiccups that persisted for >48 hours or occurred from cancer or from cancer care). Of 113 eligible healthcare providers, 90 completed the survey. Healthcare providers described hiccups as associated with stress/anxiety, fatigue, sleep problems, and decreased work/school productivity. In 49% of patients, healthcare providers initially prescribed medications (commonly chlorpromazine or baclofen); 18% expressed dissatisfaction with current palliation. Proffered comments included, “When current therapies do not work, it can be very demoralizing to our patients; ” and “…my biggest complaint is that current treatments also come with their own side effects which can be quite severe.” Discordance appears to exist between the percentage of cancer patients with hiccups and the percentage of cancer healthcare providers with awareness of their patients’ hiccups. Nonetheless, healthcare providers described notable hiccup-associated symptoms in their patients and a need for more palliative options.

Abstract PurposeHistorically, reported incidence of brain metastasis secondary to esophageal carcinoma is low. We sought to determine the incidence of brain metastasis in a contemporary cohort of patients with carcinoma of the esophagus.MethodsData from patients with localized esophageal carcinoma prospectively enrolled on three curative intent Alliance treatment trials (N0044, N0342, N044E) were reviewed including time to diagnosis of first progression event (brain versus other site) and overall survival.ResultsEighty-five patients comprised the cohort of which 85% were male and 86% had adenocarcinoma primary tumor histology. Thirty-nine of the 85 patients had documented progression to any site, and of those, brain metastasis occurred as the first event in 15% (6 of 39). Adenocarcinoma was the primary histology in all 6 patients and tumor grade was high (3 or 4) in 5 of the 6 patients (one not documented). Median time to brain metastasis (9.6 months) versus non-brain metastasis (12.4 months) and median survival after first progression (5.4 months versus 8.1 months, respectively) were not statistically different.ConclusionIn this prospective cohort of patients with esophageal carcinoma, those with high grade adenocarcinoma appear to have a higher incidence of brain metastasis than historically reported. The pattern of brain metastases corroborates recent findings in terms of incidence, predominance of adenocarcinoma primary tumor histology, timing after diagnosis, and overall survival. Further study to confirm these findings, as well as the value of baseline, restaging and follow-up cranial imaging for brain metastasis is recommended.ClinicalTrials.gov Identifiers: NCT00022139 (NCCTG N0044); NCT00100945 (NCCTG N0342), and NCT00100945 (NCCTG N044E)

Rural patients are often underrepresented in cancer clinical trials. This is a secondary analysis of a study that tested short (2000 word) versus long (6000 word) consent forms with a focus on rurality. Among 240 patients, 89 (37%) were rural. Seventy-one (80%) rural and 117 (77%) nonrural patients signed a consent form of any length ( P = .68). Forty-one of 47 (87%) rural patients signed a short consent form; in contrast, 30 of 42 (71%) signed a long form. These trends suggest rural patients are more likely to sign short consent forms. Further study is indicated.

6513 Background: Pt recruitment receives well-deserved attention, but pt retention is also important for trial interpretability and generalizability. We report on trends and predictive factors for withdrawal of pt consent, defined as pt cessation from trial participation for reasons not mandated in the protocol. Methods: Alliance phase II/III trials that enrolled pts during 2013 – 2019 were included. All pts had ≥2 years (yrs) of follow-up. Primary outcome was withdrawn consent (yes; no) within 2 yrs of enrollment. Pt factors included year of enrollment, age, race, ethnicity, and gender. Trial factors included randomization, use of placebo, and use of radiation. Univariable (Uni) and full multivariable (MV) logistic regression models (including all factors from Uni setting) with a Bonferroni p-value correction (p <.004 considered significant) were used. Results: Median age was 62 yrs, with 67% female, 82% White, 9% Black or African American, and 7% Hispanic. 52% of trials were phase II, 5% II/III and 43% III. Common (> 10%) trial categories included 22% experimental therapeutics or rare tumors, 12% gastrointestinal, 12% genitourinary, 12% neuro-oncology and 10% symptom intervention. 78% of trials were randomized, 22% placebo-controlled and 14% used radiation. 1060 (9%) pts withdrew consent within 2 yr of enrollment (range,5.7% -9.8%) during 2013-2019. In Uni models, all trial and pt factors significantly predicted pt withdrawal except age, race, and gender (See table). In MV models, pts of Hispanic origin, and >75 yrs were more likely to withdraw. Trials using radiation had less likelihood of pt withdrawal. Placebo-controlled randomized trials had higher likelihood of withdrawal. Conclusions: Both trial and pt factors contribute to higher rates of pt withdrawal from clinical trials. Understanding these factors will enable investigators to focus on pt education and optimization of trial design to improve pt retention and the overall clinical trial plan. Support: U10CA180821, U10CA180882 [Table: see text]

Objective This qualitative study sought to learn from patients with cancer -- in their own words -- about anxiety associated with medical testing. Methods Patients with cancer or a history of cancer were recruited from an oncology clinic. After oral consent, each was interviewed in person. A semi-structured interview guide was used to help focus the interviews. Interviews were then recorded, transcribed, and analyzed with rigorous qualitative methods. Results Twenty patients are the focus of this report, which highlights 2 main themes from the data. The first is that anxiety related to medical testing is a real entity. Although not all patients experienced it, those who did described it as such (“I was a little apprehensive.” “It’s the anticipation.” “I don’t think it bothers me until I get near the time for testing.”). The second theme focused on coping. Patients offered insight on how to cope (“So I just deal with it and work.” “And don’t let myself sink into a pity pot ….” “See your scan as a tool instead of … instead of um … a death sentence, I suppose.”) Conclusion In patients with cancer, the anxiety from medical testing is real, could perhaps be mitigated by sharing coping methods from patient to patient, and merits further study.

Background: Epidermal growth factor receptor (EGFR) inhibitors cause cutaneous toxicity in over 90% of patients. Conceivably, healthcare providers could overlook such toxicity in African American/Black patients because of a darker complexion. This qualitative study sought to learn about such cutaneous signs and symptoms and, if present, to report them in patients’ own words. Methods: Any patient who self-identified as African American/Black and who had been prescribed an EGFR inhibitor was eligible. The current report focuses on patients’ responses to the following question, “What have you noticed since starting your cancer treatment (the EGFR inhibitor), any particular symptoms or reactions, positive or negative?” All interview data were audio-recorded, transcribed, and then independently coded and analyzed by two investigators. Results: Fifteen patients are the focus of this report, and all described cutaneous toxicity. Patients appeared troubled by the cosmetic aspect of these drug-induced skin changes, including their acneiform appearance, describing “little pimples with little, little pus in it.” Notable were comments on hyperpigmentation, “I’m a black person but…. became darker.” Furthermore, patients experienced physical symptoms: “it itches;” “it’s like you stuck a pin in it;” “stinging;” and “burning;”. Conclusion: Although cutaneous toxicity from EGFR inhibitors might be more difficult to visualize among darkly complected patients, the graphic descriptions offered in this qualitative study underscore the need for clinicians to heighten their awareness of such toxicity in African American/Black patients.

This editorial comments on an important study by Williams and colleagues. Their study provides direction for future research and for the next steps in clinical cancer care.

Objective Because hiccup palliation remains an unmet clinical need, we report here on an early experience with Hiccupops, ® a patented product designed for the express purpose of providing a mechanism-based intervention for hiccup palliation. Methods Meter Health, the developer and manufacturer of this patented product, used a purposive sampling approach to allow individuals with hiccups and a desire for hiccup palliation to purchase their agent and then to report on its efficacy or lack thereof. The authors of this report were provided these outcome data and allowed to analyze, report, and publish with no input from Meter Health with the exception of comments on accuracy. Results This report focused on 43 surveys that were completed. In response to the question, “Did the Hiccupops work for the person they were purchased for?” 29 (67%) responded, “yes.” Seven individuals (16%) responded, “no;” and 7 (16%) were “not sure.” Write-in comments appeared to substantiate the effective palliative nature of the intervention: “A friend with 10 days of hiccups following… brain tumor surgery, after 2 days, they stopped!!!#.” Another noted the following: “I like that if my hiccups get painful they’re there as a quick relief.” Less favorable comments were also noted: “She couldn’t get past the…. taste.” Another read as follows: “They were not effective in stopping my father’s intractable hiccups…. I like that there is someone out there who cares about trying to stop people’s hiccups.” Conclusions This patented product appears to palliate hiccups in some individuals and merits further study.

Abstract Ketogenic diets appear promising for obesity, diabetes, cancer, and other illnesses. Because older patients are more likely to contend with such illnesses and because of a paucity of dietary outcomes among these patients, we examined ketogenic diets in older patients. This multisite study focused on patients (≥65 years of age) on a ketogenic diet. Medical records were identified with the keywords “keto,” “ketogenic,” and “Atkins.” Records were reviewed in detail with extraction of direct quotations to substantiate observations. We report on 200 consecutive patients with a median age of 70 years. Reasons for diet included weight loss, diabetes, and cancer; the majority remained on the diet for >1 month. In 134 (67%: 95% confidence interval: 60, 73%), the ketogenic diet appeared beneficial: 93 of 117 (79%) who sought weight loss lost weight (“She has lost 15 pounds and plans to lose another 8”); 36 of 67 (54%) who sought glucose control appeared to achieve the latter (“He has gone on a ketogenic diet and has been able to bring his sugars down significantly”); and 5 of 8 (63%) who sought improved cancer outcomes appeared to derive them (“He attributes part of the control of his cancer and increased QOL to adopting the keto for cancer diet”). Adverse events occurred in 30 patients (15%): dyslipidemia (n = 14), constipation (n = 9), sub-therapeutic international normalized ratio (n = 3), pancreatitis (n = 2), diarrhea (n = 1), and fatigue (n = 1). Trials that test ketogenic diets for a variety of illnesses should enroll older adults.

To our knowledge, this is the first study to suggest that skeletal muscle mitochondrial deficits are associated with cancer-associated weight loss in humans. Mitochondrial deficits and alterations in the phospholipid metabolome were concurrent with reductions in whole body and skeletal muscle functional capacity. Whether mitochondrial deficits are causal or secondary to cancer-associated weight loss and functional deficits remains to be determined, but this study supports further exploration of mitochondria as a driver of cancer-associated losses in muscle mass and function.