The Financial and Psychosocial Impact of Medicinal Cannabis

Introduction: Therapeutic utilization of medicinal cannabis for symptom management in oncology patients is a burgeoning area of research focus. We hypothesize that medicinal cannabis use can result in subjective improvements in quality of life (QOL) metrics for cancer patients. Methods: Adult palliative care patients at a medical oncology clinic are consented to the study after being certified to access medicinal cannabis. After three months, subjective changes in QOL, including well-being, financial burden, pain, chemotherapy induced nausea and vomiting (CINV), and other categories are recorded via telephone interview. Responses are documented with a numerical Likert scale (from 1-5, with a score of 1 = greatly decreased satisfaction, and 5 = greatly increased satisfaction; a score of 3 is no change from baseline). Scores \u3e3.5 were deemed meaningful in terms of improvement. Results: An aggregate of 35 patient scores showed meaningful increases in subjective satisfaction across most metrics. Satisfaction with CINV symptoms showed the most marked improvement, with an average score of 3.63. While pain scores were similar at 3.53, more general QOL metrics were lower, at 3.46. Most patients did not find the cost to be burdensome, with an average score of 3.03. Discussion: The initial 35 interviews of our desired n of 120 suggest that medicinal cannabis may provide analgesic, antiemetic, and anxiolytic benefits for cancer patients. We anticipate that additional interviews will follow this pattern. If so, our study could bolster the evidence that therapeutic use of medicinal cannabis may be helpful for patients undergoing cancer treatment

The Impact of Outpatient Supportive Oncology on Cancer Care Cost and Utilization

Research Objective In patients with advanced cancer, interprofessional, non hospital-based care models of palliative care or Supportive Oncology (SO) have been shown in some studies to reduce symptom severity, hospital admissions, and healthcare costs. However, there is little consistency in the composition of SO programs or the degree of integration of social work, nutrition counseling, patient navigation, and nursing care services. There is limited research on quality of care and cost outcomes and current fee-for-service models do not cover the high costs of these non-billable services. We examine the impact of Interprofessional SO care on utilization and medical costs in patients with advanced cancer.https://jdc.jefferson.edu/medoncposters/1018/thumbnail.jp

Development of an Equitable, Interprofessional Medical Cannabis Education, Certification and Research Program in an NCI-Designated Cancer Center

Background: Medical cannabis (MC), state-regulated cannabis programs accessible with a physician certification for a qualifying diagnosis, now exist in 47 states. Little attention has been paid to ensuring equitable access to such programs for the most vulnerable cancer patients.1 Estimates of cannabis use in cancer patients range from 30-40%2 yet access to MC is highly dependent on a number of variables including: geography, cost, availability of certifying providers, lack of provider education and a confusing array of state programs coupled with ongoing federal illegality. The historic criminalization of cannabis and the disproportionate impact on People of Color creates another significant barrier. Most state MC programs require patients to have a variety of skills and resources to participate. These may include internet access, email addresses, a credit or debit card, funds to pay for the certifying visit and product and the ability to access a proximal dispensary.https://jdc.jefferson.edu/medoncposters/1014/thumbnail.jp

Engaging Patients with Late-Stage Non-Small Cell Lung Cancer in Shared Decision Making about Treatment

Few treatment decision support interventions (DSIs) are available to engage patients diagnosed with late-stage non-small cell lung cancer (NSCLC) in treatment shared decision making (SDM). We designed a novel DSI that includes care plan cards and a companion patient preference clarification tool to assist in shared decision making. The cards answer common patient questions about treatment options (chemotherapy, chemotherapy plus immunotherapy, targeted therapy, immunotherapy, clinical trial participation, and supportive care). The form elicits patient treatment preference. We then conducted interviews with clinicians and patients to obtain feedback on the DSI. We also trained oncology nurse educators to implement the prototype. Finally, we pilot tested the DSI among five patients with NSCLC in treatment SDM at the beginning of an office visit scheduled to discuss Treatment with an oncologist. Analyses of pilot study baseline and exit survey data showed that DSI use was associated with increased patient awareness of the alternatives’ treatment options and benefits/risks. In contrast, patient concern about treatment costs and uncertainty in treatment decision making decreased. All patients expressed a treatment preference. Future randomized controlled trials are needed to assess DSI implementation feasibility and efficacy in clinical care

Conformal Robotic Stereolithography

Additive manufacturing by layerwise photopolymerization, commonly called stereolithography (SLA), is attractive due to its high resolution and diversity of materials chemistry. However, traditional SLA methods are restricted to planar substrates and planar layers that are perpendicular to a single-axis build direction. Here, we present a robotic system that is capable of maskless layerwise photopolymerization on curved surfaces, enabling production of large-area conformal patterns and the construction of conformal freeform objects. The system comprises an industrial six-axis robot and a custom-built maskless projector end effector. Use of the system involves creating a mesh representation of the freeform substrate, generation of a triangulated toolpath with curved layers that represents the target object to be printed, precision mounting of the substrate in the robot workspace, and robotic photopatterning of the target object by coordinated motion of the robot and substrate. We demonstrate printing of conformal photopatterns on spheres of various sizes, and construction of miniature three-dimensional objects on spheres without requiring support features. Improvement of the motion accuracy and development of freeform toolpaths would enable construction of polymer objects that surpass the size and support structure constraints imparted by traditional SLA systems.American Society for Engineering Education. National Defense Science and Engineering Graduate FellowshipNational Institute of Mental Health (U.S.) (University of Michigan Microfluidics in Biomedical Sciences Training Program. 5T32-EB005582)Singapore-MIT Alliance for Research and Technology (SMART

Sleep Problems, Anxiety and Cognitive Style in School-Aged Children.

The associations between sleep problems, anxiety, anxiety sensitivity and attributional style were examined in self-report data from 79 children aged 8–11 years. Total anxiety score was associated with different types of sleep problems (bedtime resistance, sleep anxiety and nightmares). Conversely, total sleep problem score was associated with different sub-scales of anxiety (from r(78) = 0.15, p = NS to r(79) = 0.47, p < 0.01). Symptoms of anxiety correlated significantly with anxiety sensitivity, but not with attributional style. After controlling for other symptoms of anxiety, school phobias (Beta = 0.26, p < 0.05), the mental incapacitation concerns scale of anxiety sensitivity (Beta = 0.26, p < 0.05), and attributional style (Beta = −0.31, p < 0.01, R2 = 0.45) predicted sleep problems. These results suggest that anxiety is associated with a range of sleep problems, and that sleep problems are associated with different types of anxiety. Furthermore, certain cognitive styles are associated with both anxiety and sleep problems and may be good candidates for further research into the association between sleep problems and anxiety in children

Gastric Cancer in Individuals with Li-Fraumeni Syndrome

PURPOSE: Li-Fraumeni syndrome is a rare hereditary cancer syndrome associated with germline mutations in the TP53 gene. Although sarcomas, brain tumors, leukemias, breast and adrenal cortical carcinomas are typically recognized as Li-Fraumeni syndrome-associated tumors, the occurrence of gastrointestinal neoplasms has not been fully evaluated. In this analysis, we investigated the frequency and characteristics of gastric cancer in Li-Fraumeni syndrome. METHODS: Pedigrees and medical records of 62 TP53 mutation-positive families were retrospectively reviewed from the Dana-Farber/National Cancer Institute Li-Fraumeni syndrome registry. We identified subjects with gastric cancer documented either by pathology report or death certificate and performed pathology review of the available specimens. RESULTS: Among 62 TP53 mutation-positive families, there were 429 cancer-affected individuals. Gastric cancer was the diagnosis in the lineages of 21 (4.9%) subjects from 14 families (22.6%). The mean and median ages at gastric cancer diagnosis were 43 and 36 years, respectively (range: 24-74 years), significantly younger compared with the median age at diagnosis in the general population based on Surveillance Epidemiology and End Results data (71 years). Five (8.1%) families reported two or more cases of gastric cancer, and six (9.7%) families had cases of both colorectal and gastric cancers. No association was seen between phenotype and type/location of the TP53 mutations. Pathology review of the available tumors revealed both intestinal and diffuse histologies. CONCLUSIONS: Early-onset gastric cancer seems to be a component of Li-Fraumeni syndrome, suggesting the need for early and regular endoscopic screening in individuals with germline TP53 mutations, particularly among those with a family history of gastric cancer

A high-resolution map of human evolutionary constraint using 29 mammals.

The comparison of related genomes has emerged as a powerful lens for genome interpretation. Here we report the sequencing and comparative analysis of 29 eutherian genomes. We confirm that at least 5.5% of the human genome has undergone purifying selection, and locate constrained elements covering ∼4.2% of the genome. We use evolutionary signatures and comparisons with experimental data sets to suggest candidate functions for ∼60% of constrained bases. These elements reveal a small number of new coding exons, candidate stop codon readthrough events and over 10,000 regions of overlapping synonymous constraint within protein-coding exons. We find 220 candidate RNA structural families, and nearly a million elements overlapping potential promoter, enhancer and insulator regions. We report specific amino acid residues that have undergone positive selection, 280,000 non-coding elements exapted from mobile elements and more than 1,000 primate- and human-accelerated elements. Overlap with disease-associated variants indicates that our findings will be relevant for studies of human biology, health and disease