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  • 1
    In: JAMA Network Open, American Medical Association (AMA), Vol. 4, No. 11 ( 2021-11-12), p. e2134330-
    Type of Medium: Online Resource
    ISSN: 2574-3805
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2021
    detail.hit.zdb_id: 2931249-8
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  • 2
    In: JAMA Oncology, American Medical Association (AMA), Vol. 9, No. 1 ( 2023-01-01), p. 128-
    Abstract: Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR] , 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration ClinicalTrials.gov Identifier: NCT04354701
    Type of Medium: Online Resource
    ISSN: 2374-2437
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
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  • 3
    In: JAMA Oncology, American Medical Association (AMA)
    Abstract: Systematic data on the association between anticancer therapies and thromboembolic events (TEEs) in patients with COVID-19 are lacking. Objective To assess the association between anticancer therapy exposure within 3 months prior to COVID-19 and TEEs following COVID-19 diagnosis in patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included patients who were hospitalized and had active cancer and laboratory-confirmed SARS-CoV-2 infection. Data were accrued from March 2020 to December 2021 and analyzed from December 2021 to October 2022. Exposure Treatments of interest (TOIs) (endocrine therapy, vascular endothelial growth factor inhibitors/tyrosine kinase inhibitors [VEGFis/TKIs], immunomodulators [IMiDs] , immune checkpoint inhibitors [ICIs], chemotherapy) vs reference (no systemic therapy) in 3 months prior to COVID-19. Main Outcomes and Measures Main outcomes were (1) venous thromboembolism (VTE) and (2) arterial thromboembolism (ATE). Secondary outcome was severity of COVID-19 (rates of intensive care unit admission, mechanical ventilation, 30-day all-cause mortality following TEEs in TOI vs reference group) at 30-day follow-up. Results Of 4988 hospitalized patients with cancer (median [IQR] age, 69 [59-78] years; 2608 [52%] male), 1869 had received 1 or more TOIs. Incidence of VTE was higher in all TOI groups: endocrine therapy, 7%; VEGFis/TKIs, 10%; IMiDs, 8%; ICIs, 12%; and chemotherapy, 10%, compared with patients not receiving systemic therapies (6%). In multivariable log-binomial regression analyses, relative risk of VTE (adjusted risk ratio [aRR] , 1.33; 95% CI, 1.04-1.69) but not ATE (aRR, 0.81; 95% CI, 0.56-1.16) was significantly higher in those exposed to all TOIs pooled together vs those with no exposure. Among individual drugs, ICIs were significantly associated with VTE (aRR, 1.45; 95% CI, 1.01-2.07). Also noted were significant associations between VTE and active and progressing cancer (aRR, 1.43; 95% CI, 1.01-2.03), history of VTE (aRR, 3.10; 95% CI, 2.38-4.04), and high-risk site of cancer (aRR, 1.42; 95% CI, 1.14-1.75). Black patients had a higher risk of TEEs (aRR, 1.24; 95% CI, 1.03-1.50) than White patients. Patients with TEEs had high intensive care unit admission (46%) and mechanical ventilation (31%) rates. Relative risk of death in patients with TEEs was higher in those exposed to TOIs vs not (aRR, 1.12; 95% CI, 0.91-1.38) and was significantly associated with poor performance status (aRR, 1.77; 95% CI, 1.30-2.40) and active/progressing cancer (aRR, 1.55; 95% CI, 1.13-2.13). Conclusions and Relevance In this cohort study, relative risk of developing VTE was high among patients receiving TOIs and varied by the type of therapy, underlying risk factors, and demographics, such as race and ethnicity. These findings highlight the need for close monitoring and perhaps personalized thromboprophylaxis to prevent morbidity and mortality associated with COVID-19–related thromboembolism in patients with cancer.
    Type of Medium: Online Resource
    ISSN: 2374-2437
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
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  • 4
    In: International Journal of Environmental Research and Public Health, MDPI AG, Vol. 17, No. 7 ( 2020-03-28), p. 2280-
    Abstract: Continued smoking after a cancer diagnosis increases mortality, risk of recurrence, and negatively impacts treatment effectiveness. However, utilization of tobacco use cessation treatment among cancer patients remains low. We conducted a clinical trial assessing patient preferences, treatment acceptability, and preliminary effectiveness (7-day point prevalence at 12 weeks) of three tobacco treatment options among cancer patients at an academic health center. Implementation strategies included electronic referral and offering the choice of three treatment options: referral to external services, including the quitline (PhoneQuit) and in-person group counseling (GroupQuit), or an internal service consisting of 6-week cognitive behavioral therapy delivered via smartphone video conferencing by a tobacco treatment specialist (SmartQuit). Of 545 eligible patients, 90 (16.5%) agreed to enroll. Of the enrolled patients, 39 (43.3%) chose PhoneQuit, 37 (41.1%) SmartQuit, and 14 (15.6%) GroupQuit. Of patients reached for 12-week follow-up (n = 35), 19 (54.3%) reported receiving tobacco treatment. Of all patients referred, 3 (7.7%) PhoneQuit, 2 (5.4%) SmartQuit, and 2 (14.3%) GroupQuit patients reported 7-day point prevalence abstinence from smoking at 12 weeks. Participants rated the SmartQuit intervention highly in terms of treatment acceptability. Results indicate that more intensive interventions may be needed for this population, and opportunities remain for improving reach and utilization.
    Type of Medium: Online Resource
    ISSN: 1660-4601
    Language: English
    Publisher: MDPI AG
    Publication Date: 2020
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  • 5
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2016
    In:  Cancer Epidemiology, Biomarkers & Prevention Vol. 25, No. 3_Supplement ( 2016-03-01), p. C14-C14
    In: Cancer Epidemiology, Biomarkers & Prevention, American Association for Cancer Research (AACR), Vol. 25, No. 3_Supplement ( 2016-03-01), p. C14-C14
    Abstract: Background and Objective: There is a need to develop a cadre of racially and ethnically diverse, well-trained scientists to: (1) increase the capacity for scientific research among underserved populations; (2) address cultural appropriateness of the conceptualization, design and implementation of research ideas; (3) effectively and respectfully deliver health care interventions for diverse populations; and (4) eliminate health disparities. To achieve our long-term goal of increasing the pool of minority cancer researchers, the objective of the Florida Cancer Research Training Opportunities for Outstanding Leaders (ReTOOL) program is to develop, promote and sustain an independent, competitive cancer research training program that creates opportunities and promotes careers in cancer research for underrepresented minority (URM) students. The ReTOOL program trains URM students from University of Florida (UF), Florida A & M University (FAMU) and Bethune-Cookman University (BCU) at UF Health Cancer Center (UFHCC). Research Strategy: Based on over 10 years research training experiences for URM students in Florida, our strategy includes: (1) partnership between a minority institution and a comprehensive cancer center, with the training occurring at the cancer center; (2) dedicated mentor pool of nationally recognized scientists who are committed to diversity and have expertise in the area of basic, behavioral or clinical sciences; (3) committed faculty advisors at the home (minority) institutions who provide preparatory training and continuous mentoring for trainees; (4) a culturally responsive staff at the cancer center to assist trainees effectively navigate the resources at the cancer center and provide support outside academic/professional development; (5) an effective recruitment process that includes rigorous screening process and orientation; (6) clear requirements and expectations for the training program; (7) cradle to grave system to support trainees; and (8) trainee tracking and evaluation. The ReTOOL program focuses on successfully bridging URM students to graduate or medical school and supporting the trainees throughout their career. The program includes: (i) Basic ReTOOL 12-week summer training, funded by the US Department of Defense, for URM students without research experience; (ii) Academy I ReTOOL 12-week summer training, funded by the National Cancer Institute and UFHCC, for continuous/subsequent training of Basic ReTOOL alumni; (iii) Academy II ReTOOL 1-year post-baccalaureate training (if needed), funded by the UFHCC, to bridge ReTOOL alumni to graduate/medical school; and (iv) triad continuous mentoring by ReTOOL program director, FAMU/BCU minority institution faculty advisor and UF faculty mentor. Results: 19 URM students successfully completed the program between 2012 and 2015. The scholarly achievements of the program include 20 completed projects by URM students, 12 published scientific abstracts presented at national/international conferences, 3 publications, 3 publications in progress, 3 grant awards based on the ReTOOL program, and 12 student recognitions/awards. Six students have been admitted to graduate/medical schools, including UF, FAMU, Duke University, Indiana University and Howard University. 2 students have just been admitted to the Academy II ReTOOL 1-year post-baccalaureate training at UF. The ReTOOL program has also led to an increase in cancer health disparities research at UF, especially among the ReTOOL mentors. According to a ReTOOL mentee: “The growth that I have made is without a doubt beneficial to me progressing towards the next chapter in my life.” A ReTOOL mentor stated in his evaluation, “Rewarding opportunity to teach and mentor minority students in the field of prostate cancer.” Conclusion: Developing and sustaining the interests of URM students in biomedical science requires a comprehensive and sustainable approach, as seen in the ReTOOL program. The success of the ReTOOL program has led to a training model for diversity in graduate programs at UF and currently being adopted by multiple departments at UF. Citation Format: Folakemi T. Odedina, Merry Jennifer Markham, Renee Reams, Bereket Mochona, Dixon Alma, Nguyen Jennifer, Gilbert Lauren. The Florida ReTOOL Program: Creating a training bridge for the next generation of biomedical scientists. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C14.
    Type of Medium: Online Resource
    ISSN: 1055-9965 , 1538-7755
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2016
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    detail.hit.zdb_id: 1153420-5
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  • 6
    In: ESMO Open, Elsevier BV, Vol. 1, No. 5 ( 2016), p. e000097-
    Type of Medium: Online Resource
    ISSN: 2059-7029
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
    detail.hit.zdb_id: 2844985-X
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  • 7
    In: Implementation Research and Practice, SAGE Publications, Vol. 3 ( 2022-01), p. 263348952211121-
    Abstract: The objective of this study was to determine how to optimize implementation of tobacco cessation treatment interventions in cancer care by (1) investigating the feasibility and acceptability of a multi-level approach to tobacco cessation treatment intervention, (2) identifying barriers and facilitators to implementation, and (3) eliciting additional strategies to improve implementation of the intervention. Methods We conducted qualitative interviews with oncologists ( n = 15) from one large academic health center in the Southeastern United States. We asked about their knowledge, attitudes, and current practices regarding tobacco use screening and treatment. We also asked about two proposed strategies to support implementation of tobacco cessation treatment: (1) developing a registry of tobacco users in collaboration with the state-run tobacco cessation program, and (2) providing on-site tobacco cessation counseling from trained professionals. Results Oncologists saw addressing tobacco use as valuable; however, they felt restricted from consistently addressing tobacco use by multi-level barriers such as workload, electronic health record (EHR) design, patient anxiety, and low self-efficacy for treating tobacco dependence. Oncologists responded positively to on-site treatment and felt this strategy would increase treatment accessibility and enhance engagement. Reaction to developing a registry of tobacco users was mixed, with concerns regarding lack of oncologist involvement and patient privacy expressed. Other suggested strategies for supporting implementation of tobacco cessation treatment included reducing referral complexity, establishing financial or quality incentives for oncologists, and leveraging existing EHR tools to facilitate integration of cessation interventions into clinic workflows. Conclusions We identified several challenges to implementing tobacco use treatment in cancer care; however, we considered strategies to overcome these barriers that were viewed as feasible and acceptable. Our work highlights the importance of engaging stakeholders in implementation efforts. Future work should explore the impact of the implementation strategies identified in this study. Plain Language Summary Tobacco cessation significantly improves cancer patients’ treatment outcomes, quality of life, and chances of survival; however, tobacco cessation interventions are not routinely delivered in oncology care. Interviews with oncologists identified barriers to delivering tobacco cessation interventions at multiple levels. Suggested strategies for overcoming these barriers included simplifying cessation intervention processes, establishing incentives for oncologists to address tobacco use, and using the electronic health record to support intervention activities. Oncologists generally supported implementing on-site tobacco cessation counseling for cancer patients. Although there was support for developing a registry of tobacco users with an external tobacco cessation program, more reservations were expressed. Our work identifies several stakeholder-endorsed strategies for implementing tobacco cessation interventions in cancer care. Future research should test the effectiveness of these strategies.
    Type of Medium: Online Resource
    ISSN: 2633-4895 , 2633-4895
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 3058598-3
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  • 8
    In: Patient Education and Counseling, Elsevier BV, Vol. 104, No. 6 ( 2021-06), p. 1380-1386
    Type of Medium: Online Resource
    ISSN: 0738-3991
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2019572-2
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  • 9
    In: BMJ Open Quality, BMJ, Vol. 6, No. 2 ( 2017-10), p. e000096-
    Type of Medium: Online Resource
    ISSN: 2399-6641
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2952859-8
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  • 10
    In: JAMA Network Open, American Medical Association (AMA), Vol. 5, No. 3 ( 2022-03-28), p. e224304-
    Type of Medium: Online Resource
    ISSN: 2574-3805
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2022
    detail.hit.zdb_id: 2931249-8
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