Search

Antibiotic exposure during immunotherapy (IO) has been shown to negatively affect clinical outcomes in various cancer types. The aim of this study was to evaluate whether antibiotic exposure in patients with high-risk early-stage HER2-negative breast cancer (BC) undergoing treatment with neoadjuvant pembrolizumab impacted residual cancer burden (RCB) and pathologic complete response (pCR) in the pembrolizumab-4 arm of the ISPY-2 clinical trial. Patients received pembrolizumab for four cycles concurrently with weekly paclitaxel for 12 weeks, followed by four cycles of doxorubicin plus cyclophosphamide every 2 or 3 weeks. Patients who received at least one dose of systemic antibiotics concurrently at the time of immunotherapy (IO) were included in the antibiotic exposure group (ATB+). All other participants were included in the control group (ATB-). RCB index and PCR rates were compared between the ATB+ and ATB- groups using t-tests and Chi-squared tests, and linear and logistic regression models, respectively. Sixty-six patients were included in the analysis. 18/66 (27%) patients were in the ATB+ group. Antibiotic use during IO was associated with a higher mean RCB index (1.80 ± 1.43 versus 1.08 ± 1.41) and a lower pCR rate (27.8% versus 52.1%). The association between antibiotic use and the RCB index remained significant in multivariable linear regression analysis (RCB index-coefficient 0.86, 95% CI 0.20-1.53, P = 0.01). Our findings suggest that concurrent antibiotic exposure during neoadjuvant pembrolizumab in HER2-negative early-stage BC is associated with higher RCB. Further validation in larger cohorts is needed to confirm these findings.

School resource officer (SRO) programs were expanded to improve school safety, but limited research has assessed factors impacting students' perspectives on and intended utilization of SROs. We analyzed the relationships of students' experiences with law enforcement and school discipline with views and intended use of SROs. We used multilevel logistic regression models based on the 2019 Minnesota Student Survey to estimate odds ratios of negative attitudes toward SROs. Among all students, 94.4% agreed having an SRO at school was a good idea, 62.1% said they would feel comfortable going to their SRO with a problem, and 68.1% that they would tell their SRO if they saw something unsafe. Among students with recent suspensions, a parent/guardian who was ever in prison, or attending alternative learning centers, there was still widespread support for SROs, albeit lower support for SROs. Furthermore, only about half of students with recent suspensions or impacted by parental incarceration stated they would utilize SROs. These findings highlight discrepancies in students' attitudes toward versus utilization of SROs, especially for those disproportionately impacted by law enforcement or school discipline. This is relevant, as having trusted adults to turn to with problems has been identified as a cornerstone of school safety. [ABSTRACT FROM AUTHOR]

Restorative justice diversion aligns with youths' developmental needs more than traditional approaches. However, there is a research gap regarding its effectiveness among diverse youth, and when initiated by police. This study evaluated misdemeanor cases that occurred in Minneapolis between September 2014 and December 2018 finding that youth who participated in restorative justice diversion after arrest were less likely to experience re-arrest in the following year compared to those processed traditionally. Positive program impacts for Black and American Indian youth demonstrate RJ diversion can be effective with diverse youth while differences in rates of successful diversion by participating community agency highlight opportunities for further study. This study demonstrates the importance of continuing to understand and expand restorative justice diversion with youth. [ABSTRACT FROM AUTHOR]

Background In qualitative work, patients report that seemingly short trips to clinic (eg, a supposed 10-minute blood draw) often turn into "all-day affairs." We sought to quantify the time patients with cancer spend attending ambulatory appointments. Methods We conducted a retrospective study of patients scheduled for oncology-related ambulatory care (eg, labs, imaging, procedures, infusions, and clinician visits) at an academic cancer center over 1 week. The primary exposure was the ambulatory service type(s) (eg, clinician visit only, labs and infusion, etc.). We used Real-Time Location System badge data to calculate clinic times and estimated round-trip travel times and parking times. We calculated and summarized clinic and total (clinic + travel + parking) times for ambulatory service types. Results We included 435 patients. Across all service day type(s), the median (IQR) clinic time was 119 (78-202) minutes. The estimated median (IQR) round-trip driving distance and travel time was 34 (17-49) miles and 50 (36-68) minutes. The median (IQR) parking time was 14 (12-15) minutes. Overall, the median (IQR) total time was 197 (143-287) minutes. The median total times for specific service type(s) included: 99 minutes for lab-only, 144 minutes for clinician visit only, and 278 minutes for labs, clinician visit, and infusion. Conclusion Patients often spent several hours pursuing ambulatory cancer care on a given day. Accounting for opportunity time costs and the coordination of activities around ambulatory care, these results highlight the substantial time burdens of cancer care, and support the notion that many days with ambulatory health care contact may represent "lost days." [ABSTRACT FROM AUTHOR]

Cancer treatment often creates logistic conflicts with everyday life priorities; however, these challenges and how they are subjectively experienced have been largely unaddressed in cancer care. Our goal was to describe time and logistic requirements of cancer care and whether and how they interfered with daily life and well-being. We conducted interviews with 20 adults receiving cancer-directed treatment at a single academic cancer center. We focused on participants' perception of the time, effort, and energy-intensiveness of cancer care activities, organization of care requirements, and preferences in how to manage the logistic burdens of their cancer care. Participant interview transcripts were analyzed using an inductive thematic analysis approach. Burdens related to travel, appointment schedules, healthcare system navigation, and consequences for relationships had roots both at the system-level (e.g. labs that were chronically delayed, protocol-centered rather than patient-centered bureaucratic requirements) and in individual circumstances (e.g. greater stressors among those working and/or have young children versus those who are retired) that determined subjective burdensomeness, which was highest among patients who experienced multiple sources of burdens simultaneously. Our study illustrates how objective burdens of cancer care translate into subjective burden depending on patient circumstances, emphasizing that to study burdens of care, an exclusive focus on objective measures does not capture the complexity of these issues. The complex interplay between healthcare system factors and individual circumstances points to clinical opportunities, for example helping patients to find ways to meet work and childcare requirements while receiving care. [ABSTRACT FROM AUTHOR]

Introduction: While demographic risk factors of cancer‐related financial hardships have been studied, having minor children or being single have rarely been assessed in the context of healthcare‐related financial hardships. Methods: Using data from the 2015 to 2018 National Health Interview Survey, we assessed financial hardship (material and psychological hardship; behavioral coping due to costs: delaying/foregoing care, reducing prescription costs, or skipping specialists or follow‐up care) among adults aged 18–59 years with cancer (N = 2844) by minor child parenting status and family structure. In a secondary analysis, we compared this group with individuals without cancer. Using logistic regression models, we compared those with and without children aged <18 years, further distinguishing between those who were single versus one of two or more adults in the family. Results: Compared to individuals from families with two or more adults/without children, single adults with children more often reported cancer‐related financial hardships, for example material hardship (45.9% vs. 38.8%), and reducing prescription costs, (50.7% vs. 34.4%, adjusted OR 1.57, 95% CI 1.07–2.28). Single adults without minor children and those from families with two or more adults/with minor children also reported greater financial hardships on some dimensions. Associations were similar among those without cancer, but the overall magnitude of financial hardships was lower compared to those with cancer. Conclusions: Our findings suggest that having minor children, and being a single adult are risk factors for cancer‐related financial hardship. Financial vulnerability associated with family structure should be taken into consideration in healthcare, and especially cancer care. [ABSTRACT FROM AUTHOR]

Purpose: Melanoma incidence is higher in rural than in urban areas in the United States, possibly due to greater incidental sun exposures from rural outdoor‐focused lifestyles and occupational patterns. Our aim was to compare activities at the time of a sunburn between rural and urban residents. Methods: Utilizing the nationally representative 2019 cross‐sectional Health Information National Trends Survey (HINTS), we report odds ratios (OR) and confidence intervals (CI) from logistic regression models comparing self‐reported activities at most recent sunburn among rural versus urban adults. Findings: About one‐third of participants (37.2%) reported a sunburn in the past year, higher in urban (38.0%) than in rural populations (32.5%). At the time of most recent sunburn, swimming (36.6%) and working outside a home (29.4%) were the most commonly reported activities. Working on a job (30.4% vs 10.4%; OR: 3.30, 95% CI: 1.33, 8.20) or outside the house (38.7% vs 28.1%; OR: 1.86, 95% CI: 1.03, 3.33) were more common, while exercising or sunbathing were less common, among rural compared to urban participants. Conclusions: Incidental sun exposures during outdoor‐focused rural occupations and work outside the house may be critical skin cancer prevention targets in rural populations; outdoor exercise and sunbathing may be more important in urban populations; incidental exposures while swimming may be important in both populations. [ABSTRACT FROM AUTHOR]