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A prospective cohort study comparing efficacy of 1 dose of quadrivalent human papillomavirus vaccine to 2 and 3 doses at an average follow up of 12 years postvaccination. 一项前瞻性队列研究,在接种后平均 12 年的随访中,比较了接种 1 剂四价人类乳头瘤病毒疫苗与接种 2 剂和 3 剂疫苗的效果。
Pub Date : 2024-11-01 DOI: 10.1093/jncimonographs/lgae042
Sylla G Malvi, Pulikkottil O Esmy, Richard Muwonge, Smita Joshi, Usha Rani Reddy Poli, Eric Lucas, Yogesh Verma, Pesona Grace Lucksom, Anand Shah, Bijal Patel, Eric Zomawia, Sharmila Pimple, Kasturi Jayant, Sanjay Hingmire, Aruna Chiwate, Uma Divate, Shachi Vashist, Gauravi Mishra, Radhika Jadhav, Maqsood Siddiqi, Catherine Sauvaget, Subha Sankaran, Thiraviam Pillai Rameshwari Ammal Kannan, Surendra S Shastri, M Radhakrishna Pillai, Devasena Anantharaman, Neerja Bhatla, Rengaswamy Sankaranarayanan, Partha Basu

Background: While recommending a human papillomavirus (HPV) single-dose vaccination schedule in 2022, the World Health Organization highlighted the need for long-term follow-up studies to monitor waning of protection. We report on vaccine efficacy against HPV infections in 1-, 2-, and 3-dose schedules and protection against cervical precancers at a median follow-up of 12 years postvaccination.

Methods: This randomized multicenter study in India was originally designed to vaccinate unmarried girls aged 10-18 years with either 2 or 3 doses of quadrivalent HPV vaccine. A ministerial decree to halt vaccination in trials resulted in the creation of cohorts receiving different doses, including just a single dose. Cohorts were assessed for incident and persistent infections by genotyping cervical samples collected yearly for 4 consecutive years after participants were married. Cervical screening with an HPV test was initiated at age 25 years for married participants. Age- and site-matched unvaccinated married women were recruited to be compared with vaccinated cohorts. Vaccine efficacy was assessed using proportional incidence ratios.

Results: The number of participants in the 1-, 2- (at 0 and 6 months), and 3-dose cohorts was 4949, 4980, and 4348, respectively. Of the recipients, 71%-82% in the different cohorts were eligible to provide samples for genotyping. Vaccine efficacy against persistent HPV 16 and 18 infection was 92.0% (95% confidence interval [CI] = 87.0% to 95.0%) in 3022 recipients of the single dose; and comparable with that observed in the 2-dose arm (94.8%, 95% CI = 90.0% to 97.3%) and the 3-dose arm (95.3%, 95% CI = 90.9% to 97.5%). No high-grade precancer associated with HPV 16 and 18 was detected among vaccinated participants compared with 8 precancers detected among the unvaccinated women.

Conclusion: This observational cohort study has established that a single dose of HPV vaccine provides high protective efficacy against persistent HPV 16 and 18 infections and associated neoplasia 15 years postvaccination.

背景:世界卫生组织建议在 2022 年实施人类乳头瘤病毒 (HPV) 单剂量疫苗接种计划,同时强调需要进行长期随访研究,以监测保护作用的减弱情况。我们报告了1剂、2剂和3剂疫苗对HPV感染的疗效,以及接种后12年的中位随访对宫颈癌前病变的保护作用:这项在印度进行的随机多中心研究最初的目的是为 10-18 岁的未婚女孩接种 2 或 3 剂四价 HPV 疫苗。由于部委下令停止试验中的疫苗接种,因此建立了接受不同剂量(包括仅接种一剂)疫苗的队列。通过对参与者结婚后连续 4 年每年采集的宫颈样本进行基因分型,对组群中的偶发感染和持续感染进行评估。已婚参与者在 25 岁时开始接受 HPV 检测进行宫颈筛查。招募了年龄和地点相匹配的未接种疫苗的已婚妇女与接种疫苗的妇女进行比较。疫苗疗效采用比例发病率进行评估:1剂、2剂(0个月和6个月)和3剂组群的参与者人数分别为4949人、4980人和4348人。在不同组别中,71%-82%的受试者符合提供基因分型样本的条件。在3022名单剂接种者中,疫苗对HPV 16和18持续感染的有效率为92.0%(95%置信区间[CI] = 87.0%至95.0%);与2剂接种组(94.8%,95% CI = 90.0%至97.3%)和3剂接种组(95.3%,95% CI = 90.9%至97.5%)的有效率相当。接种疫苗的妇女未发现与HPV 16和18相关的高级别癌前病变,而未接种疫苗的妇女则发现了8例癌前病变:这项观察性队列研究证实,单剂 HPV 疫苗对接种后 15 年的 HPV 16 和 18 持续感染及相关肿瘤具有很高的保护效力。
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引用次数: 0
Impact of single-dose HPV vaccination on HPV 16 and 18 prevalence in South African adolescent girls with and without HIV. 单剂量 HPV 疫苗接种对感染和未感染 HIV 的南非少女中 HPV 16 和 18 流行率的影响。
Pub Date : 2024-11-01 DOI: 10.1093/jncimonographs/lgae041
Sinead Delany-Moretlwe, Dorothy A Machalek, Danielle Travill, Kathy Petoumenos, Dorothy C Nyemba, Zizipho Z A Mbulawa, Nontokozo Ndlovu, John M Kaldor, Helen Rees

Background: The World Health Organization has endorsed single-dose human papillomavirus (HPV) vaccination, but data on the impact on HPV prevalence in high HIV burden settings are limited.

Methods: A single-dose bivalent HPV vaccine was delivered to adolescent girls in grade 10 in a schools-based campaign in 1 district in South Africa. Impact on HPV 16 and 18 prevalence was evaluated using repeat cross-sectional surveys. A clinic-based survey in girls aged 17-18 years established HPV 16 and 18 prevalence in a prevaccine population (n = 506, including 157 living with HIV) in 2019 and was repeated in the same age group and sites in a single-dose eligible population in 2021 (n = 892, including 117 with HIV). HPV DNA was detected on self-collected vaginal swabs using the Seegene Anyplex II HPV 28. Population impact was estimated overall and by HIV status using prevalence ratios adjusted for differences in sexual behavior between surveys.

Results: Single-dose vaccination campaign coverage was 72% (4807 of 6673) of eligible girls attending high school (n = 66) in the district. HPV 16 and 18 prevalence was 35% lower in the postvaccine survey overall (adjusted prevalence ratio = 0.65, 95% confidence interval [CI] = 0.51 to 0.83; P < .001) and 37% lower in those living with HIV (adjusted prevalence ratio = 0.63, 95% CI = 0.41 to 0.95; P  = .026). No protective effect was seen for nonvaccine oncogenic HPV types 33, 35, 39, 51, 52, 56, 58, 59, or 68 overall (adjusted prevalence ratio = 1.14, 95% CI = 1.03 to 1.26; P = .011) or in those living with HIV (adjusted prevalence ratio = 1.00, 95% CI = 0.83 to 1.21. P = 0.99).

Conclusion: These data provide reassuring evidence of single-dose impact on population-level HPV 16 and 18 prevalence in a South African population, irrespective of HIV status.

背景:世界卫生组织已经批准了单剂量人类乳头瘤病毒(HPV)疫苗接种,但在艾滋病高负担地区,有关其对 HPV 感染率影响的数据十分有限:方法:在南非的一个地区开展了一项以学校为基础的活动,为 10 年级的少女接种了一剂二价 HPV 疫苗。通过重复横断面调查评估了对 HPV 16 和 18 流行率的影响。2019 年,在接种疫苗前人群(n = 506,包括 157 名艾滋病病毒感染者)中对 17-18 岁女孩进行的诊所调查确定了 HPV 16 和 18 的流行率;2021 年,在同一年龄组和地点对符合单剂量接种条件的人群(n = 892,包括 117 名艾滋病病毒感染者)进行了重复调查。使用 Seegene Anyplex II HPV 28 在自取的阴道拭子上检测 HPV DNA。使用根据不同调查之间性行为差异调整后的流行率估算了总体人口影响和不同艾滋病毒感染状况的人口影响:在该地区符合条件的高中女生(n = 66)中,单剂量疫苗接种活动的覆盖率为 72%(6673 名中的 4807 名)。在疫苗接种后的调查中,HPV 16 和 18 感染率总体降低了 35%(调整后感染率比值 = 0.65,95% 置信区间 [CI] = 0.51 至 0.83;P < .001),HIV 感染者的感染率降低了 37%(调整后感染率比值 = 0.63,95% 置信区间 = 0.41 至 0.95;P = .026)。非疫苗致癌 HPV 类型 33、35、39、51、52、56、58、59 或 68 在总体(调整流行率比值 = 1.14,95% CI = 1.03 至 1.26;P = .011)或艾滋病毒感染者(调整流行率比值 = 1.00,95% CI = 0.83 至 1.21。P = 0.99)中均未见保护作用:这些数据提供了令人欣慰的证据,证明单剂量对南非人群中的 HPV 16 和 18 流行率有影响,与艾滋病毒感染状况无关。
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引用次数: 0
Population-level health impact of hypothetical waning 1-dose human papillomavirus vaccination and 2-dose mitigation strategies in a high cervical cancer burden setting. 在宫颈癌负担较重的环境中,假设性减弱 1 剂人类乳头瘤病毒疫苗接种和 2 剂缓解策略对人群健康的影响。
Pub Date : 2024-11-01 DOI: 10.1093/jncimonographs/lgae039
Emily A Burger, Jean-François Laprise, Allison Portnoy, Jennifer C Spencer, Stephen Sy, Mary Caroline Regan, Élodie Bénard, Mélanie Drolet, Marc Brisson, Jane J Kim

Background: We simulated the impact of hypothetical waning scenarios of a 1-dose human papillomavirus (HPV) vaccination paired with switching to 2-dose mitigation strategies guided by empirical vaccine trial reporting timelines.

Methods: Using 2 independent mathematical models fitted to a high-burden setting, we projected the cumulative cervical cancer cases averted over 85 years for alternative HPV vaccination scenarios under 2 program adoption timelines: 1) de novo introduction of a 1-dose HPV vaccination and 2) a switch from an existing 2-dose HPV vaccination program to a 1-dose vaccination. We assumed 80% vaccination coverage with the bivalent vaccine and an average duration of a 1-dose HPV vaccine protection of either 30 or 25 years with 100% efficacy. We varied the eligible age group(s) at program introduction and the 2-dose mitigation (single-age cohort or multi-age cohort). If needed for mitigation, reintroduction of 2-dose vaccination was assumed to occur in 2036 (ie, 30 years after initiation of the Costa Rica Vaccine Trial).

Results: Under both vaccine adoption timelines, the models projected that countries could achieve the same level of health benefits by switching to 2 doses in 2036 using a multi-age cohort approach as with initiating a 2-dose or 1-dose vaccination program with no waning. With only a single-age cohort 2-dose mitigation approach, 98%-99% of cases would be prevented compared with the health benefits of 2 doses or a noninferior, durable 1 dose.

Conclusions: Countries hesitant to adopt a 1-dose HPV vaccination program may have opportunities to leverage the benefits and efficiency of a 1-dose schedule while awaiting longer-term reporting from 1-dose durability studies, including Costa Rica Vaccine Trial.

背景:我们模拟了1剂人乳头瘤病毒(HPV)疫苗接种的假设减弱情景,以及在经验疫苗试验报告时间表的指导下转向2剂缓解策略的影响:我们使用两个独立的数学模型来模拟高负担环境,预测了在两种计划采用时间表下,HPV 疫苗接种方案在 85 年内可避免的宫颈癌累计病例数:1)重新引入 1 剂 HPV 疫苗接种;2)从现有的 2 剂 HPV 疫苗接种计划转为 1 剂疫苗接种。我们假设二价疫苗的接种覆盖率为 80%,1 剂 HPV 疫苗的平均保护期为 30 年或 25 年,有效率为 100%。我们改变了计划引入时的合格年龄组和 2 剂缓解(单年龄组群或多年龄组群)。如果需要缓解,则假定在 2036 年(即哥斯达黎加疫苗试验启动 30 年后)重新引入 2 剂疫苗接种:结果:在采用两种疫苗的时间表下,根据模型预测,采用多年龄队列方法在2036年改用2剂疫苗接种,各国可获得的健康益处与启动2剂或1剂疫苗接种计划所获得的健康益处水平相同,且不会减弱。与2剂或非劣效、持久的1剂疫苗的健康益处相比,仅采用单年龄队列2剂缓解方法可预防98%-99%的病例:结论:对采用1剂HPV疫苗接种计划犹豫不决的国家可能有机会利用1剂接种计划的益处和效率,同时等待包括哥斯达黎加疫苗试验在内的1剂耐久性研究的长期报告。
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引用次数: 0
Single-dose human papillomavirus vaccination: an update. 单剂量人类乳头瘤病毒疫苗接种:最新进展。
Pub Date : 2024-11-01 DOI: 10.1093/jncimonographs/lgae030
Aimée R Kreimer, Deborah Watson-Jones, Jane J Kim, Peter Dull

Human papillomavirus (HPV) vaccines received regulatory approval and were recommended for use in young girls nearly 2 decades ago. Uptake is mostly high in resource-rich settings. In resource-limited settings, where the burden of cervical cancer is disproportionately high, access to and uptake of HPV vaccines are nowhere near satisfactory, despite evidence that HPV vaccination is highly cost-effective and a significant value-for-money investment. The discovery that only a single dose of the HPV vaccines may be needed to confer adequate protection may make equitable access to HPV vaccines possible. Indeed, the recent World Health Organization recommendation allowing for 1 or 2 doses is already gaining traction. This monograph aims to update the state of the science related to single-dose HPV vaccine protection and includes both primary data and modeling efforts that address key gaps in the knowledge regarding 1) durability of protection of a single dose of the HPV vaccine, 2) single-dose HPV vaccine effectiveness in both high-income and low-income settings, 3) implementation of single-dose HPV vaccination, and 4) how to accelerate control of cervical cancer by integrating a 1-time screen for cervical disease. The content published in this monograph will continue to advance the science of HPV vaccination and will be vital as new countries make informed decisions about how best to use this remarkable vaccine.

近 20 年前,人类乳头瘤病毒 (HPV) 疫苗获得了监管部门的批准,并被推荐用于少女。在资源丰富的环境中,疫苗的接种率很高。在资源有限的环境中,宫颈癌的发病率特别高,尽管有证据表明接种 HPV 疫苗具有很高的成本效益,是一项物有所值的投资,但 HPV 疫苗的接种率和使用率却远远不能令人满意。人们发现,只需接种一剂 HPV 疫苗就能提供足够的保护,这可能会使公平接种 HPV 疫苗成为可能。事实上,世界卫生组织最近提出的允许接种 1 或 2 剂疫苗的建议已获得越来越多的支持。本专著旨在更新与单剂 HPV 疫苗保护相关的科学现状,包括原始数据和建模工作,以解决以下方面的关键知识空白:1)单剂 HPV 疫苗保护的持久性;2)单剂 HPV 疫苗在高收入和低收入环境中的有效性;3)单剂 HPV 疫苗接种的实施;以及 4)如何通过整合宫颈疾病的一次性筛查来加速宫颈癌的控制。本专著中发表的内容将继续推动 HPV 疫苗接种科学的发展,对于新的国家就如何最好地使用这种卓越的疫苗做出明智的决定至关重要。
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引用次数: 0
Cannabis and opioid perceptions, co-use, and substitution among patients across 4 NCI-Designated Cancer Centers. 4 个 NCI 指定癌症中心的患者对大麻和阿片类药物的认知、共同使用和替代情况。
Pub Date : 2024-08-15 DOI: 10.1093/jncimonographs/lgad027
Rebecca L Ashare, Brooke Worster, Shannon M Nugent, Danielle M Smith, Benjamin J Morasco, Amy E Leader, Amy A Case, Salimah H Meghani

Prescription opioids are used for managing pain in persons with cancer, however, there are socioeconomic and racial disparities in medication access. Cannabis is increasingly used for cancer symptom management and as an opioid alternative. Limited data are available about patterns of opioid and cannabis use among patients with cancer. We used survey data from 4 National Cancer Institute-designated cancer centers in 3 states (n = 1220) to assess perceptions, use of cannabis and opioids for pain, their substitution, and racial and ethnic differences in each outcome. Compared with White patients, Black patients were less likely to use opioids for pain (odds ratio [OR] = 0.66; P = .035) and more likely to report that cannabis was more effective than opioids (OR = 2.46; P = .03). Race effects were mitigated (P > .05) after controlling for socioeconomic factors. Further research is needed to understand cannabis and opioid use patterns and how overlapping social determinants of health create a disadvantage in cancer symptom management for Black patients.

处方类阿片可用于控制癌症患者的疼痛,但在获得药物方面存在社会经济和种族差异。大麻越来越多地被用于控制癌症症状和作为阿片类药物的替代品。有关癌症患者使用阿片类药物和大麻模式的数据十分有限。我们利用来自 3 个州的 4 个国家癌症研究所指定癌症中心的调查数据(n = 1220),评估了患者对大麻和阿片类药物的认知、使用情况、替代情况以及每种结果的种族和民族差异。与白人患者相比,黑人患者使用阿片类药物止痛的可能性较低(几率比 [OR] = 0.66;P = .035),并且更有可能报告大麻比阿片类药物更有效(OR = 2.46;P = .03)。在对社会经济因素进行控制后,种族影响得到缓解(P > .05)。需要进一步研究以了解大麻和阿片类药物的使用模式,以及重叠的健康社会决定因素如何导致黑人患者在癌症症状管理方面处于不利地位。
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引用次数: 0
Patient-provider communication about the use of medical cannabis for cancer symptoms: a cross-sectional study. 关于使用医用大麻治疗癌症症状的患者与医护人员沟通情况:一项横断面研究。
Pub Date : 2024-08-15 DOI: 10.1093/jncimonographs/lgad026
Kea Turner, Oliver T Nguyen, Jessica Y Islam, Sahana Rajasekhara, Yessica C Martinez, Amir Alishahi Tabriz, Brian D Gonzalez, Heather S L Jim, Kathleen M Egan

Background: There has been limited study regarding patient-provider communication about medical cannabis for cancer symptom management. To address this gap, this study assesses the determinants and prevalence of patient-provider communication about the use of medical cannabis for cancer symptoms at a National Cancer Institute-designated Comprehensive Cancer Center.

Methods: Individuals who completed cancer treatment from July 2017 to December 2019 were invited to participate in a survey regarding medical cannabis. An electronic survey was administered in English and Spanish from August to November 2021 and completed by 1592 individuals (response rate = 17.6%).

Results: About one-third (33.5%) of participants reported discussing medical cannabis for cancer symptom management with a health-care provider. Controlling for other factors, individuals with malnutrition and/or cachexia had higher odds (odds ratio [OR] = 2.30, 95% confidence interval [CI] = 1.50 to 3.53) of reporting patient-provider discussions compared with individuals without malnutrition and/or cachexia. Similarly, individuals with nausea had higher odds (OR = 1.94, 95% CI = 1.44 to 2.61) of reporting patient-provider discussions compared with individuals without nausea. A smaller percentage (15.6%) of participants reported receiving a recommendation for medical cannabis for cancer symptom management. Among individuals who reported using cannabis, a little over one-third (36.1%) reported not receiving instructions from anyone on how to use cannabis or determine how much to take.

Conclusions: Overall, our study suggests that patient-provider communication about medical cannabis for cancer symptom management is limited. As interest and use of medical cannabis continues to grow among cancer patients, there is a need to ensure patients have access to high quality patient-provider communication.

背景:有关医用大麻治疗癌症症状的患者与医护人员沟通的研究十分有限。为了填补这一空白,本研究评估了在国家癌症研究所指定的综合癌症中心,患者与医护人员就使用医用大麻治疗癌症症状进行沟通的决定因素和普遍程度:邀请在 2017 年 7 月至 2019 年 12 月期间完成癌症治疗的个人参与有关医用大麻的调查。2021 年 8 月至 11 月期间,以英语和西班牙语进行了电子调查,共有 1592 人完成了调查(回复率 = 17.6%):结果:约三分之一(33.5%)的参与者表示曾与医疗服务提供者讨论过医用大麻治疗癌症症状的问题。在控制其他因素的情况下,与没有营养不良和/或恶病质的人相比,有营养不良和/或恶病质的人报告与患者和医护人员进行讨论的几率更高(几率比 [OR] = 2.30,95% 置信区间 [CI] = 1.50 至 3.53)。同样,与没有恶心症状的患者相比,有恶心症状的患者报告患者与医护人员讨论的几率更高(OR = 1.94,95% 置信区间 [CI] = 1.44 至 2.61)。有较小比例(15.6%)的参与者报告收到了医用大麻治疗癌症症状的建议。在报告使用大麻的人中,有略高于三分之一(36.1%)的人报告未从任何人那里获得关于如何使用大麻或确定服用量的指导:总体而言,我们的研究表明,患者与医护人员就医用大麻治疗癌症症状进行的沟通是有限的。随着癌症患者对医用大麻的兴趣和使用不断增加,有必要确保患者能够获得高质量的患者-提供者沟通。
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引用次数: 0
Cancer stage and consideration of cannabis use among adult cancer survivors in Southern California. 南加州成年癌症幸存者的癌症阶段和使用大麻的考虑。
Pub Date : 2024-08-15 DOI: 10.1093/jncimonographs/lgad028
Nasim Kasiri, Matthew Banegas, Jesse Nodora, Maria Elena Martinez, David Strong, Neal Doran, Corinne McDaniels-Davidson, Humberto Parada

Background: The benefits of cannabis in symptom management among cancer survivors are widely acknowledged; however, patterns of cannabis use by cancer stage at diagnosis are unknown.

Methods: Here, we examined the association between cancer stage at diagnosis and consideration of cannabis use since diagnosis. We analyzed cross-sectional survey data from 954 cancer survivors, weighted to be representative of a National Cancer Institute-Designated Comprehensive Cancer Center's patient population. We used survey-weighted multivariable logistic regression to examine the association between cancer stage at diagnosis (advanced [III/IV] versus non-advanced [I/II]) and consideration of cannabis use (yes versus no) since diagnosis.

Results: Sixty percent of the population was diagnosed with non-advanced stages of cancer, and 42% had considered using cannabis since diagnosis. The odds of consideration of cannabis use were 63% higher (odds ratio = 1.63, 95% confidence interval = 1.06 to 2.49) among cancer survivors diagnosed at stages III/IV than among those diagnosed at stages I/II.

Conclusion: Cancer stage may be a predictor of consideration of cannabis use after diagnosis.

背景:方法:在此,我们研究了癌症确诊阶段与确诊后考虑使用大麻之间的关联。我们对 954 名癌症幸存者的横断面调查数据进行了分析,这些数据经过加权处理,能够代表国家癌症研究所指定的综合癌症中心的患者群体。我们使用调查加权多变量逻辑回归法研究了癌症诊断分期(晚期 [III/IV] 与非晚期 [I/II])与诊断后考虑使用大麻(是与否)之间的关联:结果:60%的人被诊断为非晚期癌症,42%的人在确诊后考虑过使用大麻。诊断为 III/IV 期的癌症幸存者考虑使用大麻的几率比诊断为 I/II 期的癌症幸存者高 63%(几率比 = 1.63,95% 置信区间 = 1.06 至 2.49):结论:癌症分期可能是确诊后考虑使用大麻的一个预测因素。
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引用次数: 0
Cannabis use and patient-reported outcomes among patients at a comprehensive cancer center. 综合癌症中心患者的大麻使用情况和患者报告的结果。
Pub Date : 2024-08-15 DOI: 10.1093/jncimonographs/lgae012
Brian D Gonzalez, Xiaoyin Li, Yessica C Martinez, Heather S L Jim, Laura B Oswald, Jessica Y Islam, Kea Turner, Kathleen M Egan

Background: Patients with cancer report increasing rates of cannabis use, often to manage symptoms and toxicities. The efficacy and safety of cannabis, however, for some use cases remains unclear. To better understand characteristics of patients with cancer who report using cannabis, we examined data from a cannabis use survey of among patients with cancer seen at a National Cancer Institute-Designated Cancer Center.

Methods: In late 2021, patients with cancer (N = 1608) treated between July 2017 and December 2019 provided cannabis use data. Additional data were obtained from medical records data and routine patient-reported outcomes collected for clinical purposes. Univariable analyses and multivariable regression analyses were conducted to identify correlates of cannabis use at different stages in the cancer care trajectory.

Results: Rates of self-reported cannabis use by patients with cancer were 59% before cancer diagnosis and 47% after diagnosis. Longitudinal rates of cannabis use were 29% for no cannabis use, 23% before diagnosis, 12% after diagnosis, and 35% for both before and after diagnosis. Demographic factors associated with cannabis use included age, sex, race, and educational achievement. Tobacco use and binge drinking were associated with higher odds of cannabis use. Cannabis use was also associated with greater self-reported interference with physical functioning due to pain and interference with social functioning due to health problems.

Conclusions: We found high rates of cannabis use among patients with cancer, both before and after their cancer diagnosis. Future studies should further investigate psychosocial factors associated with cannabis use among patients with cancer as well as psychosocial outcomes among patients with cancer using cannabis.

背景:据报告,癌症患者使用大麻的比例越来越高,通常是为了控制症状和毒性。然而,大麻在某些情况下的疗效和安全性仍不明确。为了更好地了解报告使用大麻的癌症患者的特征,我们研究了美国国家癌症研究所指定癌症中心对癌症患者进行的大麻使用调查数据:2021 年底,在 2017 年 7 月至 2019 年 12 月期间接受治疗的癌症患者(N = 1608)提供了大麻使用数据。其他数据来自医疗记录数据和为临床目的收集的常规患者报告结果。我们进行了单变量分析和多变量回归分析,以确定在癌症治疗轨迹的不同阶段使用大麻的相关因素:癌症患者自我报告的大麻使用率在癌症诊断前为 59%,诊断后为 47%。未使用大麻的纵向使用率为 29%,诊断前为 23%,诊断后为 12%,诊断前后均为 35%。与大麻使用相关的人口统计学因素包括年龄、性别、种族和教育成就。吸烟和酗酒与吸食大麻的几率较高有关。使用大麻还与自我报告的因疼痛而对身体功能造成的更大干扰以及因健康问题而对社会功能造成的更大干扰有关:我们发现癌症患者在癌症确诊前后使用大麻的比例都很高。未来的研究应进一步调查与癌症患者使用大麻相关的社会心理因素,以及使用大麻的癌症患者的社会心理结果。
{"title":"Cannabis use and patient-reported outcomes among patients at a comprehensive cancer center.","authors":"Brian D Gonzalez, Xiaoyin Li, Yessica C Martinez, Heather S L Jim, Laura B Oswald, Jessica Y Islam, Kea Turner, Kathleen M Egan","doi":"10.1093/jncimonographs/lgae012","DOIUrl":"10.1093/jncimonographs/lgae012","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer report increasing rates of cannabis use, often to manage symptoms and toxicities. The efficacy and safety of cannabis, however, for some use cases remains unclear. To better understand characteristics of patients with cancer who report using cannabis, we examined data from a cannabis use survey of among patients with cancer seen at a National Cancer Institute-Designated Cancer Center.</p><p><strong>Methods: </strong>In late 2021, patients with cancer (N = 1608) treated between July 2017 and December 2019 provided cannabis use data. Additional data were obtained from medical records data and routine patient-reported outcomes collected for clinical purposes. Univariable analyses and multivariable regression analyses were conducted to identify correlates of cannabis use at different stages in the cancer care trajectory.</p><p><strong>Results: </strong>Rates of self-reported cannabis use by patients with cancer were 59% before cancer diagnosis and 47% after diagnosis. Longitudinal rates of cannabis use were 29% for no cannabis use, 23% before diagnosis, 12% after diagnosis, and 35% for both before and after diagnosis. Demographic factors associated with cannabis use included age, sex, race, and educational achievement. Tobacco use and binge drinking were associated with higher odds of cannabis use. Cannabis use was also associated with greater self-reported interference with physical functioning due to pain and interference with social functioning due to health problems.</p><p><strong>Conclusions: </strong>We found high rates of cannabis use among patients with cancer, both before and after their cancer diagnosis. Future studies should further investigate psychosocial factors associated with cannabis use among patients with cancer as well as psychosocial outcomes among patients with cancer using cannabis.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2024 66","pages":"259-266"},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11303852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141899112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The association of perceived cannabis risks and benefits with cannabis use since cancer diagnosis. 感知到的大麻风险和益处与癌症确诊后使用大麻的关联。
Pub Date : 2024-08-15 DOI: 10.1093/jncimonographs/lgad024
Corinne McDaniels-Davidson, Humberto Parada, Nasim Kasiri, Sandip P Patel, David Strong, Neal Doran

Background: Many patients with cancer use cannabis to help alleviate untreated cancer symptoms and side effects.

Methods: We examined associations of perceived benefits and risks and postdiagnosis cannabis use in a weighted sample of adult cancer survivors through a 1-time survey. Fifteen perceived cannabis use benefits and 19 perceived risks were operationalized as both summary scores and report of any benefits or risks. Survey-weighted logistic regression provided covariate-adjusted odds of postdiagnosis cannabis use for each benefit-risk measure.

Results: Among the weighted population of 3785 survivors (mean [SD] age = 62.2 [13.5] years), one-third used cannabis after diagnosis. Perceiving any benefits increased the odds of postdiagnosis cannabis use more than 500%, and perceiving any risks lowered the odds by 59%. Each SD increase in endorsed benefits doubled the odds of postdiagnosis cannabis use, while each SD increase in endorsed risks reduced the odds by 36%.

Conclusion: An accurate understanding of benefits and risks is critical for informed decision making.

背景:许多癌症患者使用大麻来帮助缓解未经治疗的癌症症状和副作用:许多癌症患者使用大麻来帮助缓解未经治疗的癌症症状和副作用:我们通过一次性调查,在成年癌症幸存者的加权样本中研究了感知到的益处和风险与确诊后使用大麻的关联。15 种感知到的使用大麻的益处和 19 种感知到的风险均以总分和对任何益处或风险的报告来表示。调查加权逻辑回归为每种益处-风险测量提供了经过协变量调整的确诊后使用大麻的几率:在 3785 名加权幸存者(平均 [SD] 年龄 = 62.2 [13.5] 岁)中,三分之一的人在确诊后使用大麻。认为有任何益处的幸存者在确诊后使用大麻的几率增加了 500% 以上,而认为有任何风险的幸存者使用大麻的几率降低了 59%。认可的益处每增加一个标准差,诊断后使用大麻的几率就会增加一倍,而认可的风险每增加一个标准差,几率就会降低 36%:结论:准确了解益处和风险对于做出知情决策至关重要。
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引用次数: 0
Patient out-of-pocket costs for cannabis use during cancer treatment. 癌症治疗期间使用大麻的患者自付费用。
Pub Date : 2024-08-15 DOI: 10.1093/jncimonographs/lgad030
Kaitlyn Lapen, Akriti Mishra Meza, Edward Christopher Dee, Jun J Mao, Nirupa Jaya Raghunathan, Sankeerth Jinna, Jessica Brens, Deborah Korenstein, Helena Furberg-Barnes, Talya Salz, Fumiko Chino

Background: We assessed patient costs associated with cannabis use during cancer treatment.

Methods: Adults treated for cancer at a large, comprehensive center completed an anonymous survey regarding their thoughts and experiences with cannabis and cancer. Bivariate and weighted multivariable logistic regression assessed clinical and sociodemographic factors associated with patient-reported out-of-pocket costs for cannabis products.

Results: Overall, 248 cannabis users provided data on cost and were analyzed. Median monthly out-of-pocket cost for cannabis was $80 (interquartile range = $25-$150). On regression analysis, male gender (odds ratio = 2.5, 95% confidence interval = 1.2 to 5.5, P = .026) and being 45 years of age or older (odds ratio = 7.5, 95% confidence interval = 1.9 to 30.0, P = .0042) were associated with spending $100 a month or more on cannabis. Of the 166 patients who stopped using cannabis early or used less than preferred, 28% attributed it to cost and 26% to lack of insurance coverage.

Conclusion: Cannabis use during cancer treatment may contribute to significant out-of-pocket costs, with men and younger patients more likely to pay higher costs.

背景:我们评估了患者在癌症治疗期间使用大麻的相关费用:在一家大型综合中心接受癌症治疗的成年人完成了一项匿名调查,内容涉及他们对大麻和癌症的看法和经历。双变量和加权多变量逻辑回归评估了与患者报告的大麻产品自付费用相关的临床和社会人口因素:共有 248 名大麻使用者提供了费用数据并进行了分析。每月大麻自付费用的中位数为 80 美元(四分位间范围 = 25-150 美元)。在回归分析中,男性(几率比 = 2.5,95% 置信区间 = 1.2 至 5.5,P = .026)和 45 岁或以上(几率比 = 7.5,95% 置信区间 = 1.9 至 30.0,P = .0042)与每月 100 美元或以上的大麻费用相关。在 166 名提前停止使用大麻或使用量少于首选量的患者中,28% 的人归因于费用,26% 的人归因于缺乏保险:结论:在癌症治疗期间使用大麻可能会导致大量的自付费用,男性和年轻患者更有可能支付更高的费用。
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引用次数: 0
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Journal of the National Cancer Institute. Monographs
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