Background/Aim: The purpose of this study was to assess patients' use of a crowdfunding platform to raise funds for radiation treatment and to better understand the direct and indirect costs associated with treatments. Materials and Methods: The GoFundMe crowdfunding database was queried for four unique categories related to radiation treatment campaigns. Covariates identified included clinical and demographic variables, and associations between amount raised and these predictors were analyzed using a generalized linear model. Results: While 56% percent of campaigns cited direct costs associated with treatment, 73.4% of campaigns cited indirect costs related to treatment. Indirect expenses related to travel (31.7%) as well as living expenses (29.2%) were cited most often across all four treatment categories. Conclusion: This study enhances understanding regarding patients use of crowdfunding for radiation treatment. Increased focus should be placed on discussing the indirect costs of care with patients and their families.The United States has observed a promising trend in increased cancer survival with improved screening protocols, advanced medical technologies, and the development of targeted radiation and other treatments (1, 2). These advancements increased cancer survivorship on the world stage (3). However, the "financial toxicity", or exorbitant cost of cancer care in the United States, has increased at a substantial rate. (1) A study characterized the financial toxicity of cancer care for over 9.5 million newly diagnosed Americans over the age of 50 and found 42% of patients reported fully depleting their assets by the second year of their diagnosis (4). Patients, already dealing with the emotional and physical toll of a cancer diagnosis, may resort to radical lifestyle changes that include decreased food spending, selling their possessions and property, borrowing money from others, and declaring bankruptcy due to treatment expenses and the associated costs of treatment (5).When compared with the cost of chemotherapy and pharmaceutical therapy in cancer care, radiation treatment is a relatively cost-effective modality that accounts for less than ten percent of the total costs of cancer care (6, 7). Yet, approximately half of all patients with cancer will receive radiation therapy as part of their treatment course (6), and the cost of radiation therapy in the United States may contribute to financial toxicity for patients and families (8). Furthermore, distinct forms of radiation therapy may have substantially different costs associated with treatment. Considering the financial toxicity of cancer therapy and the personal life changes that may occur as a result, patients and families have begun to use crowdfunding sources as an avenue to fund treatments and the expenses associated with cancer care. Despite its popular use, much is not known regarding patient and family use of crowdfunding platforms in order to fund cancer treatment. Few studies to date have performed an indepth analysis of crowdfunding platf...
Thromboembolism is a leading cause of death in ambulatory patients with cancer. Patients with pancreatic adenocarcinoma have a very high risk of developing venous thromboembolism, especially within the first 6 months of diagnosis. Although primary thromboprophylaxis could reduce this risk, there are unresolved questions concerning choice of agents for anticoagulation, duration of anticoagulation treatment, and criteria for patient selection. Furthermore, the current clinical guidelines on primary thromboprophylaxis in ambulatory patients with pancreatic cancer are ambiguous. This review seeks out to understand and critically appraise the evidence supporting the use of primary thromboprophylaxis in patients with pancreatic cancer and its clinical applicability.
With rapid shifts in how health information is reported and consumed, providers and patients must consider their electronic or “eHealth” literacy. The purpose of this study was to analyze how older adults (age 60+) seek health information in the context of online and offline resources and how eHealth literacy correlates with health behaviors. We performed a cross-sectional analysis of a nationally representative sample of 2,587 U.S. older adults drawn from the Health Information National Trends Survey (HINTS) Iteration 5 Cycle 3. Weighted descriptive analyses were conducted to examine the association between CDC-recommended health behavior guidelines on produce consumption and exercise, eHealth literacy, and sociodemographics. Weighted logistic regression analyses were conducted with STATA 16.0 to assess the relationship between healthy behaviors and eHealth literacy controlling for sociodemographics. The weighted sample reported the following demographic characteristics: average age 71 years (range 60-98), 53.6% female, 73.8% White, 9.7% Black and 8.6% Hispanic. Of older adults, 26.7% performed 2 or more health behaviors regularly. Among older adults, those who have looked up medical information using electronics are 1.79 (95% confidence interval: 1.24, 2.58) times more likely to meet 2 or more CDC-recommended health behavior guidelines as compared to those that have not, after controlling for survey group, education, race/ethnicity and gender. Access and utilization of online resources among older adults may influence their health behaviors and health outcomes. Providers should consider the eHealth literacy of their older adult patients and direct them to appropriate and reliable online resources.
Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers with a 5-year survival rate less than 10%. Current therapies consisting of cytotoxic chemotherapeutic agents are not effective in most patients with metastatic PDAC, and the impact of new strategies, including immunotherapies, has not been established. Previous studies have shown that inhibition of focal adhesion kinase (FAK) modulates the PDAC immunosuppressive tumor microenvironment (TME), and sensitizes tumors to immune checkpoint blockade. However, the role of FAK in regulating tumor cell intrinsic resistance to immunotherapy is not well understood. We and others previously demonstrated FAK regulates PDAC cancer stem cells (CSCs) activity including self-renewal, tumor initiation, and drug resistance. These CSCs are responsible for metastatic dissemination and resistance to multiple therapies, including immunotherapy. In this study, we evaluated the sensitivity of PDAC cells, including CSCs to cytotoxic T cells, and we also analyzed the impact of FAK inhibition on the immunogenicity and the response to cytotoxic T cell activity of PDAC CSCs. Methods: To understand how FAK regulates tumor intrinsic resistance to antigen-specific cytotoxic T cells, we utilized OT-I T cells (OT-I cells) that specifically recognize a peptide fragment of ovalbumin (ova) within the context of MHC-I. Mouse KPC pancreatic cancer cell lines expressing ova were generated and co-cultured with cytotoxic CD8+ OT-I cells in vitro. We analyzed the effect of FAK in regulating bulk cells sensitivity to antigen-specific cytotoxic T cells and clonogenic growth of CSCs by flow cytometry, MTT assay and colony formation assay using CRISPR-Cas9 and small molecule FAK inhibitors. We also analyzed the expression of surface proteins that mediate interactions with T cells (class I MHC) in bulk cells and CSCs after FAK inhibition. Results: Loss of FAK activity decreased CSCs activity (self-renewal, colony formation) in PDAC mouse cell lines, which is consistent with our previous data. Using antigen-specific OT-I co-culture model, we found that CSCs are resistant to cytotoxic T cells anti-tumor activity compared to bulk tumor cells. We also found inhibition of FAK activity not only enhances PDAC cells to cytotoxic T cell activity, but also sensitized CSCs to T cell killing. Studies in both human and mouse PDAC cell lines demonstrated decreased MHC-I expression in CSCs compared to the bulk tumor cells which could be reversed by FAK inhibition. Conclusion: We have demonstrated that CSCs are resistant to antigen-specific cytotoxic T cells, and FAK inhibition in CSCs can sensitize these cells to anti-tumor T cell activity that is associated with changes in the expression of factors involved in antigen presentation. Our study provides novel insights into the unique immunogenicity of CSCs and the role of CSCs in regulating tumor intrinsic immunotherapy resistance in PDAC. Our findings also lead to the identification of FAK as a novel therapeutic target for CSCs to improve immunotherapy efficacy in PDAC. Citation Format: Yezi Zhu, Lyndsey Sandow, William Matsui. Inhibition of focal adhesion kinase (FAK) improves pancreatic ductal adenocarcinoma’s response to immunotherapy by targeting cancer stem cells (CSCs) [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2021 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2021;81(22 Suppl):Abstract nr PR-004.
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