BACKGROUNDCannabis is purported to alleviate symptoms related to cancer treatment, although the patterns of use among cancer patients are not well known. This study was designed to determine the prevalence and methods of use among cancer patients, the perceived benefits, and the sources of information in a state with legalized cannabis.METHODSA cross‐sectional, anonymous survey of adult cancer patients was performed at a National Cancer Institute–designated cancer center in Washington State. Random urine samples for tetrahydrocannabinol provided survey validation.RESULTSNine hundred twenty‐six of 2737 eligible patients (34%) completed the survey, and the median age was 58 years (interquartile range [IQR], 46‐66 years). Most had a strong interest in learning about cannabis during treatment (6 on a 1‐10 scale; IQR, 3‐10) and wanted information from cancer providers (677 of 911 [74%]). Previous use was common (607 of 926 [66%]); 24% (222 of 926) used cannabis in the last year, and 21% (192 of 926) used cannabis in the last month. Random urine samples found similar percentages of users who reported weekly use (27 of 193 [14%] vs 164 of 926 [18%]). Active users inhaled (153 of 220 [70%]) or consumed edibles (154 of 220 [70%]); 89 (40%) used both modalities. Cannabis was used primarily for physical (165 of 219 [75%]) and neuropsychiatric symptoms (139 of 219 [63%]). Legalization significantly increased the likelihood of use in more than half of the respondents.CONCLUSIONSThis study of cancer patients in a state with legalized cannabis found high rates of active use across broad subgroups, and legalization was reported to be important in patients' decision to use. Cancer patients desire but are not receiving information about cannabis use during their treatment from oncology providers. Cancer 2017;123:4488‐97. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Low alpha diversity in stool microbiota at neutrophil recovery associates with increased severe graft-versus-host disease (GVHD), greater abundance of oral Actinobacteria or Firmicutes, and decreased abundance of intestinal Lachnospiraceae in stool microbiota at neutrophil recovery associated with increased severe GVHD.

Background Probiotic supplementation has been promoted for numerous health conditions, however safety in immunosuppressed patients is unknown. We evaluated bloodstream infections (BSIs) caused by common probiotic organisms in hematopoietic cell transplant recipients. Methods All blood culture (BC) results from a cohort of hematopoietic cell transplant recipients transplanted at Fred Hutchinson Cancer Research Center in Seattle, Washington, between 2002 and 2011 were reviewed. Patients with at least 1 positive BC for common probiotic organisms (Lactobacillus species, Bifidobacterium species, Streptococcus thermophiles, and Saccharomyces species) within 1 year post hematopoietic cell transplantation (HCT) were considered cases. Data were collected from center databases, which contain archived laboratory data, patient demographics, and clinical summaries. Results A total of 19/3796 (0.5%) patients developed a BSI from 1of these organisms within 1 year post HCT; no Bifidobacterium species or S. thermophilus were identified. Cases had a median age of 49 years (interquartile range [IQR]: 39–53), and the majority were allogeneic hematopoietic cell transplant recipients (14/19, 74%). Most positive BCs were Lactobacillus species (18/19) and occurred at a median of 84 days (IQR: 34–127) post transplant. The incidence rate of Lactobacillus bacteremia was 1.62 cases per 100,000 patient-days; the highest rate occurred within 100 days post transplant (3.3 per 100,000 patient-days). Eight patients (44%) were diagnosed with acute graft-versus-host disease of the gut prior to the development of bacteremia. No mortality was attributable to any of these infections. Conclusion Organisms frequently incorporated in available over-the-counter probiotics are infrequent causes of bacteremia after HCT. Studies evaluating the use of probiotics among high-risk patients are needed.

The allocation of the coronavirus disease 2019 (COVID-19) vaccines has been a true Gordian knot: difficult to unravel, impossible to get right for all communities, and challenging even for experts. One can construct a rational argument justifying the prioritization of nearly any group of Americans. Rationing health care is never comfortable but has become necessary while vaccine availability remains an issue. For many health care workers, our most vulnerable patients are at the front of our minds.As the next phases of vaccine distribution begin, oncologists argue that patients with cancer should be a priority population to receive COVID-19 vaccines. [1][2][3] This approach makes sense because severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a systemic infection, and patients with cancer are at high risk for COVID-19 complications. 4 Early pandemic data showed 13% mortality among a cohort of patients with cancer, 5 nearly 10 times higher than the current 1.7% case fatality reported in the United States. Mortality among hematopoietic cell transplant recipients is even more concerning, reaching 32% within 30 days after COVID-19 diagnosis. 6 The vulnerabilities of patients with cancer are clear: therapies for their treatments leave them significantly immunosuppressed, many are elderly and chronically ill, and most have multiple comorbidities placing them at risk for severe COVID-19. The National Comprehensive Cancer Network's guidelines argue that newly diagnosed patients with cancer, those on active treatment, or those having recently completed therapy should be targeted for early vaccination. 2 Spearheaded by the American Association for Cancer Research, over 130 organizations representing researchers, health care providers, patients, and patient advocates signed a letter to prioritize patients with cancer for COVID-19 vaccinations. 7 Even the most ardent antilockdown or antimasking proponents would likely agree that we must protect this vulnerable population.However, where do informal caregivers and family members, the people cancer patients count on for social support, lie on this priority continuum? Prioritizing patients with cancer for vaccination while not accounting for the contexts of their lives is myopic. This strategy only considers a cancer patient's individual risk for complications and does not address the modifiable risk for transmission in their social network and often isolated environment. Instead, we propose that priority access to vaccination also extend to immediate family members and informal caregivers who regularly interact with these high-risk patients to strengthen SARS-CoV-2 prevention and protection.Offering early COVID-19 vaccinations to patients with cancer is undoubtedly a logical and ethical strategy. However, efficacy of current vaccines for patients with cancer are unknown because most were excluded from phase 3 clinical trials. 8,9 Patients with cancer, many of whom are immunosuppressed from their treatment or disease, may not respond to vaccines like those with full...