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Medscape
09-05-2025
- Health
- Medscape
Cancer Pain Most Common Symptom Before Acute Care Visits
Pain, nausea, and vomiting were the most frequently documented symptoms preceding unplanned acute care visits in patients with cancer, new research showed. Women, individuals from racial minority groups, and those with Medicaid insurance were more likely to have a high symptom burden, although men and White patients accounted for most of the visits. METHODOLOGY: Many patients with cancer require unplanned acute care, including emergency department (ED) visits and hospitalizations, due to complications from their disease or treatment. These encounters affect outcomes, quality of life, and healthcare costs. However, little is known about symptom patterns preceding such visits. A cohort study conducted at a single tertiary-care institution analyzed outcomes from 28,708 adult patients with cancer who had symptoms documented in the 30 days before an acute care visit. Researchers used natural language processing to scan clinical notes for symptoms recorded in the 30 days before an ED visit or hospital stay. High symptom burden was defined as more than 10 different symptoms noted during that time. The primary outcomes were symptom burden and characterization of symptoms preceding acute care visits. Secondary outcomes included associations between symptom burden and sociodemographic characteristics (sex, race and ethnicity, age, and insurance type). TAKEAWAY: Overall, 70,606 acute care encounters were observed, and 854,830 symptoms were documented before an acute care visit. Men had 53.6% of the acute care encounters, and White patients had about 56.6%. The top 10 most common documented symptoms were pain (7.54%), nausea (6.74%), vomiting (5.79%), fatigue (5.26%), constipation (3.93%), fever (3.39%), generalized muscle weakness (3.32%), extremity edema (3.28%), dyspnea (3.12%), and headache (2.92%). Women (adjusted odds ratio [aOR], 1.14); patients of Asian (aOR, 1.22), Black (aOR, 1.17), and American Indian or Alaska Native (aOR, 1.21) races; and Medicaid-insured patients (aOR, 1.10) were significantly more likely to have a documented high symptom burden. Patients aged 65 years or older (aOR, 0.96) and those without insurance (aOR, 0.58) were significantly less likely to have a documented high symptom burden preceding an acute care visit. IN PRACTICE: 'This analysis highlights differences in cancer symptom documentation across racial, sex, and socioeconomic subgroups, suggesting potential areas of disparities. This raises attention to the potential need to develop targeted interventions to ensure equitable access to health care for improved symptom management,' the authors wrote. SOURCE: This study, led by Chichi Chang, MEng, Bakar Computational Health Sciences Institute, University of California San Francisco, was published online in JAMA Network Open . LIMITATIONS: The limitations included retrospective design, single-center study, potentially incomplete data, and a predominantly White and insured population. Natural language processing methods could have limitations in accurately capturing complex clinical documentation. Repeated visits by the same patients might have biased symptom data. DISCLOSURES: This study received support from a National Cancer Institute of the National Institutes of Health grant, a Conquer Cancer Career Development Award, and a University of California San Francisco Computational Cancer Award. One author reported providing paid services to Epi-Vant Consulting, outside the submitted work. Another author reported receiving grants from Roche, outside the submitted work.
New York Times
08-05-2025
- Politics
- New York Times
Trump Declares High-Speed Internet Program ‘Racist' and ‘Unconstitutional'
President Trump on Thursday attacked a law signed by President Joseph R. Biden Jr. aimed at expanding high-speed internet access, calling the effort 'racist' and 'totally unconstitutional' and threatening to end it 'immediately.' Mr. Trump's statement was one of the starkest examples yet of his slash-and-burn approach to dismantling the legacy of his immediate predecessor in this term in office. The Digital Equity Act, a little-known effort to improve high-speed internet access in communities with poor access, was tucked into the $1 trillion bipartisan infrastructure bill that Mr. Biden signed into law early in his presidency. The act was written to help many different groups, including veterans, older people and disabled and rural communities. But Mr. Trump, using the incendiary language that has been a trademark of his political career, denounced the law on Thursday for also seeking to improve internet access for ethnic and racial minorities, raging in a social media post that it amounted to providing 'woke handouts based on race.' In reality, the law barely mentions race at all, only stating that racial minorities could be covered by the program while including a nondiscrimination clause that says that individuals could not be excluded from the program 'on the basis of actual or perceived race, color, religion, national origin, sex, gender identity, sexual orientation, age, or disability' — language taken from the Civil Rights Act of 1964. The Digital Equity Act, drafted by Senator Patty Murray, Democrat of Washington, provides $60 million in grants to states and territories to help them come up with plans to make internet access more equal, as well as $2.5 billion in grants to help put those plans into effect. Some of that funding has already been disbursed to states with approved plans — including red, rural states like Indiana, Alabama, Arkansas, Iowa and Kansas. Hundreds of millions of dollars in additional funding were approved by the Biden administration in the weeks before Mr. Trump took office, but have not yet been distributed. It was not immediately clear whether Mr. Trump had carried out his threat to end the grants, which were appropriated through Congress. The agencies that oversee the internet initiative, the National Telecommunications and Information Administration and the Department of Commerce, did not immediately to requests for comment. The cancellation of grants to states would almost certainly be challenged in the courts, where the Trump administration has had some success in blocking, at least temporarily, challenges to its suspension of grants related to equity and diversity programs. However, in late March, the administration failed to ward off a block on its sweeping freeze of federal funds to states.
