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A survey was conducted to evaluate the perception, use, and information sources of medical cannabis among patients with head and neck cancer, as well as identify opportunities for providers to help clarify its use. Three hundred thirteen consecutive patients with head and neck cancer seen in the radiation oncology department at one institution in CA from October 2022 – June 2023 were screened for eligibility to participate in the survey. Eligibility criteria included biopsy-proven cancer diagnosis, age ≥ 18 years, and primary language of English. Eligible patients were then contacted over telephone to invite their participation in the survey; the survey was administered via email upon receipt of written consent. Demographic and clinical data were collected from the electronic health record and survey, including age, gender, race, ethnicity, metastatic status, COVID-19 vaccination status, substance use history, relationship and employment status, and level of education. Survey responses were recorded and analyzed using chi-squared tests to evaluate whether clinical and socioeconomic factors were associated with patients' perception, use, and information sources of medical cannabis. All analysis was performed in R, ver. 4.3.2. Of 259 eligible patients, 123 patients responded to initial contact for invitation to participate in the study; 59 patients declined participation, and 64 patients consented to participation. 54 patients completed the survey. When patients were asked about their beliefs regarding medical cannabis, 39% responded positively or neutrally regarding its potential to cure cancer, while 63% responded positively or neutrally regarding their belief that it helps cancer patients live longer, even if it does not eliminate the cancer. Most patients (72%) agreed it can help reduce symptoms of cancer and/or its treatment. Overall, 57% of patients reported having used cannabis, 43% of patients have actively sought information on cannabis, and only 19% have discussed its use with their cancer treatment team. However, 73% expressed interest in such discussions. Education was found to be associated with patients' beliefs regarding whether cannabis can cure cancer (P = 0.039) and help cancer patients live longer (P = 0.049); more patients with education beyond a bachelor's degree disagreed with these beliefs. No patient characteristics were associated with whether patients have searched for information on cannabis or have wanted to discuss cannabis use with their treatment team. Despite significant interest in discussing cannabis with their treatment team, few patients have these conversations. Higher education correlated with disbelief in cannabis being able to cure cancer or prolong survival, highlighting the impact of educational background on patient perspectives. Improved communication between healthcare providers and patients is needed. [ABSTRACT FROM AUTHOR]

Pediatric intracranial arteriovenous malformations (AVM) have a greater cumulative lifetime risk of rupture than adults. While obliteration after radiation occurs in a dose-dependent manner, increasing radiation doses also pose a higher risk of adverse radiation effects (ARE). Radiosurgery is effective in adults, but less is known about the efficacy and safety of robotic radiosurgery for pediatric intracranial AVMs. We performed a retrospective review of consecutive pediatric patients with AVMs at a single institution with minimum follow-up of 1.75 years who underwent robotic radiosurgery between 2005 and 2021 with one of 3 radiosurgery dosing schedules: 1) single-stage unfractionated, 2) single-stage fractionated, 3) volumetrically multi-staged treatment. Cox proportional hazards regression models were performed to identify predictors of AREs and obliteration. 95 patients (age:1-21 years, M:F 50:45) with 100 intracranial AVMs were identified for analysis. Median follow-up time was 4.5 years (range = 1.75-15.25 years). Forty-four (46.3%) patients presented with ruptured AVMs. The mean AVM volume was 10.0 cm3 ± 11.88 (range = 0.11-71.86 cm3). Most had Spetzler-Martin grade III (36.2%) and IV (31.9%). The overall rate of total obliteration was 52.6% (78.8% in single-stage unfractionated, 24.2% in single-stage fractionated, and 10% in multi-staged treatment) with a median obliteration time of 3.25 years (2.8- 4.1 years). Partial obliteration was achieved in 23.2% (17.3% in single-stage unfractionated, 30.3% in single-stage fractionated, and 30% in multi-staged treatment). In the univariate analysis, higher obliteration rate was associated with small volume (hazard ratio; HR = 0.876, 0.812 – 0.945) (P = 0.001), lower Spetzler-Martin grade (HR = 0.437, 0.320 – 0.597) (P = <0.001), and higher single-fraction equivalent dose (HR = 1.160, 1.020 – 1.198) (P = 0.015), respectively. Pretreatment hemorrhages were found in 51 patients (59.6 % in unfractionated, 45.5 % in fractionated, and 50% in multi-staged treatment). Thirteen patients experienced hemorrhage in the post-treatment period (3.8% in unfractionated, 12% in fractionated, and 60% in staged treatment). AREs were found in 31.6% of patients, many of whom (50%) had deep subcortical lesions. Male gender and V12Gy correlated with AREs (HR = 0.447, 0.199 – 1.004) (P = 0.051) and (HR = 1.020, 1.000 – 1.041) (P = 0.053), respectively. Single-fraction radiosurgery is very effective in treating smaller pediatric AVMs with obliteration rates of 79%. While single-stage fractionated treatment was less effective in achieving total obliteration (24%), this approach significantly reduced the posttreatment hemorrhage rate by at least half. Unfortunately, only 10% of AVMs in the multi-staged cohort were obliterated and post-treatment hemorrhage rates were not reduced. AVMs located in deeper cortical regions and those with higher Spetzler-Martin grade remain challenging. [ABSTRACT FROM AUTHOR]