bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of sorafenib in symptomatic patients with pretreated progressive desmoid tumors.
Authors: Ferhatoglu Ferhat , Paksoy Nail , Dogan Izzet , Ak Naziye , Pehlivan Metin , Ekenel Meltem , Basaran Mert
Published: June 2021

e23556

Background: Desmoid tumor (DT) is a rare disease characterized by histologically monoclonal fibroblastic proliferation. DT does not have metastatic spread potentially but can be infiltrative and locally aggressive and decrease patients' quality of life. Although current treatment guidelines recommend active surveillance as initial therapy, systemic therapy should be considered in rapidly progressing or symptomatic patients. Systemic treatments for DT include hormonal blockade, cytotoxic chemotherapy, and tyrosine-kinase inhibitors. In this real-life study, we aimed to evaluate the efficacy of sorafenib in patients with progressing or symptomatic DT. Methods: The clinical, pathological, and treatment data of the patients were retrospectively evaluated. Also, prognostic parameters for overall survival were assessed. We used SPSS v.25 for statistical analysis. Kaplan-Meier and Cox-regression analysis were used for survival analysis. Results: Seventeen patients were included in the study. The ratio of female/male patients was 2.4, and the median age was 32 (range,14-65). Four (23.5%) patients had Gardner syndrome. The rates of extra-abdominal and ıntra-abdominal tumor locations were 64.7% and 35.3%, respectively. The median follow-up duration before sorafenib was 6±0.84 years. Before sorafenib, 15 patients had underwent surgical resection. Four (23.5%) patients received adjuvant radiotherapy. All patients received median two-line systemic therapy, and four (23.5%) patients had received chemotherapy. The median treatment duration of sorafenib was 23.4±2.2 months. One- and two-year progression-free survival ratios were 94.1% and 80.7%, respectively. Grade 3-4 toxicities were observed in six (35.2%) of the patients. In univariate analysis, we found that gender (p = 0.012), ECOG performance status (p = 0.032), and history of Gardner syndrome (p = 0.021) were statistically significant prognostic factors for progression-free survival. However, there was no statistically significant between extra-abdominal and ıntra-abdominal tumor locations (p = 0.56). Conclusions: In the study, we observed that sorafenib was an effective treatment option for previously treated advanced desmoid tumors. Despite a small number of patients, we detected that male gender, poor ECOG performance status, and history of Gardner syndrome were negative prognostic factors for progression-free survival.
Advance care planning billing practices and documentation quality for cancer patients requiring hospitalization.
Authors: Berkowitz Callie , Ma Jessica , Lowe Jared Richard , Dolor Rowena
Published: June 2021

e24000

Background: Advance Care Planning (ACP) is an important component of comprehensive cancer care, yet barriers exist to successful implementation. In 2016, Medicare introduced billing codes to provide reimbursement for ACP discussions. Our aim was to evaluate the usage of ACP billing codes and quality of accompanying documentation in patients with a prior oncology admission at an academic medical center. Methods: Using an electronic health record data warehouse tool, we identified a cohort of cancer patients who had been admitted to the inpatient oncology service and had an ACP billing encounter (CPT codes 99497 or 99498) over a 4-year period (8/1/2016 to 8/1/2020). We collected patient and provider demographics and performed descriptive statistics. We assessed ACP documentation quality for 30 patients selected at random based on 5 domains (healthcare proxy, health values or goals, scope of treatment/code status, prognosis/illness understanding, and end of life [EOL]care planning/hospice) previously identified from a literature review. Results: We identified 170 unique patients (180 ACP encounters), representing a small fraction (170/5636, 0.03%) of hospitalized oncology patients over the study period. Patients were 52% female with mean age of 64 (SD 12.9). Mean number of oncology hospitalizations was 2.6 (SD 1.96). ACP encounters took place in both inpatient (135/180; 75%) and outpatient (45/180; 25%) settings. In the outpatient setting, the majority of billing encounters were in palliative care (27/45; 60%), followed by oncology (12/45;27%) and primary care (5/45;11%). Of the sample of patient charts reviewed (n = 30), provider documentation frequently included scope of treatment (27/30; 90%), prognosis (27/30; 90%), EOL planning (21/30; 70%), and health values (19/30, 63%); healthcare proxy was infrequently included (4/30, 13%). Conclusions: ACP billing remains infrequently utilized for a cohort of oncology patients requiring hospitalization at a large academic center. In cases for which an ACP discussion is billed, the accompanied documentation is of high clinical utility and meets several key quality domains. This work lays a foundation for future research and quality improvement efforts to improve ACP and documentation.[Table: see text]
Outcomes of patients with malignancy admitted to the intensive care units (ICU): A prospective study.
Authors: Assi Hazem , Alameh Ibrahim , Bou Zerdan Maroun , Charafeddine Maya , Khoury Jessica , El Nakib Clara , Bou Khalil Pierre
Published: June 2021

e24001

Background: An important aspect of improving outcomes for patients with malignancy is the provision of critical care during periods of acute deterioration. Decisions regarding whether advanced cancer patients should be admitted to the ICU is based on a complex suite of considerations, including short- and long-term prognosis, quality of life, and therapeutic options to treat cancer. We set to describe demographic, clinical, and survival data and to identify factors associated with short- and long-term mortality in critically ill advanced cancer patients with non-elective admissions to general ICUs. Methods: Critically ill adult (≥18-year-old) cancer patients non-electively admitted to the intensive care units at the American University of Beirut Medical Center (AUBMC) between August 1st, 2015, and March 1st, 2019, were included. Demographic, clinical, and laboratory data was prospectively collected from first day of ICU admission up to 30 days after discharge. This study was strictly observational and clinical decisions were left to the discretion of the ICU team and attending physician. Results: Two hundred seventy-two patients were enrolled in the study between August 1st, 2015, and March 31st, 2019, with an ICU mortality rate of 43.4%, with the number rising to 59% within 30 days of ICU discharge. Mean length of stay in our ICU was 14 days with an interquartile range of 1 to 120 days with a median overall survival of 22 days since date of ICU admission. The major reasons for unplanned ICU admission were sepsis/septic shock (54%) and respiratory failure (33.1%). COX regression analysis showed that sepsis, uncontrolled malignancy, ARDS, multi-organ failure, use of vasopressors, use of mechanical ventilation are major predictors of poor prognosis. Direct admission from the ED was associated with a higher risk of mortality (48.9%) than being transferred from the floor (32.6%) (p = 0.014). Additionally, mortality in patients with solid malignancies (47.6%) was higher than those with hematologic malignancies (34.1%) (p = 0.0048). Conclusions: Patients admitted to the ICU in a tertiary care center in the MENA region are at high risk for short term mortality.
Chemotherapy use at the end of life in Brazil.
Authors: Murad Junior Munir , Mascarenhas Nébias Thiago Henrique , Santos Marcos Antonio da Cunha , Cherchiglia Mariangela
Published: June 2021

e24003

Background: Chemotherapy in the last days of life is not associated with a survival benefit, and recent data suggest it may cause harm by decreasing quality of life and increasing costs. Both ESMO and ASCO have published position statements encouraging discussions about the appropriate cessation of chemotherapy. End-of-life chemotherapy rates vary worldwide but in summary, up to a fifth of cancer patients are treated with chemotherapy in the last month of life with no clear benefits. The aim of this study is to describe the rate of chemotherapy use in the last month of life in patients who are candidates for palliative care in Brazil. Methods: It is a prospective non-concurrent cohort carried out from a database developed through probabilistic and deterministic linkage of data from information systems of the Brazilian Public Health System. The study population is composed of all patients who started cancer treatment between 2009 and 2014 and who was hospitalized at least 1 time after starting treatment. To address the indication for palliative care, patients whose death occurred within one year after the first hospitalization were selected. Results: A total of 299,202 patients started cancer treatment in that period and 62,249 died 1year after hospitalization. Among the deceased patients, the median age was 62 years, 50.9% of them were in stage IV and 34.1% in stage III and 46% lived in the southeastern region of the country. The most common cancers were lung (n = 17805; 28.6%) colorectal (n = 12273; 19.7%) and gastric (n = 10248; 16.5%). The average number of hospitalizations was 2.7 and 89% of these patients required emergency hospitalization. About half (45,4%; n=28,250) of the patients underwent chemotherapy at the last 30 days of life. The rates of use of chemotherapy in the last month was 44% for lung cancer, 74,4% for colon, 50.2% for gastric and 51.8% breast cancers. Conclusions: Despite international recommendations on the use of chemotherapy at the end of life, this seems to be a common practice unfortunately. Measures to implement early palliative care should be a priority for the care of cancer patients in Brazil.
Indicatives of palliative care in patients with lung cancer treated in the Brazilian public health system.
Authors: Mascarenhas Nébias Thiago Henrique , Murad Junior Munir , Santos Marcos Antonio da Cunha , Cherchiglia Mariangela
Published: June 2021

e24007

Background: In the last decade, a growing body of evidence has demonstrated that palliative care improves outcomes such as QOL, symptom burden, survival and decreases resource utilization. However, many patients eligible for PC are not referred to it or receive these services only in the last phase of their illness. Significant barriers explain the lack of access to PC, including identifying patients who would benefit from this approach. The aim of this study is to identify indicatives of palliative care in patients with lung cancer in Brazil in order to improve access. Methods: Prospective non-concurrent cohort carried out from a database developed through probabilistic and deterministic linkage of data from information systems of the Brazilian Public Health System. Study population was composed of all patients who started cancer treatment between 2009 and 2014 and who was hospitalized at least one time after starting treatment. To address the indication for palliative care, patients whose death occurred within one year after the first hospitalization were selected. Logistic regression models were used to assess the association between death in one year and sociodemographic, clinical and treatment-related variables. Results: A total of 27,634 patients diagnosed with lung cancer started cancer treatment in that period and 17,805 (64%) died one year after the first hospitalization. Among the deceased patients, the median age was 63 years, 59,8% of them were in stage IV, 32.4% in stage III and the majority received chemotherapy as their first treatment (72,3%). In this sub-group, 44,3% lived in the southeastern region of the country and 63,3% were male. Furthermore, 91% of the patients required emergency hospitalization and 20,1% were admitted in ICU units. The multivariate analysis revealed that being male (OR=1.2; CI, 1.13-1.28), live in the north region (OR=1.38, CI, 1.13-1.69) and having an older age (40-59 years, OR= 1.32; CI, 1.07-1.63; 60-79 years, OR=1.48; CI, 1.2-1.83; 80 or more years, OR=1.62; CI, 1.26-2.08) were associate with the outcome. Patients that were diagnosed with stage IV lung cancer (OR=1.99; CI, 1.7-2.33) and those who received radiotherapy (OR=7.83; CI, 6.86-8.94) as first treatment presented higher odds of dying in one year after the first hospitalization. In addition, patients who were hospitalized on an emergency basis (OR=10.94; CI, 10.19-11.74) and those who were admitted in ICU units (OR= 1.17; CI; 1.07-1.26) had higher association with the outcome. Interestingly, patients that took more than 60 days to initiate cancer treatment (OR=0.69; CI, 0.64-0.74) presented lower association with dying in one year. Conclusions: Our study demonstrates variables that can be used to identify patients who may benefit most from PC. Moreover, this indicatives can be easily assessed in the moment of hospitalization.
Palliative radiotherapy referrals in the last days of cancer patients' life: Could we do better?
Authors: Ferro Leora Brazg , Shachar Eliya , Gutfeld Orit , Wolf Ido , Natan Oz Yasmin
Published: June 2021

e24008

Background: The role of active cancer therapy towards the end of life (EOL) is debatable and may even be considered harmful. While palliative radiotherapy may be highly effective in reducing cancer-related symptoms of advanced disease, the beneficial effects are usually at least 2-4 weeks from completion of treatment. Thus, radiotherapy administered at the end of life is often ineffective, and may actually impair quality of life and be associated with an unnecessary burden to the health care system. The universal Israeli health care system enables the administration of radiotherapy without financial or regulatory barriers, even at EOL. We aimed to assess the use radiotherapy towards EOL in a tertiary care Israeli cancer center. Methods: We retrospectively analyzed data of patients receiving palliative radiation and died within 30 days of their simulation from March 2019 until September 2020. Results: Out of approximately 2,000 patients treated with radiotherapy during the study period, 148 (8%) patients were referred for palliative radiation and died within 30 days of their simulation. The majority (88, 59.5%) were male, the median age was 67.3 years and the most common malignancies patients suffered from were lung cancer (49, 33.1%), gastrointestinal tumors (28, 18.9%), genito-urinary malignancies (23, 15.5%) or breast cancer (15, 10.1%). The median ECOG PS was 3. Nineteen patients (12.8%) did not initiate radiation treatment plan, 24 patients (16.2%) completed less than half of the planned treatment and 89 patients (60.1%) completed the entire duration of treatment. Of the patients who completed the planned therapy, 34 patients (38.2%) received a single fraction protocol. The majority of patients (89, 60.1%) were referred to the radiation unit by their treating medical oncologists or hemato-oncologist. None of the patients were referred by palliative care team members at our center. Most (105, 70.9%) received previous systemic therapies; but less than half (48, 45.7%) were under active treatments within a month prior to the radiation simulation. Conclusions: Relatively large number of patients with advanced malignancies are referred for futile palliative radiotherapy during the last 30 days of their life, thus impairing their quality of life and creating an unnecessary burden on public health services. These patients are often being referred by their treating oncologists who are familiar with their oncological history. These findings call for the implementation of collaborative multi-disciplinary teams, primarily directed at optimizing care at the end of life, setting achievable treatment goals, and improving quality of life.
A 10-item frailty index based on a comprehensive geriatric assessment (FI-CGA-10) in older adults with cancer: Development and construct validation.
Authors: Nishijima Tomohiro F. , Shimokawa Mototsugu , Esaki Taito , Morita Masaru , Toh Yasushi , Muss Hyman B.
Published: June 2021

e24011

Background: A frailty index based on domain-level deficits in a comprehensive geriatric assessment (FI-CGA) has been previously developed and validated in general geriatric patients (Jones D, Aging Clin Exp Res 2005). Our objectives were to construct an FI-CGA and to assess its construct validity in geriatric oncology setting. Methods: Consecutive older adults with cancer who underwent a CGA on a geriatric oncology service were included. We developed a 10-item frailty index based on deficits in 10 domains (FI-CGA-10): cognition, mood, communication, mobility, balance, nutrition, basic and instrumental activities of daily living, social support and comorbidity. Deficits in each domain were scored as 0 (no problem), 0.5 (minor problem) and 1.0 (major problem). Scores were calculated by dividing the sum of the score of each domain by 10, and categorized as fit ( < 0.2), pre-frail (0.2–0.35), and frail ( > 0.35). Construct validity was tested by comparing the FI-CGA-10 with the following established frailty measures: the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS), CSHA rules-based frailty definition and CSHA Function Scale. To evaluate the ability to predict mortality, we tested association between the FI-CGA-10 and validated prognostic indices for mortality: the Lee index and Schonberg index (higher scores reflect a higher risk of mortality). We also examined associations between the FI-CGA-10 and several features commonly seen in frail older adults such as function (Timed Up & Go (TUG) test), cognitive impairment (Mini-Cog), and high comorbidity burden (Charlson Comorbidity Index (CCI)). Results: Of 540 patients (median age 80 years, range 66–96 years), common cancer types were gastrointestinal tract in 37%, hepatobiliary and pancreatic in 22%, and head and neck in 12%. 406 (75%) patients had ECOG PS 0 to 1. The FI-CGA-10 had a right-skewed distribution and was well approximated by the gamma distribution. Overall, 20% of patients were fit, 41% were pre-frail, and 39% were frail. The FI-CGA-10 was highly correlated with CSHA CFS (Pearson's r = 0.83), CSHA rules-based frailty definition (r = 0.67) and CSHA Function Score (r = 0.77). People who were more frail had higher scores on the Lee index (fit: 7.3, prefrail: 8.8, frail: 12.0; p < .0001) and Schonberg index (fit: 10.1, prefrail: 13.1, frail: 15.7; p < .0001), suggesting an increased probability of death. Increasing levels of frailty were significantly associated with a longer TUG (seconds), fit: 11.3, prefrail: 13.0, frail: 26.3; p < .0001, poorer cognitive function (Mini-Cog score, fit: 4.7, prefrail: 4.0, frail: 3.1; p < .0001), and higher comorbidity burden (CCI, fit: 0.8, prefrail: 1.4, frail: 1.9; p < .0001). Conclusions: The FI-CGA-10 is a clinically sensible and construct-validated measure of quantifying frailty from a CGA.
Use of the geriatric assessment in clinical practice in Mexico: A survey of cancer providers.
Authors: Verduzco-Aguirre Haydee Cristina , Bolano Guerra Laura Margarita , Martínez-Said Hector , Quintero Beulo Gregorio , Culakova Eva , Mohile Supriya Gupta , Soto Perez De Celis Enrique
Published: June 2021

e24013

Background: Despite the growing burden of cancer in older adults in Mexico, it is unknown how many cancer care providers in Mexico use information obtained through a geriatric assessment (GA) and/or geriatric oncology principles in their everyday clinical practice. Methods: We administered a cross-sectional survey to oncology providers in Mexico via the Mexican Society of Oncology mailing list (n = 1240). The survey included questions on demographics, awareness about geriatric oncology principles, and the use of the GA and other geriatric clinical tools. The primary outcome was to estimate the proportion of providers using GA tools through the question: “For your patients ≥65 years, do you perform a multidimensional geriatric assessment using validated tools?”. We hypothesized that ≤10% of respondents would give a positive answer. We used descriptive statistics and X2 tests to compare groups of respondents. Results: We obtained 196 answers (response rate 15.8%). 121 (62%) respondents were male; median age 42. 98 (50%) were surgical oncologists, 59 (30%) medical oncologists, and 38 (19%) radiation oncologists. Median time in practice was 8 years, with 39% practicing in Mexico City. A third had their practice at a public institution, 26% at a private institution, and 38% in both. The proportion of patients aged 65-79 and ≥80 seen on an average clinic day by the respondents was 30% and 10%, respectively. 121 (62%) reported having a geriatrician available at their practice site. 37 respondents (19%) reported using validated GA tools to evaluate older adults with cancer in their practice. The proportion of respondents who evaluated each GA domain is shown in Table 1. Male respondents (p=0.03), medical oncologists (p<0.01), and those with a less busy practice (≤10 patients/day) (p=0.01) were more likely to use validated tools to perform a GA. Regarding barriers for implementing GA, 37% reported lack of time, 49% lack of qualified personnel, 44% lack of knowledge of geriatric tools, 6% patient unwillingness to undergo a GA, and 8% prohibitive cost. Only 17 (9%) thought that information obtained through a GA would not lead to practice changes. Conclusions: According to our survey, the proportion of Mexican oncology providers using validated tools to perform a GA is 19%, which is higher than expected. Some GA domains, such as comorbidity and functional status, were commonly assessed, while others, such as fall history, were seldom evaluated. Common barriers for GA implementation were lack of qualified personnel and of knowledge about geriatric tools. We plan to further explore these barriers and potential facilitators through focused interviews in order to guide future interventions.[Table: see text]
Comparison of validated screening tools for the assessment of potentially inappropriate medications in older Indian patients with cancer.
Authors: Castelino Renita , Noronha Vanita , Ramaswamy Anant , Rane Pallavi , Gattani Shreya , Nair Vandhita , Gawit Kalpita , Dhekle Ratan , Nookala Manjunath , Patil Vijay Maruti , Banavali Shripad Dinanath , Prabash Kumar , Gota Vikram
Published: June 2021

e24018

Background: The use of potentially inappropriate medication (PIM) and polypharmacy are highly prevalent in older cancer patients and are recognized as potential risk factors for adverse outcomes during cancer treatment. With geriatric cases increasing steadily in India, there is a need for comprehensive studies to identify a reliable screening tool for the assessment of PIMs. Methods: Retrospective analysis of patients ≥ 60 years who visited the Geriatric Oncology Clinic of the Tata Memorial Hospital, Mumbai, India between 2018-2021. Five tools (Beers-2015, STOPP and START-2014, PRISCUS-2010, FORTA-2018, and the EU (7)-PIM list-2015) were used to assess PIM. A standardized PIM value (SPV) was assigned for each patient for each scale which represented the ratio of the number of PIMs identified by a given scale to the total number of medications taken. The median SPV of all 5 scales for each patient was considered the reference standard. Agreement between each scale and the reference was carried out using Bland-Altman plots. The agreement was determined based on bias and the width of the limit of agreement. Association between categorical variables such as sex, comorbidities, and number of medications (above and below the median) and PIM use was determined using the chi-squared test. Results: 352 patients were included; median age - 70(range: 60-100) years, 287 (81.6%) were males. The bias and limit of agreement given by the Bland-Altman plot for each scale is shown in Table 1. The EU(7)-PIM list was found to have the least bias of 0.7% and the narrowest limits of agreement of 0.43 (-0.21 to 0.22). PIM use was observed to be significantly higher in patients with diabetes than without (83/281 versus 13/82, respectively, p = 0.013) and, patients prescribed with > 7 medications compared with ≤7 (137/281 versus 06/70, respectively, p < 0.001). Conclusions: The EU(7)-PIM list was found to have the least bias and thus considered the most reliable among all other scales in our study population. A high degree of discordance was observed between the tools, thus, we emphasize the need for future studies to identify the most reliable tool for the prediction of PIMs to aid clinical decision-making in geriatric practice.[Table: see text]
The prevalence of cognitive impairment in older Indian persons with cancer and brain metastases.
Authors: Dhanawat Aditya , Noronha Vanita , Ramaswamy Anant , Gattani Shreya , Castelino Renita , Dhekle Ratan , Mahajan Sarika , Patil Vijay Maruti , Menon Nandini , Daptardar Anuradha , Gota Vikram , Prabhash Kumar
Published: June 2021

e24019

Background: Normal aging is associated with a decline in neurocognitive abilities. Regardless of age, 42% to 91% of persons with cancer and brain metastases are reported to have neurocognitive impairment. There are no data regarding the prevalence of cognitive impairment in older persons with cancer and brain metastasis. Methods: This retrospective analysis was performed on a prospectively collected dataset of patients who attended the geriatric oncology clinic at the Tata Memorial Hospital, a tertiary-care comprehensive cancer center in India from June 2018 to February 2021. Patient aged 60 years and over with malignancy were included. Cognition was assessed with the mini-mental status examination (MMSE); the Hindi MMSE was used for illiterate patients. A score of < 23 on the MMSE was considered abnormal. Correlation between the presence of cognitive impairment and brain metastases was tested using the chi-square test. Results: A total of 401 patients were included, of which 318 (79.3%) were males. The median age was 70 years (range: 60-100 years). All patients had solid tumors; 162 (40.4%) had lung, 139 (34.7%) had gastrointestinal and 48 (12%) had head and neck malignancies. Twenty-five (6.2%) patients had brain metastases, of which 5 (20%) had solitary, 19 (76%) had multiple lesions, and 1 (4%) had leptomeningeal metastases. Cognitive impairment was noted in 4 (16%) of the 25 patients with brain metastases and 61 (16.2%) out of 376 patients without brain metastases. There was no significant correlation between the presence of brain metastases and cognitive impairment, p = 0.57. Conclusions: Older persons with cancer and brain metastases do not have a higher incidence of cognitive impairment than those without brain metastases. The next step is to understand whether older persons with brain metastases are more at risk for cognitive decline as a result of therapeutic interventions such as cranial radiotherapy and chemotherapy.
Preliminary efficacy of a community-based, group-mediated cognitive behavioral lifestyle intervention among breast cancer survivors.
Authors: Haynam Marcy , Fairman Ciaran , Bowman Jessica , DeScenza Victoria , Chaplow Zachary , Kilar Megan , Dispennette Kathryn , Hohn Stephanie , Zhang Xiaochen , Lustberg Maryam B. , Focht Brian
Published: June 2021

e24035

Background: Post-treatment weight gain places breast cancer (BCa) survivors at heightened risk for cardiovascular disease, metabolic syndrome, and functional decline. Lifestyle weight management (LWM) interventions combining exercise and dietary weight loss represents an effective approach to mitigating the adverse cardiometabolic and functional effects frequently observed in BCa survivors. Unfortunately, community access to cost-effective, sustainable, LWM interventions among BCa survivors remains limited. The purpose of this study is to determine the preliminary efficacy of a community-based LWM intervention in BCa survivors on select body composition (BC), physical function, and social cognitive outcomes of the first wave of participants in the Healthy New Albany Breast Cancer (HNABC) pilot trial. Methods: The 24-week, community-based pilot trial promotes lifestyle behavior changes through a group-mediated cognitive behavioral (GMCB) approach driven by Social Cognitive Theory. The measures analyzed were BC done via Dual-energy X-ray Absorptiometry, physical function via the 400m walk test, and social cognitive outcomes via satisfaction with function and appearance and perceived competence with exercise and diet at 6-months via effect size calculations using Cohen’s d. Results: Meaningful changes were observed in fat mass ( d= -0.46), percent lean mass ( d= 0.33), lean mass ( d= -0.45), and physical function ( d= -0.59), some of which reached clinical relevance. Select self-reported outcomes also saw meaningful improvements from this LWM intervention. Conclusions: Findings from this study demonstrate the preliminary efficacy of implementing a GMCB-based LWM intervention among overweight or obese BCa survivors. Given the meaningful impact that successful weight management has on reducing risk for chronic diseases, these results highlight the utility of implementing a LWM intervention in the community for BCa survivors in an effort to extend the access, reach, and scalability of supportive care approaches during BCa survivorship.
Parotid sparing adaptive radiotherapy in head and neck cancer patients: A study evaluating resource intensiveness and impact on quality of life.
Authors: Maulik Shaurav , Mallick Indranil , Arunsingh Moses , Prasath Sriram , Arun B , Chatterjee Sanjoy
Published: June 2021

e24037

Background: Anatomical changes during the course of parotid sparing IMRT for head and neck cancer can lead to an increase in the actual dose absorbed by the parotid glands, which may be controlled with the use of interval adaptive replanning. In this prospective assessment of adaptive replanning for parotid dose changes, we explored the feasibility of carrying out adaptive replanning based on predefined objective dosimetric criteria at specified time points. We sought to assess the impact of this measure using a clinically meaningful endpoint of patient reported quality of life outcomes. Methods: 90 patients with head and neck radiotherapy indicated for definitive management or adjuvant therapy who had at least one parotid gland receiving a mean dose (MD) of between 25-30Gy were accrued in the study. The index parotid was delineated on the images acquired on 14th and 19th day and the MD was determined by overlaying the verification image on the planned CT. If the MD had increased by 2% of the initial intended dose, an adaptive plan was attempted with an aim to reduce MD by 2% without compromising PTV coverage; this plan was then used to deliver the remaining treatment. Patients were invited to complete QoL questionnaires: EORTC-QLQC30 with HN35 module, and XeQoL score at baseline, at 3 and 9 months after completion of treatment. Results: 46 out of 90 patients met the threshold for adaptive replanning and were switched to the new plan during treatment. Adaptive replanning was triggered at D14 for 31 patients and D19 for the remaining 15. Need for adaptive replanning was associated with receipt of concurrent chemotherapy and weight loss in the first two weeks of RT. QoL was evaluable for 50 patients at 3 months post treatment. In patients who required adaptive replanning per protocol, Mean XeQoL scores at 3 months showed significantly worse scores for overall scores (1.1 vs 2.3, p 0.001) and for the component individual physical, pain, psychological, and social domains. EORTC QLQ-C30 and HN35 questionnaires at 3 months also demonstrated significantly worse mean symptom scores of the relevant domains of mouth dryness (39 vs 60), stickiness (32 vs 54) and swallowing (39 vs 60) in patients who required adaptive replanning versus those who did not. No significant QoL trends were observable in the 31 patients who were evaluable at 9 months post treatment. The average time required for each step in the planning process was comparable for both the initial planning workflow and adaptive replanning process. Conclusions: The trigger criteria for replanning identified a population of patients who have significantly worsened quality of life due to radiation induced xerostomia. The benefits of adaptive replanning strategies based on weekly evaluation, binary thresholds and standard planning procedures is doubtful Clinical trial information: CTRI/2017/11/010683.
The impact of chemotherapy on subjective cognitive complaints in breast cancer: Evidence from pooled analyses with longitudinal studies.
Authors: Kim Heeju , Jung Sun-Ok , Kim Esther , Abraham Ivo
Published: June 2021

e24050

Background: Subjective cognitive impairment (SCI) is one of the most commonly occurring symptoms in breast cancer patients. Chemotherapy (CTX) may be an important contributing factor to SCI, yet its association with SCI has been inconclusive. The meta-analysis with longitudinal data can provide more conclusive evidence as to the impact of CTX on SCI. This meta-analysis aimed to (a) determine whether CTX is associated with time-dependent SCI outcomes in breast cancer patients with pooled longitudinal data and (b) identify at the time point with the highest impact of CTX on SCI. Methods: Data were collected from Pubmed, EMBASE, CINAHL, PsychInfo, and the Cochrane library in November 2020. Effect sizes (Hedges’ g) were calculated for the mean differences of the SCI level between the CTX treated patients and controls. Data were analyzed by and across clinical time periods; during CTX, within 1-month-post CTX, within 1-year-post CTX, and 1-year or longer post-CTX. Results: The longitudinal data were pooled with 9 data sets from 13 studies, including 857 patients treated by CTX, 410 patients not treated by CTX, and 517 healthy subjects. At baseline, CTX patients showed significantly better SCI compared to the non-CTX patient controls (ES=0.17, p=.031) and did not differ from healthy controls (ES = -0.04, p = .77). The CTX-treated patients had significantly worse SCI compared to both type of controls after initiating CTX. The effect sizes for the group differences were larger for the group comparison with healthy controls than the non-CTX control (- 0.16 for the comparison with non-CTX control, -0.51 for comparison with the healthy control). The largest time effect was found at the time point of within 1-month-post CTX in comparison with the healthy control (- 0.81). Conclusions: Our analysis indicated the association of CTX with SCI. Yet, more studies are needed to confirm the impact of CTX as (a) the effect size for the comparison with non-CTX control is very small and (b) limited data on the comparison with controls at the time point during active CTX and immediately after CTX. [Table: see text]
Corrected QT prolongation among chemotherapy: Treated patients, a study of a Romanian center.
Authors: Crisan Cristina
Published: June 2021

e24053

Background: Chemotherapy cardiotoxicity sometimes occurs as QTc prolongation, which may lead to ventricular arrhythmia. We assessed incidence of QTc prolongation among chemotherapy-treated patients. Methods: We enrolled 396 consecutive patients receiving chemotherapy in the Oncology Institute of Cluj-Napoca, Romania. 870 ECGs were performed at baseline and every 2 months, for 5 assessments, during 2016. Results: Most patients were diagnosed with gastro-intestinal tumors and received regimens containing more than one drug. Maximum QTc was recorded after 4 months, when we also found the maximum incidence of increased QTc (>470msec), of 3,73% and of increased ΔQTc (>60msec), of 4%. Female gender was associated with a higher baseline QTc=421 msec, ± 26,9 (p=0.02). No particular chemotherapy regimen was proved to significantly increase QTc. Age was associated with higher QTc and is also an independent variable predicting QTc prolongation (for QTc >480msec, p=0.02), as well as increase of ΔQTc (p<0.001). The number of prior chemotherapy lines correlates with baseline QTc (p<0.0001), with QTc prolongation after 2 months (p=0.01) and predicts higher ΔQTc after 2 months (p=0.01), although within normal range. There was no additive effect during all the 5 assessments. Conclusions: Our results confirm QTc prolongation with chemotherapy and a special attention should be paid to previously treated patients and to elderly patients. Key words: chemotherapy, cardiotoxicity, QTc prolongation.
Long-term follow-up outcomes and treatment among patients previously treated with Zizao Yangrong granules (ZYG) for egfris–related skin xerosis.
Authors: Xue Chongxiang , Li Jia , Lu Xingyu , Cui Huijuan
Published: June 2021

e24054

Background: Traditional Chinese medicine (TCM) has broad prospects in the treatment of targeted drugs–related dermatologic toxicity. In our previous study (ChiCTRIOR-17013498), Zizao Yangrong granules (ZYG) made effect on EGFRIs-related xerosis and improve the quality of life. However, some people still doubt that TCM could affect therapeutic benefit for patients treated with EGFRIs. Methods: Patients with EGFRIs related xerosis who underwent ZYG and vitamin E ointment from May 2016 to January 2018 were retrospectively reviewed. Survival data and quality of life data analysis were performed. Besides, patients who used ZYG for more than 8 weeks were also summarized, followed by telephone follow-up and questionnaire survey. Results: Of 68 participates randomly assigned, 54 patients were successfully followed up. Median PFS in Vitamin E Ointment plus ZYG group was 41.6 months, and that in Vitamin E Ointment group was 40.9 months, with no statistical difference (HR 0.85, 95% CI 0.48 to 1.51, P = 0.586). Subsequently, 19 patients who used ZYG for longer than 8 weeks were also included. 2 patients reported complete response, 14 patients reported partial response, and 3 patients reported no response. The overall effective rate was 84.2%. The total DLQI score of patients with long-term intervention of ZYG was 4.47±3.10. Compared with baseline DLQI score (7.00±2.91), the DLQI of patients after ZYG intervention has been significantly improved (P = 0.000). During the continuous use of ZYG treatment, incidence of adverse effects was 57.9%. Treatment-related adverse reactions were mostly mild, with no grade 3/4 adverse events. Conclusions: ZYG did not affect progression free survival of patients treated with EGFRIs. And long time-scale ZYG intervention could continuously relieve EGFRI-related xerosis and significantly improve the quality of life of patients without serious adverse effects. Clinical trial information: ChiCTRIOR-17013498.
The frequency and predictors of end-of-life symptom in patients with advanced cancer.
Authors: Hiramoto Shuji , Kikuchi Ayako , Taniyama Tomohiko , Tetsuo Hori , Yoshioka Akira , Kirishima Toshihiko
Published: June 2021

e24061

Background: Advanced cancer patients complain of highly distressing symptom at the end-of-life, and important reasons for palliative intervention to relive symptoms. Methods: We analyzed 1282 patients who died of advanced cancer from August 2011 to August 2019 retrospectively. We divided into patients who complain of symptom include fatigue, dyspnea, nausea and vomiting, and cancer pain, or didn’t for 3 days prior to death, and analyzed predictors by multiple logistics method. The primary endpoint of this study was to identify frequency and predictors of end-of-life symptoms in advanced cancer patients. Results: As a background, the median age is 73 years old, 690 males, 592 females, 227 gastroesophageal cancers, 250 biliary pancreatic cancers, 54 hepatocellular carcinomas, 189 colorectal cancer, 251 lung cancers, 71 breast cancers, 58 urological malignancies, 60 gynecological malignancies, 47 head and neck cancer, 31 hematological malignancies, and 22 sarcomas. Number of patients who complained of dyspnea, fatigue, nausea and vomiting, and cancer pain were 235 (18.3%), 318 (24.8%), 81 (6.3%), and 322 (25.1%) at the end-of-life. In a multivariate analysis, peritoneal metastasis (ORs 1.812), with mental (ORs 0.549), palliative referral (ORs 0.680), Eastern Cancer Organization Group Performance Status (ECOG-PS) (OR0.679) and consciousness level (ORs 0.610) was independent predictors in patients with fatigue at the end-of-life. Chest cancer (Odds Ratio 2.635), lung (ORs 2.159), brain (ORs 0.431) and peritoneal metastasis (ORs 0.602), with mental (ORs 0.429), respiratory (ORs 1.960) and metabolic disorder (ORs 0.520), palliative referral (ORs 0.645) and consciousness level (ORs 0.468) was independent predictors in patients with dyspnea. Lung metastasis (ORs 0.480, peritoneal metastasis (ORs 1.812), with anti-cancer therapy (OR 2.244) and consciousness level (ORs 0.610) was independent predictors in patients with nausea and vomiting. Brain metastasis (ORs 0.435, liver metastasis (ORs 1.374), and consciousness level (ORs 0.599) was independent predictors in patients with cancer pain. Conclusions: We reported frequency and independent predictors of end-of-life symptoms in advanced cancer patients. Information on these predictors be useful to explaining about their end-of-life in advance.
Effect of paracentesis on the survival of patients with terminal cancer and ascites: A propensity score-weighted analysis of the EASED study.
Authors: Masuda Ken , Ishiki Hiroto , Yokomichi Naosuke , Yamaguchi Takuhiro , Ito Tetsuya , Takatsu Hana , Amano Koji , Hiramoto Shuji , Yamaguchi Takuhiro , Kawaguchi Takashi , Mori Masanori , Matsuda Yosuke , Yamaguchi Takashi
Published: June 2021

e24063

Background: Malignant ascites (MA) is associated with progressive deterioration in quality of life and poor prognosis of patients with cancer. Paracentesis is among the most widely utilised treatments for MA. However, reports on the usefulness of paracentesis in patients with MA are limited. Thus, this study aimed to investigate whether paracentesis affects the duration of survival in such patients. Methods: We performed a post - hoc analysis of a prospective multicentre observational study that investigated the dying process and end-of-life care in patients with terminal cancer, who were admitted to 23 palliative care units in Japan. Survival duration was compared between patients who did (paracentesis group) and did not undergo paracentesis (non-paracentesis group). We used the inverse probability of treatment weighting (IPTW) method to control for baseline covariates between the two groups. Furthermore, subgroup analyses were performed to investigate the IPTW-adjusted hazard ratio (HR) of the paracentesis and non-paracentesis groups according to some of the baseline covariates, including age, sex, Karnofsky Performance Status, primary tumor site, liver dysfunction, and renal dysfunction. Results: Among the 1,896 patients, who were initially enrolled, 568 with ascites were included in the study cohort. Eighty-five (15.0%) patients underwent paracentesis. The most common primary tumour site was the gastrointestinal tract (51.9%, n = 295), followed by the pancreas (22.7%, n = 129). The non-adjusted median durations of survival were 22 days (95% confidence interval [CI]: 16–25) and 12 days (95% CI: 11–13) in the paracentesis and non-paracentesis groups, respectively (HR: 0.69, [95% CI: 0.54–0.88]; p = 0.003). The IPTW-adjusted median durations of survival were 22 days (95% CI: 16–25) and 16 days (95% CI: 12–22) in the paracentesis and non-paracentesis groups, respectively (HR: 0.89, 95% CI: 0.64–1.24; p = 0.492). There were no serious adverse events in the paracentesis group. According to the baseline covariates, a weighted subgroup analysis was performed to compare the survival of patients in the non-paracentesis and paracentesis groups. There was no significant heterogeneity across all subgroups. Paracentesis was not associated with a significant survival risk in any of the subgroups. Conclusions: Paracentesis does not negatively affect the survival of patients with cancer and MA; hence, it can be used as a standard treatment in palliative care settings.
Differential impact of inpatient and outpatient palliative care on end-of-life outcomes in hospitalized patients with cancer.
Authors: Urman Arielle R. , Buss Mary K. , Besaw Robert J. , Lee Kathleen A. , Yeh Jonathan C.
Published: June 2021

e24069

Background: Palliative care (PC) improves outcomes for patients with advanced cancer, and current ASCO guidelines recommend early outpatient referral. However, recent data show that PC teams at many cancer centers see more inpatient consults than outpatient visits; the comparative impact of inpatient versus outpatient PC is not well-described. For this reason, we conducted a retrospective cohort study of hospitalized cancer patients to quantify exposure to inpatient/outpatient PC, and to describe associations between PC exposure and end-of-life (EOL) quality measures including hospice utilization, advance care planning (ACP), and intensity of care. Methods: We identified all patients admitted to one cancer center’s inpatient oncology unit during a fiscal year (10/1/2017 - 9/30/2018). Demographics, admission statistics, inpatient/outpatient PC visits, and EOL outcomes were abstracted from the electronic medical record. Deceased patients were identified through chart review and public obituaries. Results were summarized by descriptive statistics, and standard statistical tests were used to evaluate associations between PC exposure and EOL outcomes. Results: 842 patients were hospitalized in one year. 522 patients died by the study end-date of 10/1/2020 and were included in analysis. 50% of deceased patients had any PC exposure prior to death, but only 21% had an outpatient PC visit. Patients seen by PC were younger at time of death (median: 67 vs 72 years; p < .001) and more likely to be female (52% vs 42%; p = .03). Compared to patients never seen by PC, patients with any PC exposure were significantly more likely to enroll in hospice (78% vs 44%; p < .0001), have do-not-resuscitate status (87% vs 55%; p < .0001), have scanned ACP documents (53% vs 31%; p < .0001), and die at home or inpatient hospice instead of in the hospital (67% vs 40%; p < .01). PC exposure was not associated with differences in 30-day re-admissions, systemic cancer therapy in the last 14 days of life, or intensive care (ICU) utilization in the last 30 days of life. Notably, PC exposure was associated with longer hospital length-of-stay (LOS) (8.4 vs 7.0 days), but this association was reversed for patients seen by outpatient PC versus all others (6.3 vs 8.3 days; p < .01). Patients seen by outpatient PC also had longer hospice LOS (46.5 vs 27.1 days; p < .01) and less EOL ICU use (6% vs 15%; p < .05) compared to all others. Conclusions: In this large retrospective study of hospitalized cancer patients, PC exposure was associated with significant improvements in multiple EOL quality measures. The subset of patients seen by outpatient PC experienced additional benefits, including shorter hospital LOS, longer hospice LOS, and less EOL ICU utilization. These findings point to differential effects between inpatient and outpatient PC, underscoring the importance of early, longitudinal PC involvement.