bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term cancer survivorship care: On the radar screen?
Authors: Mehta Rutika , Jain Rohit , Rhodes Lori , Abraham Joseph , Miller Kenneth David
Published: March 2020

e20567

Background: Long-term cancer survivors require comprehensive care. The purpose of this study was to describe how survivorship care fits into oncologists’ clinical time, and characterize long-term cancer survivors’ problems and oncology follow-up care. Methods: We abstracted 18,882 medical records of unique cancer patient visits during 2010 at a major NCI-designated cancer center and then evaluated survivor care for one week in April, 2010 to characterize how oncologists spend their clinical time. Finally, we selected three subgroups from the survivor population (n≈100 each) of survivors at 1-5 years, 6-10 years, and >10 years after diagnosis. We collected demographic data, purpose of visit, cancer-specific information, late and long-term effects, and type of care delivered, including surveillance for recurrence, intervention, prevention, and coordination of care. Results: In the larger group of 18,882, only 14% of survivors were more than 10 years post-diagnosis. Approximately two-thirds of the survivors were women. Breast cancer survivors comprised 38%, and survivors of hematologic malignancies accounted for 21% of the population. During the one week studied, the majority of oncologists' patients (74%) were actively receiving treatment; only 5% of their patients were 5 or more years post-diagnosis. Second or secondary malignancies were noted in 8% of patients. Late and long-term effects were uncommon. Approximately 25% of survivors beyond five years were observed to have late effects due to cancer treatment, most common being fatigue, neurological endocrine, and cardiac. Of the 300 selected survivors, sixty-two percent received only surveillance care during their visit. Only 3% of these patients received an entire array of survivorship care that included surveillance, intervention, co-ordination and prevention. Conclusions: A small proportion of oncologists’ visits were with long-term cancer survivors (5-14%) of whom only 25% had late or long-term effects of cancer treatment so overall very few of office visits were with long-term survivors who had late and long-term complications. All visits involved surveillance for cancer recurrence but there was little focus on prevention, intervention, and coordination of care for cancer survivors.
Fertility counseling in young adult patients with cancer.
Authors: Reichert Sonia Evelyn , Sanchez Sadie , Kolb Jen , Steinberg Amir S. , Holcombe Randall F. , Garland Elizabeth , Gabrilove Janice Lynn
Published: March 2020

e20570

Background: In 2008, 450,000 US cancer survivors were of reproductive age (18-45 years). Currently, oncologists receive little training about fertility preservation and counseling for patients. In 2006, the American Society of Clinical Oncology (ASCO) recommended oncologists “discuss the possibility of infertility during their reproductive years prior to chemotherapy.” This study aimed to evaluate adherence to these guidelines and determine if a chemotherapy consent form increased compliance. Methods: At a tertiary care center in New York on April 23, 2012, a specialized chemotherapy consent form, including a fertility risk statement and checkbox, was implemented. A retrospective chart review was conducted 250 days before April 23, 2012 (pre group) and 250 days after April 23, 2012 (post group). This study included patients 18-45 years old with a new malignant diagnosis who received fertility altering therapy. Patients with a prognosis less than 12 months were excludedfrom the study. Data collected included demographics, documentation of fertility discussions, presence of a signed chemotherapy consent form and the use of a fertility risk checkbox prior to initiation of treatment. Results: Of 645 new patient visits, 80 in the pre-group and 53 in the post-group met the inclusion criteria. The mean age (SD) for the pre and post groups was 35.6 (±6.7) and 36.8 (±6.7) respectively. Thirty-five (43.8%) patients had documented fertility counseling in the pre group compared to 16 (30.1%) in the post group. A Cochran–Mantel–Haenszel test determined that these 2 groups were not statistically different (p = 0.250). In the post group, 5 (12.8%) patients had both documented fertility counseling and a consent form; and only 3 (7.6%) patients had evidence of documented counseling, a consent form and the fertility risk box checked. Conclusions: Fertility counseling was documented in less than half of cancer patients for whom this procedure is recommended. The introduction of a specialized chemotherapy consent form did not improve the rates of documented fertility counseling. Further exploration is needed to identify the barriers to fertility counseling and identify the best resources and tools for providers to ensure compliance with ASCO guidelines.
Dose reduction (DR) due to chemotherapy induced peripheral neuropathy (CIPN) in breast cancer (BC) patients (pts) in the neoadjuvant/adjuvant settings.
Authors: Bhatnagar Bhavana , Gilmore Steven , Goloubeva Olga G. , Wang Lulu , Medeiros Michelle , Chumsri Saranya , Tkaczuk Katherine Hanna , Edelman Martin J. , Bao Ting
Published: March 2020

e20574

Background: CIPN is a common and potentially dose-limiting complication of many effective cytotoxic agents. Taxanes are the cornerstone of treatment in BC. Limited data are available regarding the prevalence and severity of DR due to CIPN following taxane use. Methods: Charts of 123 consecutive newly diagnosed BC pts treated with a taxane as part of standard neoadjuvant/adjuvant chemotherapy at the University of Maryland Greenebaum Cancer Center between 01/01/2008 and 12/31/2011 were reviewed. Treating physicians followed standard recommendations for DR. Results: Median age at diagnosis was 53 years (range, 32-78), 120 female/3 male, 48 Caucasian (C), 70 African-American (AA), 5 had a history of alcohol abuse, and 20 had a diagnosis of diabetes mellitus (DM). Seventy pts received docetaxel, 46 paclitaxel, 7 received both or nab-paclitaxel. Fifty (40%) pts required DR, with 21 (17%) due to CIPN and 29 (23%) due to other causes. The median relative dose intensity (received dose/planned dose) for the 21 CIPN-induced dose reduction pts was 88% (range, 62%-97%). A multivariable logistic regression model was used to compare pts who did and did not require DR based on the following possible risk factors: taxane received, DM, alcohol use, and race. Based on the effects estimated by statistical model, there was no difference between pts who did and did not undergo DR with regard to factors listed. However, diabetic pts were over twice as likely to require DR (OR = 2.4, 95% CI: 0.6-10.2, p=0.06). The univariable logistic regression model for 50 pts who had undergone DR revealed possible differences in developing CIPN between C and AA patients. The chances of DR due to CIPN are higher in AA pts (OR=4.3, 95% CI: 1.1-16.7, p=0.03). Pts who received paclitaxel are more likely to require DR due to CIPN than those treated with docetaxel (OR=10.4, 95% CI: 2.7-39.6, p=0.001). Conclusions: 1. CIPN-induced dose-reduction occurred in 17% of our study population. 2. The median relative dose intensity was 88%. 3. DM may increase the overall risk of dose reduction, and AA, paclitaxel therapy may confer a higher risk of CIPN-induced dose reduction.
A pilot study exploring issues around decision making in older women with primary operable breast cancer.
Authors: Parks Ruth M. , Hall Louise , Tang Siau-Wei , Lakshmanan Radhika , Howard Penny , Winterbottom Linda , Morgan David A. L. , Porock Davina , Cox Karen , Cheung Kwok-Leung
Published: March 2020

e20588

Background: Decision making process related to cancer treatment is complex, influenced by tumour factors, patients and clinicians, and may affect outcomes eg quality of life (QOL). Studies are scarce in exploring this subject in the older population. This pilot study aimed to investigate this in older (≥70 years) women newly diagnosed with clinically T0-2N0-1M0 breast cancer. Methods: Patients as described were invited to participate. Actual treatment planning was made by the clinical team and was not part of the study. Semi-structured interviews were conducted within 6 weeks and at 6 months, alongside Comprehensive Geriatric Assessment (CGA) and QOL assessment using EORTC QLQ-C30. Interview recordings were transcribed (intelligent verbatim) and then analysed by (i) identifying themes; and (ii) comparing them with CGA and QOL measures. Results: Forty-one patients took part at the time of analysis. The following themes emerged in different patient combinations, at both time points. 1) Symptoms - The majority presented symptomatically (87%, 21/31). At 6 months, 45% (18/40) reported a negative feeling, but 81% (22/27) said they would choose the same treatment again. 2) Knowledge - Most patients (80%, 28/35) knew someone with a cancer diagnosis, but did not know much about breast cancer or treatment (87%, 18/24). 3) Reactions - At diagnosis, only 48% (10/23) felt ‘shocked’ or ‘surprised,’ while the remainder had ‘no reaction’ or ‘were prepared’. The majority (91%, 29/32) felt that they had received enough information about treatment options or that they did not have an option. 4) QOL - Most patients (88%, 15/17) thought they had made the right treatment choice. The majority (86%, 6/7) were not worried about the future and 91% (10/11) reported no change in QOL. No relationship was seen between these interview findings and the treatment modalities received. These findings were consistent with the results of CGA and QOL assessment. Conclusions: These preliminary findings suggest that these patients were generally happy with the decision made for their treatments and had a fairly good QOL and future outlook. The study has now entered into a second stage where more in-depth interviews are being conducted.
Efficacy and safety of BCD-017, a novel pegylated filgrastim: Results of open-label controlled phase II study in patients with breast cancer receiving myelosuppressive chemotherapy.
Authors: Salafet Olga V. , Chernovskaya Tatiana V. , Sheveleva Ludmila P. , Khorinko Andrey V. , Prokopenko Tatiana I. , Nechaeva Marina P. , Burdaeva Olga N. , Matrosova Marina P. , Kovalenko Nadezhda V. , Ovchinnikova Elena G. , Koroleva Irina , Ivanov Roman A.
Published: March 2020

e20593

Background: Pegfilgrastim (conjugate of filgrastim and 20 kDa polyethylene glycol (PEG) is approved for treatment of chemotherapy-associated neutropenia. BCD-017 (empegfilgrastim) is a covalent conjugate of filgrastim with 30 kDa PEG. Increased molecular weight of PEG molecule may provide additional benefits compared to pegfilgrastim. Methods: To compare efficacy and safety of filgrastim and BCD-017 at 3 mg and 6 mg doses an open-label, randomized, active-comparator, non-inferiority trial was conducted. 60 patients with histologically or cytologically confirmed breast cancer were randomly assigned to receive either subcutaneous (s.c.) injection of 3 mg BCD-017 (n=21), 6 mg BCD-017 (n = 20), or 5 mg/kg s.c. injections of filgrastim (n=19) administered daily until ANC ≥ 10x109 cells/L (maximum of 14 days) after chemotherapy (doxorubicin 60 mg/m2 and docetaxel 75 mg/m2) with stratification for weight and prior chemotherapy exposure. The primary efficacy endpoint was the incidence of severe neutropenia (ANC < 1.0x109 cells/L) during the first cycle of chemotherapy. Results: Incidence of severe neutropenia during the first chemotherapy cycle was 85,7%, 65,0% and 61,1% in BCD-017 3 mg, BCD-017 6 mg and filgrastim groups, respectively. Differences between BCD-017 groups and filgrastim group were not significant. Mean duration of grade 4 neutropenia in cycle 1 was 0,43, 0,40 and 0,33 days, accordingly (95% CI for difference between BCD-017 3 mg and filgrastim groups -0.22 to 0.41; 95% CI for difference between BCD-017 6 mg and filgrastim groups -0.25 to 0.38). Febrile neutropenia was observed only in BCD-017 3 mg and BCD-017 6 mg groups (one case in each group). A single administration of BCD-017 at the doses of 3 mg and 6 mg was as safe and well tolerated as standard daily filgrastim administration. There were no unexpected adverse events in all groups. Conclusions: The results of this study support comparable efficacy of single s.c. injection of 6 mg BCD-017 versus daily 5 mg/kg s.c. injections of filgrastim. Further phase III study of BCD-017 for treatment and prophylaxis of neutropenia in patients receiving chemotherapy is necessary. Clinical trial information: NCT01569087.
Integrating patients’ values into decisions to enroll in phase I trials: A feasibility study.
Authors: Hendershot Kristopher A , Dossul Tehseen , Wall Louise , Owonikoko Taofeek Kunle , Harvey R Donald , Thomas Cheryl B , McCormick Jennifer B , Khuri Fadlo Raja , Pentz Rebecca D.
Published: March 2020

e20608

Background: The American Society of Clinical Oncology recommends that physicians (MDs) assess the treatment goals and preferences of patients (pts) with advanced stage cancer. Available data, however, shows that pts’ values are not always well prioritized when making a treatment plan. Therefore, we iteratively developed a values tool containing 16 belief domains to inform MDs during conversations with their pts about the pts’ current priorities as they plan the next step in care. The purpose of this study was to determine the feasibility of using this values tool (defined as half of the tools having at least one value checked and half of the MDs discussing at least one value) in a phase I clinic setting. Methods: We audio-taped initial MD-pt conversations about potential enrollment in a phase I clinical trial at two academic medical centers (Emory and Mayo). The pts completed the values tool by selecting the 4 most important considerations for their next stage of care and were instructed to give the completed tool to the MD. The MDs were informed through the consent process but not specifically coached on use of the tool. The recorded conversations were coded using standard qualitative methodology to determine if a value from the tool was discussed. Results: There were 23 recorded encounters. All of the completed tools had at least one value checked and 19 of 23 (83%) completed tools were delivered to the MDs by the pts, as instructed. Of those who received the tool, 12 (63%) MDs discussed one or more of the values. The average satisfaction scores on a 5-point Likert scale were 3.9, 4.0, and 4.0, respectively, for tool clarity, ease of understanding, and benefit for pts who are offered a phase 1 trial (22/23 pts completed the evaluation). Average satisfaction scores from the 19 MDs who completed evaluations were 4.2 and 4.6, respectively, for influence of the tool on their treatment recommendation and accurate reflection of pts’ desires. Conclusions: The study met the predefined feasibility threshold and provides a strong rationale for future efficacy testing, including coaching of MDs. The tool was well accepted by both MDs and pts, and failure to deliver the completed tool by the pt was identified as a potential barrier to its effectiveness.
Survival effects of erythropoiesis-stimulating agents (ESAs) in patients with breast cancer: A meta-analysis.
Authors: Leyland-Jones Brian , Aapro Matti S. , Moebus Volker , Nitz Ulrike , O'Shaughnessy Joyce , Pronzato Paolo , Untch Michael , Tomita Dianne , Bohac Gerry C.
Published: March 2020

e20616

Background: New data are available from two trials of ESA use in patients with breast cancer receiving chemotherapy. We conducted a meta-analysis of trials of ESA use in this population. Methods: A literature search identified reports from 1997-2012 that included mortality data from controlled ESA trials (epoetin alfa, epoetin beta, darbepoetin alfa, biosimilars) in patients with breast cancer receiving chemotherapy. We used data from company databases for Amgen Inc. or Janssen Products LP studies and published data for other studies. Random-effects odds ratios (OR) were calculated to compare results for patients randomized to ESA to patients randomized to control. Analyses were stratified by metastatic stage; mixed stage or treatment; and adjuvant/neoadjuvant treatment. Results: We analyzed 9 studies (N = 4713; ESA n = 2346, control n = 2367) (Table).The overall stratified random-effects OR for death was 1.17 (95% confidence interval, 0.99-1.39). Details are presented in the Table. Conclusions: Overall survival OR remains consistent with prior data after including recent results. [Table: see text]
Tumor-related symptoms (TRS) assessment in patients (pts) with advanced non-small cell lung cancer (NSCLC) treated with gefitinib or erlotinib: Preliminary results of an observational study.
Authors: Mansueto Giovanni , Narducci Filomena , Quadrini Silvia , Mentuccia Lucia , Grande Roberta , Sperduti Isabella , Gamucci Teresa
Published: March 2020

e20619

Background: Edmonton Symptoms Assessment Scale (ESAS) is a validated tool in palliative care, which evaluates physical symptoms through a numeric scale (0-10). Symptoms improvement as a predictive factor for response rate (RR) in pts with advanced NSCLC treated with tyrosine-kinase inhibitors (TKIs) has not yet been evaluated. To this purpose, we performed an observational retrospective study. Methods: Pts with advanced NSCLC treated with gefitinib or erlotinib were eligible. Primary outcome was the association between treatment response and tumor-related symptoms (TRS) (pain, asthenia, dyspnea) improvement. ESAS was performed at day 1 and 14 of each 28-d cycle. Symptoms' scores were divided into: not clinically relevant (0-4, NCR) and clinically relevant (5-10, CR). Sample size estimation was 115 to 165 pts to be needed for the expected difference in the primary outcome. Differences between symptoms' groups were analyzed with the paired-data McNemar-test. All the associations were estimated using the Chi-Square test. Kaplan-Meier method was used for survival calculation. Uni- and multivariate survival analysis were carried out using the Cox regression model. Results: Here we report data about 73 consecutive pts; median age: 69 years, males 68%, ECOG PS 0-1 86%, smokers 68%, EGFR-mutated 22%. Treatment was gefitinib (23%) or erlotinib (77%). RR: RC/RP 14%, SD 20%, PD 66%. Median follow-up was 7 months. 63% of pts had at least one CR TRS at baseline. Among these pts, a significant reduction (p<0.0001) of TRS during treatment was observed (Table). Our preliminary data show a significant association between dyspnea/asthenia and RR (p=0.01). At the multivariate analysis, TRS improvement correlates with both PFS and OS. Also related with survival were PS, EGFR status (PFS) and RR (OS). Conclusions: Our preliminary data show that TRS improvement is significantly associated with treatment response and appears to be a prognostic factor during treatment with TKIs. [Table: see text]
Predictors of adequate financial resources 5 years after breast cancer diagnosis in low-income women.
Authors: Patil Sujata , Blinder Victoria Susana , Gany Francesca , Maly Rose C.
Published: March 2020

e20620

Background: Financial security is often viewed as a social determinant of health, especially in low income populations. Among low-income breast cancer patients, identifying early predictors of financial security could aid researchers in developing tools to improve long-term financial stability. Methods: A consecutive sample of 921 low-income, underinsured/uninsured women treated for stage 0-III breast cancer was surveyed 6 months following diagnosis. Women were surveyed again at 18, 36 and 60 months. Eligible participants were English/Spanish speaking women enrolled in California’s Breast and Cervical Cancer Treatment Program. The relationship between clinical, demographic, economic, health variables and adequacy of financial resources at 60 months was explored using logistic regression. Results: Of 590 women with complete data at 60 months, 45% said they did not have adequate financial resources 60 months following the diagnosis of breast cancer. Of these women, 74% (n=197) did not have adequate financial resources at 6 months, and 26% (n=70) went from having adequate financial resources at 6 months to not at 60 months. In univariate analyses, predictors of 60 month financial inadequacy included: employment status at 6 months (p=.017), ethnicity (p<.001), number of people living in the home (p=.004), age (p=.024), and adequate financial resources at 6 months (p<.001). In multivariate analyses, ethnicity (p=.008) and adequate financial resources at 6 months (p<.001) were independent predictors. Compared to non-Latina whites, Latinas had the lowest odds of having adequate financial resources at 60 months (adjusted OR: 0.51 95% CI: 0.32-0.82), followed by all other ethnicities (adjusted OR: 0.80 95% CI: 0.44-1.44). Conclusions: Financial stability after breast cancer diagnosis continues to be an issue faced by low income women five years following initial diagnosis. Ethnicity was an independent predictor of long-term financial stability. Latinas were especially likely to have inadequate financial resources 5 years after diagnosis. Long-term financial stability was not associated with any of the treatment and health or disease-related measures.
Quality-of-care provided to prostate cancer (PC) patients for prevention and treatment of osteoporosis-induced by androgen deprivation therapy (ADT): Results of a chart audit.
Authors: Chahin Rehab , Breunis Henriette , Alibhai Shabbir M.H.
Published: March 2020

e20622

Background: Men with PC on ADT are at risk of developing decreased bone mineral density (BMD) and osteoporosis, frequently associated with increased risk of fractures and related consequences. Guidelines recommend referral to specialized clinics for bone health care, but the quality of care in osteoporosis clinics and benefits to patients has never been reported. Methods: Charts for 67 consecutive men (mean age 74.2 y) on ADT referred to the osteoporosis clinic at the Toronto General Hospital, Toronto, Canada, between 2010 and 2011, were reviewed by a single reviewer using a structured data abstraction sheet. The following quality of care issues were examined: (a) bone health services provided to PC patients receiving ADT, i.e. screening, preventing, and treating osteoporosis; (b) use of Canadian guidelines and fracture risk assessment during ADT for targeting the appropriate therapy. Results: 56 (83.6%) were receiving continuous ADT and 11 (16.4%) intermittent for a mean duration of 27.4±30.7 months at the time of baseline visit. 19.4% had their first BMD before starting ADT and 50.7% during the first year. At initial consultation, 55.2% were taking <1000 mg calcium daily from all sources, while 26.9% were taking more than 1200 mg; 22.4% were taking Vitamin D ≥ 3 months, 81.8% of them had a blood level of Vitamin D ≥ 75 nmol/L. Based on a validated fracture risk assessment tool (CAROC), the 10-year fracture risk was moderate in 28 (41.8%) and high in 9 (13.4%). 71.4% of the patients with a sedentary lifestyle were advised to increase exercise or were referred to a formal exercise program. Of the 39 (70%) and 24 (39.2%) of patients who were not taking appropriate amounts of calcium and vitamin D, respectively, 100% were recommended to adjust their intake to guideline levels. All the patients with high fracture risk were recommended to take bisphosphonates. Conclusions: The osteoporosis clinic performed a comprehensive assessment and recommended guideline-based bone health care for the vast majority of men on ADT, suggesting a systematic approach to assessing bone health is associated with high rates of guideline-adherent care.
Effect of hyponatremia on cancer patients' in-patient rehabilitation length of stay.
Authors: Nelson Megan , Palmer J. Lynn , Fu Jack Brian , Williams Janet L. , Yadav Rajesh R. , Guo Ying
Published: March 2020

e20626

Background: The incidence of hyponatremia in cancer patients has been reported as high as 47%. Hyponatremia is associated with gait and attention impairments, increased falls, increased risk of fractures, and osteoporosis. Our aim is to determine if hyponatremia impact cancer patients’ rehabilitation length of stay, functional outcome, and survival. Methods: Retrospective study was conducted in a tertiary cancer center on two hundreds and ninty-five patients who underwent inpatient cancer rehabilitation between January 27, 2009 through July, 31, 2010. Hyponatremia incidence, rehabilitation length of stay (LOS), functional independence measure (FIM) for ambulation and transfers, and survival information were collected. Results: The incidence of hyponatremia in cancer patients admitted to our inpatient rehabilitation unit was 41.4%. Median rehabilitation LOS for patients with mild (Na 130-134 mEq/L) and moderate-severe (Na<130 mEq/L) hyponatremia was 11 and 15 days, respectively, which was significantly longer than patients with eunatremia (10 days; P = .03). FIM change for ambulation and transfers during inpatient rehabilitation stay was not significantly different, nor was survival significantly different, between different patient groups. Conclusions: A high percentage of patients have hyponatremia upon admission to our inpatient cancer rehabilitation unit, and this is associated with a prolonged rehabilitation LOS.
Advanced cancer survival in a rural community: The impact of hospice services.
Authors: Cowall David Eric , Holdai Veera
Published: March 2020

e20628

Background: The intensity of end-of-life (EOL) cancer care in a rural community has been previously reported (Cowall et al: J Oncol Pract 8: 40e-44e, 2012) using a random sample of all cancer deaths from Wicomico County, Maryland for calendar years 2004-2008. We now examine the impact of hospice services on survival in this same population. Methods: Significance (P-value) of diagnosis to death median survivals (MS) between different groups was calculated by log-rank analysis. Hazard ratios (HR) with 95% confidence intervals (CI) were obtained using Cox regression analysis. Results: 179 patients from our sample did not receive hospice services, and 211 were enrolled in hospice at some point during their illness. MS were 6.0 and 9.0 months respectively (P= 0.050, HR 1.222, CI 1.000-1.492). In the lung cancer subset, 54 patients did not receive hospice services and 78 were enrolled in hospice. MS were 5.0 and 7.0 months respectively (P=0.034, HR 1.468, CI 1.030-2.093). Other subsets were too small for analysis. Conclusions: Prolongedsurvival was significantly associated with hospice services in our sample, and that effect was more pronounced with lung cancer patients. The hospice effect on survival may reflect some combination of the following: hospice services result in better symptom management as well as counseling against toxic therapies at EOL and/or the bias of some patients against toxic treatments even before hospice enrollment.
Analysis of fatigue in non-small cell lung cancer patients treated with second-line pemetrexed.
Authors: Li Li , Winfree Katherine B. , Pennella Eduardo J. , Girvan Allicia C , Pohl Gerhardt , Obasaju Coleman K.
Published: March 2020

e20629

Background: Cancer-related fatigue can be attributed to both treatment (tx) and the disease. Fatigue is a common adverse event (AE) of cancer tx and can profoundly affect patient (pt) well-being. It is unclear how often fatigue is a reason for dose adjustment, treatment delays, and discontinuations. Methods: To assess fatigue in pemetrexed (pem)-treated pts, we conducted post-hoc analyses of a prospective observational study of non–small cell lung cancer (NSCLC). Pts who received ≥ 1 dose of pem in routine 2nd-line medical care settings (N=434) were included in the analysis.Pt-reported fatigue scores were obtained from the MD Anderson Symptom Inventory-Lung Cancer (0 - not present to 10 - as bad as you can imagine) at the beginning of cycles (C) 1, 2, 4, 6 and at tx end. Physician (phys)-reported scores were obtained from AE assessments (grades 1-4) at C 2, 4, 6 and at tx end. Associations between pt-/phys-reported fatigue and dose reduction/treatment delays were explored using chi-square/exact tests at each cycle. Logistic regression explored the association between severe fatigue occurrence and possible confounders (α=0.05). Results: The table shows phys-reported fatigue incidence (%). Overall, 94% of pts reported some fatigue across all assessed cycles with 83% of pts reporting fatigue at baseline; 47% of pts reported severe fatigue (score ≥7) overall with 29% reporting severe fatigue at baseline. A significant association between severe phys-reported fatigue and treatment delay was observed only at C2 (p=0.02). After adjusting for possible confounders, low income and age ≤70 years were associated with severe pt-reported fatigue. ECOG PS ≥1, stage IV disease, and historical fatigue were associated with severe phys-reported fatigue. General pt- and phys-reported fatigue did not differ among racial groups. Conclusions: While pts and phys reported similar amounts of fatigue in general, pt-reported incidence of severe fatigue was higher. Factors related to severe fatigue differed between pts and phys. Fatigue had little influence on tx adjustments. [Table: see text]
Patterns of hospice use in patients with hematologic malignancies.
Authors: Sexauer Amy , Cheng M. Jennifer , Riley W. Anthony , Knight Louise , Smith Thomas J.
Published: March 2020

e20638

Background: Despite advances in treatment there are still 70,000 deaths among U.S. patients with hematologic malignancies (HM). Nationally, fewer than 2% of HM patients use hospice and there is scarce published experience about palliative care programs for HM patients. The limited hospice use has been because of perceived HM special needs including curative intent, a less predictable course and the potential use of expensive anti-neoplastics, antibiotics, and transfusions. Methods: Study design: A single center retrospective review. Study endpoint(s): 1. What proportion of HM patients at the Sidney Kimmel Comprehensive Cancer Center (SKCCC) were referred to and utilized hospice? 2. What are the locations of hospice services? 3. What is the median hospice length of stay (LOS)? Results: The patient characteristics were summarized using descriptive statistics. Fifty-nine HM patients were referred to hospice over this 30-month period. Only 53 patients (age 64, 26 women) utilized hospice services, representing about 20% of the estimated 250 HM decedents during this time period. Of the 53 patients, 34 received home hospice and 17 were admitted to inpatient hospice. The median home hospice LOS was 9 days (SD 12) and inpatient hospice 6 days (SD 11). Nine patients with open access hospice received only a few blood transfusions, and only one patient received radiation therapy. Conclusions: HM patients usually are referred late or not at all for hospice services. Of the patients who use “open access” hospice, there is infrequent utilization of expanded services. Studies evaluating integration of palliative care with usual HM care, triggers for hospice referral, and new open access models are needed.
Efficacy of scalp cryotherapy in preventing alopecia among patients with breast cancer patients receiving adjuvant docetaxel and cyclophosphamide.
Authors: Cigler Tessa , Fiederlein Barbara , Schneider Sarah E. , Chuang Ellen , Vahdat Linda T. , Donovan Diana , Welch Roberto , Cobham Marta E. , Moore Anne
Published: March 2020

e20641

Background: Chemotherapy induced alopecia (CIA) is a distressing adverse effect of many chemotherapy agents. The TC chemotherapy regimen (four cycles of docetaxel 75mg/m2 and cyclophosphamide 600mg/m2 given every 3 weeks apart) commonly used for aduvant therapy of breast cancer is associated with complete alopecia, with rare reports of permanent alopecia. Scalp cryotherapy has been reported to minimize or prevent CIA. Penguin cold caps are a commercially available scalp cooling product gaining increasing media attention. We conducted a prospective study aimed to assess efficacy of scalp cryotherpy in preventing CIA among women receiving adjuvant TC chemotherapy for early stage breast cancer who independently elected to use Penguin cold caps. Methods: Women at the Weill Cornell Breast Center who elected to use scalp cryotherapy with Penguin cold caps during adjuvant TC chemotherapy were asked to participate in the study. Degree of hair loss was rated by practitioner assessment using Dean’s alopecia scale (poor (>75% hair loss), moderate (50-75%), good (25-50%) or excellent (<25%)), by digital photographs, and by asking patients whether they felt a need to wear a wig or head covering due to hair loss. Assessments were made before each chemotherapy treatment and at a follow up visit between 3 weeks and 3 months after the completion of chemotherapy. Results: 17 patients have enrolled. 13 patients have completed chemotherapy. 2 patients currently undergoing chemotherapy and 2 patients who discontinued chemotherapy due to toxicity not related to alopecia are excluded from analysis. Dean’s alopecia scale score was excellent for 10 patients (77%) at every assessment. Dean’s score was good for 2 participants (15%) and moderate for 1 participant (8%) starting prior to fourth cycle of chemotherapy. Only 1 patient (8%) reported needing to wear a wig or head covering as a result of alopecia. Conclusions: Scalp cryotherapy using Penguin cold caps appears to be effective in preventing CIA among women undergoing chemotherapy with the TC regimen.
Communication of diagnosis in elderly lung cancer patients: Who is informed, what information is given, and what patients know and want to know.
Authors: Girones Regina , Aparicio Jorge , Torregrosa Maria Dolores
Published: March 2020

e20643

Background: Lung cancer chemotherapy decisions in patients > 70 years old are complex; in order to integrate patients in the decision-making process, they must be informed. To assess the modes of communication with older lung cancer patients, we prospectively collected data in order to assess patients’ level of knowledge about diagnosis and prognosis. We examined who informed the patient, the information given and what the patient knew and wanted to know. Relationships, among other parameters were presented. Methods: 83 patients diagnosed with lung cancer from January 2006 to February 2008 were recruited from a single center. Logistic regression and multiple imputation methods were used to assess associations between patient information and independent variables. Results: In the majority of cases, families received the diagnosis of lung cancer (92.8%). Family was more protective when the patients were elderly (p: 0,036), depressed (p: 0,054), had dementia (p: 0,03), had poor performance status (p: 0,03) or complied with frailty criteria (p: 0,014). At our institution, physicians who gave cancer diagnoses were not oncologists. We received the patient diagnosed yet. We found that they usually gave cancer diagnosis preferably to family members. Only 27,7% of patients were informed that they had tumors. There was a correlation between age and more protective attitudes on the part of physicians. 73,5% of patients actively solicited information, however elderly and frail patients tended to do so less. Conclusions: A large proportion of elderly lung cancer patients do not receive adequate information about their disease prior to contact with oncologists however they do actively ask for information and speak about cancer with oncologists. Information about cancer is difficult to provide, even in elderly patients.
Providers' concordance with survivorship clinical algorithms.
Authors: Zandstra Frances Ann , Palos Guadalupe R. , Russell Ludivine , Gilmore Katherine R. , Flores Jacklyn J. , Ozeri Delrose , Rodriguez Maria Alma
Published: March 2020

e20645

Background: The utility of algorithms to guide clinical practice related to long-term survivorship care is unclear. In 2012, lymphoma survivorship algorithms for Hodgkin’s and Large B-Cell were developed as part of an institutional clinical practice initiative to enhance survivors’ outcomes. Here we describe providers’ concordance with minimum standards recommended in survivorship lymphoma algorithms. Methods: Concordance, the primary outcome, was defined as whether minimum recommendations, summarized in lymphoma algorithms, were provided during a survivorship visit. Concordance was measured using a “yes/no” response format assessing whether a provider’s recommendations were consistent with algorithms’ minimum standards including: 1) physical examination, 2) laboratory and imaging testing, 3) cancer screening procedures, and 4) health promotion education. Data were abstracted from electronic medical records and Passports (summary care plans). Secondary outcomes were number of survivors seen and Passports issued. All data included in these analyses were de-identified. Results: From 05/01 to 09/30/2012, all 63 survivors seen in the Lymphoma Survivorship Clinic received a Passport. Providers individualized Passports based on a survivor’s needs relevant to disease surveillance, life-style changes, screening recommendations, and specific procedures to assess for a recurrence or late treatment effects. Results indicated 100% of survivors received a physical exam, adult vaccinations, and cardiovascular screening. Similar rates were achieved for CBC testing, chest X-rays, assessing survivors’ psychosocial distress, and counseling survivors on screening recommendations specific to breast, cervical, colorectal and prostate cancers. Additionally, rates for skin exam recommendations were 97%. Conclusions: Based on concordance results, providers met the minimum recommendations listed in the lymphoma algorithms. Future research is needed to assess the impact of providers’ use of algorithms on survivors’ outcomes and feasibility of replicating concordance analyses in other clinical care settings.
Chemotherapy-associated thrombosis in cancer outpatients: Risk factors and decision making of a prophylactic approach.
Authors: Torchio Martina , Franceschetti Benvenuto , Cavali Carla , Zanirato Sonia , Olgiati Angelo , Gristina Valerio , Danova Marco
Published: March 2020

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Background: Venous thromboembolism (VTE), is a negative predictor of survival in pts with advanced cancer. International guidelines don’t recommend routine prophlaxis but suggest to consider pts, undergoing chemotherapy (CT), with high risk of VTE. Many clinical risk factors for cancer-associated VTE have been evaluated in a 5 parameter-based (body mass index, platelet and leucocyte counts, hemoglobin value and tumor site) scoring system, the Khorana score, utilized to indicate a prophylactic approach. We prospectively applied this score in cancer outpts beginning CT and an implementation based on 6 addictional factors analysis (sex, age, central venous catheter, CT-agents, antiangiogenetic drugs, erithropoiesis stimulating agent) to evaluate their impact in pts assignment into risk groups. Methods: We studied adult pts, followed at our Department from August 2011 to December 2012, with advanced cancers (breast, NSCLC, colorectal, pancreatic/gastric, urogenital, LNH, Hodgkin's disease, HD, and MM), receiving a first or second line standard CT. We stratified pts into three risk groups (score 0= low; score 1-2=intermediate; score 3-4-5=high) considering both the Khorana scoring system and its implementation. Results: We analyzed 169 pts (103F/66M, median age 62.3, range 35-80 yrs), pt population included: 38 breast, 32 colorectal, 31 LNH, HD and MM, 27 urogenital, 22 NSCLC and 19 pancreatic/gastric. With the Khorana score 49 pts were assigned to the low risk, 87 pts to the intermediate risk (57 with score=1, 28 with score=2), 16 pts (9.4%) to the high risk group (9 with score=3, 4 with score=4, 3 with score=5). When we considered 11 parameters 37 pts (21.8%) were assigned to the high risk group. Conclusions: A more comprehensive quantification of VTE risk, also considering new independent factors, is mandatory for a correct decision making of an antithrombotic-prophylactic approach.
Treatment pattern trends of erythropoiesis-stimulating agents used for chemotherapy-induced anemia by U.S. community oncologists from 2008 to 2011.
Authors: Wang Zhaohui , Katler Ann , Todoroff Karen , Bergstrom Kimberly A.
Published: March 2020

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Background: In 2007 the FDA and national treatment (tx) guidelines recommended restricting use of erythropoiesis-stimulating agents (ESAs) to treat chemo-induced anemia (CIA). This study examines ESA tx started for CIA in non myeloid cancer (NMC) patients (pts) by U.S. community oncologists from 2008 to 2011. Methods: Adult NMC pts with CIA receiving initial ESA [epoetin α (EPO) or darbepoetin α (D-EPO)] tx from 2008 to 2011 were identified using an oncology drug dispensing database. Chemo drug combinations (drug-co) prescribed prior to CIA, Hb levels that triggered the start (1st Hb) and end (last Hb) for initial ESA tx, time to tx w/ ESA and ESA dose and duration were evaluated. Results: 523 oncology practices across 48 states prescribed initial tx w/ EPO or D-EPO for 4,489, 3,845, 2,813, and 1,393 NMC pts w/ CIA in 2008, 2009, 2010, 2011, respectively. Average age was 65, 66, 66, and 67 yrs in 2008, 2009, 2010, 2011, respectively. For all pts w/ CIA, carboplatin-paclitaxel, gemcitabine, and carboplatin-etoposide were the top 3 out of 2,605 drug-co given to 7.5, 4.2 and 3.7% of pts respectively. The Table summarizes data recorded for pts evaluated with CIA and initial ESA tx. Hb starting and ending values declined while time to treat with initial ESA tx increased from 2008 to 2011. No significant change of total dose of EPO or D-EPO was observed from 2008 to 2011. Conclusions: Since restrictions on ESA use were recommended, fewer CIA pts have received ESA TX, and the Hb value for initiation has declined. Additionally, ESA tx was initiated later in the course of chemotherapy from 2008 to 2011 but total time on ESA therapy remained relatively constant. [Table: see text]
Observational study of ferric carboxymaltose in France (OncoFer; interim analysis).
Authors: Toledano Alain , Luporsi Elisabeth , Scotté Florian , Morere Jean F. , Huot-Marchand Philippe , Zakin Lorraine B. , Mahi Lamine , Bugat Roland
Published: March 2020

e20654

Background: Iron deficiency with anemia is a frequent complication in cancer.Ferric carboxymaltose (FCM) is approved for the correction of iron deficiency in France since the beginning of 2011. This observational multicenter study has recruited 2 cohorts of patients to describe FCM use in daily practice for patients with hematological malignancies or solid tumors. Methods: Cohort 1 (retrospective): 450 patients treated in 2010 with any intravenous (IV) iron or red blood cell transfusion (BT); Cohort 2 (prospective): 450 patients treated with FCM after July 1, 2011. Patient characteristics are collected for 3 months pre and post intervention. Recruitment of the 810 patients has been completed. Results: Outcomes of the first 100 patients are described below. The majority of patients receiving FCM had metastatic solid tumors and received just under 1000 mg iron. Hematological malignancies were only included in BT cohort. Results are detailed below. Number of patients at baseline with serum ferritin (SF) level and TSAT are 10 and 7 respectively in cohort 1 and 28 and 26 respectively in cohort 2, therefore the reason for initiating FCM appeared to be based predominately on Hb level. Functional iron deficiency was present in 85% where TSAT and ferritin were measured. No related serious adverse events were reported for the IV iron preparations. Conclusions: FCM was well tolerated and seemed effective in treating iron deficiency anemia. Administration was usually delivered at home with fewer infusions required for FCM compared to iron sucrose. These interim results need to be confirmed in the final analysis. [Table: see text]
Is anemia due to chronic disease the main cause of anemia in cancer patients?
Authors: Utkan Gungor , Kenar Gokce , Akbulut Hakan , Demirkazik Ahmet , Onur Handan , Icli Fikri
Published: March 2020

e20655

Background: Causes of anemia in cancer patients are often multifactorial. It may be atrributed to underlying nutritional deficiencies, such as cobalamin, folate, iron. The aim of our study is to determine prevalence of anemia and evaluate anemia parameters in newly diagnosed cancer patients. Methods: 310 newly diagnosed cancer patients (gastrointestinal tract (GIT) cancers, 35.8%; non-GIT malignancies, 64.2%) and 301 healthy individuals as control group were retrospectively evaluated in terms of anemia parameters: complete blood count (CBC) , ferritin, transferrin saturation (TSAT) , serum iron (SI), vitamin B12, folate levels. The exclusion criteria were, to be treated with cytotoxic treatments or radiotherapy before, and having a story of hemorrhage within last 3 months. Results: Anemia was observed in 49.7% of newly diagnosed cancer patients and in 13.7% of control group (P< 0.001). Mean ferritin level was 153 ng/mL in patients group and 47 ng/mL in control group (P< 0.001). By contrast, in patient group, SI and TSAT were lower (P< 0.001). Folate deficiency (≤ 3.1 ng/mL) was seen more frequent in patient group than control group (6.5% and 1%, P< 0.001). Cobalamin deficiency (≤ 200 pg/mL) was also seen more frequent in patients group than control group (39.3% and 17.7% , P< 0.001). Anemia parameters were similar in both groups of patients with GIT cancers and non-GIT cancers. Conclusions: In the current study, we found that nutritional deficiencies are more prevalent in newly diagnosed cancer patients than control group. However ferritin levels were higher in cancer patients, SI and TSAT levels were lower. This situation can be explained by acute phase response. Both cobalamin and folate deficiencies may cause ineffective erythropoiesis and also pancytopenia. If cytotoxic therapies will be administered additionally to cobalamin or folate deficient cancer patients, duration of bone marrow depression may become longer. In conclusion, we suggest to evaluate anemia parameters routinely at the time of diagnosis in cancer patients. This may provide an opportunity to replace these nutritional factors earlier and to reduce the requirement of transfusion.