bluuebunny/crossref_metadata_2025 huggingface dataset:
Weight loss during concomitant chemo-radiation therapy for squamous cell head and neck cancer: Possible role of transient hyperthyroidism
Authors: Mehrotra B. , Caramalis A. , Nissel-Horowitz S. , Radhakrishnan N. , Marsh J. , Limaye S.
Published: March 2020

16531

Background: Concomitant Chemoradiotherapy (CRT) is a standard treatment modality for locally advanced squamous cell head and neck cancer (HNC). This treament is often associated with significant weight loss which is commonly attributed to nutritional depletion secondary to mucositis, pain and inadequate oral intake. We undertook an evaluation of thyroid function as measured by Thyroid Stimulating Hormone (TSH) levels during CRT to evaluate the possible role of a thyroid hormone flare during treatment that may account for part of this weight loss. Methods: Institutional Review Board approval was obtained to conduct this retrospective analyses. Patients treated at our institution during the past six months who were treated with CRT for HNC and had recorded TSH levels at baseline (when available), mid treatment (week 4 to 6 of CRT), and post CRT (6 to 9 weeks later), at least 5% weight loss during treatment, and feeding tube requirement data available were identified. Age, Gender, Stage and Primary site of disease, Radiation dose and fields, chemotherapy regimen, were recorded. Results: Twelve patients were identified. Mid treatment TSH levels were suppressed below normal reference range (0.49–4.67 mIU/L) in 7of 12 pts (58%). A decline in TSH levels was noted in all 8 of 8 pts (100%) that had recorded pre-CRT TSH levels and mid treatment levels. Improvement of TSH levels was noted in all 9 of 9 patients that had mid treatment and post treatment TSH levels recorded, although in three of these nine patients TSH levels remained below normal range. Four of twelve pts required PEG placements for nutritional support. Conclusions: Transient suppression of TSH levels suggesting a thyroid flare is frequently observed early during CRT for HNC and appears to improve by 6–9 weeks post treatment. This may contribute to weight loss in this nutritionally challanged population. Further studies evaluating more specialised thyroid function testing to exclude sick euthyroid states and other etiologies for suppressed TSH levels are warranted. In addtion, therapeutic methods to abbrogate this flare may reduce weight loss during aggressive CRT treatment protocols.

No significant financial relationships to disclose.
Nasopharyngeal carcinoma: Comparison of concomitant chemoradiotherapy with neoadjuvant chemotherapy in the caucasian population
Authors: Sancho A. , Rubio I. , Diaz de Corcuera I. , Munoz A. , Martinez-Bueno A. , Mane J. M. , Ruiz de Lobera A. , Fernandez-Rodriguez R. , Gil-Negrete A. , Carrera S.
Published: March 2020

16532

Background: Nowadays, concomitant chemoradiotherapy (CT-RT) is the standard treatment for nasopharyngeal carcinoma (NPC). Neoadyuvant chemotherapy (CT) has been investigated without definitive conclusions. The aim of this study is to compare results of patients(pts) treated with neoadyuvant CT with those treated with concurrent CT-RT. Methods: 38 pts with histologically proven NPC stage II-IVb (PS 0–2) were treated. 27 pts (71.1%) (Group A) (June 1994-May 2000) received Cisplatin (P) 100 mg/m2, Epirrubicin (E) 70 mg/m2, Bleomicin (B) 15 mg D1 and B 12 mg/m2 continous infusion (c.i) for 5 days every 3 week with sequential RT. The other 11 pts (28.9%) (Group B) (June 2002-August 2006) received P 100 mg/m2 D1, D22 and D43 concurrent with RT followed by adyuvant CT P 80 mg/m2 and 5-Fluorouracil 1,000mg/m2/d D1-D4 c.i every 28 day for 3 cycles. Results: 38 pts: 30 male(79%), 8 female(21%). Median age: 53(range 15–75). Stages:II:7, III:11, IVA:12, IVB:8(AJCC 2002). Histology:WHO I-II:11, WHO III:27. Overall response rate: Group A: 25/27 (92.5%), Group B: 10/11 (90.9%) p=0.65. Group A: CR: 17/27 (62.9%); PR: 8/27 (29.6%); PD: 1/27( 3.7%). Group B: CR: 8/11(72.7%); RP: 2/11 (18.1%). 1 pts of each group was not evaluated. Median overall survival (OS) was 34 months (m) in Group A and has not been reached in Group B. Estimated 3 years OS was 48% in GroupA and 80% in GroupB. Median progression free survival (PFS) was 42 m in Group A and 45 m in Group B p=0.72. Estimated 3 years PFS was 50.6% and 66.7% respectively. In the multivariate analysis concurrent CT-RT (HR=5.94 p=0.03) and stage (HR=0.17 p=0.01) were associated with OS. There was 2 toxic death in Group A. The most common toxicities was; Group A: bone marrow suppresion, nausea; Group B: mucositis. Conclusions: These data suggest that P based concomitant CT-RT improves OS and PFS compared with neoadyuvant CT (BEC) followed by RT.

No significant financial relationships to disclose.
Treatment outcomes in anaplastic thyroid carcinoma from 1966–2006: Failure of overall survival enhancement despite four decades of progress in surgery, radiotherapy and chemoradiation
Authors: Chan P. , Yau T. , Epstein R. , Lam K. , Liang R. , Lo C.
Published: March 2020

16537

Introduction: Anaplastic thyroid carcinoma (ATC) is a notoriously aggressive malignancy associated with a highly lethal clinical course despite therapeutic intervention. To identify factors that could suggest improved therapeutic strategies, we have analysed the clinicopathological features, treatment and outcome of all patients with ATC treated over the past four decades in our institution. Methods: Fifty patients presenting with biopsy-proven ATC to our centre between 1966 and 2006 were studied. All patients were managed with surgery, radiotherapy, chemotherapy, and/or chemoradiation. Survival was calculated using the Kaplan-Meier method. Potential factors affecting survival were compared using the log-rank test. Results: Most patients (88%) presented with a neck mass, while 17 (34%) patients also had cervical lymphadenopathy. Distant metastases at diagnosis were present in 9 (18%) of patients. Median survival was 97 days, while the 1- and 3-year survival was 14 % and 8% respectively. On univariate analysis, patients aged ≤65 years (p=0.04), undergoing surgical resection (p<0.01), receiving RT to the neck (p<0.01) and without metastatic disease on presentation (p<0.01) enjoyed longer survival. Cytotoxic chemotherapy was not associated with survival enhancement (p = 0.4). Moreover, no change in survival was evident as a function of treatment era (p = 0.5). Conclusions: ATC remains a uniformly lethal disease despite numerous technical advances in surgery, radiotherapy and chemotherapy over the last forty years. Nonetheless, our results indicate that younger patients with localized ATC be treated aggressively in a multimodality manner. Identification of signalling pathways that can be medically blocked to reduce ATC metastatic/invasive potential and enhance apoptotic sensitivity should now be the main priority for multicentre collaborative clinical research.

No significant financial relationships to disclose.
Endoscopic treatment for superficial squamous cell carcinoma in the head and neck region (HNSCC)
Authors: Omori T. , Kawakubo H. , Sato Y. , Yokoyama A.
Published: March 2020

16542

Background: The HNSCC are usually diagnosed at advanced stage, therefore, the prognosis is dismal. Recently we can find the superficial HNSCC by using high-resolution and magnifying endoscopy. We expect to get a good prognosis by the endscopic treatment (EMRC: Endoscopic Mucosal Resection by Cap-method/ELPS: Endoscopic Laryngo-Pharyngeal Surgery) for the superficial HNSCC. The purpose of this study is to examine the usefulness and effectiveness of endoscopic treatment for the superficial HNSCC. Methods: The superficial HNSCC means that the depth of cancer invasion is within the subepithelial layer. When we diagnose superficial HNSCC with no lymphnode metastasis, the endoscopic treatment (EMRC/ELPS) becomes the first line treatment under general-anesthesia. For those treatment cases, We examine the method of treatment, complication, pathological diagnosis and prognsis. Result: We have 130 patients (201 lesions) of the superficial HNSCC from Jan 2000 to Jan 2007. The endoscopic treatment cases were 92 (142 lesions), 87 male and 5 female, ranging in age from 40 to 86 years. Of the 92 patients, 56 (60.9%) had been treated by EMRC, 36 (39.1%) had been treated by ELPS. EMRC is good for small lesion (less than 10 mm in diameter). ELPS is suitable for large lesion. In EMRC case, a wound pain was often slight after the operation, and patient could leave the hospital in 4–5POD. In ELPS case, a wound pain was stronger than EMRC, and needed more hospital days. Major complication was not recognized both in EMRC and ELPS. Of 142 lesions which clinical assessments of the depth of cancer invasion were ep (epithelial layer) or sep (subepithlial layer), 140 lesions (98.6%) were histopathologically ep or sep. Two lesions (1.4%) were mp (proper muscular layer). Of the 92 patients, 83 are alive, 9 had been dead. There was no lymphnode metastasis, distant metastasis and local recurrent case. Forty patients of 3 years observation were accrued from Jan 2000 to Dec 2003. Of the 40 patients, 33 were alive, 7 were dead. No HNSCC patients died. The cause specific 3 years survival rate is 100%. Conclusion: The result of our trial indicated the usefulness of endoscopic treatment for superficial HNSCC and the effectiveness for improving the prognosis of HNSCC

No significant financial relationships to disclose.
Cost effectiveness of whole breast IMRT for reduction of moist desquamation
Authors: Strauss J. B. , Chen S. S. , Dickler A. T. , Griem K. L.
Published: March 2020

17004

Background: Cost minimization studies have compared conventional whole breast radiation therapy (C-WBRT) to whole breast intensity modulated radiation therapy (IMRT). Consistently, IMRT has proved to be far more expensive. The weakness of cost minimization studies is that they assume the outcomes and toxicities of the treatment modalities in question are identical. Data from a case- control trial and a recent randomized controlled trial show that IMRT reduces the incidence of moist desquamation. We performed an analysis to estimate the cost effectiveness of breast IMRT to prevent moist desquamation. Methods: The direct medical costs of C-WBRT and IMRT were estimated using the 2006 Medicare Fee Schedule. We assumed rates of moist desquamation of 48 to 31% in accordance with Pignol, et al., ASTRO 2006. The cost effectiveness ratio (additional dollars spent per case of desquamation avoided) was calculated under two circumstances: 1) every patient received IMRT, or 2) only those patients destined to desquamate were treated with IMRT. Results: The direct medical costs of C-WBRT are $7,948 vs. $29,790 for IMRT. Thus, the marginal cost of IMRT is $22,142. In circumstance 1, the marginal cost to avoid one case of desquamation is $130,247. In circumstance 2, this cost is $62,518. Conclusions: The two circumstances described above are extremes that bound the range of cost estimates. Patient risk factors for desquamation, such as large breast size, can be used to identify high risk patients, obviating the need to treat all patients with IMRT. However, perfect prospective identification of all patients destined to desquamate is unlikely. Instead, the true marginal cost to avoid one case of moist desquamation will lie between $62,518 and $130,247. This cost may be too high to justify the benefit of reduced acute skin toxicity, but it is likely that the benefits of IMRT have been underestimated. IMRT may shorten the duration of moist desquamation. Late effects such as breast fibrosis and color variegation of the skin caused by desquamation as well as dose to the heart and lungs may be decreased by IMRT. If new data support these benefits, then IMRT may become a more cost effective option.

No significant financial relationships to disclose.
Risk assessment and medical decision model for prophylaxis and treatment of hyperuricemia and tumor lysis syndrome (TLS): International expert panel analysis
Authors: Cairo M. S. , Cornelis M. , Baruchel A. , Bosly A. , Cheson B. , Pui C. , Ribera J. M. , Rule S. , Younes A. , Coiffier B.
Published: March 2020

17006

Background: Hyperuricemia, a major component of TLS, has historically been prevented and treated using allopurinol and alkalinization, and recently managed effectively by rasburicase (recombinant urate oxidase) in children and adults at high risk of TLS. We sought to determine the risk factors associated with TLS and develop a risk adapted medical decision model for the prevention and treatment of hyperuricemia in TLS. Methods: TLS risk scoring was performed by an expert panel, based on an odds ratio evaluation of 68 patient characteristics and cancers with known TLS risk. The RAND Appropriateness Method (RAM) (1–3 inappropriate, 4–6 uncertain, 7–9 appropriate) was utilized to investigate the appropriateness of prevention and treatment in 92 different scenarios. All appropriateness ratios were validated using a set of 36 clinical cases. The strategies analyzed included no therapy, hydration (± diuretics [DI]), rasburicase, allopurinol, and allopurinol + alkalinization. Results: Risk factors (±SD) identified included age ≥ 60 years (1.6±0.5), decreased renal function (2.7±1.1), renal tumor infiltration (1.5±0.3), initial cytoreductive therapy (2.5±1.2), acute lymphoblastic leukemia with WBC ≥50x109/L [Burkitt 8.6±5.3; pre-B 4.3±2.4; T-cell 4.6±2.8]; and non-Hodgkin lymphoma with LDH≥ 2x normal [Burkitt 6.6±3.0; lymphoblastic 3.2±2.8; diffuse large B-cell 2.4±1.9]. Hydration (± DI) was considered appropriate while no treatment and allopurinol + alkalinization were inappropriate in all scenarios. For prophylaxis, rasburicase was more appropriate than allopurinol (8.5±0.5 vs 4.9±2.1; p<0.025) in patients with hyperuricemia and/or at high risk of TLS, whereas allopurinol was more appropriate than rasburicase (6.2±1.0 vs 4.9±1.9; p<0.05) in those at low or moderate risk. In patients with TLS and normal urine output and uric acid, allopurinol and rasburicase were considered equally appropriate (5.0±0.9 vs 5.8±0.3). Conclusions: In summary, in addition to hydration (± DI), rasburicase is appropriate for patients at high risk of TLS and/or with hyperuricemia, and allopurinol for those with low risk of TLS and/or normal uric acid concentration.

[Table: see text]
Long-term survival following colon cancer surgery: Variation associated with choice of anesthesia
Authors: Christopherson R. , James K. E. , Tableman M. , Marshall P. , Kline A. L. , Johnson F. E.
Published: March 2020

17015

Background: VA Cooperative Trial 345 randomized patients having abdominal surgery to unsupplemented general anesthesia (UGA) or epidural-supplemented general anesthesia (ESGA). The long-term clinical significance of the type of anesthesia for patients having surgery for colon cancer has not been well studied. We compared survival of patients with colon cancer randomized to ESGA to survival of those randomized to UGA. Methods: Survival of colon cancer patients was not a primary trial end point. We conducted a post hoc analysis of the colon cancer patients in the trial using TNM staging data from patient records. A Cox survival model was used to test the effects of pathological stage, type of anesthesia and other covariates on survival. Results: 177 patients were evaluable. In both trial arms, survival was similar (P = 0.23) until 4.56 years. After 4.56 years, patients assigned to UGA had significantly better survival (P = 0.01). In both trial arms, the survival in patients without metastases was similar initially, but those who received UGA had significantly better survival later. A similar statistically significant pattern was evident in patients with metastases. The long-term survival benefit of UGA was even more pronounced among patients with metastases and a diagnosis of alcoholism. Conclusions: This study provides the first evidence that ESGA may worsen long-term survival in colon cancer patients, especially those with metastases and alcoholism. Epidural anesthesia affects visceral blood flow, immunological parameters, post-operative pain and other physiological variables, which could explain these findings. Additional studies to confirm or refute these unexpected findings are warranted.

No significant financial relationships to disclose.
The adequacy of pain treatment in advance stage non-small cell lung cancer: A longitudinal study
Authors: Mendoza T. , Wang X. , Mobley G. , Palos G. , Cleeland C.
Published: March 2020

17016

Background: Pain is a prevalent symptom in advance stage non-small- cell lung cancer (NSCLC). Previous studies have shown these patients to be at risk for inadequate pain management. This longitudinal study evaluated pain and analgesic management in this patient population. Patients were treated at a major tertiary cancer center. Methods: Data from 102 patients receiving chemotherapy were used. Their pain was assessed weekly using the pain item from the M.D. Anderson Symptom Inventory, administered through an interactive voice response system. Analgesic orders were collected three times every two cycles of chemotherapy across 18 weeks (T1, T2 and T3). Adequacy of pain management was evaluated by the Pain Management Index (PMI). Chi-square tests were used to test for differences in proportions. Results: This analysis was based on all available data, as sensitivity analyses of pain trajectory by dropout as a function of time did not show differences. At baseline, 60% of 102 patients reported pain (ratings of 1 or greater on a 0- 10 scale) with the following distributions: 39% mild, 14% moderate and 7% severe. The proportions of patients with moderate to severe pain were 21%, 15%, 17% and 20% at baseline, T1, T2 and T3, respectively. The proportion of patients with moderate to severe pain did not increase over time. According to the PMI, there were 21%, 18%, 15% and 21% of patients who were inadequately treated at baseline, T1, T2 and T3, respectively. The percentages of patient receiving orders for strong opioids were 19%, 25%, 26% and 41% at baseline, T1, T2 and T3, respectively. Conclusions: About 80% of patients seen in a major tertiary cancer center were adequately treated for pain, while about 20% of patients experienced moderate to severe pain. Both these percentages were seen over time and did not significantly change during the course of their cancer treatment. These may be accounted for by a significant increase in the prescription orders for strong opioids by twice as much during the latter stage of their treatment.

No significant financial relationships to disclose.
The use of the internet for medical information and a needs assessment for a web based educational resource: A survey of Canadian medical oncology trainees and training program directors
Authors: Horn L. , Berry S. , Chung J. , Vijayaratnam S. , Verma S.
Published: March 2020

17022

Background: Medical Oncology trainees develop their skills and knowledge through formal educational sessions, independent learning and clinical rotations. The internet serves as a source of up to date information and a potential educatinal resource. Despite the existence of many websites with oncology related information, there has not been a comprehensive assessment of how medical oncology trainees and program directors use the internet to meet educational objectivs. Method: In the first phase of developing a new educational website (OncologyEducation.com), we surveyed medical oncology trainees and program directors from training programs across Canada to assess how they accessed the internet to determine the elements they considered essential for a trainee-oriented site. Results: 12 out of 13 Canadian medical oncology training programs participated in our survey. A total of 12 program directors and 23 trainees responsed to our survey for a 74.5% response rate. 71.4% of respondents spend up to 10 hours per week on the internet for work related reasons. Pubmed and UptoDate were the most frequently visited sites. Respondents reported using the internet for email (97.1%), answering clinical questions (88.6%), accessing practice guidelines (80%), and literature updates (71.4%). Respondents expressed a need for an educational website stressing the following content: (1) Key updates by disease sites (2) Access to pivotal journal articles (3) Access to upcoming conferences/information (4) Links to other medical sites/medical oncology sites (5) Fellowship Opportunities. Conclusion: The internet is an important resource for supplementing the training of medical oncology trainees. The development of an educational website based on the needs assessed in this survey is warranted. Upon development of the website it will be evaluated for effectiveness and impact on oncology training and clinical practice.

No significant financial relationships to disclose.
Lobular invasive pleomorphic breast cancer (BC) should be isolated from the classic type
Authors: Gil Deza E. , Japaze H. , García Gerardi C. , Diaz C. , Gercovich N. , Morgenfeld E. , Rivarola E. , Russo M. , Frahm I. , Gercovich F. G.
Published: March 2020

17024

Background: Lobular invasive BC represents between 5 and 10% of all breast tumors. The MD Anderson Hospital has published a study of 122 pt with lobular invasive carcinoma classic type (LIC) with a better long-term outcome than pt with invasive ductal carcinoma (JCO 23:41, 2005). In most papers, the lobular invasive pleomorphic type (LIP) represents a small number of cases and can be easily confused with the NOS carcinoma. The aim of this study is to compare the onset and prognosis of patients (pt) with LIP vs LIC breast cancer. Methods: A search in the IOHM database of 1169 BC was carried out. All of them had been reviewed by two pathologists and classified according the USA Association of Directors of Anatomic and Surgical Pathology's recommendations. The entire cohort was diagnosed and treated at the IOHM. Only those with lobular invasive BC were included in this paper. Results: Between Oct 97 and Nov 06, 116/1169 pt (10%) were diagnosed with invasive lobular carcinoma. Seventy pt (60%) were LIC, and 46 pt (40%) were LIP. Characteristics of the Population: All pt were females. Both groups were comparable in terms of age (median age for both groups = 60 yo) Staging: LIP presented in more advanced stages: A) LIP group: Stage I: 14 pt; II: 22 pt; III: 8 pt; IV: 2 pt B) LIC group: Stage I: 42 pt ; II:13 pt; III: 15 pt; (p:0,001). The LIP group had a higher histological grade (p:0,0001), and more multifocality (p: 0.023), and vascular invasion (p:0,0001) than the LIC group. There were no differences in hormonal receptors status or the ductal extensive component. The retrospective determination of the Her2/neu status is underway. Treatment: Both groups were treated similarly according to the different stages of the illness. Follow-Up: The average follow up time was 23 months (range 4–102) and the LIP group showed a worse prognosis than the LIC group as measured by a higher rate of metastasis (LIP: 12 pt - LIC: 4 pt) (p:0,002) and a higher mortality rate (LIP: 6 pt - LIC: 0) (p:0,003). Conclusions: 1- The LIP carcinoma is a more aggressive variant and has a worse prognosis than the LIC. 2- The incidence for LIP is higher than expected, as it stands for 40% of the total cases in our study. 3- The results justify the establishment of a clear cut differentiation between the classical and pleomorphic types.

No significant financial relationships to disclose.
A prospective evaluation of combined modality therapy for breast cancer with ipsilateral supraclavicular node metastases
Authors: Dienstmann R. , Noronha Filho H. , Branco L. G. , Lima C. F. , Rodrigues G. J. , Freitas L. C. , Rezende L. M. , Small I. A. , Bines J.
Published: March 2020

17025

Background: Based on retrospective data, the most recent breast cancer staging classification changed the status of ipsilateral supaclavicular node mestastases from M1 to N3c. This carried along with it modifications in the treatment of a small subset of breast cancer patients. The aim of this study is to prospectively evaluate surgery and radiation therapy besides systemic treatment in pts with stage IIIC breast cancer. Methods: Phase II single-institution trial. Eligibility: patients with non-metastatic breast cancer and pathological confirmation of ipsilateral supraclaviclular node metastases. Treatment: FAC (fluorouracil 500 mg/m2, doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2) q 21 days × 6; followed by modified radical mastectomy (MRM); adjuvant radiotherapy and tamoxifen (if estrogen and/or progesterone receptors positive - ER/PR). Results: Since May 2002, 22 patients entered the trial, with a median follow-up of 25 months (4–50). Median age was 50 years (29–69). Median tumor size was 6 cm (2.5–15), most patients had T4 disease (77%) and ER/PR positive tumors (64%). All patients underwent MRM after neoadjuvant FAC. Clinical response: 1 (5%) complete, 20 (90%) partial, 1 (5%) minor response. Until December 2006, 13 patients progressed and 7 died. Five patients (23%) had loco-regional relapse and 5 (23%) developed brain metastases. Median estimated progression-free survival was 41 months (14.1–67.8) with median survival not reached. The estimated 2-year progression-free and overall survival rates were 32% and 67%, respectively. Conclusions: Our results, collected in a prospective fashion, are in agreement with previous retrospective studies. Combined-modality treatment for breast cancer with ipsilateral supraclavicular node metastases is recommended.

No significant financial relationships to disclose.
Choice of adjuvant and first-line metastatic chemotherapy (CT) for colorectal cancer (CRC) treated in the Carolinas
Authors: Rowe K. , Patwardhan M. , Herndon J. E. , Martin M. G. , Zafar Y. , Morse M. , Abernethy A. P.
Published: March 2020

17039

Background: CT choice is influenced by many factors including published evidence, guidelines, cost, reimbursement, patient considerations, key opinion leaders, and anecdote. Substantial locoregional variation in practice patterns can exist, and therefore studies of locoregional practice provide important information on local drivers of care. Methods: Using a population-based strategy, we identified CRC patients who developed metastatic disease since 6/1/03 from 9 Duke Oncology Network community practices and 1 academic practice in North and South Carolina. Demographic, comorbidity, diagnostic, stage, initial treatment, and metastatic treatment data were abstracted by retrospective chart review, double-entered and verified for accuracy. Results: Of the first 743 charts screened, 306 were eligible (mean age 61 (SD 13), 49% male; 65% white; 22% black; 77% colon cancer and 19% rectal; stages II 8%, III 16%, IV 64%). 26 earlier stage rectal cancer patients received neoadjuvant treatment, 50% infusional fluorouracil (5FU) and 42% capecitabine (Cap). 46 colon cancer patients received adjuvant CT, including 5FU/leucovorin (LVN; 54%), 5FU/LVN/oxaliplatin (21%), Cap (9%), and 5FU/LVN/irinotecan (7%). First-line CT for metastatic colon cancer (n=149) included FOLFOX+-bevacizumab (Bev; 42%), Cap/oxaliplatin +- Bev (23%), 5FU/LVN + Bev (9%), FOLFIRI +- Bev (7%), IFL +- Bev (7%), clinical trial (7%), Cap (3%), and unknown (1%). 54% of patients received Bev overall, reflecting 49% usage before 6/05 and 69% after 6/05. CT was not offered for 25 (8%) at initial diagnosis. Conclusion: Locoregional practice patterns in the Carolinas suggest that for adjuvant treatment of CRC, oxaliplatin has been used in 21% of adjuvant and 75% of first-line metastatic colon CT regimens, and that bevacizumab use has increased to 69% of first-line metastatic CRC patients.

No significant financial relationships to disclose.
Evaluating compliance (com) with hematology (H) -oncology (O) quality (Q) standards in a community-based managed care population
Authors: Bosserman L. , Presant C. , Der A. , Estrella A. , Greenburg A. , Upadhyaya G. , Vakil M.
Published: March 2020

17050

Background: Better Q and outcomes in HO practice are associated with com with national treatment guidelines (TG). Institution of an O specific electronic medical record (EMR) within a community HO specialty practice allowed analysis of com with TG as well use of high cost treatments (HCT) data from an HMO population in a multi site HO practice are presented. Methods: HO physicians agreed to treat patients (pts) using common EMR, TG and regular treatment (tx) reviews. EMR data over 18 months for the HMO population was reviewed for diagnosis, stage, and tx. This was compared to TG of NCCN. A panel of high cost therapies (HCT) was identified by the HMO medical director, and pt treatment com with TG was tabulated. Non-com was further evaluated as acceptable alternative practice (acc) by NCCN description, recommended (rec) by academic specialist consultation or not appropriate by TG (non-app). Results: Between 1/1/04 and 6/31/05, the HMO had ∼75,000 covered lives at risk. 1210 evaluable HO pts were treated by 5 oncologists. 163 pts had benign H diagnoses (dx), 155 had malignant H dx, and 892 had solid tumor dx (breast 373, colorectal 76, lung 63, prostate 28, ovary 15). Of pt with cancer (ca), 49 had active ca but no rx, 639 had ca in complete remission and had no tx, and 256 had active ca and received tx. 102 had clinical diagnosis but incomplete evaluations, none received tx. Of HMO chosen HCT, Rituximab was given to 25 pt, and all rx was com to TG. Bevacizumab was given to 14 pt and was com in 11, acc in 1, and non-com/acc in 2. Trastuzumab was given to 8 pt, and was com in 4, acc in 3, and rec in 1 pt. IVIG was com in 1 and rec in 1 pt. Of a total 49 HCT, 8 were non-com with TG (16%), but only 2 were non-com, non-acc, and non-rec (4%). Both were associated with 1 new physician whose performance improved after pre tx review of HCT by a senior physician prior to pt tx. Conclusions: Ongoing review and feedback to physicians using EMR and national TG allows objective monitoring and improvement of Q in HO practice. Issues of concern, such as HCT, can also be detailed. Payors and practices can consider using such methods and data to negotiate fair payment for Q care. .

No significant financial relationships to disclose.
Baseline diagnostic imaging in early breast cancer—Five-year analysis of a large cohort
Authors: Morris P. G. , Gray J. , O' Rafferty C. , O' Connor M. , Kennedy M. J.
Published: March 2020

17059

Background: Many patients with newly diagnosed breast cancer undergo multiple investigations as part of baseline staging, although the evidence base for this is poor. To assess the use of baseline diagnostic imaging and its benefit a review of practice was carried out. Methods: A retrospective review of all patients diagnosed with breast cancer in St James's Hospital in Dublin, Ireland over a five-year period was carried out. Baseline demographics and the appropriateness of baseline diagnostic imaging were assessed. Results: Between 01/01/2001 and 12/31/2005 781 patients were diagnosed with breast cancer in St James's Hospital, of whom 776 were women and 5 were men, with a mean age of 56.7 years. At diagnosis 266 patients (34%) underwent a bone scan, which showed evidence of skeletal metastases in 42 (15.8%). Of the patients with positive bone scans 26 (61.9%) were symptomatic with bone pain, and 16 (38.1%) were not. In the 16 patients without bone pain a diagnostic workup for metastatic disease was undertaken in 5 patients because of clinical findings, in 4 patients because of abnormal liver blood tests and in 5 patients because of radiological findings. Only two patients out of 266 who underwent a bone scan were found to have an incidental finding of metastatic bone disease, of whom one had a bone scan as part of a clinical trial. At diagnosis 261 patients (33.4%) underwent a liver ultrasound, which showed evidence of metastases in 23 (8.8%). Of these, 19 patients had abnormal liver blood tests. Four patients had metastatic disease on liver ultrasound with normal liver blood tests and of these, one patient had a malignant pleural effusion and one patient had inflammatory breast cancer and was considered high risk for metastatic disease. Only two patients out of 261 who underwent a liver ultrasound had incidental findings of liver metastases. Conclusions: Over a five-year period, occult metastases were discovered in only two patients on bone scans and in two patients on liver ultrasounds. The routine use of these imaging modalities to detect metastases in early breast cancer is not justifiable.

No significant financial relationships to disclose.
Phenotypic characteristics of triple negative breast cancer in a rural population
Authors: Howard-McNatt M. , Hazard H. , Jaime A. , Vona-Davis L.
Published: March 2020

17060

Background: Triple negative breast tumors are a basal-like subtype of breast cancer associated with the poorest clinical outcomes. Typically they are found in younger patients, African-American women, and patients with the BRCA mutation. To date, however, the epidemiology of triple negative breast cancers in a rural, Caucasian population has not been described. Methods: 96 breast cancer patients presenting with a basal-like subtype of breast cancer had tumor biopsies and demographic and epidemiologic information were collected. Standard histologic and immunohistochemical analysis was done for ER, PR, HER-2/neu status for all high nuclear grade tumors from January 2000 to December 2005 at West Virginia University Hospital. The tumor registry was reviewed to determine tumor size, stage at diagnosis, age at diagnosis, race, menopausal status, body mass index (BMI) and BRCA1/BRCA2 status. Variables in the triple negative group were then compared to all patients who were diagnosed with infiltrating ductal carcinoma between 1999–2004. Results: The basal-like breast cancer subtype was more prevalent among the 40–59 year old group (52%, 50/96) versus women <40 years (12.5%, 12/96) (p= 0.01). Most patients presented with T2 tumors (57%) and the majority had stage II disease (61%, p-value = 0.01). 67% of the population was postmenopausal and were more likely to be overweight or obese (73%, p-value = 0.03). Only one African-American patient met all criteria (2.8%). Of the 7 patients with triple negative tumors who received BRCA testing, four were BRCA1 positive. Age, tumor stage and BMI were similar between the populations of triple negative tumors and infiltrating ductal carcinoma. Conclusions: The demographic and phenotypic characteristics of basal-like breast cancers are still being defined. In contrast to previous findings, triple negative tumors in a rural area were found in middle aged, postmenopausal Caucasian women with Stage II disease and a higher BMI. This analysis will help to identify possible risk factors such as obesity in triple negative cancer subtypes and may prompt further research into differences in breast cancer survival in obese populations from rural areas.

No significant financial relationships to disclose.
Use of complementary and alternative medicine in Korean cancer patients: Results of a survey from the Korean Cancer Study Group (KCSG)
Authors: Kim D. , Lee M. , Kim B. , Lee K. , Hong Y.
Published: March 2020

17061

Background: The aim of this study was to explore the use of complementary and alternative medicine (CAM) in cancer patients of Korea. This study was performed to identify the prevalence, types, subjective effects, and side effects of CAM use, reasons for CAM use, and patients' expectations of doctors regarding their CAM use among Korean cancer patients. Methods: From August to December, 2006, face to face structured interviews were conducted and the data were analyzed in the KCSG. Results: A total 251 patients were recruited. 84% of patients had used at least one type of CAM since the time of initial diagnosis. The most prevalent types of CAM used by these patients included special diet (60%), ginseong (54%), medicinal mushrooms (50%). Energy therapies, acupuncture and spiritual therapy were used uncommonly. The main reported reason for the use of CAM was to feel hopeful. Patients expected that CAM could cure cancer (64%) and improve immune system (52%). 62 % of patients did not inform their physicians about their CAM use. Patients attributed the reason of nondisclosure that physicians never asked about CAM (43%) and physicians would disapprove the CAM use (23%). 6% of CAM users experienced side effects. Demographic variables were not predictive for the use of CAM. 60% of patients wanted to get more information about CAM with their doctors. Conclusions: More than two-thirds of cancer patients used various kinds of CAM. Physicians treating cancer patients should aware of the frequency of CAM use and should share their opinion about CAM use with cancer patients. In order to help patients make informed decisions, physician should pay more attention to CAM for making appropriate utilization of CAM.

No significant financial relationships to disclose.
Attitudes about chemotherapy for Japanese patients with or without cancer: Doctors, nurses, and the general public
Authors: Kubota K. , Nagai K. , Nishiwaki Y. , Sugiura T. , Tsuchiya S. , Matsui K. , Tada A. , Nishimura Y. , Kawahara M.
Published: March 2020

17062

Background: A prospective survey in England demonstrated that patients with cancer were much more likely to accept radical treatment with minimal chance of benefit than people who did not have cancer (Slevin et al. Br Med J 1990; 300: 1458–60). We compared responses of Japanese patients with cancer with those of a control group of physicians, nurses, and patients without cancer in assessing personal cost-benefit of chemotherapy using the same questionnaire with Slevin's study. Methods: Subjects were asked with questionnaires whether of not to accept intensive and mild chemotherapy with a supposed minimum chance of effectiveness. 153 patients with cancer, 265 controls, 213 doctors, 397 nurses, and 51 patients without cancer were subjects of the study. Results: Percentage of subjects who accepted intensive chemotherapy with a supposed minimum chance of effectiveness (1% chance of cure, 3-month prolonging life, 1% relief of symptoms) by subject group were as follows: cancer patients; 62/55/52, doctors; 27/32/4, nurses; 11/12/5, non-cancer patients; 35/40/36, controls; 23/24/15, respectively. Conclusions: More patients with cancer than people without cancer accepted treatments giving the minimal benefit for cure, prolonging life or palliation of symptoms. Interestingly, the results in Japanese survey were similar to the previous study in England.

No significant financial relationships to disclose.
Using an interactive CD-ROM to gain informed consent for chemotherapy: Attempting to improve patient anxiety and depression during treatment
Authors: Olver I. N. , Whitford H. S.
Published: March 2020

17071

Background: In a previous study, we found that an interactive CD-ROM did not adequately improve patients’ recall of chemotherapy treatment information compared to standard written information enough to warrant changes to the consent procedure. However, we further investigated whether this alternative mode of information delivery helped improve patients’ anxiety and depression over the treatment phase. Methods: Ninety-eight new patients about to commence chemotherapy were randomized to receive written information or an interactive CD-ROM containing treatment information before giving informed consent. Patients’ anxiety and depression were assessed pre- treatment using the Hospital Anxiety and Depression Scale (HADS) and once again at their second chemotherapy session along with their recall of treatment related information. Seventy patients completed all assessments. Results: Results indicated that anxiety and depression levels of the current sample were greater than those of normative groups including general population and cancer samples. Between/within subjects ANOVAs revealed that anxiety did decrease over the first phase of patients’ treatment (p = .001), but that written and CD-ROM groups did not differ in that increase (p = .99). Alternatively, depression scores increased during treatment but not significantly (p = .58) and once again, scores did not differ between the two information groups (p = .64). Conclusions: Given the results of some additional correlational analyses it appears that anxiety and depression scores are negatively associated with patients’ ability to recall and essentially understand aspects of treatment information given to them prior to chemotherapy. However, changing the mode of treatment information delivery does not appear to affect these psychological problems, and in turn, how they affect informed consent.

No significant financial relationships to disclose.
The risk of hepatocellular carcinoma in patients with previous malignancy
Authors: Siegel A. B. , McBride R. B. , El-Serag H. , Hershman D. , Zablotska L. , Brown R. , Neugut A. I.
Published: March 2020

17075

Background: Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. Its incidence has doubled over the past 20 years in the United States. Determination of the pattern of occurrence of HCC as a second primary malignancy might give clues for new risk factors for HCC, or may reveal common genetic or environmental risks. Methods: We identified patients with a diagnosis of a second primary HCC between 1973 and 2002 using the Surveillance, Epidemiology, and End-Results Program (SEER) a compilation of population-based cancer registries in the United States, to calculate the observed to expected (O/E) frequency of second primary HCC after a different primary cancer. We stratified by ethnicity, latency from the year of diagnosis of primary cancer to HCC diagnosis, and period of diagnosis of primary cancer as early (1973–1987) or late (1987–2002). Results: We reviewed 1,931,911 subjects with cancer, and identified 1,185 second primary HCC cases. Overall, a second primary HCC after any primary cancer was less frequent than expected (O/E=0.82, 95% CI=0.77–0.87). We found positive associations with head and neck cancers (oral cavity/pharynx O/E=2.1, 95% CI=1.7–2.5), Kaposi's sarcoma (O/E=3.3, 95% CI=1.2–7.1) and Hodgkin's disease (O/E=2.3, 95% CI=1.2–4.0). Negative associations were seen for breast cancer (O/E=0.7, 95% CI=0.6–0.8), colorectal cancer (O/E=0.6, 95% CI=0.6–0.8), and prostate cancer (O/E=0.7, 95%CI=0.6–0.8). Overall, lower O/E ratios were seen in whites, while in African Americans and those of other races, the O/E ratios were close to one. Latency times were relatively short for head and neck cancers and Kaposi's sarcoma (most within 12–59 months), and greater than 120 months for most cases of HCC after Hodgkin's disease. All cases of Kaposi's sarcoma were seen in the later time period. Conclusions: These results highlight possible shared risk factors of alcohol ingestion and viral exposures which may predispose to second primary HCC after other primary malignancies. Providers should maintain heightened alertness for second primary HCC in these patients, especially those with head and neck cancers and HIV.

No significant financial relationships to disclose.
Incidence of grade 3/4 adverse events in imatinib resistant/intolerant chronic phase CML (CP-CML): A comparison of nilotinib and dasatinib
Authors: Carpiuc K. T. , Stephens J. M. , Liou S. Y. , Botteman M. F.
Published: March 2020

17501

Background: Toxicities of new treatments may increase the care and resources required to manage patients (pts). The objective of this study was to compare the rates of Grade 3/4 AEs reported for nilotinib and dasatinib, the second generation tyrosine kinase inhibitors (TKIs) in imatinib resistant/intolerant CP-CML pts in preparation for an economic analysis. Methods: A systematic literature review was conducted to identify published articles, registration documents, or abstracts of clinical trials in CP-CML for nilotinib 400 mg bid and dasatinib 70 mg bid. The base case incidence rates were selected from the most rigorous sources, specifically data from the dasatinib product label and the nilotinib phase II trial, both populations having a median drug exposure of slightly >5 months. The AEs selected for the comparison were based on frequency (>5%) and/or high likelihood of incurring incremental costs for medical treatment/monitoring. The full ranges for the incidence of AEs (if available) were summarized from other papers/abstracts for sensitivity analyses in future economic analyses. Results: The Grade 3/4 hematologic AEs were the most common AEs (table below) and were ∼2 times higher for dasatinib than for nilotinib. Common Grade 3/4 biochemistry abnormalities included lipase elevations in 5% of nilotinib pts (1 pt developed a Grade 1/2 pancreatitis; no Grade 3/4 pancreatitis) and hypophosphatemia in 11% of dasatinib pts. Rates of Grade 3/4 non-hematologic AEs such as pleural effusion, GI bleeding, arrhythmia, and pneumonia/infection were >2–7 times higher for dasatinib than nilotinib, though they occurred in <5% of the population. Conclusions: The toxicity profiles of the second generation TKIs for imatinib resistant/intolerant CP-CML appear to be different and favor nilotinib with its reduced rates of Grade 3/4 AEs. Further analysis is required to understand the cost impact to health care payers of the differences in safety profiles among the new TKIs.

[Table: see text]

No significant financial relationships to disclose.
Complete blood count may provide risk stratification for survival and AML transformation in CMML
Authors: Cerny J. , Galili N. , Liu Q. , Devuni D. , Hassan K. , Upadhyay R. , Mumtaz M. , Mehdi M. , Raza A.
Published: March 2020

17502

We performed a retrospective analysis of 120 patients with CMML (98 de novo CMML and 22 evolving from MDS) to examine clinical features that may influence survival and AML transformation. Univariate analysis showed low hemoglobin level; WBC > 13,000, platelet count < 50,000 and abnormal cytogenetics as poor prognostic features. Univariate analysis also determined that BM blasts >5% and Int2/High IPSS were associated with higher rates of AML but IPSS could not be used for survival assessment. Multivariate analysis showed hemoglobin < 12 g/dL, older age, abnormal cytogenetics as risk factors for shorter survival; older age, male sex, low platelet count, BM blasts > 5%, lymphocyte and monocyte counts were independent risk factors for AML transformation. Previous attempts to devise prognostic scoring systems for CMML have incorporated both peripheral blood and bone marrow features. We have used hemoglobin, lymphocyte count and platelet count to generate 3 prognostic scoring systems, which differed by severity of thrombocytopenia. Score 1 (>100, 50–100, <50) identified 3 different risk groups (low, intermediate, and high) with median OS: not reached (n/a), 18, and 9 months for all CMML patients (p<0.0001) as well as for the de novo CMML patients (p<0.0001). Score 2 (>50, <50) divided patients into 3 risk groups (low, intermediate, and high) with median OS: n/a, 19 and 10 months for all CMML (p=0.0002) versus n/a, 28 and 11 months for de novo CMML patients (p=0.0011). Score 3 (<100, >100) separated all CMML (p=0.0073) and de novo CMML patients (p=0.0054) into 2 risk groups (high, low) with median time to AML 53 months and n/a. In conclusion we suggest three new scoring systems for CMML patients that can be easily calculated after an initial CBC. Scores 1 and 2 help to assess survival while score 3 indicates risk for AML transformation. *Acknowledgements: This work has been partially supported by the AMA Foundation Seed Grant Research Program 2006.

No significant financial relationships to disclose.