bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors associated with successful publication of abstracts in women malignancies: Are we closing the gender gap?
Authors: Kapoor Ankita , Khunger Arjun , Bhatia Unnati , Gill Simrat , Ahlawat Yagya , Sarma Maithreyi , Kapoor Harshit , Jizzini Mazen , Nasir Samar , Agrawal Nikhil , Kokolus Kathleen , Zsiros Emese , Gandhi Shipra
Published: June 2021

11034

Background: We aimed to determine abstract characteristics associated with successful peer-reviewed publication after presentation at ASCO annual meeting in the women’s malignancy category (breast & gynecologic cancer). Awareness of this could help meeting organizers & attendees understand factors associated with impactful abstracts. Methods: All oral & poster abstracts (OA: n = 53 & PA: n = 527) in Breast (Loco/Regional/Adjuvant & Metastatic) & Gynecologic cancers category (2017 & 2018 meeting) were included. Subsequent publication was confirmed by searching PubMed by title, names of first & last authors for abstracts published by January 2021. Time to online publication, US or foreign journal publication & impact factor (IF) were recorded. We also recorded number of authors, single/ multi-institution studies & gender of first/ last author, which was confirmed by viewing biography details on their institutional websites. Descriptive analysis was performed & association between above factors & publication matrix was analyzed using multiple logistic regression model, Chi-square and t-test. Results: 45/53 OA (85%) & 269/527 PA (51%) were published in peer-reviewed journals. Median number of authors for published PA was 12 vs 11 for unpublished (p = 0.24). Females (F) presented 34% (18/53) OA & 49.3% (260/527) PA. 55% (143/260) PA presented by female authors & 47.1% (126/267) presented by male (M) authors (p = 0.073) were published. No difference in publication between single vs multi-institution studies (p = 0.76) for PA was noted. Average time to journal publication for OA & PA was 15.45 (SD +/- 3.37) & 17.73 (SD +/- 1.27) months (mo) respectively. Mean IF for OA was 27.95 (SD+/- 6.18) while for PA was 10.96 (SD+/- 1.75). For published OA, 33% (15/45) had female first & 29% (13/45) had female last authors. For published PA, 50.2% (135/269) had female first while only 37.5% (101/269) had female last authors. There was no association between gender of last author to IF (p = 0.39), single vs multi-institution study (p = 0.48) or time to publication (p = 0.44) for PA. Conclusions: More than 75% of OA & 50% of PA were successfully published regardless of gender, number of authors or institutions involved. We observe a slight disparity in senior authorship for females and although this was not statistically significant, we are encouraged that the gap is closing in first authorship.[Table: see text]
Incorporating HER2/HER3 targeted therapies across solid tumors: Assessing the impact of digital education on clinician practice patterns.
Authors: Ackbarali Tariqa , Turell Wendy , del Nido Elizabeth L. , Brufsky Adam , Liu Stephen V.
Published: June 2021

11036

Background: Improved understanding of the interactions between HER2 and HER3, the heterogeneity of HER-expressing disease, and mechanisms of resistance to anti-HER2 therapy has led to increasing number of treatment options to address clinical needs. Tumor types of interest, impacted by HER2/HER3 expression and pathophysiology were breast cancer, non-small cell lung cancer (NSCLC), gastric cancer, and colorectal cancer (CRC). Increasing competency in these areas is deemed critical to clinician’s ability to individualize treatment plans and improve patient outcomes. Methods: A 2-hour CME activity was broadcast live-online in September 2020 and remains on-demand through September 2021 at OMedLive.com. The educational initiative was divided into one hour addressing HER2 and HER3, testing guidelines, resistance mechanisms and emerging data elucidating recent and ongoing clinical trials across NSCLC, gastric cancer, and CRC. The second hour focused on individualizing metastatic HER2+ breast cancer, HER2-low breast cancer as an emerging subtype, and management of side effects. Knowledge and competence questions were administered pre-, immediate post-, and 2 mos. post-activity. Behavioral impact questions were also asked at follow-up. Data from these questions were analyzed to determine engagement and clinical impact. Results: To date, 448 clinicians participated in the activity. Across the seven CME test questions, improvements in knowledge and competence were observed in the clinical applications of HER2-directed agents and HER3 antibody drug conjugates (ADCs), first-line standard of care for HER2+ breast cancer, and adverse event management for HER2 ADCs. At 2-mos. follow-up, 67% reported improved behavioral impact on both clinical practice and patient experience and outcomes. Clinicians provided specific write-in examples of these changes, noting improved patient-reported outcomes, improved treatment adherence, improved competence developing treatment plans, and increased understanding of HER2/HER3 pathophysiology. Updated and expanded results will be shared. Conclusions: The activity was successful in improving clinician understanding of the relationship between HER2/HER3, pathophysiology across tumor types, and applications of emerging targeted therapies. Open-ended responses to behavioral impact questions illustrated clear improvements in clinician-reported patient experience and outcomes, clinical practice management, and knowledge of emerging HER2/HER3 therapies and their uses across multiple solid tumors.
Specialty representation on national comprehensive cancer network guideline committees.
Authors: Odei Bismarck , Agabalogun Temitope , Bello-Pardo Erika , Huang Christina C. , Vanderbilt Daniel , Omeh Seyi , Chino Fumiko
Published: June 2021

11041

Background: Among the National Comprehensive Cancer Network (NCCN) guidelines, the existence of Category 1 evidence for cancer management decisions remains low, resulting in the reliance on multispecialty perspective to determine optimal treatment approach. Multiple studies suggest that the specialty composition of oncological teams is important in the trajectory of decision-making. Consequently, we sought to determine if there was adequate representation of radiation oncologists (ROs) on NCCN committees (NCMs). Methods: NCMs with Category 1 or 2A recommendations for radiotherapy use were identified. Committee members were documented including specialty, academic rank, and committee role. H-index and gender was assessed for each member. A minimum arbitrary threshold of < 10% was used to define underrepresentation of ROs. Univariate and multivariate (MVA) logistic regression identified factors predictive of underrepresentation. Results: Of 57 assessed guidelines, 38 (66.7%) NCMs recommended radiation as Category 1 or 2A from which a total of 1284 committee members were identified. Median committee size was 33 (range 29-38). Overall, 42.2% were Medical Oncologists (MOs), 23.9% were Surgical Oncologists (SOs), and 11.5% were ROs [22.4% were a mix of Radiologists, Pathologists, other specialty physicians, and non-physician members like Patient Advocates]. ROs constituted 4.4% of NCM Chairs (MOs: 68.9%, SOs: 13.3%, Other: 13.3%); 29% of Vice Chairs (MOs: 35.5%, SOs: 35.5%); and 5.9% of the discussion writing committee (MOs: 70.6%, SOs: 23.5%). The representation of ROs was highest for Head/ Neck Cancer NCM (38.8%) and Prostate Cancer NCM (25.8%). 42% of the NCMs recommending radiation had < 10% representation of ROs; 17% of guidelines recommending radiation had 1 or less RO including 4 NCMs which did not have a single RO committee member. On univariate analysis, factors predictive of RO underrepresentation were low SO representation (p = 0.038) and low median H-index of the NCM (p = 0.013); low proportion of full professors trended towards significance (p = 0.060). On MVA, median H-index had a negative association with RO underrepresentation (p = 0.038) —no association was found to rank, gender or specialty. Conclusions: Our study shows alarmingly low representation of ROs among NCCN committees which include radiation as a Category 1 or 2A recommendation. This can both limit the discussion during guideline development and negatively impact the diversity of perspectives in management recommendations. Efforts to ensure more proportional representation of ROs on NCCN guideline committees are warranted including exploring potential barriers to committee leadership.
Eribulin and gemcitabine in previously treated patients with advanced liposarcoma or leiomyosarcoma: A multicenter, single-arm, phase 2-trial.
Authors: Kim Chang Gon , Ahn Jin-Hee , Kim Jeong Eun , Kim Jee Hung , Jeon Min Kyung , Rha Sun Young , Kim Hyo Song
Published: June 2021

11516

Background: Eribulin and gemcitabine have shown encouraging efficacy in soft-tissue sarcoma (STS) as a monotherapy. Here, we evaluated the activity and safety of combined use of eribulin and gemcitabine in two most common histologic types of STS, liposarcoma and leiomyosarcoma. Methods: In this non-randomized, multi-center phase 2 study, patients were included if they had progressive disease after one or two prior chemotherapy including doxorubicin. Patient were given eribulin 1.4 mg/m2 and gemcitabine 1,000 mg/m2 on day1 and day 8 every 3 weeks. The primary endpoint was progression-free survival rate at 12 weeks (PFSR12wks) with null and alternative hypothesis of PFSR12wks≤20.0% and ≥40.0%, respectively. Results: Of 37 patients included, 22 had leiomyosarcoma, and 15 had liposarcoma. At 12-weeks after treatment, 16 and (72.7%) 11 (73.3%) patients in leiomyosarcoma and liposarcoma were progression-free. Overall PFSR12wks was 73.0%, satisfying the primary endpoint. Objective response rate, disease control rate, median progression-free survival, and median overall survival were 16.2%, 78.4%, 23.9 weeks, and 88.9 weeks, without any statistical differences according to histologic subtypes. No new safety signals and treatment-related death were observed. Conclusions: Eribulin and gemcitabine showed promising activity and manageable safety profile in patients with STS of liposarcoma and leiomyosarcoma histology. Updated outcomes for ongoing patients will be presented. Clinical trial information: NCT03810976.
Activity of erlotinib in patients (pts) with advanced chordoma: A retrospective study.
Authors: Mir Olivier , Briand Sylvain , Lazure Thierry , Adam Julien , Bahleda Rastilav , Blay Jean-Yves , Cavalcanti Andrea , Chamseddine Ali N. , Dutour Aurélie , Faron Matthieu , Haddag Leila , Henon Clemence , Le Pechoux Cecile , Levy Antonin , Ngo Carine , Verret Benjamin , Honoré Charles , Court Charles , Le Cesne Axel
Published: June 2021

11528

Background: Chordoma is a rare tumor with no approved therapy. Preclinical studies have shown expression of EGFR and activated EGFR family kinases (EGFR, HER2 and HER4). Erlotinib and other anti-EGFR agents (gefitinib and cetuximab) have shown clinical activity in advanced chordoma in single case reports or small series. We aimed to evaluate the activity of erlotinib in a larger, homogeneous series of pts with advanced chordoma. Methods: We retrospectively reviewed the electronic medical records of consecutive adult pts with advanced chordoma progressive over 6 months (+/- 2 weeks, according to RECIST 1.1), treated with erlotinib (150 mg daily) at Gustave Roussy (Villejuif, France) following multidisciplinary tumor board discussion, from January 2010 to January 2021. All cases were confirmed by an expert pathologist. Response was evaluated according to RECIST 1.1, and survival was estimated using the Kaplan-Meier method. Results: Thirty-one pts [median age : 60 years (range : 32-88), median PS : 2 (range : 1-3), 30 males)] were identified. Twenty-seven (87%) had locally advanced disease; the median number of metastatic sites was 1 (range : 1-2) in the remaining 4 pts. Primary tumor site was sacral (25), lumbar (3) or cervical (3). All pts but 6 had undergone prior surgery, and 29 (94%) had undergone radiotherapy of the primary tumor. Eight pts had received previous systemic treatments (imatinib in 4, sorafenib and regorafenib in 2 each). Best tumor response by RECIST 1.1 was PR (4 pts, 13%), SD (14 pts, 45%) or PD (13 pts, 42%). Median PFS was 6.2 months (95%CI : 4.5-9.8), and median OS was 15.9 months (95%CI : 10.6-20.2). Fourteen pts (45%) remained progression-free after 1 year, and three (10%) after two years under erlotinib. Grade 3 diarrhea occurred in 4 pts (13%) and grade 3 skin rash in 13 pts (42%). Twelve pts (39%) required dose reduction to 100 mg daily due to multiple grade 2 toxicities. Ongoing studies are exploring whether candidate biomarkers such as EGFR and HER2 expression or amplification, and their mutational status could help predicting the benefit of erlotinib in pts with advanced chordoma. Conclusions: Erlotinib has clinically meaningful but unpredictable activity in advanced chordoma. Molecular profiling would probably be of high interest in this setting. This series may serve as a benchmark for future clinical trials in chordoma.
Comparison of treatment effect and long-term outcomes for pediatric and adult Ewing sarcoma patients in British Columbia, Canada.
Authors: Hajjaj Omar , Corke Lauren , Strahlendorf Caron , Simmons Christine E.
Published: June 2021

11531

Background: Treatment of Ewing Sarcoma (EWS) is challenging. While it is known to be sensitive to chemotherapy and radiation, the number of lines of therapy available are limited. This disease affects pediatric patients (PP) more often than adults (AP), and reported outcomes are worse for AP onset EWS in the literature. It is unclear if this is due to difference in the biology of disease in AP compared to PP, or if this is due to differences in treatment approach. Furthermore, optimal treatments and real world impact of treatment is unclear in both the PP and AP populations. This study identifies the features of therapy received by AP and PP with EWS in a large, mutli-institutional cohort, and provides real world evidence for the expected outcomes in both AP and PP with EWS. Methods: A cohort study analysis of the Sarcoma Outcomes Unit database at BC Cancer was conducted to identify patients diagnosed with EWS in British Columbia from January 1, 2000 to December 31, 2018. Data on the frequency, amount, and regimen of chemotherapy were collected. Baseline Charlson comorbidity index, age at diagnosis, progression free survival and overall survival were collected. Results: 108 patients with EWS were identified, 66 AP and 42 PP Median age at diagnosis for adults was 37 (19-86) and median age for diagnosis of pediatric patients was 14 (1-18). Real world median PFS and OS for AP were 23 mos and 79 mos, and for the PP were 32 mos and NE. Five year overall survival was 54% in AP and 77% in PP. Overall, there was no difference in the number of lines of therapy received between PP and AP, but the type of therapy was more dose-dense in the PP than in the AP, (85% vs 28% for dose dense chemo). 5 year overall survival was longer for PP who received dose dense regimens compared to non-dose dense regimens (HR 0.87), but was not different in the AP receiving dose dense regimens (HR 0.95), even when controlling for comorbidities. The most common chemotherapy regimen for AP was Vincristine, Adriamycin, cyclophosphamide alternating with Ifosfamide and Etoposide q3weeks, whereas in the pediatric population the most common chemotherapy regimen was the same but alternating q2weeks. Conclusions: The treatment plans for PP with EWS were more often dose dense compared to the AP. Outcomes for PP were vastly better than for APs, despite overall similarities in the number of lines of therapy and types of agents used. Given the lack of difference between dose dense and non-dose dense regimens for APs, this is not the likely cause of difference in survival between PPs and APs. Extrapolating pediatric protocols to the adult setting may not be appropriate given the differences in outcomes. Further work to identify effective therapies and predictive biomarkers in this disease are needed, and my further identify reasons for discrepant outcomes in pediatric and adult populations.
ESMO Magnitude of Clinical Benefit Scale (MCBS): An evaluation of systemic treatment trials for soft tissue sarcomas (STS).
Authors: Salawu Abdulazeez , Lemieux Christopher , Abdul Razak Albiruni Ryan
Published: June 2021

11553

Background: Patients with STS have poor prognosis in the metastatic setting. Although some treatment options are associated with improved outcomes, such as progression-free (PFS) or overall survival (OS), the overall magnitude of clinical benefit can be unclear. The ESMO MCBS is a validated and reproducible tool developed to quantify the clinical benefit of treatments evaluated in trials ( www.esmo.org/guidelines/esmo-mcbs ). Herein, we report the application of ESMO MCBS to systemic treatment trials involving metastatic STS patients. Methods: A systematic search of Medline, Embase and Cochrane databases for adult phase II and III trials in advanced STS (01/1998 to 12/2020) was carried out. Gastrointestinal stromal tumor trials were excluded. Outcomes, including but not limited to OS, PFS, objective response rate (ORR), toxicity and quality of life (QoL) data were extracted and analyzed. Studies with outcomes that met the criteria for ESMO MCBS v1.1 were evaluated to generate a score of 1 to 5 (score of ≥ 4: substantial benefit). MCBS scoring of each study was performed by at least 2 co-authors for consensus. Results: Among 3454 abstracts screened, a total of 140 Phase II and 28 phase IIII trials were identified. A total of 41 studies fulfilled the criteria for ESMO MCBS scoring. These include 5 phase III studies, as well as 9 randomized and 27 single-arm phase II trials. Fifteen studies involved specific histology, while remaining 26 studies were of all STS subtypes. Chemotherapy, alone or in combination was evaluated in 29 trials, while molecular-targeted agents (MTA) and immune checkpoint inhibitors (IO) were evaluated in 11 and 3 studies, respectively (Table). The median MCBS score was 2 (range 1-4), regardless of drug class or combination. Only 3 studies, all randomized in design, had a MCBS score of 4. All three trials were in the 2nd line setting or beyond, where there is no standard control treatment. None of the trials, irrespective of drug class had a score of 5 and no study showed evidence of significant improvement in QoL. The observed MCBS scores were low, partly because the trials evaluated mainly comprise single-arm studies without QoL assessments, restricting to a maximum MCBS score of 3. Conclusions: Most systemic therapy trials in advanced STS did not confer substantial clinical benefit when evaluated using MCBS. Although randomized phase 3 trials remain the gold standard of treatment evaluation, clinical benefit evaluation of STS trials using tools such as MCBS may be useful. Incorporation of QoL evaluation, even in single-arm studies should be prioritized in metastatic STS trials.[Table: see text]
The efficacy and safety of anlotinib in refractory/recurrent/advanced pediatric solid tumors: A retrospective study.
Authors: Lu Suying , Hong Ye , Chen Huimou , Wu Liuhong , Zhu Jia , Wang Juan , Sun Feifei , Zhen Zijun , Que Yi , Zhang Lian , Sun Xiaofei , Huang Junting , Zhang Yizhuo
Published: June 2021

11556

Background: Refractory and recurrent advanced pediatric solid tumors are short of effective treatment and with a dismal outcome, thus an urgent need for novel and effective treatment. The aim of the study is to evaluate the efficacy and safety of anlotinib, a novel and oral multi-target receptor tyrosine kinase inhibitor, in refractory or recurrent advanced pediatric solid tumors. Methods: The retrospective, single-institutional, observed study was conducted in Sun Yat-sen University cancer center in China. Refractory, recurrent, or advanced pediatric solid tumors patients treated with anlotinib between 2018 to 2020 were evaluated. Results: Forty-one patients and thirty patients were enrolled in the study to evaluated efficacy and safety, respectively. The objective response ratio (ORR) was 12.2% (95%CI 1.7-22.7): complete response (n = 0) and partial response (n = 5) (Table). The disease control rate (DCR) was 65.9% (95%CI 50.7-81). The median progression-free survival (PFS) was 2.87 months (95%CI 0.86-4.88). According to anlotinib treatment schedule, all patients were divided into three groups: anlotinib monotherapy (A, n = 16), anlotinib combined with immune checkpoint inhibitor treatment (A + ICI, n = 6), anlotinib combined with salvage chemotherapy (A + SC, n = 19). The ORR, DCR and median PFS for three groups were 6.3% (95%CI 7.1-19.6), 56.3% (95%CI 28.9-83.6), 2.43months, 16.7% (95%CI 26.2-59.5), 66.7% (95%CI 12.5-120.9), 1.13months, 15.8% (95%CI 2.3-33.8), 73.7% (95%CI 51.9-95.5), 2.87months, respectively. There was no significantly difference between three groups in aforementioned response index. The incidence rates of any grade and grade 3-4 adverse events were 80% and 20%, respectively. Bleeding (20%), hand-foot syndrome (13.3%), and diarrhea (13.3%) were the most common adverse events. Grade 3-4 adverse events include hypertension, hand-foot syndrome, diarrhea, anemia, and thrombocytopenia. There was no adverse events-related death. Conclusions: For heavily pretreated pediatric solid tumors, anlotinib may be an effective treatment with tolerable adverse events. Further prospective randomized controlled clinical study is warranted.[Table: see text]
Evaluation of homologous recombination deficiency (HRD) score and immuno-tumor microenvironment (iTME) as biomarkers of soft tissue sarcoma (STS) survival and response to immune checkpoint inhibitor therapy.
Authors: Zhang Chenlu , Guo Xi , Xu Fei , You Yang , Wang Zhiming , Zhuang Rongyuan , Liu Wenshuai , Ma Li-Jie , Tong Hanxing , Zhang Yong , Lu Weiqi , Liu Jun , Zhou Yuhong
Published: June 2021

11568

Background: Soft tissue sarcoma (STS) are highly heterogenous in both histology and underlying genetic alterations, resulting in heterogenous outcomes of standard therapy. With recent stride of immunotherapies in oncology it is crucial to find the optimal match of the new therapies to disease subtypes. HRDScore and iTME parameters are two top candidate biomarkers to predict clinical outcomes in complex diseases such as STS. Methods: We prospectively profiled 102 Chinese STS patients who had received more than 1 line of prior treatment, mainly chemo-drugs. We then classified the patients according to their HRDScore (calculated from WES data using the Richardson method, ref. Telli M.L. et al. Clin. Cancer Res. 2016) and iTME parameters (calculated from RNAseq data using CIBERSORT method). Lastly, we tested the correlation of HRDScore or iTME with patient survival and clinic outcomes of anti-PD-1/L1 based combination therapy. Results: The histological subtypes of the patients included 32 LMS, 44 LPS, and 26 others (such as UPS, clear cell, myxofibrosarcoma, uterus LMS etc.). The top mutation genes (frequency > 5%) included TP53 29%, KMT2C 16%, NOTCH2 9%, ATRX 8%, NF1 8%, RB1 8% and PTEN 6%. The patients could be classified to HRD-high or HRD-low (HRDScore > or < = 42). Alternatively, unsupervised clustering of iTME revealed three patient subgroups (named iTME-I, -II, and -III). While all the three groups are characterized by a generally suppressed immune environment, iTME-I have high proportion of M0 macrophages and median M2 macrophages; iTME-II have high proportion of M2 macrophages but low M0 cells; and iTME-type III are low in both M0 and M2 cells. No significant M1 cells present in all the three iTME groups. Patient survivals were correlated with the iTME types but not HRDScore in Kaplan-Meyer analysis. The trend of survival time was iTME-III > iTME-II > iTME-I, with an HR = 0.156 for iTME-III over iTME-I (p = 0.008, log-rank test). Treatment response of anti-PD-1/L1 based combination therapies also showed a positive correlation to iTME-III, but not HRDScore although the small sample size prevented a definitive conclusion. Clinical evaluation of the 22 patients who received anti-PD-1/L1 therapy showed 1 PD (20%) and 4 SD/PR (80%) in iTME-III, 4 PD (40%) and 6 SD/PR (60%) in iTME-II, and 1 PD (33%) and 2 SD (67%) in iTME-I. Conclusions: iTME is a better biomarker than HRDScore in STS for survival and treatment outcomes. Differential Infiltration of M0 and M2 macrophages can distinguish patients with different survival and response to anti-PD-1/L1 combination therapy. The iTME subtypes may be used for treatment screen of combination immunotherapy but larger and randomized clinical studies are required to validate the discovery.
Intensity of end-of-life care for gynecologic cancer patients by primary oncologist specialty.
Authors: Hicks-Courant Katherine , Kanter Genevieve P. , Schapira Marilyn M. , Brensinger Colleen , Liu Qing , Ko Emily Meichun
Published: June 2021

12032

Background: The impact of primary oncologist specialty, medical oncology (MO) versus gynecologic oncology (GO), on intensity of care at the end of life (EOL) in elderly patients with gynecologic cancer is unclear. Methods: This retrospective cohort study used Surveillance, Epidemiology and End Results (SEER) Medicare data. Subjects were fee-for-service Medicare enrollees over 65 years old, who had seen a GO or MO in an outpatient setting in the last year of life and died of a gynecologic cancer between 2006 and 2015. The primary oncologist was defined as the provider with the majority of outpatient visits in the last year of life. The primary outcome was intensity of care at the EOL, a composite score defined by receipt of chemotherapy in the last 14 days of life, death in the hospital, enrollment in hospice for less than three days, more than one ED visit, more than one hospital admission, spending more than 14 days in the hospital, or any ICU admission in the last 30 days of life. Simple and multivariable linear regression analyses were conducted to evaluate for differences in EOL care outcomes by primary oncologist specialty. Linear regressions were repeated after creating a more similar control group through nearest-neighbor propensity score matching, with and without replacement. Results: Of 12,189 subjects, 63% were primarily treated by a MO and only 27% by a GO for EOL care. Most died of ovarian cancer (55.1%), followed by uterine (31.4%), cervical (6.9%), and other cancers (6.7%). Compared to GO patients, MO patients were younger, more likely to be white, married, not dual-eligible, higher stage, and to die of ovarian cancer. Overall, 55.4% (95% CI 54.73-56.49) received intense care at the EOL. Although both specialties engaged in high levels of intense EOL care, the adjusted rates for GO (54.03%; 95% CI 52.28-55.77) were significantly less compared to MO (56.53%; 95% CI 55.36-57.69; p=0.023) in unadjusted and adjusted analyses of the entire and propensity-matched cohorts (Table). Conclusions: Approximately 2/3 of women with gynecologic cancer will receive EOL care from a MO, compared to 1/3 from a GO. Both specialists engage in high levels of intense EOL care in over half of their patients, although GO less so. Future work should focus on identifying approaches to reduce high-intensity EOL care, which may include additional training or incorporation of palliative medicine into cancer care.[Table: see text]
Code status and outcomes in patients with cancer and COVID-19: A COVID-19 and cancer consortium (CCC19) registry analysis.
Authors: Loggers Elizabeth Trice , Wulff-Burchfield Elizabeth Marie , Subbiah Ishwaria Mohan , Khaki Ali Raza , Egan Pamela , Farmakiotis Dimitrios , Phull Hardeep , Nakasone Elizabeth , Labaki Chris , Yu Peter Paul , Joshi Monika , Griffiths Elizabeth A. , Wise-Draper Trisha Michel , Jani Chinmay , Thakkar Astha , Puc Matthew , Hwang Clara , Mavromatis Blanche H. , Shah Dimpy P , Warner Jeremy Lyle
Published: June 2021

12035

Background: In-hospital mortality among patients with cancer (pts) and COVID-19 infection is high. The frequency of, and factors associated with, do-not-resuscitate (DNR) or do-not-intubate (DNI) orders at hospital admission (HA), and their correlation with care, has not been well studied. In November 2020, we began collecting this information for pts who were hospitalized at initial presentation in the CCC19 registry (NCT04354701). Methods: We investigated: 1. the frequency of, and factors associated with, DNR/DNI orders at HA; 2. change in code status during HA; and 3. the correlation between DNR/DNI orders and palliative care consultation (PC), mortality or length of stay (LOS). We included hospitalized, adult pts with cancer and COVID-19 from 57 participating sites. Reported characteristics include age, ECOG performance status (PS), and cancer status. Comparative statistics include 2-sided Wilcoxon rank sum and Fisher’s exact tests. Results: 744 pts had known baseline and/or changed code status (CS); most (79%) maintained their baseline CS (Table). Those with DNR±DNI orders at HA were older (median age 79 vs 69 yrs, p<0.001) and more likely to have: ECOG PS 2+ vs 0-1 (45% vs 22%, OR 3.95, p<0.001), metastatic disease (45% vs 35%, OR 1.72, p=0.005) and progressing cancer (32% vs 16%, OR 2.69, p<0.001), but equally likely to have received systemic anticancer therapy in the prior 3 months (38% vs 45%, p=0.15). N=192 pts with a change in CS from full to DNR±DNI were younger (median age 73), had better PS (37% ECOG PS 2+), and were less likely to have progressing cancer (23%) than those with DNR±DNI orders at baseline. However, their LOS was significantly longer, median 9 vs 6 days, p<0.001. Compared to those with DNR±DNI orders at HA, pts whose CS changed to DNR±DNI were more likely to die, OR 2.94, 95% CI 1.76-4.97, p<0.001. PC was obtained in 106 (14%) pts and associated with transition to DNR±DNI in 47 (44%), affirmation of admission CS in 58 (55%), and reversal in 1 (1%). Median LOS for pts receiving PC was 11 vs 6 days, p<0.001. Conclusions: In our sample, the majority of patients with cancer and COVID-19 were full code at hospital admission. DNR±DNI status, whether at baseline or assigned during the hospital course, was associated with worse prognosis. Longer length of stay for patients changing code status and/or receiving palliative care consultation was observed likely suggesting earlier palliative care consultation is an important, but likely underutilized component in the care of patients with cancer and COVID-19.[Table: see text]
High intensity interval training safety and efficacy in patients with advanced NSCLC receiving systemic treatment: Results of a prospective trial.
Authors: Nait Ajjou Myriam , Bastarache Guillaume , Walsh Emily , Routy Bertrand , Blais Normand , Tehfe Mustapha , Coulombe Genevieve , Alameddine Raafat , Florescu Marie
Published: June 2021

12054

Background: Patients with advanced NSCLC experience fatigue and physical deconditioning altering their quality of life. Safety and feasibility of high intensity exercise in advanced NSCLC has not been explored yet. Methods: We report the results of a single-center, prospective two-arm study. Patients with advanced NSCLC actively receiving systemic therapy or having completed treatment less than 2 months prior to enrollment were included. Patients were allocated to either an intervention arm consisting of kinesiologist supervised high intensity interval training (HIIT) at 2 sessions per week for a total of 12 weeks; or a control arm of home exercise guided by an informative pamphlet. All patients were evaluated at baseline, 6 and 12 weeks by a kinesiologist. Quality of life (QoL) exercise surveys and measurement of strength were measured. Results: Sixty patients were enrolled between January 2018 and March 2020. The study was interrupted due to COVID-19. Thirty-two patients were included in the exercise program and 28 patients in the control group. Both groups were balanced in respect to baseline characteristics. A total of 32 (53%) patients went off protocol, 13 (18%) patients stopped due to symptomatic disease progression which included 2 (3%) deaths, 2 (3%) stopped due to COVID-19 preoccupations and the remaining patients withdrew for other reasons. 42 (70%) patients were evaluated at 6-weeks and 28 (47%) completed the 12-week follow-up, with equal distribution in each group. There were no significant difference at 12 weeks in the physical assessment nor the overall QoL scores between both groups: FACT-L on 135 points (+4.1 vs +1.7, p = 0.342) and FACIT on 52 points (+3 vs -0.2, p = 0.832). Patients in the exercise group demonstrated a significant improvement at 12 weeks in the Lung Cancer Symptoms domain on 28 points (22.3 vs 19.8, p = 0.015) as well as the Physical Wellbeing domain on 28 points (23.6 vs 20.6, p = 0.056) compared to the control group, respectively. No significant exercise related complications were reported. After the study, 9 of the 14 patients (64%) who completed the HIIT program continued to exercise virtually with a kinesiologist in contrast to none in the control group. Conclusions: This study demonstrated the safety and potential benefit of a HIIT program on lung-specific and physical wellbeing in patients with advanced NSCLC on active treatment. This study provides further support on the role of supervised physical exercise in patients living with cancer. Clinical trial information: 16.229.
Weight management following endometrial cancer treatment: A pilot trial to evaluate the efficacy of the profile by Sanford program.
Authors: Bell Maria , Reed Valerie , Wernisch Jan , Papini Natalie , Herrmann Steve
Published: June 2021

12056

Background: Excess weight and weight gain are risk factors for endometrial cancer and cancer recurrence following treatment for women with endometrial cancer. Conversely, weight loss among women with obesity has been shown to reduce endometrial cancer risk. Intensive behavioral weight management programs may be an effective method to improve health and reduce weight following treatment. Methods: Twenty-two women following endometrial cancer treatment (age = 59.4 ± 11.5; weight = 241.3 ± 46.3; BMI = 40.5 ± 7.8; time since last treatment 19 ± 17.4 months) were enrolled in a behavioral weight management program and followed for 12 months and 28 matched controls (age = 58.4 ± 11.5; weight = 246.9 ± 60.3; BMI = 41.6 ± 8.6) were assessed over 12 months. The program consists of weekly health coaching meetings to discuss nutrition, activity, and behavior change topics. The nutrition plan targets ≥4 cups of vegetables per day, a ‘lean and green’ grocery meal, complimented with meal replacement foods to provide a nutritionally complete meal plan. Cost of participant membership, coaching, and meal replacements were covered for 6 months and available to purchase for months 7-12. Results: The treatment group completed 28.3 ± 14.1 appointments throughout 12 months resulting in an average weight change of -31.2 ± 17.3 pounds (-13.3 ± 7.4%) at 6 months and -36.1 ± 27.6 pounds (-15.3 ± 11.4%) at 12 months (all p<0.001). Controls had a weight change of -3.9 ± 18.4 pounds (-2.3 ± 7.6%) at 12 months which was significantly different than the treatment group (p<0.001). BMI was significantly reduced in the treatment group at 6 months (-4.8 ± 4.5, p<0.001) and 12 months (-5.2 ± 5.9, p<0.001) and significantly different than in the control group at 12 months (-0.9 ± 3.2, p=0.007). Conclusions: This behavioral weight management program with health coaching and structured nutrition provided clinically significant weight loss that was sustained to 12 months. Future research should examine long-term enrollment in the Profile by Sanford program with reduction in endometrial cancer recurrence.[Table: see text]
Late cardiac events and their impact on overall survival in patients receiving an allogeneic stem cell transplant.
Authors: Auberle Christine , Lenihan Daniel John , Gao Feng , Cashen Amanda F.
Published: June 2021

12070

Background: There is limited data on the impact of cardiac disease on long term outcomes of allogeneic stem cell transplant (alloSCT). We sought to describe the importance of adverse cardiac events on long term outcomes of alloSCT. Methods: We performed a retrospective analysis of pts who underwent alloSCT from 2007 to 2017 and survived at least one year after transplantation. Late cardiac events were defined as occurring at least one year after transplant. Data was obtained through electronic medical records and the transplant database at Siteman Cancer Center. Univariate Cox proportional hazards model was used to assess the effect of baseline characteristics on cardiac events and overall survival. Time-dependent Cox model was used to determine the effect of cardiac events on overall survival. Gray’s sub-distribution methods, while accounting for death as a competing risk, were used to calculate the incidence of cardiac events. Results: 804 pts met our criteria (58.7% male, average age 49.7 years). Median duration of follow up was 59.3 months. Most pts were transplanted for acute myeloid leukemia (49.9%) and had a match-related or unrelated donor (56.1%). The majority received myeloablative conditioning (74.4%), and 34.6% received total body irradiation (TBI). The most common late cardiac events were an elevated troponin (20.9%), elevated brain natriuretic peptide (BNP) or N-terminal pro-BNP (16.9%), shock (15.3%), and reduced left ventricular ejection fraction (LVEF) defined as < 45% (10.4%). Pts were at significantly increased hazard of developing late cardiac events if they were of male sex (HR 1.29, P = 0.026), had pre-existing diabetes (HR 1.45, P = 0.022), pre-existing atrial fibrillation or flutter (HR 1.77, P = 0.008), history of congestive heart failure (HR 1.82, P = 0.032) or increasing age at time of transplant (HR 1.02, P < 0.001). Primary disease for alloSCT, donor type, TBI and myeloablative conditioning regimen had no significant association with late cardiac events. The cumulative incidence of developing any cardiac event in the period 1-5 years after transplant was 28.2% with a cumulative incidence of shock at 13.6%, reduced ejection fraction at 8.7% and an atrial arrythmia at 7.1%. Most cardiac events were associated with an increased risk of death (Table). Conclusions: Cardiac events after alloSCT have a substantial impact on overall survival. Efforts to optimally manage cardiac disease after alloSCT are likely to have a major benefit, and cardiac protection should be a major focus for post-alloSCT follow up.[Table: see text]
Anthracycline exposure and breast cancer risk in female Hodgkin lymphoma survivors.
Authors: Neppelenbroek Suzanne I.M. , Geurts Yvonne M. , Aleman Berthe M.P. , Janus Cecile P.M. , Rademakers Saskia E , de Weijer Roel J. , Van Der Maazen Richard W.M. , Zijlstra Josée M. , Beijert Max , Verschueren Karijn M.S. , Ta Bastiaan , Nijziel Marten R. , Posthuma Eduardus F.M. , Kersten Marie José , Muller Karin , te Boome Liane , Bilgin Yavuz , de Jongh Eva , Schaapveld Michael , Van Leeuwen Flora
Published: June 2021

12074

Background: Female Hodgkin lymphoma (HL) survivors treated with chest radiotherapy (RT) at a young age have a strongly increased risk of breast cancer (BC). Recently concern has been raised that anthracyclines may also increase BC risk, based on studies in childhood cancer survivors with/without a history of chest RT. So far, the association between anthracyclines and BC risk has not been examined in cancer survivors treated at adolescent/adult ages. Now that RT dose and volumes are decreasing, the potential contribution of anthracyclines to BC risk is an important issue. Methods: We assessed BC risk in a cohort of 2314 female 5-year HL survivors, treated at ages 15-50 years and diagnosed between 1965 and 2008 in 20 Dutch hospitals. Treatment factors were time-dependently included in the analysis, focusing on the effect of anthracycline exposure on BC risk. Results: After a median follow-up of 18.8 years, 258 women developed invasive BC or ductal carcinoma in situ as a subsequent malignancy. The 30-year cumulative incidence was 15.0% (95% Confidence Interval (CI) 12.8-17.4%). Mantle field RT (or other RT involving both axillae) was associated with increased risk of BC (Hazard ratio (HR) 1.9; 95% CI 1.2-2.8) compared to no supradiaphragmatic RT or RT to the neck only (Table 1). Gonadotoxic treatment (>4.2 g/m2 procarbazine or pelvic RT) significantly decreased this risk. In a multivariable analysis, anthracycline exposure was associated with increased BC risk (HR 1.8; 95% CI 1.3-2.5) in patients who received a cumulative dose of >200 mg/m2. Among patients exposed to gonadotoxic treatment, the HR of BC associated with >200mg/m2 anthracyclines was 3.8 (95% CI 2.0-7.2), with a trend for higher risk with higher anthracycline dose (HR 1.58 per 100mg/m2 anthracycline, p<0.001). Conclusions: Our results suggest an association of anthracyclines with BC risk in HL survivors. Also when accounting for the protective effect of gonadotoxic treatment on RT-associated BC risk, anthracyclines significantly contributed to a higher BC risk.[Table: see text]
Dermatologic diagnoses in oncology patients of color on anticancer therapy: Five-year retrospective review of outpatient dermatology consultations.
Authors: Wilson Britney N. , Sun Mary , Lacouture Mario E. , Noor Sarah
Published: June 2021

12084

Background: Dermatologic toxicities from cancer treatments affecting patients from racial and ethnic minority backgrounds or skin of color (SOC) patients is an understudied area of research. These patients are also significantly underrepresented in therapeutic clinical trials, limiting complete understanding of toxicities associated with cancer therapies. Current treatment algorithms for dermatological adverse events (dAE) also do not take into account possible biologic differences in different skin types affecting toxicity presentation and treatment response. In this study we summarize the demographic, clinical, and treatment characteristics of oncology patients from racial and ethnic minority backgrounds who developed dermatologic adverse events related to cancer therapies. Methods: We performed a retrospective review of all SOC patients (Asian, Black, Hispanic) on active cancer therapy who received outpatient dermatology consultation at Memorial Sloan Kettering Cancer Center from January 1, 2014 to December 31, 2019. Electronic health record information for 2917 patients was obtained. A computational keyword-based text analysis of medical chart text, developed in consultation with a board-certified dermatologist, was performed to determine dermatologic diagnoses categories for each patient. All analyses were conducted using R statistical programming software, version 4.2.06. Results: There were 2917 outpatient dermatology consultations. Our population consisted of 1992 (68.29%) females and 925 (31.71%) males with a mean age of 53 (range 0-97). There were 35.55% Black, 41.28% Asian, 1.02% (30) Native American or Alaskan Native, 0.17% (5) Native Hawaiian or Other Pacific Islander. 729 were Hispanic ethnicity of which 641 were Caucasian. A total of 4,026 dermatologic diagnoses occurred in the study population. Bacterial infections were the most commonly observed, occurring in 15% of patients. Nail disorders were the second most common dAE, occurring in 14% of the study population, followed by eczema/eczematous reactions at 9%. In all racial groups, eczema/eczematous reactions, nail disorders, and dermatomyositis were in the top five most common observed dAEs. Asian patients made up the largest proportion of those who had morbilliform rash dAEs (55%) while Black patients made up the largest proportion of those with hyperpigmentation dAEs (54%) and vascular insufficiency dAEs (47%). Conclusions: The findings from our study indicate that pigmentary changes, bacterial infections, eczema/eczematous reactions, and nail disorders are the most common dAE types that occurred in our group of SOC patients. We hope to use this information to aid in the development of specific management strategies within the field of supportive oncodermatology to meet the needs of minority patient populations.
Province-wide analysis of patient reported outcomes for stage IV non-small cell lung cancer.
Authors: Tjong Michael Chandra , Doherty Mark , Tan Hendrick , Chan Wing , Zhao Haoyu , Hallet Julie , Darling Gail Elizabeth , Kidane Biniam , Wright Frances Catriona , Mahar Alyson , Davis Laura E , Delibasic Victoria , Parmar Ambika , Mittmann Nicole , Coburn Natalie G. , Louie Alexander V
Published: June 2021

12092

Background: Stage IV NSCLC patients have significant disease and treatment-related morbidity. In Ontario, Canada, cancer patients complete Edmonton Symptom Assessment System (ESAS) questionnaires, a tool that elicits patients’ self-reported severity of common cancer-associated symptoms at clinical encounters. ESAS domains are: anxiety, depression, drowsiness, appetite, nausea, pain, shortness of breath, tiredness and well-being. The purpose of this study is to examine moderate-to-severe symptom burden in the 12 months following a diagnosis of stage IV NSCLC. Methods: Using administrative databases and unique encoded identifiers, stage IV NSCLC diagnosed between January 2007 and September 2018 were evaluated for symptom screening with ESAS in the 12 months following diagnosis. Proportion of patients reporting moderate-to-severe score (i.e. ESAS ≥4) in each domain within 12 months were calculated. Patients reporting moderate-to-severe within the different ESAS domains of were plotted over time. Multivariable (MV) Poisson regression models with potential covariates such as age, sex, Elixhauser comorbidity index, income quintiles, and lung cancer treatments received were constructed to identify factors associated with moderate-to-severe symptoms. Results: Of 22,799 stage IV NSCLC patients, 13,289 (58.3%) had completed ESAS (84,373 unique assessments) in the year following diagnosis. Patients with older age, high comorbidity, and not receiving active cancer therapy were less likely to complete ESAS. Most (94.4%) reported at least 1 moderate-to-severe score. Most prevalent moderate-to-severe ESAS symptoms within 12 months after diagnosis were tiredness (84.1%), lack of wellbeing (80.7%), low appetite (71.7%), and shortness of breath (67.8%); nausea was the least prevalent (34.6%). Most symptoms peaked at diagnosis and persisted in the year after diagnosis. On adjusted MV analyses, patients with high comorbidity, low income, and urban residency were associated with increased moderate-to-severe symptoms. Moderate-to-severe scores in all ESAS symptoms were associated with delivery of radiotherapy within 2 weeks prior, while moderate-to-severe nausea, drowsiness, tiredness, low appetite, and lack of wellbeing were associated with delivery of systemic therapy within preceding 2 weeks. Conclusions: In this population-based analysis of stage IV NSCLC PROs in the year following diagnosis, moderate-to-severe symptoms were highly prevalent and persistently high, underscoring the need to address supportive requirements in this at-risk population.