bluuebunny/crossref_metadata_2025 huggingface dataset:
Precision oncology and AI: The ACMA system for personalized treatment matching using real-world data.
Authors: Chen Hui , Xu Zanmei , Zhang Peng , Pang Fei , Chen Lijuan , Yuan Shaohua , Wang Kai
Published: June 2024

e23134

Background: Precision oncology promises tailored cancer treatments, yet current methods often overlook individual patient variability. The AI-powered Case Matching Assistant (ACMA) system addresses this by utilizing real-world data (RWD) from over 100,000 clinical cases to personalize treatment strategies, considering genetic profiles, cancer types, treatment stages, and drug interactions. Methods: ACMA enhances the Large Language Model (LLM) with oncology-specific pretraining that encompasses both molecular and clinical data, ensuring a holistic understanding of patient profiles. It employs cosine similarity for multi-faceted case comparisons, integrating genetic, biomarker, and vital clinical information. Context-aware learning prompts fine-tune the LLM, generating recommendations that reflect the full spectrum of patient-specific data, from genetic variations to clinical histories and treatment responses, facilitating truly personalized treatment pathways. Results: Preliminary results show ACMA's tailored recommendations improve patient outcomes, with increased median survival rates and cost-effective treatment options. The system's 90% relevance match for clinical trial enrollment also expands access to novel therapies. In the absence of a standard treatment protocol for BRCA germline mutations in advanced lung cancer, ACMA provides crucial insights. For instance, a 36-year-old female with BRCA1 c.527del mutation achieved complete remission with a PFS of 38 months after a combination therapy trial. A 56-year-old male with a BRCA2 S1722Yfs*mutation saw partial remission and over 6 months PFS with olaparib. Another male patient, a smoker with concurrent BRCA2 G1712X and TP53 mutations, experienced partial remission following apatinib therapy. ACMA analyzed treatment data from similar genetic profiles and identified a targeted therapy that had shown efficacy in comparable cases. The oncologist used this information as a reference to adjust the treatment plan, resulting in a positive clinical outcome for the patient. This example underscores the potential of ACMA to provide actionable insights for personalized cancer care. Conclusions: Surpassing traditional single-feature matching, ACMA rapidly aligns multi-dimensional characteristics such as cancer type, disease stage, molecular data, and treatment phases. It customizes the interplay of these features with medical logic, delivering tailored outputs through the LLM. This approach offers an economical, convenient, and timely solution, setting a new benchmark in personalized oncology and establishing ACMA as a leader in the field. This distinctive advantage not only enhances patient outcomes but also establishes a formidable barrier to entry for competitors, solidifying ACMA's position at the forefront of oncology practice.
EHR documentation of cost discussions and financial interventions for a cohort of patients with advanced cancer: Findings from a retrospective chart review-based study.
Authors: Burkenroad Aaron , Anand Sidharth , D'Ambruoso Sarah F. , Glaspy John A. , Walling Anne M.
Published: June 2024

e23150

Background: Financial Toxicity (FT), the adverse impact of high medical costs on quality of life, notably affects many oncology patients. In a prior initiative to improve quality of life for advanced cancer patients, a palliative care-trained nurse practitioner (PCNP) was embedded in an academic oncology practice. Patients completed the Edmonton Symptom Assessment System (ESAS) and Canadian Problem Checklist (CPC) to gauge physical symptoms, psychosocial issues, and financial concerns. However, the incidence of self-reported financial issues and electronic health record (EHR) documentation of cost discussions and interventions remain unclear for this patient group. Methods: The study included adult oncology patients with advanced cancer seen by the PCNP from January 1, 2020, to January 1, 2022. We assessed incidence of self-reported financial concerns via CPC checklists in this cohort. Ten charts underwent detailed manual review for evidence of cost discussions or referral to finance-related interventions for up to 1 year from the initial consult with the PCNP or until death. During the review, we identified keywords in documentation of cost discussions and finance-related interventions to create a keyword library. We iteratively compared the library to our reference standard manual chart review to ensure 100% sensitivity. We then employed this keyword library to evaluate the remaining charts. Descriptive statistics were employed to assess correlations between self-reported financial concerns, chart documentation of cost discussions or financial interventions, and patient demographics. Results: Out of 109 eligible patients, 71% (77) completed pre-visit questionnaires, with 30% (23) reporting financial issues. Of this group, 43% (10) died during the study period. Average follow-up was 5.0 months among the decedents. Among those reporting financial concerns, 65% (15) had documented cost discussions or financial assistance referrals in the EHR, involving physicians, social workers, and other clinic staff. Most interventions addressed medication costs and referrals to financial assistance as indicated. Patient demographics (age, sex, insurance type) showed no apparent association with chart documentation of cost discussions or financial assistance. Conclusions: We used retrospective chart review to evaluate the extent of documentation of cost discussions and finance-related intervention in a cohort of patients with advanced cancer. In our patient cohort, 30% self-reported financial concerns, a proportion consistent with previously reported incidence of FT among oncology patients. Notably, 35% of the patients with known financial concerns had no other relevant documentation in the EHR. More work is needed to establish best practices for systematic screening for FT and interventions to support patients.
Racial disparities in incidence and survival in renal cell carcinoma in adolescents and young adults (AYA).
Authors: Wasifuddin Mustafa , Uche Ifeanyi , Becerra Henry A. , Oluwadeyi Esther Yemisi , Lin Htet , Ilerhunmwuwa Nosakhare Paul
Published: June 2024

e23153

Background: Renal cell carcinoma (RCC) has doubled in incidence over the past 50 years. Most cases are incidentally discovered. AYA cancer is defined as cancer in individuals 15 to 39 years. There is paucity of data in the literature on racial disparities in the incidence and survival outcomes of RCC in AYA. We aim to determine the influence of race on incidence and survival outcomes in AYA. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) 17 program were utilized to obtain annual percentage change (APC) of RCC from 2000-2020 for patients aged 15-39 years. Patient characteristics were expressed in proportions. Relative survival rate (RSR) was used to determine survival outcomes. The 5-year RSR was defined as the percentage of patients alive 5 years after the diagnosis of cancer. SEER*Stat software was used to determine the RSR. Results: We identified 8751 patients with RCC. A higher proportion of cases were males (57.9%) vs females (52.1%). Patients were predominantly non-hispanic whites (NHW, 54.7%), hispanics (24.9%), non-hispanic blacks (NHB, 11.4%), non-hispanic asian or pacific islander (NHAPI, 0.06%) & non-hispanic american indian/alaska native (NHAIAN, 0.01%). There was significant increase in RCC incidence (APC: 4.0%, CI: 3.0, 4.9). Incidence was higher in males (APC: 4.0, CI: 3.1, 5.0) vs females (APC: 3.9, CI: 2.8, 5.0). Incidence was highest in Hispanics (APC: 5.6%, CI: 4.4, 6.8), followed by NHW (APC: 4.1 % CI: 3.1, 5.2, -2.3), NHAPI (APC: 3.3%, CI: 1.2, 5.5) and NHB (APC: 1.5%, CI: 1.1, 2.0). The 5-year RSR was 79.7% (CI: 77.7, 81.6). Survival was greatest in females (RSR: 82.8, CI: 79.8, 85.4) vs males (RSR: 77.3%, CI: 74.4, 79.9). NHB had the lowest survival (RSR: 65.9%, CI: 60.2, 71.0) compared to NHW (RSR: 83.9%, CI: 81.3-86.2). Conclusions: In AYA, RCC incidence has increased; consistent with global trends. Significant racial disparity in incidence and survival exists. Survival in NHB remained poorer than other racial groups despite minimal increase in incidence. More studies are needed to explore the reasons for these racial differences to improve the outcomes among AYA patients. [Table: see text]
Evolution of quality of life (QoL) and symptom burden (SB) in patients receiving inpatient palliative care (PC) following one week of care in a specialized palliative care unit (PCU): A comparison of two groups, with one receiving specialized outpatient palliative care prior to admission.
Authors: Salm Hanna , Doberschütz Florian , Hallmann Franziska , Munzert Philipp , Rahm Johannes , Uhlig Sarah , Pink Daniel
Published: June 2024

e23160

Background: This study sought to investigate changes in QoL and SB among PC Pt undergoing one week of inpatient care in a specialized PCU. The Pt population was stratified into two groups (Gp), with one Gp pretreated from pre-admission PC provided by an outpatient multidisciplinary PC team, while the other Gp did not receive such support prior to admission. Although the average duration of treatment at a PCU in Germany is 1-2 weeks, the question also arises as to whether a significant improvement in SB/QoL can be expected after just one week of PC in a PCU. Methods: PC Pt with various cancer entities were prospectively included in a non-randomized study. Pt in Gp 1 received outpatient specialized PC prior to admission, while Pt in Gp 2 did not. Over an 8-month period, we gathered data from one academic cancer center, utilizing the EORTC QLQ-C30, one of the most widely used Pt reported outcome (PRO) instruments to assess health-related QoL in cancer Pt. Pt completed the QLQ-C30 at T0 (admission) and T1 (day 7), enabling the assessment of potential changes in their QoL and SB over time. Results: A total of 103 pt (51.5% male) were enrolled (Gr 1: 42%, Gr 2: 58%). At T0, there were no significant differences regarding QLQ-C30 scores between Gp 1 and 2. Over the course of one week several significant and clinically relevant changes in QoL and SB were found: Emotional functioning demonstrated an uplift in both Gp (Gp 1: mean (M) 41.5 IQR 33 vs. 53.1 IQR 50, p 0.014, Gp 2: M 48.2 IQR 46 vs. 56.8 IQR 58, p 0.029), as did the global health status (Gp 1: M 20.7 IQR 17 vs. 36.2 IQR 33, p < 0.001, Gp 2: M 25.6 IQR 25 vs. 35.3 IQR 33, p < 0.001). Nausea and vomiting showed a reduction (Gp 1: M 29.9 IQR 17 vs. 6.8 IQR 0, p < 0.001, Gp 2: M 22.6 IQR 17 vs. 8.2 IQR 0, p < 0.001), along with a notable decline in pain (Gp 1: M 67.4 IQR 67 vs. 25.3 IQR 17, p < 0.001, Gp 2: M 73.1 IQR 83 vs. 29.7 IQR 17, p < 0.001). A decrease was observed in insomnia (Gp 1: M 63.6 IQR 67 vs. 27.6 IQR 33, p < 0.001, Gp 2: M 60.1 IQR 67 vs. 27.6 IQR 33, p < 0.001). There were no significant differences between Gp 1 and 2 in the extent of improvement in the various symptom scales from T0 to T1, except for cognitive functioning, where Gp 1 exhibited an increase while Gp 2 demonstrated a decrease (p 0.044). Conclusions: The findings of our study demonstrate that QoL and several symptoms prevalent in cancer Pt cared for in the PCU experienced significant enhancement over the span of just one week of PCU care. Both Gp, Pt receiving specialized outpatient PC prior to admission and those without, equally benefited from inpatient PC. All mentioned changes from T0 to T1 are considered not only significant, but clinically relevant.
Immunotherapy related patient-reported outcomes from five randomized controlled trials in patients with triple negative breast cancer: A systematic review.
Authors: Sha Carrie , Liu Marie , Goldberg Johanna , Norton Larry , Robson Mark E. , Zhi Iris
Published: June 2024

e23167

Background: Immunotherapy (IO) has improved clinical outcomes in patients with early-stage Triple Negative Breast Cancer (TNBC) receiving neoadjuvant therapy and certain patient subsets in the metastatic setting. This study aims to evaluate IO-related Patient-Reported Outcomes (PRO) in patients older than 65 years. Methods: We searched Medline ALL (Ovid), Embase (Elsevier), Cochrane Central (Wiley), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. The searches combined terms reflecting (1) the immune checkpoint inhibitors atezolizumab, durvalumab, and pembrolizumab; (2) breast cancer; and (3) randomized controlled trials. Results were limited to items published in English from 2013 through September 2023. We excluded review articles and clinical trial records without results. Two independent reviewers (C.S. and M.L.) screened the studies using the systematic review management tool Covidence, and conflicts were resolved by a third reviewer (W.I.Z.). We included studies that reported on PRO in adults with TNBC receiving any of the three immunotherapies of interest. Results: Five publications composed of two peer-reviewed papers and three abstracts were identified, including 3878 total patients and 3184 with PRO. Three pembrolizumab studies had 2643 total patients (2056 with PRO) and two atezolizumab studies (IMPASSION 130, IMPASSION 031) had 1235 total patients (1128 with PRO). The PRO analysis in KEYNOTE 522 included 1145 patients in the neoadjuvant phase and 847 in the adjuvant phase. The PRO analysis in KEYNOTE 355 included total 847 patients and 317 with Combined Positive Score (CPS) ≥10. No study specified PRO data for patients older than 65 years. Baseline completion rates for all studies were > 80%. All studies used standardized PRO instruments, including the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC- QLQ C30) and its Breast Cancer Module (QLQ-BR23), the Functional Assessment of Cancer-Therapy-General (FACT-G GP5), and the EuroQol-5 Dimension (EQ-D5). All studies showed no statistical difference, or clinical meaningful decline in PRO endpoints between patients who received chemo with IO versus chemo with placebo, during and post treatment follow up. The PRO analysis from KEYNOTE 119, which included total 594 patients of which 187 had CPS ≥10, demonstrated that patients receiving single agent chemotherapy had worse PROs related to systemic therapy side effects and hair loss while the pembrolizumab group had decreased worry about future health. None included subgroup analysis by age, including patients older than 65 years. Conclusions: Our systematic review demonstrates that in both early and advanced TNBC, IO did not worsen PRO. Prospective and retrospective data in IO-related PRO in older patient population are needed.
The Progress Tracker Breast Cancer Registry: Feasibility of a longitudinal patient-led, patient-reported outcomes (PROM) registry.
Authors: Leduc Shaniah , Gibson Amanda Williams , Dean Michelle Liane , Carson Kimberly , Khan Omar Farooq , Howell Doris
Published: June 2024

e23169

Background: A breast cancer diagnosis has the greatest disability-adjusted life years lost of all cancers and significant impact on physical, psychoemotional, social and overall global functioning. Directed by Breast Cancer Canada, a registered non-profit patient-led organization and data managed by the University of Calgary’s POET Program, PROgress Tracker uses a novel, peer-to-peer support model for recruitment, engagement and retention, and is the first national longitudinal and non-interventional PROMs registry. Our aim is to demonstrate the feasibility and potential of this registry in centering patient voice and lived experience to transform breast cancer management. Methods: PROgress Tracker, with 10-year enrollment goal of 50,000 Canadians with Stage 0-IV breast cancer, extends a series of validated PROMs (PROMIS, BREAST-Q, FACT-B, GAD, PHQ-9, COST-FACIT, ISI and ESASr-CA) via a digital platform every 3 months for up to 10 years. Dynamic customization of additional PROMs (PRO-CTCAE, BREAST-Q) based on patient and treatment-specific trigger questions assess evolving components of wellbeing, including financial stress, work life and adverse treatment effects. Results: Recruitment began in October 2023. 162 participants from all Canadian regions including remote/rural geographic areas have shared baseline demographic and clinical data including stage, genetic/molecular tumor markers, treatment type(s) and completed an initial series of PROMs. Comprehensive PROMs including sensitive topics (finances, sexuality, mental health) were completed with minimal missing data ( < 5%); 3-month follow-up surveys show a current retention rate of 57%. Preliminary analysis: median age of participants 54 yrs, 95% identify as Caucasian, and 57% are currently working. 46% reported financial stress (99% response rate); 63% reported ongoing symptoms requiring follow-up. 6% were BRCA+ and 19% triple negative, 7% experienced recurrence, 3% Stage IV, 75% received systemic and/or radiation therapy, 38% received targeted therapy. Conclusions: The lived experience of breast cancer is integral to patient-centred change in the era of precision/personalized medicine and is captured by PROgress Tracker using a diverse set of periodic PROMs to understand the evolution of global measures of wellbeing over time. Initial data indicates that this novel peer to peer model via digital administration of comprehensive and longitudinal PROMs is feasible. This initiative demonstrates attaining this scope of data is achievable, has interest and participation from the national breast cancer community and growing capacity to accrue important, real-time data to inform best practice and identify additional supports required for breast cancer care. While early feasibility is evident, further outreach and recruitment initiatives will ensure diversity of participants.
Unveiling impacts: A quality of life survey for individuals with a history or diagnosis of cancer.
Authors: Tinianov Stacey , Shanahan Kelly , Mason Ginny , Bachini Melinda , Horn Marcia K. , Hutcheson Laurie , Hayashi Joanne , Conneran Terri , Glenn Lesley Kailani , Thomsen Catherine
Published: June 2024

e23179

Background: Cancer treatments, despite increasing effectiveness, involve significant short and long-term side effects profoundly impacting a person's quality of life (QoL). In response, Advocates for Collaborative Education, a global coalition of patient advocates, initiated an exempt, online survey to gather insights on the perceived QoL impact of cancer diagnosis and treatment. The effort sought to identify community priorities and hopes to guide improvements in supportive care. Methods: A comprehensive survey, developed by patients, survivors, and advocates, comprised six sections and 93 questions. Co-creation played a vital role in determining relevant categories, questions, and measurement scales to assess severity and impact of QoL challenges. The study requested demographic and cancer diagnosis data before inquiring about 17 treatment-related side effects, their perceived severity, preparation, unintended side effects of supportive care, and personal preferences for cancer-related information. Recruitment was conducted via social media. Results: The survey garnered responses from 515 individuals with a history of cancer and a wide range of demographic subsets, including age, race, stage of cancer, and treatment modalities. Survey respondents reported an average pre-diagnosis QoL score of 8.87 out of 10, which declined to a mean score of 6.41 post-diagnosis. Across all cancer types, physical well-being was a top priority for most respondents (51.5%), followed by emotional well-being (25.4%). Across a variety of side effects, unintended consequences of side effect treatments were highlighted, revealing complexities in supportive care. Detailed results for all categories and stratification by subsets of age, race, metastatic vs. early stage, treatment type, and others are available for presentation and publication purposes. Conclusions: This study highlights the significant negative impact of cancer treatment on an individual's QoL, addressing an underexplored area of cancer research. While managing treatment side effects is crucial, supportive therapies may introduce additional side effects, exacerbating an overall burden on patients. The collaborative survey development with patients and survivors represents a pivotal step, offering valuable insights for enhancing the well-being of individuals affected by cancer. [Table: see text]
Evaluating the impact of translational research enrollment on the patient care experience of Veterans with prostate cancer who receive care through the Veterans Affairs (VA) healthcare system.
Authors: Carlson Alexander , Hamilton Ian , Pollen Joel , Lesnik Dyan M. , Kosoff David
Published: June 2024

e23210

Background: Veterans with cancer represent a unique subset of patients with distinct exposure histories and cancer epidemiology. Translational research studies that incorporate Veteran-derived biospecimens are therefore critical to advance our understanding of Veteran cancer biology and improve treatment options for Veterans with cancer. Biospecimen-based translational studies also offer an opportunity to enhance the Veteran care experience by enabling Veterans to directly contribute to cancer research efforts. While the biologic benefits of biospecimen research have been well established, the benefit of translational research on the Veteran care experience has yet to be defined. In this study, we evaluated: 1. Whether Veteran enrollment in a biospecimen-based prostate cancer research study improved their VA patient care experience and satisfaction and 2. Whether a VA-based data analyst tool could be used to optimize patient enrollment in translational research studies. Methods: Beginning in January, 2022, Veterans with a diagnosis of prostate cancer receiving care at the William S. Middleton VA were enrolled in a translational research study that collected blood and tissue biospecimens for subsequent investigation and analysis. After at least 30 days of enrollment, subjects were sent an anonymous survey inquiring about how participation in the translational research study impacted their VA care experience and healthcare satisfaction. To optimize enrollment in the study, an ICD-9 code search function was employed within the medical record database to readily identify eligible VA clinic patients based on an active prostate cancer diagnosis. Descriptive analyses were performed using Prism statistical software. Results: Nearly all Veterans who responded to the questionnaire agreed that participation in translational research was a meaningful experience that increased their satisfaction with their VA medical care. In addition, a vast majority of Veterans surveyed felt that their research participation could help improve care for other Veterans, and most expressed willingness to participate in future VA research opportunities. In a secondary analysis, our ICD-9 search function accurately identified eligible VA clinic patients with a prostate cancer diagnosis, and implementation of this tool has saved approximately 30 minutes of weekly physician and research coordinator work compared to manual chart review. Conclusions: Veteran enrollment in translational research studies provides a meaningful experience for Veterans that can lead to increased satisfaction with the VA healthcare system. Future VA initiatives to improve the Veteran care experience should focus on expanding translational research opportunities for Veterans as well as addressing potential barriers to enrollment.
Targeted interventions to address local challenges in HR+/HER2- and HER2+ breast cancer treatment in community-based settings.
Authors: Mahtani Reshma L. , Hamilton Erika P. , Storey Janet , Dewald Ilona , Dooyema Samuel , Carter Jeffrey D. , Heggen Cherilyn , McKinnon Kelly E.
Published: June 2024

e23213

Background: Advancements in novel targeted agents and antibody-drug conjugates (ADCs) have dramatically improved patient outcomes and survival for breast cancer patients, yet the successful utilization of these agents remains a key challenge for clinicians, particularly in the community. To improve the care of HR+/HER2- and HER2+ patients, a quality improvement (QI) initiative was conducted across 6 community-based oncology practices. Methods: Between 7/2023 and 10/2023, multidisciplinary oncology team members (N = 98) across 6 US-based community oncology practices were surveyed to identify gaps in the treatment and management of patients with HR+/HER2- and HER2+ breast cancer. Providers then participated in audit/feedback (AF) sessions where they (a) assessed site-specific practice gaps identified via the provider surveys; (b) received targeted education based on their specific gaps; and (c) developed action plans for improvement. Follow-up surveys administered 90 days after AF sessions will evaluate the impact of practice changes driven by the QI initiative. Results: Top challenges reported by providers in caring for patients with HR+/HER2- and HER2+ breast cancer were providing patient-centered supportive care measures (37%), individualizing treatment plans (18%), and managing treatment-related adverse events (14%). Reported challenges in treatment sequencing included rapidly evolving guideline recommendations (44%) and knowing which treatment to select when patients are eligible for multiple lines of therapy (34%). Additionally, oncology team members reported having the most difficulty managing treatment-related neurological effects (32%), neutropenia (16%), and GI toxicities (14%). Providers believed improved collaboration across interprofessional teams (28%) and increased patient education/referrals for supportive care (26%) would most improve care for breast cancer patients. To address the identified gaps at each location, teams participated in targeted AF sessions focused on addressing their specific gaps and developed action plans, such as developing new workflows for improving care coordination, implementing institutional protocols for identifying and managing adverse events, and improving patient supportive care, quality-of-life assessments, and distress screenings. Full findings from baseline surveys will be presented, along with follow-up surveys measuring real-world impact of the system-level practice changes. Conclusions: Through this QI initiative, teams identified gaps/barriers in their own practices, and developed and implemented action plans for improvement. These data and actionable insights support safe, effective, and evidence-based integration of novel therapies into HR+/HER2- and HER2+ breast cancer care to optimize patient outcomes.
Insight into quality of life: Understanding the experience of patients with cancer in southern Brazil's public healthcare system.
Authors: Aleixo Sabina B. , Pulido Jose Zago , Parmanhane Narelle , Sartoli Ana Arlete , Siller Ana Paula
Published: June 2024

e23223

Background: This study explores the quality of life of individuals undergoing cancer treatment in the southern region of Brazil within the public healthcare system. Recognizing the potential negative impacts of both the disease and its treatment on patients' well-being, there is a pressing need to comprehensively assess their quality of life. The study aims to understand the challenges faced by these individuals in various well-being dimensions. Methods: Data collection occurred from August 1, 2023, to December 31, 2023, approved by the Ethics and Research Committee (Opinion Number: 6,136,833). Quality of life was assessed using the Brazilian version of the Medical Outcome Survey Short-Form 36 (SF-36), a validated instrument comprising 11 questions. Inclusion criteria included individuals over 18, of any gender, residing in the southern region if the state of Espirito Santo, diagnosed with cancer, and receiving treatment at the public healthcare reference oncology center. Exclusion criteria encompassed those under 18, non-residents of southern region, lacking a cancer diagnosis and undergoing oncohematological treatments. Among 263 eligible participants, 21 were excluded for not meeting inclusion criteria and 16 invited individuals chose not to participate, resulting in a final sample of 226 individuals. Results: The composition of the participant pool comprised 71.6% women and 28.4% men. The evaluation of quality of life utilized the SF-36 instrument, which explores various domains: Functional Capacity, Limitation due to Physical Aspects, Pain, General Health Status, Vitality, Social Aspects, Emotional Aspects, and Mental Health.Functional Capacity saw 44.20% facing significant difficulties, 32.80% experiencing mild difficulties, and 23% reporting no hindrance in daily activities. Physical limitations due to cancer treatment were reported by 61%, while 39% did not face such limitations. Most patients experienced some level of pain; only 24.20% were pain-free. General Health Status varied from excellent (9.10%) to very bad (2%). Vitality fluctuated, with 31% reporting vitality all the time. Regarding the social dimension, most individuals experience interference, while only 37% report no impact.Emotional aspects interfered with daily life for 59% of participants. Conclusions: This research indicates that both physical and emotional aspects are significantly affected in cancer patients from southern Espírito Santo. While physical limitations and pain are prevalent, emotional aspects, including manifestations of anxiety and depression, also play a substantial role in influencing daily life. Understanding these dimensions is vital for developing targeted interventions, especially for vulnerable individuals relying on Brazil's public healthcare system, to enhance the quality of life during cancer treatment.
Improving adequacy rates of bone marrow aspirate and core biopsies through training and a bedside X-ray device.
Authors: Vegunta Rathnamitreyee , Karakus Gulen Kuaybe , Ghanta Snigdha , Seiter Karen , Dewar Rajan
Published: June 2024

e23228

Background: Bone marrow (BM) evaluation is crucial to the diagnosis of hematolymphoid disorders. WHO requires an adequate number of well-spread-out spicules in aspirates and defines an adequate BM core biopsy as ≥1.5 cm with at least 10 inter-trabecular areas (ITA). Gross examination of the core biopsy at the bedside can be misleading due to attached clot, thick periosteum, and cortical bone, or tangential biopsies, which histologically results in biopsy without adequate ITAs. Suboptimal BM biopsies hinder appropriate diagnosis, delay patient care, and may require the patient to undergo additional BM biopsies. Bedside image analysis via a cabinet x-ray system can be utilized as a point-of-care tool to assess the amount of evaluable marrow permitting re-biopsy at the time of the procedure. Methods: The study was conducted over 5 months at Westchester Medical Center. We retrospectively estimated BM adequacy rates by analyzing the aspirate quality and measuring the BM core biopsy length. Subsequently, a training demonstration to the proceduralist (fellows in training) by an experienced attending was performed and the adequacy rates were reassessed. BM biopsies were analyzed with a cabinet x-ray system, Faxitron, soon after biopsy, then subjected to routine histology and processing. High-resolution images of the core biopsy were obtained. The length of the core biopsy and the number of ITAs were calculated from the x-ray images. Measurement of the gross biopsy length and microscopic assessment of evaluable marrow were compared to the measurements obtained by x-ray imaging. Results: Our adequacy rates which met aspirate quality were 5% (1/20) pre-intervention and 65% (13/20) post-intervention. The aspirate smear quality improved after the demonstration technique to 65%. Only 13/53 core biopsies exceeded the WHO standard of 1.5 cm by microscopy, while 34/53 were grossly estimated to be > 1.5 cm. There was general concordance between the number of ITAs and the length of core biopsies by microscopy. In approximately 20% of cases, the x-ray images highlighted suboptimal core biopsy ( < 10 ITA/cortical bone/cartilage), which weren’t apparent by gross examination alone at the bedside. Utilizing x-ray image measurements, core biopsy fragment length was shown to be in concordance with microscopic estimation of length and number of ITAs. X-ray imaging readily identified clot sections (non-radiopaque), sclerotic cortical bone (absence of trabeculae), and periosteum (soft tissue shadow) in all 10 sub-1 cm biopsies. Conclusions: We conclude that a standard instruction technique of slide preparation can improve the quality of bone marrow aspirate. Core biopsy length and number of ITAs can easily be estimated using bedside point-of-care x-ray analysis to ensure adequate BM evaluations. We propose training and the routine use of bedside x-ray machine to improve the adequacy rates of BM biopsies.
An international expert consensus on improving the quality of care in patients with cancer by optimal central vascular access device selection.
Authors: Jahanzeb Mohammad , Wu Ching Yang , Lim Howard J , Muro Kei , Xu Lichao , Somashekhar Manjiri , Somashekhar S.P. , Zhang Xiaotao , Qiu Xiaoxia , Fu Ying , Pittiruti Mauro
Published: June 2024

e23233

Background: In cancer patients (CPs), selection of an appropriate venous access is critical not only for delivering effective treatment, but also for enhancing patient comfort and quality of life to ensure treatment continuity. This consensus provides recommendations on the selection of the most appropriate central venous access device (CVAD) and its management in CPs. Methods: Eleven experts from three continents, including oncologists and healthcare professionals (HCPs) skilled in CVAD placement & maintenance, convened electronically and face-to-face at a 2-day meeting. A comprehensive review of clinical trials & guidelines on CVADs published between January 2013 and December 2023 from PubMed & Cochrane Library was conducted. Preliminarily drafted statements were discussed by the panel and voted on. Evidence and panelists' expertise was employed in an anonymous polling for consensus. The final recommendations were approved by all panelists. Results: A summary of the panel’s consensus (ten statements) is shown in Table 1. Conclusions: The present consensus provides a robust clinical framework for HCPs to select the most suitable CVAD to facilitate therapy for CPs. [Table: see text]
Aesthetics treatment with injectable fillers in patients with cancer: Safety and quality of life during active antineoplastic therapy.
Authors: Shachar Eliya , Hasson Eden , Arzi Ofir , Levy Bar , Pantanowitz Mabjeesh Lee , Adar Lyri , Shani Omer , Safra Tamar
Published: June 2024

e23245

Background: Patients treated with antineoplastic treatment,commonly experience physical changes,secondary to the disease,weight loss,stress,and cancer therapy side-effects.Injectable fillers,offer effective and safe soft-tissue manipulations improving patients’ positive body image.While FDA-approved fillers are used in various medical settings,data on the safety and implications on quality of life(QOL)in oncology patients during active cancer therapy are limited.The study aimed to assess oncology patients' safety,QOL and both physician and patients’ perceived skin changes when fillers are used during active cancer therapies. Methods: The study was conducted at the Women's Cancer Center and Dermatology Department between 2021-2023.Female oncology patients treated with antineoplastic therapies completed a validated QOL questionnaire,dermatologist and patient self-evaluation,prior and following aesthetic intervention.Patients were randomly assigned to receive aesthetic treatments. Results: 127 female patients diagnosed with cancer,and treated at a single cancer center were included in the study.Patient mean age was 57 years.Patient diagnoses included breast,ovarian,uterine,cervical,and other cancers(58%, 22%,7%,5%,8%,respectively).31 (24%) patients were randomized to receive filler treatment.106(83%)patients were not treated with fillers,patients were either not randomized to filler treatments,or attributing their abstention to their cancer diagnosis,potential risks shared by other patients,or their treating oncologist.Patients receiving fillers were treated with chemotherapy,chemotherapy and biological agents,biological agents,hormonal therapies,immunotherapy,biological and hormonal therapy(39%,23%,10%,19%,6%,3%,respectively).3 independent dermatologists assessed improved aesthetic parameters following filler treatment,patients appeared less ill,sad,distracted.6-8 weeks post filler injections,there was a markedly improved QOL score,and noticeable positive skin changes by dermatologists and patients evaluation.Patients appeared less tired,angry,worried(45%,38%,35%,respectively).Most patients were satisfied following injections(81%) and planned future aesthetic treatments.More than half of the patients(55%)had no adverse events.Thirteen patients experienced minor dermal side effects (grade 1,42%).While 1 patient developed delayed inflammatory reaction 6-months post injection(grade 2,3%). Conclusions: Aesthetic treatment with filler injections while on anti-cancer treatment,with minimal side effects,statistically improved patient QOL and dermatological measures,enhanced dermatologist and patient sense of positive body image,demonstrating that injectable fillers can be safely recommended to patients receiving anti-neoplastic therapies.
Addressing misinformation about cancer care in the clinical setting: A pilot study of a conversation guide and training for cancer care providers.
Authors: Palmer Amitabha , Lopez Gabriel , Taylor Jolyn Sharpe , Gallagher Colleen M.
Published: June 2024

e23250

Background: Medical misinformation about cancer care is understudied despite its pervasiveness and harmful effects on patients. This misinformation causes a) delays in care or forgoing of treatment for curable conditions; b) economic harm such as spending and travel on ineffective or harmful treatments; c) potentially toxic effects of the suggested test/treatment; and d) harmful medical interactions with standard curative treatments. Recently, in an IRB study we surveyed MD Anderson clinicians about their ability to successfully address patients who endorse medical misinformation. We found that ~40% of physicians report success rates below 60% for correcting misinformation. ~50% of respondents answered that they have insufficient resources to address patients who endorse misinformation; ~65% answered that they have insufficient training, and ~50% answered that there is insufficient institutional support. In response to these findings, we developed (as far as we know) the first pilot conversation guide and training to improve provider skills and confidence in addressing misinformation about cancer in clinical encounters. Methods: For our quality improvement project, we partnered with clinicians in integrative oncology and gynecologic oncology to develop the conversation guide. The techniques, strategies, and model dialogue in the guide are adapted from best practices developed for addressing vaccine hesitancy. Before the training, we asked 11 physicians to provide a self-assessment of their comfort, confidence, and competence in addressing patients who endorse misinformation about cancer. Then we provided a 25min training in which participants role-played to learn strategies and model dialogue for four common scenarios. After, we resurveyed participants’ self-assessment measures and assessment of the training’s utility. Results: All participants believed the conversation guide and training will be significantly (82%) or moderately (18%) helpful for correcting patients/families who endorse medical misinformation about cancer. 91% said the conversation guide and training significantly (9% moderately) improved their ability to correct patients/patients’ families who endorse medical misinformation. All participants reported improved comfort, confidence, and competence in their ability to address patients/families who endorse misinformation about cancer care. 100% would recommend the guide and training to their peers. Conclusions: Given the prevalence of medical misinformation generally, the training and resources we have developed will be valuable to clinicians effectively address the growing number of patients who endorse misinformation about their care. Our long-term goal is to conduct a larger study and turn our conversation guide and training into a replicable model available for widespread use.
Real-world clinical effectiveness and treatment patterns in the early-stage esophageal/gastroesophageal junction cancer (EC/GEJC) population treated in the community oncology setting in the United States.
Authors: Ramakrishnan Karthik , Beeks April , Valderrama Adriana , Shi Junxin , Patton Gregory , Wilson Thomas W. , Herms Lisa , Bordia Sonal , Nallapareddy Sujatha
Published: June 2024

e23273

Background: Definitive chemoradiotherapy (dCRT) is the recommended treatment for patients with early-stage EC/GEJC not eligible for surgery. There have been improvements with treatment for esophageal cancer, but the overall 5-year survival rates remain low at approximately 20%. This study examined patient characteristics, current treatment patterns and outcomes with dCRT regimens in the US community oncology setting. Methods: This was a retrospective observational cohort study using structured and unstructured electronic health records data of 300 adult patients with locally advanced/unresectable EC/GEJC who initiated dCRT (index date) within The US Oncology Network between 1 January 2015 and 30 June 2021. Patients were followed through 31 December 2022, last patient record or death, whichever occurred first. Descriptive analyses were conducted to evaluate patient and treatment characteristics. Kaplan-Meier methods were used to assess overall survival (OS) and real-world event-free survival (EFS) from index date. Results: Median age at index was 73 years; three-fourths of patients were male (74.3%), and three-fourths were Caucasian (73.7%). Stage III was the most common stage at initial diagnosis, followed by stage II and stage IVA (55.7%, 34.7%, and 5.3% respectively). The majority of the initial tumor location at diagnosis was esophageal (70.7%) whereas 29.3% were GEJ. Most patients had a baseline ECOG score of 0-1 (63.3%). Median (IQR) follow-up time to death or censor was 10.5 (4.0, 21.0) months from index. The most common initial regimen received was carboplatin+paclitaxel (87%), followed by cisplatin+fluorouracil (9%). Almost all patients received chemoradiotherapy concurrently (99.7%). Median radiation dose was 5040 cGy. Median duration of index treatment was 1.4 months. One-fifth of patients went on to receive a second treatment (21.7%). One-half of patients died before the end of the study observation period (53.7%), and 66% of patients experienced a clinical event (progression, locoregional recurrence, metastatic recurrence or death). Median (95% CI) OS and EFS were 18.1 (13.3, 21.8) and 8.9 (7.7, 10.6) months, respectively. Conclusions: Our study showed that patients mostly received carboplatin+paclitaxel as chemotherapy and did not receive further lines of treatments. Over 60% of patients experienced disease progression with a median survival of a year and a half. These clinical outcomes are poor for early esophageal cancer and support the development of more effective therapies to improve outcomes.
Real-world treatment patterns and overall survival (OS) in locoregionally advanced head and neck squamous cell carcinoma (LA HNSCC) in the U.S.
Authors: Zheng Dandan , Zhang Su , Bidadi Behzad , Lerman Nati , Song Yan , Song Rui , Li Jiayang , Zhu Anyu , Tang Yuexin , Signorovitch James , Merchant Sanjay , Hanna Glenn J.
Published: June 2024

e23275

Background: Multimodal therapy, including definitive radiotherapy (RT) with or without systemic therapy (ST) or surgery followed by adjuvant RT ± ST is typically recommended for patients (pts) with LA HNSCC treated with curative intent. Assessing real-world use of various treatment modalities and OS helps to better understand the unmet needs in this population. Methods: The linked SEER-Medicare data (2007–2019) was used in this retrospective cohort study. Pts with newly diagnosed stage III-IVB (AJCC 6/7th) LA HNSCC (larynx, hypopharynx, oral cavity, or oropharynx) who received primary treatment within 4 months after initial diagnosis were included. HPV status was not available. OS from index date, i.e., primary treatment initiation date, was described using the Kaplan-Meier method. Baseline (12 months prior to index date) factors associated with OS were assessed using a Cox proportional hazards model. Hazard ratios (HRs), 95% confidence intervals (CIs), and p values were reported. Results: In total, 1885 pts met the selection criteria (median follow-up: 24.8 months). The mean age at initial diagnosis was 74.3 years, 67.2% were male, and 81.6% were white. Less than 1/3rd of pts received primary surgery (resected). More than half of resected pts received RT±ST post-surgery. In unresected pts, nearly 2/3rds received definitive concurrent RT+ST. The median OS and 5-year OS were 32.7 months and 37.6%, respectively, for all pts and were comparable between resected and unresected pts. In the multivariable Cox models for both resected and unresected pts, older age, more advanced tumor stage, hypopharynx (vs. oropharynx), and higher Charlson comorbidity index scores were associated with significantly shorter survival. Additionally, surgery followed by RT+ST (vs. surgery only) (HR = 0.50, 95% CI = 0.34-0.72, p < 0.001) and definitive RT+ST (vs. definitive RT only) (HR = 0.69, 95% CI = 0.58-0.81, p < 0.001) were associated with significantly longer survival in resected and unresected pts, respectively. Conclusions: In elderly pts with LA HNSCC, surgery followed by RT and definitive RT+ST were the most common treatment modalities in resected and unresected pts, respectively. The suboptimal real-world survival across all pts with LA HNSCC regardless of treatment strategy highlights a significant unmet need. Studies focused on the novel application and sequencing of effective immunotherapies are needed. Table 1. Primary treatment and OS in LA HNSCC1 [Table: see text]