bluuebunny/crossref_metadata_2025 huggingface dataset:
Breast cancer survivorship visits: Presenting concerns and resulting recommendations.
Authors: Stricker Carrie Tompkins , Jacobs Linda A. , Panzer SarahLena , Palmer Steven C
Published: March 2020

e20553

Background: Survivorship care plans (SCPs) are mandated for cancer patients following initial cancer therapy. However, appropriate content, processes, and outcomes of survivorship visits are not yet defined. Neither the concerns that patients bring to these visits nor the degree to which they recall information given by providers is known. As part of a multicenter pilot study of breast cancer survivorship visits, we examined patient concerns at time of presentation for such visits, as well as patient and provider perceptions of resulting recommendations. Methods: We assessed post-treatment breast cancer survivors’ (BCSs’) survivorship concerns prior to a survivorship visit at 1 of 9 cancer centers associated with the LIVESTRONG Survivorship Center of Excellence Network. Following that visit we queried providers as to what referrals and recommendations were made during the visit. Three months later we asked patients to report what recommendations were made by providers. We then examined prevalence of patient concerns and agreement between patients and providers concerning survivorship visit recommendations for managing health. Results: 103 BCS at 9 centers participated. BCS most endorsed concerns were reducing risk of recurrence (81.4%), receipt of appropriate breast cancer follow up care (57.4%), weight loss (55.5%), risk for second cancers (54.9%), fatigue/sleep management (50.0%), and symptoms important to report to providers (50.0%). Although exercise was recommended to 63% of participants by providers, patients recalled this correctly only 79% of the time (Kappa = .16, ns). Moreover, there was a generally poor concordance between provider-reported and patient-recalled recommendations, with kappas ranging from 0.46 for recommendations about tobacco/alcohol to -0.11 for general health recommendations. Conclusions: Survivors report an array of concerns ranging from a risk of recurrence (81.4%) to concerns about peripheral neuropathy and lymphedema (51%). Survivors and providers, however, show little concordance concerning recommendations made visits. Provision of personalized survivorship care plans may improve agreement between survivors and providers concerning health recommendations.
Examining caregiver perceptions and distress related to patient pain.
Authors: Sherrod Amanda M. , Wells Nancy L. , Dietrich Mary S. , Murphy Barbara A.
Published: March 2020

e20555

Background: We conducted a randomized trial comparing a brief baseline pain educational intervention with the addition of either a hot line for pain related issues or weekly calls from health providers to assess pain and medication use. Results of this trial have been previously reported (J Pain Symptom Manage. 2003 Apr;25(4):344-56). Caregiver beliefs may impact patient compliance with pain treatment so caregivers also received pain education. As a secondary endpoint we investigated caregiver beliefs related to: 1) known barriers to compliance with pain medication (feasibility of pain control, addiction concerns, fears of overdose and toxicity), 2) perceptions regarding patient pain level, 3) distress related to patient pain, and 4) efficacy in helping control patient pain. Methods: 28 informal caregivers completed the Family Pain Questionnaire (part 1: 8 items related to beliefs, part 2: 6 items related to pain perceptions). All items were scored using a 10cm visual analogue scale. Questionnaires were completed at baseline, immediately and 1 month post-education. Results: Caregiver characteristics: 64% married, 54% ≤ high school education. The caregiver pain belief subscale mean score was 4.9 (SD 1.7) at baseline, 5.6 (SD 1.4) post-education and 5.9 (SD 0.9) at 1 month indicating improved beliefs over time (p=.001). Caregivers consistently rated pain higher than patients (baseline: M=6.7 (SD=2.6) vs. M=4.1 (SD=2.3), p<0.001, 1-Month: M=5.1 (SD=3.2) vs. M=3.4 (SD=2.7), p=0.003). They also reported more distress related to pain than patients . Distress among caregivers due to patient pain was high at baseline (median=8.4, IQR: 5.6-9.5), and remained high at 1 month (median=7.7, IQR: 4.7-9.3). While not statistically significant, caregiver perception of ability to relieve pain improved from baseline (median=4.6, IQR: 0.8-8.3) to 1 month (median=2.4, IQR: 1.2-4.5, p=0.115). Conclusions: Despite improvements in caregiver beliefs regarding barriers to good pain control, decrease in levels of patient pain, and improved self-efficacy in assisting with pain control, caregiver distress related to patient pain remained high. Future research should be focused on further characterizing the factors that contribute to caregiver distress.
Incidence of febrile neutropenia and effectiveness of pegfilgrastim prophylaxis in patients with advanced-stage solid tumors receiving chemotherapy.
Authors: Crawford Jeffrey , Reiner Maureen , Morrow Phuong Khanh H. , Lyman Gary H.
Published: March 2020

e20564

Background: Advanced disease stage has been identified as an independent risk factor for the development of febrile neutropenia (FN), which continues to be associated with substantial morbidity. We report here results from two clinical trials on the impact of pegfilgrastim (PEG) in patients with advanced stage solid tumors. Methods: Patients were pooled from two placebo-controlled trials: a) a phase III trial of 928 patients with breast cancer, randomized to placebo or PEG 6 mg on day 2 of each 21-day cycle (Vogel CL, et al. JCO 23:1178-84, 2005); and b) a phase II trial of 241 patients with colorectal cancer (CRC), randomized to placebo or PEG 6 mg on day 4 of each 14-day cycle (Hecht JR et al. Clin CRC 9:95-101, 2010). Patients were grouped by disease stage at baseline: advanced (stage III, IIIA, IIIB, IV) or limited (stage I, II, IIA, IIB). Grade 3/4FN was defined as a temperature of ≥ 38.2°C and an ANC of <1.0 x 109/L. The Cochran-Mantel-Haenszel test was used to evaluate the association between PEG and grade 3/4 FN, odds ratio (OR) for FN was estimated by logistic regression, and a trend in the number of FN events per patient was estimated using a Cochran-Armitage test. Results: Characteristics of the 982 patients with advanced stage cancer are shown in the table. PEG was associated with significantly fewer grade 3/4 FN events (p < 0.001), with OR for PEG vs placebo of 0.12 (95% CI: 0.07, 0.22). The percentage of patients with 0, 1, and ≥ 2 FN events was 97%, 3%, and 0% with PEG and 81%, 18%, and 0.4% with placebo, and PEG significantly reduced the number of FN events (p< 0.001). Conclusions: Patients with advanced stage cancer are at considerable risk for developing FN, and PEG prophylaxis reduced that risk. Assessment of FN risk is essential in the advanced/metastatic treatment setting. [Table: see text]
The burden of chemotherapy-induced nausea and vomiting in the Asia Pacific (AP) region: The Pan Australasian chemotherapy-induced emesis study.
Authors: Kim Hoon-Kyo , Chan Alexandre , Hsieh Ruey Kuen , Yu Shi Ying , Hernandez Ana Banos , Burke Thomas A. , Keefe Dorothy Mary Kate
Published: March 2020

e20580

Background: There are limited data on CINV in AP, a region diverse in healthcare systems and standards of care. The primary objective was to estimate the country-specific percentage of patients with complete response (CR: no emesis and no use of rescue medication) in the overall phase (0-120 hours) during cycle 1 by regimen emetogenicity. Methods: This was a prospective, observational study of highly and moderately emetogenic chemotherapy (HEC/MEC)-naive adults from 6 AP countries. Patients completed a diary over a 120 hour period following chemotherapy. The study was designed to enroll a minimum of 45 patients by HEC/MEC and country to describe CR with a 95% CI +/-15%. Results: There were 648 evaluable patients enrolled at 31 sites from Aug. 2011 - Jul. 2012. The mean age was 55.8. 57.7% were female. The most common regimens were cisplatin-based (168/318; 52.8%) for HEC, and oxaliplatin-based (156/330; 47.3%) for MEC. Site of chemotherapy administration was outpatient/day case (51.4%; 333/648) and inpatient (48.6%; 315/648). Outpatient/day case chemotherapy administration was used for all patients in Australia and Singapore. Inpatient administration was common in China (85%, 130/153) and S. Korea (64.2%, 97/151). ASCO QOPI-recommended antiemetic prophylaxis was used in 38.7% (123/318) of HEC (5HT3-RA/steroid/NK1-RA) and 83.9% (277/330) of MEC (5HT3-RA/steroid). Prophylaxis differed between countries (p<0.001). CR is shown below. Conclusions: CINV outcomes, use of guideline-recommended prophylaxis, and site of chemotherapy administration significantly varied across AP countries. There is considerable room to improve CINV outcomes and use of recommended antiemetic prophylaxis in the region. [Table: see text]
Relationship of age, smoking, alcohol use, and exercise among adults with cancer.
Authors: Alston Shani Malia , Deal Allison Mary , Gordon Brittaney-Belle Elizabeth , Jolly Trevor Augustus , Williams Grant Richard , Dixon Samara Ann , Muss Hyman Bernard
Published: March 2020

e20582

Background: Smoking, alcohol use, and exercise among cancer patients (pts) are important health concerns due to their effects on treatment outcomes. Few studies have focused on health behaviors (HB) in this group. The goal of this study was to assess HB in cancer pts seen at an academic medical center. Methods: The Health Behavior Questionnaire (HBQ) is a nine-item survey that assesses smoking, alcohol and exercise behaviors based on the 2006/7 National Health Interview Survey (http://www.cdc.gov/nchs/nhis.htm). Pts completed the HBQ from 2010 to present as part of two breast cancer (BC) trials and a geriatric assessment trial. The Jonckheere-Terpstra test compared differences among groups as age increased (Jonckheere, Biometrika 41:1/2, 1954). Results: Of 371 pts, 66% were age ≥60 (median 66), 81% white, 16% black and 95% were female. BC was most common (92%). 5% were current and 40% former smokers. 43% reported having ≥1 drinks per week (dpw). Alcohol users averaged 5 dpw (range of 1-18). 40% never exercised vigorously (≥10 minutes that causes heavy sweating or large increases in heart rate/breathing). Older pts were less likely to exercise (p <0.001). Pts who exercised vigorously were more likely to drink (p<0.02). Former smokers were more likely to use alcohol (p<0.0004). The frequency of HB by age is tabulated below. Conclusions: The % of current smokers in this sample of cancer pts was lower than the national average (5% vs 19%) as was the % of current drinkers when compared nationally (43% vs 51.5%). There was no association of age with alcohol use or smoking status. Older pts in this cohort were significantly less likely to report vigorous exercise. As exercise is important for older pts, future studies in exercise intervention would be beneficial. Support: Breast Cancer Research Foundation, New York, NY and Lineberger Comprehensive Cancer Center, Chapel Hill, NC. [Table: see text]
Phase I, double-blind, placebo-controlled, ascending single subcutaneous dose, safety, tolerability, and pharmacokinetic study of sustained release granisetron (APF530).
Authors: Barr John , O'Boyle Erin , Johnson Martin
Published: March 2020

e20587

Background: Although several 5-HT3antagonists are approved for chemotherapy-induced nausea and vomiting, agents with longer duration of therapeutic benefit are needed. APF530 incorporates a polymer that allows for controlled and sustained release of granisetron. Methods: Adult males were randomized to receive subcutaneous (SC) APF530 125 mg, 250 mg, 500 mg, or 1 g (groups A-D, respectively) and simultaneous placebo. Groups B-D subsequently received intravenous (IV) granisetron ≥ 7 days after APF530 dosing. Safety, tolerability, pharmacokinetics (PK), and absolute bioavailability of granisetron from APF530 were examined. Results: 26 subjects were randomized. All APF530 doses were well tolerated; most adverse events (AEs) were mild injection site reactions (pain on palpation, erythema); all resolved. Other AEs included headache (IV, SC), upper abdominal pain (SC), and constipation (SC). PK parameters were generally dose proportional (Table). APF530 elicited slow sustained absorption of granisetron; tmax was 8-10 h, and some subjects had secondary plasma peaks at 24-96 h. Systemic levels were reached within 30 min. Based on AUCall, granisetron was shown to be completely bioavailable from the SC dose formulation of APF530. Conclusions: APF530 safety profile was similar to that of granisetron, with the addition of mild injection site reactions. Granisetron was completely bioavailable at all APF530 doses. PK parameters were generally dose proportional. Absorption of granisetron from APF530 was prolonged compared with that from IV granisetron. Clinical trial information: NCT01416259. [Table: see text]
Patterns of follow-up in oncologic care across Canada.
Authors: Ye Allison Y. , Cheung Winson Y. , Goddard Karen , Olson Robert Anton
Published: March 2020

e20589

Background: With continual advancements in cancer care, improved outcomes and increasing survivor populations, cancer survivorship has become an important area of research. Methods: A 35-question electronic survey was sent to physician members of the Canadian Association of Radiation Oncologists. Based on their scope of practice, respondents were presented with brief clinical scenarios pertaining to various survivor populations. A subsequent series of questions were posed to determine routine follow-up practices. Results: In total, 111 radiation oncologists (RO) responded (44% response rate); 29% were female, 43% were in practice less than 10 years, and most regions of Canada were well represented. Most worked in centers staffed by more than 10 oncologists (69%), and saw more than 200 new patient consults per year (78%). 10% would not follow patients routinely, mainly in cases involving breast or prostate survivors. 73% of such patients (73%) would be followed by their primary care providers (PCP) whereas ROs would follow their CNS, GI, HN and GYNE patients. Lack of resources (55%) and a belief that follow-up by PCPs is equally effective (55%) were the top two reasons for not following patients. Treatment toxicity (92%) and the possibility of salvage or palliative treatment (86%) were the two most common reasons for routine follow-up. The majority (55%) of ROs follow patients for < 5 years, with 36% following for 5-10 years, and a minority (9%) following for longer than 10 years. 54% would not change the frequency of their follow-up, but 39% would decrease and only 7% would make no change. Workload and lack of resources were major barriers to follow-up, but in addition, many felt that follow-up by FPs or Advanced Practice Nurses could be equally effective. Some felt this would require additional training and more guidelines to make this effective. Conclusions: The majority of ROs follow their patients, especially when salvage treatment is possible. A significant portion would decrease their follow-up in frequency because of workload burden, resource limitations and a belief that there can or should be increased involvement from FPs and other allied health care providers.
Low molecular weight heparin (LMWH) for primary thrombophylaxis in patients with solid malignancies: Systematic review and meta-analysis.
Authors: Ben-Aharon Irit , Stemmer Salomon M. , Shpilberg Ofer , Sulkes Aaron , Gafter-Gvili Anat
Published: March 2020

e20595

Background: Patients receiving chemotherapy for cancer are at increased risk for venous thromboembolism (VTE). The role of low molecular weight heparin (LMWH) as antithrombotic prophylaxis has been appraised in several studies, yielding conflicting results. We performed a meta-analysis of all randomized controlled trials (RCTs) which evaluated the addition of LMWH as primary prophylaxis in patients with solid malignancies while receiving chemotherapy. Methods: RCTs were identified by searching the Cochrane Library, MEDLINE databases and conference proceedings. Relative risks (RR) of thrombotic events, mortality as well as adverse events were estimated and pooled. Results: Nine trials met the inclusion criteria, and evaluated a total of 6691 patients. Primary prophylaxis with LMWH reduced both symptomatic VTEs: (RR 0.47, 95% CI(0.32 to 0.69)) and the rate of pulmonary embolism(PE): (RR 0.51, 95% CI(0.30 to 0.86)).Symptomatic DVT was reduced as well (RR 0.35, 95% CI(0.21 to 0.60). Meta-analysis of six trials which reported survival outcomes revealed no statistically significant benefit for LMWH in 1 year mortality rates (RR 0.93, 95% CI(0.83 to1.04)). There was no significant increase in major bleeding events. Conclusions: LMWH reduces the incidence of symptomatic VTE and PE in patients receiving chemotherapy for cancer, with no apparent increase in major bleeding. Nevertheless, LMWH had no significant effect on survival outcomes. Future studies should delineate whether specific populations may derive a survival benefit from LMWH primary prophylaxis.
Impact of palliative care on end-of-life management of cancer patients dying in the hospital.
Authors: Karim Syed Mustafa , Zekri Jamal M , Abdelghany Ehab Mosaad , Rizvi Azhar , Al-Gahmi Aboelkhair , Munsoor Husna , Ahmad Imran , Dada Reyad , Ansari Mohammed Iqbal , Kerr Ian G.
Published: March 2020

e20613

Background: A substantial number of cancer patients receive inpatient care at the end-of-life (EoL). Involvement of palliative care teams during the course of cancer treatment has been shown to improve quality of life (QoL) in cancer patients. In this study, we compare the EoL care of cancer patients dying in the hospital under medical oncology (MO) and palliative care (PC) services. Methods: A retrospective review of medical records of adult cancer patients who received chemotherapy during their illness and died in our hospital between January 2010 and January 2012 was conducted. The quality metrics measured as endpoints were: chemotherapy given within 21 days of death, death in the ICU, CPR at time of death, and time from last chemotherapy to death (TLCD). These endpoints were compared between patients who died under the MO service (cohort A) and those dying under PC service (cohort B). Chi-square test and T-test were used to compare the endpoints between the two cohorts. Results: Of the 106 cancer patients who died in the hospital, 40 and 66 were in cohorts A and B respectively. 30% of all patients were 65 years of age or older, and were equally distributed between the two cohorts. Patients in cohort A were more likely to receive chemotherapy within last 3 weeks of life (27.5% versus 7.5%, p=0.012, 95% CI 4.16-37.15), to have CPR at time of death (15% versus 0%, p=0.005, 95% CI 4.2-29.8) and to die in the ICU (52.5% versus 1.5%, p=<0.001, 95% CI 33.3-67.1) as compared to patients in cohort B. The average time from last chemotherapy to death was significantly longer (221 days) for cohort B patients as compared to cohort A patients (96 days), p=0.01. Patients in cohort A who had PC consultation during their hospitalization had no differences in the measured endpoints when compared to patients in cohort B. Conclusions: Cancer patients who die in the hospital while under MO service without PC involvement tend to have more aggressive EoL care. This may impact negatively on some QoL features. Early referral to palliative care services may facilitate better understanding and fulfillment of the needs of cancer patients and their caregivers by the healthcare-providers.
Arrhythmias during and after zoledronic acid infusion patients with bone metastasis.
Authors: Yazici Ozan , Aksoy Sercan , Ucar Ozgul , Özdemir Nuriye , Demir Mevlut , Sendur Mehmet Ali Nahit , Arik Zafer , Yaman Sebnem , Eren Tulay , Uncu Dogan , Zengin Nurullah
Published: March 2020

e20614

Background: Zoledronic acid (ZA) is one of the important biphosphanate which is widely used in bone metastatic cancer patients and osteoporotic patients. In a few studies it has been reported that treatment with biphosphonate was associated with an increased risk for atrial fibrillation. We aim to evaluate the arrhythmias that developed during infusion and immediately after infusion of the ZA. Methods: Bone metastatic 52 patients were included in study group. All of patients had totally 24 hour holter motorization during the first dose ZA infusion day. All of patients had 4 hours basal cardiac rhythm records before ZA infusion and about 19 hours after infusion. A short survey including demographic data and past medical history was completed. None of patients had clinically important arrhythmias before ZA infusion. We divided arrhythmias as supraventricular and ventricular. We evaluated arrhythmias pre, during and after ZA infusion. ZA were administered 4 mg IV in 15 minutes. Results: Thirty three of patients (63,5%) were male and 19 (36,5%) female. Median age of the patients was 52 (27-73). Most frequent cancers were breast (25%) and lung cancer (15,3%).Twelve (23%) patients had history of mediastinal radiotherapy. Three patients had history of myocardial infarction. In basal records we detected that twenty four of patients had supraventricular tachycardia (SVT) or ventricular premature systole (VPS). Fifteen of patients had SVT and fourteen had VPS during infusion period. After infusion period 48 of patients had SVT and 41 had VPS. Only 3 patients had none of arrhythmia after infusion. Three of the patients had sinusoidal arrhythmia and two had Mobitz type 2 bloc after infusion and also one of our patient who had no history of co morbidities and had SVT basal records, developed atrial fibrillation that refractory to medical cardioversion after 10 days of seventh dose ZA infusion. Conclusions: In this study we found that both SVT and VPS increased in cancer patients treated with ZA. Furthermore ZA may induce clinically important arrhythmias.
Predictive factors for winged scapula in breast cancer patients after immediate axillary dissection.
Authors: Nevola Teixeira Luiz Felipe , Lohsiriwat Visnu , Veronesi Paolo , Rietjens Mario , Teixeira Luiz Carlos , Garusi Cristina , Luini Alberto , Simoncini Maria Claudia , Sandrin Fabio , Zanatta Sarian Luis Otavio , Gandini Sara , Casales Schorr Mario , Sasse Andre Deeke
Published: March 2020

e20634

Background: Axillary lymph node dissection is an inevitable part of breast cancer surgery in certain cases. Definitive data regarding the incidence of postoperative winged scapula remains inconsistent. Ignorance of its diagnosis may lead to under-treatment and result in physical morbidity. Methods: All breast cancer patients who underwent axillary lymph node dissection procedures were recruited. In the early postoperative period, within 24 hours after surgery, the physiotherapy staff performed physical examinations to evaluate and identify the physical signs of long thoracic nerve injury by means of two specific orthopedic evaluation tests. The factors that may relate to winged scapula were recorded and analyzed. Results: From July to October 2012, 51 out of 187 patients were diagnosed with winged scapula (27.2%). The median age was 49.0 years old. 130 patients had undergone mastectomy and 100 cases had immediate breast reconstruction. Age, BMI, history of shoulder joint morbidity and previous breast surgery were not significantly associated with winged scapula. Administration of neoadjuvant treatment, mastectomy or breast conservative surgery, immediate reconstruction and its type, tumor size and nodal involvement also did not show any correlation. Conclusions: The winged scapula is not an infrequent sequela after axillary lymph node dissection in the breast cancer patient. It is usually underestimated and overlooked. There is no association between age, BMI, neoadjuvant treatment, type of breast surgery, tumor size or nodal stage. As breast reconstruction plats an ever-increasing role in current breast surgery practice it is interesting to note that reconstruction with prosthesis, even with serratus muscle dissection does not increase the incidence of winged scapula. Post reconstruction morbidity could interfere with the physical evaluation and outcome, but the result of our subgroup analysis showed no significant correlation among them. In our clinical experience, this sequela is not irreversible, being a transitory problem. Our series show only immediate 24 hr result that lack of long term follow-up and still need physical therapy proctocols to evaluate the recovery.
Which personal qualities do cancer patients value the most in their clinical oncologists?
Authors: Gil Deza Ernesto , Martin Reinas Gaston , Gercovich Daniela , Morgenfeld Eduardo L. , Tognelli Flavio , Montiel Monica , Garcia Gerardi Carlos Fernando , Rivarola Edgardo G. J. , Gercovich Felipe G.
Published: March 2020

e20636

Background: In the History of medicine, the most desired qualities in a doctor have changed over time. The objective of the following paper is to analyze which qualities do our patients (Pt) consider most important in their doctors. Methods: Between Oct 15th and Nov 15th, 2012, 1003 out of 3,795 Pt who were assisted at the IOHM were given the option to partake in an anonymous survey which evaluated the qualities they valued the most in their doctor, such as: knowledge, experience, honesty, sympathy, availability, humility, humanity or other. Each Pt was asked to pick the three they thought most important. Answers were gathered and analyzed according to frequency distribution. Results: A total of 845 out of 1003 (84%) Pt elected to participate. Population characteristics: Sex: fem: 332, male: 207, left blank (LB): 306. Mean age 58y (range 18 – 94). Married: 355, unmarried: 211, LB: 279. Children: Yes 460 No/LB: 385. Highest educational level achieved: primary studies:186, high school: 348, university: 216. LB: 98. Employed: 382, retired: 240, unemployed: 112, LB 111. The following results are expressed as a percentage of 845 Pt. The most valued qualities in a doctor were: knowledge (51%), honesty (44%), humanity (43%), availability (32%), experience (31%), humility (19%), sympathy (18%), others (3%). Although the most important quality was always knowledge, there was a marked difference between sexes: women valued humanity more than honesty (Chi square p=0.001) while men believed honesty (Chi square p=0.001) and experience (Chi square= 0.01) were more important than humanity. Conclusions: These results showed that there is no set of qualities that is valued above all others. Even though knowledge was always the most important, the value of the other six characteristics depends in great measure from the individual condition of the patients (such as sex, age and stage of the disease). However as the Pt usually do not have the skills to evaluate the Dr’s knowledge, honesty and humanity remains the most valued personal conditions.
Prospective assessment of hypercalcemia of malignancy and infectious complications.
Authors: Tavares Monique Celeste , Dal Molin Graziela Zibetti , Felismino Tiago Cordeiro , Fanelli Marcello Ferretti , Freitas Helano C. , Barros e Silva Milton Jose
Published: March 2020

e20644

Background: The hypercalcemia of malignancy (HM) is the major metabolic disorder seen in oncologic patients. Is a poor prognostic factor, given the median survival of 60 to 90 days. One hypothesis for this high mortality is a predisposition to infections. In the immune system, the vitamin D receptor and the vitamin D are responsible for immunomodulatory activities and may lead to an inhibition of proinflammatory cytokines production. Consequently, it creates an immunosuppression environment favoring the presence of infections. Methods: Descriptive study with prospective data collection. Data of selected adult patients, with ionized calcium (ICA) levels greater than or equal to 1.4mmol/L, hospitalized on Hospital AC Camargo, São Paulo, Brazil, were prospectively colected. Main objective: correlate the HM with infection and mortality. Survival analysis was performed by Kapplan-Meier curve and group’s comparison by the log-rank test. Results: Between Jan/2012 to Jan/2013, 90 patients were assessed. Mean age: 61 years. Most male (54.4%), solid tumors (89.9%), adenocarcinoma (46%). Tumors with higher incidence were gastrointestinal, head and neck and gynecological. Immunosupressive therapy was used by 10% of patients and 5.6% were neutropenic. Infection was diagnosed by 74,4% overall. Pulmonary and urinary tract were the main infection sites. Infection was observed in 100% of patients with ICA above 2mmol/L and 71% with ICA above 1.7 mmol/L. Fever was present in 58.9% of patients. 71,6% of these developed infection. Among patients with infection, the agent was isolated in 33.8%. Related to these, 52.7% were Gram-negative (GN) and 34.7% Gram-positive (GP). The overall survival (OS) at 90 days was 63% for all. OS at 90 days was 82.1% in patients without fever versus 47% in febrile (p = 0.040) and 82.2% in patients without infection versus 42.1% with documented infection site (p = 0.002). When the agent has been isolated, OS at 90 days was 62.9% for GN versus 33.4% for GP (p = 0.027). Conclusions: This study suggests that the prognosis of HM may be associated with higher incidence of infection. In this study we observed that the association of HM, fever and GP infection contributed significantly to higher mortality.
The psychological projective test Wartegg-Zeichentest: A contribution to the knowledge of patient with cancer—The experience of two Italian centers.
Authors: La Spina Chiara Maria , Beretta Giordano D. , Stinco Sergio , Ceresoli Giovanni Luca , Salvini Piermario , Ripa Cristina , Sauta Maria Grazia , Squadroni Michela , Rossi Agnese , Barone Carlo
Published: March 2020

e20650

Background: There is growing recognition that psychological implications are important in the comprehensive care of cancer patients (pts); the personality conformation may be an useful and constructive tool ground in order to promote psychic adaptation to cancer, improve communication with patient and keep a good level of quality of life. Methods: A personality projective test, the Wartegg-Zeichentest (WZT), was administered to cancer pts at the start of chemotherapy, in two Italian Oncology Departments from February 2010 to August 2012. During treatment, quality of life level with the Edmonton Symptom Assessment Scale (ESAS) and the possible presence of psychological disorder with the Psychological Distress Inventary (PDI) were also evaluated. Each patient followed a psychological support program. Results: Overall, 106 pts were enrolled. 47 (44%) received adjuvant chemotherapy, while palliative treatment was delivered in the remaining 59 (56%) cases. 39 (37%) pts showed ESAS values related to a poor quality of life, and PDI scores showed the presence of moderate-severe psychological disorders in 38 (35%) pts. Considering both test (ESAS e PDI), 24% of subjects had poor quality of life and moderate to severe psychological disorders. In this subgroup, 81% of pts showed a WZT profile characterized by depressive tendencies, liabilities, inhibition and passiveness behaviour. There was a significant correlation between ESAS and WZT (p<0.001), and between PDI and WZT (p<0.001). WZT had a predictive role in disclosing susceptibility to psychological disorders and treatment compliance. Conclusions: Cancer diagnosis affects perception of reality and discloses in some pts a personality profile characterized by depression, demoralization, inhibition and passiveness behaviour. This group of pts may be more keen to develop physic and psychological distress following cancer diagnosis and treatment. Early evaluation by WZT may be a useful instrument in preventing patient distress, as well in promoting the adaptation process to illness and maintaining a better level of quality of life.
Nausea and vomiting during high-dose interleukin-2 (HD IL-2) therapy.
Authors: Fesler Mark , Chu Melinda Bernabe , Armbrecht Eric , Fosko Scott , Hsueh Eddy C. , Richart John M.
Published: March 2020

e20661

Background: Nausea and vomiting (N/V) are two common side effects during HD IL-2 therapy. They may be severe enough to cause electrolyte imbalances or lead to missed doses, which may compromise response. Our aim was to describe the incidence of N/V during HD IL-2 therapy at our institution. Methods: A retrospective chart review of patients treated with HD IL-2 therapy (720,000 IU/kg per dose intravenously; 14 doses, 2 cycles per course, maximum 2 courses) from January 1999 to June 2011 at Saint Louis University was performed. Patients received scheduled PO ondansetron 24 mg daily and prochlorperazine 10 mg IV or PO every 4 hours as needed per standard protocol. Additional antiemetics were ordered at the clinician’s discretion. Data regarding incidence of N/V and use and type of rescue medication for N/V were recorded. Results: 104 patients were identified (68 melanoma and 36 renal cell carcinoma). Median age was 53.7 years (17.7-77.7 years) and there were 66 men and 38 women. Only 3.8% of patients (4 out of 104) were able to complete HD IL-2 therapy without rescue medication. All patients (n = 100) who needed rescue therapy received prochlorperazine on day 1 of treatment (acute phase) and at least 1 additional day during days 2-6 of each admission (delayed phase). Metoclopramide (n = 23) was the most common supplemental antiemetic ordered followed by promethazine (n = 16), meclizine (n = 5), and palonsetron (n = 3). Conclusions: Almost all patients who underwent HD IL-2 therapy had N/V that necessitated rescue therapy during both the acute phase and the delayed phase. Decreasing the incidence and severity of N/V may increase patients’ quality of life during this demanding regimen. Current protocols are single-institution based, but generally include daily 5HT-3 antagonists and prochlorperazine as needed. Our data suggests that this regimen is inadequate. One challenge to management is that steroids, which are commonly used as adjuncts, are contraindicated during immunotherapy. Additional therapeutic options are still needed. Recently new drug targets, including neurokinin-1 receptor (NK1R) inhibitors, have been approved to treat N/V during chemotherapy. NK1R inhibitors may be of assistance during immunotherapy with HD IL-2 in the future.
Practice patterns of bevacizumab-induced hypertension in cancer patients.
Authors: Escalante Carmelita P. , Lahoti Amit , Palla Shana L. , Lu Maggie , Overman Michael J. , George Marina , Abisaid Baker Rana , Palasamudram Shakar Saketh , Durand Jean-Bernard
Published: March 2020

e20664

Background: Vascular endothelial growth factor (VEGF) inhibitors such as bevacizumab (BV) can result in side-effects such as hypertension (HTN), proteinuria and acute kidney injury (AKI). The objectives are to evaluate practice patterns of BV-induced HTN; to assess frequency of BV dose reduction, withdrawal and delay due to HTN, proteinuria and AKI; and to determine the time course for initial resolution of BV-induced HTN, proteinuria and AKI. Methods: We retrospectively reviewed random charts of 75 cancer patients (pts) treated with BV from 1/1/2009 to 9/30/2011. This included demographic, clinical and outcome parameters. Descriptive statistics were utilized. Results: 37 (56%) were males with median age 56 years (range 19-84). Most had lung (14, 19%), breast (11, 15%), and colorectal cancer (10, 13%). 69 (92%)had metastatic disease. 70 (93%) pts were on BV with other antineoplastic agents. 37 (49%) had a diagnosis of HTN at study entry. The median days from first BV treatment (tx) to first hypertensive reading was 7 (0-279) and days to receiving new or dose increase of HTN meds was 49 (0-283). 44 (59%) pts had 2 consecutive readings ≥ 140 or ≥ 90 mmHg during BV tx and 49 (65%) during post-tx follow-up of 6 months or less. 14 pts received new or dose increase of HTN meds during tx. The most frequent HTN meds used were diuretics (26%), beta blockers (21%) and calcium channel blockers (17%). The average number of new HTN meds at last BV tx was 1.5. No pt had BV dose reduced due to HTN, proteinuria or AKI. BV was withdrawn in 2 (3%) due to HTN, 2 (3%) due to proteinuria and 1 (1%) due to AKI. 5 pts had a delay due to HTN (4) and AKI (1). 57% (8 /14) of pts receiving additional HTN meds during BV tx had first dose decrease of additional HTN meds post-tx at a median of 30.5 (11-162) days. The median number of days to resolve first proteinuria and first AKI was 20 (1-193) and 14 (0-34) days, respectively. Conclusions: HTN occurred in a majority with few receiving extra HTN meds although meeting HTN criteria. Patients continued to have HTN post-tx. However, despite HTN, few stopped BV due to cardiovascular events. Further education regarding HTN guidelines may be necessary and should be considered.
Simultaneous assessment of targeted anticancer therapy-associated mucocutaneous adverse events.
Authors: Boers-Doets Christine Bettine , Gelderblom Hans , Epstein Joel Brian , Lacouture Mario E. , Kaptein Ad A
Published: March 2020

e20669

Background: Mucocutaneous adverse events (mcAEs), including papulopustular rash, xerosis, pruritus, paronychia, hand-foot skin reaction, edema, taste alterations, oral pain and ulceration, hair-, periungual-, and ocular changes occur in the majority of patients during targeted anticancer therapies. Different mcAEs can be present with a variable symptom burden and affect upon patients’ quality of life. Use of standardized targeted therapy specific tools allows comparison of outcomes from different studies and in meta-analyses, advancing patient care and improving outcomes. A mcAE specific assessment tool about symptom burden is currently not available. A questionnaire which assesses both targeted therapy specific patient reported outcomes (PRO) measures and healthcare provider reported outcomes (HPRO) measures is warranted, therefore. Methods: A three-phase process was utilized for item generation, item reduction and scale construction. A comprehensive literature review was performed in PubMed, CINAHL and Embase, and study protocols were screened. Keywords were assessment, questionnaire, tool, EGFRI, and rash. All items with potential relevance for the tool were selected for further evaluation. Twentyone EGFRI treated patients filled out the draft-questionnaire. Results: The search resulted in a simultaneous tool in the form of 61 PRO, and 50 HPRO items. Both tools assess experienced mcAEs inclusive number of papules and pustules, area involved, severity and duration of the symptoms, used products, effectiveness of various (medical) interventions, treatment adherence and distress from the symptoms. Patient input resulted in the addition of 1 item, modification of 7 items, and deletion of 2 items. Conclusions: A novel tool has been generated to assess the experienced mcAEs and effectiveness of supportive care interventions. Since the patient and the provider report mcAEs simultaneously, the provided data are directly comparable, facilitating assessment of quality of life and, therefore, improving quality of medical care.
Prevalence of antibiotic resistant strains in fecal surveillance cultures of patients from a new tertiary care cancer center in eastern part of India.
Authors: Radhakrishnan Vivek Sulekha , Goel Gaurav , Das Dipmala , Ravichandran Sriram , Khushoo Vishvdeep , Bhave Saurabh Jayant , Chakrapani Anupam , Nair Reena , Bhattacharya Sanjay , Chandy Mammen
Published: March 2020

e20686

Background: Drug resistant organisms are a very common cause of infections in critically ill patients in India. Surveillance Cultures is part of a multi-factorial approach to control MDRO[Multi-Drug Resistant Organisms]. Colonization surveillance may have the potential to improve empiric antimicrobial treatment in a critical care setting. Methods: Design: Retrospective. Setting: Newly started Comprehensive Cancer Center in Eastern part of India. Period: Dec 2011 - Jan 2013. Review of fecal surveillance cultures of patients undergoing intensive chemotherapy for hematological cancers or haemopoietic stem cell transplant. Fecal Surveillance cultures were done prior to Intensive Chemotherapy using a method based on Landman D et al (J Clin Microbiol 2005). Results: 48 patients [35 male,13 female] admitted with diagnoses of AML(22), ALL(6), APL(1), Acute Mixed Lineage Leukemia(1), MDS(1), Hodgkin Lymphoma(1), DLBCL(1), Fanconi Anemia(1), Multiple Myeloma(4), and Myeloproliferative Disorder(1) had information on Fecal Surveillance Cultures. Mean age: 35yrs [range; Male: 6-67yrs, Female:10-59yrs]. Total Samples collected: 67. Median sample per pateint: 1(range 1-4). All samples excepting one, grew MDRO isolates (98.5%). No. of Isolates:136 [95 gram negative bacilli (GNB), 41 gram positive cocci (GPC)]. Among GPC isolates, resistance to Ampicillin, Vancomycin, High level Gentamycin, and Linezolid were 86.5% (32/37), 7.3%(3/41), 60.9%(25/41) and nil(0/41) respectively. Among GNB isolates, resistance to Cefotaxime, Ciprofloxacin, Co-Amoxiclav, Gentamycin, Amikacin, Piperacillin-Tazobactum, Meropenem and Colistin were respectively 90.8%(79/87), 67.4%(60/89), 67.4%(60/89), 45.2%(43/95), 23.4%(22/94), 39.7%(37/93), 25.8%(24/93) and 6.4%(5/78). In the coliform group, the prevalence of ESBL/Amp-C producing isolates was 91.7%. Carbapenamase production was noted in 25.8% of GNB isolates. Conclusions: There is a very high prevalence of background antimicrobial resistance in the enteric flora of patients receiving intensive chemotherapy at our center. The causes of widespread MDRO in our setting needs further studies.
An Irish breast cancer survivorship study: Are we meeting our patients' needs?
Authors: Naidoo Jarushka , Hayes Ellen , Teo MinYuen , Calvert Paula , Horgan Anne M. , O'Connor Miriam
Published: March 2020

e20687

Background: Breast cancer survivors account for the majority of cancer survivors in Ireland. There are no published data on the issues facing this group of patients. This study investigates the needs of a cohort of Irish breast cancer survivors who completed hospital-based follow-up and were recently discharged to their general practitioners (GP’s.) Physical, psychological, social and spiritual concerns were investigated. Secondary aims were to assess patient satisfaction with discharge from hospital-based services, satisfaction with GP follow-up, and the benefit of a survivorship discharge pack. Methods: A cohort of patients in the South East Cancer Centre was identified. Inclusion criteria were: a history of localized breast cancer, completion of adjuvant therapy within the last 5 years, and discharge to the patient’s GP in the last 6 years. An anonymous questionnaire was developed from standardized survivorship questionnaires, and ethical approval obtained. Subgroup analyses were completed for age and time since diagnosis using Fisher’s exact and Cochran-Armitage tests. Results: 80 patients were identified. 44 patients (55%) completed and returned the questionnaire. 5 patients were excluded (6%). The median age was 53 years (range: 41-65 years.) The commonest concerns were fatigue (51%), fear of recurrence (69%) and concerns regarding second cancers (69%.) 23 patients (59%) were satisfied with discharge to their GP and 25 patients (64%) were content with GP follow-up. 23 patients (59%) reported that a treatment summary would be of benefit. 27 patients (67%) felt they would benefit from a discharge pack. Patients under 60 years of age were more likely to report physical concerns (p=0.012). Patients reported fewer physical and psychological concerns over time after diagnosis (p-trend <0.001). Conclusions: This is the first Irish breast cancer survivorship study. Irish breast cancer survivors had ongoing concerns, but were satisfied with GP follow-up care. The current model of care could potentially be improved by the provision of a discharge pack that includes a treatment summary.
Detection of free radical formation in human skin upon systemic application of chemotherapeutics.
Authors: Patzelt Alexa , Zastrow Leonhard , Darvin Maxim E. , Chekerov Radoslav , Sehouli Jalid , Lademann Juergen
Published: March 2020

e20689

Background: A wide variety of chemotherapeutics is available for systemic therapy of cancers some of which, e.g., pegylated liposomal doxorubicin (PLD), paclitaxel, docetaxel, and capecetabin may induce dermal side effects (DSE). PLD is most prominent for its risk to induce palmar plantar erythrodysethesia (PPE). Recent investigations have shown that PLD escapes onto the skin surface with the sweat, and penetrates into deeper dermal layers like topically applied destroying the tissue via radical forming processes. PPE seems to be avoidable if antioxidant-containing ointments are applied previous and during therapy. To which extent this prevention strategy is feasible also for other chemotherapeutics was investigated in the presented study. Methods: The investigations were performed on 20 patients aged between 53 and 72 years who underwent their 2ndcycle of therapy with any of the aforementioned therapeutics. These volunteers exhibited no or only a mild form (grade I) of PPE at the timepoint of investigation. Using an optical skin scanner, the radical formation was indirectly measured via the decline of the antioxidant concentration immediately before and 2-4 h after the chemotherapy, respectively. Results: In about 50% of the volunteers treated with paclitaxel and in about 30% treated with capecetabin, the antioxidant concentration distinctly declined during chemotherapyThis decline was predominantly found in patients with a weak initial antioxidative protection system. Conclusions: Thus, the application of an antioxidant-containing ointment seems to be also a reasonable prevention measure for patients under therapy with other chemotherapeutics. Analyzing the antioxidant concentration with the optical skin scanner is a simple, non-invasive option to investigate any chemotherapeutic for radical forming processes in the skin during patient treatment.
Living with terminal hepatocellular carcinoma: The patient and family perspective.
Authors: Hansen Lissi , Rosenkranz Susan J. , Vaccaro Gina M.
Published: March 2020

e20702

Background: Hepatocellular carcinoma (HCC) is a growing problem worldwide; incidence of HCC in the U.S. has increased from 1.4 to 2.4 per 100,000 primarily because of people infected by hepatitis B or C. For those diagnosed with intermediate-advanced or terminal HCC, there is no curative treatment, and duration of survival is typically one to two years. Despite a high death rate, no studies were found examining experiences of living with terminal HCC and how it may affect end of life care from perspectives of both patients and family members. Methods: This pilot study used a prospective, longitudinal descriptive design, and qualitative and quantitative methods (mixed methods). Interview and survey (symptoms, quality of life) data were collected once a month for a 6-month period from 20 patient-family member dyads. Two researchers independently coded transcribed interview data into synthesized themes using inductive analysis, and met regularly to establish consensus on coding disagreements. Results: This poster reports on interview data from a convenience sub-sample of 14 patient-family member dyads. The interview data set comprised 56 interviews (14 conducted with patients, 11 with family members, and 31 with patient-family member dyads). Of the 14 patients, 11 were male and 3 were female (mean age=61.5, range=54-68 years). Of the 14 family members, 4 were male and 10 were female (mean age=57.4, range=22-68 years). Eight patients died during the study period. Findings from patient-family member dyad interviews included 5 major themes: 1) comparing diseases—differences and similarities between HCC and other types of illnesses/cancers (e.g., breast cancer), 2) uncertainty about treatments over time, 3) symptom management, 4) lack of support, and 5) family member caregiving struggles. Differences were found between interviews conducted with patients only and family members only, including perceived challenges in patient-family member relationships. Conclusions: From this first step, knowledge gained will serve as the foundation for a larger scale study and test of future interventions to address challenges (e.g., symptom management, caregiver burden) at the end of life for these cancer patients and their family members.