bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiotoxicity and heart failure in patients receiving chemotherapy: A nationwide analysis.
Authors: Mariam Roy Arya , Goel Akshay , Konda Manojna , Verma Rashmi
Published: May 2020

e19097

Background: Cardiotoxicity resulting in heart failure (HF) is one of the most common complications of chemotherapy which significantly impacts patient care and results in poor clinical outcomes. Based on prior clinical studies, cancer patients have multiple cardiovascular comorbidities and higher prevalence of cardiovascular diseases which makes them more vulnerable to cardiovascular injuries during chemotherapy. It may increase their risk of developing cardiomyopathy or worsening of the already existing cardiac conditions which result in HF and death. Methods: We conducted a retrospective analysis of the National Inpatient Sample Database for the year 2017. Patients who were admitted in the hospital for chemotherapy administration and those who have HF were identified using ICD-10 codes. The mortality of patients with HF who receive chemotherapy and the factors affecting the mortality were studied. The two groups that were studied are chemotherapy patients with and without HF. Results: A total of 29,018 admissions for chemotherapy were identified during the year 2017. Out of these, 2.64% of patients were found to have HF (n = 767). The median age for the patients who have an associated diagnosis of HF was 63. The overall mortality of chemotherapy-related admission was 0.80%. The mortality of patients with HF who received chemotherapy was higher than the patients without HF who received chemotherapy (4.3% vs 0.7%, OR = 1.82, p = 0.001). Patients with HF who were admitted for chemotherapy were 82% more likely to die while in hospital than those without HF. Females who have HF had a higher mortality rate and had 64% more odds of dying while admitted for chemotherapy than males with HF (7.92% vs 1.93%, OR = 1.64, P = 0.00, CI = 1.31- 1.82). Also, interestingly Asians who have HF had higher mortality while admitted for chemotherapy than all the other races who had HF who received chemotherapy (Asians vs Caucasians vs African Americans 13.63% vs 4.64% vs 2.85%, p = 0.041). Conclusions: The mortality of patients with heart failure who receives chemotherapy is higher than the overall mortality from chemotherapy-related side effects. Females and Asians who have HF had higher mortality while admitted for chemotherapy. Patients who have prior cardiovascular diseases have to be given diligent care and special attention while we plan for chemotherapy to prevent the development or worsening of heart failure.
The effect of regional anesthesia on cancer related outcomes after oncological surgeries: A systematic review.
Authors: Lin Jun , Jin Zhaosheng , Li Ru
Published: May 2020

e19099

Background: Surgical resection remains one of the main curative treatment options for most solid-organ malignancies, and oncological surgery caseload has been steadily increasing over the years (1). It has been hypothesized that regional anesthesia may improve cancer related outcome. Both retrospective and prospective studies have been conducted on various cancer types, using different regional anesthesia techniques; and most meta-analyses did not specify the cancer type or regional anesthesia technique as part of their primary outcome (2, 3). In this systematic review, we will review the evidence base of regional anesthesia techniques for each cancer sites. Methods: We systematically reviewed literature from PubMed for studies related to oncological surgery with regional anesthesia, and cancer related outcomes. Main outcomes of interest are recurrence rate or recurrence free survival. The strength of the evidence is reported descriptively. Results: Regional anesthesia techniques most studied in relation to oncological surgery and cancer outcomes are neuraxial (spinal and epidural) anesthesia, and paravertebral block. Neuraxial anesthesia have been shown to improve outcomes in both prostate and ovarian cancer surgeries. On the other hand, current evidence suggest that paravertebral block does not improve breast cancer outcomes, and neuraxial anesthesia does not improve colorectal cancer outcomes. Evidence regarding the use of neuraxial anesthesia in bladder cancer is conflicting. There are also limited evidence suggesting that regional anesthesia may not improve outcomes in lung and upper GI cancers. Conclusions: The protective benefit of regional anesthesia appears to be limited to certain cancer types. More studies are needed in order to determine the effect of regional anesthesia techniques on each cancer types and underlying mechanisms. 1 Vesey SG, McCabe JE, Hounsome L, Fowler S. UK radical prostatectomy outcomes and surgeon case volume: based on an analysis of the British Association of Urological Surgeons Complex Operations Database. BJU Int 2012; 109: 346-54. 2 Sun Y, Li T, Gan TJ. The Effects of Perioperative Regional Anesthesia and Analgesia on Cancer Recurrence and Survival After Oncology Surgery: A Systematic Review and Meta-Analysis. Reg Anesth Pain Med 2015; 40: 589-98. 3 Chen WK, Miao CH. The effect of anesthetic technique on survival in human cancers: a meta-analysis of retrospective and prospective studies. PLoS One 2013; 8: e56540.
National estimates of mental health needs among non-elderly adult cancer survivors.
Authors: Ji Xu , Cummings Janet , Gilleland Marchak Jordan , Han Xuesong , Mertens Ann C.
Published: May 2020

e19103

Background: As advancements in cancer therapies expand the population of long-term cancer survivors, it is important to understand long-term mental health (MH) outcomes associated with cancer experience. This study used a U.S. nationally-representative sample of adult cancer survivors to assess and compare MH outcomes across age groups. Methods: We used the 2015-2017 National Survey of Drug Use and Health to identify respondents aged 18-64 years who reported a history of cancer (survivors) or never had cancer. MH outcomes were operationalized as events in past year of: major depressive episodes, serious psychological distress, suicidal thoughts, suicidal plans, suicidal attempts, any mental illness, and serious mental illness. We compared these outcomes between survivors and those without cancer in adjusted regression analyses, controlling for respondents’ demographic (gender, race/ethnicity) and socioeconomic (health insurance, employment, education status, marital status) characteristics. All analyses were stratified by age group (18-34, 35-49, and 50-64 years). Results: When comparing 2,656 survivors and 112,952 adults without cancer within each age group, survivors had elevated prevalence of MH problems in in five of the seven domains of adverse MH measures. Among young adults (aged 18-34 years), survivors were more likely than their noncancer counterparts to experience major depressive episodes (18.1% versus 9.6%, p< 0.001), serious psychological distress (34.2% versus 17.9, p< 0.001), suicidal thoughts (10.5% versus 7.0%, p= 0.011), any mental illness (41.1% versus 23.3%, p< 0.001), and serious mental illness (13.2% versus 5.9%, p< 0.001) in the past year. These differences persisted in adjusted analyses ( p-values < 0.01). While similar survivor-comparison differences were observed among older groups, the magnitude of these differences was smaller. When comparing MH outcomes across age groups among survivors, young adult survivors had the highest likelihood of experiencing MH problems across all seven domains of adverse MH measures ( p-values < 0.05). Conclusions: This population-based study shows elevated prevalence of MH problems among adult cancer survivors, as compared to the general noncancer population. We also identified a clear age gradient in the prevalence of MH problems, with young adult survivors exhibiting the highest prevalence of adverse MH outcomes. Our findings highlight the importance of developing strategies to ensure early detection and screening of mental illness and improve access to MH treatment for cancer survivors.
Partner engagement and patients’ receipt of colorectal cancer surveillance.
Authors: Veenstra Christine M , Abrahamse Paul , Morris Arden M. , Hawley Sarah T.
Published: May 2020

e19106

Background: Over 50% of survivors of colorectal cancer do not receive guideline-concordant surveillance. In light of growing recognition that members of couples influence each other’s health behaviors, we sought to describe partner engagement in surveillance and evaluate associations between partner engagement and patient receipt of surveillance. Methods: In 2019 we surveyed patients who, in 2014-18, underwent resection of Stage III colorectal cancer and were seen at a community oncology practice, an academic cancer center, or reported to Georgia SEER (current RR 46%). Patients gave a separate survey to their partner. 254 partners (68% RR) completed surveys. Using existing measures, we assessed 3 partner-reported elements of engagement: 1) informed about surveillance; 2) involved (extent of and satisfaction with) in surveillance; 3) aware of patients’ values/preferences. Each measure was scored on a continuous scale with higher scores indicating greater engagement. We assessed patient receipt of surveillance by patient-report of receipt of CEA blood test, imaging, and colonoscopy/sigmoidoscopy (all y/n response). We performed multivariable regression analyses to assess associations between each element of partner engagement and patient receipt of surveillance, controlling for important partner- and patient-level variables. Results: Most partners (85%) were > age 50, female (64%), and white (86%). 27% had <high school education. Most patients (60%) had colon primary (vs rectal), received chemotherapy (95%), and were 3-4 years out from diagnosis (62%). Female partners and those with <high school education were more likely to report a greater extent of involvement; Partners < age 50 were more likely to report greater satisfaction with involvement. Female partners, those with <high school education, and partners of patients who received chemotherapy were more likely to report greater awareness (all p < 0.05). Being informed did not vary by partner or patient factors. Having a more aware partner was associated with greater patient receipt of surveillance colonoscopy/sigmoidoscopy (p = 0.01). Receipt of surveillance CEA or imaging did not vary by partner engagement. Conclusions: Partner engagement in patients’ surveillance varied by partner age, gender and education. Partner awareness of patient preferences was associated with patient receipt of surveillance colonoscopy/sigmoidoscopy. Our findings suggest that interventions to engage partners in patients’ surveillance may improve receipt of guideline-concordant care for survivors of colorectal cancer.
Feasibility of randomized controlled trials (RCTs) for drugs approved by the United States Food and Drug Administration (FDA) based on single arm studies.
Authors: Rittberg Rebekah , Czaykowski Piotr , Niraula Saroj
Published: May 2020

e19115

Background: US FDA introduced an Accelerated Approval (AA) pathway in 1992 to expedite access to promising new drugs, based on the assumption that RCTs would delay introduction or prove unfeasible. One resulting trade-off is an “interim” compromise in acceptable level of evidence: such approvals have increasingly relied on Overall Response Rates (ORR) from Single Arm Studies (SAS). FDA requires confirmation of benefits for such drugs in future RCTs, but that requirement may take years and often never met. Methods: We pooled drugs approved by FDA over 5 years based on ORR observed in SASs for solid tumors. We calculated the differences in ORR between the newly approved drugs and existing standard of care for each cancer sub-type, and designed hypothetical RCTs necessary to detect that difference. RCTs were designed based on power of 0.80, α-error of 5% (two-sided), and 1:1 randomization, using PS software (Vanderbilt University). We estimated accrual time for the RCTs using disease incidence and annual death rates for each cancer subtype in USA using Surveillance, Epidemiology & End Results records. Results: 28 of 129 (22%) FDA approved drugs for solid tumors, from 2015-2019, were based on SAS. Median sample size of 107 patients per approval (range 26-550). Drugs were approved based on median ORR of 38.9% (range 13-78%), compared to median ORR of 24.4% (range 5-62%) for existing standard of care [median difference in ORR 14.9% (range 6-45%)]. Using established statistical standards, median sample size required to conduct RCTs was 206 patients (range 44-1724); based on a conservative accrual rate of 5% of all eligible US patients, for 22 of 24 approvals RCTs with ORR as primary endpoint could have been completed within a timeframe equal to or less than the time used for undertaking the SAS. Drugs for 4 indications of 28 had a lower ORR compared to existing standard of care, while lacking evidence of superiority in any other survival outcome, raising important concerns about the approval process. Conclusions: Feasibility of conducting RCTs with an ORR endpoint within an acceptable time-frame does not appear to be a practical constraint for an overwhelming majority of drugs approved by FDA based on SAS alone. This finding questions the necessity of accepting a lower bar for efficacy and toxicity while approving drugs using the AA pathway, especially when supported by clinical equipoise with existing standards of care. ORR was lower than existing standard of care for 4 indications, putting rationale for these approvals into question.
Unplanned hospital admissions are a marker of decreased overall survival in patients with solid tumor malignancies.
Authors: Quinn Zachary L. , Vershvovsky Maria , Xu Alexander , Zibelli Allison M.
Published: May 2020

e19118

Background: For patients being treated for solid tumor malignancies, an unplanned hospitalization is a significant event that may help predict outcomes. Prior studies have demonstrated a 1 year mortality rate as high as 73% for oncology patients following an unplanned admission. As our therapies continue to improve, better understanding of the significance of acute hospitalizations is needed to help influence management decisions for oncology providers. Methods: We conducted a retrospective review of all patients admitted to a solid oncology inpatient service at Thomas Jefferson University Hospital (TJUH) who were discharged between January 1st and March 31st 2019. We excluded all patients who had not established care with a provider at TJUH prior to the index admission. We collected data on age, sex, length of stay (LOS), diagnosis, treatment activity, ECOG performance status (PS), 30 day and total re-admissions, survival and whether hospice was discussed during index admission. We censored data at 180 days after date of index discharge. We evaluated overall survival (OS) using the Kaplan-Meier method and compared survival to 30-day readmission and ECOG status using a log-rank test. Results: During our investigational time period there were 263 discharges, which yielded a study population of 182 patients. Median LOS was 5 days and 55% of patients were female. Gastrointestinal and genitourinary cancers were the most prevalent, observed in 32% and 28% of patients respectively. 75% of patients were on active treatment at time of admission. Survival data was available in 174 patients and at 6 months, OS was found to be 47%. 35% of patients were readmitted within 30 days of their index discharge. Patients readmitted within 30 days had a significantly lower OS than patients without a readmission (31% vs. 56%, P = 0.002). 70% of patients had a PS of 0 or 1 prior to index admission and OS in this group was significantly better in comparison to patients with a higher ECOG score (57% vs. 33%, P = 0.001). Hospice was discussed with 31% patients during index admission. Conclusions: We observed a 6 month overall survival of 47% following an unplanned admission and this was lower for patients that were re-admitted within 30 days. Higher PS scores predicted worse outcomes; however, the majority of patients had a favorable PS prior to index admission. This study suggests that following an unplanned admission, oncology patients are at elevated risk for poor outcomes and that providers should reassess goals of care at follow up clinic visits.
Prognostic value of programmed death-ligand 1 in solid tumors: A meta-analysis.
Authors: Scott Jordan L , Nadler Michelle , Desnoyers Alexandra , Almugbel Fahad , Fazelzad Rouhi , Amir Eitan , Saleh Ramy
Published: May 2020

e19121

Background: The programmed cell death 1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) pathway plays a crucial role in cancer immuno-surveillance and is the target of approved immunotherapeutic drugs. Available data suggest a variable prognostic impact of PD-L1 expression in solid tumors. Methods: A systematic literature search of electronic databases identified publications exploring the effect of PD-L1 on overall survival (OS) and/or progression-free survival (PFS). Hazard ratios (HR) were pooled in a meta-analysis using generic inverse-variance and random effects modeling. Subgroup analyses were conducted based on disease site, stage of disease, and method of PD-L1 quantification using the Deeks method. Results: One hundred eighty-eight studies comprised of 212,748 patients met the inclusion criteria. PD-L1 expression was associated with worse OS (HR 1.32, 95% confidence interval (CI) 1.25 - 1.38; P < 0.001). There was significant heterogeneity between disease sites (subgroup P = 0.002) with pancreatic, hepatocellular and genitourinary cancers being associated with the highest magnitude of adverse outcome (Table). PD-L1 was also associated with worse overall PFS (HR 1.19, 95% CI 1.09 - 1.30; P < 0.001). Stage of disease did not significantly affect the results (subgroup P = 0.52), nor did the method of quantification (immunohistochemistry or mRNA) (subgroup P = 0.70). Conclusions: High expression of PD-L1 is associated with worse cancer outcomes albeit with significant heterogeneity between disease sites. The effect seems consistent in early stage and metastatic disease and is not sensitive to method of PD-L1 quantification. [Table: see text]
An ethnographic study illuminating the effect of endogenous and exogenous uncertainty on tumor board decision making.
Authors: Oureilidis-DeVivo Barbara
Published: May 2020

e19156

Background: Hospital tumor boards (TBs) exist to help multidisciplinary specialists determine the best treatment plan for patients through multidisciplinary input and evidence-based treatment recommendations. However, decision-making processes and outcomes vary and may not consistently follow a linear, rational decision-making process or represent evidenced-based clinical guidelines. The ad hoc nature of multidisciplinary cancer teams can create limitations in interoperable functioning, especially in ambiguous environments. Methods: This qualitative ethnographic study explores levels of patient situational complexity under TB review within different structural dynamics in a group and describes how TBs cope with uncertainty when making treatment decisions. The study reports on original research and used ethnographic methods in 44 tumor boards at seven research hospitals in the United States and United Kingdom. Results: Results show TB decision-making process and outcomes are obstructed by the level of situational complexity in each patient’s case depending on the social dynamics of the group. Conclusions: Although multidisciplinary teams provide the benefit of variety in backgrounds and expertise, this structural diversity can also lead to limitations in the actual functioning of a group. By exploring the variations in this decision-making process, a deeper understanding can be reached of how oncology physicians make decisions about the clinical pathway for cancer patients and how this affects TB functionality.
Patient-centered pathology reports for breast cancer care: Interim results of a randomized pilot study.
Authors: Gore John L. , Javid Sara , Austin Elizabeth , Kilgore Mark , Parker Elizabeth , Holt Sarah K , Brewer Elena , Chan William , True Lawrence D.
Published: May 2020

e19157

Background: Receiving a new cancer diagnosis event is a daunting event, quickly followed by complex decision-making between patients and care teams. In order for patients to fully engage in shared decision-making with their providers, they must have access to understandable, patient-centered information that empowers them to take an active role. Yet cancer pathology reports currently target providers and are marred by complex medical terminology. To address this gap, we designed and piloted patient-centered pathology reports (PCPRs) for breast cancer surgical pathology. We hypothesized that PCPRs would result in patients having greater pathology knowledge and decisional self-efficacy. Methods: PCPRs were designed with continuous guidance from breast surgeons, pathologists, and patient advocates with the goal of providing a supplemental tool to translate standard pathology reports to layman’s terms for patients. PCPRs were built into the electronic medical record and tested for quality and accuracy over a 4-month period. Participants were recruited from the clinical practices of two breast surgeons and randomized to receive either the PCPR and standard pathology report or standard pathology report alone. Patients were surveyed at baseline and one month after to assess their breast cancer knowledge and ratings of confidence (scale 1-5) and decisional self-efficacy (DSE) for treatment decision-making (scale 0-100). Results: Of a planned 40 pilot patients, 30 have been enrolled, randomized (20 standard report patients, 10 PCPR patients), and have follow up data. Evaluation of patient knowledge showed that compared with the control group, patients who received a PCPR had similar knowledge of the important elements of their report (p = 0.10-p = 0.69) with greater specificity for those report elements. Confidence in their diagnosis slightly favored PCPR recipients (confidence rating mean 4.00 vs. 3.77 for control patients, p = 0.67). Patients receiving the PCPR had better DSE immediately after receipt of the pathology report than standard report patients (DSE 96.0 vs. 82.2, respectively, p = 0.05) with a more attenuated DSE difference one month later (DSE 87.3 vs. 79.2, respectively, p = 0.35). Conclusions: This interim analysis suggests that providing breast cancer patients with patient-centered pathology reports may contribute to an improved ability to engage in shared decision-making. Confirming these results with complete pilot data could inform a larger multicenter study to validate their effectiveness in clinical cancer care.
Clinical benefits of a nutrition-focused quality improvement intervention at a safety-net hospital gastrointestinal oncology clinic.
Authors: Levonyak Nicholas , Hodges Mary P , Broome Nicole , Mhoon Verca , Beg Muhammad Shaalan , Kainthla Radhika , Jones Amy Little , Sanjeevaiah Aravind , Kazmi Syed Mohammad Ali
Published: May 2020

e19163

Background: Patients with GI cancer have high rates of malnutrition related poor outcomes. In the GI Oncology clinic at Parkland Health and Hospital System (PHHS), a safety net hospital, the number of GI cancer patients with a documented nutrition assessment by a registered dietitian was 5-7%. The aim of QI project was to increase the rate of documented nutrition assessment by a registered dietitian to 25%. Methods: Three PDSA cycles were conducted after identifying barriers to nutritional interventions. A registered dietitian was assigned to the GI oncology clinic during the 1st PDSA cycle, an adapted Malnutrition Screening Tool (MST) was implemented through the institute electronic medical record during 2nd PDSA cycle, and clinical staff was trained during 3rd PDSA cycle. Patient weight, ECOG performance status, and serum albumin were recorded at initial visit and 3-month follow up from May-July 2019. Paired t Test was performed. Results: Through PDSA cycles, the percentage of GI oncology patients with documented nutrition assessment increased from 5.9% to 21.8% by July 2019 and has sustained over subsequent 6-month period. From May-July 2019, there were 132 new patients seen by the registered dietitian, with 63/132 patients (47.7%) with GI cancer. Between the initial dietitian visit and 3-month follow up, significant average difference in weight -1.14 kg (CI: -2.17, - 0.19; p 0.02) was observed among all patients. However, there was no significant difference observed in average difference in weight in GI cancer patients -0.78 kg (CI: -2.4, +0.9; p = 0.34). Improvement and stability in ECOG performance status was observed in 87.5% of GI cancer patients and there was a non-significant improvement in average difference in serum albumin. Conclusions: Through a nutrition focused QI program on GI cancer patients at high risk of malnutrition, the rate of documented nutrition assessment was doubled. The GI cancer patients maintained weight, ECOG performance status, and serum albumin over 3-months.
The impact of a precision medicine program on molecular testing rates for advanced non-small cell lung cancer (aNSCLC): Based on community-based provider survey assessment.
Authors: Clinton Natasha , Patel Kashyap B. , Weidner Susan
Published: May 2020

e19179

Background: Rapid development in the Precision Medicine has provided oncologists the opportunity to offer individualized approaches to treat advanced non-small lung cancer(aNSCLC), one of the most devastating cancers, which until the past decade was thought to be invariably fatal within months. Despite superior outcomes associated with targeted therapy, most patients are not tested for all guideline-recommended molecular alterations. There is a need to educate and train health care providers (HCPs) and create standard testing patterns across the care continuum. Methods: We developed and launched a precision medicine program in January 2018 through the inception of a Precision Medicine Advisory Panel made up of community oncologists, oncology pharmacists and oncology nursing and research staff. The goal of our precision medicine program is to facilitate and drive the adoption of appropriate biomarker testing. To accomplish this, we focused on the development of testing recommendations and proactive HCP education. To evaluate the effectiveness of our program, improvements have been measured through annual audience response surveys of providers treating this patient cohort. Results: Year 1 less than 30% of survey participants were always requesting tissue-based molecular testing prior to starting first-line therapy. This increased to over 70% within an 15 month timeframe. Approximately 95% of respondents never or infrequently considered both tumor- and peripheral blood-based testing. Through the survey it was demonstrated that at least 25% are ordering both always or frequently. Timing of test results is very important within this patient population. In year 1, more than 50% of survey respondents would initiate therapy before the test results were received. The survey demonstrated significant improvement in Year 2, with more than 70% reporting never or rarely start therapy ahead of result availability. Conclusions: Although there has been demonstrated progress, areas for continued improvement exist. These include tissue allocation and payer coverage for molecular testing. Through continuing education and quality initiatives, we plan to maintain and demonstrate further improvements in testing adoption and appropriate utilization.
Bone pain associated with rhG-CSF or PEG-rhG-CSF in oncology patients.
Authors: Fan Zhisong , Su Yu , Wang Long , Wang Yudong , Zuo Jing , Liu Fengling , Jiang Da
Published: May 2020

e19186

Background: Recombinant human granulocyte colonystimulating factor (rhG-CSF) and glycoPEGylated G-CSF (PEG-rhG-CSF) are two kinds of drugs in reducing the incidence and duration of neutropenia in oncology patients treated with chemotherapy. Although the acting time is different, bone pain is one of the most common adverse events in rhG-CSF and PEG-rhG-CSF. The purpose of this study is to describe the occurrence and management of bone pain in oncology patients receiving rhG-CSF and PEG-rhG-CSF. Methods: Two hundred and forty patients with malignant tumor received rhG-CSF or PEG-rhG-CSF after chemotherapy were enrolled to finish questionnaires about the side effect of bone pain. The incidence, location, duration, degree and treatment of bone pain after rhG-CSF or PEG-rhG-CSF used were collected and analyzed. Results: A total of 240 patients enrolled and 56.3% (135) patients had bone pain after rhG-CSF or PEG-rhG-CSF delivered. The most common parts of bone pain were thigh (35.6%), back (29.6%), waist (25.9%), shoulder (23.7%) and chest (21.5%). The bone pain of 39.2% patients last for 72h and 27.2% patients last less than 72h. The duration time of bone pain was longer in PEG-rhG-CSF than rhG-CSF. There was no significant difference in the rate of pain occurrence and the proportion of severe pain between rhG-CSF and PEG-rhG-CSF. Only 22.2% patients took drugs to relieve bone pain. Downregulated the doses of rhG-CSF or PEG-rhG-CSF could significantly relieve bone pain. Besides bone pain, 34.0% patients suffered muscle ache which was the second most side effect and occurred more often than runny nose and fever. Conclusions: The percentage of bone pain occurrence are similar in rhG-CSF and PEG-rhG-CSF, but the duration time was longer in PEG-rhG-CSF. For most patients, bone pain need not to deal with, Dose reductions can effectively relieve the mild to severe pain.
Pattern of prescribing after disease progression following upfront docetaxel in metastatic hormone-naïve prostate cancer within the UK: Results from a national study.
Authors: Das Prantik , Taylor Sarah , Abdullah Sadia , Das Kiran
Published: May 2020

e19190

Background: Upfront docetaxel is now standard of care for men with newly diagnosed metastatic hormone naïve prostate cancer .After disease progression following upfront docetaxel, various treatment agents including further lines of chemo or novel hormonal agents are used but there have been no convincing evidence or consensus opinion about optimal sequencing. Methods: We have conducted a national study in the UK by approaching oncologists who treat prostate cancer with systemic therapies. The oncologists were requested to complete a web based survey about their treatment decisions . Aim were to gain an insight about current practice following docetaxel in the UK and to identify the various disease and patients related factors which could influence the decision-making process. Results: 114 oncologists were invited and 59 have responded, 80% clinical oncologist and 20% medical oncologists respectively. At the point of castrate-resistant disease progression, following docetaxel, abiraterone was most commonly used agents (63%), followed by Enzalutamide (29%), cabazitaxel (6%) and docetaxel re-challenge respectively. Time difference between finishing docetaxel and disease progression was considered the most important deciding factor to choose next agents. Other important factors as per responders were volume of the disease, patients current symptoms, co morbidities and site of metastases . Most oncologists felt initial PSA and Gleason scores were two least important deciding factors. Patients with low volume disease, 92 % oncologist preferred abiraterone or enzalutamide as opposed to chemotherapy. When disease progressed within 6 months of completion of docetaxel, only one fifth of responder would use further chemo in next line .After novel hormone agents, cabazitaxel was the most commonly prescribed agents. 81% of clinicians would consider re-challenging with Docetaxel at some point of treatment sequencing; of these the majority would only consider this after a minimal interval of 12-18 months following upfront treatment. Conclusions: Our study has demonstrated a wide variation of practice in the UK. It has reflected that the decision is complex and there is clear need for further evidence or guideline for sequencing.
What is most important in predicting survival? Quantifying the relative effect of patient factors, stage, hospital, quality metrics, and treatment on survival following GI cancer resection.
Authors: Aquina Christopher Thomas , Becerra Adan Z , Tsung Allan
Published: May 2020

e19203

Background: Prior studies have identified patient characteristics, TNM stage, quality metrics, and systemic therapy as factors associated with survival. However, studies have not quantified the relative predictive impact these factors have on survival. The purpose of this study was to rank the importance of factors effecting survival following GI cancer resection. Methods: The National Cancer Database identified patients who underwent potentially curative surgery for esophageal, gastric, pancreatic, colon, or rectal cancer from 2006-2015. Hierarchical Cox proportional hazards models for the outcome of 5-year overall survival assessed the proportion of explained variance by sociodemographic patient factors, TNM stage, the hospital where surgery was performed, perioperative quality metrics (lymph node [LN] yield, margin status, prolonged length of stay [LOS], unplanned readmission), and treatment (chemotherapy and radiotherapy [RT]). Results: Among 306,164 GI cancer resections, stage, LN yield, margin status, prolonged LOS, readmission, and chemotherapy were independently associated with survival. The relative importance of these factors varied by organ system. However, aside from patient factors, the hospital where surgery was performed ranked as one of the most important factors across all organ systems, and prolonged LOS was important across all organ systems. Conclusions: The hospital where surgery is performed is one of the most important factors explaining variation in survival, and it appears that prolonged LOS, which serves as a proxy for postoperative complications, also has a strong predictive ability on survival. Research identifying differences between hospitals that explain this hospital effect as well as which complications reduce survival is warranted. [Table: see text]
Evaluation of the inclusion rate in clinical trials of bladder cancer patients evaluated for first time in the oncology department.
Authors: Vidal Natalia , Puente Javier , Moreno Fernando , Alfonso María del Rosario , Suárez Lydia , Paz Cabezas Mateo , Pérez-Segura Pedro
Published: May 2020

e19219

Background: In the Genitourinary (GU) Cancer Unit of Clínico San Carlos Hospital the inclusion rate in Clinical-Trials (CTs) from January-October 2018 was 39%. However, in bladder cancer patients it was only 24%. We identified improvement areas in order to increase the inclusion rate of these patients up to 30% from November 2018-March 2019. Methods: We used as an instrument the American Society of Clinical Oncology (ASCO) Quality Training Program (QTP). We collected the number of proposals and available CTs, the number of bladder cancer patients evaluated for the first time and the patients enrolled in CTs. We also identified the causes of non-enrollment and elaborated a list of possible solutions. Results: We developed a cause-effect diagram showing that the most relevant causes of non-enrollment in CTs were the eligibility criteria (60%) and the absence of available CTs (35%). We created a list of measures and identified which would have a higher impact. On November 2018 we started a protocolized Supportive-Care evaluation by our Oncology nurses to increase the number of eligible patients. We also initiated the diffusion of CTs in the Investigation Unit and in the GU-board to increase the number of available CTs and recruitment. In January 2019 we implemented a Geriatric evaluation for the elderly, also to increase the number of eligible patients. With these measures the number of accepted trials increased from 5 in January-October 2018 to 12 in November 2018-March 2019. Also, in January-October 2018, 46% of patients were not-enrolled in a CT due to ineligibility, which decreased to 25% from November 2018-March 2019. As a result, the enrollment rate increased to 43, 75% from November 2018-March 2019. We maintained the measures, and achieved an enrollment rate of 54, 83% from May-December 2019. Conclusions: The implementation of a Supportive-Care and a Geriatric evaluation, and the diffusion of CTs helped increase the percentage of eligible patients and the number of available CTs. With these improvements, we were able to increase the enrollment rate in CTs from 24 to 58, 83%.
Characterizing patients with breast cancer who seek second opinions at an academic cancer center.
Authors: Fracci Sarah , Balanean Alexandrina , Kapadia Heli , Swamy Sidarth , Grace-Louthen Cathy , Lo Shelly S. , Silva Abigail , Markossian Talar
Published: May 2020

e19229

Background: Although second-opinion (SO) seeking is common in the field of oncology, there is limited empirical research on its drivers and consequences. This study’s objective is to compare the demographic and tumor characteristics between patients with newly diagnosed breast cancer who seek out SOs for treatment planning purposes with those who do not. Methods: This retrospective study includes women with newly diagnosed breast cancer who attended a single academic cancer center between 2017 and 2018 for an initial treatment consultation. Data elements were extracted from the medical record. Characteristics of first opinion and SO seekers were compared using descriptive statistics and chi-square testing. Multivariate logistic regression was used to identify predictors of SO seeking. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated. Results: Of the 547 newly diagnosed patients, 147 (26.8%) were SO seekers. Compared to those seeking a first opinion, SO seekers were statistically significantly more likely to be younger and White and to have multiple primary (versus single) tumors, and have more advanced stage (II-IV) tumors. The two groups did not differ in terms of marital status, insurance, tumor grade, and tumor hormone receptor status. In the multivariate analysis, age, race/ethnicity, and tumor stage remained statistically significant. Compared to those age 65 and older, those age <54 (OR=2.28; 95% CI:1.38-3.79) and those age 55-64 (OR=1.83; 95% CI:1.10-3.06) had a higher odds of seeking a SO. Compared to White women, Black (OR=0.33; 95% CI:0.18-0.63) and Hispanic women (OR=0.51; 95% CI:0.25-1.05) had a lower odds of SO seeking. Women with advanced stage tumors (OR=1.86; 95% CI:1.22-2.86) had a higher odds of seeking a SO compared to those with earlier stage tumors. Additionally, SO seekers had higher odds of multiple primary tumors (OR=1.63; 95% CI:0.99-2.69). Conclusions: In this study, SOs for breast cancer care were relatively common. SO seekers were more likely to be younger, White, and to have more advanced disease stage. Further analyses will include investigating the role of psychosocial factors in SO seeking and treatment changes resulting from SOs. More research on the value of SOs is needed to help guide patients and providers.
Number of sentinel lymph nodes (SLN) removed in breast cancer (BC) patients undergoing sentinel lymph node biopsy (SLNB) in the province of Saskatchewan, Canada: Real-world experience.
Authors: Wees Tyrell , Narasimhan Gopinath , Souied Osama , Khan Muhammad , Bashir Ayesha , Ahmed Shahid , Ahmed Osama , Salim Muhammad , Chalchal Haji I.
Published: May 2020

e19240

Background: SLNB is considered standard of care for BC patient's undergoing surgery. This standard of care is based on several randomized, prospective clinical trials showing non inferiority of this procedure compared to full axillary lymph node dissection (FALND). Retrieval of less than 3 lymph nodes at the time of SLN biopsy has been shown to be associated with decrease in disease specific survival. In the NSABP B-32 study, removal of two SLN rather than one almost halved the false negative rate. SK has an area of 651,900 square kilometer, with a small population of 1,098,352. This population is widely distributed throughout the province with variable access to health care. This study provides us with a unique opportunity to see if data obtained in clinical trials can be replicated in community settings. Methods: After approval from SK Cancer Agency and research ethics board of University of SK. Female Patient’s with BC who underwent SLNB from Jan 2010 to Dec 2014, were identified using cancer registry. 529 charts were reviewed retrospectively. Exclusion criteria’s were Male BC, pathology other than invasive ductal or lobular, locally advanced or metastatic disease, T4 tumors, patients who received neo adjuvant therapy, patients who had declined or were unable to receive post-operative recommended adjuvant systemic or radiation therapy, patients with full axillary lymph node dissection. Data was analyzed using SAS 9.4 software. Results: Rate of 1, 2 and 3 or more SLN was 21, 35 and 44% respectively. The median number of lymph nodes retrieved were 2. 14% of patients had positive lymph nodes. 259/529 (48.9 %) of patients used both vital blue dye and radiotracer method for detection of SLN. In 510/529 (96.4%) radiotracer method was used to detect lymph nodes. Blue dye was used in 264/529 (49.9%). Median number of SLN retrieved using both methods were 2. No change in median number of SNL retrieved in different quadrants and central part of the breast were noted, the number remained 2. Conclusions: Our review showed that rate of single lymph node retrieval was lower than what is reported in US SEER data base study of 37%, however the number of median lymph node retrieval was 2 which is considered less than optimal with reported higher rate of false negative rate. We did not attempt to look at disease-specific survival as our sample size is small. Continued data evaluation of established practice is required to improve quality of care and replication of advances established in clinical trials.
Engaging patients on tumor boards: A multi-stakeholder perspective study.
Authors: Smith Kelly M , Hill Mary A , Rosendall Kelly , Farha Maen
Published: May 2020

e19243

Background: Patient and family-centered care (PFCC) is grounded in the concepts of dignity and respect, information sharing, and active participation and collaboration in their health care. Efforts to engage patients and family members as part of the healthcare team as part of robust multidisciplinary breast cancer care (MBCC), including in multidisciplinary tumor boards, is an extension of PFCC for breast cancer care. Our team explored multi-stakeholder perspectives of engaging patients as partners on a virtual multidisciplinary tumor board (MTB) using an mHealth application. Methods: We conducted a prospective cohort study employing semi-structured interviews and focus group methodology to explore stakeholder (patients with Stage 0-III breast cancer, family members/caregivers, clinicians, and tumor board staff) perspectives of engaging patients in a virtual MTB. Interviews and focus groups were audiotaped, transcribed, and analyzed using concurrent content analysis to identify common themes. Recruitment continued until saturation of themes was achieved. Results: We conducted 22 interviews and 5 focus groups with 49 participants. Patients and family members reported discomfort with idea of engaging in MTB discussions about their cancer. Disease burden, limited understanding of medical terminology, and not wanting to be a part of the early discussions about their disease (e.g., being overwhelmed, need to trust clinician’s advice) were commonly reported. Clinicians and staff also reported concerns about patient engagement in MTB. Clinicians reported that it may change the candor of the discussions at MTB and obfuscate the problems/issues if they needed to modify their language to accommodate patients’ sensitivities. Clinicians and staff were also concerned about patient’s perception of discordance within the MTB clinician members and how to explain this uncertainty to patients. Staff concerns centered around the use of medical terminology which may create anxiety and result in patient misunderstanding. Conclusions: Clinicians, staff, patients and family members were overwhelmingly concerned about adding patients to the MTB. Engaging patients in the frank and candid early treatment planning discussions may need further evaluation in a clinical environment and among different patient cohorts.
Impact of a multidisciplinary tumor board in the treatment of genitourinary tumors: Real-world data from a referral center in Mexico.
Authors: Salazar-Mejía Carlos Eduardo , Zayas-Villanueva Omar , Wimer-Castillo Blanca Otilia , Gallegos-Arguijo Daniel Alberto , Piñeiro-Retif Rafael , Arrambide-Gutiérrez Gustavo , Gutiérrez-González Adrián , Salinas-Chapa Matías , Hernández-Barajas David , Vidal-Gutiérrez Oscar , González-Guerrero Juan Francisco , Vera Badillo Francisco Emilio
Published: May 2020

e19248

Background: International guidelines for genitourinary cancers recommend treatment decisions by a multidisciplinary tumor board (MTB). The benefits of a MTB include greater accuracy in staging and in the probability of receiving care in compliance with international clinical practice guidelines, greater access to clinical trials, better communication between treating physicians and cost-effective care with greater patient satisfaction, which could translate into better outcomes. Our objective was to assess the impact of a MTB in the management of patients with genitourinary tumors in a tertiary referral university center of México. Methods: We performed a retrospective analysis of all cases presented to the Genitourinary Tumor Committee of our hospital from March to August 2019. Results: A total of 84 patients were included in the analysis; of these 80% were men with a median age of 61 years. Of all the cases, 68% were first-time presentations with a median time from evaluation to presentation of 4 days. The most frequently discussed diagnoses were prostate, urothelial and renal cancer, each corresponding to about 28% of the sample. Forty-six percent of the cases presented were in metastatic disease. The median time for discussion of each case after its presentation was 10 minutes. Changes were made in the clinical stage and treatment plan proposed by the most responsible physician in 4% and 46% of the cases, respectively, achieving a unanimous consensus in 88%. After the MTB session, 29 patients were lost to medical follow-up and were not subsequently evaluated. Among the 55 patients who underwent reassessment, the recommendations of the MTB were applied in 92%. Conclusions: Discussion of urologic oncology cases at the MTB led to a change in the treatment plan in almost half of the patients. Although MTBs are an increasingly common practice in Mexico, this is the first study that describes the impact that these sessions have on the management of genitourinary tumors in our population. The high rate of loss to medical follow-up remains an important problem in developing countries, negatively affecting the prognosis of these patients.