bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of compliance in colposcopy clinic follow-up among the uninsured
Authors: Wenzel L. , Chase D. , Hawk J. , Osann K. , Tewari K.
Published: August 2020

e20511

Background: Despite successful screening programs for cervical cancer, ethnic disparities persist. The no-show rate for follow-up appointments after HPV-related abnormal pap smears approximates 50% in high risk populations. We sought to identify factors that may influence follow-up compliance in a multi-ethnic, low income population at risk for cervical cancer. Methods: A longitudinal cohort study was conducted by chart review for all patients identified as having had a colposcopy exam for HPV-associated cervical dysplasia at a southern California inner city clinic from 2006 to 2007. Compliance was defined as obtaining a pap smear within 3 to 14 months from the initial colposcopy. The following variables were evaluated in a multivariate logistic regression model to identify factors which predicted follow-up compliance: race, age, preferred language, insurance, income, marital status, cytology, histology, history of a LLETZ, and pregnancy status. Results: During the study period, 438 patients attended the colposcopy clinic. This approximates 52% of the 912 scheduled clinic appointments during 2006. Patients’ median age was 28 years, 41% were Spanish speaking, with an estimated median income of less than $20,000 for half of the sample. Approximately 71% of patients had temporary publically-funded insurance. Only 55% (239/438) returned for recommended follow-up pap smear. In univariate and multivariate analysis, neither language, Spanish surname, median income, age, histology, nor insurance status predicted adequate follow-up (p=ns). A history of having undergone a large loop excision of the transformation zone (LLETZ) was the only factor which significantly predicted compliance with recommended follow-up pap smear (OR=1.76; 95% CI 1.08–2.895). Conclusions: Follow-up compliance for this high-risk, low income population is very poor. Identifying factors which predict noncompliance could inform strategies to improve care. In this analysis a history of LLETZ was the only variable which predicted whether follow-up care occurred as recommended. Results suggest that intensive, culturally-sensitive colposcopy clinic-based educational interventions should be developed and evaluated.

No significant financial relationships to disclose.
Treatment of chemotherapy-induced breakthrough nauea and vomiting
Authors: Navari R. M. , Gray S. E.
Published: August 2020

e20536

Background: Patients may experience breakthrough nausea and vomiting (BNV) despite adequate prophylaxis for chemotherapy-induced nausea and vomiting (CINV). BNV presents a difficult situation as treatment of ongoing nausea and vomiting is challenging. We investigated three different drug classes for the treatment of BNV: phenothiazines (prochlorperazine)(Pro), dopamine-serotonin receptor antagonists (metoclopramide) (Meto), and a corticosteroid-thiobenzodiazepine combination (dexamethasone plus atypical antipsychotic olanzapine) (Dex-Olan). Methods: Adult patients, receiving moderately emetogenic chemotherapy and CINV prophylaxis with a 5-hydroxytryptamine-3 receptor antagonist and Dex pre-chemotherapy and Dex post-chemotherapy according to ASCO guidelines, who experienced BNV during the five days post-chemotherapy were randomized to receive Pro, 10 mg IV, and 10 mg, po, bid for three days; Meto, 20 mg IV, and 10 mg, po, bid for 3 days; or Dex, 20 mg IV and Olan, 5 mg, po, bid for three days. All patients also received at least one liter of IV fluids during the IV phase of their treatment. Patients were excluded if they had undergone rescue therapy with any of the study agents. Beginning with the first day of treatment for BNV (day 1) and daily through day 5, patients recorded episodes of vomiting/retching, nausea, other symptoms utilizing the M.D. Anderson Symptom Inventory, and the utilization of any additional rescue therapy. One hundred six patients (median age 61, range 37 - 85, 60 males, ECOG performance status ≤ 2) consented to the protocol and 100 were evaluable. Results: A complete response (no emesis, no additional rescue) for the five days post-initiation of BNV treatment was recorded for 7 of 35 patients (20%) in the Pro regimen, 12 of 33 patients (36%) receiving the Meto regimen, and 21 of 32 patients (66%) receiving the Dex-Olan regimen. There were no Grade III or IV treatment related toxicities. Conclusion: The combination of Dex-Olan was an effective treatment for BNV and was significantly more effective than Pro or Meto alone.

No significant financial relationships to disclose.
Evaluating the use of cardiac biomarkers for early detection of chemotherapy induced cardiotoxicity: A pilot study in a minority population
Authors: Bahekar A. , Grewal P. D. , Monga V. , Bhuriya R. , Molnar J. , Khosla P.
Published: August 2020

e20546

Background: Doxorubicin and trastuzumab are associated with characteristic Type I and Type II cardiomyopathy. As breast cancer survival improves and concern about long-term cardiotoxicity grows, we will need appropriate markers to detect cardiotoxicity before measurable myocardial systolic dysfuntion. Recent data and several guidelines suggest that Troponin-I and B-type natriuretic peptide (BNP) may serve as cardiac biomarkers for early detection of cardiotoxicity. This study seeks to evaluate feasibility and utility of these markers in an outpatient oncology clinic setting. Methods: As a quality care initiative in a high risk minority patient population for cardiac disease, 55 consecutive patients who received doxorubicin and/or trastuzumab for the treatment of breast cancer had serum Troponin-I and BNP measured prior to each dose of doxorubicin, and every three months on trastuzumab. All patients also had normal baseline left ventricular ejection fraction (≥ 50%) measured by MUGA scan. IRB approval was obtained and medical records were reviewed independently by two authors. Results: Of the 55 patients, two did not have adequate data; 58% of patients received dose dense doxorubicin; 15% of patients received trastuzumab. Significantly more number of patients had troponin-I rise as compared to BNP. Total 7 (13%) patients had abnormal LVEF by MUGA scan following chemotherapy. Five (71%) of these patients had rise in Troponin-I/BNP. Negative predictive value of biomarkers was 91%, with sensitivity of 71% and specificity of 44%. Conclusions: Use of standard cardiac biomarkers to detect early cardiotoxicity is feasible with a high negative predictive value for Troponin I and BNP in the first 90 days following chemotherapy with doxorubicin and/or trastuzumab. Patients with normal markers may not need intense cardiac monitoring.

[Table: see text]

[Table: see text]
Physical and mental health correlates of pregnancy following breast cancer
Authors: Gorman J. , Roesch S. , Pierce J. , Parker B. , Madlensky L. , Saquib N. , Newman V.
Published: August 2020

e20552

Background: The possibility and safety of pregnancy after breast cancer is an important issue for many younger breast cancer survivors and their health care providers. Current research does not indicate that survival is negatively affected by pregnancy. However, the “healthy mother bias”, suggesting that survivors who go on to become pregnant are a self-selected healthier group based on their prognosis, has led to cautious interpretation of these findings. No studies have systematically evaluated the potential for this bias. Methods: This nested case-control study includes 81 participants, age 40 or younger at diagnosis, from the Women's Healthy Eating and Living Study (WHEL) (N=3,088). Our sample includes 27 cases who went on to have a child after breast cancer and 54 controls, matched on age and stage at diagnosis, who did not. We used hierarchical linear modeling to accommodate longitudinal data with individuals nested within matched sets (cases and controls). The primary aim was to evaluate the association between summary scores of health and successful pregnancy after breast cancer. The outcome variables, physical health summary score (PHSS) and mental health summary score (MHSS), were taken from the RAND 36 item health survey (SF-36). Covariates were added for adjustment and to improve model precision. Results: Controlling for other variables in the model, mean PHSS were not different among cases compared to controls (B=0.14, p=0.96) (n=152). MHSS were marginally higher among cases (B=6.40, p=0.08), as compared to controls (n=154). This difference is considered clinically significant. Conclusions: While based on a small sample size, this preliminary study did not find evidence of a healthy mother bias based on scores of physical health. However, mental health was marginally better among those who went on to have a child, indicating that the role of mental health should be evaluated in future research.

No significant financial relationships to disclose.
The role of cancer Nurse coordinator in foregut malignancy: Workload and costing considerations in the Australian setting
Authors: Wade F. M. , Pavlakis N. , Receveur I. , Leibman S. , Smith G. S.
Published: August 2020

e20559

Background: Foregut (esophageal and gastric) malignancy (FM) encompasses a number of diseases with poor outlook and complex and often morbid treatment. In keeping with world wide trends, the investigation and management of patients with FM is undertaken in the context of a multidisciplinary group consisting medical, nursing and paramedical specialists. Crucial to the delivery of co-ordinated and compassionate care is the Cancer Nurse Co-ordinator (CNC). Further, the CNC is pivotal in ensuring that benchmarks regarding intervals from diagnosis, to multidisciplinary assessment to treatment commencement are met. The aim of this study was to quantify the workload of the CNC in a newly established esophagogastric surgical unit. Methods: Clinical data and data regarding workload of the CNC in our unit was recorded prospectively. Results: Of 218 patients with newly diagnosed FM referred to our unit between November 2005 and December 2008 198 (91%) were seen by the CNC. The number of cancers arising from the esophagus or esophagogastric junction was 135 (62%), stomach 78 (36%) and small bowel 5 (2%). The interval between CNC referral and initial contact was 4 days (range -13 to 40 days) and 89 (45%) patients were seen at the initial consultation with the surgeon. The mean number of CNC contacts with individual patients was 18 (range 1–76), comprising 9 (range 0–42) face to face consultations, 9 (range 0–58) telephone contacts and 0.2 (range 0–14) email contacts. Referrals to other support services were made for 164 (83%) patients with an average of 1 referral made per patient. This workload was carried out over 29 hours per fortnight at $43 AUD per hour. The average cost per patient with FM cared for by the CNC was $491 AUD ($349 USD). Conclusions: The complex care of patients with FM is augmented by the presence of a specialist CNC. The resource requirement for CNC funding is a small proportion on the costs of overall patient treatment and represents a prudent use of finite health care resources.

No significant financial relationships to disclose.
Can adjuvant homeopathy improve the control of post-chemotherapy emesis in breast cancer patients? Results of a randomized placebo-controlled trial
Authors: Ray-Coquard I. L. , Provençal J. , Hardy-Bessard A. C. , Bachelot T. , Coeffic D. , Jacquin J. P. , Guastalla J. P. , Agostini C. , Pivot X. , Bajard A. , Pérol D.
Published: August 2020

e20566

Background: Homeopathy used as an adjunct in the treatment of chemotherapy (CT)-induced emesis has rarely been evaluated. Methods: Patients with non-metastatic breast cancer treated with 6 courses of FAC 50, FEC 100 or TAC chemotherapy were randomized to Cocculus/nux vomica/tabacum/petroleum extract (Cocculine, C) or Placebo (P) in a multicentric comparative double-blind phase III study. Anti-emetic treatment was standardized (corticoids + ondansetron). Patients were evaluated after each course. The primary endpoint was nausea measured after the 1st CT course using the FLIE (Functional Living Index for Emesis) with 5-day recall. The planned sample size was 396 evaluable patients based on a minimum expected difference in mean of 0.5 ± 1.6 on a scale from 1 (a lot) to 7 (not at all) with 5% two-sided α error and 85% power. An intent-to-treat analysis was planned. Secondary evaluation criteria were: vomiting measured by the FLIE score, patient self-evaluation (EVA) and investigator recording (NCI-CTC) of nausea and vomiting intensities, and compliance. Results: From September 05 to January 08, 431 patients were randomized (217 to P and 214 to C). Patient characteristics were well balanced between groups. Median age was 53 years, 35% of the patients experienced nausea or vomiting. In total, 403 patients (93.5%) were assessable for the primary endpoint, with few nausea episodes (FLIE nausea scores after the 1st CT course were 6.02 and 6.07 for P and C, respectively) and very good compliance (81% patients complied with the protocol). Adverse events related to nausea occurred in 51% vs. 47% of the patients treated with P and C, respectively (p = 0.48). FLIE and NCI-CTC vomiting scores were similar between the 2 arms (6.91 vs. 6.88, p = 0.47, and 20% vs. 21%, p = 0.73, for P and C, respectively). Grade II-III nausea occurred in 17.6% and 15.7% of patients receiving P and C (p = 0.62). Conclusions: No benefit of homeopathy over standard treatment was noted in this study. But surprisingly we observed lower rates of nausea and vomiting measured by patients and by investigators, than in other studies using identical chemotherapy regimens. The observation and management of emesis could modify the perception and rate of such adverse events.

No significant financial relationships to disclose.
Feasibility study of neurocognitive assessment of melanoma patients treated with adjuvant interferon
Authors: Combs D. , Baker A. , Fu J. , Herring A. , Jeter J. , Cranmer L.
Published: August 2020

e20567

Background: Interferon α-2b (IFN) is the only approved adjuvant therapy for patients diagnosed with high-risk melanoma. Cognitive and mood alterations have been consistently reported during IFN therapy. Rigorous documentation of the magnitude and duration of these changes is lacking. Here, we assess the feasibility of conducting a quantitative study of such effects. Methods: We enrolled patients with at least stage 2B melanoma who were eligible to receive adjuvant IFN. Controls were those IFN-eligible, but not receiving it or those with unresectable melanoma eligible to receive dacarbazine-based chemotherapy (DTIC). Six cognitive function tests were administered: mini-mental status exam (MMSE), Hopkins Verbal Learning Test-Revised (HVLT), controlled oral word association, Ruff 2 and 7 (R27), Trail Making Tests A and B, and the Profile of Mood States-Short Form (POMS). Test results were compared at baseline and after the high-dose phase of IFN, 1–3 months of observation, or first cycle of chemotherapy. Results: A supervising neuropsychologist trained personnel in study instrument administration. Fourteen patients (4 IFN, 8 Obs., 2 DTIC) were seen for a total of 26 testing visits. Study visits lasted 30–40 minutes, and were coordinated with patient clinic schedules. Interpretable test results were obtained in 98% of 144 instrument administrations. Three unrelated administration errors occurred. Differences between observation and IFN patients were seen in the MMSE, HVLT, R27 and POMS, but were not statistically significant. Based on our HVLT data, a total of 17 subjects per arm are required to demonstrate a statistically significant difference (alpha=0.05, beta=0.10). Conclusions: Our pilot results indicate that administration of this test battery is feasible in this population and is a promising tool to quantify adverse cognitive effects of IFN therapy. Such baseline data will allow development of measures to mitigate such effects.

[Table: see text]
Early switching from morphine to methadone plus acetaminophen in the analgesia of oncologic patientes: A randomized, double-blind, placebo-controlled study
Authors: Cubero D. I. , David Filho W. J. , del Giglio A.
Published: August 2020

e20579

Background: The objective of this study is to evaluate the efficacy of methadone as substitute for morphine and to investigate if the addition of acetaminophen could reduce the time to attain an equianalgesic methadone dose and to improve the level of analgesia of oncologic patients. Methods: Fifty patients in regular use of morphine with a stable dose for at least 1 week were submitted to the sudden change of this opioid for methadone and randomized in a double blind way to receive acetaminophen (750 mg PO every 6 hours) or placebo for a 7-day period. Data regarding level of pain and side effects were collected and a quality of life questionnaire (QLQ-C30) was applied. Results: Substitution of morphine for methadone resulted in improvement of the toxicity profile with reduction in obstipation (p < 0.001) and xerostomia (p = 0.03). There was improvement in the Numeric Pain Scale (p = 0.03) as well as a significant improvement in the functional level and symptomatology according to the QLQ-C30 questionnaire. Addition of acetaminophen did not reflect improvement in analgesia and also reduction in time of stabilization of methadone doses. At the end of the study most patients (70.8%, p 0.001) preferred to continue with methadone instead of returning to morphine. Conclusions: Early switching from morphine to methadone showed to be safe and efficient in the reduction of side effects improvement of analgesia allowing a comfortable dosage at a lower cost. In this scenario the association with acetaminophen did not reflect improvement of analgesia or reduction in time for equianalgesia.

No significant financial relationships to disclose.
Lifestyle modifications including complementary and alternative medicine and quality of life among women at high risk for breast cancer
Authors: Malaka D. O. , Lee R. , Lewin R. , Cummings S. , Curlin F. , Bradbury A. , Olopade O.
Published: August 2020

e20583

Background: Breast cancer (BC) patients commonly employ lifestyle modifications (LM) such as complementary and alternative medicine (CAM), but limited information exists among women who are high risk for BC (HRBC). This study's aims were to estimate the prevalence of LM use among HRBC patients, describe communication patterns, and determine correlations with quality of life (QoL) measures. Methods: Women enrolled in a multi-modality screening study for HRBC patients (≥20% lifetime risk) were distributed a questionnaire asking about the use of CAM therapies and other LM, timing of use, reasons, costs, and communication patterns. QoL measures included the Short-Form 36 (SF-36) and Beck Depression Inventory (BDI). Demographic variables and those instruments with significant correlations (p<0.05) were included in a multivariate model. Results: A total of 173 HRBC patients are enrolled on this study and 123 have completed the survey. General characteristics of these women include a median age of 45 years, 91% Caucasian, 30% have a gene mutation (e.g. BRCA1/2), and 33% have had breast and/or ovarian cancer. Ninety-nine percent reported a lifetime prevalence of LM and CAM, and nearly half of subjects (48%) did so for cancer-related reasons. The most popular LM were exercise (83%), massage (68%), yoga (44%), vitamin E (38%), and chiropractic medicine (36%). The most common cancer-related changes were low fat diet (15%), exercise (11%), and meditation (10%). Half of subjects (48%) did not discuss any of these LM with their physicians, and the most common reason was their physician did not ask. In the multivariate model for cancer-related LM, subjects having a history of BC or ovarian cancer were 6.2 times (p<0.001) more likely to use LM and CAM. Subjects with a below average SF-36 general health subscale score were 3.4 times (p<0.05) more likely to pursue non-biologically based CAM, and those with an elevated BDI (score>9) were 6.2 times (p<0.05) less likely to pursue dietary changes. Conclusions: LM including CAM are highly prevalent among women at HRBC. Oncologists should inquire about LM and CAM use and explore reasons for this including QoL.

No significant financial relationships to disclose.
Evaluation of clinical use of darbepoetin alfa in patients with chemotherapy-induced anemia
Authors: Bustos A. , Cruz M. A. , Aramburo P. , Carabantes F. , Díaz N. , Florián J. , Lázaro M. , Martín de Segovia J. M. , Gasquet J. A. , Alegre A.
Published: August 2020

e20585

Background: Chemotherapy-induced anemia (CIA) is a frequent complication of patients (pts) with cancer and could be treated with erythropoiesis-stimulating agents such darbepoetin alfa (DA). The aim of this study was to investigate the patterns of use and effect of DA to treat CIA in clinical practice conditions. Methods: This was an observational, retrospective, multicenter study performed in 58 Spanish centres. Eligible pts were ≥18 yrs, diagnosed with non-myeloid malignancies and treated with chemotherapy (CT) and DA from October 2005 to October 2006. Data on demographic and clinical characteristics, CT and radiotherapy (RT), DA administration, red blood cell (RBC) transfusions, and haemoglobin (Hb) levels were collected from DA treatment initiation up to a maximum of 16 weeks or until treatment discontinuation. Results: A total of 685 pts were included in the study. Median age was 64.66 years (range 18.54–88.95), 50.7% were women, 74.11% had ECOG status 0–1 and 71.38% had stage III/IV cancer. Solid tumours represented 72.55% of the cases. The CT regimen included platinum derivates in 33.58% of the pts. At DA initiation, mean (SD) Hb was 10.00 g/dL (1.05) Administration of DA every three weeks occurred in 54.01% of the pts. Mean (SD) DA administration was 9.20 weeks (5.31). Hematopoietic response (defined as Hb ≥ 12 g/dL or Hb rise from baseline >2 g/dL in the absence of RBC transfusions during the previous 28 days) occurred in 63.24% (95% CI 59.49–66.83) of pts. A total of 88 pts (12.85%) required RBC transfusions from week 5 to end of treatment. Mean Hb (SD) at the end of treatment with DA was 11.36 g/dL (1.73). Adverse event (AE) potentially related to DA were reported in 20 pts (2.92%) and considered severe in 6 cases (0.88%). Conclusions: The findings of this study indicate that the use of DA for the treatment of CIA in real-life, daily oncology and haematology practice, is well-tolerated and effective for increasing haemoglobin to reduce the need of RBC transfusions.

[Table: see text]
Electrolyte imbalances in patients admitted with chemotherapy-induced febrile neutropenia: Patterns and impact on outcomes, a single-centre study from Pakistan
Authors: Shaikh A. J. , Masood N. , Adil S. N. , Bawany S. A. , Khan A. A. , Kumar S. , Lal A. , Zaidi A. , Niamutullah N.
Published: August 2020

e20586

Background: Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity of chemotherapy. Various factors have been studied to be associated and affect outcome of patients admitted with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and impact has been only scarcely studied. This study was conducted with the aim to observe the trends of electrolyte abnormalities seen synchronously in patients admitted with chemotherapy induced febrile neutropenia and their possible influence on the outcomes. Methods: This was a prospective, observational study. A total of 215 patients admitted with FN between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0. Toxicity profile was graded according to CTC version 3.0. Results: Febrile neutropenia was seen to be almost equally distributed among patients with solid or hematological malignancies. Males and females were seen to be affected almost equally as well. A total of 83.5% patients demonstrated some degree of electrolyte abnormalities. Hypokalemia, of any grade, was seen in 48% of patients, 51.4% having grade I, 33.3% grade III and 15.2% had grade IV hypokalemia. Hyponatremia of all grades was seen in 67.9% patients, 60.3% had Grade I, 33.3% grade III and 0.7% patients had grade IV hyponatremia. Hypomagnesaemia was seen in 54.3% patient, 94.7% having grade I decline. About 12% of patients with electrolyte deficit also had a co-existing Vomiting or diarrhea or both. Average length of stay was 5.7 days in patients having coexisting electrolyte abnormalities, compared to 4.2 days in those who had not. Out of 90 patients who requires special care unit 75 had electrolyte abnormalities, of 15 patients who expired 13 had electrolyte abnormalities. Conclusions: This analysis, which is perhaps first of its kind, suggests that electrolyte abnormalities are frequently observed in patients presenting with FN, independent of co existing vomiting or diarrhea. They can have a negative affect on the outcome such patients. Therefore the incidence and impact of electrolytes abnormalities on FN outcomes should be elaboratively studied further.

No significant financial relationships to disclose.
Pain, depression, asthenia, and insomnia: Prevalence of this symptoms cluster and its impact on health-related quality of life in a cohort of advanced cancers
Authors: Blasco A. , Galan A. , Almenar D. , Gironés R. , Diaz R. , Alberola V.
Published: August 2020

e20607

Background: Pain (P), depression (D), asthenia (A), and insomnia (I), alone or in combination, are some of the most important and invalidating cancer symptoms. But little is known about the relationship between the symptoms of this cluster, and its impact on health-related quality of life (HRQoL). This analysis has been carried out to better know the prevalence of this symptoms cluster and its impact on HRQoL in cancer patients (pts). Methods: An observational and longitudinal multicentre study was carried out on a sample of cancer pts with breast, lung or colon cancer, any site and period of disease duration, receiving chemotherapy. Data were collected at inclusion and 3 months later. Sociodemographic data, key clinical indicators, as well as P, D, A and I complaints or diagnosis were collected. HRQoL was assessed by means of Nottingham Health Profile (NHP) scale (a generic health measure. Analyses were focused on baseline cross-sectional data). Results: A total of 116 pts were analyzed: 73.3 men, 61 years old (SD=9,1), 2.9 years (SD=2,3) since diagnosis, 16.4 % breast, 54.3% lung, and 29.3% colon cancer; 97.4% with metastasis. At least one symptom cluster under study was presented in 69% of pts: >25% a symptom alone, ≈25% two symptoms, >15% three symptoms, <3% all symptoms in the cluster. Pts could be classified in 13 of the 15 symptoms cluster possible combinations (according to their symptoms complaints/diagnosis) ranging from 0.9% to 12.9%. The two symptoms cluster combinations which did not obtain representation included D + I, while the two symptoms cluster combinations more frequents always included pain. It has been observed that a more quantity of symptoms worst physical and psychological NHP scores. Conclusions: The prevalence of the studied symptoms cluster in cancer pts is high (≈70%) and divers in combinations (13 different symptoms profiles). The quantity of prevalent symptoms cluster is clearly associated with HRQoL.

[Table: see text]

No significant financial relationships to disclose.
Clinical impact and follow-up of taste disturbances following myeloablative or nonmyeloablative chemotherapy and stem cell transplantation
Authors: Mayer F. , Weidmann J. , Federmann B. , Schwarz S. , Hartmann J. T. , Kanz L. , Bethge W.
Published: August 2020

e20609

Background: Stem cell transplantation (SCT) after myeloablative (MA) or non-myeloablative (NMA) chemotherapy is a successful treatment option for a variety of diseases. Although alterations of taste and smell are frequently encountered after these modalities, no systematic evaluation is available so far. Methods: A questionaire was developed covering aspects of the dietary pattern and changes in the perception of taste and smell. Clinical data were gathered from the charts. The study was approved by the institutional review board. Data of the first 100 of 200 planned patients’ (pts) are presented. Results: pts were surveyed after a median of 22 months from SCT (range 1–292), their age ranged from 20–76 years. Indications for SCT included acute leukemia (n=38), myeloproliferative disease (n=20), lymphoma (n=13), and others (n=29). Pts received an allogeneic graft after MA (n=48) or NMA (n=32) conditioning, 20 pts received an autologous one. 75% of pts reported moderate to severe changes in taste perception on a semiquantitative visual analogue scale during the acute phase of SCT with no differences between the three groups (73%, 79%, 75%). 28% of the pts reported a complete regression at the time of survey, 25% still suffered from moderate to severe changes. This finding was more prevalent after allogeneic SCT (30% after MA conditioning, 28% after NMA) compared to pts with autologous grafts (10%). Whereas pts without persisting changes in taste perception lost a median of 3 kg of body weight, pts suffering from severe changes lost 15 kg. Conclusions: Taste disturbances are a common after SCT. Symptoms are persistant in one third of the pts. In the allogeneic setting, no differences exist between MA and NMA conditioning. The lower incidence of persiting changes in taste perception after autologous SCT might be attributed to the absence of graft versus host disease or the dispensability of immunosuppression. Changes in taste perception correlate with weight loss.

No significant financial relationships to disclose.
Efficacy of palonosetron (PAL) compared to other serotonin inhibitors (5-HT3R) in preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately or highly emetogenic (MoHE) treatments: Systematic review and meta-analysis
Authors: Clark O. , Engel T. , Clark L. , Paladini L. , Faleiros E. , Pegoretti B.
Published: August 2020

e20620

Background: Chemotherapy-induced nausea and vomiting (CINV) are frequent side effects of cancer treatment, with negative effects on quality of life. CINV may be acute (occurring within 24 hours after the chemotherapy) or delayed (up to 7 days after it). There are currently five serotonin inhibitors (5-HT3R) available on the market. PAL has the longer half-life, but there are controversies regarding if a better control of CINV (particularly delayed) is obtained with it. This controversy is reflected in recommendations of practice guidelines. Objective: To perform a systematic review and meta-analysis of all randomized controlled trials comparing a single intravenous dose of PAL 0,25mg with other 5-HT3R in patients receiving MoHE chemotherapy. Methods: We searched several databases, including MEDLINE, EMBASE, LILACS, and CENTRAL. The primary endpoints were the incidence of acute and delayed nausea and vomiting. The side effects of each treatment were analyzed. A subgroup analysis on the impact of added corticosteroids was performed.The results of individual studies were pooled in a meta-analysis, using the RevMan 5.1 software. The results are expressed as Risk Ratio (RR) and the correspondent 95% Confidence Interval (CI). Results: We included 4 studies, with 1,298 patients. PAL was compared to ondansetron, granisetron and dolasetron. Patients in PAL group had less nausea, either acute (RR=0.75; CI= 0.64 to 0.88; P = 0.0004) or delayed (RR= 0.73; CI= 0.66 to 0.82; P < 0.00001). They also had less acute vomiting (RR = 0.78; CI= 0.67 to 0.90; P = 0.0008) and delayed vomiting (RR= 0.75; CI= 0.67 to 0.84; P < 0.00001). There were no statistical differences in side effects like headache (RR = 0.83; P = 0.29), dizziness (RR = 0.40; P = 0.12), constipation (RR = 1.35; P = 0.30) or diarrhea (RR = 0.67; P = 0.44). Patients receiving PAL presented less nausea and vomiting regardless of the use of corticoids. There was no statistical heterogeneity in the analises. Conclusions: PAL was more effective than the other 5-HT3R in preventing acute and delayed CINV in patients receiving MoHE treatments, regardless of the use of concomitant corticosteroids.

[Table: see text]
Utility of Schwartz Center Rounds in fostering compassion, communication, teamwork, and caregiver support
Authors: Mann P. , Schapira L. , Lynch T. , Penson R.
Published: August 2020

e20640

Background: Schwartz Center Rounds are a multidisciplinary forum where clinicians discuss difficult emotional and social issues that arise in caring for patients with the goal of improving the patient-caregiver relationship. Rounds were initiated at the MGH Cancer Center in 1997 and have since grown to include 165 sites including 24 cancer centers nationwide. We report on a recent evaluation of the impact of Rounds. Methods: The Schwartz Center Rounds evaluation focused on three major research questions: 1) Do professional caregivers have increased insight into the non-clinical aspects of care after attendance at Rounds? 2) Is there increased teamwork among caregivers after attendance? 3) Do caregivers perceive increased support after attendance at Rounds? The evaluation included a retrospective survey of 256 caregivers at six sites where Rounds had existed for ≥ 3 years; 44 semi-structured interviews with participants at these sites; and pre/post surveys of 222 caregivers from ten hospitals newly implementing Rounds. Results: The highest percentage of attendees were nurses (35%), followed by physicians (23%), social workers (15%), psychologists (4%), physical therapists (6%) and clergy (5%). After attending Rounds, participants reported increased insight into psychosocial aspects of care; enhanced compassion; increased ability to respond to patients’ social and emotional issues; enhanced communication amongst caregivers; greater appreciation of colleagues’ roles and contributions. Attendees reported decreased feelings of stress and isolation and a greater sense of teamwork. Participants reported that Rounds discussions led to changes in institutional practices or policies. Conclusions: Schwartz Center Rounds provide a forum for discussion of challenging psychosocial and emotional issues arising during clinical care. Evaluation data suggests this educational strategy may enhance compassion, professional support, communication, teamwork, and instigate institutional changes that enhance patient care. We are currently exploring other outcomes, including but not limited to the impact of rounds on quality of patient care and patient safety.

[Table: see text]
Cancer-related anemia: Correlation analysis among serum levels of hemoglobin, IL-6, hepcidin, albumin, and erythropoietin
Authors: Takahashi S. , Kosaka T. , Hattori M. , Fujimoto-Ouchi K. , Shimonaka Y. , Yasuno H. , Noguchi M. , Mori K. , Ogata E.
Published: August 2020

e20655

Background: Hepcidin is a peptide hormone that regulates iron re-utilization and has been implicated as causing anemia by restricting the delivery of iron to erythrocyte progenitors. A potent inducer of hepcidin in hepatocytes is IL-6, an inflammatory cytokine. In the present study, we investigated the relationship between cancer-related anemia and inflammatory activity, including the cytokines. Methods: Anemia in newly diagnosed patients (pts) with solid tumors or malignant lymphoma was studied excluding pts showing evidence of myelosuppression and hepatic and renal failure. The characteristics of anemia in cancer pts were compared with those in mice bearing human lung large cell cancer LC-6-JCK. Hematological assessment was conducted using clinical practice methods. Serum levels of cytokines were determined by ELISA. Hepcidin was measured by LC/MS/MS. Results: Thirty parameters were analyzed in 11 pts. Clustering analysis of the 30 parameters resulted in 3 clusters including hemoglobin (Hb)/albumin (Alb), IL-6/hepcidin/ferritin, and erythropoietin (EPO). Hb levels showed weak negative correlation with IL-6 and hepcidin and a positive correlation with Alb levels (R=0.763, P=0.006). In addition, IL-6 levels weakly correlated with hepcidin and Alb. Hepcidin correlated with ferritin (R=0.729, P=0.011). Correlations were observed between quality of life in cancer pts and anemia parameters including Hb and IL-6. Mice bearing LC-6-JCK tumors developed anemia with characteristic parameters similar to cancer pts with anemia ( Table ). A rat anti-mouse IL-6 receptor monoclonal antibody prevented the development of anemia in the LC-6-JCK model. Conclusions: Present results suggest that cancer-related anemia associates with IL-6, Alb and inflammatory acute phase reaction including hepcidin and ferritin. Further analysis of anemia in cancer pts and murine models would be useful for investigating the mechanisms of cancer anemia.

[Table: see text]

No significant financial relationships to disclose.
Cytoreductive surgery combined with peritoneal intraoperative heated chemotherapy for management of peritoneal carcinomatosis in 59 adults older than age 65
Authors: Bereder I. , Guerin O. , Boulahssass R. , Couderc A. , Mailland V. , Macone F. , Mounier N. , Habre J. , Karimdjee- Soilihi B. , Bereder J.
Published: August 2020

e20657

Background: Peritoneal carcinomatosis (PC) has long been regarded as a terminal disease with short median survival. Recent success of new approach, combining surgery and intraperitoneal heated chemotherapy (HIPEC) are reported. But in the most studies patients over 65 years are excluded. We report our experience in this selected group of patients. Methods: A retrospective study was performed to evaluate toxicity and to identify the principal prognostic indicators with this combined treatment. All patients had cytoreductive surgery and HIPEC. This population of patients was compared with younger over the same period. We have excluded patient with frailty by comprehensive onco-geriatric assessment based upon cognitive, nutritional assessment and cormorbidities. Results: The study included 291 procedures in 249 patients between 2000 and 2008. 64 procedures were performed in 59 older patients (group 1) and 227 procedures in 190 younger patients (group 2). The principal etiologies of PC in group1 were recurrent ovarian cancer (N=33), colorectal cancer (N=9), peritoneal mesothelioma (N=6), pseudomyxoma (N=9) and sarcomatosis (N=2). No death occurred in post operative course and the procedure related morbidity rate was 10%. 5 years overall and free survival rate were respectively 33% and 15%. Median overall survival was 44 months and median disease free survival was 13 months. There were no difference between group1 and 2 for survival. Independent prognostic factors for survival by multivariate analysis were extent of carcinomatosis, completeness of cytoreductive surgery and performance status. Conclusions: Therapeutic approach combining cytoreductive surgery with HIPEC may achieve long-term survival in a selected group of patients with PC with acceptable mortality and morbidity. For elderly patients, this treatment could be performed in selected cases without frailty.

No significant financial relationships to disclose.
Social interaction and stigmatization of cancer patients with orbitofacial disfigurement
Authors: Bonanno A. , Esmaeli B. , Nelson D. V. , Fingeret M. , Weber R. S.
Published: August 2020

e20659

Background: Advances in cancer treatment extend the survival of orbitofacial cancer patients who undergo orbital exenteration. Survivorship creates social problems as facial deformities potentially engender social stigma (a mark of social disgrace). Stigmatization is created through social interaction and depends on reactions of “others” to disfigured patients and patients’ postures toward others. In this qualitative study, we investigated a) patterns of stigmatization in interaction with acquaintances and friends in small and large groups and b) whether interactions with family members is always positive and non-stigmatizing and interaction with strangers is always stigmatizing. Methods: In-depth interviews with 12 patients and 12 family members (8 spouses, 4 offspring and siblings) were carried out with an open-ended questionnaire. Cancer diagnoses included lacrimal gland adenoid cystic ca. (n=3), conjunctival SCCA(n=3), and 1 each of conjunctival melanoma, eyelid sebaceous gland ca., lacrimal sac transitional cell ca., orbital adenoca., orbital neuroendocrine ca., and eyelid basal cell ca. The median time from orbital exenteration to interview was 44 months. None were receiving active cancer therapy and none had cancer recurrence at interview time. Results: Patients were comfortable in interactions with friends and family members as they respond in supportive and non-stigmatizing ways. Interaction with acquaintances and strangers engender varying outcomes. In large groups, actions toward patients characterized by “benign neglect” (n=3) - kind indifference toward patients - generate non-stigmatizing outcomes. Actions characterized by sympathy (n=5) - overt support for patients - generate inconsistent patterns of interaction. “Intrusion” - unsolicited attention paid to patients - (n=4) leads to feelings of stigmatization. In small groups, intrusion creates stigmatization. Sympathy creates positive outcomes, while interaction characterized by benign neglect generates varying patterns. Conclusions: Patients should be warned about possible difficulties interacting in large and small groups. Health care professionals should be trained to address these problems through programs of social intervention for head and neck cancer survivors.

No significant financial relationships to disclose.
Aprepitant/5HT-3 antagonist (EMEND) for the prevention of chemoradiation-induced nausea and vomiting (CRINV) in patients receiving gemcitabine/ 5-FU–based chemoradiation and concurrent upper abdominal radiation for pancreatic cancer
Authors: Blackstock A. W. , Aklilu M. , Lovato J. , Degrass L. , Sommer J. , Howerton R. , Mishra G. , Levine E. , McQuellon R.
Published: August 2020

e20661

Background: Significant chemoradiation-induced nausea and vomiting (CRINV) occurs in patients (pts) receiving chemoradiation for pancreatic cancer. The aim of this trial was to determine if prophylactic Aprepitant/5HT-3/dexamethasone added to standard chemoradiation resulted in less CRINV when compared to historical controls. Methods: Pts with locally advanced or resected pancreatic cancer received wkly Gemcitabine (200 mg/m2) and continuous infusion 5-fluorouracil (5-FU) or oral capecitabine with concurrent radiation (50.4 Gy). Aprepitant (125 mg p.o.) was given each Monday (day 1) of each week 1 hr before the gemcitabine infusion and on days 2 and 3 (80 mg p.o.) - 1 hour prior to the radiation. A 5HT-3 antagonist was given orally 30–60 minutes prior to the chemotherapy and dexamethasone (12 mg) was given on day 1 and repeated at a dose of 8 mg on days 2 and 3 with the aprepitant. Grade III/IV nausea was assessed using NCI CTC v. 3.0. The Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) questionnaire was completed at baseline prior to the start of all therapy, Time 1 (T#1), repeated at the end of the first week (T#2) and then repeated again at the end of the last full week of chemoradiation (T#3). Results: Of the 17 patients available for analysis, CTC grade III nausea and grade IV vomiting was observed in one patient (6%) during the entire treatment course. Utilizing the MAT at T#1, T#2 and T#3 respectively; 3/15, 4/15 and 2/13 pts reported experiencing any level of nausea. At those same time points; 0/15, 1/15 and 0/13 pts reported vomiting. The range of the average degree of nausea reported on a scale from 1–10 (worst) was 2.5 -3.67 over the study period. During treatment, 54–64% of participants reported no nausea/vomiting (N/V). For those patients who experienced N/V, it was rated as mild to moderate with only 3 of 17 requiring additional anti-emetics. Conclusions: Prophylactic Aprepitant/5HT-3/dexamethasone therapy resulted in minimal CRINV for pts receiving upper abdominal chemoradiation in this feasibility study. This regimen may be soon be integrated in to future CALGB pancreatic chemoradiation trials.

[Table: see text]
Health-related quality of life and pain assessment in 36 patients with resected pancreas adenocarcinoma: Preliminary analysis
Authors: Carr B. I. , Summers D. , Menefee L. , Pierpoint S. , Yeo C. , Kennedy E. , Lavu H.
Published: August 2020

e20692

Background: In order to begin to understand the effects of disease on the patient (pt) and possibly of the pt on the disease, we have begun a systematic psychological inventory of all our pts who have has a pancreatectomy for pancreas adenocarcinoma and have began to correlate this with disease extent, and later with survival. Methods: Prior to post-op discharge home, pts were invited to fill out a brief pain inventory (BPI-SF), BPI interference, emotional (EWB) and physical well-being score (Fact-Hep), as well as social/family and functional well-being (FWB) Fact-Hep. The data was entered into a database, together with pertinent lab results, tumor markers, and tumor characteristics from the pre-op CT scan and post-op pathology report. Data was analyzed by descriptive statistics, frequencies and Pearson Correlation (2-tailed sig). Results: Descriptive means (and ranges) were - tumor size 3.43 cm mean (2.0 min-5.2 max), bilirubin 1.26 (0.2–4.7), albumin 2.69 (1.5–3.6), Hb 10.3 (7.5–13.2), platelets 254K (109K-672K), CEA 4.7 (0.8–24), and Ca 19–9 was 987 (1.0–8127). Pain at presentation pre-op of moderate severity was present in 11% of pts and severe pain was present in 5.6% of pts (16.6% total). Pathologically, LNs were involved by cancer in 50% of pts, vascular invasion in 30%, neural invasion in 35% and any margin positive in 14%. 22% had metastases noted at surgery. Statistically significant correlations were found for tumor size and pain severity (p<.035), platelets and FWB (p<.022), albumin and Hb (p=.000), CA 19–9 and bilirubin (p<.030 i.e. high CA 19–9 and high bilirubin). There was a negative correlation between CEA (but not CA 19–9) and both EWB (p<.039) and FWB (p<.035). Pain severity correlated with depressed mood (p<.010), lower physical well-being (p<.01) and interference with life activities (p<.01). Conclusions: CEA, but not CA 19–9 correlated with both emotional and functional well-being. Baseline pain was present in only 16.6% of this cohort. We plan to follow up to examine how these parameters correlate with pt coping throughout therapy and survival.

No significant financial relationships to disclose.