bluuebunny/crossref_metadata_2025 huggingface dataset:
Anticancer–drug-induced interstitial lung disease (DIILD): With great power comes great responsibility.
Authors: Maseeh Arun , Awasthy Bhawana , Modak Somrita
Published: June 2023

e18699

Background: DIILD accounts for 3-5% of all ILD cases, with Anticancer agents accounting for 23-51% of all cases, and Case-Fatality Rates of 51.3%. Guidelines for anticancer therapy-related DIILD are lacking. DIILD was not often identified as an adverse event until late in drug development or after launch. Methods: Publications till Feb 2023 were reviewed for incidence, time to onset, prevention and early identification of anticancer DIILD. Results: Highest reportedincidence of DIILD was associated with targeted therapies [mTOR Inhibitors (9.5- 58%), Anti-EGFR (0.9 - 5.9%), MEK inhibitors (2.4%), CDK 4/6 inhibitors (1.6%), PARP inhibitors (0.79%)]; Chemotherapy [Bleomycin (6.8-21%), Gemcitabine(1.1-3.9%), Irinotecan (0.74%)]; ADCs (11.4%); CTLA4 inhibitors (5.44%); and Check-point inhibitors [(CPIs: 1.1-3.6%), PD-1 inhibitors (3.6%), PD-L1 inhibitors (1.3%)]. The rates of DIILD were higher in combinations compared to single-agents. Higher Mortality rates were associated with Anti-EGFR (18-51.3%), Irinotecan (24%), Bleomycin (8.1-23%), Gemcitabine (0-22%), mTOR Inhibitors (0-20%), Check-point inhibitors (all CPIs: 8-9.4%). The time of onset was as early as a week for CPIs (42% occurred within first two months), 28 days for EGFR:TKIs, 60-172 days for MEK Inhibitors, and 14-638 days for ADCs. Risk-mitigation strategies for DIILD: Identification of high-risk patients – (multiple prior lines of therapy, combination therapy, lung comorbidities, poor respiratory reserve, smokers). Early radiological diagnosis accompanied by Monitoringfor early signs of ILD with wearable technology. Conclusions: Research in Genomics and biomarkers to identify patients at risk, development of Artificial Intelligence (AI) algorithms for PFT interpretation, early radiological detection and audiometry analysis are ongoing and urgently needed.
Defining and implementing meaningful advance care planning.
Authors: Hannan Emma , Collins Elizabeth , Csik Valerie Pracilio , Garber Greg D. , Sitko Ramona , Cammy Rebecca , Worster Brooke
Published: June 2023

e18708

Background: Advance Care Plans (ACP) capture a patient’s preferences for care before the patient becomes unable to make their own decisions. Our center (SKCC) participates in external quality programs, including the ASCO Oncology Medical Home model and CMS’ Oncology Care Model, that require ACP among cancer patients. Evidence from other centers suggest ACP, as defined by these external programs, do not impact patient outcomes. In an effort to increase the rate of “meaningful” ACP our interdisciplinary team completed an iterative quality improvement (QI) project to define an internal, more rigorous standard of ACP. Methods: Clinicians at SKCC developed a standardized Personalized Care Discussion (PCD) appointment conversation template to guide meaningful, goals-based care discussions with cancer patients. Our project assessed the rate at which different patients completed a scheduled PCD appointment between 6/2/2021 and 7/1/2022. The objectives of our QI project were to: identify a sub-population of cancer patients with the highest expected value from PCD; and define an evidence-based metric to hold care teams accountable for completing PCD. Our interdisciplinary QI project team monitored and evaluated 5 cycles of plan-do-study-act (PDSA) over the course of 1 year to meet the project objectives. Each PDSA included either an adjustment to the patient population or an adjustment to the workflow. The key performance indicator in each PDSA was the % of patients with a scheduled PCD appointment who completed the appointment. Results: Of the all the PDSA cycles, the ones with the highest completion rate of a scheduled PCD appointment were cycles in which: the patient’s oncologist introduced the patient to PCD (as opposed to automated scheduling); and the patient was introduced to PCD early on in their care at SKCC. Conclusions: The results of this project led us to develop an internal quality metric that requires oncology providers (OP) facilitate PCD with all new cancer patients within 9 months of the new patient visit. This metric exceeds expectations of external programs by requiring OPs complete goals-based ACP with patients and introducing ACP as a universal standard of cancer care for all new patients. Operational support for OPs is critical for success in this initiative. Patient education that manages sensitivities and stigma about ACP enhances successful OP-patient collaboration. SKCC continues to monitor the impact of this metric on patient outcomes. [Table: see text]
Physical therapy and rehabilitation for improvement of quality of life of breast cancer patients.
Authors: Abuladze Mariam , Esakia Tamar , Melkadze Tamar , Mariamidze Elene , Otkhozoria Nana , Tsitsilashvili Sofia , Katcharava Margarita , Chokoshvili Nikoloz , Cholikidze Tamta , Barabadze Davit , Tchatchiashvili Bakar , Saganelidze Khatuna
Published: June 2023

e18711

Background: One of the most critical factors that cancer patients need to consider when it comes to their rehabilitation is the availability of effective and personalized rehabilitation programs. Aside from being a vital part of cancer rehabilitation, exercise can also improve the quality of life for cancer patients and help them maintain a healthy and balanced lifestyle. The purpose of this study is to adapt an evidence-based exercise program and rehabilitation techniques for breast cancer patients undergoing adjuvant chemotherapy and test the efficacy of this approach combining physical therapy, massage therapy, equine therapy (intervention group) compared to chemotherapy only (control group) for improving quality of life. Methods: This is two-armed, randomized controlled trial to test the efficacy of physical therapy and rehabilitation for improving quality of life of breast cancer patients undergoing adjuvant chemotherapy. The intervention program included physical therapy, massage therapy, equine therapy. Control group received standard care, treatment group received standard care plus intervention. All patients completed the quality of life questionnaire (EORTC-QLQ-C30) at baseline and at 4 months. All participants randomized to treatment group first received one-on-one consultation with oncologist, Physical Medicine and Rehabilitation (PM&R) physicians and physical therapists. The intervention components include tri-weekly program that included physical therapy, massage therapy and equine therapy. Statistical methods (STATA) were used to analyze the data. We began data analyzes with observational statistics and independent variable analyzes. Results: Even though we did not find any difference in some aspects of intervention group during observational study, we saw a significant difference in DID model which showed significant improvement in data. Compared to control group, intervention group showed improved Quality of life (43.57***), improved PF (48.76***), RF (53.3***), EF (56***), CF (37.66**) and SF (52.85***). Another important observation is a fact that age and stage of the disease had no effect on quality of life or affected any aspect of this study, reasons of which has to be further analyzed. Conclusions: Our study proved that physical therapy and rehabilitation can be useful in improving the quality of life of breast cancer patients undergoing chemotherapy.
DelPHI: A novel program to accelerate access to precision oncology in the community oncology setting.
Authors: Magliocco Anthony Martin , Khalife Roy , Wilson Catherine , Love Tara M , Balaraman Rama
Published: June 2023

e18713

Background: It has been well recognized that the rapid advances in precision oncology have not fully been translated into improved access for community cancer programs in the USA, where as much as 95% of oncological assessment and treatment occurs. To address this growing gap, Protean BioDiagnostics and Roche Information Solutions have created a novel project to improve the Delivery of Precision Health Information (DelPHI) to community-based oncology programs using an innovative precision oncology testing system (MAPS™) integrated with a digital decision support and telemedicine framework (navify). The project seeks to bridge the clinical and administrative gaps to help bring precision oncology to the community. Methods: In an initial implementation of DelPHI, 28 cases were analyzed from a community oncology clinic. Analyses included immunohistochemistry (IHC) testing, rapid molecular testing, and a 523-gene DNA, 55-gene RNA comprehensive cancer panel. These cases were grouped together and queried for IA actionability alterations, potentially actionable alterations, potentially germline, pathogenic variants, time to each step, diagnosis changes, and noted if there were any inadequate case materials. Results: Based on the 28 patients that were run (13 lung, 4 breast, 1 prostate, 2 colorectal, 2 gastric, 1 esophagus, 1 melanoma, 2 bladder, 1 glioma, 1 poorly differentiated carcinoma), 50 total actionable alterations were detected. 90% of the patients had at least one potentially actionable alteration, 46% of patients had a IA actionability alteration, and 29% of patients had a potentially pathogenic germline variant that may warrant further testing. We identified 2/28 patients with incorrect diagnoses that were corrected after testing. 23/28 patients underwent testing via the large, comprehensive panel, and 16 of these 23 had additional targets. 3 individuals had inadequate tissue to analyze, and 1 patient had an ALK expression imbalance that was not seen in other tests, which may be due to heterogeneity of the sample; both of these issues may benefit from liquid biopsies. Conclusions: Precision medicine can be delivered to community cancer centers using a combined integrated molecular testing system coupled with a digital knowledge support framework leading to improved speed of patient testing and uncovering of actionable biomarkers. Numerous challenges were identified, including delays in accessing tissue and limited tissue availability. These challenges could be overcome with alternative testing approaches, such as liquid biopsy and education to improve strategies for tissue collection and management.
Addition of doxycycline to fluoroquinolones for bacterial prophylaxis in autologous stem cell transplantation for multiple myeloma.
Authors: Guare Emma , Cioccio Joseph , Rakszawski Kevin , Nickolich Myles , Naik Seema , Zheng Hong , Wirk Baldeep , Ehmann Christopher , Claxton David , Rybka Witold B. , Hohl Raymond J. , Mierski Joseph , Silar Brooke , Vajdic Caitlin , Sivik Jeffrey Michael , Hale Cory , Mineishi Shin , Minagawa Kentaro , Paules Catharine I
Published: June 2023

e18732

Background: Autologous stem cell transplant (ASCT) is standard therapy for patients (pts) with multiple myeloma (MM), yet the risks of such treatment include neutropenic fever (NF) and bacteremia. Fluoroquinolones (FQs) are a mainstay of bacterial prophylaxis (ppx) of NF in ASCT at many transplant centers and reduce the incidence of bacteremia. Nevertheless, ppx regimens for ASCT are not standardized and variability exists even within single institutions. While antibacterial ppx decreases infections, antibiotic use can also cause toxicity, resistance, and microbiome disturbance. The addition of doxycycline (doxy) to FQs was previously linked to reduced NF and bacteremia when utilized for ppx in MM pts at our institution, leading some providers to incorporate doxy into their ppx regimens. However, our prior study introduced multiple confounders, including differing pre-transplant conditioning regimens between ppx groups. We sought to further compare the incidence of NF and bacteremia in MM pts receiving ppx with FQ alone and FQ-doxy during a time when ppx strategies varied but transplant conditioning was consistent between groups. Methods: This is a single institution retrospective review. We analyzed all medical charts in the ASCT database of MM pts treated at our institution between Jan 2016 and Dec 2021. The primary objective was to determine the effect of bacterial ppx on the rate of NF and bacteremia within 30 days of ASCT. Data was also collected on several pt characteristics. Results: Out of 341 pts with MM who underwent ASCT following melphalan (mel) conditioning, 121 received FQ (ciprofloxacin or levofloxacin) ppx and 220 received FQ-doxy ppx. Pt characteristics and outcomes of interest are shown in Table 1. NF developed in 71 (58.7%) and 103 (46.8%) pts in the FQ and FQ-doxy groups, respectively (p = 0.042). The odds of NF in FQ-doxy compared to FQ is 0.62 (95% CI 0.4, 0.97). Bacteremia developed in 7 (5.8%) and 6 (2.7%) pts of the FQ and FQ-doxy groups (p = 0.235). The odds of bacteremia in FQ-doxy compared to FQ is 0.46 (95% CI 0.15, 1.39). Documented bacteremia was infrequent, yet resistance profiles demonstrated FQ-resistant E. coli strains in the 7 total Gram-negative bacteremia cases and 5 extended-spectrum beta-lactamases. Conclusions: Overall, there were fewer cases of NF in the FQ-doxy ppx group than FQ, however there was no significant difference in the cases of bacteremia. This finding does not support the addition of doxy to FQ ppx at our institution and a future randomized controlled trial investigating appropriate ppx for ASCT is warranted. [Table: see text]
Participation in a multidisciplinary institutional committee, “RQUEST,” to enhance quality improvement education, project design, and implementation for hematology/oncology fellows.
Authors: Fugere Tyler , Chen Jim Zhongning , Baltz Alan , Schmit Troy , Douli Rana , Hoque Md Shadiqul , Khalil Muhammad , Bhatti Sajjad Akbar
Published: June 2023

e18733

Background: Participation in quality improvement (QI) projects allows medical trainees to develop an essential skillset to systematically analyze practice and implement changes with the goal of practice improvement. The ACGME designates QI education and participation as a core competency for all fellows. Training programs and institutions can vary significantly in QI educational format, participation, and direct support for project design and implementation. Here we present a description of the Resident Quality, Experience, and Safety Team (RQUEST) committee, which is being utilized by Hematology and Oncology fellows for QI project design and implementation at our institution. Methods: The first RQUEST committee was convened in August of 2021. RQUEST holds formal monthly meetings from August to June of each academic year. At the initial meetings, committee members are introduced to quality, safety, and patient experience structures and receive introductory training in QI tools and techniques. RQUEST members are then split into smaller project groups and work to select a QI project, perform current state analysis and baseline data collection, design and implement improvement interventions, and re-measure to determine the impact of the chosen interventions. The year concludes with each team presenting their project at a joint session to a larger audience of program directors, quality officers, service line directors, department chairs, graduate medical education staff, and hospital leadership RQUEST participation provides fellows with direct access to a multidisciplinary team and resources throughout project design and implementation. The timeline of monthly meetings provides both accountability and productive feedback. This facilitates the identification of system-specific opportunities for improvement and the most practical points of contact within the hospital, clinic, or EMR to design and apply quality interventions promptly and effectively. Results: We sent a voluntary survey to RQUEST participants, and 40% of participants responded to the survey. 100% of those who responded said participating in RQUEST has been beneficial in developing and implementing a QI project, and 100% said they would recommend participating in RQUEST to other medical trainees. The most common benefits listed were: · Structured approach/guidance · Institutional support and resources · A collaborative environment with a team of members from various departments, including IT. Conclusions: Fellow participation in a multidisciplinary QI committee at our institution has improved fellow QI education, participation, and project implementation. This engagement model has proven valuable to fellows and faculty in enhancing QI competency and clinical practice.
Quality improvement interventions targeting vaccine uptake in cancer patients: A systematic review.
Authors: Kazi Basil , Talukdar Zain
Published: June 2023

e18734

Background: Patients with cancer are more susceptible to morbidity and mortality from preventable infection. Despite this, patients with cancer have low rates of vaccination and quality improvement interventions to improve their rates of vaccination have not been well studied. Methods: We searched PubMed and Cochrane Library for studies that evaluated quality improvement interventions that aimed to improve vaccine uptake in patients with cancer. We searched PubMed and Cochrane library using keywords that covered cancer, vaccines and quality improvement. Title and abstract screening, data extraction and categorization was conducted by two authors with any disagreements were resolved by consensus. Results: In total, 13 studies were identified as meeting our inclusion criteria. Studies were published from 2014 to 2022. Seven studies studied the influenza vaccine, five studied the pneumococcal vaccine, and one studied both. Twelve studies employed multiple interventions, and one study employed a single intervention. Most studies evaluated interventions designed to increase patients’ and families’ knowledge of the vaccines and interventions designed to identify vaccine-eligible patients before their visit. All studies showed improvement in vaccine uptake after implementation of the study’s interventions. Conclusions: We found a broad range of quality improvement interventions that improved pneumococcal and influenza vaccine uptake for patients with cancer. Future studies should test barriers to implementation of these interventions and review if these same interventions improve uptake of other vaccines.
New insights on oncologist use of genomic testing.
Authors: Smith Mary Lou , White Carol B. , Railey Elda , Gray Stacy W. , Gerber David E
Published: June 2023

e18741

Background: As the indications and complexity of precision medicine in oncology increase, we sought information about current provider needs and experiences. Methods: In early 2023, we conducted qualitative interviews with medical oncologists who reported treating patients with lung, breast, and/or colorectal cancer. Questions focused on use, concerns, patient communication, resources, and needs related to genomic testing and precision medicine. Results: A total of 24 oncologists were interviewed (50% in practice > 20 years, 71% at community sites, 88% general oncology). Three patterns of tumor genomic testing emerged: (1) Frequent use and an exploratory mindset; (2) measured use, often with a limited set of alterations tested initially, focused on actionable findings; and (3) infrequent use, requiring availability of effective and affordable treatment. Concerns included turnaround time (particularly for lung cancer), workflow and electronic medical record (EMR) non-integration, non-actionable results, cost, and tissue adequacy. Most respondents find test results easy to use, focusing on the first two pages; some use the entire report. Respondents identified problems securing patient access to indicated targeted therapies, particularly oral agents with costly copays requiring substantial staff administrative effort, with the greatest challenges faced by underinsured rather than uninsured patients. Recommendations included improving EMR integration, shortening time-to-result, reflex performance so results are available at initial oncology appointment, standardizing result presentation, and addressing cost issues. In addition, some suggested that centralized collection and analysis of patient outcome data would inform questions of actionability and access. Conclusions: This qualitative work identifies several major challenges practicing oncologists face in delivering precision medicine. Notably, downstream issues related to treatment access may influence decisions regarding tumor genomic profiling. Further investigation of barriers and potential solutions is needed.
Safety and feasibility of implementation of ERAS in CRS and HIPEC: Enhancing recovery or complications.
Authors: Somashekhar S.P. , Rajgopal Ashwin K. , Srinivasa Murthy H , Ramachandra Karnate , Fernandes Aaron marian , Tatakuri Mrudula , Kumar Rohit
Published: June 2023

e18745

Background: We report our experience of implementation of ERAS protocol in patients undergoing CRS and HIPEC for peritoneal carcinomatosis. Methods: ERAS protocol for CRS± HIPEC was implemented in 90 patients from January 2021 to October 2022. We documented compliance rate and analysed the reason for non-compliance, effect of compliance on length of hospital stay, postoperative complications and readmission rate and compared the same with the 95 patients who had CRS HIPEC before adopting ERAS protocol from January 2019 to December 2020. Results: Of 185 patients in the study, 95 were in pre eras group and 90 in ERAS group. Demography, pre-operative and operative parameters were comparable between the groups. The average compliance rate achieved for entire cohort was 78.5%. Lowest compliance rates were seen for post-operative elements especially, early feeding and early mobilization. After implementation of ERAS, median length of hospital stay reduced from 12 to 9 days, length of ICU stay reduced from 4 to 2 days and postoperative complications sepsis reduced from 14.7% to 7%, respiratory complications 15.7% to 7%, surgical complications 10.5% to 2.9%, resurgery from 6.3% to 1.4% and in hospital mortality reduced from 5.3% to 1.4%. The ERAS group didn’t receive any long acting opioids, less usage of intraoperative crystalloids(7ml/kg/hr vs 13ml/kg/hr, p = 0.0001),early extubation and less readmission rates. Conclusions: The implementation of ERAS protocol is safe and feasible for CRS and HIPEC patients. Implementation of ERAS program has significantly reduced the length of hospital stay, length of ICU stay and postoperative morbidity.
Quality care of patients with HR+/HER2- breast cancer: Insights from an implementation science program.
Authors: McKinnon Kelly E. , O'Shaughnessy Joyce , Gurska Lindsay , Carter Jeffrey D. , Heggen Cherilyn
Published: June 2023

e18756

Background: Oral oncolytics have transformed the treatment landscape of HR+/HER2- breast cancer, shifting the responsibility for medication adherence and side effect management to patients. To optimize patient outcomes, collaborative patient-provider education on treatment expectations, adverse event management, and shared decision-making is imperative. Methods: From 11/2021 to 2/2022, HR+/HER2- breast cancer patients (N = 55) and health care professionals (HCPs) (N = 69) who treat breast cancer from 5 community practices were surveyed on attitudes, values, and challenges related to treatment, adherence, and adverse event management on oral therapies. HCPs (N = 59) participated in audit-feedback (AF) sessions to reflect on their own practice and develop action plans to improve care, which were implemented in subsequent collaborative patient-provider learning sessions. Informed by survey findings and insights from patient focus groups a, a point-of-care oral oncolytic toolkit was disseminated to support patients and providers in effective communication, treatment adherence, and side effect management. Results: In surveys, HCPs and patients reported side effects of medication as the top challenge impacting treatment adherence, with fatigue (33%), nausea/vomiting (28%), and hair loss (28%) the most challenging side effects. Notably, 46% of HCPs reported inadequate time to discuss patient goals, preferences and concerns as the biggest barrier for shared decision-making, and 15% of patients reported their doctor does not always ask about goals, preferences, and concerns. Reflection on survey and focus group insights in AF sessions enabled providers to develop and implement action plans including the provision of patient education resources on medication adherence and side effect recognition and management, scheduling adequate follow-up appointments to ensure side effect management and medication compliance, and engaging in shared decision-making. In patient-provider collaborative sessions, patients demonstrated substantial knowledge gains in how to communicate, recognize, and manage side effects associated with treatment, and providers committed to continuing patient education. Conclusions: Through a combination of a patient and provider survey study, patient focus groups, HCP AF sessions, and collaborative patient-provider learning sessions, action plans and education resources were developed and implemented to support the provision of effective treatment management for HR+/HER2- breast cancer. The methods and findings of this study represent key opportunities for improvement in caring for patients with HR+/HER2- breast cancer. Study Sponsor Statement: This activity is supported by educational grants from Lilly and Novartis Pharmaceuticals Corporation, who had no role in the study design, execution, analysis, or reporting.
Oncology patients through the eyes of their physicians.
Authors: AbdelAziz Riham H. , Abdelsalam Marwa , Shabaan Saeed
Published: June 2023

e18757

Background: There is a continuous need for optimizing and rationalizing cancer care according to national and international guidelines. The aim of the survey is exploring the thoughts and expectations of oncologists worldwide regarding their patients' management and prognosis and the factors affecting these expectations. This survey shed light on the oncologists' side of the relationship with their patients, which is often ignored. Methods: This is an observational cross-sectional study via an online pre-tested self-administered survey, targeting subspecialties of Oncologists across the world. Results: Among 929 Oncologists who completed the survey, 50.7% worked at University hospitals. They came from 17, 27, 23 and 14 countries in Africa, Asia and Australia, Europe, and the Americas respectively. Our results showed that, 58.7% thought stage of the disease is the most important factor affecting the prognosis. Additionally, 34.4%, 21.4% and 14.2% agreed that the 2nd most important factor was Performance status, stage of the disease, and disease pathology and immunohistochemistry respectively. Also 63% agreed that targeted therapy improves their expectations of the outcomes in eligible patients. While, 56% agreed that Immunotherapy improves their expectations. Only 42.3% indicated that they always inform patients of the detailed management plan and only 20.7% agreed that they always inform advanced cases about their incurable disease. Moreover, 52% usually expect the patients to fully understand the detailed management plan, but only 7% always expect that. The main factor affecting this is the patients’ education level as indicated by 76% of the respondents. The 2nd leading cause is that patients usually have some degree of denial as indicated by 35%, followed by patients’ unrealistic expectations as indicated by 30% of oncologists. Results also showed that 63.5% always inform their patients about all adverse events of their therapy directly, and 59% agreed that patients usually accept them, but only 6.5% indicated that patients always accept them. The fear of death or possible disabilities are the main factors causing some patients to reject these adverse events as indicated by 52%, while 31% thought fear of the looming social or financial difficulties is the main cause. The majority agreed that patients are either always (33%) or usually (46.9%) open to their case being discussed in Multidisciplinary clinics. Contrarily, only 5.3% indicated patients are always open to being referred to Psychiatrists. The majority agreed that patients are open to being referred to nutritionists or non-oncology physicians. However, only 19% and 7% agreed that patients are always open to being referred to Palliative care and Hospice respectively. Conclusions: The survey shows that oncologists worldwide have consistent evidence-based prognosis. Contrary to that, it shows widely varying perceptions regarding the patients’ reactions, due to variable factors.
The impact of COVID-19 on patient involvement in treatment decisions in the US and EU4+UK.
Authors: Ng Elsa , Moseley Angelena , Gallo Federico
Published: June 2023

e18758

Background: The COVID-19 pandemic has impacted many facets of the healthcare landscape. This study aims to assess the effect of COVID-19 on the evolution of patient involvement in cancer treatment decisions at different time points throughout the pandemic. Methods: The Ipsos COVID-19 Evolution study was run online from April to June 2022 with a total of 353 oncologists responding in the US and EU4+UK (US: 100, EU4+UK: 253). Each physician completed a demographic form and a questionnaire. The demographic form gathered information regarding specialty, practice type and volume of patients treated with anti-cancer drugs in an average month. The questionnaire collected information from physicians on patient workload, diagnosis/tumor characterization, patient management, patient treatment, personal attitude and events, and expectation in the next 6 months. Physicians were required to provide this information by referencing the different time points with regards to the pandemic including pre-pandemic, 1st peak, Delta/Omicron spread, current state and in the next 6 months. Results: Sampled physicians in the US reported an average of 50% of their managed patients involved in treatment decisions pre-pandemic, while the EU4+UK physicians reported an average of 45% of patients. This increased to 56% and 53% in US and EU4+UK, respectively, at the time of this study and was expected to increase further to 57% and 56%, respectively, in 6 months’ time. While most of the physicians reported an increase in the proportion of patients involved, physicians in the UK reported a drop at the 1st peak and Delta/Omicron spread compared to pre-pandemic (-1% and -3% respectively). Physicians in Germany reported the highest increase in the volume of patients being involved at the 1st peak of COVID-19 that quickly dropped during the Delta/Omicron spread (+18% and +6%, respectively). Physicians in Italy reported a much bigger change in the current state and predicted this to grow further in the next 6 months (+27% and +32%, respectively). Besides the recorded growth in the volume of patients involved in treatment decisions, the level of involvement has also increased from pre-pandemic. The average involvement score was 4.8 and 4.7 out of 7 in US and EU4+UK respectively pre-pandemic and grew to 5.2 and 5.0 at the 1st peak. This further increased to 5.6 and 5.8 at the time of this study. Conclusions: Results from this study highlighted participating physicians reported their patients to be more involved in their cancer treatment decisions compared to pre-pandemic levels and predicted more patients to become increasingly involved in the coming months. Further investigation into the continued impact of the pandemic on patient involvement and the benefits of patient participation would provide further insight into optimal ways to provide better treatment experiences through inclusivity. Further investigation using comparator cohort is warranted.
National population-based analysis of demographics and outcomes of patients diagnosed with extranodal NK/T-cell nasal type lymphoma in the US: Does ethnicity play a role?
Authors: Velez-Mejia Carolina , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique
Published: June 2023

e18772

Background: Extranodal Natural Killer/T-cell Lymphoma Nasal Type (ENKTL-NT) in an uncommon malignancy with rising incidence in the United States (US) despite previously being described only in Asia and Latin America (J Oral Maxillofac Pathol PMC3125667 Crit Rev Oncol Hematol PMID33493634). Although primarily occupying the nasal cavity, other locations may be affected, which makes its presentation ambiguous. Diagnosis is important as omitting radiation has been associated with detrimental survival (J Oncol Pract PMID31600462). This is the first national population-based analysis evaluating ethnic differences for Hispanics (HI) diagnosed with ENKTL-NT. Methods: Data were analyzed on ENKTL-NT patients in the US reported to the Surveillance, Epidemiology, and End Results (SEER) database between 2000-2018. Demographic, clinical and survival patterns were analyzed. Kaplan-Meier and Cox regression analyses were used when appropriate. Multivariate analysis and propensity score matching were performed with adjustment for age, stage and B-symptoms. Results: 1,205 patients (HI=409, Non HI (NH)=796) were diagnosed with ENKTL-NT. Male sex predominated in both. HI were diagnosed at younger median age, 43 years (y) vs 59y in NH [p <0.001]. Most of HI and NH were whites 98% vs 58%; however, for NH other races were noted. Most of the patients were diagnosed between 2010-2014. For both, the presence of B symptoms was predominantly unknown. At diagnosis stage I was mainly for HI while unknown stage was most likely noted for NH [p = 0.013]. HI were less likely than NH to receive radiation as part of their treatment, 47% vs 57% respectively [p = 0.003]. Median survival for HI was 1.7y vs 1.2y for NH; survival probability at 2, 5 and 10y for HI corresponded to 0.467, 0.413 and 0.355, while for NH it was 0.444, 0.352 and 0.292, respectively. OS probability at 10y had no statistically significant difference [p = 0.06]. On multivariate analysis, those who were older than 80y and between 60-80y, had worse OS compared to those younger than 60y (HR 2.3 - 95% CI: 1.7 – 3 and 1.2 - 95% CI: 1 – 1.5). Regarding stage, those who were at stage III/IV had worse OS than those at early stage I/II (HR 2.4 -95% CI: 1.7 - 3.2 and HR 3.4 -95% CI: 2.7 - 4.30). Conclusions: This national population-based study identified statistical differences in HI diagnosed with ENKTL-NT. Interestingly, HI were less likely to receive radiation therapy which is the mainstay treatment and key determinant for survival. The fact that there was no statistical difference in survival for HI and NH may underrepresent the improved survival from HI as they are not optimally treated and still living as longer as the NH. Additional research with biological variables should be carried out to better understand this oncological outcome and potentially offer improved targeted treatments for this ethnic minority.
Real world data evidence (RWDE) on cancer patients' (pts) awareness and knowledge of cancer associated thrombosis (CAT) events.
Authors: Duek Adrian Marcelo , Haikin Bozhena , Litvin Alon , Vorobiof Daniel A.
Published: June 2023

e18774

Background: Cancer pts are mostly unaware of the higher than normal risk of developing a CAT event. A recently reported European survey, with 745 participants, showed that just above two-thirds (69%) of pts never received information and were not aware of the higher thrombotic risk associated with cancer diagnosis and its diverse treatments. Methods: A comprehensive survey was sent, during July-September 2022, to members of Belong.life, a social and professional international free application for cancer pts and their caregivers. Pts who registered within the diagnostic groups, received a 24 questions survey of demographic and specialized questions referring to their knowledge on the possible increased risk of associated thromboembolic events, as well as determine the available resources for pts education. 1200 adult pts with a variety of cancers, replied to the survey. Most pts were receiving active anticancer treatments. Independent demographic and clinical variables were analyzed. Results: 1200 cancer pts, Belong users from English speaking countries, completed the survey, most of them females (74%, 889/1200) and > 50 years of age (85%,1014/1200). Commonest cancers were breast (29%,350/1200), gastrointestinal (15%,182/1200), lung (12%,144/1200) and gynecological (11%,142/1200). 80% (964/1200) never suffered thrombosis before their cancer diagnosis. Overall, at the time of answering the survey, 71% (861/1200) claimed not being aware of their CAT risks. 28% (339/1200) of the responders were aware of CAT at the time of replying to the survey, and of them only 17% (49/289) confirmed to be fully informed of CAT risks. Among all those that received information on CAT, 10% (120/1200) obtained it at the time of their first thrombotic event occurrence, while 14% (172/1200) were informed at the time of their cancer diagnosis and/or commencement of their planned treatments. Verbal information on CAT was mostly conveyed (51%) by the medical staff, in face to face meetings, while family and friends gave mostly internet and social media guidance (73%). Conclusions: The presence of a CAT impacts cancer pts clinical outcomes and quality of life. Available data on CAT education and awareness have been sparse. A recent European survey has shown important awareness gaps. Our RWDE survey, on 1200 Belong members with diverse geographical backgrounds and a variety of cancers, confirmed that 71% of the surveyed pts are not aware of their CAT risks before their diagnosis and/or treatment of cancer, indicating a major need for education on the known CAT risk factors, signs and symptoms, and available diagnostic imaging and treatment approaches. It is imperative that oncologists, together with allied medical professionals involved in cancer care, provide relevant CAT information, at the time of a patient’s cancer diagnosis, when individual treatments are planned, and along the pts’s cancer journey.
The impact of Covid-19 pandemic on breast cancer multidisciplinary management at the Vall d'Hebron University Hospital.
Authors: Pimentel Isabel , Viaplana Cristina , Ortiz Carolina , Villacampa Guillermo , Aguilar-Company Juan , Rodriguez Ana , Reyes Victoria Magdalena , Balmana Gelpi Judith , Martinez Xavier , Gómez Pardo Patricia , Arumí Miriam , Saura Cristina , Espinosa-Bravo Martin
Published: June 2023

e18782

Background: The impact of breast cancer screening program interruption, restrictions and delays on diagnostic exams and access to primary care due to COVID-19 is not fully understood. We report our experience on breast cancer (BC) multidisciplinary management during 2020 in a Spanish COVID-19 reference centre, and the largest hospital in Catalonia. Methods: Cohort analysis of 2020 newly BC diagnosis, as compared to 2019 and 2018 period. Results: Overall, 54% less women were called to participate on the breast screening program and only 54% of those have accepted to take part of the program during March to May 2020 (lockdown period), as compared to 76% of acceptance in 2018/2019. Consequently, during the lockdown period there was a 38% reduction on breast oncologic surgeries and a 49% decrease on first medical oncology visits vs the same period of 2018/2019. Nevertheless, time from diagnosis to first oncologic treatment was similar between study periods. Stage IV BC diagnosis has doubled in 2020 representing 9.8% vs 4.2% and 4.8% in 2018 and 2019 respectively (p < 0.001). Medical oncologists’ decision on dose dense (dd) or weekly paclitaxel chemotherapy exposure have not changed in 2020 vs 2019. Conclusions: COVID-19 pandemic has had a strong impact on screening programs, with the double of patients being diagnosed at advanced stage in 2020, as compared to the two previous years.
Chronic leukemias and COVID-19: An analysis of mortality and morbidity outcomes in the United States.
Authors: Abuhelwa Ziad , Abuhelwa Ahmad Y , Safi Mohammad , Zeidalkilani Jehad , Abrahamian Andrew , Khuder Sadik , Skeel Roland T.
Published: June 2023

e18783

Background: COVID-19 pandemic has resulted in a global health crisis with widespread mortality and morbidity. Patients with chronic leukemias (CL) are at an increased risk for severe outcomes due to their compromised immune system. Despite the potential impact of COVID-19 on this population, there is a scarcity of information on the outcomes for CL patients. Our study aims to evaluate the mortality and morbidity of COVID-19 in CL patients in the United States. Methods: In this retrospective cohort study, we employed the National Inpatient Sample database of 2020, the largest inpatient database in the United States, to include adult patients (age ≥ 18 years) with chronic leukemias (CL) who were hospitalized for COVID-19, as identified by ICD-10-CM codes. The primary outcome was all-cause in-hospital mortality, while the secondary outcomes were acute respiratory failure (ARF) and the requirement for mechanical ventilation (MV). To identify the predictors of mortality, we conducted multivariable logistic regression analyses, with a p-value of less than 0.05 being considered statistically significant. Additionally, we conducted sensitivity analyses based on the type of CL (chronic lymphocytic leukemia (CLL) or chronic myeloid leukemia (CML)) and the remission status (in remission, not achieved remission, and relapse). The statistical analysis was performed using STATA software. Results: Among 91,375 patients with CL, 5.2% were hospitalized for COVID-19, with 87% of these patients having CLL. The majority of the CL patients (88.6%) had not achieved remission. The mean age of the patients was 72.7 years, with 62.4% being male and 78.9% being white. The mortality rate among CL-COVID-19 patients was 17%, with no significant difference in mortality rates between patients with and without CL (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.81-1.14, p-value 0.65). About 61.5% of CL-COVID-19 patients had ARF and only 10.5% required MV. Patients with CL showed a 16% increase in the odds of ARF (OR 1.16, 95% CI 1.01-1.32, p-value 0.03) while no significant difference was found in the odds of MV. Sensitivity analysis showed no significant differences in mortality, ARF, or MV rates between CLL and CML groups. Another analysis by remission status revealed that patients who had not achieved remission had higher odds of ARF (OR 1.64, 95% CI 1.09-2.46, p-value 0.018) compared to those in remission or relapse. Conversely, patients in remission had a significantly lower likelihood of ARF (OR 0.63, 95% CI 0.41-0.97, p-value 0.036). No significant differences in mortality and MV odds were found according to remission status. Conclusions: Our findings emphasize the importance of vigilant monitoring and management of CL patients during the COVID-19 pandemic, particularly for those who have not achieved remission, to reduce their risk of severe respiratory outcomes.
Real-world experience with liposomal doxorubicin in metastatic and locally advanced sarcoma.
Authors: Hodge Allen , Charlson John A.
Published: June 2023

e18795

Background: Sarcomas are a type of cancer that have been historically difficult to treat given their rarity, numerous subtypes, and variable response to treatment. Doxorubicin is the most used first-line chemotherapy in metastatic sarcoma; pegylated liposomal doxorubicin (PLD) has been explored as a potentially better tolerated alternative to free doxorubicin, with less myelosuppression, alopecia, and potentially less cardiotoxicity. In this work, we examine the efficacy and real-world challenges of using PLD as treatment for metastatic and locally advanced sarcoma. Methods: Medical records of metastatic and locally advanced sarcoma patients treated with single agent PDL as a therapy were obtained from a single tertiary medical center. Retrospective analysis was conducted to measure overall survival, progression free survival, best overall RECIST response, dosage, and complications. Results: 58 subjects were identified with 52% being male and 48% female. Sarcoma subtypes included liposarcoma (28%), leiomyosarcoma (21%), undifferentiated sarcoma (16%), synovial sarcoma (5%), and other subtypes (30%). Mean age at time of initiating therapy was 64 years. 22% of patients had previously been treated with doxorubicin, in the neo-adjuvant or adjuvant setting. Patients received an average of 5 cycles of PLD. Starting dosage was 50 mg/m² every 28 days, however, changes to lower the starting dose were made in 38% of cases to adjust for anticipated tolerance, and in 21% subsequently due to side effects such as cutaneous toxicity and fatigue. There were no complete responses, 12% partial response, 31% stable disease, and 57% progressive disease. Mean overall survival and progression free survival was 452 and 180 days, respectively. Sixty-seven percent of participants had at least one follow-up echocardiogram, and 15% of those had some evidence of cardiotoxicity, with an ejection fraction of < 50% or 10% decrease from baseline. Of the participants with changes in ejection fraction, 67% had received prior anthracycline therapy and 33% had received a total lifetime dose of doxorubicin exceeding the recommended 500 mg/m² limit. Conclusions: PLD is an option for first-line therapy for metastatic sarcoma in general, however, its efficacy remains limited in a real-world setting with most patients showing a best RECIST response of progressive disease and a mean progression free survival of 180 days. While PLD is generally well-tolerated, there are potential toxicities that require attention, including cutaneous toxicity, such as hand-foot syndrome, and infusion reactions. Furthermore, a significant portion of our sample had echocardiographic changes, with decreased ejection fraction, pointing out that, while PLD may be less cardiotoxic than free doxorubicin, there is potential risk. This highlights the need to continue the search for novel therapeutic strategies in metastatic and locally advanced sarcoma.