bluuebunny/crossref_metadata_2025 huggingface dataset:
Fault Tolerance and 2-Domination in Certain Interconnection Networks
Authors: Chen Lian , Zhang Xiujun
Published: March 2019

A graph could be understood as a sensor network, in which the vertices represent the sensors and two vertices are adjacent if and only if the corresponding devices can communicate with each other. For a network G, a 2-dominating function on G is a function f : V(G) → [0, 1] such that each vertex assigned with 0 has at least two neighbors assigned with 1. The weight of f is Σ_u∈V(G) f (u), and the minimum weight over all 2-dominating functions is the 2-domination number of G. The 2-dominating set problem consists of finding the 2-domination number of a graph and it was proposed to model the fault tolerance of a sensor network. In this paper, we determined substantial 2-domination numbers of 2-dimensional meshes, cylinders, tori and hypercubes.
Abrasion Resistance of Thermally and Chemically Modified Timber
Authors: Brischke Christian , Ziegeler Neele , Bollmus Susanne
Published: March 2019

Wood modification is an appropriate way of improving the natural durability and dimensional stability of wood without the use of biocides. Different thermal and chemical wood modification processes are available for this purpose, very differently affecting the structural integrity of wood. In this study, thermally modified, melamine resin treated, acetylated, furfurylated, and mDMDHEU treated wood underwent abrasion tests according to two different methods representing different loads in practice. The Taber Abraser method caused crosswise cutting into the wood surface, while the Shaker method challenged mainly the specimen edges with dynamic loads. Abrasion resistance of wood was affected by all types of cell wall modification, but the effects were strongly dependent on the type of modification and the applied load type. For characterising the suitability of wooden materials with respect to wear resistance under outdoor conditions, it is recommended to apply a set of methods rather than a single test procedure to fully reflect the loads occurring in practice.
The Science of Patterns
Authors: Perkins Annie , Pettis Christy
Published: March 2019

Mathematics is sometimes called the science of patterns. Many kinds of patterns can be explored.
QIM119-120: Utilizing Technology to Identify Oncology Patients to Impact Patient Care
Authors: Blackmore Brook , Centers Nicole , Gifford Troy
Published: March 2019

Background: Sarah Cannon has established a standardized nurse navigation program for breast, lung, and Gi cancer patients. Navigators play a significant role in addressing barriers that may adversely impact patient outcomes. Historically, nurse navigators were spending up to 65% of their time data mining to identify new patients for navigation. This lost time compromises a navigator’s ability to effectively support patients. Sarah Cannon implemented a technology solution to address this manual process. Methods: A patient identification software application (patient ID), utilizing natural language processing technology, was developed to identify positive pathology reports across the enterprise in real time. Patient ID instantly routes those reports to a tumor site-specific oncology nurse navigator. The impact of this technology was assessed in 3 Hospital Corporation of America (HCA) markets from December 2016–March 2017. Total patient recall, total volume of reports reviewed, navigated patient volumes, navigator time allocation, and time from diagnosis to first treatment were studied. Results: Patient ID reviewed 47,544 pathology reports during the 4-month pilot, identifying 7,224 potential cancer reports. 2,782 of those represented breast, lung, or Gi cancer patients and were routed to a nurse navigator. Patient ID performed with an overall total patient recall of 98%, respectively. Decreased time spent data mining was observed, and navigator caseload increased by 71%. Time from diagnosis to first treatment decreased by an average of 6 days. Time allocated to direct patient contact and physician interaction increased by 35%. Conclusions: Implementation of a technology solution to rapidly identify new cancer patients for navigation in a community health system is feasible and associated with multiple benefits. Increased navigator patient volumes and navigator productivity were observed. Navigator time spent with patients and physicians increased with a concurrent reduction in data mining time. Timeliness of care metrics improved, suggesting a favorable impact on quality. This technology is now being deployed across the HCA enterprise.
CLO19-043: Assessing the Risk of Chemotherapy Toxicity and Hospital Admission Due to Toxicity
Authors: Malton Samuel
Published: March 2019

Background: Acute chemotherapy toxicity is common and can have negative effects for the patient and the health economy. Finding overall toxicity incidence for a typical teaching hospital population proved difficult, although a 2008 report into deaths within 30 days of chemotherapy found that 43% of patients who died reported a grade 3 or 4 toxicity (Mort D et al, available at: http://www.ncepod.org.uk/2008report3/Downloads/SACT_report.pdf). At Nottingham University Hospitals (NUH), a Cancer Admissions and Triage Team was established, who undertake a telephone assessment 24 hours following the administration of a first cycle of chemotherapy, in which a proactive toxicity assessment is completed. This had the aim of reducing hospital admission due to toxicity through timely advice and intervention and allowed the accrual of data regarding reported toxicity. Methods: Data was obtained from the telephone assessment of acute toxicity 24 hours after administration of a first cycle of chemotherapy, once the service had been in use for 1 year. Descriptive statistics were produced to establish toxicity incidence and severity and hospital admission rates as well as length of stay. Regression modelling was used to identify predictors of the 4 outcome measures. The commonest toxicities were explored as secondary outcome measures. Results: 1,539 patients were studied, and the overall incidence of toxicity was 35.6%. Disease site and number of chemotherapy agents given were shown to predict toxicity, with breast and upper gastrointestinal cancers having a higher likelihood of toxicity. The more anticancer agents used, the higher the risk of toxicity. Disease was predictive of toxicity grade, with urology, gynecology, and lung patients experiencing higher grades of toxicity than other tumor sites. The rate of hospital admission due to toxicity was 13.1% and mean length of stay 4.4 days. The risk of admission had some risk factors in common with toxicity. Disease and the number of drugs in the regimen affected the risk of admission, with gynecology, head and neck, and lung cancer patients and patients who received 3 drugs having a higher likelihood of admission. No predictors could be reliably identified for length of stay. Predictors in the subgroups of breast, lower gastrointestinal, and lung cancers did not differ greatly from the whole population, and the number of drugs was shown to be a predictor of nausea, vomiting, and fatigue when explored as secondary outcomes. Conclusion: Predictors were identified for occurrence of toxicity, severity of toxicity, risk of hospital admission, but not for length of stay. Subgroup analyses were undertaken. The overall burden of acute chemotherapy toxicity of a heterogeneous population was elucidated.
QIM19-132: Trastuzumab Induced Cardiotoxicity: Are We Monitoring and Managing Appropriately?
Authors: Katz Heather , Jafri Hassaan , Leigh Emilia Cindy , Biglow Layana , Urella Madhulika , Tirona Maria Tria
Published: March 2019

Background: Per the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer (available at NCCN.org), left ventricular ejection fraction (LVEF) should be evaluated prior to and during treatment with trastuzumab. Optimal frequency of assessment is unknown. The FDA label recommends monitoring prior to and every 3 months during therapy. Trastuzumab should be held for 4–8 weeks when LVEF decreases ≥16% from pretreatment values or LVEF is below normal limits and decreases ≥10% from pretreatment values. Trastuzumab should be permanently discontinued for persistent (>8 weeks) LVEF decline or if trastuzumab is stopped >3 times for cardiomyopathy (trastuzumab package insert). Methods: A retrospective chart review was performed analyzing 98 charts of patients with stage I–III HER2-positive breast cancer who were seen at the Edwards Comprehensive Cancer Center (ECCC) in Huntington, WV from January 1, 2012–December 30, 2017. Patients who received trastuzumab at ECCC (59) were further reviewed to see if cardiac function was assessed prior to treatment, at 3 month intervals, and if trastuzumab was held or discontinued permanently if indicated. Results: Analysis of 98 patient charts with stage I–III HER2-positive breast cancer was performed. 59 patients (60.2%) received trastuzumab under supervision of medical oncology at ECCC and continued in the study. LVEF was evaluated in all patients (100%) prior to treatment. LVEF was evaluated every 3 months in 36 (61%) patients while 23 (38.9%) occurred at longer time intervals. Preserved EF was seen in 41 (69.4%) patients. 18 (30.5%) patients had a decrease in LVEF by the defined criteria. Trastuzumab was not held appropriately in 4 of those patients (22.2%). 10 of 18 patients that had a drop in LVEF had persistent LVEF decline or had stopped treatment >3 times for cardiomyopathy. Trastuzumab was permanently discontinued appropriately in 4 of the 10 patients (40%). Conclusions: Better compliance is needed to monitor LVEF at 3-month intervals while on trastuzumab. Improvement to recognize when to hold trastuzumab to prevent cardiotoxicity is needed. Better documentation, easier accessibility to previous EF results, and a multidisciplinary team (breast navigator, cardiologist, oncologist, and pharmacist) will likely improve adherence to current recommendations for cardiac assessment and to determine if Trastuzumab should be held or stopped.
CLO19-037: Reducing the Duration, Incidence and Severity of Mucosal Injury Due to Cancer Radiation therapy (RT); Positive Randomized Phase 2b Trial Results With GC4419 (Avasopasem Manganese), a Small Molecule Superoxide (SO) Dismutase (SOD) Mimetic
Authors: Holmlund Jon T. , Anderson Carryn M. , Sonis Stephen T. , Beardsley Robert , Riley Dennis , Brill Jeffrey Mark , Brookes Melissa , Terry Kara , Sorensen J. Mel
Published: March 2019

Introduction: RT-induced SO contributes to initiation of mucosal injury; eg, oral mucositis (OM) and esophagitis. GC4419 specifically mimics SOD’s dismutation of SO to hydrogen peroxide (H2O2), interdicting OM initiation. GC4419 reduced RT-severe OM (SOM) in a hamster cheek pouch model, and protected mucosa and other normal tissues from radiation-induced injury in other animal models. In a published phase 1b/2a open-label trial (Anderson et al, IJROBP, 1 Feb 2018), GC4419 attenuated SOM in patients (Pts) receiving intensity-modulated RT (IMRT) plus concurrent cisplatin (CDDP) for locally advanced head & neck cancer (HNC). Objectives: Determine whether GC4419 reduces duration, incidence, & severity of SOM. Methods: Pts with locally advanced oral cavity or oropharyngeal cancer; definitive or postoperative intensity-modulated (IM)RT (approximately 70 Gy [>50 Gy to > 2 oral sites]) plus CDDP (weekly or q3wk) were randomized (stratification: tumor HPV status, CDDP schedule) to 30 or 90 mg of GC4419, or placebo (PBO), 60-minute IV infusion, M–F, ending <60 minutes before IMRT delivered in 35 fractions over 7 weeks. WHO grade OM was assessed by trained evaluators biw during IMRT & qwk for up to 8 wks after IMRT. Primary endpoint: duration of SOM. Efficacy was tested for each active dose vs PBO (ITT population) by a sequential, conditional approach (2-sided alpha, 0.05). Results: 223 pts (44 sites): 90 mg (n=76), 30 mg (n=73), or PBO (n=74). Baseline patient and tumor characteristics and treatment delivery were balanced. Efficacy: At 90 mg GC4419 vs PBO, duration of SOM was significantly reduced (median, 1.5 vs 19 d; P=.024). SOM incidence (43% vs 65%; P=.009), and grade 4 incidence (16% vs 30%; P=.045) also improved. There were intermediate improvements with 30 mg. Safety was comparable across arms; no significant GC4419-specific toxicity; other known toxicities of IMRT/CDDP were not increased. Conclusions: GC4419 demonstrated a significant, clinically meaningful reduction of SOM duration, and dose-dependent improvements in other SOM parameters, with acceptable safety. A confirmatory phase 3 trial (NCT03689712) is in progress. Clinical trials to reduce RT-related esophagitis are also planned.
HSR19-098: Opportunities and Challenges of Managing Breakthrough Cancer Pain (BTCP): An Educational Exercise
Authors: Mariano Dean J.
Published: March 2019

Background: Cancer pain is one of the most feared symptoms of cancer and is usually moderate to severe in intensity, particularly in later stages. Opioids are the mainstay maintenance treatment of chronic cancer-related pain. However, between one third and two thirds of cancer patients treated with opioids still experience episodes of severe and debilitating pain known as breakthrough cancer pain (BTCP). Given the number of available treatment approaches for BTCP, healthcare professionals (HCPs) need guidance in selecting the treatment that best meets their patient’s needs and provide the best opportunity for a positive outcome. Aim: Describe the pathophysiology and characteristics of BTCP, its prevalence, and the negative impact on patients. Discuss the characteristics of ideal BTCP treatments and available options. Evaluate the concepts of dependence, addiction, and diversion; ways to minimize risk in cancer patients using opioids; and strategies to address issues. Apply shared decision-making resources to improve collaboration with clinician and patient for optimal BTCP management outcomes by providing best standard of care. Methods: 12 live expert faculty meetings held in oncology/hematology departments in community hospitals, regional cancer centers, and academic centers nationwide from November 17, 2017–June 01, 2018 (Table 1). Target audience of hematologists/oncologists, oncology nurses, physician assistants (PAs), nurse practitioners (NPs), palliative care physicians, pain management specialists, pharmacists, and other HCPs involved in the treatment of patients with BTCP. Results: Overall participation: 321 (anticipated 265; 186 CME completers); 193 oncology MDs; 61 oncology nurses/NP; 17 pharmacists; 22 PAs; 28 other HCPs interested in BTCP. Pre/post-test and 90-day follow-up surveys assessed. 0% commercial bias. Satisfaction of program rated 97%–100%; 96% intend to apply what they acquired to their practice; 97% have a strategy to combat BTCP; 99% are better able to describe BTCP and its negative impact on patients; 98% can better evaluate dependence, addiction, and diversion and to minimize risk of using opioids. +35% average pre- to post-test change with 4 of 5 questions achieving a P≤.0001 at 90-day follow-up. 72% of participants implemented practice changes by 90-day follow-up. Conclusion: Results suggest that participation in this activity is associated with increased competence and positive practice changes for BTCP.
CLO19-034: The Clinical Outcomes of Next-Generation Sequencing Testing at a Community Oncology Practice
Authors: Hancock Christie , Bitran Jacob
Published: March 2019

Background: The value of next-generation sequencing (NGS) tests is dependent on how it changes clinical management, if at all. There are not any guidelines on when a physician should obtain testing; what certain genetic variations can be clinically, meaningfully intervened on; and if this active drug is financially practical. A NGS test ideally should identify a targetable mutational profile that leads to a treatment that can be obtained and produces lasting responses. We reviewed the NGS testing practices at our community hospital. Methods: Patients in our oncology clinic that underwent NGS testing of their tumor were reviewed. Specifically, the patient’s age, gender, diagnosis, date of diagnosis, previous lines of treatment, date of NGS testing, and reported molecular targets were recorded. Details of the changes in clinical management based on the NGS and survival time after the NGS test was ordered were also analyzed. Results: Forty-three patient cases were reviewed that had NGS testing obtained between the years 2014–2015 and 2017. Eighteen patients were males and 25 were females. Median age was 60 years. Most common tumor type was breast; 3 were triple-negative and 6 were only hormone-receptor positive. Second most common type was colorectal. NGS changed management in 12 cases. Two patients were able to enter a clinical trial and the other 10 had therapeutic changes based on protein or mRNA overexpression. Median time of change in management to survival in these patients was 7 months. Thirty-seven patients died; overall time from ordering of test to death was 7 months. Overall time of ordering test to survival for all patients was 8 months. Conclusions: NGS gathers a significant amount of information of a patient’s cancer, but this information is difficult to interpret in the clinical setting. Twenty-eight percent of our patients had a change in treatment, but this did not translate into lasting responses compared to other patients. Furthermore, the responses that were seen may have not been related to the therapeutic interventions, but intrinsic tumor biology. It is important to be aware of the clinical utility in ordering these tests for both the physician and patient.
YIA19-002: Axl-RTK Inhibition Modulates T Cell Functions and Synergizes With Chimeric Antigen Receptor T Cell Therapy in B Cell Malignancies
Authors: Kenderian Saad S. , Sakemura Reona , Yang Nan , Cox Michelle , Sinha Sutapa ,   Mehrdad Hefazi, Hansen Michael , Schick Kendall , Forsman Cynthia , Boysen Justin , Ding Wei , Parikh Sameer , Kay Neil
Published: March 2019

Despite the remarkable outcomes of CD19-directed chimeric antigen receptor T (CART19) cell therapy in B-cell malignancies, the durable responses in diffuse large B-cell lymphoma are less than 40%, and strategies to enhance this response are desperately needed. Inhibition of AXL RTK with TP0903, a high-affinity AXL inhibitor has been found to induce robust apoptosis of malignant B cells. Here, we aimed to examine the role of AXL RTK inhibition with TP0903 on T-cell function in B-cell malignancies. First, we investigated the influence of TP0903 on CART19 cell phenotype and functions. Here, we used 41BB costimulated, lentiviral-transduced CART cells. AXL inhibition led to polarization of CART cells into a Th1 phenotype when T cells were stimulated with the CD19+ mantle cell lymphoma (MCL) cell line Jeko or with leukemic B cells isolated from patients with chronic lymphocytic leukemia (CLL), in the presence of TP0903 (Fig 1A). Exposure of activated CART cells to TP0903 also resulted in significant downregulation of inhibitory receptors on activated CART cells (Fig 1B), a reduction of conical cytokines known to be associated with the development of cytokine release syndrome (CRS) (Fig 1C). To investigate the effect of AXL RTK inhibition of CART cells with TP0903 in vivo, we established MCL xenografts through the injection of 1.0x106 of Jeko into NSG mice. A week later, mice were treated with either vehicle alone, TP0903 (20 mg/kg/day) alone, 0.5x106 of CART19 alone, or TP0903 (20mg/kg/day)+0.5x106 of CART19. Three weeks after the treatment, mice were rechallenged with 1.0x106 of Jeko. Mice treated with CART19 and TP0903 rejected the tumor challenge while mice previously treated with CART19 alone redeveloped MCL, suggesting that AXL inhibition enhanced CART cell persistence (Fig 1D). Finally, we validated our preclinical findings in correlative analyses of phase 1 clinical trial of TP0903 in patients with solid tumors (NCT02729298). Similar to our findings, there was a significant reduction in Tregs, reduction of inhibitory receptors and polarization to a Th1 phenotype. These findings will be further investigated in a planned phase 1 clinical trial of TP0903 in relapsed/refractory CLL (NCT03572634) In summary, we demonstrated for the first time that AXL inhibition polarizes T cells into a Th1 phenotype, downregulates inhibitory receptors, and synergizes with CART cells in B-cell malignancies. These findings encourage further study of TP0903 as an enhancer of T-cell immunotherapies.
HSR19-105: The Role of Chemotherapy in Elderly Colorectal Cancer Survivors: An Observational Study
Authors: Pawloski Pamala A. , Vazquez-Benitez Gabriela , Ziegenfuss Jeanette Y. , DeFor Terese A. , Seburg Elisabeth M.
Published: March 2019

Background: Older patients diagnosed with colorectal cancer are not routinely included in clinical trials and are frequently treated with less aggressive chemotherapy. To identify factors associated with treatment initiation in older adults, we conducted an observational study of patients diagnosed with stage I–IV colon or rectal cancer at 65 years and older between 2010 and 2014 across 6 integrated health care systems. Methods: Data were obtained from cancer registries based on chart abstraction and medical records. Time from diagnosis to surgery, chemotherapy, and radiation was measured in weeks and censored when disenrollment, death, or the end of the study period occurred. We assessed patient factors associated with time to chemotherapy initiation using survival analysis methods. Results: Among 8,088 patients diagnosed after the age of 65 with colon cancer, the mean age at diagnosis was 76 years (SD 7.7), 4,150 (51%) were female, and 34% were stage 3 or greater. More than half, 55% (n=4,434) of colon cancers were right-sided (RCC), 23% (n=1833) were left-sided (LCC), and 19% (n=1,559) were rectal cancers. Two-thirds (n=5,201) had moderately differentiated disease. Most (57%) received surgery within 4 weeks and 89% within 6 months of diagnosis (median, 3.4 weeks). At 6 months following diagnosis, 33% of patients had received chemotherapy, and only 4% received radiation. Factors associated with the receipt of chemotherapy were assessed in a multivariable survival model that included age, gender, stage, and site. Patients of older age were less likely to receive chemotherapy (HR, 0.49; 95%CI, 0.45–.53 for 75–79 vs 65–69 years), and more likely for advanced stage, and rectal site. No difference was observed between men and women. Refusal of chemotherapy was reported for only 6% of patients and was associated with age, stage, and site. Six month mortality was 13.3%. Conclusions: Factors associated with the receipt of treatment among older cancer survivors are similar to those in the general population.
BPI19-010: Febrile Neutropenia Induced by Chemotherapy: Impact of Risk Re-Stratification
Authors: da Silva Dias David , Jorge Catarina , Baptista Mafalda , Arede Ana Júlia , Luz Paulo , Madureira Tânia , Gosalbez Beatriz
Published: March 2019

Introduction: Febrile neutropenia (FN) induced by chemotherapy (ChT) arises until 6 weeks after the last cycle, usually between 5 and 10 days post-ChT. Infection risk is 20%–30%. It is difficult to stratify patients with low risk of complications due to FN. MASCC index is useful but has limitations. This correlates with unnecessary hospital admissions, complications, and costs. Methods: Retrospective study of patients with diagnosis of FN induced by ChT, admitted to our center between 2012 and 2016. Primary goal was to describe this population. Secondary goal was to re-stratify the risk of FN using MASCC and CISNE indexes, clinical judgement, and social/logistic factors. SPSS v23 was used for statistical analysis. Results: 211 patients were included; median age, 66 years. Median hospital stay was 6 days (1–89). 25% were nosocomial admissions. At admission 46% of patients presented with stage IV cancer. 75% were solid neoplasms and 25% were hematologic. Profound neutropenia was observed in 43% and severe neutropenia in 36%. Overall mortality rate was 13%. Sepsis was diagnosed in 24 patients (11%), with a mortality rate of 54%. Only 12.3% of patients had prophylaxis with granulocyte-colony stimulating factor. At admission, 64% of patients had no obvious focal infection; 20% had probable focus; and in 16% a microorganism was identified, most commonly gram-negative Enterobacteriaceae. Most used antibiotics were piperacillin/tazobactam (44%) and its combination with aminoglycoside (34%). This combination showed benefit against some extended-spectrum beta-lactamase (ESBL)–producing strains and multiresistant (MR) Pseudomonas aeruginosa (2.8%). MASCC index identified 31% of patients with low risk FN. After applying the CISNE index, clinical judgement, and social/logistic factors, only 11% were identified as low-risk FN and did not benefit from admission. This translates to an avoidable cost of €48,000 according to the center’s annual report. Conclusion: The combination of β-lactam and aminoglycoside is overused in our practice. It is not recommended in hemodynamically stable patients and contradictory in unstable ones; still it shows some effect versus MR and ESBL strains. A study to evaluate their incidence in our center is now in progress. Low risk FN was observed in 11% of admitted patients. Our center has an internal protocol and has been able to provide a good overall response.
HSR19-086: Healthcare Costs and Resource Utilization Associated With Adverse Events Among Hairy Cell Leukemia Patients Treated With Purine Nucleoside Analogs
Authors: Epperla Narendranath , Pavilack Melissa , Olufade Temitope , Bashyal Richa , Huang Teng , Yuce Huseyin , Andritsos Leslie
Published: March 2019

Background: Purine nucleoside analogs (PNAs) are highly effective for first-line treatment of hairy cell leukemia (HCL). In clinical trials of single PNAs, several adverse events (AEs) were reported; however, little is known regarding the costs and healthcare resource utilization (HRU) resulting from AEs in HCL patients (pts) treated with PNAs in non-clinical trial settings. Objective: Determine the costs and HRU of high incident and clinically important AEs associated with PNA therapy in HCL pts in the Truven MarketScan database. Methods: Adults (aged ≥18 years) with ≥2 HCL diagnosis codes ≥30 days apart during January 1, 2006–December 31, 2015 were included. Pts had ≥1 prescription claim for a PNA (cladribine or pentostatin ± rituximab) after HCL diagnosis date. First PNA claim date was defined as the index date. Pts had continuous health plan enrollment for ≥6 months at baseline and ≥12-months follow-up with no PNA in the baseline period. Pts were placed into cohorts based on the occurrence of myelosuppression (MSPN) and opportunistic infections (OI) as these were highest incident and clinically important AEs observed. Generalized linear models were used to compare outcomes during the 12-month follow-up. Results: Of the 219 pts with no history of MSPN, 101 developed MSPN (incidence [I]: 461 per 1000 pt-years) and of 619 pts with no history of OI, 26 developed OI (I: 42 per 1000 pt-years). Demographics were similar between pts with and without MSPN and OI. Pts who developed OI or MSPN had significantly higher inpatient admissions and costs (Table 1). Conclusions: PNA-treated HCL pts who developed MSPN or OI incurred higher HRU than those who did not develop either condition. This indicates the need for new therapeutic strategies to reduce HCL-treatment-associated toxicities.
YIA19-001: Mechanisms of Diagnostic Delay Among Black women With Endometrial Cancer (EC): Results from Qualitative Interviews and a National Analysis of Healthcare Data
Authors: Doll Kemi M. , Khor Sarah , Hempstead Bridgette , Alson Julianna G. , Kellogg Liz , Wolff Erika , Flum David , Ramsey Scott , Goff Barbara
Published: March 2019

Background: A major contributor to the black-white mortality gap in endometrial cancer (EC) is late stage at diagnosis for black women, which may be driven by delays in diagnosis both prior to and after symptom disclosure. Methods: For phase 1, black women with EC were recruited through oncology clinics and a local cancer support group. In-depth interviews were conducted focused on experiences of menopause, postmenopausal bleeding (PMB), and symptom disclosure, and transcripts coded using directed content analysis. For phase 2, EC cases from 2001–2015 were identified in SEER-Medicare. Location, provider type, and dates of symptom report and diagnosis were defined by claims data. The diagnostic interval was then calculated and step-wise multivariate modeling used to determine factors associated with time to diagnosis. Results: Phase 1 included 11 black women from 4 states (WA, LA, GA, CA), ages 47–70, stages 1––3 at diagnosis, for a total of 147 pages of transcribed interviews. Most were insured, with access to routine medical care. Common themes were a lack of knowledge of normal vs abnormal menopausal symptoms and silencing about bleeding among friends and family. The predominant interpretation of PMB was a resumption of normal menstruation, leading to significant delay in symptom disclosure. Reporting to an MD was largely driven by increased severity of bleeding or the onset of pain. Phase 2 included 3,363 EC cases, with 293 (8%) black women. The median diagnostic interval was 28 days (IQR: 8–110 days). After adjusting for age, region, gynecologic history and other presenting symptoms, provider differences were noted with shorter time for ER MDs (84%; P<.01) and PCPs (16%; P=.05) vs OBGYN. Characterization of bleeding as ‘abnormal’ rather than ‘postmenopausal’ prolonged time to diagnosis by 60% (P<.001). Black race was associated with a 2.4-fold increased diagnostic time interval (P=.017). Step-wise modeling showed that this association was explained by differences in diagnostic work-up: Compared to those with a biopsy within 7 days of presentation, women who had an ultrasound or no procedures had longer intervals (42% and 99%, respectively) to diagnosis (P<.001 for all). Conclusion: Among black women with access to medical care, there are modifiable factors that contribute to delays in diagnosis of EC both prior to and after symptom disclosure to a physician. This is the first study to identify targets for intervention to reduce the mortality rate in this high-risk group.
HSR19-104: Patterns of Providers’ Mammogram Referrals for Asymptomatic Breast Cancer Survivors
Authors: Palos Guadalupe R. , Gilmore Katherine , Chapman Patricia , Bi Weiqi , Lewis-Patterson Paula , Rodriguez Alma Maria
Published: March 2019

Background: NCCN Guidelines recommend annual mammography for surveillance in asymptomatic women diagnosed with breast cancer. There is limited evidence to support which type of mammogram—screening or diagnostic—should be ordered for asymptomatic breast cancer survivors. Our objective was to assess the referral patterns for mammograms in 2 breast clinics: survivorship (SC) and oncology (OC). Methods: A retrospective analysis of institutional databases was conducted to identify a convenience sample of women with limited invasive breast cancer who were (1) alive 5 years post-treatment and (2) seen at a SC or OC visit scheduled from January 1 to December 31, 2015. The primary outcome was women who received a diagnostic or screening mammogram during the 2015 calendar year. Demographic, clinical, and mammogram characteristics were also analyzed. Simple descriptive statistics were used to aggregate and compare data. Chi-square analysis tested for statistical significance. Results: A convenience sample of 354 cases was identified. Of those, 247 met the eligibility criteria for this analysis, SC=147 and OC=100. In this cohort, the mean age of diagnosis was 50.42 (±11.12), the majority were white (74.1%), and most received a diagnostic mammogram (64.4%). A greater proportion of diagnostic mammograms were ordered for women seen in OC (40.1%) vs SC (24. 3%). This finding was statistically significant (P=.00). Overall, 91.9 % of the mammogram results were negative and with a low proportion of “positive” (2.0%) or “need for additional imaging testing” (6.1%) reported. Recurrence rates in this cohort were also found to be low (1.6%). Conclusions: In this cohort, we found a difference in the type of mammogram ordered by providers in dedicated survivorship or medical oncology clinics. Our findings suggest that despite the greater use of diagnostic mammograms among this cohort of long-term breast cancer survivors, the overall proportion of positive findings, further imaging tests, or recurrence rates was low. It is concerning that many asymptomatic breast cancer survivors continue to receive a diagnostic mammogram as part of their surveillance visit. Further studies are needed to identify the emotional, financial, and physical toxicities associated with diagnostic mammograms.
HSR19-089: Misperceptions Regarding Palliative and Hospice Care Among Cancer Patients: What Can We Learn from Patient-Reported Treatment Decision Making
Authors: Hayes Sara , Green Brian M. , Yeates Shayna , Bhowmick Amrita , McNamara Kaitlyn , Herbert Leslie Beth
Published: March 2019

Background: Despite NCCN Guidelines and clear definition of palliative care, patients often carry misperceptions about palliative care and how it can be beneficially integrated into a patient’s care plan. In order to better understand the misinformation about palliative and hospice care, this study aims to assess patient-healthcare provider (HCP) communication regarding treatment decisions. Methods: An online survey was conducted with individuals who have had a diagnosis of cancer (n=1,517) to better understand their healthcare experiences as well as the impact their cancer diagnosis had on their quality of life. Measures included agreement scale questions assessing patient information needs surrounding treatment decision making. Open-ended questions where respondents were prompted to provide a written response allowed researchers to further assess patients’ understanding of palliative and hospice care. Responses to agreement-scale questions were evaluated using descriptive statistics. Openended question responses were analyzed using Dedoose qualitative data analysis software. Results: Among patients with a diagnosis of cancer, there were a broad range of patient misperceptions regarding palliative care, hospice care, and how they are used in cancer care. The majority of respondents (81%) stated that their HCP played a role when deciding on their treatment plan. Despite this, only 46% were confident they knew about the treatment’s impact on their daily life, 56% were confident they knew about the potential side effects of treatment, and 57% felt they had all of the information they needed. Themes identified through qualitative analysis include: patient conflation of palliative and hospice care, belief that palliative and hospice care are only relevant to end-of-life decision-making, and uncertainty about whether quality of life can actually be improved. Conclusions: Institutions and HCPs are recommended to integrate palliative care into cancer care. However, as this research shows, oncology patients are often misinformed about the benefits of palliative care. This follows a parallel concern of patients making treatment decisions without optimal information. A potential factor behind this unmet need may be lack of effective communication between patient and HCP. Palliative care may be mentioned by the HCP, but not discussed with enough empathy or depth, leading to patient misunderstanding and lack of inclusion in treatment plans.
QIM19-144: Health-Related Quality of Life and Stress Level in Patients After Thyroid Resection Due to Cancer Depends on Patients’ Knowledge About Their Disease and Treatment Plan: Preliminary Results
Authors: Spychala Arkadiusz , Oko Michal , Zając-Spychala Olga , Kycler Witold
Published: March 2019

Background: Relevant information is a prerequisite for patients to acquire enough knowledge to enable them to be actively involved in shared decision making, to comply with the treatment plan, and to understand what are potential benefits and side-effects of proposed therapy. Aim: The aim of this prospective, longitudinal study was to investigate whether cancer patients’ level of knowledge about their disease and treatment was associated with their health-related quality of life (HRQOL), particularly stress level. Patients and Methods: From October 2017 till September 2018, 41 patients aged 26–69 (median, 42) years referred for curative thyroidectomy were included into the study. EORTC QLQ-INFO25 questionnaire was used to measure level of patients’ knowledge about their disease and treatment, while thyroid-specific HRQOL was measured using Polish version of ThyPRO questionnaire and stress level by COPE Inventory. Assessments were done directly before the surgery (T1), 3 months after (T2), and 6 months after the treatment (T3). Results: The information about the disease (T1: 39.2, T2: 47.6, T3: 52.8; P=.024), information about treatment (T1: 27.2, T2: 42.6, T3: 60.8; P<.001), information about what patients can do to help themselves (T1: 22.6, T2: 39.4, T3: 52.2; P=.037), and satisfaction with the received information (T1: 32.6, T2: 41.0, T3: 49.7; P=.049) increased significantly during the study period. Moreover, the proportion of patients who wished they had received more information decreased from 59.4% at T1 to 22.8% at T3 (P<.001). Almost all of HRQOL domain scores were increasing in the consecutive time points with respect to role-physical (T1: 72.7, T2: 79.2, T3: 80.7; P=.003), role-emotional (T1: 77.6, T2: 82.8, T3: 88.9; P=.001), general health (T1: 52.7, T2: 60.2, T3: 63.4; P<.001), physical functioning (T1: 69.7, T2: 77.8, T3: 79.4; P=.011), social functioning (T1: 82.7, T2: 88.9, T3: 89.4; P=.047), and vitality (T1: 69.3, T2: 72.8, T3: 79.9; P<.001). Based on COPE Inventory, from the relative scores on various coping strategies in each time point, the 5 most common coping strategies adopted were active coping, planning, suppression of competing activities, focus on emotions, and positive reinterpretation and growth. There was significant correlation between EORTC QLQ-INFO25, ThyPRO, and COPE Inventory, in particular study time point (P<.001). Conclusions: Patients’ knowledge increased significantly during the study period, and they reported that they felt better informed and were more satisfied with the information. This significantly influenced improvement of HRQOL and stress reduction. Psychological outcome must be considered as important measurement assessing treatment effect.
CLO19-023: Induction Chemotherapy Followed by Chemoradiation and Trans-Anal Full Thickness Local Excision or Total Mesorectal Resection in Patients With T2-T3/NO-N+ Adenocarcinoma of the Rectum; Preliminary Results of Phase 2 Prospective Clinical Trial
Authors: Abdalla Ahmed , Aref Amr , Alame Amer , Barawi Mohamad , Ma Danny , Kafri Zyad
Published: March 2019

Background: The National Comprehensive Cancer Network (NCCN) Guidelines recently recognized total neoadjuvant therapy (TNT) as an acceptable option in patients with T3 and any N rectal cancer. Previous studies suggested that patients who received chemotherapy prior to conventional preoperative chemoradiation (CRT) and surgery allowed patients to receive more of their planned treatment with a better toxicity profile and increase in pathological response. However, those studies used a long course of FOLFOX or used capecitabine and oxaliplatin as an induction regimen. We are conducting a phase 2 prospective clinical trial to evaluate the use of 6 cycles of FOLFOX as TNT in patients with T2-T3/N0-N+. Patients and Methods: Patients with T2-T3/N0-N+ enrolled on our phase 2 prospective trial were included for this analysis. Patients received 6 cycles of FOLFOX (infusional fluorouracil, leucovorin, and oxaliplatin), which was administered every 2 weeks. After 3 weeks of recovery period, patients then received conventional CRT with 5FU or capecitabine. All patients got MRI and endorectal ultrasound (ERUS) at baseline, after completing FOLFOX 3-months regimen and after finishing conventional CRT. Patients underwent either full-thickness local excision or total mesorectal resection depending on their tumor response to neoadjuvant therapy. The time interval between completion of radiation therapy and surgery ranged between 7and 12 weeks. Results: A total of 10 patients completed the chemotherapy and CRT treatment regimen. 9 patients proceeded to surgery and the 10th patient is scheduled for surgery. Clinical downstaging by MRI or ERUS was shown in 9 of 10 patients with only 6 cycles of FOLFOX. Complete clinical response was achieved in 6 patients as evident by ERUS/MRI of the pelvis after 3 months of FOLFOX before CRT. Complete pathological response was found in 4 of 9 patients (44%). In addition, 4 other patients had significant albeit not complete pathological response. Conclusions: This study suggests that adding only 6 cycles of neoadjuvant FOLFOX before CRT improved clinical and pathological downstaging of T2-T3/N0-N+ rectal adenocarcinoma and may facilitate organ preservation surgery. This is strategy needs to be investigated in larger phase III trials to validate these findings.
EPR19-068: Association of Oral Premalignant Lesions with the Consumption of Tobacco
Authors: Jani Chinmay T. , Joshi Arpita , Jain Khushboo , Bala D. V.
Published: March 2019

Introduction: Tobacco use is a major public health problem globally. According to the WHO, tobacco is the second most important cause of death in the world. Tobacco is used in different forms: smoke and smokeless. In India, people also consume beetle nut along with tobacco, causing more harmful effects. The present study was done to determine prevalence of tobacco use in industrial workers and associate it with the prevalence of oral premalignant lesions. Methodology: A cross-sectional observational study of 909 industrial workers working in 4 industries was undertaken from March 2014 to October 2014. Cases who had consumed tobacco in either form for over a year were included. Sociodemographic history and the history of current and past tobacco consumption were recorded. The oral cavity was examined for premalignancy. Results: Of 909 subjects, 537 (59.1%) had a history of consuming tobacco; of which, 360 (39.6%) were consumers of smokeless tobacco (SLT) and 141 (15.5%) were smokers. Oral premalignant lesions were present in around 52% of the study population that was exposed to tobacco, amongst which tobacco quid lesion was the most common (10.9%) followed by oral submucous fibrosis (9.8%). OSMF was seen more in beetle nut chewers. The odds of developing an oral premalignant lesion as a result of exposure to tobacco are 43.62 times more than the odds of acquiring a lesion without exposure. Conclusion: Tobacco consumption in any form is hazardous and causes various kinds of oral premalignant lesions. Beetle nut exposure causes more harmful effect which goes unnoticed. Awareness should be created about various lesions caused by tobacco as well as beetle nut and special steps should be taken for early diagnosis and its treatment.
Les carnets de Julien Gracq : « la promenade entre toutes préférée »
Authors: Daunais Isabelle
Published: March 2019

Durant toute sa vie d’écrivain, mais de façon de plus en plus exclusive au fil du temps, Julien Gracq a pratiqué ce qu’il appelle une « littérature fragmentaire », composée de notes et de « notules », de cahiers et de souvenirs, de textes critiques et d’essais brefs, publiés sous la forme de carnets (même s’il ne recourt que très rarement à ce terme). Si cette écriture du fragment s’oppose, chez Gracq, à l’effort et à la dynamique de continuité qui caractérisent, à ses yeux et dans sa pratique, l’écriture romanesque, elle est aussi une façon de rendre une certaine mesure du monde, qui est aussi bien une manière de l’habiter. La préférence de Gracq pour les lieux clos et abrités, pour les instants hors du temps, pour ce qui se suffit à soi-même, pour ce qui n’est pas suspendu à une suite, trouve dans l’écriture du fragment une forme d’expression non seulement privilégiée, mais aussi la plus adéquate possible.
Des fenêtres sur l’infini ? Usages du cahier dans la construction de la posture chez Henry Bauchau
Authors: Meurée Christophe
Published: March 2019

L’écrivain belge Henry Bauchau utilisait le cahier pour ses manuscrits comme pour ses journaux personnels. À partir du moment où il décide de publier ses journaux, il commence à décorer les couvertures de ses cahiers avec des photographies, des reproductions d’oeuvres d’art, etc., afin de créer une matière d’archive unique. Cette pratique éclaire le processus créateur aussi bien que la façon dont Bauchau s’est construit une posture d’écrivain, en veillant à orienter ses lecteurs aussi bien que ses exégètes.
Le fil du carnet chez André Major
Authors: Biron Michel
Published: March 2019

Depuis Le Sourire d’Anton ou l’adieu au roman (2001), André Major a fait du carnet sa forme de prédilection, le fil conducteur de sa vie et de son écriture. Cet article vise à suivre ce fil à partir du « désir d’impersonnalité » auquel le personnage de carnettiste s’identifie au fur et à mesure qu’il prend conscience de lui-même. Dans un premier sens, ce désir d’impersonnalité le conduit à simplement témoigner le plus exactement possible de ce qui l’entoure, de ce qu’il voit, de ce qu’il lit. Mais ce faisant, le carnettiste découvre une paradoxale radicalité dans sa manière en apparence si modérée de se tenir en retrait du monde. Il revendique alors le rôle de déserteur et obéit à ce qui peut sembler une forme de trahison en donnant à celle-ci un sens à la fois moral et littéraire : il s’agit de déserter le monde pour écrire, mais aussi de déserter l’écriture pour vivre. C’est en restant fidèle à ce nécessaire va-etvient que l’écriture du carnettiste trouve sa raison d’être et sa plus grande justesse.
The Multiple Geographies of Peterloo and Its Impact in Britain
Authors: Navickas Katrina
Published: March 2019

The Peterloo Massacre was more than just a Manchester event. The attendees, on
whom Manchester industry depended, came from a large spread of the wider textile
regions. The large demonstrations that followed in the autumn of 1819,
protesting against the actions of the authorities, were pan-regional and
national. The reaction to Peterloo established the massacre as firmly part of
the radical canon of martyrdom in the story of popular protest for democracy.
This article argues for the significance of Peterloo in fostering a sense of
regional and northern identities in England. Demonstrators expressed an
alternative patriotism to the anti-radical loyalism as defined by the
authorities and other opponents of mass collective action.
Investigação sobre desigualdades sociais de saúde em Portugal: breve panorama a partir de uma revisão da literatura
Authors: Leite Conceição Sara Luísa
Published: March 2019

O aumento global da esperança média de vida e a melhoria dos indicadores de saúde da população mundial não traduzem uma redução das desigualdades sociais de saúde, nacionais ou internacionais. No artigo que aqui se apresenta procurámos identificar e rever os estudos mais representativos da investigação feita em Portugal nas últimas quatro décadas sobre desigualdades sociais de saúde, a partir de indicadores de pertença socioeconómica. Tecem-se algumas considerações sobre a necessária consolidação deste campo de investigação.