bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term efficacy and safety of anlotinib in advanced sarcomas.
Authors: Yao Weitao , Du Xinhui , Wang Jiaqiang , Zhang Peng , Niu Xiaohui , Wang Xin
Published: June 2022

e23564

Background: Treatment of sarcomas has advanced in recent years partly because of the application of multitarget tyrosine kinase inhibitor (TKI) drugs. Anlotinib is an oral TKI with the dual effects of antiproliferation and antiangiogenesis, and it has a therapeutic effect with good tolerance and low side effects. In theory, physicians can gain long-term tumor control with anlotinib in certain advanced sarcomas. Methods: We conducted a retrospective analysis of patients with advanced sarcomas with measurable target lesions who had been treated in our ward since 2018. There were 22 patients who had taken anlotinib regularly for more than 12 months. Their general information, clinical efficacy, and toxicities were statistically analyzed. We used a swimmer plot to observe the efficacy and duration of the drugs and a waterfall plot to express the best treatment effect. Results: There were 14 male and 8 female patients, ranging in age from 14 to 75 (44.77 on average) years. The primary sarcomas were ASPS in five cases; synovial sarcoma (SS) in four cases; LMS in three cases; epithelioid sarcoma (ES) and UPS in two cases each; and clear cell sarcoma, RMS, angiosarcoma (AS), fibrosarcoma (FS), pleomorphic liposarcoma (LS), and osteosarcoma (OS) in one case each. The sites of metastasis were the lung in 15 cases, lymph nodes in 4 cases, and multiple sites in 3 cases. Therapies were as follows: first-line therapy (6 cases), second-line therapy (9 cases), third-line therapy (5 cases), and more than third-line therapy (2 cases). The current therapy protocols were nine cases with oral anlotinib alone, nine cases with combination chemotherapy, and four cases with combination immunotherapy (anti-PD1). The best clinical efficacy of this group was complete response (CR) in four cases (18.18%), partial response (PR) in five cases (22.73%), and stable disease in 13 cases (59.09%), with an overall response rate of 40.91% and the longest lasting time of 26, 16, 38 months in different response groups. The mean of progression-free survival (PFS) was 23.32 months. The main adverse effects included myelosuppression in seven cases (31.82%), hypertension in three cases (13.64%), and hand-foot syndrome and weakness in two cases (9.10%). Severe adverse effects included hypothyroidism with weakness in one case and wound ulceration with pneumothorax formation in another case. Conclusions: Anlotinib monotherapy or combination therapy can be an effective and safe choice for some advanced sarcomas with a longer maintenance time and acceptable side effects. Besides, anlotinib combined with anti-PD1 therapy has better therapeutic efficacy for specific diseases such as ASPS and ES. Anlotinib combined with chemotherapy has therapeutic efficacy for SS, LMS, FS, and RMS. Clinical efficacy such as CR and PR may be a prediction of long-term PFS in some advanced sarcomas.
Prospective comparison between provider’s assessment and geriatric assessment among older adults with gastroesophageal cancer.
Authors: Connors Meghan , Handorf Elizabeth A. , Meeker Caitlin R. , Filchner Kelly A. , Vijayvergia Namrata , Dotan Efrat
Published: June 2022

e24013

Background: Geriatric Assessment (GA) can help oncologists determine fitness of their older patients for cancer therapy. Our objective was to identify gaps that exist in the care of older adults with gastroesophageal cancer (GEC). Methods: Patients age 65 or older with any stage of GEC were consented and completed a self-administered GA. The patient’s provider completed a baseline assessment (PA) and abnormalities detected by both assessments were centrally reviewed and compared. Geriatric domains assessed include functional status, nutrition, comorbidities, psychological distress, cognition, social support, chemotherapy toxicity risk, and financial toxicity. Any abnormalities found within an evaluated domain were considered in the analysis. Providers reviewed patient GA alongside indicated interventions and identified those they would implement. We compared the proportions detected/not detected by PA vs GA using McNemar’s test for paired data, and we measured agreement using Kappa statistics. This is an interim report of an ongoing trial with total accrual goal of 100 older adults with GEC. Results: 33 patients were enrolled at the time of the interim analysis, majority were male (22, 67%), median age 74 (65-91), with stage III (9, 50%) disease treated with combination chemotherapy (12, 36%). Cancer site was distributed between gastric (45%), esophageal (36%), GEJ (18%). 90% of patients had ECOG status 0 or 1. GA detected 164 abnormalities in geriatric domains, mean 5 per patient, and PA detected 104 abnormalities, mean 3 per patient (see Table). Significant difference in abnormality identification between GA and PA were seen in domains of nutrition, chemotherapy toxicity risk, financial toxicity and psychological distress. 37% of patients had abnormal TUG score and those patients were more likely to have other geriatric abnormalities detected by GA (6.2 vs 4.4). Providers for 28 patients (85%) indicated they would make at least one change, with the majority being referral to social work. Conclusions: Among older adults with gastroesophageal cancer, GA identifies more abnormalities as compared to routine provider’s assessment in most cases leading to important clinical interventions.[Table: see text]
The association between perioperative frailty and ability to complete a web-based geriatric assessment in older adults with cancer.
Authors: Cuadra Andrea , Tin Amy L. , Shahrokni Armin
Published: June 2022

e24022

Background: With expansion of web-based geriatric assessment (GA), the aim of our study is to assess whether patients’ independency and time to complete electronic Rapid Fitness Assessment (eRFA), a web-based GA at our institution, is associated with frailty. Methods: Retrospective study of 3456 patients with cancer who underwent cancer surgery in 2015-2020 with hospital length of stay of 1+ days and completed the eRFA prior to surgery. Frailty was assessed by two methods: Memorial Sloan Kettering Frailty Index (MSK-FI, score 0-11) and accumulative geriatric deficits (AGD, score 0-13). In both measures, higher score is reflective of higher degree of frailty. Patient’s independency to complete the eRFA was self-reported (no help, some help, someone else). Time to complete the eRFA was captured by the system based on survey start time and submission time. Association between characteristics and patient’s independency to complete the eRFA were assessed using Kruskal Wallis test for continuous variable and Chi-square test for categorical variables. Analysis into time to complete the eRFA excluded surveys completed by someone else (n = 407), those completed in < 2 min (n = 1) or > 40 min (n = 82). Association between time to complete the eRFA and frailty was assessed using two separate linear regression models with frailty—MSK-FI and AGD, separately—as the outcome, and minutes to complete the eRFA as the predictor, in surveys completed with no help and some help, separately. Time to complete the eRFA was included in the model as a non-linear term with restricted cubic splines with knots at the tertiles. Results: Among our cohort, the median age at the time of survey completion was 78 (quartiles 75, 82), just under half (49%) of patients were male. Survey completion corresponded to 58% with no help, 30% with some help, and 12% by someone else. Independency in completing the eRFA was associated with younger age (median ages: no help 77, some help 80, someone else 80), and lower frailty (median AGD: no help 4, some help 6, someone else 8; median MSK-FI: no help 2, some help 3, someone else 3) (all p < 0.001). Longer time to complete the eRFA was associated with higher degree of frailty measured by MSK-FI and AGD (all non-linear association p < 0.001). For example, for surveys completed with no help in 5, 10, and 15 minutes, the estimated MSK-FI is 1.4 (95% CI 1.3, 1.6); 2.3 (95% CI 2.2, 2.4); and 2.3 (95% CI 2.1, 2.6), and the estimated AGD is 3.1 (95% CI 2.9, 3.3); 5.1 (95% CI 4.9, 5.4), and 5.1 (95% CI 4.7, 5.5). Conclusions: Patients who needed assistance or took a longer time to complete the assessment were more likely to have a higher degree of frailty. To avoid burdening the hospital, placing undue stress on patients, and possibly inaccurate responses, we should test solutions that may enhance the ability of frail patients to complete the eRFA faster and without assistance from others, such as by using voice assistants.
Factors associated to hospitalizations in older cancer patients treated with chemotherapy.
Authors: Bordignon Claudia , Rosa Daniela Dornelles
Published: June 2022

e24025

Background: Chemotherapy toxicity (CT) is higher in elderly cancer patients, mainly due to fragilities identified in this subgroup. Hospitalization can be an adverse outcome of cancer treatment, which is disruptive in older patients, leading to worse functional status and cognitive disfunction, as well as increased costs for the health system. We evaluated patients treated with chemotherapy to identify hospitalizations related to oncological treatment and factors associated with this outcome. Methods: A retrospective study was conducted in a Brazilian Oncology Center. Patients ≥65 years old who started chemotherapy for solid tumors as curative or first-line therapy in 2019 were included and data was collected of the entire treatment until suspension or change in therapy (because of progression, completion, toxicity, or death). Those treated concomitantly with immunotherapy and radiotherapy were excluded. Characteristics of patients and their treatments were analyzed as risk factors for hospitalization through univariate analysis (UVA) with Fisher’s Exact Test and Mann-Whitney Test, and those variables considered significant (p < 0.05) were submitted to a multivariate analysis (MVA) with Logistic Regression. Results: We included 124 patients with a median of 70 (65-93) years old and a median of 6 (1-26) cycles of chemotherapy completed. There were 67% of women, 42.8% had Charlson Comorbidity Index (CCI) ≥1; polypharmacy (≥5 medications) was present in 38.7%; the main cancer treated were gastrointestinal (34.7%), breast (21%) and pancreas/biliary tract (20.2%). Most patients had metastatic disease (54%) and received polychemotherapy (80.6%) as primary treatment ;body index measure was ≥25 in 50.8% and 24.2% lost 5% or more of body weight during the time analyzed. Unplanned hospitalizations occurred in 40 patients and 25 were considered associated with CT (febrile neutropenia, infections, gastrointestinal adverse events, worse renal function). In UVA, age, pancreas/ biliary tract cancers, CCI≥1 and polypharmacy were factors associated to hospitalization due to CT. After MVA, only CCI≥1 (OR 3.23, CI95%1.12 – 10.05) continued as an independent factor associated to CT. Conclusions: Evaluation of comorbidities with CCI can identify older patients at higher risk of hospitalization due to toxicity during treatment with chemotherapy. Comprehensive geriatric assessment should be offered to high-risk patients in order to develop strategies to prevent this adverse outcome.
More than just “vaginal dryness”: Addressing an unmet need for sexual health intervention in female cancer survivors.
Authors: Pon Fay , Satish Sanjana , Penedo Frank J. , Rojas Kristin E.
Published: June 2022

e24050

Background: Female sexual dysfunction (FSD) in cancer survivors is underreported and therefore undertreated. This study aims to describe the population of female cancer survivors seeking treatment for sexual dysfunction through a novel sexual health after cancer program. Methods: We conducted a retrospective analysis to characterize patients presenting to the MUSIC (Menopause, Urogenital, Sexual Health and Intimacy Clinic) Program at a NCI-designated cancer center in South Florida. Patients received a baseline Female Sexual Function Index (FSFI) and underwent a physical, including abdominopelvic, exam. The FSFI is a 19-item survey previously validated for use in female cancer survivors. Severity of dysfunction (by presenting symptom, physical exam, and FSFI) was correlated to demographic and cancer characteristics. Sexual dysfunction was defined as ≤26.55. Results: Between 2020-2021, 104 female cis-gender women with a median age of 46 (range 19-75) at diagnosis were seen. 56% identified as Hispanic/Latinx. Most were treated for breast (80%) or gynecologic (10%) cancer. Common presenting symptoms included vaginal dryness (55%), painful sex (45%), low desire (36%) and hot flashes (22%). Patients who disclosed details about pain (n = 62) reported penetration was possible but uncomfortable (16%), possible but painful (66%) or impossible due to pain (18%). Those who disclosed changes with orgasm (n = 43) reported it was more difficult (26%), or impossible (23%). Of those completing the FSFI (n = 66), median Desire Domain score was 1.2 (IQR 1.2-2.4), and median Total Score was 8.1 (IQR 2.9-16.4), with 97% of patients meeting criteria for FSD (Table). Conclusions: The present study highlights a continued unmet need to address severe sexual health concerns in the growing female cancer survivor population. Future work will describe treatment strategies employed and their effectiveness at symptom resolution and quality-of-life improvement.[Table: see text]
A cross sectional study on female sexual function following pelvic radiotherapy.
Authors: Joseph Deepa , Singh Pragya , Abraham Bruzily , Nair Sharanya , Gupta Manoj Kumar
Published: June 2022

e24051

Background: Pelvic radiotherapy (PRT) is an integral part of treatment in many pelvic cancers. PRT is associated with multiple organic changes in the genital area that have the potential to negatively impact female sexuality and quality of life. Fear of cancer transmission and stigma associated can result in lack of sexual activity and many women get abandoned by their partners. Often this topic is neglected and limited studies are available assessing female sexual function (FSF) especially from Indian subcontinent. This study was an attempt to assess the FSF in patients who had received PRT as part of their curative treatment for pelvic malignancy. Methods: This was an observational cross-sectional study conducted in January 2022. Study included female patients who received RT for pelvic malignancy. Patients with a minimum of 6 months follow up after RT with clinical complete response, sexually active before start of treatment & living with their partners at time of study were included. Demographic profile was collected from treatment records. Socioeconomic status calculated using updated B J Prasad’s scale. Female Sexual Function Index (FSFI) questionnaire was used with score ≤ 26 indicating female sexual dysfunction (FSD). Questionnaire was filled by patients under supervision of a trained staff. 6 domains of sexual function i.e. desire, arousal, lubrication, orgasm satisfaction & pain were studied. Patients reporting zero score in any of the domain indicating no sexual activity in the last 4 weeks were also included. Results: 38 eligible patients with age range from 34-69 years, mean age 51 years, 37% patients were > 60 years. All were house wives, 40% illiterate, 50% high school & below, 10% were above high school. 70% were from rural area. 13% belonged to upper class, 35% upper middle & middle class, 52% to lower middle and lower class. Commonest diagnosis was carcinoma cervix (86%) followed by endometrium (10%) & anorectum (4%). All patients with carcinoma cervix received radical chemoRT. Patients with Ca Endometrium were postoperative. 92% of all patients received pelvic EBRT & 3% only vault brachytherapy. The mean duration from completion of RT was 17 months (range 6 – 41 months). FSD was found in 89%. Age wise mean scores in six domains of FSFI & overall score is illustrated in the table. 0 score in at least one of the domain was reported by 65% patients. Conclusions: Study showed a very high incidence of FSD among pelvic cancer survivors after RT. Since there are limited data in this domain from Indian patients, this can become baseline data for further studies. Our data is limited by lack of comparison of FSD from age adjusted healthy females of this region.[Table: see text]
Which patients are at risk for poorer outcomes from testicular cancer (TC) and its treatment?
Authors: Jacobs Linda A. , Vaughn David J. , Blauch Abigail N. , Pucci Donna A. , Palmer Steven C
Published: June 2022

e24060

Background: TC is a highly treatable disease with a 5-year combined relative survival rate of 95%. Survival, however, can come at a price, and longer-term negative physical and psychosocial sequelae have been described in the literature. We examined unmet needs and psychological and physical well-being in a sample of TC survivors attending a survivorship visit with the aim of describing the outcomes achieved and identifying characteristics of individuals most at risk of poor outcomes. Methods: Patients attending a survivorship clinic visit completed measures assessing 13 common physical and psychosocial needs, anxiety and depression (HADS), and QoL (SF-12V2). These data were described, subjected to hierarchical cluster analysis, and the resulting clusters were examined for disease, treatment, and demographic differences. Results: Participants (N = 312) from the same institution were primarily white (94%), non-Hispanic (98%), middle-aged (M = 42.8, SD = 11.1), married (74%), college graduates (79%), making more than $80,000/year (72%). On average, participants were diagnosed 9.8 (SD = 6.5) years earlier, though that ranged from 2-44 years, with Stage I or II TC (80%) that required surgery (99%) including RPLND (22%), chemotherapy (50%), and/or radiation (12%). Unmet needs were generally low (M = 0.91, SD = 2.1, R = 0-13) with 72% reporting no unmet need, and no unmet need was endorsed at a rate higher than 10%. Depressive symptoms were uncommon (HADS-D M = 2.3 SD = 2.6) with 95% classified as having no depressive symptoms. Symptoms of anxiety were more common (HADS-A M = 4.9; SD = 3.7) although 78% were classified as having no symptoms. QoL was similar to population norm values (M = 50) for both mental (M = 51.8) and physical (M = 51.7) well-being. Hierarchical cluster analysis of unmet needs, anxiety and depressive symptoms, and QoL revealed 2 distinct groups, one (86%) experiencing more positive outcomes than the other (14%). These groups differed significantly in unmet needs (M's 0.5 vs. 3.3), anxiety (M's 3.9 vs. 10.6) and depressive symptoms (M's 1.6 vs. 6.3), and mental QoL (M's 54.4 vs. 34.3; all p's < 0.001). Groups did not differ with respect to physical well-being (M's 51.4 vs. 53.2, ns). Individuals in the less well-functioning group were more likely to have been diagnosed with Stage 3 disease, be unmarried, and have a lower income (all p < 0.05). Treatment intensity, educational attainment, age, and time from diagnosis were not significantly associated with group membership. Conclusions: Most TC survivors report good functioning with few unmet needs and low levels of anxiety and depression during survivorship. A minority of TC survivors, however, experience substantially greater psychosocial but not physical difficulties, and these individuals are likely to be unmarried, have lower income, and been initially diagnosed with more advanced disease.
Elucidation of the mechanisms of trastuzumab-induced severe cardiotoxicity using patient-derived iPSCs cardiomyocyte model.
Authors: Sasaki Ritsuko , Kurebayashi Nagomi , Eguchi Hidetaka , Horimoto Yoshiya , Shiga Takahiro , Miyazaki Sakiko , Kashiyama Taku , Akamatsu Wado , Saito Mitsue ,   Department of Breast Oncology, Juntendo University Graduate School of Medicine
Published: June 2022

e24065

Background: Trastuzumab (Tmab) is a highly effective anticancer drug, but it is associated with unpredictable and non-accumulative cardiotoxicity, which can interfere with continuous treatment. In order to elucidate the mechanism of Tmab-induced cardiotoxicity, we attempted to reproduce the cardiotoxicity using disease-specific iPS cells from patients who had suffered myocardial dysfunction after Tmab administration. Methods: From 468 breast cancer patients treated with Tmab at our hospital, we selected three patients exhibiting severe cardiotoxicity (SP) with left ventricular ejection fraction reduced by more than 30% from baseline, and three non-cardiotoxic patients (NP)matched with the SP group on various clinical factors. Patient-specific iPSCs established from peripheral blood samples were differentiated to cardiomyocytes (iPSC-CMs). We evaluated contractility and intracellular metabolic function. Results: Treatment of iPSC-CMs with Tmab for 7 days reduced contraction and relaxation velocity, which were more evident in SP than in NP ( p= .032, .044, respectively). In addition, SP-iPSC-CMs showed a significant decrease in ATP ( p= .048), increase in reactive oxygen species production ( p= .046), and increase in autophagy activity ( p= .030) compared to NP-iPSC-CMs. In contrast, there was no significant difference in the suppression of mitochondrial maximal respiratory rate by Tmab between the two groups. Conclusions: We demonstrated that iPSC-CMs well recapitulate the individual differences in contractile and intracellular metabolic dysfunction caused by Tmab.
Association between palliative care consultation, hospital length of stay, and in-hospital costs in women with metastatic breast cancer in United States.
Authors: Subramaniam Divya S. , Al-Hammadi Noor , Jenkins Alexandria , Hinyard Leslie J.
Published: June 2022

e24068

Background: Regardless of detailed advantages of palliative care for cancer patients, there is limited research about the utilization of palliative care services for women with metastatic breast cancer, particularly at the end-of-life. The purpose of this study was to determine the incidence of inpatient palliative care consultations (PCC) in women with metastatic breast cancer and to examine the association between palliative care consultation and hospital length of stay (LOS) and in-hospital costs in a nationally representative sample. Methods: Women, 18 years and older, with a metastatic breast cancer related hospitalization in the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Database (NIS) 1998-2017 were included in the study. Multivariable logistic and linear regression analyses were used to examine the effects of patient and hospital characteristics on the receipt inpatient palliative care, length of stay and total hospital charges. SAS software survey procedures (version 9.4, SAS Institute Inc, Cary, NC) were used for all analyses to account for the sampling design of NIS. Results: Older women were associated with higher odds of getting PCC [aOR, 95% CI (60-69 yrs: 1.08 (1.01, 1.16); ≥70 yrs: 1.25 (1.17, 1.34))]. Women of races other than White [Blacks: 1.12 (1.07, 1.16); Other races 1.08 (1.04, 1.13)], and patients from Zip codes of with lower household income levels were more likely to receive a palliative care consult [0-25th percentile: 1.17 (1.12, 1.21); 26-50th percentile 1.05 (1.01, 1.09); 51-75th percentile 1.06 (1.02, 1.20)]. Women receiving governmental insurance had slightly lower odds of receiving palliative care compared to women receiving commercial types of insurance [0.94 (0.91, 0.98)]. Small and medium-sized hospitals were less likely to offer the service to admitted women [0.87 (0.84, 0.91)]. Hospitals located in the Northeast, Midwest, South were associated with lower odds of offering inpatient PCC when compared to hospitals in the West. A woman with any comorbidity had higher odds of receiving a PCC during their hospital admission. Hospitals were likely to charge patients receiving palliative care services less compared to patients who did not have a PCC encounter (Estimate: -5450; 95% CI: -5968, -4936) despite being associated with higher odds of a longer hospital stay (> 4 days) [1.17 (1.14, 1.20)]. Conclusions: Our study found that inpatient PCC for women with metastatic breast cancer increased LOS and hospital costs. We also found that inpatient palliative care consultation was provided to sicker patients; patients who would likely have longer length of stay, and in return, higher hospital costs compared to those without multiple acute comorbidities. Hence, targeted interventions must be implemented to increase PCC for metastatic breast cancer patients in the United States.
Effect of traditional Chinese medicine on pyrotinib-associated diarrhea in patients with HER2-positive breast cancer.
Authors: Jiang Zhansheng , Yang Yanfang , Wang Hao , Tong Zhongsheng , Pan Zhanyu
Published: June 2022

e24096

Background: Pyrotinib, an irreversible pan-HER tyrosine kinase inhibitor, has been a salvage regimen for metastatic HER2+ breast cancer failed to trastuzumab in Chinese guidelines. However, the incidence of pyrotinib induced diarrhea is more than 80% as neratinib. TCM-padia001 (clinicaltrials.gov: NCT04988165) is an open-label, phase II study investigating the effectiveness of Traditional Chinese Medicine (TCM) in treating diarrhea and improving tolerability of pyrotinib. Methods: All patients in the group had diarrhea after taking pyrotinib, and they could not be controlled after previous use of other antidiarrheal drugs (loperamide, Bifidobacterium, montmorillonite powder). All patients were treated with oral TCM (a Chinese herbal formula, one dose per day divided in two times) for 3 weeks. Diarrhea assessment was graded according to NCI-CTCAE v5.0 and quality of life was graded according to EORTC QLQ-C30. The primary endpoint was incidence of grade ≥3 diarrhea. Results: A total of 28 patients were enrolled, and 23 patients completed 3 weeks of TCM treatment and were followed up. The median number of diarrheas was 7 times (4-13), and 15 cases in these 23 patients were ≥grade 3 before treatment with TCM. After treatment with TCM, none of patients had grade 3 diarrhea, and the rate of grade 2 diarrhea was 17.4% (4/23). The scores of global health status/quality-of-life assed with EORTC QLQ-C30 in patients were dramatically improved (40.90+7.68 vs. 62.88+7.15) after treatment with TCM. Most importantly, in the symptom domains scores, we found that TCM treatment did not increase the incidence of constipation, but also significantly improved the fatigue, pain, nausea, vomiting and anorexia of patients. Conclusions: TCM is very effective in the treatment of Pyrotinib related diarrhea, and compared with Western antidiarrheal drugs, it will not produce secondary painful symptoms such as constipation. Clinical trial information: NCT04988165.
Patient and caregiver-reported acceptability of an automatic phone call offering supportive and palliative care referral for advanced non-small cell lung cancer patients.
Authors: Pabani Aliyah , King Seema , Ahmed Sadia , Shirt Lisa , Slobogian Vanessa , Vig Chandra , Hao Desiree , Barbera Lisa Catherine , Kurien Elizabeth , Santana Maria , Biondo Patricia , Sinnarajah Aynharan , Simon Jessica
Published: June 2022

e24097

Background: Timely palliative care interventions can help to alleviate the distress people experience after a diagnosis of an incurable, life-threatening cancer. However, referrals to palliative care continue to be late due to various provider and patient barriers. The Palliative Care Early and Systematic (PaCES)-Automatic study was co-designed with patients and providers and implemented an early palliative care intervention for newly diagnosed stage IV non-small lung cancer (NSCLC). The objective of this study was to determine patient/caregiver-reported acceptability of a phone call from a supportive and palliative care (SPC) nurse offering consultation, automatically (without referral) after first oncologist appointment. Methods: Two SPC specialist nurses screened out-patient clinic lists at a tertiary cancer center weekly and called all eligible patients offering an in-home consultation. Eligibility: > 18 years, newly diagnosed/suspected Stage IV NSCLC and had first medical/radiation oncologist visit. Patients/caregivers were surveyed about the acceptability (5-point Likert scale) of the automatic phone call offering a palliative care consult, using Sekhon’s Framework of Acceptability domains. Results: Among the 113 patients screened, 81 patients/caregivers were contacted and offered SPC consultation and 72% accepted the in-home consult. Of 70 patients/caregivers that agreed to be contacted for the survey: 4 did not recall the call offering SPC, 3 declined participating in the survey, and 15 were not reached. Of 48 respondents, 93.6% rated overall acceptability of the automatic call offering SPC consultation somewhat/completely acceptable, with the other 6.4% rating it as neither acceptable nor unacceptable. Of 35 patients/caregivers that completed the full survey: 31% caregivers, 63% female, 57% ≤65 years, 29% ≤high school education, 67% (n = 27) < $60,000 household income, 80% spoke only English/French, and 71% Caucasian. Within the domains of acceptability, 94.7% were comfortable receiving the call, 91.9% understood why they received it; 86.5% thought the call was a valuable; 69.5% thought the call helped them; 65.7% learned about SPC from the call; no one expressed concern that the SPC nurse had access to their contact/health information; 97.2% thought the call didn’t take much physical/emotional effort and were confident in their ability to participate (ask questions/make decisions). Conclusions: Nearly all patients/caregivers found the automatic SPC call offering consultation to be acceptable. Most patients agreed to the consultation offer. Routine calls offering SPC consultation may be a timely alternative to awaiting conventional referral by oncologists.
Cost-utility of apixaban and rivaroxaban in the thromboprophylaxis of cancer patients treated with chemotherapy in Spain.
Authors: Ortega Laura , Muñoz Martín Andrés J. , Rubio-Terres Carlos , Rubio-Rodriguez Dario , Soria Jose Manuel
Published: June 2022

e24102

Background: Apixaban and rivaroxaban are two direct-acting oral anticoagulants (DOACs) recommended for thromboprophylaxis in cancer patients treated with chemotherapy. The objective was to assess the cost-utility of thromboprophylaxis with apixaban and rivaroxaban vs no thromboprophylaxis in ambulatory cancer patients starting chemotherapy with an intermediate-to-high risk of venous thromboembolism (VTE), Khorana score ≥ 2 points. Methods: A cost-utility analysis was performed from the perspective of Spain´s National Health System (NHS) using an analytical decision model in the short term (180 days) and a Markov model in the long term (5 years). Transition probabilities were obtained from randomized, double-blind, placebo-controlled clinical trials of apixaban and rivaroxaban in adult ambulatory patients with cancer at risk for VTE, treated with chemotherapy (AVERT and CASSINI trials). The costs (€ 2021) were taken from Spanish sources. The utilities of the model were obtained through the EQ-5D questionnaire. Deterministic (base case) and probabilistic (second-order Monte Carlo simulation) analyses were conducted. Results: In the base case, apixaban was dominant (with a gain of 0.005 QALY, quality-adjusted life years, and a saving of €59.49 per patient) compared to no prophylaxis. Rivaroxaban would be cost-effective (with a gain of 0.006 QALY and an additional expense of €116.23 per patient) with a cost per QALY gained of €18,747 compared to no prophylaxis. For an willingness to pay of €25,000 per QALY gained, the probability that apixaban or rivaroxaban will be cost-effective would be 62.6% and 51.9%, respectively. Conclusions: VTE thromboprophylaxis with apixaban generates savings and with rivaroxaban it generates an additional cost vs. no prophylaxis. With both DOACs, a modest QALY gain would be obtained. The probability that prophylaxis with apixaban would be cost-effective is 10.7% higher than with rivaroxaban.
Hypokalemia, hypomagnesemia, and hyponatremia are associated with acute kidney injury in patients treated with cisplatin.
Authors: Pinard Louis , Adam Jean-Philippe , Chagnon Miguel , Bollée Guillaume , Soulieres Denis
Published: June 2022

e24105

Background: Cisplatin-associated acute kidney injury (C-AKI) is common. Predictive factors of C-AKI include age > 60 years, hypertension, cisplatin dose, diabetes, and serum albumin < 3.5g/L. The association between C-AKI and hypokalemia, hypomagnesemia or hyponatremia has not been well characterized to date. Methods: Data from a previous retrospective observational study was obtained. Patients who received at least one dose of cisplatin between September 2010 and December 2016 at the Centre Hospitalier de l’Université de Montréal were included. Patients were separated into 3 groups with similar cisplatin doses and schedules. Group A received cisplatin 60-100 mg/m2 q 3 weeks with laboratories before day 1, group B received cisplatin 60-75 mg/m2 q 3 weeks with laboratories before days 1 and 8 of each cycle and group C had weekly cisplatin 40 mg/m2 and laboratories. Association between hypomagnesemia, hypokalemia, hyponatremia, and risk of AKI, as defined by KDIGO criteria, was determined using a counting process specification of Cox’s regression models. These were used to estimate hazard ratio (HR) of AKI incidence with 95% confidence intervals (CI) of patients with and without cisplatin-induced electrolyte disorders. Estimates were adjusted for confounding factors such as volume of hydration (3 or 4 L), fluids (D5/0.45 NS or NS), age, sex, presence of furosemide and mannitol. Results: A total of 1305 patients were separated in group A (714 pts), B (205 pts) and C (386 pts). The proportion of patients with at least one event of hypokalemia, hypomagnesemia or hyponatremia was lower in group A (29.1%, 57.7% and 36.3%) compared to group B (43.4%, 66.8%, 60.0%) and group C (48.7%, 78.6%, 50.8%). The incidence of all grade C-AKI was 35.7% (group A), 46.8% (group B), 18.2% (group C). The HR of C-AKI based on each electrolyte disorder per group is presented in table I. Conclusions: The presence of one event of hypokalemia, hypomagnesemia, or hyponatremia was significatively associated with increased risk of C-AKI only in group A. This could be related to the higher average dose per cycle in this group. Other studies are needed to characterize the presence of an electrolyte disorder as a risk factor that can predict the risk of C-AKI in this subpopulation. [Table: see text]
A whole-food, plant-based (WFPB) dietary intervention to improve cancer-related and cardiometabolic outcomes in metastatic breast cancer patients.
Authors: Campbell Thomas , Campbell Erin , Culakova Eva , Janelsins Michelle Christine , Mustian Karen Michelle , Kamen Charles Stewart , Lin Po-Ju , Guido Joseph John , Peppone Luke Joseph
Published: June 2022

e24116

Background: Obesity rates in the US have increased dramatically in recent years. Breast cancer treatment is associated with additional weight gain, and among patients with breast cancer, obesity and weight gain are associated with negative outcomes such as reduced progression-free and overall survival due to cardiometabolic co-morbidities. New evidence suggests that cardiometabolic comorbidities themselves can further accelerate breast cancer progression. We used a WFPB dietary intervention because it results in significant weight loss and larger improvements in cardiometabolic outcomes than a traditional, calorie-restricted omnivore diet. Methods: Patients with stage 4 breast cancer receiving treatment were randomized 2:1 into: 1) a WFPB dietary intervention (N = 19) or 2) usual care (N = 9) for 8 weeks with assessments at baseline, 4, and 8 weeks. Our WFPB diet consisted of education and an ad libitum whole-food, plant-based diet; 3 prepared meals a day were provided to WFPB subjects for the duration of the trial. The diet included fruits, vegetables, whole grains, legumes, nuts/seeds and excluded meat, dairy, and eggs. Outcomes include compliance, weight, cardiometabolic outcomes, and cancer progression markers. Effects of the WFPB on the outcomes were assessed by comparing marginal means by arm estimated at 8 weeks from the analysis of covariance model controlling for baseline. Results: Dietary compliance was high, with 95% of WFPB subjects consuming ≥80% of their calories from on plan foods. The WFPB group (mean baseline BMI = 31.6 kg/m2), on average, lost 6.7% (p < 0.01) of their total body weight. Adjusting for baseline weight, the WFPB group lost 8.9 lbs. more (p < 0.01) and 5.8% more of their total body weight (p < 0.01) than the control group. Conclusions: Our WFPB dietary intervention resulted in clinically meaningful and statistically significant improvements in weight and cardiometabolic outcomes, with a trend towards improving a clinically used cancer progression marker. Larger studies with longer interventions are needed to confirm these findings and investigate the sustainability of the benefits. Clinical trial information: NCT03045289. [Table: see text]
The COVID-19 in oncological settings: The buffering role of the physician’s empathic communication protects from the impact of fear on hopelessness.
Authors: Rossi Alessandro , Marconi Maria , Taccini Federica , Mannarini Stefania , Verusio Claudio
Published: June 2022

e24126

Background: During the lockdown related to the recent COVID-19 pandemic, many oncological patients, in addition to the fear of the COVID-19, have also experienced a sense of hopelessness related to the difficult management of their medical and oncological care. However, several studies showed that the physician’s empathic communication about medical care management may act as a buffer against this negative relationship. Thus, the study aimed to test a model in which the physician’s empathic communication mediates the relationship between fear of COVID-19 and hopelessness related to aforementioned difficulties. Methods: A sample of 70 oncological outpatients [36 females (51.4%), aged from 40 to 81 years ( mean = 65.94, SD = 11.13)] were recruited at the Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona. An ad hoc structured interview was developed to assess: (A) fear of COVID-19 (KR20: 0.86); (B) feelings of hopelessness related to the COVID-19 (KR20: 0.80); and (C) the patient's perception of empathy shown by the physician in communicating care management during the pandemic (KR20: 0.71). The factor score of each dimension was used as the total score. A mediation analysis (10,000 bootstrap resampling) was performed. Results: The mediation model showed statistical significance: F = 31.852, p < 0.001; R2 = 0.487. The relationship between ‘fear of COVID-19’ and ‘hopelessness’ was partially mediated by physician’s empathic communication ( path c’: β = 0.369, se = 0.096, 95%CI[0.177; 0.561], p < 0.001) – revealing its buffering role; path a: β = -0.488, se = 0.073, 95%CI[-0.634; -0.342], p < 0.001; path b: β = -0.375, se = 0.124, 95%CI[-0.623; -0.128], p = 0.003. Conclusions: These results highlight the protective role (buffer) of the physician’s empathic communication in the process that leads to hopelessness from the fear of COVID-19. Results suggest how physicians as well as psycho-oncologists should structure stronger interventions – based on the improvement of communication strategies – that may lead to an improvement of patients’ quality of life.
“More than conquerors”: A qualitative analysis of war metaphors for patients with cancer.
Authors: Bodd Monica Himaani , Daniels Nikki C. , Amonoo Hermioni L. , Tate Tyler P. , Herring Kris W. , LeBlanc Thomas William
Published: June 2022

e24134

Background: Limited research suggests that war metaphors may be harmful for patients with cancer. For instance, it has been claimed that the use of war metaphors is associated with increased anxiety and depression, as well as poor coping for patients with cancer. However, little is known about how patients use and perceive these metaphors. Metaphors, which are intrinsic to the human conceptual system, help articulate patients’ experiences and needs. In this study, we explored patient narratives of illness metaphors in cancer, focusing particularly on war metaphors. Methods: Fifteen patients diagnosed with various stages of lung, colorectal or breast cancer completed semi-structured qualitative interviews about their use of metaphors after their cancer diagnoses. Interviews explored war metaphors in the context of treatment decisions, aggressiveness of care, and quality of life. Patients were also provided with a curated list of metaphors and asked about their use and experience thereof. Transcribed interviews were organized and analyzed by descriptive content analysis using NVivo software. Results: The most used metaphor categories were: 1) nature (e.g., journey, season); 2) militaristic (e.g., battle, victory, fight); and 3) uncertainty (e.g., mystery, puzzle). War metaphors were frequently referenced in patients’ support communities rather than in hospital or clinician encounters. Next, all patients with non-metastatic disease (n = 7) used war metaphors to describe their illness experience. Among all patients who used metaphorical language to describe their experience (n = 14), the only ones who did not use war metaphors (n = 2) had metastatic disease; these patients found war metaphors to be unhelpful due to their sense of having no control over the outcome. Lastly, participants reported that war metaphors served the following purposes in their illness experience with cancer: 1) promoted perseverance in the face of adversity, 2) expressed optimism, and 3) allowed them to relate cancer to previous life challenges. Conclusions: The hypothesis that war metaphors are invariably counterproductive for patients appears to be misguided. Metaphors of fighting, victory and battle worked both to empower and harm patients in this study, depending on the individual patient and their prognosis. While more prospective studies with robust sample sizes are needed to elucidate the role of metaphors in the lived experience of patients with cancer, our patients suggest the need to individualize, acknowledge and explore these metaphors for cancer populations.
Change in breast cancer risk perception related to perceived COVID-19 risk: A WISDOM sub-population analysis.
Authors: Huang Tina Qing , Baxter-King Ryan , Naeim Arash , Rudkin Aaron , Vavreck Lynn , Sepucha Karen , Sabacan Leah P. , Esserman Laura , Wenger Neil ,   WISDOM Study and Athena Investigators
Published: June 2022

e24135

Background: Obstacles to access to care due to the perceptions of the risk posed by COVID-19 have led to unprecedented disruptions in cancer care. Yet, little is understood about whether perceived COVID-19 risk influences perceptions of cancer risk. We examined how COVID-19 risk perception was associated with perceptions of breast cancer risk over one year of the pandemic among women enrolled in the WISDOM study, a PCORI-funded pragmatic trial testing risk-based cancer screening that began before the pandemic. Methods: We conducted four longitudinal surveys among the 13,002 women enrolled in the WISDOM study from May - December 2020. Responses from 8,285 women are eligible for inclusion in this analysis leading to a total sample size of 16,859 survey responses. Surveys were conducted online and asked women’s perceived lifetime chance of developing breast cancer (0-100%). COVID-19 risk perception was reported on a 5-point scale from Very Low to Very High. We computed the difference between breast cancer risk perception at each COVID-19 survey to pre-COVID breast cancer risk perception, measured as a secondary aim of the WISDOM study, and compared that to COVID-19 risk perception at each time point. Results: Across the four survey waves, most women perceived low COVID risk: 29% very low, 42% moderately low, 23% neither high nor low and 6% high or very high. Overall, breast cancer risk perception declined for those with very low COVID-19 risk perception and rose for women in the highest levels of COVID-19 risk perception. However, changes in breast cancer risk perception associated with COVID risk perception were small. For example, in survey wave 4, breast cancer risk change was -2.4% very low, -1.4% low, 2.5% not high or low and 3.1% high or very high. (Table). Conclusions: Among women participating in a pragmatic trial testing risk-based cancer screening, COVID risk perception had a small relationship with change in breast cancer risk perception. Change in breast cancer risk perception paralleled COVID-19 risk perception. This calls for exploration of the underpinnings of these risk changes and may have implications for changes in cancer screening behavior related to COVID-19.[Table: see text]
Depression trajectories among women undergoing chemotherapy.
Authors: Suskin Johanna A. , Paul Steven M , Stuckey Ashley , Miaskowski Christine , Dunn Laura B.
Published: June 2022

e24144

Background: Depressive symptoms are common among women undergoing chemotherapy (CTX) for breast or gynecological cancer. Many studies have examined the prevalence of depressive symptoms (usually at the beginning or end of CTX). However, given that CTX unfolds over a number of cycles, there is a need to better understand patterns of change in depressive symptoms over the course of treatment, and to identify factors that may predispose individuals to worse symptom trajectories. The purpose of this study, among women who underwent CTX for breast or gynecological cancer, was to evaluate for interindividual differences in depressive symptoms over the course of two cycles of CTX, and to identify characteristics associated with both initial levels (i.e., at the beginning of the study) and trajectories of depressive symptoms. Methods: Patients undergoing CTX for breast (n = 530) or gynecologic (n = 233) cancer completed the Center for Epidemiological Studies-Depression (CES-D) questionnaire six times over two treatment cycles. Patient-reported measures were used to assess demographic, clinical, symptom, stress, and coping characteristics at enrollment. Using hierarchical linear modeling (HLM), we evaluated characteristics associated with initial levels and trajectories of depressive symptoms. Results: One demographic (marital status) and two clinical (number of comorbidities, functional status) characteristics predicted interindividual differences in initial levels of depressive symptoms. One demographic (education) and one clinical (MAX-2 score, a CTX toxicity metric) characteristic were associated with interindividual differences in depressive symptom trajectories. Several symptom characteristics predicted interindividual differences in initial levels (i.e., morning fatigue), trajectories (i.e., initial level of depression), or both initial levels and trajectories (i.e., sleep disturbance, attentional function) of depressive symptoms. Two stress-related variables (i.e., perceived stress, cancer-related distress) predicted interindividual differences in both initial levels and trajectories of depressive symptoms. Several coping variables predicted interindividual differences in initial levels (i.e., behavioral disengagement), trajectories (i.e., venting), or both initial levels and trajectories (i.e., self-blame) of depressive symptoms. Conclusions: The range of demographic, clinical, symptom, stress and coping characteristics associated with interindividual differences in depressive symptoms underscores the importance of evaluating risk and protective factors. These factors may serve as useful markers for both screening and intervention to address depressive symptoms during CTX.