bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer's role in chemotherapy-induced neuropathy.
Authors: Housley Stephen Nick , Nardelli Paul , Wang Allison B. , Flores Ann Marie , Perreault Eric J. , Cope Tim
Published: May 2020

e24064

Background: For the constellation of neurological disorders known as chemotherapy-induced neuropathy, mechanistic understanding, and treatment remain deficient. This might be due to the fact that studies on the effects of chemotherapies on the nervous system have utilized experimental models that exclude cancer perhaps due to the presumption that chemotherapy alone explains the neuropathology. However, the convergence of cancer and chemotherapy on the same biological processes seems likely to yield non-linear interactions. This led us to hypothesize that clinically relevant neuropathy emerges from codependent actions of cancer and chemotherapy. Methods: We established a clinically-relevant animal model of chronic sensory neuropathy in rats with cancer (adenomatous polyposis coli in rat colon: Apc+/Pirc) and age-matched animals without cancer ( ApcWT) that were randomly assigned to receive a human-scaled course of oxaliplatin (OX) or control treatment (4 groups). We quantified behavioral deficits during precision ladder walking, a validated measure of locomotor performance. Neuronal signaling was measured during terminal in vivo experiments to examine the response of sensory neurons to physiologically-relevant stimuli. We defined statistical significance as when 95% of a highest density interval (HDI) of posterior probabilities do not overlap (hierarchical Bayesian modeling). Results: Apc+/Pirc+OX (n = 11) rats exhibited significantly higher error rate (19.2±5.6%, 95%HDI) during precision ladder walking in comparison to ApcWT+control (2.4±2.7%: n = 9) or Apc+/Pirc +control (2.5±2.9%: n = 7) and significantly exceeded the error rate observed in animals treated with OX alone (8.4±3.1%: n = 10). In contrast to the observations in all other groups, we found drastically impaired neuronal signaling in Apc+/Pirc+OX rats which manifested as significantly reduced sensitivity and attenuated static and dynamic firing patterns (95%HDI). Conclusions: We present the first evidence that chronic neuropathy cannot be explained by the effects of chemotherapy alone but instead depend on non-linear interactions between cancer and chemotherapy. This understanding is a prerequisite for developing meaningful treatment or prevention of neuropathy.
Patterns of self-reported symptom distress among survivors of head and neck cancers.
Authors: Palos Guadalupe R. , Gilmore Katherine Ramsey , Hutcheson Kate A. , Pytynia Kristen B , Gruschkus Stephen K. , Chapman Patricia Hansberry , Bi Weiqi , Rodriguez Maria Alma
Published: May 2020

e24073

Background: Head and neck cancer (HNC) survivors are known to experience debilitating disease-related symptoms and late effects. Patterns of symptoms among HNC survivors who have transitioned care to survivorship clinics could inform supportive care needs. We sought to assess patterns of self-reported symptoms in HNC survivors and to describe the level to which these symptoms interfered with their function. Methods: Symptoms and their interference were assessed using the MD Anderson Symptom Inventory Head and Neck (MDASI–HN). This validated patient-reported outcome (PRO) instrument consists of 28 questions grouped into 3 subscales; 1) 13 “core” or general symptoms, 2) 9 symptoms specific to HN and 3) 6 daily life interference items. Symptom severity is measured using a 0 to 10 scale, 0 = not present, 10 = as bad as can be imagined. Patients completed the MDASI-HN during a visit to the HNC Survivorship Clinic. Three databases a) MDASI HN, b) institutional, and c) the HNC survivorship provided data. We defined the primary outcome, symptom distress, as the combination of severity and interference rated ≥5 (0-10). Descriptive statistics were used to characterize the sample. Results: The sample included 1390 HNC survivors, majority were male (77%), Caucasian (83%) with a median age of 63 years (range 22- 95 years). The median years since diagnosis was five (range 2-37 years). The top disease sites were oropharynx (37%), oral cavity (35%), and larynx/hypopharynx (15%). The table summarizes the patterns of symptom distress. Conclusions: These results highlight the variation in symptom distress reported by long-term HNC survivors. Understanding the clinical implications of these patterns is important to ensure the well-being of those with head and neck cancers. [Table: see text]
Determining the impact of chemotherapy-induced peripheral neuropathy: A survey of cancer survivors.
Authors: Battaglini Eva , Goldstein David , Park Susanna
Published: May 2020

e24080

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a major yet poorly understood side effect of cancer treatment, leading to symptoms including numbness, tingling and pain. It can lead to cessation of effective treatment, long-term functional disability and reduced quality of life. Despite this, there is currently little understanding of its impact. Methods: The aim of the study was to investigate the impact of neurotoxic chemotherapy side effects on the lives of cancer survivors. Data was collected via an online survey covering demographics, cancer diagnosis and treatment, CIPN and other side effects of chemotherapy, using standardised measures to assess comorbidities, quality of life, physical activity, pain and CIPN symptoms. Results: Data was analysed from 986 respondents who were treated with neurotoxic therapies (83% female, 16% male), with mean age 59 years ( SD 10.7 years). A majority of respondents were treated for breast cancer (59%), 14% for colorectal cancer and 11% for multiple myeloma. Chemotherapy types received included paclitaxel (32%), docetaxel (32%) and oxaliplatin (13%), and respondents completed treatment a mean of 3.6 years ago. The majority of respondents (80%) reported experiencing neuropathic symptoms after finishing chemotherapy, with 77% reporting current CIPN. Those with CIPN reported functional impacts, with 23% reporting moderate to severe problems with hand function and 28% reporting moderate to severe walking difficulties. CIPN was second most commonly rated as the treatment side effect having the greatest impact, following fatigue. Respondents with high levels of current CIPN symptoms had poorer quality of life, more comorbid health conditions, higher BMI and more often received multiple neurotoxic chemotherapies than those with low levels of CIPN symptoms. In addition, respondents who reported meeting government physical activity guidelines had lower CIPN and higher quality of life scores than those who did not meet the guidelines. Regression analyses investigating the association between quality of life and clinical and sociodemographic characteristics resulted in a model with comorbid health conditions, CIPN symptoms, years since treatment, age and physical activity as significant predictors of quality of life. Conclusions: These findings suggest that CIPN has a lasting impact on cancer survivors, leading to decreases in quality of life, often occurring alongside poorer general health. This impact supports the need for further research to improve assessment, prevention and treatment.
Asymptomatic cardiotoxicity in long-term breast cancer survivors.
Authors: Saidi Mohammed Alaeddine , Ghomari Soumeyya
Published: May 2020

e24084

Background: Multimodal approach in the adjuvant treatment of early breast cancer has led to a significant number of survivors. However, the combination of these treatments may increase the risk of long-term cardiotoxicity, particularly in the presence of cardiovascular risk factors (CVRF). Methods: We examined cardiac function in patients who had previously been treated for early breast cancer. Echocardiograms were performed at least 2 years after therapy. We measured left ventricular ejection fraction (LVEF) and reported pre-treatment LVEF and all CVRF. The initial Framingham Risk Score (FRS) has been calculated. Asymptomatic cardiotoxicity was defined by decrease of 5% or more in the LVEF value without clinical symptoms of CHF. Doxorubicin, Trastuzumab, Radiotherapy, older age, and CVRF (hypertension (HTN), diabetes, dyslipidemia, obesity, Waist circumference) were evaluated as potential risk factors for the development of cardiotoxicity. All statistical analysis was performed using SPSS version 25.0. Results: A total of 143 breast cancer survivors with a median age of 46 ± 10 years (range: 26-72) underwent Echocardiogram imaging after a median follow-up of 9,22 years (range: 2 - 22). 48 women were postmenopausal at diagnostic. 32,2% were obese. HTN was present in 15%, diabetes in 12%, and dyslipidemia in 12% of patients. ARA-II was the most used treatment of HTN (55%). 11,9% of patients were under statin therapy. FRS was low in 69%, moderate in 22% and high in 9% of patients. 4 patients had received endocrine therapy alone, none of whom developed cardiotoxicity. There was only one case of symptomatic cardiotoxicity. In the remaining 138 women who received multimodal treatment (Anthracyclines:100%, Docetaxel:62,9%, Endocrine therapy:72%, Trastuzumab:7%, Radiotherapy:83,2%), a statistical but non-clinically significant decrease was observed in LVEF (67.7 ± 3.6 to 65.4 ± 5.1, p < 0.001). 39 women (28,3%) developed asymptomatic cardiotoxicity. In multivariate analysis, factors that contributed to decreased LVEF were HTN (p = 0,006), diabetes (p = 0,008) and dyslipidemia (p = 0,03). Conclusions: The use of adjuvant therapy in breast cancer may increase long term cardiotoxicity particularly in survivors with CVRF. Long-term cardiac follow-up is essential in order to initiate cardioprotective therapy at the right time.
Incidence of breast pain in breast cancer patients in a multi-ethnic cohort.
Authors: Fukui Jami Aya , Meister Madison , Pagano Ian , Bantum Erin
Published: May 2020

e24085

Background: Breast cancer is the most common cancer in women. Prevalence rates for persistent pain following breast cancer surgery are reported to be up to 60%. Younger age, radiation, more invasive surgery, and acute post-operative pain have been identified as predictors of chronic pain after surgery. Several studies have looked at factors predicting breast pain, but to our knowledge none of these studies have reported on perceived pain among ethnic groups beyond white and non-white comparisons. Methods: Participants were asked to complete an anonymous breast pain questionnaire based on the McGill pain questionnaire, either online or face-to-face in a clinical setting. Incidence and type of breast pain, common risk factors (age, type of surgery, treatment: chemotherapy, radiation and endocrine therapy), and race/ethnicity was collected and analyzed through descriptive and multivariate analysis. Results: 238 responses were collected and analyzed. About 36% of participants reported breast pain, where 82% reported these symptoms for more than a year. More than 71% identified as non-white, with the majority identifying as Asian (50%) followed by White (11%), Multi-ethnic (9%) and Native Hawaiian (8%). The majority of participants were older than 60 years of age (57%), with 30% being older than 70. Japanese, Filipino and Native Hawaiian participants reported significantly more pain compared to White participants (p < .0001). The majority of participants reported a 3/10 pain level on a pain scale and described overall breast pain as mild. The most common descriptor of mild pain was aching and represents the dullness pain characteristic. The most common descriptor of moderate pain was sharp characterizing an incisive pressure, and the most common descriptors of severe pain were heavy, tender, shooting and throbbing, representing various pain characteristics. Participants who were undergoing radiation (p < .0001) or chemotherapy (p < .05) reported statistically higher breast pain, although there were no differences in breast pain according to the type of surgery (mastectomy vs lumpectomy). Participants who completed the survey online also reported more pain (p < .0001) than participants who completed the survey face-to-face. Conclusions: Breast pain is a significant problem in our breast cancer community. This questionnaire has informed our understanding of the type of pain our multi-ethnic breast cancer patients are experiencing and in turn we are developing culturally appropriate pain management strategies to treat this challenging symptom for breast cancer survivors.
Determining the unmet survivorship needs in patients with head and neck cancer: A prospective, longitudinal study.
Authors: Giuliani Meredith Elana , Weiss Jessica , Jones Jennifer M. , Toulany Alexander , Quartey NaaKwarley , Papadakos Janet , Ringash Jolie
Published: May 2020

e24088

Background: Head and neck cancer patients commonly have unmet needs. Our purpose was to determine the number, type, and predictors of unmet survivorship needs in patients with head and neck cancer over their cancer journey. Methods: Patients with primary, non-metastatic head and neck cancer were prospectively enrolled prior to curative intent treatment (surgery, radiation and or systemic therapy in any combination). Patients completed baseline demographics, the Cancer Survivors' Unmet Needs Measure (CaSUN) and the FACT-HN and then again 3, and 6 months post-treatment. Mean unmet needs at each time point were calculated. Univariable and stepwise multivariable analyses of predictors for number of unmet needs were performed at each time point. Results: Among 187 participants, median age was 64 (31-88) and 148 (79%) were male. Education was beyond high school in 117 (63%) and 63 (41%) were working at diagnosis. Most patients had oropharynx (n = 84; 46%), hypopharynx/larynx (n = 40; 22%) or oral cavity (n = 28;15%) cancers. At least one unmet need was reported by 68%, 52%, and 56% at baseline, 3 and 6 months. The mean number of unmet needs was 7.5 ± 9.1 at baseline, 3.8 ± 6 at 3 months and 5.4 ± 8.5 at 6 months. Higher education level [3.24 (0.24,6.24); p = 0.035] and worse QOL [-0.14 (-0.22,-0.06); p < 0.01] were associated with increased survivorship unmet needs on multivariable analysis at baseline. Worse QOL was associated with increased survivorship unmet needs on multivariable analysis at 3 [-0.21 (-0.31,-0.12); p < 0.01] and 6 months [-0.27 (-0.49,-0.06); p < 0.01]. Table describes the top unmet needs. Conclusions: A high proportion of patients with head and neck cancer have unmet needs, more commonly in patients with poorer quality of life. Post-treatment, unmet needs were more often related to treatment toxicities and their impact on quality of life. [Table: see text]
N-terminal pro-brain natriuretic peptide levels after receipt of anthracycline for breast cancer.
Authors: Patel Shruti R , Herrmann Joerg , Vierkant Robert A. , Olson Janet E. , Couch Fergus , Hazim Antonious Ziad , Loprinzi Charles L. , Ruddy Kathryn Jean
Published: May 2020

e24103

Background: Many of the 200,000 patients diagnosed with breast cancer (BC) annually in the United States receive anthracycline-based therapy, increasing their risk of future congestive heart failure. N-terminal brain natriuretic peptide (NT-proBNP) has been used as a biomarker of asymptomatic cardiac dysfunction in the general population and is of interest to identify patients who might benefit from echocardiography during survivorship. This study aimed to assess how age, baseline comorbidities, and time since BC diagnosis impact NT-proBNP levels after anthracycline-based chemotherapy. Methods: This retrospective study, using samples collected in our ongoing prospective Mayo Clinic Breast Disease Registry, included 20 survivors of non-metastatic BC patients per year for each of the first 5 years after anthracycline-based chemotherapy (n=100 total). NT-pro-BNP levels were assessed using a Roche immunoassay. Cardiac risk factors were obtained by chart review. Multivariable linear regression models assessed associations between NT-proBNP values and these independent variables: baseline cardiac risk factors (including hypertension, hyperlipidemia, obesity, diabetes mellitus, and smoking), tumor ER status (surrogate for possible endocrine therapy), time between diagnosis and serum collection, T and N status, use of trastuzumab, and age. Results: The mean age at the time of BC diagnosis was 52.2 (SD 9.8). 13% of tumors were human epidermal growth factor receptor (HER2)-positive and 71% were estrogen receptor (ER) positive. NT-proBNP was elevated in 34%. Mean NT-BNP level was higher (p=0.047) for those in years 4-5 (158 pg/mL) compared to those in years 1-3 (106 pg/mL) (See Table.) Models revealed years from diagnosis to serum draw (p=0.026), older age (p=0.006), more cardiac risk factors (p=0.064), and N2-3 (p=0.001) were associated with elevated NT-pro-BNP level. Use of trastuzumab, ER status, and tumor size were not associated with NT-proBNP. Conclusions: NT-proBNP is elevated in 1/3 of survivors who received anthracycline therapy for BC. As expected, cardiac risk factors and advancing age are associated with higher NT-proBNP. NT-proBNP values >300 were only found in patients who were 4-5 years after diagnosis. Additional research will be needed to further define the diagnostic and prognostic merit of NT-proBNP in survivors after receipt of anthracycline therapy. [Table: see text]
Assessment of scalp cooling to prevent chemotherapy-induced alopecia using standard infusion room documentation and patient surveys.
Authors: Hagigeorges Dina , Bartholomay Mimi , Senna Maryanne M , Isakoff Steven J.
Published: May 2020

e24106

Background: Chemotherapy induced alopecia (CIA) is one of the most distressing reported side-effects of cancer treatment, with patients (pts) reporting negative impacts on self-image and quality of life. Scalp cooling (SC) devices can prevent CIA. SC efficacy varies by chemotherapy regimen and dose, and taxane-based therapies report better outcomes. Here we report the efficacy of SC with the Paxman SC system using a standard infusion room nursing assessment and patient surveys. Methods: Pts using SC at the MGH Cancer Center between 4/2018 and 12/2019 were included in the analysis. Routine infusion room nursing assessments included CTCAE 4.0 grading for alopecia. A retrospective review of SC pts with documented CTCAE grades was conducted with success defined as grade (Gr) 0 or 1 alopecia at the final infusion. CTCAE results were compared to patient surveys of self-assessed success. Additional data include disease type, regimen and SC discontinuation details. Results: 64 pts who initiated SC and had CTCAE grade recorded were included. The most common chemotherapy regimens were docetaxel/cyclophosphamide (33%), docetaxel/carboplatin/trastuzumab/pertuzumab (19%), paclitaxel/trastuzumab (16%) and paclitaxel weekly/pertuzumab/trastuzumab (6%). Breast cancer was the most common disease type (92%). 77% of pts had successful hair retention (Gr 0 = 23 (36%), Gr 1 = 26 (41%)). 3 pts received anthracycline-based therapy and 1 successfully retained hair. Among 11 pts who completed post-treatment surveys, patient reported outcome and CTCAE were concordant in 9 (82%) pts. 13 (20%) pts terminated SC early; 9 (69%) after 2 treatments (tx), 2 (15%) after 3 tx, 1 (8%) after one tx and 1 (8%) after 5 tx. The most common reason for early dc was extent of alopecia (10, 77%). Other factors in the decision were time and discomfort. Of the 51 pts who completed SC for the entire chemotherapy tx, 48 (94%) received a taxane-based regimen and 46 (90%) had successful hair retention. Conclusions: In this single institution experience, we observed a high success rate of scalp cooling to prevent chemotherapy induced alopecia in a population of mostly breast cancer patients receiving taxane-based regimens. Concordance between patient reported outcome of success and routine standard of care nursing CTCAE documentation in the electronic medical record provides a simple and accurate method to monitor outcomes with scalp cooling. Despite high success, 20% discontinued SC, suggesting further studies to improve outcomes and tolerability are needed.
Finding a risk assessment model for thromboembolic events in hospitalized cancer patients: The Indicate Study.
Authors: Platania Marco , Nichetti Federico , Provenzano Leonardo , Montelatici Giulia , Franza Andrea , Porcu Luca , De Braud Filippo G.
Published: May 2020

e24108

Background: Hospitalized cancer patients are at increased risk for Thromboembolic Events (TEs). Given the hemorrhagic risk associated with untailored thromboprophylaxis, the identification of patients at low TE risk who might not receive it during in-hospital stay would be clinically useful. Methods: The INDICATE study was a monocentric, observational study enrolling patients with active solid malignancy hospitalized for at least two nights for treatment administration, diagnostic procedures or acute medical illness (excluding TEs). The primary objective was to assess the Negative Predictive Value (NPV) of low-grade Khorana Score (e.g. KS = 0), evaluated at the time of patients’ in-hospital admission, for TEs prediction during and after (next 45 days) hospitalization. The primary analysis was conducted on patients with KS = 0. However, all-grade KS patients were enrolled for secondary outcomes analysis. Assuming a 7% of TEs as the unsatisfactory percentage and a 3% as the satisfactory percentage, expecting about 5% of collected data as incomplete, all consecutive patients who fulfil the inclusion criteria irrespective of the KS were enrolled, until a total of 149 patients with KS = 0 were included to detect the favorable NPV with one-sided alpha equal to 0.10 and power equal to 0.80. Results: Between November 2016 and May 2019, a total of 535 patients were enrolled. Among these, 153 (28.6%) had a KS = 0. The primary study endpoint was met: 29 (5.4%) patients received a diagnosis of TEs during or after hospitalization, with 7 (4.6%) cases in the KS = 0 group. However, patients with higher KS values did not show increasing TE incidence. Among the other evaluated risk assessment models, the ONKOTEV scoreshowed the best predictive potential, with significantly higher values in patients with TEs (p < 0.001).Of note, TEs were associated with poorer overall survival (median, 6.7 vs 24.8 months, log rank p < 0.001). Conclusions: The INDICATE study showed that hospitalized cancer patients with KS = 0 at admission have a low risk of TEs, and could thus be spared from routine thromboprophylaxis. Further studies are needed to better define a RAM in this population.
A pilot randomized, placebo-controlled, double-blind study of omega-3 fatty acids to prevent paclitaxel-associated acute pain syndrome.
Authors: Dayao Zoneddy R. , Brown-Glaberman Ursa Abigail , Pankratz V. Shane , Chen Lu , Lafky Jacqueline M. , Loprinzi Charles L. , Barton Debra L.
Published: May 2020

e24115

Background: Paclitaxel, a widely used chemotherapeutic agent, is associated with an acute pain syndrome (P-APS) and chronic chemotherapy-induced peripheral neuropathy (CIPN). Currently, there is no standard of care for P-APS. Commonly used analgesics, including NSAIDs and narcotics, have considerable toxicity profiles. Omega-3 fatty acids, a common dietary supplement, have well established anti-inflammatory and neuroprotective properties. The primary aim of the study was to assess if omega 3 fatty acids could prevent P-APS. Methods: Patients scheduled to receive weekly paclitaxel (70-90mg/m2) were randomized to receive 4 g of omega-3 acid ethyl esters (Lovaza) or placebo, beginning 1 week prior to starting paclitaxel and continued until paclitaxel was discontinued. Patients completed acute pain questionnaires at baseline, Days 2-7, prior to each subsequent treatment and one month after completion of therapy. The EORTC- QLQ CIPN 20 questionnaire was completed prior to each dose of paclitaxel and 1 month after completion. The primary objective was to compare the effect of omega 3 fatty acids, versus placebo, on the maximum pain score for the week following the 1st treatment and each subsequent paclitaxel treatment, and to compare pain medication use between the 2 arms. The secondary objective was to compare the effect of the intervention on the severity of CIPN. Results: 49 patients were randomized to treatment versus placebo. Linear mixed effects models were applied with the addition of a bootstrap approach to overcome limitations in the distributional assumptions to compare outcomes between treatment groups. Placebo results were similar to the reported natural history of P-APS. There was no significant difference in trends over time between the 2 groups in the maximum pain score at week 1 (p = .14) and over 12 weeks (p = .21). There was also no difference noted in the rates of use of over the counter analgesics (p = .39) and narcotics (p = .46). CIPN results did not differ between the 2 groups (p = .08). Conclusions: The results of this pilot study do not support the use of omega-3 fatty acids for the prevention of paclitaxel-associated pain syndrome. Clinical trial information: NCT01821833 .
A phase III randomized clinical trial of diclofenac versus tramadol for mucositis-related pain in head and neck cancer patients undergoing concurrent chemoradiation.
Authors: Dhumal Sachin Babanrao , Noronha Vanita , Patil Vijay Maruti , Joshi Amit , Menon Nandini Sharrel , Jain Parmanand , Prabhash Kumar
Published: May 2020

e24124

Background: Oral mucositis related pain during CTRT in head and neck cancers is a common problem. Unfortunately, in spite of it being common, there is limited evidence for selection of systemic analgesic in this situation. Hence, this study was designed to compare the analgesic effect of an NSAID (diclofenac) versus a weak opioid (tramadol). Methods: This was an open-label, parallel design, superiority randomized controlled study. In this study head and neck cancer patients undergoing radical or adjuvant chemoradiation, who had grade 1 or above mucositis (in accordance with CTCAE version 4.03) and had pain related to it were randomly assigned to either diclofenac or tramadol for mucositis related pain control. The primary endpoint was analgesia after the 1st dose. The secondary endpoints were the rate of change in analgesic within 1 week, adverse events, and quality of life. Results: 128 patients were randomized, 66 in diclofenac and 62 in tramadol arm. The median AUC for the diclofenac arm and the tramadol arm were 348.936 units (Range 113.64-1969.23) & 420.87 (101.97-1465.96) respectively (p = 0.05619). Five patients (8.1%) in the tramadol arm and 11 patients (16.7%) in the diclofenac arm required a change in analgesic within 1 week of starting the analgesic (p = 0.184). There was no statistically significant difference in any adverse events between the 2 arms. However, the rate of any grade of renal dysfunction was numerically higher in diclofenac arm (10.6% versus 4.8%, p = 0.326). Conclusions: In this phase 3 study, evaluating diclofenac and tramadol for Chemoradiation induced mucositis pain, the analgesic efficacy of both analgesics was found to be similar but diclofenac was associated with a higher rate of renal dysfunction. Clinical trial information: CTRI/2016/09/007302 .
Prevalence of chemotherapy-induced nausea and vomiting with moderately emetogenic chemotherapy in platinum-based regimens.
Authors: Shah Nilomi , Nishimura Kris , Tan Evelyn , Hsu Hana
Published: May 2020

e24131

Background: Kaiser Permanente East Bay considers cisplatin ≤40 mg/m2, carboplatin at any AUC, and oxaliplatin at any dose as moderate emetogenic risk where patients are administered 5-hydroxytriptamine type 3-receptor antagonist (5-HT3 RA) and dexamethasone. However, national guidelines differ in their management with cisplatin and carboplatin of AUC ≥4. Moreover, it has been noted within our institution that patients receiving oxaliplatin often require escalation of antiemetic regimen despite 5-HT3 RA and dexamethasone prophylaxis. The objective of the study was to determine the prevalence of CINV in patients receiving platinum-based chemotherapy despite moderate prophylaxis for cycle 1. Methods: The study was a retrospective single-center cohort-control analysis assessing patients from Kaiser Permanente East Bay initiated on cycle 1 with carboplatin AUC ≥4, low dose cisplatin ≤40 mg/m2, or any dose of oxaliplatin. Evaluation of CINV was defined as rates of no complete response (emesis or use of rescue) during the acute (0 – 24 hours), delayed (24 – 120 hours) and overall periods (0-120 hours) after cycle 1 of treatment. A descriptive analysis was performed for the primary endpoint where the rate of no complete response (emesis or use of rescue) was expressed using the percentage of patients with the outcome. For the secondary endpoint, the patient-related risk factors associated with no complete response were determined by chi-squared for univariate covariates. Results: Between January 2016 to August 2019, 90 patients on cisplatin ≤40 mg/m2, 243 patients on carboplatin AUC ≥4, and 204 patients on any dose of oxaliplatin were enrolled in the study. The percentages of patients who had no complete response were 16%, 13%, 11% in the acute phase; 39%, 34%, and 38% in the delayed phase; 47%, 36%, and 39% in the overall phase, respectively. Univariate analysis using chi-squared revealed that age less than 60 years and females were associated with an increased risk for no complete response in the overall phase. In contrast, prior chemotherapy was significantly associated with a decreased risk in the overall phase. Conclusions: The prevalence of CINV despite moderate antiemetic management at Kaiser Permanente East Bay is more prominent in the delayed phase compared to the acute phase and consistent with trends determined in literature. Patients who are younger than 60 years of age, who are female, or had no prior history of chemotherapy are relevant risk factors associated with CINV in our patient demographics.
Advanced cancer patients' (CP) attitudes and perceptions regarding reasons for outpatient supportive care (SC) referral at a comprehensive cancer center: A randomized controlled study.
Authors: Wong Angelique , Fossella Frank V. , Simon George R. , Maddi Rama , Lu Zhanni , Williams Janet L. , Thomas Lisa , Liu Diane D. , Wu Jimin , Hui David , Bruera Eduardo , Yennu Sriram
Published: May 2020

e24135

Background: Current ASCO guidelines propose early access to SC in all CP to improve quality of care, quality of life, and symptoms. Very few studies have evaluated patients’ perceived criteria for referral to outpatient SC and perceptions of patients who are referred early in their disease trajectory. Methods: In this study we evaluated CP attitudes and perceptions regarding the role of and access to outpatient Supportive Care clinic (SCC) at a comprehensive cancer center. CP with life expectancy of greater than 6 months (as determined by the oncologist) and who are newly registered at MD Anderson Cancer Center were randomized to either obtain an educational brochure that explained the role of the SCC or no brochure. Both groups then completed a survey regarding the role and access to of outpatient SCC. After completion of the survey, patients were asked if they would like to be seen by the SC team. If so, they were scheduled by their oncologist for a SC consult. Results: 288 patients were evaluable: median age was 63, 43% were female, 84% were Caucasian, and the most common cancer type was lung cancer (39%). Median survival was 15 months. Patients who received a brochure reported more understanding of the role of SC vs those who did not receive a brochure (63% vs 37%, p = 0.04). Both groups felt that SC could help to address physical (47% vs 54%) and psychosocial (50% vs 50%) symptoms. Both groups felt SC could help to address questions regarding prognosis (50% vs 50%) and future care (53% vs 47%). Both groups did not feel that time (50% vs 50%) nor financial concerns (49% vs 51%) would be barriers to access SC. Both groups did not feel that receiving SC would impede their cancer care (60% vs 40%) nor change their oncologists’ perspective of them (25% vs 75%). Both groups felt they could receive SC and cancer care simultaneously (50% vs 50%). Approximately half of the patients in both groups perceived it was not too early for a referral to SC. There were no statistical differences in these groups for these findings. Conclusions: Patients who received a brochure had a better understanding of the role of SC. A very significant proportion in both groups had limited awareness of the value of SC. Oncologist driven referral and education of SC may facilitate better understanding of the value of SC. Further studies are needed.
Correlational study of different analgesic programs on patients' quality of life, mood, and dignity.
Authors: Wang Long , Zhang Xue , Liu Zhimin , Shan Mei , Hu Xinyan , Zuo Jing , Wang Yudong , Fan Zhisong , Cui Yanzhi , Jiang Da
Published: May 2020

e24139

Background: To evaluate the effects between oral sustained release opioids and other analgesic drugs on the quality of life, mood and dignity of patients with cancer pain. Methods: Participants were cancer patients with cancer pain recruited from a tertiary cancer hospital in North China. Patients were divided into group A (oral sustained-release strong opioids,) and group B (non-sustained release strong opioid analgesia, as tramadol, oxycodone aminophenol, non-steroidal analgesia, etc.) to assess their quality of life, mood and dignity. Data were collected using the Patient Dignity Inventory, the MD Anderson Symptom Inventory–Chinese, the distress thermometer, the Hospital Anxiety and Depression Scale, and the 30-question core Quality of Life Questionnaire from the European Organisation for Research and Treatment of Cancer, and were analyzed using quantitative methods. Results: The study included 297 cancer pain patients, including 172 males and 125 females, with a median age of 58 years, most of whom were lung cancer (n = 88), esophageal/gastric cancer (n = 63) and colorectal cancer (n = 52). Patients in group A(n = 224) had better pain control (P < 0.001), symptom burden (P < 0.001), psychological distress (P < 0.001), anxiety (P = 0.001) and Sense of dignity (P = 0.014) than those in group B(n = 73). In terms of quality of life assessment, patients in group A were more likely to suffer from nausea and vomiting (P = 0.003), and patients in group A were better than those in group B (Ps < 0.05), except for the similarity of social cognitive function, decreased appetite, diarrhea and constipation. Conclusions: The analgesic program with oral sustained - release strong opioids for cancer pain patients not only has better analgesic effect than other programs, but also has obvious advantages in physical symptoms, psychological emotion, sense of dignity and overall quality of life.
Effect of music therapy on symptoms, adverse events, and quality of life of breast cancer patients undergoing chemotherapy: A randomized clinical trial.
Authors: Cossetti Leal Rachel Jorge Dino , Lima Talita Uchoa , Pereira Emanuel Cabral , Nascimento Raniere Victor Braga , Oliveira Eduardo José Silva Gomes , Oliveira Caio Marcio Barros , Moura Ed Carlos Rey , Nogueira Neto Joao , Leal Plinio da Cunha
Published: May 2020

e24140

Background: Music can influence human behavior and may be used as complementary therapy in health care. Objective: To assess the effect of music therapy on symptoms, adverse events and quality of life (QoL) of breast cancer patients undergoing chemotherapy (CT). Methods: Non-blinded, randomized clinical trial. Patients were randomized into two groups: musical group (MG) or control group (CG), and followed during the first 3 cycles of CT. Sociodemographic data, WHOQOL-BREF, BDI-II, BAI and Chemotherapy Toxicity Scale were assessed. Patients were evaluated after each of the first three CT cycles. MG underwent a 30-minute musical intervention prior to CT. There was no intervention in the CG. Results: Higher QoL scores on functional scales were observed for the MG in comparison to the CG after the first and third sessions of chemotherapy. Depression (p < 0.001) and anxiety scores (p < 0.001) and vomiting (p 0.01) incidence were lower for the MG in the third CT session. All participants in the MG reported positive changes in life in the Subjective Impression of the Subject questionnaire, as well as improvement in fatigue and reduced stress levels. Conclusions: Improvements in QoL, anxiety, depression, and incidence of vomiting were associated with music therapy intervention, suggesting a positive effect of music therapy on adverse events of cancer CT. Clinical trial information: RBR-88r347 .
The clinical significance of gabapentin in combination with opioids in controlling outbreak of pain in cancer patients.
Authors: Zhang Xue , Jiang Da , Yan Qingyu , Huang Fang , Jin Hui , Fan Shaoshuang , Li Ying , Zhou Xinliang , Wang Zhe
Published: May 2020

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Background: This study compared the pain relief effects of opioids combined with gabapentin and opioids alone after an outbreak of pain in patients with opioid-tolerant cancer pain to explore better cancer pain management. Methods: A total of 60 patients with moderate and severe cancer pain from September 2016 to April 2017 in the Department of Oncology of the Fourth Hospital of Hebei Medical University. They were randomly divided into two groups when they experienced an outbreak of pain, only oxycodone hydrochloride sustained-release tablets group (A group) 30 cases and gabapentin capsule combined with oxycodone hydrochloride sustained-release tablets group (B group) 30 cases, The degree of pain relief before and after treatment, the consumption of oxycodone hydrochloride sustained-release tablets, quality of life scores and adverse reactions, and nighttime sleep time were compared between the two groups. Results: 1. The NRS score in group B after treatment was significantly lower than that in group A after treatment (1.83±0.46 vs. 2.30±0.75). There was a statistically significant difference (P < 0.05). 2. The consumption of oxycodone hydrochloride sustained-release tablet in group B was lower than that in group A (19.000±6.074 vs. 25.667±10.063). There was statistical significance (P = 0.003). 3. The quality score was higher than before, and the quality of life score in group B was higher than that in group A (P < 0.05). 4. The main adverse reactions in both groups were constipation, nausea, vomiting and dizziness. The incidence was 86.67% vs. 50.00%、33.33% vs. 23.33%, 20.00% vs. 16.67%, respectively, there was no significant difference (P > 0.05). The nighttime sleep time of both groups was higher than that before treatment (6.017±0.636 vs. 5.167±0.735, 6.433±0.583 vs. 5.167±0.661). 5. The nighttime sleep time of Group B was longer than that of Group A after treatment (6.433±0.583 vs. 6.017±0.636). The difference was statistically significant (P < 0.05). Conclusions: Opioids combined with gabapentin are superior to opioids alone in the treatment of cancer pain with analgesic efficacy, improved quality of life, reduced opioid consumption, adverse drug reactions, and effective night time sleep.
Cannabis use patterns and patient reported outcomes in oncology and hematology patients: An anonymous survey.
Authors: Subbiah Shanmuga , Presant Cary A. , Upadhyaya Gargi , Zheng Meizi
Published: May 2020

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Background: In a contemporary era of rapidly evolving social and regulatory changes, it is important to understand and characterize patient (pt) cannabis usage and response. Methods: In order to avoid responding bias, we performed the first ever anonymous survey in consecutive patients (pts) cared for in a City of Hope practice site in California. We analyzed demographic information, qualifying conditions, symptoms, and the cannabis product used. Pt reported outcomes of response to cannabis were collected. Improvement in control of symptoms was defined as pts choosing “total” or “a lot”. Results were tabulated and analyzed by the Chi-squared and Fisher’s Exact statistics. Results: 154 of 176 consecutive patients agreed to participate (87.5%). 72.7% had a malignancy (CA), 18.1% non-malignant hematologic disease (HEME), and 10.3% had other illnesses (OTHER). Age was < 45 in 10.3%, 45-64 in 37.0%, and > 64 in 52.6%. Older pts more frequently had CA (32.5% < 45, 70.2% 45-64, vs 81.5% > 64p = .0012). 41.8% were male. Cannabis use was reported in 24.7%. Surprisingly, this did not vary significantly by age (37.5% age < 45, 28.0% age 45-64, and 19.8% age > 64 p = .24), by disease (CA 22.9%, HEME 34.6%, OTHER 28.6% p = .41), nor by gender (male 21.9%, female 25.8% p = .57). Pts used cannabis to control their disease in 42.1%, GI symptoms (nausea, vomiting) in 28.9%, weight loss in 10.5%, fatigue in 42.1%, pain in 73.6%, and other symptoms in 36.8%. Cannabis product was marijuana (MJ) in 32%, CBD in 58% and THC in 8% and varied by age (p = .0006) but not by illness or gender. Improvement in disease was reported in 62.5%, GI symptoms in 63.6%, weight loss in 50%, fatigue in 50%, and pain in 60.7%. Symptom improvement trend was numerically higher with MJ or THC (71%) vs CBD (47%, p = .27). 73% of pts reported they would participate in a cannabis clinical trial. Conclusions: There is a high usage of cannabis. While cannabis use does not vary by age, preference for cannabis product however does vary by age. Pts reported high response rates for various symptoms, which can confound the effectiveness of anticancer or supportive medications. Clinical trials of anticancer agents should stratify by use of cannabis products to avoid misattribution of antitumor effects or side effects. Since cannabis access is expanding across the country, it provides an opportunity to perform randomized trials looking into benefits and risks of cannabis use, and dose and administration methods. Clinicians should screen for cannabis use and document it in social histories separate from the category of illegal drug use.
Evaluation of prescribing practices of denosumab and zoledronic acid in breast and prostate cancer patients at University of Chicago Medicine.
Authors: Yang Heng , Knoebel Randall W , Parsad Sandeep , Carroll Emma , Stadler Walter Michael
Published: May 2020

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Background: Zoledronic acid (ZA) and denosumab are both bone-modifying agents (BMAs) approved for use in patients with bone metastases with breast or prostate cancer as well as patients who are receiving aromatase inhibitors (breast cancer) or androgen deprivation therapy (prostate cancer). There are various frequencies of administration, doses, and duration of these agents depending on indication and extent of disease. Currently there is data to show that ZA can be given every 3 months in patients with metastatic breast and prostate cancer, however, there is no data that clearly indicates that denosumab every 3 months is non-inferior to every 28 days. This study aimed to analyze current prescribing patterns of ZA and denosumab in metastatic breast cancer and metastatic castration resistant prostate cancer patients at The University of Chicago Medicine (UCM). Methods: This was a retrospective study of 80 patients who received at least one dose of ZA or denosumab between July 1st 2018 to June 30th 2019 from UCM outpatient oncology clinic for the purpose of treating metastatic breast cancer or metastatic castration resistant prostate cancer in conjunction with standard antineoplastic therapy. All included patients must have bone metastases. Patients were divided into four groups by disease state (breast or prostate cancer) and BMA agent (ZA or denosumab). The primary outcome was BMA therapy adherence rate, which was defined by those who received greater than or equal to 80% of appropriately scheduled doses. Descriptive statistics were used for skeletal-related events (SREs) and BMA associated adverse effects. Results: Patients who received ZA achieved higher adherence rates (100% breast, 86% prostate) compared to patients that received denosumab (63% breast, 23% prostate). The most common reason for the lower adherence rate in denosumab groups was scheduling convenience. During the study period, there were 3, 0, 2 and 5 patients had SREs in the above four groups respectively. The predominant adverse event across all groups was hypocalcemia and two patients with prostate cancer on denosumab developed osteonecrosis of the jaw. The cost analysis showed using ZA as primary BMA agent might save up to 2.5 million dollars per year at UCM. Conclusions: The use ofZA was associated with higher adherence rates compared to denosumab. Implementing a pharmacy driven protocol for ZA use for patients with metastatic breast and prostate cancer may improve BMA regimen adherence rates and significantly reduce costs.
Real-world evidence highlights sizeable gap in adopting early palliative care referral in patients with advanced cancers.
Authors: Cole Suzanne , Storie Sarah , Owens Sonya , Gipson LaShanta , Hardy Michael , Turk Ashley , Subbiah Ishwaria Mohan
Published: May 2020

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Background: Early referral to palliative care (PC) for patients w/ adv cancer is supported by compelling evidence from large RCTs demonstrating a lower symptom burden, higher QOL, and increased OS. However, these studies reflect pts who have self-selected to accept a PC referral and attend a PC visit. WHO/NCCN/ASCO guidelines support early integration of PC. We sought to characterize the referral patterns in our heme/onc practice to identify and mitigate the barriers to early PC adoption in the community setting. We began a concerted effort to discuss early PC referral w/ pts recently diagnosed w/ adv cancer at the time systemic therapy was initiated. Methods: To ensure real-world applicability of this study, we identified a large satellite clinic of a major academic center w/ access to PC on the main campus (located 20 miles from the satellite clinic). We retrospectively reviewed new pts age 18y+ w/ adv cancer, characterized PC referrals and outcomes. Using qualitative methodology, we identified pt-reported barriers to accepting PC care. Results: 407 new pts were seen; 168 w/ benign heme, 145 w/ early cancers, 94 w/ adv cancers. Of the 94 pts w/ adv cancers, 25 pts had one-time 2ndopinion visits, and 16 pts were not candidates for, or did not desire cancer treatment and directly enrolled on hospice. Our analysis cohort consisted of 53 pts w/ adv cancer pursuing life prolonging therapy. At initiation of treatment, 57 % (n=30) were not offered a PC referral, 22% (n=12) received a PC referral and attended the appt, however 21% (n=11) received a PC referral but did not attend the appt. A qualitative analysis of the 11 patients referred to early PC who did not attend the appt revealed; 5 patients scheduled an appt but did not attend (3-unknown reason, 2-hospitalized during appt, 1-lack of transportation), 2 pts were unreachable, and 4 pts were contacted but declined to schedule stating: “I feel pressured” “I want to hear what other treatment options I have” “I want to be treated first and then see if I need it” "I am overwhelmed with too many new doctors and visits". Conclusions: Despite the benefit of early PC referral in pts w/ adv cancer, we identified a considerable gap in its adoption in our community practice despite access to proximate PC clinic. Further studies are under design to address institutional and pt-related factors to improve real-world adoption of this critical service.