bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing elderly and non-elderly adult cancer survivors: Differences in modifiable behaviours of smoking and alcohol cessation and physical activity.
Authors: Niu Chongya , Eng Lawson , Qiu Xin , Shen Xiaowei , Espin-Garcia Osvaldo , Pringle Dan , Mahler Mary , Halytskyy Oleksandr , Charow Rebecca , Lam Christine , Shani Ravi M. , Villeneuve Jodie , Tiessen Kyoko , Brown M Catherine , Selby Peter , Howell Doris , Jones Jennifer M. , Xu Wei , Alibhai Shabbir M.H. , Liu Geoffrey
Published: March 2020

9551

Background: In developing a cancer survivorship program at Princess Margaret Cancer Centre (Canada), cancer survivors were surveyed on modifiable behaviours: smoking/alcohol intake and physical activity. We evaluated whether special considerations should be given to elderly cancer survivors (age 65 years or higher), where few data currently exists. Methods: 616 adult cancer survivors of all disease sites were asked about their smoking, alcohol, and physical activity habits, and their attitudes and knowledge about effects of these habits on cancer outcomes. Univariate and multivariate logistic regression models evaluated the effect of age on these factors. Results: 23% were elderly; 53% female; 15% breast, 20% gastrointestinal/gynecologic, 24% hematologic, 19% thoracic/head and neck, and 13% genitourinary cancers. Median follow up was 24 months. Elderly survivors were more likely to be ever smokers (OR=1.69, 95% CI [1.12-2.53]) and ex-smokers than current (OR=4.11 [2.02-8.33]), but less likely to know how smoking could affect cancer treatment (OR=1.72 [1.09-2.69]) or outcome (OR=1.66 [1.07-2.60]). Elderly patients were less likely to binge drink (OR=2.07 [1.34-3.19]), but more likely to perceive alcohol as improving quality of life (OR=1.98 [1.11-3.56]) and overall survival (OR=2.32 [1.22-4.41]) in their own situation. Elderly survivors were less likely to receive information about alcohol use (OR=2.89 [1.29-6.49]). Meeting exercise guidelines at diagnosis (OR=1.76 [1.16-2.67]) and improving/maintaining them after treatment (OR=2.02 [1.12-2.93]) was substantially lower in elderly survivors, but perceived benefits/harms of exercise did not differ with age. Conclusions: Elderly patients know less about the impact of smoking on their overall health, despite having higher rates of cumulative exposure. A lower proportion received information on alcohol use. Elderly patients are less able to achieve the same exercise goals as younger patients. Survivorship programs may need to tailor counselling on modifiable behaviours by age group. CN, LE, SMHA, and GL contributed equally.
The influence of autologous stem cell transplant (ASCT) on survival in older adults with multiple myeloma (MM).
Authors: Wildes Tanya Marya , Finney Joseph D , Fiala Mark , Gao Feng , Vij Ravi , Stockerl-Goldstein Keith , Carson Kenneth Robert , Colditz Graham A.
Published: March 2020

9559

Background: In randomized trials, ASCT improves survival in MM patients (pts) < age 65. The impact of ASCT on survival in older adults with MM is unknown. Methods: In a retrospective cohort study, all pts ≥ age 65 with MM diagnosed between 2000 and 2010 were identified from the Barnes-Jewish Hospital Oncology Data Services Registry (N=199), including demographic, comorbidity (ACE-27 index) and survival data. Medical records were reviewed for stage, ECOG Performance Status (PS) and treatment. Pts > age 77 or who received only steroids/supportive care were excluded (N=53). The primary endpoint was overall survival (OS), defined as time from diagnosis to death, censored at last follow-up. Univariate analyses for factors associated with undergoing ASCT were performed using Fisher’s exact test or nonparametric rank-sum test; multivariate logistic regression was used to create propensity scores for ASCT. The association between ASCT and OS was assessed using a multivariate Cox proportional hazard model with propensity scores adjustment; missing values in predictors were imputed using multiple imputations. Results: Of 146 pts included, the median age was 68 (range 65-77); 53% were male, 81% Caucasian; 43% underwent ASCT. Comorbidities were common (43.9% mild, 21.6% moderate and 9.3% severe). Durie-Salmon Stages were I – 9.5%, II-18.1%, III-72.4%. PS at diagnosis was 0 - 18.3%, 1 - 51.0%, 2 - 21.2% and 3 - 9.6%. Most received novel agents (thalidomide, lenalidomide or bortezomib) in their initial treatment (25.2% alkylators only, 58.6% novel single agents ± steroids, 16.2% novel combination regimens). Age (p<0.0001) and insurance/payer (p=0.02) were associated with ASCT. On univariate analysis, ASCT [Hazard Ratio (HR) 0.54 (95% confidence intervals (CI) 0.35-0.82)] and PS [PS 1: HR 2.3 (CI 1.0-4.9), PS2: HR 3.3 (1.4-7.9); PS 3: HR 3.5 (CI 1.3-9.3)] were associated with mortality. On multivariate analysis controlling for PS, comorbidity, stage and propensity to undergo ASCT, ASCT was associated with reduced mortality [HR 0.52 (CI 0.30-0.92), p=0.02]. Conclusions: In pts over age 65 with MM, ASCT is associated with better OS after adjusting for propensity to undergo ASCT.
Patient-reported outcomes for determining prognostic groups in veterans with stage IV solid tumors starting systemic therapy.
Authors: Chang Victor T , Scott Charles B. , Einhorn Jan , Yan Houling , Gonzalez Melanie L. , Sullivan Maryann , Srinivas Shanthi , Zhong Fengming , Paz-Querubin Emma R , McPherson Monica , Crump Barbara , Duque Lourdes , Kasimis Basil
Published: March 2020

9567

Background: A Recursive Partitioning Analysis (RPA) algorithm predicted four groups with distinct median survivals in patients with advanced cancer entering palliative care (ASCO 2010, Abst 9040). We investigated whether this algorithm could apply to cancer patients starting systemic therapy. Methods: The RPA algorithm is based upon Karnofsky performance status (KPS), Functional Assessment of Cancer Therapy (FACT) physical well-being (PWB) subscale, and Memorial Symptom Assessment Scale Short Form (MSAS-SF) physical symptom distress (PHYS) subscale. Starting in 2007, a convenience sample of Veterans who were prescribed systemic treatment for their cancer was enrolled in an IRB approved protocol, and completed quality of life (FACT- G) and symptom (MSAS SF) questionnaires prior to starting the first cycle of treatment. We analyzed records of patients with stage IV metastatic solid tumors enrolled through August 2011, and determined survival as of December 1, 2012. Analyses were performed with STATA 11.0. Results: There were 72 patients (pts). The median age was 63 yrs, (range 46-86). Men comprised 71 (98%) pts. First line systemic therapy was given to 59 (82%) pts. The most common primary sites were lung cancer (25 pts, 35%), prostate 9 pts(12%) and colon 7 pts (10%). Median KPS was 90% (range 40-100%), PWB median 23 (range 6-28), and MSAS SF median PHYS 0.73 (range 0-2.93). Overall median survival was 269 days (range 6-1762) and 57 pts (79%) had died. There was 1 pt in group 1, 45 pts in group 2, 8 pts in group 3, and 18 pts in group 4. Median survival (days) by RPA group was 155 for group 1, 177 for group 2, 292 for group 3, and 610 for group 4 (p=.011). Conclusions: These preliminary findings suggest that this algorithm is capable of dividing patients with metastatic solid tumor who are starting chemotherapy into prognostic groups. It may have applications in clinical trials. Further development is indicated. [Table: see text]
Breaking bad news: Comparison of perspectives of Middle Eastern cancer patients and their relatives.
Authors: Zekri Jamal M , Karim Syed Mustafa , Bassi Sawsan , Bin Sadiq Bakr M , Fawzy Ehab Esmat , Nauf Yousseff Ibrahim
Published: March 2020

9568

Background: It is believed in some Middle Eastern (ME) cultures that disclosure of bad news to cancer patients may cause loss of hope. On many occasions the relatives’ and patients’ wishes are opposed regarding this matter. This study investigates cancer patients’ and their relatives’ perspectives regarding communication of cancer-related bad news in a ME population. Methods: Nine close-ended questions were designed in a questionnaire format to obtain cancer patients’ (cohort I) and their relatives’ (cohort II) perspectives regarding communication of cancer related bad news from diagnosis to end-of-life. The questionnaire was answered by patients and relatives during out-patient visits. Chi-square test was used to test differences in responses between the two cohorts. Results: 203 participants (100 patients and 103 relatives) completed the questionnaire. In cohorts I and II, 28% and 58% of participants were males respectively (p<0.001). In contrast to relatives’ views, majority of patients preferred to be informed of diagnosis and possible adverse outcome of their illness, as detailed in the Table. Conclusions: Our study indicates that there is significant discordance between the preferences of ME cancer patients and their relatives regarding disclosure of cancer related bad news to the patient. As opposed to relatives’ beliefs, most patients would prefer to know bad news throughout the course of their illness. Unless a patient indicates otherwise, physicians should strive to keep cancer patients informed of their health related events. [Table: see text]
Use of modafinil to moderate the relationship between cancer-related fatigue and depression in 541 patients receiving chemotherapy: A URCC CCOP study.
Authors: Conley Claire , Heckler Charles E , Morrow Gary R. , Mustian Karen Michelle , Kamen Charles Stewart , Janelsins Michelle Christine , Peppone Luke Joseph , Scalzo Anthony Joseph , Gross Howard M. , Dakhil Shaker R. , Palesh Oxana
Published: March 2020

9572

Background: Over 50% patients with cancer report symptoms of depression; 15% meet diagnostic criteria for Major Depressive Disorder. Depression is associated with increased insomnia, fatigue and reduced quality of life. We previously found that modafinil is effective for reducing high levels of fatigue among patients undergoing chemotherapy. This study aims to test whether modafinil can alleviate symptoms of depression by reducing fatigue. Methods: This study is a secondary analysis of 541 cancer patients receiving chemotherapy and experiencing fatigue (Brief Fatigue Inventory (BFI) >=3) that were randomized to receive either 200 mg of modafinil (N=260) or placebo (N=281) daily from baseline (Cycle 2) until post-test (Cycle 4). Depression was measured by the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and post-test. The CES-D total score and its subscales (Positive Affect, Negative Affect, Somatic Symptoms, and Interpersonal Symptoms) were analyzed. A linear model with CES-D post (outcome) and BFI baseline, Arm, and BFI*Arm interaction term (independent variables) was used to address the hypothesis; p<0.05 indicates significance. Results: We found no overall effect of modafinil on depression; however, the model demonstrated a significant moderating effect of modafinil on the relationship between baseline fatigue and CES-D total scores (p = 0.04). For subjects with severe fatigue (BFI ≥ 7), the drug reduced CES-D scores by 3-4. Modafinil also significantly moderated the relationship between baseline fatigue and Positive Affect subscale scores (p = 0.003), but not the relationship between baseline fatigue and Somatic, Negative Affect, or Interpersonal subscales. Conclusions: Modafinil differentially impacts depression based on a patient’s level of fatigue; reduced depressive symptoms occurred in those with extreme fatigue. This effect is driven by increases in positive affective symptoms. These results have significant implications for intervention; in patients with high levels of fatigue, modafinil might also reduce depression. Future RCTs are needed to confirm these results. Funding: U10CA37420, K07CA120025, K07CA132916.
A feasibility study using a touchscreen tool in the AYA population.
Authors: Espenschied Jonathan R. , Wolfson Julie Anna , Bogardus Alicia , Chen Yanjun , Folbrecht Jeanelle , Wong Florence Lennie , Rosenthal Joseph , Patel Sunita K.
Published: March 2020

9575

Background: Adolescent and young adults (AYA) 15 to 39 years present unique health care needs; however, barriers to communication of treatment-related and psychosocial difficulties exist. We hypothesized that a tailored AYA Touchscreen Tool (AYATT) in cancer patients/survivors would facilitate patient-provider communication, toward the larger goal of timely intervention. As a first step, we evaluated the feasibility of such a tool, operationally defined as an 80% acceptance and completion rate. Methods: Eligible City of Hope AYA patients receiving treatment and follow up care for oncologic or hematologic disease were systematically approached for study participation. Target accrual to assess feasibility was set at 50 participants. Consented patients completed a concise AYATT battery, mostly standardized measures, assessing access to care (CHIS), needs, neurocognitive function (BRIEF-A, CogState), and other quality of life (PedsQL) issues. Patients and clinical/support staff completed satisfaction and ease-of-use surveys to further evaluate feasibility. Results: 54 participants were accrued over 8 weeks, with a 96% completion rate exceeding our primary feasibility criteria. At the time of participation: Mean age=26.2 years; Range 15.3 to 38.9 years. Acceptability was high with positive responses throughout the survey. Based on patient responses, the AYATT helped 52% remember issues they had, or have, with their care or treatment; 39% were encouraged to discuss medical issues with their care team that they might not have discussed; 92% found it a useful way to communicate with their health care team; and 98% would recommend that other patients use AYATT. A separate survey from 31/36 clinical/support staff reported AYATT had minimal negative impact in clinic or patient care, increased communication, and was useful in maintaining/improving care. Conclusions: The aggregate findings from this feasibility study support utilizing a tailored touchscreen device in the AYA oncology population. Predictably, high levels of computer knowledge in our AYA cohort may account for the success and acceptance of using such a tool. These results provide evidence for further exploration and continued use in the AYA clinic and patient care setting.
ALGA: A cancer patient profiling tool to improve physician-patient communication—An analysis in breast cancer patients.
Authors: Pravettoni Gabriella , Gandini Sara , Curigliano Giuseppe , Gorini Alessandra , Mazzocco Ketti , McVie J. Gordon , Munzone Elisabetta
Published: March 2020

9582

Background: Considerable improvement of communication between physicians and patients (pts) will need to occur as personalised medicine becomes the norm. An accurate profile of the pt’s cognitive and psychological status should help the physician shape his language and his messages to maximise the pt’s understanding of her management options. To this aim a computerized tool (ALGA questionnaire) has been created and validated. Methods: The validation process produced a questionnaire with 4 main factors: Health State Perception, Psychological, Psychosocial and Cognitive aspects. To test its ability to discriminate between healthy people and pts, ALGA has been administered to 50 newly diagnosed primary Breast Cancer (BC) pts prior to their first visit with the oncologist to discuss their adjuvant treatment, and to 50 healthy women (age range:20-60), using an iPad. Results: A multivariate analysis showed a significant difference between BC pts and healthy women relatively to the four aforementioned broad areas: Psychosocial (F(1,56)=13.42, p<.001), Cognitive (F(1,56)=6.53, p<.01), and Psychological Aspect (F(1,56)=2.77, p=.05). ALGA detected pts with higher levels of anxiety and depression. Pts tended to ruminate more than healthy subjects. Finally, pts showed higher level of positive Health State Perception, suggesting a dissociation between cancer illness and general health. Cognitive and Psychological aspects and Health State Perception interacted with participants’ level of education (respectively: F(1,56)=12.23, p<.001; F(1,56)=4.58, p<.05; F(1,56)=7.9, p<.05). Starting from this results a personal profile for each pt was created. Conclusions: The ALGA confirmed ability to discriminate between healthy people and BC pts, and is a good tool to create a personal pt’s profile with which physicians can empower patient with tailored knowledge. Starting from ALGA questionnaire, a smart environment is being implemented as a decision support infrastructure to help communication, interaction and information delivery process from doctor to patient, influencing patient’s quality of life and satisfaction.
Discussions regarding reproductive and sexual health among young adult survivors of cancer.
Authors: Wang Ying , Chen Leo , Cheung Winson Y.
Published: March 2020

9588

Background: Infertility and sexual dysfunction can result from many cancer treatments and may become a source of significant distress for young adult cancer survivors. Our aims were to 1) characterize the frequency in which reproductive and sexual health discussions occur in a population-based cohort of young cancer patients and 2) identify clinical factors associated with such discussions. Methods: Patients aged 20 to 39 years who were diagnosed with solid tumors from 2006 to 2008, evaluated at any 1 of 5 regional cancer centers in British Columbia, Canada and alive at 2 or more years after their initial diagnosis were included. Demographics, tumor and treatment characteristics, and information on patient-physician conversations were analyzed. Using regression models, we explored the relationships between clinical factors and whether or not discussions had occurred. Results: A total of 397 patients were identified: median age was 35 years (IQR 31-38), 28% were men, 88% had ECOG 0, and 73% reported being in a relationship. Tumor sites included breast (50%), testicular (27%), gynecological (17%), and colorectal (6%). A significant proportion of patients received chemotherapy and radiation that posed the potential risk of infertility or sexual dysfunction. However, only 224 (56%) and 24 (6%) of individuals had a discussion about reproductive and sexual health, respectively, within the first month of their diagnosis. At 6 months, an additional 25 (6%) and 16 (4%) patients had discussed these concerns with their physicians. Age, gender, ECOG, relationship status, and type of chemotherapy and radiation were not correlated with whether or not discussions had occurred (all p>0.05). In regression models, tumor site was associated with differences in reproductive and sexual health discussions between patients and physicians (Table). Conclusions: Among young adult survivors of cancer, fertility and particularly sexual function are inadequately addressed during discussions near the time of initial cancer diagnosis. [Table: see text]
RESTART: Rehabilitation Evaluation in Survivors of Testicular Cancer after Radical Treatment—Pilot study effect on HADS-anxiety subscore.
Authors: White Jeff D. , Rustin Gordon J. S. , Harrington Jennifer , Hewitt Chris , White Sandra , Young Teresa , Lawless Claire , McCartney Elaine , Abbas Vivienne , Brannan Christine , Somerville Lesley , Thomson Nicola , Winterbotham Melanie , Paul James ,   National Cancer Research Institute's Testis Clinical Studies and Palliative & Supportive Care Groups
Published: March 2020

9590

Background: Most testis cancer (TC) patients are cured, but some experience significant physical and psychological consequences. Multi-dimensional rehabilitation programmes have largely been studied in breast cancer, with positive effects on physical and psychological well being. The needs of young males are likely to be significantly different. Addressing the ‘Survivorship agenda’, we performed a study of the feasibility, composition and acceptability of a rehabilitation programme for TC patients. Methods: TC patients, aged >16, who had completed all radical treatment within the preceding 8 weeks, with no major cardio-respiratory problems were eligible. The 6 week multi-dimensional programme consisted of the following; exercise, psychological wellbeing, nutrition, finance, fertility, return to work and follow up. Primary end point was change in the HADS anxiety sub-score from pre (Week 1) to post the programme (Week 6). To detect with 90% power at the 10% 1-sided level of statistical significance a within patient change of 1.5 in the HADS anxiety sub-score (assuming a within patient SD of 3), 26 evaluable participants were required. Secondary objectives were the effect on QOL, HADS depression, exercise capacity and BMI. Results: 35 patients were recruited in 5 cohorts between Feb 2012 and Nov 2012 from 2 UK Cancer Centres; 32 patients were evaluable for the primary end point. Mean age at registration was 38 years (SD =10.45). 94% of the evaluable participants attended 5 or more sessions (30/32 participants). Participant feedback; 36.7% rated their overall score as 10 out of 10, with 93% of participants rating the programme ≥8. Conclusions: A multi-faceted rehabilitation programme appears deliverable and acceptable in TC patients. The study demonstrates a positive effect with a reduction in HADS anxiety score following participation. Having established the feasibility of this programme, a RCT of the programme vs. standard care is planned. Clinical trial information: ISRCTN77608320. [Table: see text]
Anthropometric change among breast cancer survivors provided a behaviorally based weight loss intervention.
Authors: Dittus Kim , Bunn Janice , Paul Zachary , Harvey-Berino Jean
Published: March 2020

9591

Background: A majority of women with breast cancer are overweight or obese. Weight gain and loss of lean body mass often accompany chemotherapy. Excess weight is associated with increased risk of recurrence and decreased overall survival. Our aim was to determine the feasibility of a behavioral based weight loss intervention for breast cancer survivors who did and did not receive chemotherapy and to determine if additional resistance training enhances weight loss. Methods: Women with a BMI of 26-50 and stage I-III breast cancer were recruited for a 6 mo weight loss program which included individualized calorie reduction, 300 min of weekly exercise and a weekly online “chat”. Resistance training consisted of 2x/wk 30 min resistance exercises. Anthropometric measures; kcal measured by 24-hr recalls; and physical activity measured by accelerometer were assessed. Results: Seventy-four women were recruited and 52 completed post testing. The average age was 54 and average time since diagnosis was 33 mos. The average BMI at study initiation was 33 kg/m2. Overall the survivors lost 5.9 kg (6.7 % of baseline weight). Based on paired t-test evaluation weight, BMI and % body fat were all significantly lower after the intervention for completers and when using intent to treat analysis. There were no differences between groups for anthropometric change. The kcal deficit was significant for the chemo + wt loss + resistance (274kcal) and the no chemo (327kcal) groups but not the chemo+ wt loss group (196kcal). Exercise did not significantly increase between the baseline and post testing. Conclusions: Breast cancer survivors lose significant amounts of weight with a standard behaviorally based weight loss intervention. Receipt of chemotherapy did not influence ability to lose weight. Resistance training may increase weight loss while decreasing amount of fat free mass lost. Supervised exercise may be needed to achieve increases in exercise. Clinical trial information: NCT01482702. [Table: see text]
Gaps in survivorship care plan delivery and potential benefits to survivorship care.
Authors: Forsythe Laura Pence , Parry Carla , Alfano Catherine M. , Kent Erin E. , Leach Corinne , Haggstrom David , Ganz Patricia A. , Aziz Noreen , Rowland Julia Howe
Published: March 2020

9594

Background: Survivorship care plans (SCPs), consisting of a treatment summary and follow-up plan, are intended to promote coordination of post-treatment cancer care. Yet, little is known about the provision of these documents by oncologists to primary care physicians (PCPs). This study compared self-reported oncologist provision and PCP receipt of treatment summaries and follow-up plans, characterized oncologists who reported consistent provision of these documents to PCPs, and examined associations between PCP receipt of these documents and survivorship care. Methods: A nationally representative sample of medical oncologists (N=1130) and primary care physicians (PCPs; N=1020) were surveyed regarding follow-up care for breast and colon cancer survivors using the cross-sectional Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) in 2009. Results: Nearly half of oncologists reported always/almost always providing treatment summaries, while 20.2% reported always/almost always providing SCPs (treatment summary + follow-up plan). Approximately one-third of PCPs indicated always/almost always receiving treatment summaries, while 13.4% reported always/almost always receiving SCPs. Oncologists who reported training in late and long-term effects of cancer and use of electronic medical records were more likely to report SCP provision (p<0.05). PCP receipt of SCPs was associated with better PCP-reported care coordination, physician-physician communication, and confidence in survivorship care knowledge compared to receipt of neither treatment summaries nor SCPs (p<0.05). Conclusions: Providing SCPs to PCPs may enhance survivorship care coordination, physician-physician communication, and PCP confidence in caring for survivors. However, a minority of oncologists report routinely delivering SCPs to PCPs. Considerable progress will be necessary to achieve sharing of SCPs among oncologists and PCPs.
Perceptions of benefits and harms of alcohol consumption as predictors of alcohol cessation in adult cancer survivors.
Authors: Liu Geoffrey , Pringle Dan , Espin-Garcia Osvaldo , Niu Chongya , Mahler Mary , Halytskyy Oleksandr , Charow Rebecca , Lam Christine , Shani Ravi M. , Villeneuve Jodie , Tiessen Kyoko , Brown M Catherine , Alibhai Shabbir M.H. , Howell Doris , Jones Jennifer M. , Xu Wei , Selby Peter , Eng Lawson
Published: March 2020

9595

Background: Survivorship programs are being developed at many cancer centers, addressing secondary prevention and healthy lifestyle issues. We evaluated whether perceptions regarding the harms and benefits of alcohol use influenced alcohol cessation or recidivism in adult cancer survivors. Methods: 531 cancer patients of all subtypes were surveyed at a comprehensive cancer center for their alcohol habits before and after cancer diagnosis and their perception of benefits/harms for continued drinking. Multivariate logistic regression models evaluated the association of each variable with change in alcohol consumption after diagnosis adjusted for significant socio-demographic and clinico-pathological covariates. Results: Among 325 current drinkers at diagnosis, 55% quit or cut down their alcohol consumption 1 year after diagnosis, while 16% of 95 ex-drinkers at diagnosis restarted drinking at 1 year. Negative perceptions of the effects of alcohol on the individual patient were strongly associated with cessation: the adjusted odds ratio (aOR) of quitting were significant for a perceived negative effect on quality of life (aOR=2.2, p=0.006), survival (aOR=3.8, p=1.3E-5), fatigue (aOR=3.1, p=4.6E-5) or an increased chance in self-harm (aOR=2.6, p=0.01). Perceptions of how alcohol affected the average cancer patient had similar associations. While perceptions did not influence alcohol recidivism rates, receiving chemotherapy was the only variable associated with continued abstinence (aOR=5.5, p=0.007). Although only 8% of patients received alcohol cessation information from an oncologist, it had the greatest impact on cessation (aOR=6.6, p=0.006), an association not seen with other information sources or other healthcare providers. Conclusions: Perception to the negative effects of alcohol use on their health in cancer survivors strongly predicted for alcohol cessation. The oncologist had a most significant counselling role for alcohol cessation.
The unmet needs of cancer survivors and their preferences for discussing them with oncologists and general practitioners (GPs).
Authors: Webber Kate , Girgis Afaf , Bennett Barbara Kaye , Bonaventura Antonino , Boyle Frances M. , Koh Eng-Siew , Friedlander Michael , Segelov Eva , Goldstein David
Published: March 2020

9602

Background: Cancer survivors experience a range of post-treatment issues which are not well met by current services. This study explores the unmet needs of adult cancer survivors and their levels of comfort in addressing issues with oncologists and GPs. Methods: A cross-sectional survey was mailed to adult cancer survivors 4 years from diagnosis from 6 oncology units. Self-report data were obtained ranking physical, psychological and practical areas of importance to survivors; unmet needs in these areas; and the providers with whom they were happy to discuss each issue. Descriptive statistics were obtained regarding needs and preferences. Univariate and multivariate logistic regression analyses assessed demographic and clinical variables associated with 4 or more unmet care needs. Results: 228 surveys were returned (response rate 50.5%). Respondents had a mean age of 59.3 years (range 32-87), 71.5% were female, with most common primary cancers being breast (71.5%), colorectal (13.9%), prostate (4.5%) and ovarian (2.2%). The most commonly reported unmet needs were information about late effects (50.3%), managing fatigue (41.7 %), genetic risk to family (34.7%), reassurance (32.0 %) and diet (31.4 %). The median number of unmet needs was 4 (range 0-23). On univariate analysis, female gender, younger age and tertiary education were associated with greater unmet needs (p<0.001, p=0.01 and p=0.02). On multivariate analysis higher education (p=0.04) remained independently associated. Conclusions: Cancer survivors report significant unmet care needs, and their comfort levels for discussing them varies between providers. Some key issues are not entrusted to either oncologists or GPs. Models of care for survivors must address these potential deficits in care. [Table: see text]
Bridging to survivorship in breast cancer: How BMI weighs in.
Authors: Espirito Janet L. , Turnwald Brian , Harrell Robyn K. , Bhowmik Debajyoti , Denduluri Neelima , Brooks Barry Don , Hoverman J. Russell , Beveridge Roy A. , Patt Debra A.
Published: March 2020

9605

Background: Obesity and depression complicate survivorship in early stage breast cancer (BC) by having a direct impact on survival and morbidity among patients (pts) who complete treatment (tx). The prevalence of obesity after BC tx in the community and concordance with BC tx type is poorly described, but important as we characterize risks of tx and optimize goals for survivorship care planning. Methods: We queried the electronic health record (EHR), iKnowMed, from a large network of community oncology practices for pts diagnosed with stage I-III BC from 2007-2010 with at least 5 office visits and follow up through 11-2012 for our retrospective study. We excluded pts who developed metastatic disease or died. We stratified pts by chemotherapy (CT) utilization (yes/no), hormone receptor (HR) status, age, and documented body mass index (BMI) at first office visit and annually. We evaluated changes in BMI characteristics by tx cohort. Results: We identified 8,506 pts with a documented BMI at first office visit and 1, 2, and 3 years (yrs) thereafter. 4369 (51% of the total) pts received adjuvant CT and 4137 (49%) did not. 6897 pts (81%) were HR positive. Baseline BMI between tx cohorts were similar, though the prevalence of overweight (31%) and overweight or obese (68%) is high. Percent change of BMI at 3 yrs varied significantly between T cohorts (p<0.01) with greater rise among the cohorts who received CT in comparison to those who did not. Pts receiving CT were 46% more likely to have a 5 point or more increase in BMI at 3 yrs compared to pts that did not receive CT (OR 1.46, CI[1.08-1.96]). A stronger association for BMI increase of at least 0.5 points at 3 yrs (OR 1.53, CI [1.4-1.7]) was also observed amongst pts who received CT compared to those that did not. HR positive pts were less likely than HR negative or unknown pts to increase their BMI by at least 0.5 points (OR 0.84, p<0.01), but there was no difference at detecting a difference of 5 points in BMI (OR 0.88, p=0.49). Conclusions: With 3 yrs of follow up, overweight and obese status is remarkably common among BC survivors in the community and appears to be more prevalent after CT tx. Determinants of obesity require further study and point to necessary intervention to improve the health of early stage BC pts.
Body mass index (BMI) and its impact on quality of life (QOL) in childhood leukemia survivors.
Authors: Blaes Anne Hudson , Baker Kevin Scott , Lee Jill Lunsford , Moen Catherine , Mulrooney Daniel A. , Vankina Srilakshmi , Vogel Rachel Isaksson , Kunin-Batson Alicia
Published: March 2020

9606

Background: Obesity after childhood cancer carries implications for survivors’ future health risks; however little is known about the impact of weight after treatment on QOL. Methods: Adult survivors of childhood leukemia in remission (51% male) completed the Health Related QOL Short Form (SF-36) between 2006-2012. Standard BMI cut points were assessed at the time of survey completion. 97% received treatment with chemotherapy, 55.6% stem cell transplant (SCT), 27.8% were in remission from a second cancer. The impact of demographic (age at diagnosis, current age, gender), treatment [radiation therapy, SCT, total body irradiation (TBI), cranial radiation, disease characteristics, history of relapse] were explored. For each subscale, linear regression models were performed. All statistical tests were two-sided, P-values < 0.05 considered statistically significant. Results: 73 survivors diagnosed at a median age of 9.0 (1.0-27.0) years and surveyed at a median of 17.4 (2.5-34.7) years later completed SF-36. 75.6% had received a median dose of 1800 (800-8750) cGy of radiation. The distribution of BMI was underweight <18.5 (9.6%), normal 18.5-24.9 (42.5%), overweight 25-29.9 (27.4%), or obese >30 (20.6%). Consistent with previous studies, those who received whole brain radiation had greater BMI at the time of survey than those who did not receive radiation and those who received TBI (F=2.52, p=0.065). In analyses adjusted for age at diagnosis and time since diagnosis, the reported vitality (fatigue) for those who were obese (mean 45.0+/-8.9) or underweight (45.8+/-9.5) was significantly lower (p=0.002) than normal (55.7+/-10.4) or overweight (50.4+/-10.0), and those who were underweight (39.0+/-13.3) also reported poor physical functioning (endurance and strength) (p=0.038) compared with the others (52.3+/-8.1 normal weight, 49.5+/-11.7 overweight, 47.1+/-9.0 obese). Conclusions: Weight management in leukemia survivors is problematic with 48% of our sample being overweight or obese. Weight status is associated with QOL, impacting survivors’ fatigue and physical functioning. Interventions to help survivors achieve a healthy weight after cancer treatment are needed, and may lead to improvements in QOL.
Longitudinal changes in physical activity of head and neck squamous cell carcinoma patients.
Authors: Jolly Shruti , Peterson Lisa A , Rozek Laura S , Chepeha Douglas Brian , Prince Mark E , McLean Scott A , Ward Brent , Bradford Carol Rossier , Helman Joseph , Stanley Jeffrey , Worden Francis , Eisbruch Avraham , Wolf Gregory T. ,   University of Michigan Head and Neck SPORE
Published: March 2020

9607

Background: Head and neck cancer (HNCa) treatment results in unfavorable changes in physical function, body composition and quality of life. The ability of these patients to perform physical activity after cancer treatment has not been previously evaluated. To develop clinical models that will guide the care of HNCa survivors, it is important to characterize these physical activity changes. Methods: From 2008 to 2011, as part of an institutional Head and Neck SPORE longitudinal epidemiology project, health survey data including the Physical Activity Scale in the Elderly (PASE) was collected at baseline, 6 months and annually thereafter. The PASE score assesses the hours doing leisure time physical activity, walking, occupational, and household chores over a typical 7-day period. During follow up, subjects deceased, were lost to follow-up, or refused survey completion. Paired t-test was used to compare the mean PASE score at various endpoints from baseline. Results: 294 HNCa patients completed the survey at baseline. Following a mean follow-up of 25.7 (+/-11.9) months, 66%(n=193), 73%(n=215) and 42%(n=124) of patients completed the assessment at 6-months, 1-year and 2-years respectively. Majority (97%) of the HNCa patients had oropharynx, oral cavity or larynx cancer, which were treated by chemoradiation (36%), surgery followed by chemoradiation (23%) or surgery alone (20%). Results of the PASE score revealed the lowest levels of physical activity at baseline with steady statistically significant improvement at each subsequent timepoint (p<0.05). Stratifying by treatment modality, the difference between baseline and 1-year PASE score was significant only for chemoradiation patients (p<0.05). Conclusions: Baseline cancer burden appeared to have the most impact on physical activity levels in HNCa patients. In patients who completed the survey, the levels of physical activity improved longitudinally over time and are most notable for patients treated by chemoradiotherapy. Therefore, the most benefit of a physical activity intervention would be either during or immediately following treatment.
Effect of abiraterone acetate (AA) on patient-reported pain in metastatic castration-resistant prostate cancer (mCRPC) post-docetaxel: Results of longitudinal sensitivity analyses.
Authors: Hao Yanni , Cleeland Charles S. , Gagnon Dennis , Espindle Derek , Molina Arturo , Basch Ethan M.
Published: March 2020

9618

Background: The COU-AA-301 phase 3 trial showed that AA + prednisone (P) improved overall survival in mCRPC patients (pts) post-docetaxel. Compared with P alone, AA + P also had significant benefits on patient-reported pain. Here we describe post hoc sensitivity analyses of pain data from that trial, using different methods to compensate for the potential impact of missing data. Methods: Pts with mCRPC progressing after docetaxel-based chemotherapy were randomized 2:1 to AA + P or placebo + P. Pain intensity and interference of pain with daily activities were assessed with the Brief Pain Inventory-Short Form (BPI-SF) questionnaire at baseline, Day 15 of Cycle 1, and Day 1 of each 28-day treatment cycle thereafter until treatment discontinuation. The effect of treatment on BPI-SF scores was analyzed using repeated measure mixed-effects (RMM) models, piecewise linear mixed-effects (PWLME) models, and joint mixed-effects and log time-to-dropout (JMEL) models. RMM and PWMLE models assumed missing data (due to death, study dropout, or administrative issues) to be missing at random, the JMEL model to be missing not at random. Model results were compared between treatment arms. Results: 797 pts were randomized to AA + P, and 398 to P only. RMM model estimates suggested statistically significant (p < 0.05) differences in change from baseline for pain intensity and pain interference scores in favor of AA + P at the majority of study visits through cycle 11. PWLME models yielded significantly smaller areas under the curve (AUCs) for AA + P vs P for pain intensity (p = 0.0031) and pain interference (p = 0.0006); smaller AUCs reflect better pain outcomes. Results using JMEL models were nearly identical to those with PWLME models, with AUCs for AA + P significantly smaller than for P alone for pain intensity (p = 0.0031) and pain interference (p = 0.0007). Conclusions: Using various modeling methods that assess the impact of missing data, AA + P showed superior patterns of pain outcomes over time compared with P only in mCRPC pts refractory to docetaxel. These results support the previously reported pain benefits of AA + P over P alone from the same trial. Clinical trial information: NCT00638690.
Differential effects of bevacizumab on the risk of hand-foot syndrome associated with cytotoxic chemotherapy: An updated meta-analysis.
Authors: Gopal Arun , Flores Ronald A. , Lacouture Mario E. , Wu Shenhong
Published: March 2020

9622

Background: Hand-foot syndrome (HFS) is a dose-limiting toxicity of many chemotherapeutic agents. In a prior meta-analysis of published randomized-controlled clinical trials (RCTs) we showed that the risk of HFS increased significantly with the use of bevacizumab, an angiogenesis inhibitor that is widely used for the treatment of many cancers. In this study, we have included more recent trials and updated our findings. Methods: Databases from PUBMED, Cochrane Database, and abstracts presented at the American Society of Clinical Oncology until December, 2012 were searched for the identification of relevant studies. Eligible studies included prospective RCTs in which the addition of bevacizumab to chemotherapy was compared directly to chemotherapy alone in cancer patients. Relative risk (RR), and 95% confidence interval (CI) were calculated using a fixed- or random-effects model based on the heterogeneity of the studies. Results: A total of eight RCTs including 8,150 patients (bevacizumab 4211, control 3939) with a variety of tumors were analyzed. The summary incidence of HFS was 14.3% (95% CI: 4.8-36.0%). The addition of bevacizumab to chemotherapy did not significantly increase the risk of developing all-grade (RR: 1.17, 95% CI: 0.90-1.51, P=0.240) and high-grade HFS (RR: 1.50, 95% CI: 0.92-2.47, P=0.11) as opposed to chemotherapy alone. The risk of HFS did not vary significantly with tumor types (P=0.21) and bevacizumab dose (P=0.28). However, the risk of HFS varied significantly with concurrent chemotherapeutic agents (P=0.004). Bevacizumab significantly increased the risk for 5-FU based agents (RR 1.2, 95% CI 1.08-1.33, P=0.001) but decreased the risk for non-5-FU based agents (RR 0.63, 95% CI: 0.41-0.96, P=0.03). Conclusions: Bevacizumab may enhance or reduce the risk of HFS depending on particular chemotherapeutic agents used in cancer patients. These findings are of importance to direct supportive care efforts.
Antibiotic prescribing in primary care for end-of-life cancer patients.
Authors: Gao Wei , Spicer James F. , Higginson Irene
Published: March 2020

9627

Background: There is ongoing debate on whether it is appropriate to administer anti-infection medications to patients approaching end of life. Population-based epidemiologic data on current antibiotic prescribing status is needed to shed lights on this issue. Methods: A population-based retrospective cohort study, based on data extracted from the General Practice Research Database (GPRD). Patients (N=29,810) with one of five major cancers (lung, colorectal, breast, prostate, head and neck), and who died in 2000-2008 were included for this analysis. Prescriptions of antibiotics(BNF codes: 5.1.1-5.1.13) for individual patients in the last 3 months of life were reviewed and analysed. The outcome was with (1) or without (0) antibiotic prescriptions. A Generalized Estimating Equation (GEE) logistic regression model was used to assess for the associations between outcome and explanatory variables. Results: Overall, 26.8% of patients(95%CI: 26.3-27.3%) had been prescribed antibiotics. There was an increasing trend in antibiotic prescribing for end-of-life cancer patients, rising from 23.2%(21.5-24.9%) in 2000 to 29.5%(28.0-31.0%) in 2008 (p<0.001). Patients with the following characteristics were more likely to be prescribed antibiotics(p<0.001): being younger(<70:ORs 1.14-1.27) vs 80+, male gender(OR: 1.10; 1.03-1.18), lung & head & neck cancer(ORs:1.50-2.00) vs colorectal cancer, higher co-morbidity score(ORs vs 0-3:1.02-1.19), smoking(OR vs non-smoking 1.17;1.07-1.27), living in Northern Ireland(OR:1.43; 1.17-1.75) and Scotland(ORs: 1.23; 1.03 to 1.47) vs London. No difference by whether they drank alcohol or social economic status. Conclusions: Antibiotic prescribing at the end of life was common and increasing over the years. Further studies need to investigate clinical conditions associated with antibiotic prescribing to inform clinical practices and end of life care policy.
A prospective multicenter, single blinded, randomized phase III trial to compare the efficacy of ramosetron, aprepitant and dexamethasone with ondansetron, aprepitant, and dexamethasone for preventing chemotherapy-induced nausea and vomiting: KCSG PC10-21.
Authors: Kim Hyo Jung , Song Eun-Kee , Kim Jun Suk , Ahn Jin Seok , Yun Hwan Jung , Cho Yo Han , Park Keon Uk , Kim Si-Young , Jang JoungSoon , Kim Sang-We , Lee Hyun Woo , Lee Se Ryeon , Kim Yang Soo , Lee Soon-Nam , Ko Yoon-Ho , Kim Hwa Jung , Kang Jin Hyoung , Shin Sang Won ,   Korean Cancer Study Group
Published: March 2020

9633

Background: Combination of aprepitant, 5-HT3 receptor antagonist and steroid improve complete response (CR) of chemotherapy induced nausea and vomiting (CINV). But until now, there was no information whether ramosetron is as effective as other 5-HT3receptor antagonists for the combination regimen. Therefore, we compared a ramosetron, aprepitant and dexamethasone (RAD) with ondansetron, aprepitant and dexamethasone (OAD) to establish the non-inferiority of RAD in controlling highly emetogenic chemotherapy induced nausea and vomiting. Methods: A total of 334 patients with malignant disease who were scheduled to receive highly emetogenic chemotherapy were randomized to RAD or OAD. Aprepitant (125 mg day 1; 80 mg day 2, 3) and dexamethasone (12 mg day 1; 8 mg day 2-4) were administered to both group. Intravenous ramosetron (0.3mg day 1) or ondansetron (16mg day1) was given to RAD or OAD, respectively. Patients recorded vomiting and nausea (VAS score) on the diary. The primary end point was CR (no vomiting or retching and no rescue medication) rate in the acute period (chemotherapy day 1). The non-inferiority margin was defined as -15% differences. Results: 299 patients (RAD 143, OAD 156) were eligible for the efficacy analyses of modified intention-to-treat. Median age and sex were 60 (IQR 52 – 66) and 61 (51.5 – 68, p=0.54), 90 Male/66 Female and 114 Male/29 Female (p<0.0001) in RAD and OAD, respectively. There were no significant differences between two groups on the other baseline characteristics. The CR rates of RAD vs OAD were 84.6% vs 77.6% (95% C.I. -0.4 – 14.5%) at acute period, 69.5% vs 62.6% (-2.1 – 16.0%) at delayed period (days 2-5), and 66.7% vs 58.1% (-0.6 – 17.8%) at overall period. Median nausea score at acute period were 4 (IQR 2 – 5) and 3 (2-5, p=0.14) in RAD and OAD, respectively. There were no grade 3 or 4 toxicities. Conclusions: RAD regimen is as effective and tolerable as OAD antiemetic combination for the prevention of CINV in patients receiving highly emetogenic chemotherapy. Ramosetron could be considered as one of the best partners for aprepitant. Clinical trial information: NCT01536691.
A randomized study of ganetespib, a heat shock protein 90 inhibitor, in combination with docetaxel versus docetaxel alone for second-line therapy of lung adenocarcinoma (GALAXY-1).
Authors: Ramalingam Suresh S. , Goss Glenwood D. , Andric Zoran Gojko , Bondarenko Igor , Zaric Bojan , Ceric Timur , Poddubskaya Elena Vladimir , Ciuleanu Tudor-Eliade , Spicer James F. , Felip Enriqueta , Hirsh Vera , Manegold Christian , Rosell Rafael , Khuri Fadlo Raja , Vukovic Vojislav M. , Teofilovici Florentina , El-Hariry Iman , Guo Wei , Bahcall Safi R. , Fennell Dean
Published: March 2020

CRA8007

The full, final text of this abstract will be available at abstract.asco.org at 7:30 AM (EDT) on Monday, June, 3, 2013, and in the Annual Meeting Proceedings online supplement to the June 20, 2013, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Monday edition of ASCO Daily News.